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Berteau JPP. Systematic narrative review of modalities in physiotherapy for managing pain in hip and knee osteoarthritis: A review. Medicine (Baltimore) 2024; 103:e38225. [PMID: 39331867 PMCID: PMC11441874 DOI: 10.1097/md.0000000000038225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2024] Open
Abstract
Osteoarthritis (OA) affects 528 million individuals globally, predominantly in knee and hip joints, with a notable impact on females aged over 55, resulting in a substantial economic burden. However, the efficacy of modalities used in physiotherapy to manage OA pain for reducing the need for joint replacement remains an open question, and guidelines differ. Our systematic narrative review, drawing from reputable databases (e.g., PubMed, Cochrane, and CINAHL) with specific Mesh terms investigated evidence from 23 Randomized Controlled Trials (that included a control or a sham group in 30 different protocols) using therapeutic modalities like ultrasound, diathermy, and electrical stimulation for knee and hip OA pain, involving a total of 1055 subjects. We investigated the attainment of minimal clinically important differences in pain reduction, operationalized through a 20% decrement in the Western Ontario and McMaster University Arthritis Index or Visual Analog Scale (VAS) score. Our results indicated that 15 protocols out of 30 reach that level, but there were no statistical differences among modalities. Half of the protocol presented in the literature reached clinical efficiency but studies on hip remains scarce. We recommend a comprehensive, sequential, and multimodal intervention plan for individuals with joint OA with initial transcutaneous electrical nerve stimulation and progressing to a 2-week protocol of continuous ultrasound, potentially combined with deep microwave diathermy. Long-term intervention involves the use of pulsed electrical stimulation. For hip OA, a cautious approach and discussions with healthcare providers about potential benefits of spinal cord nerve stimulation.
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Affiliation(s)
- Jean-Philippe Paul Berteau
- Department of Physical Therapy, City University of New York-College of Staten Island, New York City, NY
- New York Center for Biomedical Engineering, City University of New York-City College of New York, New York City, NY
- Nanoscience Initiative, Advanced Science Research Center, City University of New York, New York City, NY
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Fugazzola MC, De Ruijter M, Veraa S, Plomp S, van Buul W, Hermsen G, van Weeren R. A hybrid repair strategy for full-thickness cartilage defects: Long-term experimental study in eight horses. J Orthop Res 2024. [PMID: 39292194 DOI: 10.1002/jor.25972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/19/2024] [Accepted: 08/19/2024] [Indexed: 09/19/2024]
Abstract
The objective of this study was to evaluate a non-resorbable implant for the focal repair of chondral defects in eight adult horses with 12-month follow-up. The bi-layered construct composed of a polycarbonate-urethane-urea biomaterial which was printed in 3D fashion onto a bone anchor was implanted into surgically created osteochondral defects into the femoropatellar joints of eight horses. The analysis of post-mortem outcomes were compared to defects treated with microfracture in the same animal on the contralateral femoropatellar jointfemoropatellar joint. The overall macroscopic scoring after 12 months yielded higher scores in the OCI-treated stifles compared to MF treatment (p = 0.09) with better quality and filling of the defect. Histology revealed good anchorage of repair tissue growing into the 3D structure of the implant and histopathology scoring for adjacent native cartilage showed no difference between groups. MRI and micro-CT showed overall less sclerotic reactions in the surrounding bone in the implant group and no foreign body reaction was detected. Biomechanical analysis of the repair tissue revealed a significantly higher peak modulus (p < 0.05) in the implant group (0.74 ± 0.45) compared to the microfracture control group (0.15 ± 0.11). Dynamic loading yielded higher values for the repair tissue overgrowing the implant group (0.23 ± 0.17) compared to the microfracture control (0.06 ± 0.06) (p < 0.05). The bi-layered osteochondral implant provided a safe implant for focal repair of full-thickness osteochondral defects, as no adverse reaction was seen within the joints and the level of degeneration of adjacent cartilage to the repair site was not different compared to that seen in defects treated with microfracture after 12 months.
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Affiliation(s)
- Maria C Fugazzola
- Department of Clinical Sciences, Faculty of Veterinary Science, Utrecht University, Utrecht, The Netherlands
| | - Mylène De Ruijter
- Department of Clinical Sciences, Faculty of Veterinary Science, Utrecht University, Utrecht, The Netherlands
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefanie Veraa
- Department of Clinical Sciences, Faculty of Veterinary Science, Utrecht University, Utrecht, The Netherlands
| | - Saskia Plomp
- Department of Clinical Sciences, Faculty of Veterinary Science, Utrecht University, Utrecht, The Netherlands
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - René van Weeren
- Department of Clinical Sciences, Faculty of Veterinary Science, Utrecht University, Utrecht, The Netherlands
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Bonecka J, Turek B, Jankowski K, Borowska M, Jasiński T, Smyth G, Domino M. Relationship between Feline Knee Joint Osteoarthritis and Bone Mineral Density Quantified Using Computed Tomography and Computed Digital Absorptiometry. Animals (Basel) 2024; 14:2615. [PMID: 39272400 PMCID: PMC11394321 DOI: 10.3390/ani14172615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 09/04/2024] [Accepted: 09/04/2024] [Indexed: 09/15/2024] Open
Abstract
Osteoarthritis (OA), including knee joint OA, is a common chronic condition in cats. In both cats and humans, knee joint OA is characterized radiographically by the presence of osteophytes, enthesiophytes, subchondral sclerosis, and joint space narrowing. However, only in humans have these radiographic signs been reported to increase bone mineral density (BMD). Therefore, this study aims to quantify the volumetric (vBMD) and relative (rBMD) BMD measures of the feline knee joint and compare BMD measures between various severities of OA to test the hypothesized OA-BMD relationship in the knee joint in cats. The 46 feline knee joints were imaged using computed tomography (CT) and conventional radiography supported by the computed digital absorptiometry (CDA) method to obtain vBMD and rBMD, respectively. Both BMD measures were assessed in three regions of interest (ROIs): the distal femur (ROI 1), patella (ROI 2), and proximal tibia (ROI 3). In all locations, vBMD and rBMD showed moderate (ROI 2: r = 0.67, p < 0.0001) to strong (ROI 1: ρ = 0.96, p < 0.0001; ROI 3: r = 0.89, p < 0.0001) positive correlations. Due to differences (p < 0.0001) in the width of the distal femur (17.9 ± 1.21 mm), patella (8.2 ± 0.82 mm), and proximal tibia (19.3 ± 1.16 mm), the rBMD was corrected (corr rBMD) using the thickness coefficient of 0.46 ± 0.04 for ROI 2 and 1.08 ± 0.03 for ROI 3. Regardless of the quantification method used, BMD measures increased linearly from a normal knee joint to severe OA, with differences in BMD between normal and mild to severe knee joint OA. The OA-BMD relationship in the feline knee joint can be preliminarily confirmed.
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Affiliation(s)
- Joanna Bonecka
- Department of Small Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (WULS-SGGW), 02-787 Warsaw, Poland
| | - Bernard Turek
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (WULS-SGGW), 02-787 Warsaw, Poland
| | - Krzysztof Jankowski
- Institute of Mechanics and Printing, Warsaw University of Technology, 02-524 Warsaw, Poland
| | - Marta Borowska
- Institute of Biomedical Engineering, Faculty of Mechanical Engineering, Białystok University of Technology, 15-351 Bialystok, Poland
| | - Tomasz Jasiński
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (WULS-SGGW), 02-787 Warsaw, Poland
| | - Graham Smyth
- Menzies Health Institute Queensland, Griffith University School of Medicine, Southport, QLD 4222, Australia
| | - Małgorzata Domino
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences (WULS-SGGW), 02-787 Warsaw, Poland
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Ripmeester EGJ, Steijns JSJJ, Wijnands KAP, Stassen RHMJ, Pitelka V, Peeters LCW, Cremers A, Astryde NMSA, Chabronova A, Surtel DAM, Emans PJ, van den Akker GGH, van Rietbergen B, van Rhijn LW, Caron MMJ, Welting TJM. The BMP7-Derived Peptide p[63-82] Reduces Cartilage Degeneration in the Rat ACLT-pMMx Model for Posttraumatic Osteoarthritis. Cartilage 2024:19476035241233659. [PMID: 38501739 DOI: 10.1177/19476035241233659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE Osteoarthritis (OA) is characterized by articular cartilage erosion, pathological subchondral bone changes, and signs of synovial inflammation and pain. We previously identified p[63-82], a bone morphogenetic protein 7 (BMP7)-derived bioactive peptide that attenuates structural cartilage degeneration in the rat medial meniscal tear-model for posttraumatic OA. This study aimed to evaluate the cartilage erosion-attenuating activity of p[63-82] in a different preclinical model for OA (anterior cruciate ligament transection-partial medial meniscectomy [anterior cruciate ligament transection (ACLT)-pMMx]). The disease-modifying action of the p[63-82] was followed-up in this model for 5 and 10 weeks. DESIGN Skeletally mature male Lewis rats underwent ACLT-pMMx surgery. Rats received weekly intra-articular injections with either saline or 500 ng p[63-82]. Five and 10 weeks postsurgery, rats were sacrificed, and subchondral bone characteristics were determined using microcomputed tomography (µCT). Histopathological evaluation of cartilage degradation and Osteoarthritis Research Society International (OARSI)-scoring was performed following Safranin-O/Fast Green staining. Pain-related behavior was measured by incapacitance testing and footprint analysis. RESULTS Histopathological evaluation at 5 and 10 weeks postsurgery showed reduced cartilage degeneration and a significantly reduced OARSI score, whereas no significant changes in subchondral bone characteristics were found in the p[63-82]-treated rats compared to the saline-treated rats. ACLT-pMMx-induced imbalance of static weightbearing capacity in the p[63-82] group was significantly improved compared to the saline-treated rats at weeks 5 postsurgery. Footprint analysis scores in the p[63-82]-treated rats demonstrated improvement at week 10 postsurgery. CONCLUSIONS Weekly intra-articular injections of p[63-82] in the rat ACLT-pMMx posttraumatic OA model resulted in reduced degenerative cartilage changes and induced functional improvement in static weightbearing capacity during follow-up.
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Affiliation(s)
- Ellen G J Ripmeester
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Jessica S J J Steijns
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Karolina A P Wijnands
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Roderick H M J Stassen
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Vasek Pitelka
- Department of Physiology and Pharmacology, University of Western Ontario, London, ON, Canada
| | - Laura C W Peeters
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Andy Cremers
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Nzekui M S A Astryde
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Alzbeta Chabronova
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Don A M Surtel
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Pieter J Emans
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Guus G H van den Akker
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Lodewijk W van Rhijn
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marjolein M J Caron
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tim J M Welting
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University, Maastricht, The Netherlands
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Lei L, Cong R, Ni Y, Cui X, Wang X, Ren H, Wang Z, Liu M, Tu J, Jiang L. Dual-Functional Injectable Hydrogel for Osteoarthritis Treatments. Adv Healthc Mater 2024; 13:e2302551. [PMID: 37988224 DOI: 10.1002/adhm.202302551] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/09/2023] [Indexed: 11/23/2023]
Abstract
Osteoarthritis (OA) is a prevalent, chronic degenerative disease that affects people worldwide. It is characterized by the destruction of cartilage and inflammatory reactions. High levels of reactive oxygen species (ROS) cause oxidative stress, which damages lipids, proteins, and DNA, leading to cell damage and death. Furthermore, ROS also induces the production of inflammatory cytokines and cell chemotaxis, further worsening the inflammatory response and damaging cartilage resulted in limited movement. Herein, this work reports a dual-functional injectable hydrogel, which can help inhibit inflammation by scavenging ROS and provide lubrication to reduce wear and tear on the joints. To create the hydrogel, 3-aminophenylboronic acid modified hyaluronic acid is synthesized, then which is crosslinked with hydroxyl-containing polyvinyl alcohol (PVA) to construct a dual dynamic covalent crosslinked hydrogel oHA-PBA-PVA gel, Gel (HPP). The hydrogel mentioned here possesses a unique bond structure that allows it to be injected, self-heal, and provide lubrication. This innovative approach offers a new possibility for treating osteoarthritis by combining anti-inflammatory and lubrication effects.
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Affiliation(s)
- Lei Lei
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients and Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing, 210009, China
| | - Rui Cong
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients and Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing, 210009, China
| | - Yifei Ni
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients and Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing, 210009, China
| | - Xin Cui
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients and Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing, 210009, China
| | - Xulei Wang
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients and Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing, 210009, China
| | - Hongmei Ren
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients and Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing, 210009, China
| | - Zun Wang
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients and Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing, 210009, China
| | - Mengyuan Liu
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients and Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing, 210009, China
| | - Jiasheng Tu
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients and Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing, 210009, China
| | - Lei Jiang
- NMPA Key Laboratory for Research and Evaluation of Pharmaceutical Preparations and Excipients and Department of Pharmaceutics, School of Pharmacy, China Pharmaceutical University, 24 Tong Jia Xiang, Nanjing, 210009, China
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Kasaeian A, Roemer FW, Ghotbi E, Ibad HA, He J, Wan M, Zbijewski WB, Guermazi A, Demehri S. Subchondral bone in knee osteoarthritis: bystander or treatment target? Skeletal Radiol 2023; 52:2069-2083. [PMID: 37646795 DOI: 10.1007/s00256-023-04422-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 09/01/2023]
Abstract
The subchondral bone is an important structural component of the knee joint relevant for osteoarthritis (OA) incidence and progression once disease is established. Experimental studies have demonstrated that subchondral bone changes are not simply the result of altered biomechanics, i.e., pathologic loading. In fact, subchondral bone alterations have an impact on joint homeostasis leading to articular cartilage loss already early in the disease process. This narrative review aims to summarize the available and emerging imaging techniques used to evaluate knee OA-related subchondral bone changes and their potential role in clinical trials of disease-modifying OA drugs (DMOADs). Radiographic fractal signature analysis has been used to quantify OA-associated changes in subchondral texture and integrity. Cross-sectional modalities such as cone-beam computed tomography (CT), contrast-enhanced cone beam CT, and micro-CT can also provide high-resolution imaging of the subchondral trabecular morphometry. Magnetic resonance imaging (MRI) has been the most commonly used advanced imaging modality to evaluate OA-related subchondral bone changes such as bone marrow lesions and altered trabecular bone texture. Dual-energy X-ray absorptiometry can provide insight into OA-related changes in periarticular subchondral bone mineral density. Positron emission tomography, using physiological biomarkers of subchondral bone regeneration, has provided additional insight into OA pathogenesis. Finally, artificial intelligence algorithms have been developed to automate some of the above subchondral bone measurements. This paper will particularly focus on semiquantitative methods for assessing bone marrow lesions and their utility in identifying subjects at risk of symptomatic and structural OA progression, and evaluating treatment responses in DMOAD clinical trials.
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Affiliation(s)
- Arta Kasaeian
- Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Frank W Roemer
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Elena Ghotbi
- Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hamza Ahmed Ibad
- Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jianwei He
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mei Wan
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wojciech B Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Shadpour Demehri
- Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Amorim D, Fonseca-Rodrigues D, David-Pereira A, Costa O, Lima AP, Nogueira R, Cruz R, Martins AS, Sousa L, Oliveira F, Pereira H, Pirraco R, Pertovaara A, Almeida A, Pinto-Ribeiro F. Injection of kaolin/carrageenan in the rat knee joint induces progressive experimental knee osteoarthritis. Pain 2023; 164:2477-2490. [PMID: 37390363 DOI: 10.1097/j.pain.0000000000002954] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/25/2023] [Indexed: 07/02/2023]
Abstract
ABSTRACT Osteoarthritis (OA), the most common joint disorder worldwide, is characterized by progressive degeneration of articular and periarticular structures, leading to physical and emotional impairments that greatly affect the quality of life of patients. Unfortunately, no therapy has been able to halt the progression of the disease. Owing to the complexity of OA, most animal models are only able to mimic a specific stage or feature of the human disorder. In this work, we demonstrate the intraarticular injection of kaolin or carrageenan leads to the progressive degeneration of the rat's knee joint, accompanied by mechanical hyperalgesia and allodynia, gait impairments (reduced contact area of the affected limb), and radiological and histopathological findings concomitant with the development of human grade 4 OA. In addition, animals also display emotional impairments 4 weeks after induction, namely, anxious and depressive-like behaviour, important and common comorbidities of human OA patients. Overall, prolonging kaolin or carrageenan-induced monoarthritis mimics several important physical and psychological features of human OA in both male and female rodents and could be further applied in long-term studies of OA-associated chronic pain.
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Affiliation(s)
- Diana Amorim
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Institute of Biomedicine/Physiology, University of Helsinki, Helsinki, Finland
| | - Diana Fonseca-Rodrigues
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ana David-Pereira
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Wolfson CARD, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
| | - Octávia Costa
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Antónia Palhares Lima
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rosete Nogueira
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rute Cruz
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ana Sofia Martins
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Liliana Sousa
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Hélder Pereira
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Minho University, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
| | - Rogério Pirraco
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Minho University, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
| | - Antti Pertovaara
- Institute of Biomedicine/Physiology, University of Helsinki, Helsinki, Finland
| | - Armando Almeida
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Filipa Pinto-Ribeiro
- Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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8
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Chee A, Çeliker P, Basedow K, Islam M, Baksh N, Shah NV, Eldib AM, Eldib H, Diebo BG, Naziri Q. A call to "own the bone": osteoporosis is a predictor for adverse two-year outcomes following total hip and knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2889-2894. [PMID: 36894707 DOI: 10.1007/s00590-023-03499-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/05/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE While bone health is instrumental in orthopedic surgery, few studies have described the long-term outcomes of osteoporosis (OP) in patients undergoing total hip (THA) or knee (TKA) arthroplasties. METHODS Using the New York State statewide planning and research cooperative system database, all patients who underwent primary TKA or THA for osteoarthritis from 2009 to 2011 with minimum 2-year follow-up were identified. They were divided based on their OP status (OP and non-OP) and 1:1 propensity score matched for age, sex, race, and Charlson/Deyo index. Cohorts were compared for demographics, hospital-related parameters, and 2-year postoperative complications and reoperations. Multivariate binary logistic regression was utilized to identify significant independent associations with 2-year medical and surgical complications and revisions. RESULTS A total of 11,288 TKA and 8248 THA patients were identified. OP and non-OP TKA patients incurred comparable overall hospital charges for their surgical visit and hospital length of stay (LOS) (both, p ≥ 0.125). Though OP and non-OP THA patients incurred similar mean hospital charges for their surgical visit, they experienced longer hospital LOS (4.3 vs. 4.1 days, p = 0.035). For both TKA and THA, OP patients had higher rates of overall and individual medical and surgical complications (all, p < 0.05). OP was independently associated with the 2-year occurrence of any overall, surgical, and medical complications, and any revision in TKA and THA patients (all, OR ≥ 1.42, p < 0.001). CONCLUSION Our study found OP was associated with a greater risk of 2-year adverse outcomes following TKA or THA, including medical, surgical, and overall complications as well as revision operations compared to non-OP patients.
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Affiliation(s)
- Alexander Chee
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Pelin Çeliker
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Kayla Basedow
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Mahee Islam
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Nayeem Baksh
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Ahmed M Eldib
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Hassan Eldib
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA.
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9
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Poulsen RC, Jain L, Dalbeth N. Re-thinking osteoarthritis pathogenesis: what can we learn (and what do we need to unlearn) from mouse models about the mechanisms involved in disease development. Arthritis Res Ther 2023; 25:59. [PMID: 37046337 PMCID: PMC10100340 DOI: 10.1186/s13075-023-03042-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
Efforts to develop effective disease-modifying drugs to treat osteoarthritis have so far proved unsuccessful with a number of promising drug candidates from pre-clinical studies failing to show efficacy in clinical trials. It is therefore timely to re-evaluate our current understanding of osteoarthritis pathogenesis and the similarities and differences in disease development between commonly used pre-clinical mouse models and human patients. There is substantial heterogeneity between patients presenting with osteoarthritis and mounting evidence that the pathways involved in osteoarthritis (e.g. Wnt signalling) differ between patient sub-groups. There is also emerging evidence that the pathways involved in osteoarthritis differ between the STR/ort mouse model (the most extensively studied mouse model of spontaneously occurring osteoarthritis) and injury-induced osteoarthritis mouse models. For instance, while canonical Wnt signalling is upregulated in the synovium and cartilage at an early stage of disease in injury-induced osteoarthritis mouse models, this does not appear to be the case in the STR/ort mouse. Such findings may prove insightful for understanding the heterogeneity in mechanisms involved in osteoarthritis pathogenesis in human disease. However, it is important to recognise that there are differences between mice and humans in osteoarthritis pathogenesis. A much more extensive array of pathological changes are evident in osteoarthritic joints in individual mice with osteoarthritis compared to individual patients. There are also specified differences in the pathways involved in disease development. For instance, although increased TGF-β signalling is implicated in osteoarthritis development in both mouse models of osteoarthritis and human disease, in mice, this is mainly mediated through TGF-β3 whereas in humans, it is through TGF-β1. Studies in other tissues have shown TGF-β1 is more potent than TGF-β3 in inducing the switch to SMAD1/5 signalling that occurs in osteoarthritic cartilage and that TGF-β1 and TGF-β3 have opposing effects on fibrosis. It is therefore possible that the relative contribution of TGF-β signalling to joint pathology in osteoarthritis differs between murine models and humans. Understanding the similarities and differences in osteoarthritis pathogenesis between mouse models and humans is critical for understanding the translational potential of findings from pre-clinical studies.
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Affiliation(s)
- Raewyn C Poulsen
- Department of Pharmacology & Clinical Pharmacology, Faculty of Medical & Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand.
| | - Lekha Jain
- Department of Pharmacology & Clinical Pharmacology, Faculty of Medical & Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
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10
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Yu ZC, Fu R, Li Y, Zhao DY, Jiang H, Han D. The STING inhibitor C-176 attenuates osteoclast-related osteolytic diseases by inhibiting osteoclast differentiation. FASEB J 2023; 37:e22867. [PMID: 36906288 DOI: 10.1096/fj.202201600r] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/11/2022] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Abstract
Inflammatory osteolysis occurs primarily in the context of osteoarthritis, aseptic inflammation, prosthesis loosening, and other conditions. An excessive immune inflammatory response causes excessive activation of osteoclasts, leading to bone loss and bone destruction. The signaling protein stimulator of interferon gene (STING) can regulate the immune response of osteoclasts. C-176 is a furan derivative that can inhibit activation of the STING pathway and exert anti-inflammatory effects. The effect of C-176 on osteoclast differentiation is not yet clear. In this study, we found that C-176 could inhibit STING activation in osteoclast precursor cells and inhibit osteoclast activation induced by nuclear factor κB ligand receptor activator in a dose-dependent manner. After treatment with C-176, the expression of the osteoclast differentiation marker genes nuclear factor of activated T-cells c1(NFATc1), cathepsin K, calcitonin receptor, and V-ATPase a3 decreased. In addition, C-176 reduced actin loop formation and bone resorption capacity. The WB results showed that C-176 downregulated the expression of the osteoclast marker protein NFATc1 and inhibited activation of the STING-mediated NF-κB pathway. We also found that C-176 could inhibit the phosphorylation of mitogen-activated protein kinase signaling pathway factors induced by RANKL. Moreover, we verified that C-176 could reduce LPS-induced bone absorption in mice, reduce joint destruction in knee arthritis induced by meniscal instability, and protect against cartilage matrix loss in ankle arthritis induced by collagen immunity. In summary, our findings demonstrated that C-176 could inhibit the formation and activation of osteoclasts and could be used as a potential therapeutic agent for inflammatory osteolytic diseases.
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Affiliation(s)
- Zhen-Cheng Yu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rao Fu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Li
- Department of Burns & Plastic Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Dan-Yang Zhao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Jiang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Han
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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11
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Renaudin F, Oudina K, Gerbaix M, McGilligan Subilia M, Paccaud J, Jaquet V, Krause KH, Ferrari S, Laumonier T, Hannouche D. NADPH oxidase 4 deficiency attenuates experimental osteoarthritis in mice. RMD Open 2023; 9:rmdopen-2022-002856. [PMID: 36810185 PMCID: PMC9945017 DOI: 10.1136/rmdopen-2022-002856] [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: 11/10/2022] [Accepted: 01/18/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE Low-grade inflammation plays a pivotal role in osteoarthritis (OA) through exposure to reactive oxygen species (ROS). In chondrocytes, NADPH oxidase 4 (NOX4) is one of the major ROS producers. In this study, we evaluated the role of NOX4 on joint homoeostasis after destabilisation of the medial meniscus (DMM) in mice. METHODS Experimental OA was simulated on cartilage explants using interleukin-1β (IL-1β) and induced by DMM in wild-type (WT) and NOX4 knockout (NOX4-/-) mice. We evaluated NOX4 expression, inflammation, cartilage metabolism and oxidative stress by immunohistochemistry. Bone phenotype was also determined by micro-CT and histomorphometry. RESULTS Whole body NOX4 deletion attenuated experimental OA in mice, with a significant reduction of the OARSI score at 8 weeks. DMM increased total subchondral bone plate (SB.Th), epiphysial trabecular thicknesses (Tb.Th) and bone volume fraction (BV/TV) in both NOX4-/- and wild-type (WT) mice. Interestingly, DDM decreased total connectivity density (Conn.Dens) and increased medial BV/TV and Tb.Th only in WT mice. Ex vivo, NOX4 deficiency increased aggrecan (AGG) expression and decreased matrix metalloproteinase 13 (MMP13) and collagen type I (COL1) expression. IL-1β increased NOX4 and 8-hydroxy-2'-deoxyguanosine (8-OHdG) expression in WT cartilage explants but not in NOX4-/-. In vivo, absence of NOX4 increased anabolism and decreased catabolism after DMM. Finally, NOX4 deletion decreased synovitis score, 8-OHdG and F4/80 staining following DMM. CONCLUSION NOX4 deficiency restores cartilage homoeostasis, inhibits oxidative stress, inflammation and delays OA progression after DMM in mice. These findings suggest that NOX4 represent a potential target to counteract for OA treatment.
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Affiliation(s)
- Félix Renaudin
- Department of Cell Physiology and Metabolism, Université de Genève Faculté de médecine, Geneve, Switzerland.,Department of Orthopaedic Surgery, Geneva University Hospitals, Geneve, Switzerland
| | - Karim Oudina
- Department of Cell Physiology and Metabolism, Université de Genève Faculté de médecine, Geneve, Switzerland.,Department of Orthopaedic Surgery, Geneva University Hospitals, Geneve, Switzerland
| | - Maude Gerbaix
- Service of Bone Diseases, Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Manon McGilligan Subilia
- Department of Cell Physiology and Metabolism, Université de Genève Faculté de médecine, Geneve, Switzerland.,Department of Orthopaedic Surgery, Geneva University Hospitals, Geneve, Switzerland
| | - Joris Paccaud
- Department of Cell Physiology and Metabolism, Université de Genève Faculté de médecine, Geneve, Switzerland.,Department of Orthopaedic Surgery, Geneva University Hospitals, Geneve, Switzerland
| | - Vincent Jaquet
- Department of Pathology and Immunology, Université de Genève Faculté de médecine, Geneve, Switzerland
| | - Karl-Heinz Krause
- Department of Pathology and Immunology, Université de Genève Faculté de médecine, Geneve, Switzerland
| | - Serge Ferrari
- Service of Bone Diseases, Department of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Thomas Laumonier
- Department of Cell Physiology and Metabolism, Université de Genève Faculté de médecine, Geneve, Switzerland.,Department of Orthopaedic Surgery, Geneva University Hospitals, Geneve, Switzerland
| | - Didier Hannouche
- Department of Cell Physiology and Metabolism, Université de Genève Faculté de médecine, Geneve, Switzerland .,Department of Orthopaedic Surgery, Geneva University Hospitals, Geneve, Switzerland
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12
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Breakthrough of extracellular vesicles in pathogenesis, diagnosis and treatment of osteoarthritis. Bioact Mater 2022; 22:423-452. [PMID: 36311050 PMCID: PMC9588998 DOI: 10.1016/j.bioactmat.2022.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
Osteoarthritis (OA) is a highly prevalent whole-joint disease that causes disability and pain and affects a patient's quality of life. However, currently, there is a lack of effective early diagnosis and treatment. Although stem cells can promote cartilage repair and treat OA, problems such as immune rejection and tumorigenicity persist. Extracellular vesicles (EVs) can transmit genetic information from donor cells and mediate intercellular communication, which is considered a functional paracrine factor of stem cells. Increasing evidences suggest that EVs may play an essential and complex role in the pathogenesis, diagnosis, and treatment of OA. Here, we introduced the role of EVs in OA progression by influencing inflammation, metabolism, and aging. Next, we discussed EVs from the blood, synovial fluid, and joint-related cells for diagnosis. Moreover, we outlined the potential of modified and unmodified EVs and their combination with biomaterials for OA therapy. Finally, we discuss the deficiencies and put forward the prospects and challenges related to the application of EVs in the field of OA.
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13
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Ma C, Aitken D, Wu F, Squibb K, Cicuttini F, Jones G. Association between radiographic hand osteoarthritis and bone microarchitecture in a population-based sample. Arthritis Res Ther 2022; 24:223. [PMID: 36115996 PMCID: PMC9482179 DOI: 10.1186/s13075-022-02907-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Background Subchondral bone plays an important role in the pathogenesis of radiographic osteoarthritis (OA). However, the bony changes that occur in hand OA (HOA) are much less understood. This study aimed to describe the association between radiographic HOA and high-resolution peripheral quantitative computed tomography (HRpQCT) measures of the hand and radius in a population-based sample. Methods A total of 201 participants (mean age 72, 46% female) from the Tasmanian Older Adult Cohort (TASOAC) study underwent HRpQCT assessment of the 2nd distal and proximal interphalangeal (DIP, PIP), 1st carpometacarpal (CMC) joint, and distal radius. Radiographic HOA was assessed at the 2nd DIP, PIP joints, and the 1st CMC joint using the OARSI atlas. Results Proximal osteophyte and joint space narrowing (JSN) scores were consistently more strongly associated with HRpQCT measures compared to the distal site with positive associations for indices of bone size (total and trabecular bone area and cortical perimeter but inconsistent for cortical area) and negative associations for volumetric bone mineral density (vBMD). There was a decrease in trabecular number and bone volume fraction with increasing osteophyte and JSN score as well as an increase in trabecular separation and inhomogeneity. Osteophyte and JSN scores in the hand were not associated with HRpQCT measures at the distal radius. Conclusions This hypothesis generating data suggests that bone size and trabecular disorganization increase with both osteophyte formation and JSN (proximal more than distal), while local vBMD decreases. This process appears to be primarily at the site of pathology rather than nearby unaffected bone. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02907-6.
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14
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Huddleston HP, Cregar WM, Alzein MM, Vadhera AS, Wong SE, Yanke AB. Outcomes of Patellar Subchondroplasty Surgery: A Case Series. J Knee Surg 2022. [PMID: 35901796 DOI: 10.1055/s-0042-1747944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A select subset of patients can present with anterior knee pain in the setting of normal patellar tracking, no significant cartilage damage, and the presence of a bone marrow lesion (BML) involving the patella on advanced imaging. One novel treatment option for this condition is patellar subchondroplasty, where calcium phosphate is injected into the subchondral bone under fluoroscopic guidance. The purpose of this study is to report preliminary outcomes of patients who have undergone subchondroplasty of the patella. The surgical log of the senior author was retrospectively reviewed to identify patients who had undergone patellar subchondroplasty from January 2014 to June 2019. Indications for surgery included the presence of retropatellar pain refractory to conservative management without significant arthritis with a related focal BML on magnetic resonance imaging. International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Veterans Rand 12-item Health Survey (VR-12) were obtained preoperatively, at 6 months and at final follow-up. Eight patients (nine knees) who underwent patellar subchondroplasty with minimum 1-year follow-up participated in the study. On preoperative magnetic resonance imaging, patients had a mean BML that was 2 cm in diameter. Patients had a median Kellgren-Lawrence grade of 2 both preoperatively and at final radiographic follow-up (15.50 ± 20.52 months). No patient underwent subsequent surgery or conversion to arthroplasty. Compared with baseline, VR-12 mental (p = 0.046) and physical (p = 0.003), KOOS joint replacement (p = 0.024), KOOS pain (p = 0.033), and KOOS sports (p = 0.034) scores were significantly increased at final follow-up (24.00 ± 13.55 months). In addition, on a scale of 0 to 100, patient-reported satisfaction was 73.88 ± 33.90. This study introduces patellar subchondroplasty as a surgical treatment for patients with symptomatic BMLs of the patella without significant arthritis after failure of conservative management. Our results demonstrated good outcomes and patient satisfaction. In addition, no patients converted to patellofemoral or total knee arthroplasty. This study suggests that patellar subchondroplasty may be a reasonable treatment option in the correct patient population.
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Affiliation(s)
- Hailey P Huddleston
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois
| | - William M Cregar
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois
| | - Mohamad M Alzein
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois
| | - Amar S Vadhera
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois
| | - Stephanie E Wong
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois
| | - Adam B Yanke
- Department of Orthopaedics, Rush University Medical Center, Chicago, Illinois
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15
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Subchondral bone changes after joint distraction treatment for end stage knee osteoarthritis. Osteoarthritis Cartilage 2022; 30:965-972. [PMID: 35144003 DOI: 10.1016/j.joca.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Increased subchondral cortical bone plate thickness and trabecular bone density are characteristic of knee osteoarthritis (OA). Knee joint distraction (KJD) is a joint-preserving knee OA treatment where the joint is temporarily unloaded. It has previously shown clinical improvement and cartilage regeneration, indicating reversal of OA-related changes. The purpose of this research was to explore 3D subchondral bone changes after KJD treatment using CT imaging. DESIGN Twenty patients were treated with KJD and included to undergo knee CT imaging before, one, and two years after treatment. Tibia and femur segmentation and registration to canonical surfaces were performed semi-automatically. Cortical bone thickness and trabecular bone density were determined using an automated algorithm. Statistical parametric mapping (SPM) with two-tailed F-tests was used to analyze whole-joint changes. RESULTS Data was available of 16 patients. Subchondral cortical bone plate thickness and trabecular bone density were higher in the weight-bearing region of the most affected compartment (MAC; mostly medial). Especially the MAC showed a decrease in thickness and density in the first year after treatment, which was sustained towards the second year. CONCLUSIONS KJD treatment results in bone changes that include thinning of the subchondral cortical bone plate and decrease of subchondral trabecular bone density in the first two years after treatment, potentially indicating a partial normalization of subchondral bone.
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16
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Ontogenetic Patterning of Human Subchondral Bone Microarchitecture in the Proximal Tibia. BIOLOGY 2022; 11:biology11071002. [PMID: 36101383 PMCID: PMC9312028 DOI: 10.3390/biology11071002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 01/11/2023]
Abstract
High-resolution computed tomography images were acquired for 31 proximal human tibiae, age 8 to 37.5 years, from Norris Farms #36 cemetery site (A.D. 1300). Morphometric analysis of subchondral cortical and trabecular bone architecture was performed between and within the tibial condyles. Kruskal−Wallis and Wilcoxon signed-rank tests were used to examine the association between region, age, body mass, and each morphometric parameter. The findings indicate that age-related changes in mechanical loading have varied effects on subchondral bone morphology. With age, trabecular microstructure increased in bone volume fraction (p = 0.033) and degree of anisotropy (p = 0.012), and decreased in connectivity density (p = 0.001). In the subchondral cortical plate, there was an increase in thickness (p < 0.001). When comparing condylar regions, only degree of anisotropy differed (p = 0.004) between the medial and lateral condyles. Trabeculae in the medial condyle were more anisotropic than in the lateral region. This research represents an innovative approach to quantifying both cortical and trabecular subchondral bone microarchitecture in archaeological remains.
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17
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Auger JD, Naik AJ, Murakami AM, Gerstenfeld LC, Morgan EF. Spatial assessment of femoral neck bone density and microstructure in hip osteoarthritis. Bone Rep 2022; 16:101155. [PMID: 34984214 PMCID: PMC8693349 DOI: 10.1016/j.bonr.2021.101155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Osteoarthritis (OA) is known to involve profound changes in bone density and microstructure near to, and even distal to, the joint. Critically, however, a full, spatial picture of these abnormalities has not been well documented in a quantitative fashion in hip OA. Here, micro-computed tomography (44.8 μm/voxel) and data-driven computational anatomy were used to generate 3-D maps of the distribution of bone density and microstructure in human femoral neck samples with early (6F/4M, mean age = 51.3 years), moderate (14F/8M, mean age = 60 years), and severe (16F/6M, mean age = 63.3 years) radiographic OA. With increasing severity of radiographic OA, there was decreased cortical bone mineral density (BMD) (p=0.003), increased cortical thickness (p=0.001), increased cortical porosity (p=0.0028), and increased cortical cross-sectional area (p=0.0012, due to an increase in periosteal radius (p=0.018)), with no differences detected in the total femoral neck or trabecular compartment measures. No OA-related region-specific differences were detected through Statistical Parametric Mapping, but there were trends towards decreased tissue mineral density (TMD) in the inferior femoral neck with increasing OA severity (0.050 < p ≤ 0.091), possibly due to osteophytes. Overall, the lack of differences in cortical TMD among radiographic OA groups indicated that the decrease in cortical BMD with increasing OA severity was largely due to the increased cortical porosity rather than decreased tissue mineralization. As porosity is inversely associated with stiffness and strength in cortical bone, increased porosity may offset the effect that increased cortical cross-sectional area would be expected to have on reducing stresses within the femoral neck. The use of high-resolution imaging and quantitative spatial assessment in this study provide insight into the heterogeneous and multi-faceted changes in density and microstructure in hip OA, which have implications for OA progression and fracture risk.
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Affiliation(s)
| | | | - Akira M. Murakami
- Boston University School of Medicine, Boston, MA, United States of America
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18
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Huan C, Gao J. Insight into the potential pathogenesis of human osteoarthritis via single-cell RNA sequencing data on osteoblasts. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:6344-6361. [PMID: 35603405 DOI: 10.3934/mbe.2022297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Osteoarthritis (OA) is the most common degenerative joint disease caused by osteoblastic lineage cells. However, a comprehensive molecular program for osteoblasts in human OA remains underdeveloped. The single-cell gene expression of osteoblasts and microRNA array data were from human. After processing the single-cell RNA sequencing (scRNA-seq) data, it was subjected to principal component analysis (PCA) and T-Stochastic neighbor embedding analysis (TSNE). Differential expression analysis was aimed to find marker genes. Gene-ontology (GO) enrichment, Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis and Gene set enrichment analysis (GSEA) were applied to characterize the molecular function of osteoblasts with marker genes. Protein-protein interaction (PPI) networks and core module were established for marker genes by using the STRING database and Cytoscape software. All nodes in the core module were considered to be hub genes. Subsequently, we predicted the potential miRNA of hub genes through the miRWalk, miRDB and TargetScan database and experimentally verified the miRNA by GSE105027. Finally, miRNA-mRNA regulatory network was constructed using the Cytoscape software. We characterized the single-cell expression profiling of 4387 osteoblasts from normal and OA sample. The proportion of osteoblasts subpopulations changed dramatically in the OA, with 70.42% of the pre-osteoblasts. 117 marker genes were included and the results of GO analysis show that up-regulated marker genes enriched in collagen-containing extracellular matrix were highly expressed in the pre-osteoblasts cluster. Both KEGG and GSEA analyses results indicated that IL-17 and NOD-like receptor signaling pathways were enriched in down-regulated marker genes. We visualize the weight of marker genes and constructed the core module in PPI network. In potential mRNA-miRNA regulatory network, hsa-miR-449a and hsa-miR-218-5p may be involved in the development of OA. Our study found that alterations in osteoblasts state and cellular molecular function in the subchondral bone region may be involved in the pathogenesis of osteoarthritis.
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Affiliation(s)
- Changxiang Huan
- Zhongshan Clinical Collage of Dalian University, Dalian 116000, China
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19
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Goel S, Kamath SU, Annappa R, Krishnamurthy SL, Jain M, Thakkar S, Damsas L, Banerjee S, Divakar PM. Cross-sectional assessment of cardiovascular risk factors in patients with knee osteoarthritis. F1000Res 2022; 10:508. [PMID: 35265321 DOI: 10.12688/f1000research.27744.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Osteoarthritis (OA) and cardiovascular disease (CVD) are prevalent in India. However, there is dearth of literature among Indians studying the relationship between the two. This study was carried out to assess various cardiovascular (CV) risk factors in patients with knee OA with an objective to investigate their association, screening and management. Methods: In total, 225 patients were included in this cross-sectional study. Participants were diagnosed with knee OA on the basis of the Kellgren and Lawrence (K-L) classification of their radiograph. Participants were also assessed for CV risk factors (age, body mass index, systolic blood pressure, diabetes mellitus, total cholesterol, high-density lipoprotein, smoking) with the help of the Joint British Society QRisk3 calculator (JBS3) a comprehensive risk score calculator as well as a screening tool, which produces three more variables, namely 10-years risk of developing CVD, physiological heart age and life expectancy. Chi Square, Fishers exact test and one-way ANOVA tests were used to compare the categorical and quantitative variables, respectively. Pearson's correlation coefficient was used to assess the relationship between CV risk factors and knee OA. Multiple regression analysis was done to adjust the multiple con-founders and determine their significance. Results: Patients with severe knee OA had a statistically significantly higher prevalence of CV risk factors (p<0.05). Grade 4 knee OA patients were found to have a mean JBS3 risk of 38%, heart age of 82 years and life expectancy of 77 years as compared to grade 2 patients who had a mean JBS3 risk of 11%, heart age of 63 years and life expectancy of 82 years. Conclusions: Our study concluded that there is a strong positive correlation between knee OA and CVD, with CV risk score being directly proportional to the severity of OA.
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Affiliation(s)
- Sagar Goel
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Surendra Umesh Kamath
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Rajendra Annappa
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Sunil Lakshmipura Krishnamurthy
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Manesh Jain
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Samarth Thakkar
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Lulu Damsas
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Sayak Banerjee
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Prajwal Madapura Divakar
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
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20
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Crolla JP, Lawless BM, Cederlund AA, Aspden RM, Espino DM. Analysis of hydration and subchondral bone density on the viscoelastic properties of bovine articular cartilage. BMC Musculoskelet Disord 2022; 23:228. [PMID: 35260135 PMCID: PMC8905800 DOI: 10.1186/s12891-022-05169-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Articular cartilage is known to be a viscoelastic material, however little research has explored the impact of cartilage water content and bone density on its viscoelasticity. This study aimed to isolate subchondral bone density and hydration of articular cartilage and analyse their effects on the viscoelastic properties of articular cartilage. Methods Dynamic mechanical analysis was used to test samples at frequencies of 1, 8, 12, 29, 49, 71, and 88 Hz. Synthetic bone material with densities of 663.7 kg/m3 and 156.8 kg/m3 were used to mimic the bone mineral density (BMD). Dehydration occurred in a stepwise manner at relative humidity (RH) levels of 100%, 30%, and 1%. These relative humidity levels led to water contents of approximately 76%, 8.5%, and ≈ 0% by mass, respectively. Results Samples from eight bovine femoral heads were tested under a sinusoidal load. Storage stiffness was lower on the lower substrate density. Storage stiffness, though, increased as cartilage samples were dehydrated from a water content of 76% to 8.5%; decreasing again as the water content was further reduced. Loss stiffness was lower on a lower density substrate and decreased as the water content decreased. Conclusions In conclusions, a decrease in hydration decreases the loss stiffness, but a non-linear relationship between hydration and storage stiffness may exist. Additionally, higher BMD values led to greater storage and loss stiffnesses. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05169-0.
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Affiliation(s)
- Joseph P Crolla
- Deptment of Mechanical Engineering, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Bernard M Lawless
- Deptment of Mechanical Engineering, University of Birmingham, Birmingham, B15 2TT, UK
| | - Anna A Cederlund
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, AB25 2ZD, Foresterhill Aberdeen, UK
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, AB25 2ZD, Foresterhill Aberdeen, UK
| | - Daniel M Espino
- Deptment of Mechanical Engineering, University of Birmingham, Birmingham, B15 2TT, UK
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21
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Inhibition of Semaphorin 4D/Plexin-B1 signaling inhibits the subchondral bone loss in early-stage osteoarthritis of the temporomandibular joint. Arch Oral Biol 2022; 135:105365. [DOI: 10.1016/j.archoralbio.2022.105365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 12/30/2022]
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22
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Akiyama K, Sakai T, Koyanagi J, Yoshikawa H, Sugamoto K. Age-related differences in morphology and kinematics of the native hip. J Orthop Res 2022; 40:359-369. [PMID: 32672868 DOI: 10.1002/jor.24806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/19/2020] [Accepted: 07/13/2020] [Indexed: 02/04/2023]
Abstract
Our objectives were to clarify morphology of the hip as well as infinitesimal femoral head movement in specific positions in young and elderly volunteers without joint degeneration. Both hips of 20 young and 20 elderly healthy volunteers were examined. Magnetic resonance imaging was performed at four different positions for each hip: neutral, 45° flexion, 15° extension, and the Patrick position. Femoral and pelvic bone images were separately extracted when in the neutral position and superimposed over the images of each different position by using voxel-based registration. The distance between the acetabular center and the femoral head center (FHC) at the neutral position was defined as 3D-migration. The distance between FHCs at neutral position and that at each different position was defined as 3D-translation. The x-, y-, and z-axes pointed in the anterior, cranial, and lateral directions, respectively. 3D-migration-y in the elderly was more caudal than that in the young (P < .001). 3D-translation of 45° flexion in the elderly was larger than that in the young with statistical significance (P = .001), while 3D-translation of the Patrick position in the elderly was smaller than that in the young (P = .012). Age was significantly correlated with 3D-translation in 45° flexion (r = .431; P < .001) and that in Patrick (r = -.296; P = .008). These results can be used as a basis for the natural course with aging of morphometry and kinematics of the hip, as well as for potential disease progression in osteoarthritis of the hip.
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Affiliation(s)
- Keisuke Akiyama
- Department of Orthopaedic Surgery, Osaka Minami Medical Center, Kawachinagano, Osaka, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Junichiro Koyanagi
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuomi Sugamoto
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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23
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Sun Y, Bao X, Chen H, Zhou L. MicroRNA-128-3p suppresses interleukin-1β-stimulated cartilage degradation and chondrocyte apoptosis via targeting zinc finger E-box binding homeobox 1 in osteoarthritis. Bioengineered 2022; 13:1736-1745. [PMID: 34990303 PMCID: PMC8805990 DOI: 10.1080/21655979.2021.2019879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Accumulating studies have suggested that microRNAs (miRNAs) play vital roles in the pathogenesis of osteoarthritis (OA). Nevertheless, the specific function of miR-128-3p in OA remains unknown. In this study, we demonstrated that miR-128-3p was decreased and ZEB1 was increased in OA. Additionally, miR-128-3p expression was negatively correlated with ZEB1. miR-128-3p overexpression or ZEB1 silencing attenuated extracellular matrix degradation and cell apoptosis, and increased the proliferation of IL-1β-activated CHON-001 cells. Furthermore, ZEB1 was directly targeted by miR-128-3p. In addition, ZEB1 upregulation restored the effects of miR-128-3p overexpression on OA progression. Overall, our findings suggested that miR-128-3p might regulate the development of OA via targeting ZEB1.
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Affiliation(s)
- Yu Sun
- Department of Orthopectics, The First People's Hospital of Changzhou, Changzhou, P.R. China
| | - Xinnan Bao
- Department of Orthopectics, The First People's Hospital of Changzhou, Changzhou, P.R. China
| | - Haiou Chen
- Department of Orthopectics, The First People's Hospital of Changzhou, Changzhou, P.R. China
| | - Liping Zhou
- Department of Orthopectics, The First People's Hospital of Changzhou, Changzhou, P.R. China
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24
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Ribas LC, Riad R, Jennane R, Bruno OM. A complex network based approach for knee Osteoarthritis detection: Data from the Osteoarthritis initiative. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Wang K, Lu X, Li X, Zhang Y, Xu R, Lou Y, Wang Y, Zhang T, Qian Y. Dual protective role of velutin against articular cartilage degeneration and subchondral bone loss via the p38 signaling pathway in murine osteoarthritis. Front Endocrinol (Lausanne) 2022; 13:926934. [PMID: 35937813 PMCID: PMC9354239 DOI: 10.3389/fendo.2022.926934] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022] Open
Abstract
Osteoarthritis (OA) is a common degenerative joint condition associated with inflammation and characterized by progressive degradation of the articular cartilage and subchondral bone loss in the early stages. Inflammation is closely associated with these two major pathophysiological changes in OA. Velutin, a flavonoid family member, reportedly exerts anti-inflammatory effects. However, the therapeutic effects of velutin in OA have not yet been characterized. In this study, we explore the effects of velutin in an OA mouse model. Histological staining and micro-CT revealed that velutin had a protective effect against cartilage degradation and subchondral bone loss in an OA mouse model generated by surgical destabilization of the medial meniscus (DMM). Additionally, velutin rescued IL-1β-induced inflammation in chondrocytes and inhibited RANKL-induced osteoclast formation and bone resorption in vitro. Mechanistically, the p38 signaling pathway was found to be implicated in the inhibitory effects of velutin. Our study reveals the dual protective effects of velutin against cartilage degradation and subchondral bone loss by inhibiting the p38 signaling pathway, thereby highlighting velutin as an alternative treatment for OA.
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Affiliation(s)
- Kelei Wang
- Department of Orthopedics, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
- Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xuanyuan Lu
- Department of Orthopedics, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Xinyu Li
- Department of Orthopedics, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Yufeng Zhang
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Rongjian Xu
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yun Lou
- Department of Orthopedics, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Yanben Wang
- Department of Orthopedics, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
- Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tan Zhang
- Department of Orthopedics, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Yu Qian
- Department of Orthopedics, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
- *Correspondence: Yu Qian,
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26
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Zhou Y, Ni J, Wen C, Lai P. Light on osteoarthritic joint: from bench to bed. Theranostics 2022; 12:542-557. [PMID: 34976200 PMCID: PMC8692899 DOI: 10.7150/thno.64340] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/08/2021] [Indexed: 12/19/2022] Open
Abstract
Osteoarthritis (OA) is one of the rapidly growing disability-associated conditions with population aging worldwide. There is a pressing need for precise diagnosis and timely intervention for OA in the early stage. Current clinical imaging modalities, including pain radiography, magnetic resonance imaging, ultrasound, and optical coherent tomography, are limited to provide structural changes when the damage has been established or advanced. It prompts further endeavors in search of novel functional and molecular imaging, which potentially enables early diagnosis and intervention of OA. A hybrid imaging modality based on photothermal effects, photoacoustic imaging, has drawn wide attention in recent years and has seen a variety of biomedical applications, due to its great performance in yielding high-contrast and high-resolution images from structure to function, from tissue down to molecular levels, from animals to human subjects. Photoacoustic imaging has witnessed gratifying potentials and preliminary effects in OA diagnosis. Regarding the treatment of OA, photothermal-triggered therapy has exhibited its attractions for enhanced therapeutic outcomes. In this narrative review, we will discuss photoacoustic imaging for the diagnosis and monitoring of OA at different stages. Structural, functional, and molecular parameter changes associated with OA joints captured by photoacoustics will be summarized, forming the diagnosis perspective of the review. Photothermal therapy applications related to OA will also be discussed herein. Lastly, relevant clinical applications and its potential solutions to extend photoacoustic imaging to deeper OA situations have been proposed. Although some aspects may not be covered, this mini review provides a better understanding of the diagnosis and treatment of OA with exciting innovations based on tissue photothermal effects. It may also inspire more explorations in the field towards earlier and better theranostics of OA.
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Affiliation(s)
- Yingying Zhou
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Junguo Ni
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR
| | - Chunyi Wen
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, HKSAR
| | - Puxiang Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
- Photonics Research Institute, The Hong Kong Polytechnic University, HKSAR
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27
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Bayramoglu N, Nieminen MT, Saarakkala S. Machine learning based texture analysis of patella from X-rays for detecting patellofemoral osteoarthritis. Int J Med Inform 2021; 157:104627. [PMID: 34773800 DOI: 10.1016/j.ijmedinf.2021.104627] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the ability of texture features for detecting radiographic patellofemoral osteoarthritis (PFOA) from knee lateral view radiographs. DESIGN We used lateral view knee radiographs from The Multicenter Osteoarthritis Study (MOST) public use datasets (n = 5507 knees). Patellar region-of-interest (ROI) was automatically detected using landmark detection tool (BoneFinder), and subsequently, these anatomical landmarks were used to extract three different texture ROIs. Hand-crafted features, based on Local Binary Patterns (LBP), were then extracted to describe the patellar texture. First, a machine learning model (Gradient Boosting Machine) was trained to detect radiographic PFOA from the LBP features. Furthermore, we used end-to-end trained deep convolutional neural networks (CNNs) directly on the texture patches for detecting the PFOA. The proposed classification models were eventually compared with more conventional reference models that use clinical assessments and participant characteristics such as age, sex, body mass index (BMI), the total Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and tibiofemoral Kellgren-Lawrence (KL) grade. Atlas-guided visual assessment of PFOA status by expert readers provided in the MOST public use datasets was used as a classification outcome for the models. Performance of prediction models was assessed using the area under the receiver operating characteristic curve (ROC AUC), the area under the precision-recall (PR) curve -average precision (AP)-, and Brier score in the stratified 5-fold cross validation setting. RESULTS Of the 5507 knees, 953 (17.3%) had PFOA. AUC and AP for the strongest reference model including age, sex, BMI, WOMAC score, and tibiofemoral KL grade to predict PFOA were 0.817 and 0.487, respectively. Textural ROI classification using CNN significantly improved the prediction performance (ROC AUC = 0.889, AP = 0.714). CONCLUSION We present the first study that analyses patellar bone texture for diagnosing PFOA. Our results demonstrates the potential of using texture features of patella to predict PFOA.
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Affiliation(s)
- Neslihan Bayramoglu
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.
| | - Miika T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
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28
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Sun Y, Deng C, Zhang Z, Ma X, Zhou F, Liu X. Novel nomogram for predicting the progression of osteoarthritis based on 3D-MRI bone shape: data from the FNIH OA biomarkers consortium. BMC Musculoskelet Disord 2021; 22:782. [PMID: 34511103 PMCID: PMC8436553 DOI: 10.1186/s12891-021-04620-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/14/2021] [Indexed: 01/04/2023] Open
Abstract
Background Osteoarthritis(OA) is a major source of pain, disability, and socioeconomic cost in worldwide. However, there is no effective means for the early diagnosis of OA, nor can it accurately predict the progress of OA. To develop and validate a novel nomogram to predict the radiographic progression of mild to moderate OA based on three-dimensional(3D)-MRI bone shape and bone shape change during 24 months. Method Analysis of publicly available data from the Foundation for the National Institutes of Health (FNIH) OA Biomarkers Consortium. Radiographic progression was defined as minimum radiographic narrowing of the medial tibiofemoral joint space of ≥ 0.7 mm from baseline at 24, 36, or 48 months. There were 297 knees with radiographic progression and 303 without. The bone shapes of the tibia, femur, and patella were evaluated by 3D-MRI at the baseline and at 24 months. Two nomograms were separately established by multivariate logistic regression analysis using clinical risk factors, bone shape at baseline (nomogram 0), or bone shape change at 24 months (nomogram Δ24). The discrimination, calibration, and usefulness were selected to evaluate the nomograms. Results There were significant differences between groups in baseline Kellgren-Lawrence (KL) grade, gender, age, and tibia, femur, and patella shape. The areas under the curve (AUC) of nomogram 0 and nomogram Δ24 were 0.66 and 0.75 (p < 0.05), with accuracy of 0.62 and 0.69, respectively. Both nomograms had good calibration. The decision curve analysis ( DCA) showed that nomogram Δ24 had greater clinical usefulness than nomogram 0 when the risk threshold ranged from 0.04 to 0.86. Conclusions Nomograms based on 3D-MRI bone shape change were useful for predicting the radiographic progression of mild to moderate OA.
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Affiliation(s)
- Yingwei Sun
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China.,Department of Radiology, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning Province, China
| | - Chunbo Deng
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China.,Department of Orthopedics, Central Hospital of Shenyang Medical College, Shenyang, Liaoning Province, China
| | - Zhan Zhang
- Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xun Ma
- Department of Rehabilitation, Shengjing Hospital of China Medical University, No.16, Puhe Street, Shenyang North New Area, Liaoning Province, 110134, Shenyang, China
| | - Fenghua Zhou
- Department of Rehabilitation, Shengjing Hospital of China Medical University, No.16, Puhe Street, Shenyang North New Area, Liaoning Province, 110134, Shenyang, China.
| | - Xueyong Liu
- Department of Rehabilitation, Shengjing Hospital of China Medical University, No.16, Puhe Street, Shenyang North New Area, Liaoning Province, 110134, Shenyang, China.
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29
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Krych AJ, Nauert RF, Song BM, Cook CS, Johnson AC, Smith PA, Stuart MJ. Association Between Transtibial Meniscus Root Repair and Rate of Meniscal Healing and Extrusion on Postoperative Magnetic Resonance Imaging: A Prospective Multicenter Study. Orthop J Sports Med 2021; 9:23259671211023774. [PMID: 34423058 PMCID: PMC8371730 DOI: 10.1177/23259671211023774] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Prospective studies evaluating second-look imaging of meniscus root repair
using a transtibial pull-out technique are limited; therefore, optimal
surgical indications and the technique for meniscus root repair remain
uncertain. Hypothesis: It was hypothesized that there would be a high rate of healing, improvement
in meniscal extrusion, and prevention of articular cartilage degeneration
and subchondral bone abnormalities after meniscus root repair. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients undergoing transtibial root repair were prospectively
enrolled at 2 orthopaedic centers between March 2017 and January 2019. Pre-
and postoperative magnetic resonance imaging (MRI) scans were reviewed by a
musculoskeletal radiologist in a blinded fashion for meniscal healing,
quantification of extrusion, articular cartilage grade, subchondral bone
changes, and coronary/meniscotibial ligament abnormalities. Given persistent
extrusion observed on postoperative MRI scans, an additional 10 patients
gave consent and were enrolled for immediate (before weightbearing)
postoperative MRI scans. Results: A total of 45 patients (16 male, 29 female; mean ± standard deviation age,
42.3 ± 12.9 years; body mass index, 31.6) were prospectively enrolled in the
study; there were 47 meniscus root repairs: 29 medial and 18 lateral (2 with
both). Postoperative MRI was obtained at an average of 6.3 months (range,
5.1-8 months); 98% of meniscal repairs had evidence of healing. Mean
extrusion increased significantly, from 1.9 ± 1.5 mm preoperatively to 2.6 ±
1.4 mm postoperatively (P = .03). There was no significant
progression of chondromalacia grade, subchondral edema, insufficiency
fracture, subchondral cysts, or subchondral collapse. In the additional
10-patient cohort, the mean preoperative extrusion (1.6 ± 1.2 mm) was not
significantly different from that immediately postoperatively (2.0 ± 1.0 mm;
P = .23). Conclusion: Prospective MRI analysis of transtibial meniscus root repair confirmed a high
rate of meniscal healing and no observable progression of cartilage
degeneration or subchondral bone abnormalities at the short-term follow-up.
However, meniscal extrusion worsened in the first 6 months after
surgery. Registration: NCT03037242 (ClinicalTrials.gov
identifier).
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Affiliation(s)
- Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard F Nauert
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryant M Song
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Corey S Cook
- Department of Orthopedic Surgery, Columbia Orthopedic Group, Columbia, Missouri, USA
| | - Adam C Johnson
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick A Smith
- Department of Orthopedic Surgery, Columbia Orthopedic Group, Columbia, Missouri, USA.,Department of Orthopedic Surgery, University of Missouri, Columbia, Missouri, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
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30
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Goel S, Kamath SU, Annappa R, Krishnamurthy SL, Jain M, Thakkar S, Damsas L, Banerjee S, Divakar PM. Cross-sectional assessment of cardiovascular risk factors in patients with knee osteoarthritis. F1000Res 2021; 10:508. [PMID: 35265321 PMCID: PMC8866909 DOI: 10.12688/f1000research.27744.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 12/01/2023] Open
Abstract
Background: Osteoarthritis (OA) and cardiovascular disease (CVD) are prevalent in India. However, there is dearth of literature among Indians studying the relationship between the two. This study was carried out to assess various cardiovascular (CV) risk factors in patients with knee OA with an objective to investigate their association, screening and management. Methods: In total, 225 patients were included in this cross-sectional study. Participants were diagnosed with knee OA on the basis of the Kellgren and Lawrence (K-L) classification of their radiograph. Participants were also assessed for CV risk factors (age, body mass index, systolic blood pressure, diabetes mellitus, total cholesterol, high-density lipoprotein, smoking) with the help of the Joint British Society QRisk3 calculator (JBS3) a comprehensive risk score calculator as well as a screening tool, which produces three more variables, namely 10-years risk of developing CVD, physiological heart age and life expectancy. Chi Square, Fishers exact test and one-way ANOVA tests were used to compare the categorical and quantitative variables, respectively. Pearson's correlation coefficient was used to assess the relationship between CV risk factors and knee OA. Multiple regression analysis was done to adjust the multiple con-founders and determine their significance. Results: Patients with severe knee OA had a statistically significantly higher prevalence of CV risk factors (p<0.05). Grade 4 knee OA patients were found to have a mean JBS3 risk of 38%, heart age of 82 years and life expectancy of 77 years as compared to grade 2 patients who had a mean JBS3 risk of 11%, heart age of 63 years and life expectancy of 82 years. Conclusions: Our study concluded that there is a strong positive correlation between knee OA and CVD, with CV risk score being directly proportional to the severity of OA.
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Affiliation(s)
- Sagar Goel
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Surendra Umesh Kamath
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Rajendra Annappa
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Sunil Lakshmipura Krishnamurthy
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Manesh Jain
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Samarth Thakkar
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Lulu Damsas
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Sayak Banerjee
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
| | - Prajwal Madapura Divakar
- Department of Orthopedics, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, Karnataka, 576104, India
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31
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Snoeker BAM, Bowes MA, Roemer FW, Turkiewicz A, Lohmander LS, Frobell RB, Englund M. Is meniscal status in the anterior cruciate ligament injured knee associated with change in bone surface area? An exploratory analysis of the KANON trial. Osteoarthritis Cartilage 2021; 29:841-848. [PMID: 33676015 DOI: 10.1016/j.joca.2021.02.567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/22/2021] [Accepted: 02/23/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To study bone shape changes as a potential early feature of post-traumatic structural knee OA development, we estimated the association between meniscal status in the anterior cruciate ligament (ACL) injured knee and longitudinal condyle changes in bone surface area. DESIGN We used data from the KANON trial, including 121 young ACL-injured adults. We obtained baseline and 2-year follow-up knee MRIs. Our outcome was change in the bone surface areas (mean mm2, log-transformed) in 4 locations (femur, tibia, patella, and trochlea femur) in the medial and lateral compartment from baseline to 2 years. Meniscal pathology was defined as both present at baseline and newly developed (i.e., incident or progressed) using ACLOAS. We used multilevel linear regression adjusted for baseline bone area, age, sex, body mass index, treatment arm (i.e., early or optional delayed ACL reconstruction), and location. We analyzed medial and lateral compartment separately. We present results as percentage (%) bone area change difference with 95% confidence intervals (CI). RESULTS We analyzed 109 subjects (median 27 (18-36) years, 83% men) due to missing MRI information. The bone surface area increased on average by ∼2% over 2 years. The differences between knees with and without baseline meniscal pathology were 1.1% (95%CI 0.0-2.3%) and 1.4% (95%CI 0.6-2.2%) in the medial and lateral compartment, respectively, and 1.2% (95%CI 0.3-2.0%) and 1.3% (95%CI 0.6-2.0%) for medial and lateral newly developed pathology, respectively. CONCLUSION Our finding of ∼1% increase bone area in compartment with meniscal pathology suggests a potentially important association between meniscal integrity and early bone surface area changes after ACL injury. Trial registration number ISRCTN 84752559.
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Affiliation(s)
- B A M Snoeker
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden.
| | | | - F W Roemer
- Radiology, Universitatsklinikum Erlangen, Erlangen, Germany
| | - A Turkiewicz
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - L S Lohmander
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund, Sweden
| | - R B Frobell
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund, Sweden
| | - M Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
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Kulsirirat T, Honsawek S, Takeda-Morishita M, Sinchaipanid N, Udomsinprasert W, Leanpolchareanchai J, Sathirakul K. The Effects of Andrographolide on the Enhancement of Chondrogenesis and Osteogenesis in Human Suprapatellar Fat Pad Derived Mesenchymal Stem Cells. Molecules 2021; 26:1831. [PMID: 33805078 PMCID: PMC8037192 DOI: 10.3390/molecules26071831] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022] Open
Abstract
Andrographolide is a labdane diterpenoid herb, which is isolated from the leaves of Andrographis paniculata, and widely used for its potential medical properties. However, there are no reports on the effects of andrographolide on the human suprapatellar fat pad of osteoarthritis patients. In the present study, our goal was to evaluate the innovative effects of andrographolide on viability and Tri-lineage differentiation of human mesenchymal stem cells from suprapatellar fat pad tissues. The results revealed that andrographolide had no cytotoxic effects when the concentration was less than 12.5 µM. Interestingly, andrographolide had significantly enhanced, dose dependent, osteogenesis and chondrogenesis as evidenced by a significantly intensified stain for Alizarin Red S, Toluidine Blue and Alcian Blue. Moreover, andrographolide can upregulate the expression of genes related to osteogenic and chondrogenic differentiation, including Runx2, OPN, Sox9, and Aggrecan in mesenchymal stem cells from human suprapatellar fat pad tissues. In contrast, andrographolide suppressed adipogenic differentiation as evidenced by significantly diminished Oil Red O staining and expression levels for adipogenic-specific genes for PPAR-γ2 and LPL. These findings confirm that andrographolide can specifically enhance osteogenesis and chondrogenesis of mesenchymal stem cells from human suprapatellar fat pad tissues. It has potential as a therapeutic agent derived from natural sources for regenerative medicine.
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Affiliation(s)
- Thitianan Kulsirirat
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand; (T.K.); (J.L.)
| | - Sittisak Honsawek
- Osteoarthritis and Musculoskeleton Research Unit, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Mariko Takeda-Morishita
- Laboratory of Drug Delivery Systems, Faculty of Pharmaceutical Sciences, Kobe Gakuin University, Kobe, Hyogo 650-8586, Japan;
| | - Nuttanan Sinchaipanid
- Department of Manufacturing Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand;
| | - Wanvisa Udomsinprasert
- Department of Biochemistry, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand;
| | | | - Korbtham Sathirakul
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok 10400, Thailand; (T.K.); (J.L.)
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Oral administration of hydrolysates of cartilage extract in the prevention of osteoarthritis. J Funct Foods 2021. [DOI: 10.1016/j.jff.2021.104376] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Jarraya M, Heiss R, Duryea J, Nagel AM, Lynch JA, Guermazi A, Weber MA, Arkudas A, Horch RE, Uder M, Roemer FW. Bone Structure Analysis of the Radius Using Ultrahigh Field (7T) MRI: Relevance of Technical Parameters and Comparison with 3T MRI and Radiography. Diagnostics (Basel) 2021; 11:110. [PMID: 33445536 PMCID: PMC7826934 DOI: 10.3390/diagnostics11010110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 12/29/2022] Open
Abstract
Bone fractal signature analysis (FSA-also termed bone texture analysis) is a tool that assesses structural changes that may relate to clinical outcomes and functions. Our aim was to compare bone texture analysis of the distal radius in patients and volunteers using radiography and 3T and 7T magnetic resonance imaging (MRI)-a patient group (n = 25) and a volunteer group (n = 25) were included. Participants in the patient group had a history of chronic wrist pain with suspected or confirmed osteoarthritis and/or ligament instability. All participants had 3T and 7T MRI including T1-weighted turbo spin echo (TSE) sequences. The 7T MRI examination included an additional high-resolution (HR) T1 TSE sequence. Radiographs of the wrist were acquired for the patient group. When comparing patients and volunteers (unadjusted for gender and age), we found a statistically significant difference of horizontal and vertical fractal dimensions (FDs) using 7T T1 TSE-HR images in low-resolution mode (horizontal: p = 0.04, vertical: p = 0.01). When comparing radiography to the different MRI sequences, we found a statistically significant difference for low- and high-resolution horizontal FDs between radiography and 3T T1 TSE and 7T T1 TSE-HR. Vertical FDs were significantly different only between radiographs and 3T T1 TSE in the high-resolution mode; FSA measures obtained from 3T and 7T MRI are highly dependent on the sequence and reconstruction resolution used, and thus are not easily comparable between MRI systems and applied sequences.
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Affiliation(s)
- Mohamed Jarraya
- Department of Radiology, Massachusetts General Hospital, Harvard University, Boston, MA 02114, USA
| | - Rafael Heiss
- Department of Radiology, Friedrich Alexander University Erlangen-Nürnberg (FAU) & Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (R.H.); (A.M.N.); (M.U.); (F.W.R.)
| | - Jeffrey Duryea
- Department of Radiology, Brigham and Women’s Hospital, Harvard University, Boston, MA 02114, USA;
| | - Armin M. Nagel
- Department of Radiology, Friedrich Alexander University Erlangen-Nürnberg (FAU) & Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (R.H.); (A.M.N.); (M.U.); (F.W.R.)
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - John A. Lynch
- Department of Epidemiology and Biostatistics, University of California San Francisco (UCSF), San Francisco, CA 94143, USA;
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA 02118, USA;
- Department of Radiology, Boston Veteran Affairs Healthcare System, West Roxbury, MA 02132, USA
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, D-18057 Rostock, Germany;
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery, Friedrich Alexander University Erlangen-Nürnberg (FAU) & Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (A.A.); (R.E.H.)
| | - Raymund E. Horch
- Department of Plastic and Hand Surgery, Friedrich Alexander University Erlangen-Nürnberg (FAU) & Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (A.A.); (R.E.H.)
| | - Michael Uder
- Department of Radiology, Friedrich Alexander University Erlangen-Nürnberg (FAU) & Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (R.H.); (A.M.N.); (M.U.); (F.W.R.)
| | - Frank W. Roemer
- Department of Radiology, Friedrich Alexander University Erlangen-Nürnberg (FAU) & Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (R.H.); (A.M.N.); (M.U.); (F.W.R.)
- Department of Radiology, Boston University School of Medicine, Boston, MA 02118, USA;
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Tian Y, Chen J, Yan X, Ren D, Liu M, Zhang Q, Zhang Q, Yuan X. Overloaded Orthopedic Force Induces Condylar Subchondral Bone Absorption by Stimulating Rat Mesenchymal Stem Cells Differentiating into Osteoclasts via mTOR-Regulated RANKL/OPG Secretion in Osteoblasts. Stem Cells Dev 2021; 30:29-38. [PMID: 33176606 DOI: 10.1089/scd.2020.0163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Appropriate orthopedic force led to bone remodeling of mandibular condyle, while overloaded orthopedic force (OOF) induced condylar bone absorption. Bone absorption is ascribed to the imbalanced activities between osteoclasts (OCs) and osteoblasts (OBs), mechanism of which remains unclear. This study aimed to observe the condylar changes induced by OOF by mandible advancement appliance and to further investigate the role of mammalian target of Rapamycin (mTOR) and RANKL/OPG in osteoclastic differentiation of stem cells in vivo and in vitro. In vivo, the results of micro-CT analysis indicated that condylar bone resorption was induced by OOF through mandibular advancement appliance for 2 weeks and worsened time dependently. Morphologically, cartilage thickness was reduced, subchondral cortical bone line appeared not continuous, and subchondral bone exhibited irregular-shaped and owned uneven surface. The bone mineral density (BMD), bone volume/tissue volume (BV/TV), trabecular number (Tb.N), and trabecular thickness (Tb.Th) were decreased accomplished with the increased trabecular separation (Tb.Sp) determined by micro-CT. In addition, based on immunofluorescent labeling, OOF activated both OCs and OBs, but osteoclastogenesis prevailed over osteogenesis. The mTOR activation and ratio of RANKL/OPG in OBs were elevated by OOF. In vitro, the results of western blot and polymerase chain reaction (PCR) consistently suggested that the mTOR and RANKL/OPG ratio were upregulated by overloaded mechanical stretch. Pretreatment with mTOR inhibitor, rapamycin, could attenuate the activation of mTOR and the secretion of RANKL in OBs. Interestingly, based on the Trap staining, the supernatant of OBs exposed to OOF could promote osteoclastic differentiation of mesenchymal stem cells (MSCs), while its role was weakened by inhibition of mTOR in OBs. Collectively, OOF induced condylar bone absorption; in the process, osteoclastogenesis was prominent than osteogenesis. The activation of mTOR and secretion of RANKL/OPG were enhanced by OOF and were involved in promoting MSCs differentiating into OCs.
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Affiliation(s)
- Yihong Tian
- Department II of Orthodontics, Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
- School of Stomatology, Qingdao University, Qingdao, People's Republic of China
| | - Junbo Chen
- Department II of Orthodontics, Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Xiao Yan
- Department II of Orthodontics, Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Dapeng Ren
- Department II of Orthodontics, Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Meixi Liu
- Department II of Orthodontics, Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Qi Zhang
- Department II of Orthodontics, Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Qiang Zhang
- Department II of Orthodontics, Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Xiao Yuan
- Department II of Orthodontics, Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
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Ali M, Brogren E, Atroshi I. Assessment of a novel computer software in diagnosing radiocarpal osteoarthritis on plain radiographs of patients with previous distal radius fracture. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100112. [DOI: 10.1016/j.ocarto.2020.100112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/21/2020] [Indexed: 11/27/2022] Open
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FoxO1 is a crucial mediator of TGF-β/TAK1 signaling and protects against osteoarthritis by maintaining articular cartilage homeostasis. Proc Natl Acad Sci U S A 2020; 117:30488-30497. [PMID: 33199631 DOI: 10.1073/pnas.2017056117] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Transforming growth factor-β (TGF-β) signaling is a critical regulator for articular cartilage tissue maintenance and chondrocyte homeostasis. Nonetheless, the regulatory networks and downstream signaling pathways that govern the chondroprotective function of TGF-β in the context of osteoarthritis (OA) are not fully defined. Recent studies reveal that mice with postnatal deletion of triple forkhead box class Os (FoxOs) (1, 3, and 4) spontaneously develop OA-like pathologies. The OA phenotype largely recapitulates that observed in mice with loss of TGF-βR2. In the present study, we investigated the role of FoxOs as downstream mediators of TGF-β signaling and define their role in articular cartilage homeostasis. Among the three FoxOs (1, 3, and 4), TGF-β signaling exclusively regulates FoxO1 in a TGF-β activated kinase 1 (TAK1)-dependent manner. Furthermore, FoxO1 was genetically ablated in mice in a tissue-specific manner in articular cartilage or overexpressed in adult cartilage immediately followed by meniscal/ligament injury (MLI). Histological and microcomputed tomography (micro-CT) analyses demonstrated that loss of FoxO1 postnatally in articular cartilage leads to OA-like pathologies, and gain of FoxO1 in adult cartilage has both preventative and therapeutic effects on surgically induced OA. Mechanistically, FoxO1 was found to maintain articular chondrocyte homeostasis through induction of anabolic and autophagy-related gene expressions. Importantly, overexpression of FoxO1 markedly rescued the OA phenotypes caused by deficiency in TGF-β signaling in chondrocytes. Our study identifies that TGF-β/TAK1-FoxO1 is a key signaling cascade in regulation of articular cartilage autophagy and homeostasis and is a potentially important therapeutic target for OA-like joint diseases.
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Kasher M, Williams FMK, Freidin MB, Cherny S, Livshits G. An in-depth study of the associations between osteoarthritis- and osteoporosis-related phenotypes at different skeletal locations. Osteoporos Int 2020; 31:2197-2208. [PMID: 32556517 DOI: 10.1007/s00198-020-05504-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/12/2020] [Indexed: 01/01/2023]
Abstract
UNLABELLED The relationship between OA and osteoporosis characteristics remains controversial. This study revealed that age-adjusted hand OA is associated with lower hand/arm BMD levels. Wrist fracture occurrence is associated with increased OA hand scores and low arm BMD. Conversely, age-adjusted knee and spine OA is associated with high spine, hip, and total BMDs. INTRODUCTION Osteoarthritis (OA) and osteoporosis are two common musculoskeletal diseases which contribute a high burden of disability, yet assessments of their relationship remains controversial. The aim of this study was to clarify the association between bone mineral densities (BMD) of the hand, arm, spine, hip, and total body, and OA of the hand and knee and lumbar disc degeneration in two different ethnic groups. METHODS Radiographic assessments of the hand, knee, and spine were collected and coded for joint space narrowing, osteophytes, and the Kellgren-Lawrence score from Chuvashian (n = 1504) and British (n = 2280) individuals. BMD measurements of standard skeletal sites were estimated by dual X-ray absorptiometry. Age- and familial-adjusted regression analyses were conducted to determine associations. RESULTS Knee OA affection was positively associated with elevated hip, spine, and total body BMD levels (p < 0.001). Additionally, disc degeneration phenotypes showed significant positive associations with the hip, spine, and total BMD (p < 0.001). However, increased hand OA scores was significantly negatively correlated with arm and hand BMD measurements in males and females in both samples (p < 0.001). Additionally, higher hand OA scores were significantly associated with wrist fracture. CONCLUSIONS We discovered a clear pattern of association between hand OA and low hand and arm BMD, with increased risk of wrist fracture, as well as reproducing previous associations between knee and spine OA and elevated spine, hip, and total body BMD. It appears that hand OA manifests differently in comparison to hip and knee OA.
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Affiliation(s)
- M Kasher
- Human Population Biology Research Unit, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel
| | - F M K Williams
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - M B Freidin
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - S Cherny
- Human Population Biology Research Unit, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Livshits
- Human Population Biology Research Unit, Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK.
- Adelson Medical School, Ariel University, Ariel, Israel.
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Klose-Jensen R, Nielsen AW, Hartlev LB, Thomsen JS, Boel LWT, Laursen M, Keller KK, Hauge EM. Histomorphometric case-control study of subarticular osteophytes in patients with osteoarthritis of the hip. BMC Musculoskelet Disord 2020; 21:653. [PMID: 33023570 PMCID: PMC7542119 DOI: 10.1186/s12891-020-03648-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/15/2020] [Indexed: 01/11/2023] Open
Abstract
Objective The objective of this cross-sectional case-control study was to determine the prevalence and size of marginal and subarticular osteophytes in patients with osteoarthritis (OA), and to compare these to that of a control group. Design We investigated femoral heads from 25 patients with OA following hip replacement surgery, and 25 femoral heads from a control group obtained post-mortem. The area and boundary length of the femoral head, marginal osteophytes, and subarticular osteophytes were determined with histomorphometry. Marginal osteophytes were defined histologically as bony projections at the peripheral margin of the femoral head, while subarticular osteophytes were defined as areas of bone that expanded from the normal curvature of the femoral head into the articular cartilage. Results The prevalence of OA patients with marginal- and subarticular osteophytes were 100 and 84%, respectively. Whereas the prevalence of the participants in the control group with marginal- and subarticular osteophytes were 56 and 28%, respectively. The area and boundary length of marginal osteophytes was (median (Interquartile range)) 165.3mm2 (121.4–254.0) mm2 and 75.1 mm (50.8–99.3) mm for patients with OA compared to 0 mm2 (0–0.5) mm2 and 0 mm (0–0.5) mm for the control group (P < 0.001). For the subarticular osteophytes, the area and boundary length was 1.0 mm2 (0–4.4) mm2 and 1.4 mm (0–6.5) mm for patients with OA compared to 0 mm2 (0–0.5) mm2 and 0 mm (0–0.5) mm for the control group (P < 0.001). Conclusion As expected, both marginal- and subarticular osteophytes at the femoral head, were more frequent and larger in patients with OA than in the control group. However, in the control group, subarticular osteophytes were more prevalent than expected from the minor osteophytic changes at the femoral head margin, which may suggest that subarticular osteophytes are an early degenerative phenomenon that ultimately might develop into clinical osteoarthritis.
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Affiliation(s)
- Rasmus Klose-Jensen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 45, 8200, Aarhus, Denmark. .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Andreas Wiggers Nielsen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 45, 8200, Aarhus, Denmark
| | - Louise Brøndt Hartlev
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 45, 8200, Aarhus, Denmark.,Department of Clinical Medicine, Randers Regional Hospital, Randers, Denmark
| | | | | | - Mogens Laursen
- Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Kresten Krarup Keller
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 45, 8200, Aarhus, Denmark.,Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 45, 8200, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Hu B, Gao F, Li C, Zhang B, An M, Lu M, Liu Y, Liu Y. Rhein laden pH-responsive polymeric nanoparticles for treatment of osteoarthritis. AMB Express 2020; 10:158. [PMID: 32865763 PMCID: PMC7459081 DOI: 10.1186/s13568-020-01095-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022] Open
Abstract
Osteoarthritis (OA) is a condition associated with severe inflammation, cartilage destruction and degeneration of joints. Rhein (Rh) is an effective anti-inflammatory drug with proven efficacy in in-vitro and in-vivo models. pH sensitive Rh and NH4HCO3 laden poly (lactic-co-glycolic acid (PLGA) nanoparticles (NPs) (Rh-PLGA-NPs@NH4) are developed for an effective treatment of OA. The Rh-PLGA-NPs@NH4 are prepared along with Rh-PLGA-NPs as a control by double emulsion method. Rh-PLGA-NPs@NH4 was characterized for their size, shape, morphology and encapsulation efficiency (EE). The effect of pH on release of Rh from Rh-PLGA-NPs@NH4 was studied at different pH. Further, the cytotoxicity effect of Rh-PLGA-NPs@NH4 on THP-1 cells were evaluated. Anti-inflammatory efficacy was evaluated on LPS stimulated THP-1 cells and the release of pro-inflammatory cytokines was evaluated and compared with control. The size of Rh-PLGA-NPs@NH4 and Rh-PLGA-NPs was found to be 190.7 ± 1.2 nm and 134.6 ± 2.4 nm respectively with poly dispersity (PDI) 0.14 and 0.15. The zeta potential of Rh-PLGA-NPs@NH4 was found to be -22 ± 1.12 mV. Rh-PLGA-NPs@NH4 were uniform, smooth and spherical shape as confirmed using electron microscopy analysis. Rh-PLGA-NPs@NH4 release the Rh more effectively in the low pH of synovial fluid environment (SFE). Rh-PLGA-NPs@NH4 also significantly affect inflammatory cytokines TNF-α and IL-1β and reduced their release in LPS stimulated THP-1 cells. Reactive oxygen species (ROS), a mediator responsible for the cartilage collapse was also found to be reduced. Results proposes that Rh-PLGA-NPs could provide therapeutic solution to those patients who suffer from chronic joint ailments by reducing the progression of OA.
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Pang C, Wen L, Qin H, Zhu B, Lu X, Luo S. Sotrastaurin, a PKC inhibitor, attenuates RANKL-induced bone resorption and attenuates osteochondral pathologies associated with the development of OA. J Cell Mol Med 2020; 24:8452-8465. [PMID: 32652826 PMCID: PMC7412701 DOI: 10.1111/jcmm.15404] [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: 12/28/2019] [Revised: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 12/19/2022] Open
Abstract
Osteoarthritis (OA) is a common degenerative disease that affects the musculoskeletal structure of the whole joint, which is characterized by progressive destruction of both articular cartilage and subchondral bone. Treatment of the bone pathologies, particularly osteoclast‐mediated subchondral bone loss in the early stages of OA, could prevent subsequent cartilage degeneration and progression of OA. In the present study, the PKC inhibitor, Sotrastaurin, was found to inhibit RANKL‐induced osteoclast formation in vitro in a dose‐ and time‐dependent manner. In particular, SO exerted its anti‐osteoclastic effect predominantly at the early stages of RANKL stimulation, suggesting inhibitory effects on precursor cell fusion. Using mature osteoclasts cultured on bovine bone discs, we showed that SO also exerts anti‐resorptive effects on mature osteoclasts bone resorptive function. Mechanistically, SO attenuates the early activation of the p38, ERK and JNK signalling pathways, leeding to impaired induction of crucial osteoclast transcription factors c‐Jun, c‐Fos and NFATc1. We also showed that SO treatment significantly inhibited the phosphorylation of PKCδ and MARCKS, an upstream regulator of cathepsin K secretion. Finally, in animal studies, SO significantly alleviates the osteochondral pathologies of subchondral bone destruction as well as articular cartilage degeneration following DMM‐induced OA, markedly improving OARSI scores. The reduced subchondral bone loss was associated with marked reductions in TRAP(+) osteoclasts in the subchondral bone tissue. Collectively, our data provide evidence for the protective effects of SO against OA by preventing aberrant subchondral bone and articular cartilage changes. Thus, SO demonstrates potential for further development as an alternative therapeutic option against OA.
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Affiliation(s)
- Cong Pang
- Department of Orthopedics, The Ninth Affiliated Hospital of Guangxi Medical University, Beihai, China.,Department of Orthopedics, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Liangbao Wen
- Department of Neurosurgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Haikuo Qin
- Department of Orthopedics, The Ninth Affiliated Hospital of Guangxi Medical University, Beihai, China
| | - Bikang Zhu
- Department of Orthopedics, The Ninth Affiliated Hospital of Guangxi Medical University, Beihai, China
| | - Xuanyuan Lu
- Department of Orthopedics, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Shixing Luo
- Department of Orthopedics, The Ninth Affiliated Hospital of Guangxi Medical University, Beihai, China
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Bonnet CS, Gilbert SJ, Blain EJ, Williams AS, Mason DJ. AMPA/kainate glutamate receptor antagonists prevent posttraumatic osteoarthritis. JCI Insight 2020; 5:134055. [PMID: 32544091 DOI: 10.1172/jci.insight.134055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/29/2020] [Indexed: 01/10/2023] Open
Abstract
Musculoskeletal disorders represent the third greatest burden in terms of death and disability in the developed world. Osteoarthritis is the single greatest cause of chronic pain, has no cure, and affects 8.5 and 27 million people in the UK and US, respectively. Osteoarthritis is most prevalent in older people, but as it commonly occurs after joint injury, young people with such injuries are also susceptible. Painful joints are often treated with steroid or hyaluronic acid (HA) injections, but treatments to prevent subsequent joint degeneration remain elusive. In animals, joint injury increases glutamate release into the joint, acting on nerves to cause pain, and joint tissues to cause inflammation and degeneration. This study investigated synovial fluid glutamate concentrations and glutamate receptor (GluR) expression in injured human joints and compared the efficacy of GluR antagonists with current treatments in a mouse model of injury-induced osteoarthritis (ACL rupture). GluRs were expressed in the ligaments and meniscus after knee injury, and synovial fluid glutamate concentrations ranged from 19 to 129 μM. Intra-articular injection of NBQX (GluR antagonist) at the time of injury substantially reduced swelling and degeneration in the mouse ACL rupture model. HA had no effect, and Depo-Medrone reduced swelling for 1 day but increased degeneration by 50%. Intra-articular administration of NBQX modified both symptoms and disease to a greater extent than current treatments. There is an opportunity for repurposing related drugs, developed for CNS disorders and with proven safety in humans, to prevent injury-induced osteoarthritis. This could quickly reduce the substantial burden associated with osteoarthritis.
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Affiliation(s)
- Cleo S Bonnet
- School of Biosciences.,Biomechanics and Bioengineering Research Centre Versus Arthritis, and
| | - Sophie J Gilbert
- School of Biosciences.,Biomechanics and Bioengineering Research Centre Versus Arthritis, and
| | - Emma J Blain
- School of Biosciences.,Biomechanics and Bioengineering Research Centre Versus Arthritis, and
| | - Anwen S Williams
- Biomechanics and Bioengineering Research Centre Versus Arthritis, and.,School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Deborah J Mason
- School of Biosciences.,Biomechanics and Bioengineering Research Centre Versus Arthritis, and
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Bayramoglu N, Tiulpin A, Hirvasniemi J, Nieminen MT, Saarakkala S. Adaptive segmentation of knee radiographs for selecting the optimal ROI in texture analysis. Osteoarthritis Cartilage 2020; 28:941-952. [PMID: 32205275 DOI: 10.1016/j.joca.2020.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/29/2020] [Accepted: 03/02/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purposes of this study were to investigate: 1) the effect of placement of region-of-interest (ROI) for texture analysis of subchondral bone in knee radiographs, and 2) the ability of several texture descriptors to distinguish between the knees with and without radiographic osteoarthritis (OA). DESIGN Bilateral posterior-anterior knee radiographs were analyzed from the baseline of Osteoarthritis Initiative (OAI) (9012 knee radiographs) and Multicenter Osteoarthritis Study (MOST) (3,644 knee radiographs) datasets. A fully automatic method to locate the most informative region from subchondral bone using adaptive segmentation was developed. Subsequently, we built logistic regression models to identify and compare the performances of several texture descriptors and each ROI placement method using 5-fold cross validation. Importantly, we also investigated the generalizability of our approach by training the models on OAI and testing them on MOST dataset. We used area under the receiver operating characteristic curve (ROC AUC) and average precision (AP) obtained from the precision-recall (PR) curve to compare the results. RESULTS We found that the adaptive ROI improves the classification performance (OA vs non-OA) over the commonly-used standard ROI (up to 9% percent increase in AUC). We also observed that, from all texture parameters, Local Binary Pattern (LBP) yielded the best performance in all settings with the best AUC of 0.840 [0.825, 0.852] and associated AP of 0.804 [0.786, 0.820]. CONCLUSION Compared to the current state-of-the-art approaches, our results suggest that the proposed adaptive ROI approach in texture analysis of subchondral bone can increase the diagnostic performance for detecting the presence of radiographic OA.
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Affiliation(s)
- N Bayramoglu
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland.
| | - A Tiulpin
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - J Hirvasniemi
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - M T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
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He Z, Chu L, Liu X, Han X, Zhang K, Yan M, Li X, Yu Z. Differences in subchondral trabecular bone microstructure and finite element analysis-based biomechanical properties between osteoporosis and osteoarthritis. J Orthop Translat 2020; 24:39-45. [PMID: 32642427 PMCID: PMC7320230 DOI: 10.1016/j.jot.2020.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/12/2020] [Accepted: 05/21/2020] [Indexed: 01/06/2023] Open
Abstract
Background/Objective The microstructure of the subchondral trabecular bone, including the composition and distribution of plates and rods, has an important influence on the disease progression and mechanical properties of osteoarthritis (OA) and osteoporosis (OP). We aimed to determine whether differences in plates and rods influence the variations in the quantities and qualities of the subchondral trabecular bone between OA and OP. Materials and methods Thirty-eight femoral head samples [OA, n = 13; OP, n = 17; normal control (NC), n = 8] were collected from male patients undergoing total hip arthroplasty. They were scanned using microcomputed tomography, and subchondral trabecular structures were analysed using individual trabecular segmentation. Micro-finite element analysis (μFEA) was applied to assess the mechanical property of the trabecular bone. Cartilage changes were evaluated by using histological assessment. Analysis of variance was used to compare intergroup differences in structural and mechanical properties and cartilage degradation. Pearson analysis was used to evaluate the relationship between the trabecula microstructure and biomechanical properties. Results Compared with the OP and NC group, there was serious cartilage damage in the OA group. With respect to the microstructure results, the OA group had the highest plate and rod trabecular microstructures including number and junction density among the three groups. For the mechanical properties detected via μFEA, the OA group had higher stiffness and failure load than did the OP group. Pearson analysis revealed that compared with OP, OA had a higher number of microstructure parameters (e.g., rod bone volume fraction and rod trabecular number) that were positively correlated with its mechanical property. Conclusions Compared with OP, the OA subchondral bone has both increased plate and rod microarchitecture and has more microstructures positively related with its mechanical property. These differences may help explain the variation in mechanical properties between these bone diseases. The translational potential of this article Our findings suggested that changes in the plates and rods of the subchondral trabecular bone play a critical role in OA and OP progression and that the improvement of the subchondral trabecular bone may be a promising treatment approach.
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Affiliation(s)
- Zihao He
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Linyang Chu
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200011, China
| | - Xuqiang Liu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, The Artificial Joint Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi, China
| | - Xuequan Han
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Kai Zhang
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Mengning Yan
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xiaofeng Li
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, The Artificial Joint Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi, China
- Corresponding author.
| | - Zhifeng Yu
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Corresponding author.
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3D High-Frequency Ultrasound Imaging of Cartilage-Bone Interface Compared with Micro-CT. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6906148. [PMID: 32596353 PMCID: PMC7285412 DOI: 10.1155/2020/6906148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/06/2020] [Accepted: 05/20/2020] [Indexed: 01/03/2023]
Abstract
Cartilage-bone interface (CBI) is a complex structure which bears important information in pathophysiology of osteoarthritis (OA). While high-frequency ultrasound (US) has been widely used for the investigation of articular cartilage, 3D imaging of CBI using US is less commonly reported in this field. Here, we adopted a 3D high-frequency ultrasound imaging approach specifically for the investigation of CBI in human knee samples. Fifteen osteochondral disks from the tibial plateau of seven OA patients were prepared in vitro and scanned using both high-frequency US and micro-CT imaging. The 3D morphology of the tidemark was reconstructed and compared using an image registration approach between the two imaging modalities. Results showed that the 3D tidemark could be well registered between the two imaging methods with a mean surface discrepancy of 33.2 ± 9.9 μm. Quantitative surface waviness/roughness parameter analysis showed significant correlations between the two imaging modalities. An intensity projected en face imaging was proposed to probe characteristic details of the CBI such as its perforations. This study provided evidence for the 3D high-frequency ultrasound as a nonionizing radiation imaging tool potentially useful to evaluate the change of CBI in basic research of join diseases including OA.
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Çaglar S, Albay C. Can Ellipsoid Sign be One of the Earliest Findings of the Medial Femoral Condyle Chondromalacia of Knee Antero Posterior X-Ray? Indian J Orthop 2020; 54:518-525. [PMID: 32549968 PMCID: PMC7270317 DOI: 10.1007/s43465-020-00140-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/PURPOSE OF THE STUDY Aim of the study was to investigate whether ellipsoid sign (ES) in the region corresponding to the cartilaginous facet of the medial femoral condyle (MFC) indicates early cartilage lesion. The finding has not been defined in the literature yet. METHODS The study was performed retrospectively with 50 patients who underwent articular cartilage examination and arthroscopy between 2015 and 2018. Patients were divided into two according to the presence or absence of ES. There were 24 patients in case group (Group A) and 26 patients in controls (Group B). Weight-bearing cartilage areas of MFC in the region where ES was found in both groups were classified according to arthroscopic Outerbridge classification (OC) and compared statistically with each other. RESULTS There was no significant difference in terms of age, gender and alignment between Group A and Group B (p > 0.05). All OC grades were higher in Group A (p < 0.001). Positive correlation between ES and MFC chondromalacia grade was detected (r: 0.671, t: 6.266, p < 0.05). CONCLUSION ES, which refers to the difference in bone density in MFC seen in antero-posterior (AP) X-Ray, is a result of changes in subchondral bone due to chronic cartilage loss. ES detected on AP X-Ray may help in early diagnosis of medial femoral articular cartilage chondromalacia, even at grade 0 or 1. We recommend searching for ES, as the earliest symptom of chondromalacia, which occurs even before MRI lesions. Future studies may reveal additional information about ES.
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Affiliation(s)
- Sever Çaglar
- Department of Orthopaedics and Traumatology, Health Sciences University, Istanbul Bagcilar Research and Training Hospital, Merkez mh Mimar Sinan Cd, 34200 Bagcilar, Istanbul, Turkey
| | - Cem Albay
- Department of Orthopaedics and Traumatology, Health Sciences University, Istanbul Baltalimani Bone Diseases Research and Training Hospital, Baltalimani Hisar Cd, Sariyer, Istanbul, Turkey
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Abstract
Osteoarthritis (OA) is one of the most debilitating diseases and is associated with a high personal and socioeconomic burden. So far, there is no therapy available that effectively arrests structural deterioration of cartilage and bone or is able to successfully reverse any of the existing structural defects. Efforts to identify more tailored treatment options led to the development of strategies that enabled the classification of patient subgroups from the pool of heterogeneous phenotypes that display distinct common characteristics. To this end, the classification differentiates the structural endotypes into cartilage and bone subtypes, which are predominantly driven by structure-related degenerative events. In addition, further classifications have highlighted individuals with an increased inflammatory contribution (inflammatory phenotype) and pain-driven phenotypes as well as senescence and metabolic syndrome phenotypes. Most probably, it will not be possible to classify individuals by a single definite subtype, but it might help to identify groups of patients with a predominant pathology that would more likely benefit from a specific drug or cell-based therapy. Current clinical trials addressed mainly regeneration/repair of cartilage and bone defects or targeted pro-inflammatory mediators by intra-articular injections of drugs and antibodies. Pain was treated mostly by antagonizing nerve growth factor (NGF) activity and its receptor tropomyosin-related kinase A (TrkA). Therapies targeting metabolic disorders such as diabetes mellitus and senescence/aging-related pathologies are not specifically addressing OA. However, none of these therapies has been proven to modify disease progression significantly or successfully prevent final joint replacement in the advanced disease stage. Within this review, we discuss the recent advances in phenotype-specific treatment options and evaluate their applicability for use in personalized OA therapy.
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Affiliation(s)
- Susanne Grässel
- Department of Orthopedic Surgery, Exp. Orthopedics, ZMB/Biopark 1, Am Biopark 9, University of Regensburg, Regensburg, 93053, Germany
| | - Dominique Muschter
- Department of Orthopedic Surgery, Exp. Orthopedics, ZMB/Biopark 1, Am Biopark 9, University of Regensburg, Regensburg, 93053, Germany
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Vitali M, Ometti M, Drossinos A, Pironti P, Santoleri L, Salini V. Autologous conditioned serum: clinical and functional results using a novel disease modifying agent for the management of knee osteoarthritis. J Drug Assess 2020; 9:43-51. [PMID: 32284907 PMCID: PMC7144201 DOI: 10.1080/21556660.2020.1734009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/30/2020] [Indexed: 02/06/2023] Open
Abstract
Objective: The purpose of this study was to investigate the potential ability of autologous conditioned serum (ACS) to decrease pain and improve joint functionality in patients affected by knee osteoarthritis (OA). Methods: Fifteen patients with clinical and radiological signs of OA of the knee were recruited for this study. Each patient received 4 injections of ACS (Orthokine; orthogen, Dusseldorf, Germany) at the site of OA once per week for 4 weeks. Clinical and functional evaluation was performed using the VAS scale for pain, WOMAC scale and KSS functional and clinical scores before the first injection, at one week, at two weeks, at three weeks, at one month and at six months. Statistical analysis was done with the Wilcoxon Signed-Rank Test. Results: Our results show an improvement of all the evaluation scales at 6 months follow-up. Particularly, VAS scales among all patients decreased by 35.8% (p = .00148), KSS functional scores improved by 38.2% (p = .00148), KSS clinical scores improved by 28.9% (p = .00236) and WOMAC scores were reduced by 19.8% (p = .00188). Few adverse effects were observed in our sample. The most common complaint was pain and swelling in the subsequent days after performing the intra-articular injection. Only one patient reported rigidity following the injection of the ACS. Conclusion: Our results, in conjunction with preexisting studies in the medical literature regarding ACS, demonstrate the viability of this therapy for the treatment of knee OA, showing positive influence on pain and joint function without significant adverse effects.
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Affiliation(s)
- Matteo Vitali
- Department of Orthopedics and Traumatology, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Marco Ometti
- Department of Orthopedics and Traumatology, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Andreas Drossinos
- Department of Orthopedics and Traumatology, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Pierluigi Pironti
- Department of Orthopedics and Traumatology, San Raffaele Hospital Scientific Institute, Milan, Italy
| | - Luca Santoleri
- Immunohematology and Transfusion Medicine, IRRCS Ospedale San Raffaele, Milan, Italy
| | - Vincenzo Salini
- Department of Orthopedics and Traumatology, San Raffaele Hospital Scientific Institute, Milan, Italy
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Mukherjee S, Nazemi M, Jonkers I, Geris L. Use of Computational Modeling to Study Joint Degeneration: A Review. Front Bioeng Biotechnol 2020; 8:93. [PMID: 32185167 PMCID: PMC7058554 DOI: 10.3389/fbioe.2020.00093] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/31/2020] [Indexed: 12/13/2022] Open
Abstract
Osteoarthritis (OA), a degenerative joint disease, is the most common chronic condition of the joints, which cannot be prevented effectively. Computational modeling of joint degradation allows to estimate the patient-specific progression of OA, which can aid clinicians to estimate the most suitable time window for surgical intervention in osteoarthritic patients. This paper gives an overview of the different approaches used to model different aspects of joint degeneration, thereby focusing mostly on the knee joint. The paper starts by discussing how OA affects the different components of the joint and how these are accounted for in the models. Subsequently, it discusses the different modeling approaches that can be used to answer questions related to OA etiology, progression and treatment. These models are ordered based on their underlying assumptions and technologies: musculoskeletal models, Finite Element models, (gene) regulatory models, multiscale models and data-driven models (artificial intelligence/machine learning). Finally, it is concluded that in the future, efforts should be made to integrate the different modeling techniques into a more robust computational framework that should not only be efficient to predict OA progression but also easily allow a patient’s individualized risk assessment as screening tool for use in clinical practice.
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Affiliation(s)
- Satanik Mukherjee
- Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium.,Biomechanics Section, KU Leuven, Leuven, Belgium
| | - Majid Nazemi
- GIGA in silico Medicine, University of Liège, Liège, Belgium
| | - Ilse Jonkers
- Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Liesbet Geris
- Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium.,Biomechanics Section, KU Leuven, Leuven, Belgium.,GIGA in silico Medicine, University of Liège, Liège, Belgium
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50
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Zerrillo L, Que I, Vepris O, Morgado LN, Chan A, Bierau K, Li Y, Galli F, Bos E, Censi R, Di Martino P, van Osch GJVM, Cruz LJ. pH-responsive poly(lactide-co-glycolide) nanoparticles containing near-infrared dye for visualization and hyaluronic acid for treatment of osteoarthritis. J Control Release 2019; 309:265-276. [PMID: 31362078 DOI: 10.1016/j.jconrel.2019.07.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/17/2019] [Accepted: 07/20/2019] [Indexed: 12/26/2022]
Abstract
This study focuses on intra-articular (IA) drug delivery system for the treatment of knee osteoarthritis (OA). In osteoarthritic condition the synovial fluid presents pockets with lower pH environment. To take advantage of these pH differences, poly(lactic-co-glycolic acid (PLGA) nanoparticles (NPs) and pH- responsive PLGA NPs encapsulated with ammonium bicarbonate (NH4HCO3) were generated. The nanoparticles were loaded with hyaluronic acid (HA) as a possible model drug for OA and with near-infrared dye (NIR) that was used to visualize the NPs with molecular imaging techniques. These NPs were characterized by dynamic light scattering, transmission electron microscopy and compared in in vitro, in vivo and ex vivo experiments in the treatment of OA. The results indicate that the NPs were sufficiently small, displayed a uniform size distribution and were non-toxic both in vitro and in vivo. Both NPs treatment seem to induced a reduction in OA progression, with pH- responsive NPs showing the more pronounced effect. This is probably because the pockets of low pH environment in the synovial fluid trigger a burst release of the pH-responsive NPs. This result is corroborated by in vitro experiments since the pH- responsive NPs showed an extracellular burst release behavior and higher chondrocyte vitality than non-responsive NPs. This study demonstrates that PLGA NPs containing HA and NH4HCO3 are candidates for the treatment of knee OA.
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Affiliation(s)
- L Zerrillo
- Translational Nanobiomaterials and Imaging (TNI) Group, Radiology Department, Leiden University Medical Centrum, Leiden, The Netherlands; Percuros, Enschede, The Netherlands
| | - I Que
- Translational Nanobiomaterials and Imaging (TNI) Group, Radiology Department, Leiden University Medical Centrum, Leiden, The Netherlands
| | - O Vepris
- Translational Nanobiomaterials and Imaging (TNI) Group, Radiology Department, Leiden University Medical Centrum, Leiden, The Netherlands
| | - L N Morgado
- Section for Genetics and Evolutionary Biology (EVOGENE), Department of Biosciences, University of Oslo, Oslo, Norway; Naturalis Biodiversity Center, Leiden, The Netherlands
| | - A Chan
- Percuros, Enschede, The Netherlands
| | - K Bierau
- Percuros, Enschede, The Netherlands
| | - Y Li
- Percuros, Enschede, The Netherlands
| | - F Galli
- Leiden Institute of Physics, Niels Bohrweg 2, Leiden, The Netherlands
| | - E Bos
- Department of Molecular Cell Biology, Section Electron Microscopy, Leiden University Medical Center, Leiden, The Netherlands
| | - R Censi
- University of Camerino, School of Pharmacy, Italy
| | - P Di Martino
- University of Camerino, School of Pharmacy, Italy
| | - G J V M van Osch
- Department of Orthopedics and Department of Otorhinolaryngology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - L J Cruz
- Translational Nanobiomaterials and Imaging (TNI) Group, Radiology Department, Leiden University Medical Centrum, Leiden, The Netherlands.
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