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Xu L, Kazezian Z, Pitsillides AA, Bull AMJ. A synoptic literature review of animal models for investigating the biomechanics of knee osteoarthritis. Front Bioeng Biotechnol 2024; 12:1408015. [PMID: 39132255 PMCID: PMC11311206 DOI: 10.3389/fbioe.2024.1408015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/02/2024] [Indexed: 08/13/2024] Open
Abstract
Osteoarthritis (OA) is a common chronic disease largely driven by mechanical factors, causing significant health and economic burdens worldwide. Early detection is challenging, making animal models a key tool for studying its onset and mechanically-relevant pathogenesis. This review evaluate current use of preclinical in vivo models and progressive measurement techniques for analysing biomechanical factors in the specific context of the clinical OA phenotypes. It categorizes preclinical in vivo models into naturally occurring, genetically modified, chemically-induced, surgically-induced, and non-invasive types, linking each to clinical phenotypes like chronic pain, inflammation, and mechanical overload. Specifically, we discriminate between mechanical and biological factors, give a new explanation of the mechanical overload OA phenotype and propose that it should be further subcategorized into two subtypes, post-traumatic and chronic overloading OA. This review then summarises the representative models and tools in biomechanical studies of OA. We highlight and identify how to develop a mechanical model without inflammatory sequelae and how to induce OA without significant experimental trauma and so enable the detection of changes indicative of early-stage OA in the absence of such sequelae. We propose that the most popular post-traumatic OA biomechanical models are not representative of all types of mechanical overloading OA and, in particular, identify a deficiency of current rodent models to represent the chronic overloading OA phenotype without requiring intraarticular surgery. We therefore pinpoint well standardized and reproducible chronic overloading models that are being developed to enable the study of early OA changes in non-trauma related, slowly-progressive OA. In particular, non-invasive models (repetitive small compression loading model and exercise model) and an extra-articular surgical model (osteotomy) are attractive ways to present the chronic natural course of primary OA. Use of these models and quantitative mechanical behaviour tools such as gait analysis and non-invasive imaging techniques show great promise in understanding the mechanical aspects of the onset and progression of OA in the context of chronic knee joint overloading. Further development of these models and the advanced characterisation tools will enable better replication of the human chronic overloading OA phenotype and thus facilitate mechanically-driven clinical questions to be answered.
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Affiliation(s)
- Luyang Xu
- Department of Bioengineering, Imperial College London, London, United Kingdom
- Centre for Blast Injury Studies, Imperial College London, London, United Kingdom
| | - Zepur Kazezian
- Department of Bioengineering, Imperial College London, London, United Kingdom
- Centre for Blast Injury Studies, Imperial College London, London, United Kingdom
| | - Andrew A. Pitsillides
- Skeletal Biology Group, Comparative Biomedical Sciences, Royal Veterinary College, London, United Kingdom
| | - Anthony M. J. Bull
- Department of Bioengineering, Imperial College London, London, United Kingdom
- Centre for Blast Injury Studies, Imperial College London, London, United Kingdom
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Hay AM, Rhoades MJ, Bangerter S, Ferguson SA, Lee H, T. Gill M, Page GL, Pope A, Measom GJ, Hager RL, Seeley MK. Serum Cartilage Oligomeric Matrix Protein Concentration Increases More After Running Than Swimming for Older People. Sports Health 2024; 16:534-541. [PMID: 37697665 PMCID: PMC11195858 DOI: 10.1177/19417381231195309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Knee osteoarthritis is common in older people. Serum cartilage oligomeric matrix protein (sCOMP) is a biomarker of knee articular cartilage metabolism. The purpose of this study was 2-fold: to (1) determine acute effects of running and swimming on sCOMP concentration in older people; and (2) investigate relationships between sCOMP concentration change due to running and swimming and measures of knee health in older people. HYPOTHESES Running would result in greater increase in sCOMP concentration than swimming, and increase in sCOMP concentration due to running and swimming would associate positively with measures of poor knee health. STUDY DESIGN Cross-sectional. LEVEL OF EVIDENCE Level 3. METHODS A total of 20 participants ran 5 km and 19 participants swam 1500 m. sCOMP concentration was measured immediately before, immediately after, and 15, 30, and 60 minutes after running or swimming. sCOMP concentration change due to running and swimming was compared. Correlations between sCOMP concentration change due to running and swimming, and other measures of knee health were evaluated, including the Tegner Activity Scale and Knee injury and Osteoarthritis Outcome Score. RESULTS sCOMP concentration increased 29% immediately after running, relative to baseline, but only 6% immediately after swimming (P < 0.01). No significant relationship was observed between acute sCOMP change due to running and swimming, and observed measures of knee health (P > 0.05). Participants with clinically relevant knee symptoms exhibited greater sCOMP concentration before and after running and swimming (P = 0.03) and had greater body mass (P = 0.04). CONCLUSION Running results in greater acute articular cartilage metabolism than swimming; however, the chronic effects of this are unclear. Older people with clinically relevant knee symptoms possess greater sCOMP concentration and are heavier, independent of exercise mode and physical activity level. CLINICAL RELEVANCE These results describe the effects of exercise (running and swimming) for older physically active persons, with and without knee pain.
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Affiliation(s)
- Alexandra M. Hay
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | | | | | - Seth A. Ferguson
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Hyunwook Lee
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Martha T. Gill
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Garritt L. Page
- Department of Statistics, Brigham Young University, Provo, Utah
| | - Andrew Pope
- Department of Statistics, Brigham Young University, Provo, Utah
| | - Gary J. Measom
- Department of Nursing, Utah Valley University, Orem, Utah
| | - Ronald L. Hager
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Matthew K. Seeley
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
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Bjerre-Bastos JJ, Sejersen C, Nielsen HB, Boesen M, Secher NH, Distajo G, Flood V, Henrotin Y, Uebelhoer M, Krustrup P, Kitchen CC, Thudium CS, Andersen JR, Bihlet AR. The Impact of Weight-bearing Exercise, Non-Weight-bearing Exercise, and Cardiovascular Stress on Biochemical Markers of Cartilage Turnover in Patients With Mild to Moderate Knee Osteoarthritis: A Sequential, Cross-Over, Clinical Study. Cartilage 2024:19476035241258170. [PMID: 38853398 DOI: 10.1177/19476035241258170] [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: 06/11/2024] Open
Abstract
OBJECTIVE To investigate how running, cycling, and sedentary cardiovascular stress impact biomarkers of cartilage turnover acutely in subjects with knee osteoarthritis (OA). DESIGN This was a sequential, cross-over, clinical study. Forty subjects with primary knee OA underwent moderate-to-high-intensity cycling, running, and adrenaline infusion on separate days. Blood was sampled before, during, and at 6-time points after intervention. On a control day, similar samples were taken. Biomarkers of type II collagen degradation (C2M, T2CM, Coll2-1, Coll2-1NO2), formation (PRO-C2), and aggrecan degradation (ARGS) were measured. RESULTS Mean age was 60.4 years, 40% were male, 45% had cumulated Kellgren-Lawrence (KL)-grade (Right + Left knee) of 2 to 3 and 55% had 4 to 6. Analyzing overall changes, area under the curve was significantly lower compared with resting values for ARGS and C2M after cycling and for ARGS after running. Considering individual time points, peak changes in biomarker levels showed reduction in C2M shortly following cycling (T20min = -12.3%, 95% confidence interval [CI]: -19.3% to -5.2%). PRO-C2 increased during cycling (T10min = 14.0%, 95% CI = 4.1% to 23.8%) and running (T20min = 16.5%, 95% CI = 4.3% to 28.6%). T2CM decreased after cycling (T50min = -19.9%, 95% CI = -29.2% to -10.6%), running (T50min = -22.8%, 95% CI = -32.1% to -13.5%), and infusion of adrenaline (peak, T50min = -9.8%, 95% CI = -20.0% to 0.4%). A latent increase was seen in Coll2-1 240 minutes after running (T260min = 21.7%, 95% CI = -1.6% to 45.1%). CONCLUSION Exercise had an impact on cartilage markers, but it did not suggest any detrimental effect on cartilage. Changes following adrenaline infusion suggest a sympathomimetic influence on the serological composition of biomarkers.
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Affiliation(s)
- Jonathan J Bjerre-Bastos
- Xlab, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- NBCD A/S, Herlev, Denmark
| | - Casper Sejersen
- Department of Anaesthesiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bay Nielsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Anaesthesia and Intensive Care Medicine, Zealand University Hospital, Roskilde, Denmark
- Department of Nutrition, Exercise and Sport, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Mikael Boesen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Radiology, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark
| | - Niels H Secher
- Department of Anaesthesiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Yves Henrotin
- Department of Physical and Rehabilitation, VIVALIA, Marche-en-Famenne, Belgium
- Musculoskeletal Innovative Research Lab (mSKIL), University of Liège, Liège, Belgium
| | | | - Peter Krustrup
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Carl-Christian Kitchen
- Department of Anaesthesiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Fischer AG, Titchenal MR, Migliore E, Asay JL, Erhart-Hledik JC, Andriacchi TP. Elevated proinflammatory cytokines in response to mechanical stimulus are associated with reduced knee loading 2 years after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2024; 116:106286. [PMID: 38850881 DOI: 10.1016/j.clinbiomech.2024.106286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/25/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND The aim of this study was to test the hypothesis that proinflammatory cytokines correlate with knee loading mechanics during gait following a mechanical walking stimulus in subjects 2 years after anterior cruciate ligament reconstruction. Elevated systemic levels of proinflammatory cytokines can be sustained for years after injury. Considering roughly 50% of these patients progress to Osteoarthritis 10-15 years after injury, a better understanding of the role of proinflammatory cytokines such as tumor necrosis factor-α and Interleukin-1β on Osteoarthritis risk is needed. METHODS Serum proinflammatory cytokines concentrations were measured in 21 subjects 2 years after unilateral ACLR from blood drawn at rest and 3.5 h after 30 min of walking. An optoelectronic system and a force plate measured subjects' knee kinetics. Correlations were tested between inflammatory marker response and knee extension and knee adduction moments. FINDINGS Changes in proinflammatory cytokines due to mechanical stimulus were correlated (R = 0.86) and showed substantial variation between subjects in both cytokines at 3.5 h post-walk. Knee loading correlated with 3.5-h changes in tumor necrosis factor-α concentration (Knee extension moment: R = -0.5, Knee adduction moment: R = -0.5) and Interleukin-1β concentration (Knee extension moment: R = -0.44). However, no significant changes in concentrations were observed in tumor necrosis factor-α and Interleukin-1β when comparing baseline and post walking stimulus conditions. INTERPRETATION The significant associations between changes in serum proinflammatory markers following a mechanical stimulus and gait metrics in subjects at risk for developing Osteoarthritis underscore the importance of investigating the interaction between biomarkers and biomechanical factors in Osteoarthritis development.
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Affiliation(s)
- Arielle G Fischer
- Department of Biomedical Engineering, Technion- Israel Institute of Technology, Haifa, Israel; Department of Mechanical Engineering, Stanford University, Stanford, CA, USA.
| | - Matthew R Titchenal
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA; Palo Alto Veterans Hospital, Palo Alto, CA, USA
| | | | - Jessica L Asay
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA; Palo Alto Veterans Hospital, Palo Alto, CA, USA; Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer C Erhart-Hledik
- Palo Alto Veterans Hospital, Palo Alto, CA, USA; Palo Alto Veterans Institute for Research, Palo Alto, CA, USA
| | - Thomas P Andriacchi
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
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Kraus VB, Hsueh MF. Molecular biomarker approaches to prevention of post-traumatic osteoarthritis. Nat Rev Rheumatol 2024; 20:272-289. [PMID: 38605249 DOI: 10.1038/s41584-024-01102-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/13/2024]
Abstract
Up to 50% of individuals develop post-traumatic osteoarthritis (PTOA) within 10 years following knee-joint injuries such as anterior cruciate ligament rupture or acute meniscal tear. Lower-extremity PTOA prevalence is estimated to account for ≥12% of all symptomatic osteoarthritis (OA), or approximately 5.6 million cases in the USA. With knowledge of the inciting event, it might be possible to 'catch PTOA in the act' with sensitive imaging and soluble biomarkers and thereby prevent OA sequelae by early intervention. Existing biomarker data in the joint-injury literature can provide insights into the pathogenesis and early risk trajectory related to PTOA and can help to elucidate a research agenda for preventing or slowing the onset of PTOA. Non-traumatic OA and PTOA have many clinical, radiological and genetic similarities, and efforts to understand early risk trajectories in PTOA might therefore contribute to the identification and classification of early non-traumatic OA, which is the most prevalent form of OA.
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Affiliation(s)
- Virginia Byers Kraus
- Duke Molecular Physiology Institute, Duke University, Durham, NC, USA.
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - Ming-Feng Hsueh
- Duke Molecular Physiology Institute, Duke University, Durham, NC, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
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Armitano-Lago C, Evans-Pickett A, Davis-Wilson H, Munsch A, Longobardi L, Willcockson H, Schwartz TA, Franz JR, Pietrosimone B. Modifying loading during gait leads to biochemical changes in serum cartilage oligomeric matrix protein concentrations in a subgroup of individuals with anterior cruciate ligament reconstruction. Clin Rheumatol 2024; 43:1363-1373. [PMID: 38358589 DOI: 10.1007/s10067-024-06898-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE Strong observational evidence has linked changes in limb loading during walking following anterior cruciate ligament reconstruction (ACLR) to posttraumatic osteoarthritis (PTOA). It remains unknown if manipulating peak loading influences joint tissue biochemistry. Thus, the purpose of this study is to determine whether manipulating peak vertical ground reaction force (vGRF) during gait influences changes in serum cartilage oligomeric matrix protein (sCOMP) concentrations in ACLR participants. METHODS Forty ACLR individuals participated in this randomized crossover study (48% female, age = 21.0 ± 4.4 years, BMI = 24.6 ± 3.1). Participants attended four sessions, wherein they completed one of four biofeedback conditions (habitual loading (no biofeedback), high loading (5% increase in vGRF), low loading (5% decrease in vGRF), and symmetrical loading (between-limb symmetry in vGRF)) while walking on a treadmill for 3000 steps. Serum was collected before (baseline), immediately (acute post), 1 h (1 h post), and 3.5 h (3.5 h post) following each condition. A comprehensive general linear mixed model was constructed to address the differences in sCOMP across all conditions and timepoints in all participants and a subgroup of sCOMP Increasers. RESULTS No sCOMP differences were found across the entire cohort. In the sCOMP Increasers, a significant time × condition interaction was found (F9,206 = 2.6, p = 0.009). sCOMP was lower during high loading than low loading (p = 0.009) acutely (acute post). At 3.5 h post, sCOMP was higher during habitual loading than symmetrical loading (p = 0.001). CONCLUSION These data suggest that manipulating lower limb loading in ACLR patients who habitually exhibit an acute increase in sCOMP following walking results in improved biochemical changes linked to cartilage health. Key Points • This study assesses the mechanistic link between lower limb load modification and joint tissue biochemistry at acute and delayed timepoints. • Real-time biofeedback provides a paradigm to experimentally assess the mechanistic link between loading and serum biomarkers. • Manipulating peak loading during gait resulted in a metabolic effect of lower sCOMP concentrations in a subgroup of ACLR individuals. • Peak loading modifications may provide an intervention strategy to mitigate the development of PTOA following ACLR.
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Affiliation(s)
- Cortney Armitano-Lago
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Alyssa Evans-Pickett
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | | | - Amanda Munsch
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Lara Longobardi
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Helen Willcockson
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Todd A Schwartz
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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Mündermann A, Nüesch C, Herger S, Liphardt AM, Chammartin F, De Pieri E, Egloff C. Load-induced blood marker kinetics in patients with medial knee compartment osteoarthritis are associated with accumulated load and patient reported outcome measures. F1000Res 2024; 12:299. [PMID: 38882712 PMCID: PMC11179051 DOI: 10.12688/f1000research.131702.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2024] [Indexed: 06/18/2024] Open
Abstract
Background This study aimed to quantify the mechanoresponse of 10 blood marker candidates for joint metabolism to a walking stress test in patients with knee osteoarthritis and to determine the association among marker kinetics and with accumulated load and patient reported outcomes. Methods 24 patients with knee osteoarthritis completed questionnaires, and a 30-minute walking stress test with six blood serum samples and gait analysis. Concentrations of cartilage oligomeric matrix protein (COMP), matrix metalloproteinases (MMP)-1, -3, and -9, epitope resulting from cleavage of type II collagen by collagenases (C2C), type II procollagen (CPII), interleukin (IL)-6, proteoglycan (PRG)-4, A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-4, and resistin were determined by enzyme-linked immunosorbent assays, Joint load (moments and compartmental forces) was estimated using musculoskeletal modeling using gait analysis data. Results COMP and MMP-3 showed an immediate increase after the walking stress followed by a decrease. MMP-9 and resistin showed a delayed decrease below pre-stress levels. ∆COMP correlated with ∆MMP-3 for most time points. ∆MMP-9 correlated with ∆resistin for most time points. The load-induced increase in blood marker levels correlated among blood markers and time points. C2C and resistin correlated positively and C2C/CPII and MMP2 correlated negatively with load during gait. Immediate relative ∆CPII and ∆MMP1 and delayed relative ∆COMP, ∆IL6, ∆C2C, ∆CPII, ∆MMP1 and ∆MMP3 correlated with the load accumulated during the walking stress. Baseline C2C levels correlated with Knee Osteoarthritis Outcome Score (KOOS) subscales and load-induced changes in MMP-3 with KOOS and Short Form 36 quality of life subscores (P<0.05). Conclusions The distinct and differentiated physiological response to the walking stress depends on accumulated load and appears relevant for patient reported osteoarthritis outcome and quality of life and warrants further investigation in the context of disease progression.ClinicalTrials.gov registration: NCT02622204.
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Affiliation(s)
- Annegret Mündermann
- Department of Clinical Research, University of Basel, Basel, 4031, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland
- Department of Orthopaedics and Trauamtology, University Hospital Basel, Basel, 4031, Switzerland
| | - Corina Nüesch
- Department of Clinical Research, University of Basel, Basel, 4031, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland
- Department of Orthopaedics and Trauamtology, University Hospital Basel, Basel, 4031, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, 4031, Switzerland
| | - Simon Herger
- Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland
- Department of Orthopaedics and Trauamtology, University Hospital Basel, Basel, 4031, Switzerland
| | - Anna-Maria Liphardt
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, 91054, Germany
- Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, 91054, Germany
| | - Frédérique Chammartin
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen & FAU Erlangen-Nürnberg, Erlangen, 91054, Germany
| | - Enrico De Pieri
- Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland
| | - Christian Egloff
- Department of Orthopaedics and Trauamtology, University Hospital Basel, Basel, 4031, Switzerland
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Bjerre-Bastos JJ, Hamrouni N, Henrotin Y, Thudium CS, Bihlet AR. Joint biomarker response to mechanical stimuli in osteoarthritis - A scoping review. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100390. [PMID: 37885822 PMCID: PMC10598037 DOI: 10.1016/j.ocarto.2023.100390] [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: 01/09/2023] [Accepted: 08/04/2023] [Indexed: 10/28/2023] Open
Abstract
Objective Arthritic cartilage is primed for mechanical damage. Joint biochemical markers (JBM) could provide insight into the impact of mechanical stimulation on joint tissue turnover in osteoarthritis (OA) of potential use in clinical OA research and practice. However, existing studies of the acute impact of physical activities (PA) on JBM often contain risks of substantial bias. The purpose of this scoping review was to critically review and discuss existing reports of acute joint tissue turnover as reflected in JBM in relation to PA in OA and propose considerations for future research. Design We searched PubMed, Embase, and Scopus and reference lists for original reports on the acute impact of PA on JBM in human OA. Identified studies were reviewed by two reviewers forming the basis for the discussion of methodology. Results Search in databases resulted in nine eligible papers after full-text evaluation. Two additional papers were identified through reference lists, resulting in 11 papers included in this review. Ten investigated knee OA and one investigated hand OA. Biomarkers described were related to turnover of type II collagen, aggrecan, and cartilage oligomeric matrix protein. Conclusions The literature is dominated by small, simplistic studies, but suggests that mechanical stimulation can induce acute changes in joint biomarkers. In order to diminish the existing bias in future studies, it is important to recognize methodological considerations e.g. patient and biomarker selection as well as peri-interventional control. Common potential sources of bias include the acute shift in plasma volume due to cardiovascular stress and postural changes.
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Affiliation(s)
- Jonathan J. Bjerre-Bastos
- Xlab, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- NBCD A/S, Herlev, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Nizar Hamrouni
- Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Yves Henrotin
- Musculoskeletal Innovative Research Lab (mSKIL), Arthropôle Liège, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, CHU Sart-Tilman, 4000 Liège, Belgium
- Physical Therapy and Rehabilitation Department, Princess Paola Hospital, Vivalia, Rue du Vivier, 6900 Marche-en-Famenne, Belgium
- Artialis SA, CHU Sart-Tilman, GIGA Tower, level 3, 4000 Liège, Belgium
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Lisee C, Evans-Pickett A, Davis-Wilson H, Munsch AE, Longobardi L, Schwartz TA, Lalush D, Franz JR, Pietrosimone B. Delayed cartilage oligomeric matrix protein response to loading is associated with femoral cartilage composition post-ACLR. Eur J Appl Physiol 2023; 123:2525-2535. [PMID: 37326876 DOI: 10.1007/s00421-023-05253-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE To determine associations between immediate and delayed response of serum cartilage oligomeric matrix protein (sCOMP) to loading (i.e., 3000 walking steps) and femoral cartilage interlimb T1ρ relaxation times in individual's post-anterior cruciate ligament reconstruction (ACLR). METHODS This cross-sectional study included 20 individuals 6-12 months following primary ACLR (65% female, 20.5 ± 4.0 years old, 24.9 ± 3.0 kg/m2, 7.3 ± 1.5 months post-ACLR). Serum samples were collected prior to, immediately following, and 3.5 h following walking 3000 steps on a treadmill at habitual walking speed. sCOMP concentrations were processed using enzyme-linked immunosorbent assays. Immediate and delayed absolute sCOMP responses to loading were evaluated immediately and 3.5 h post-walking, respectively. Participants underwent bilateral magnetic resonance imaging with T1ρ sequences to calculate resting femoral cartilage interlimb T1ρ relaxation time ratios between limbs (i.e., ACLR/Uninjured limb). Linear regression models were fitted to determine associations between sCOMP response to loading and femoral cartilage T1ρ outcomes controlling for pre-loading sCOMP concentrations. RESULTS Greater increases in delayed sCOMP response to loading were associated with greater lateral (∆R2 = 0.29, p = 0.02) but not medial (∆R2 < 0.01, p = 0.99) femoral cartilage interlimb T1ρ ratios. Associations between immediate sCOMP response to loading with femoral cartilage interlimb T1ρ ratios were weak and non-significant (∆R2 range = 0.02-0.09, p range = 0.21-0.58). CONCLUSION Greater delayed sCOMP response to loading, a biomarker of cartilage breakdown, is associated with worse lateral femoral cartilage composition in the ACLR limb compared to the uninjured limb. Delayed sCOMP response to loading may be a more indicative metabolic indicator linked to deleterious changes in composition than immediate sCOMP response.
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Affiliation(s)
- Caroline Lisee
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, CB#8700, 209 Fetzer Hall, Chapel Hill, NC, 27599, USA.
| | - Alyssa Evans-Pickett
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, CB#8700, 209 Fetzer Hall, Chapel Hill, NC, 27599, USA
| | | | - Amanda E Munsch
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lara Longobardi
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Todd A Schwartz
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David Lalush
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, CB#8700, 209 Fetzer Hall, Chapel Hill, NC, 27599, USA
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Evans-Pickett A, Davis-Wilson HC, Johnston CD, Blackburn JT, Hackney AC, Pietrosimone B. Immediate Effects of Walking With a Knee Brace After Anterior Cruciate Ligament Reconstruction: A Biomechanical, Biochemical, and Structural Approach. J Athl Train 2023; 58:542-553. [PMID: 35119477 PMCID: PMC10496450 DOI: 10.4085/1062-6050-0700.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Individuals who undergo anterior cruciate ligament reconstruction (ACLR) are at higher risk of posttraumatic osteoarthritis. Altered joint tissue loading caused by aberrant gait biomechanics leads to deleterious changes in joint health linked to the onset of posttraumatic osteoarthritis. Knee braces have been used to modify joint tissue loading in individuals with joint injury, yet the effects of walking with a brace after ACLR on biomechanical, biochemical, and structural cartilage outcomes are unknown. OBJECTIVE To compare biomechanical, biochemical, and structural outcomes between braced and nonbraced walking in individuals with ACLR. DESIGN Crossover study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 34 individuals with unilateral ACLR (18 females, 16 males; time since ACLR = 50.1 ± 36.8 months). INTERVENTION(S) Gait biomechanics were assessed during braced and unbraced conditions on separate days. MAIN OUTCOME MEASURE(S) Vertical ground reaction force, knee-flexion angle, and internal knee-extension moment waveforms were evaluated throughout the stance phase and compared between conditions. Percentage changes in serum cartilage oligomeric matrix protein (%ΔCOMP) and femoral cartilage cross-sectional area (%ΔCSA) measured via ultrasound were calculated after a 3000-step walking protocol. RESULTS Braced walking increased the knee-flexion angle (largest difference = 3.56°; Cohen d effect size = 1.72) and knee-extension moment (largest difference = -0.48% body weight × height; Cohen d effect size = -1.14) compared with nonbraced walking but did not influence vertical ground reaction force. Whereas no difference (P = .20) in %ΔCOMP existed between the braced and nonbraced conditions in the entire cohort (n = 30 with complete blood data), a larger increase (P = .04) in %ΔCOMP was seen during nonbraced than braced walking in individuals who demonstrated increased COMP during nonbraced walking. No difference (P = .86) in %ΔCSA was present between the braced and nonbraced conditions. CONCLUSIONS Braced walking may improve sagittal-plane gait biomechanics and %ΔCOMP in a subset of individuals who demonstrate a typical increased COMP response to load (ie, increase in COMP) after nonbraced walking.
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Affiliation(s)
- Alyssa Evans-Pickett
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
| | - Hope C. Davis-Wilson
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Physical Therapy Department, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Christopher D. Johnston
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Athletic Training, High Point University, NC
| | - J. Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
| | - Anthony C. Hackney
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Nutrition, School of Public Health, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
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11
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Davis-Wilson HC, Thoma LM, Johnston CD, Young E, Evans-Pickett A, Spang JT, Blackburn JT, Hackney AC, Pietrosimone B. Fewer daily steps are associated with greater cartilage oligomeric matrix protein response to loading post-ACL reconstruction. J Orthop Res 2022; 40:2248-2257. [PMID: 35060165 DOI: 10.1002/jor.25268] [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: 06/26/2020] [Revised: 08/19/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
Aberrant joint loading contributes to the development of posttraumatic knee osteoarthritis (PTOA) following anterior cruciate ligament reconstruction (ACLR); yet little is known about the association between joint loading due to daily walking and cartilage health post-ACLR. Accelerometer-based measures of daily steps and cadence (i.e., rate of steps/min) provide information regarding daily walking in a real-world setting. The purpose of this study was to determine the association between changes in serum cartilage oligomeric matrix protein (COMP; %∆COMP), a mechanosensitive biomarker that is associated with osteoarthritis progression, following a standardized walking protocol and daily walking in individuals with ACLR and uninjured controls. Daily walking was assessed over 7 days using an accelerometer worn on the right hip in 31 individuals with ACLR and 21 controls and quantified as mean steps/day and time spent in ≥100 steps/min. Serum COMP was measured before and following a 3000-step walking protocol at a preferred speed. %∆COMP was calculated as a change in COMP relative to the prewalking value. Linear regressions were used to examine associations between daily walking and %∆COMP after adjusting for preferred speed. Fewer daily steps (ΔR2 = 0.18, p = 0.02) and fewer minutes spent in ≥100 steps/min (ΔR2 = 0.16, p = 0.03) were associated with greater %∆COMP following walking in individuals with ACLR; no statistically significant associations existed in controls (daily steps: ΔR2 = 0.03, p = 0.47; time ≥100 steps/min: ΔR2 < 0.01, p = 0.81). Clinical significance: Individuals with ACLR who engage in less daily walking undergo greater %ΔCOMP, which may represent greater cartilage degradation or turnover in response to walking.
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Affiliation(s)
- Hope C Davis-Wilson
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Louise M Thoma
- Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christopher D Johnston
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emma Young
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Athletic Training Program, The Steadman Clinic, Vail, Colorado, USA
| | - Alyssa Evans-Pickett
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffrey T Spang
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - J Troy Blackburn
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anthony C Hackney
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Allied Health Sciences, Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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12
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Herger S, Vach W, Nüesch C, Liphardt AM, Egloff C, Mündermann A. Dose-response relationship of in vivo ambulatory load and mechanosensitive cartilage biomarkers—The role of age, tissue health and inflammation: A study protocol. PLoS One 2022; 17:e0272694. [PMID: 35984848 PMCID: PMC9390933 DOI: 10.1371/journal.pone.0272694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To describe a study protocol for investigating the in vivo dose-response relationship between ambulatory load magnitude and mechanosensitive blood markers of articular cartilage, the influence of age, cartilage tissue health and presence of inflammation on this relationship, and its ability to predict changes in articular cartilage quality and morphology within 2 years. Design Prospective experimental multimodal (clinical, biomechanical, biological) data collection under walking stress and three different load conditions varied in a randomized crossover design. Experimental protocol At baseline, equal numbers of healthy and anterior cruciate ligament injured participants aged 20–30 or 40–60 years will be assessed clinically and complete questionnaires regarding their knee health. Biomechanical parameters (joint kinetics, joint kinematics, and surface electromyography) will be recorded while performing different tasks including overground and treadmill walking, single leg balance and hopping tasks. Magnetic resonance images (MRI) of both of knees will be obtained. On separate stress test days, participants will perform a 30-minute walking stress with either reduced (80% body weight (BW)), normal (100%BW) or increased (120%BW) load. Serum blood samples will be taken immediately before, immediately after, 30, 120 and 210 minutes after the walking stress. Concentration of articular cartilage blood biomarkers will be assessed using enzyme linked immunosorbent assays. At 24-month follow-up, participants will be again assessed clinically, undergo an MRI, complete questionnaires, and have a blood sample taken. Conclusion The study design provides a standardized set up that allows to better understand the influence of ambulatory load on articular cartilage biomarkers and thereby extend current knowledge on in vivo cartilage metabolism and mechanosensitivity. Further, this study will help to elucidate the prognostic value of the load-induced cartilage biomarker response for early articular cartilage degeneration. Trial registration The protocol was approved by the regional ethics committee and has been registered at clinicaltrials.gov (NCT04128566).
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Affiliation(s)
- Simon Herger
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- * E-mail:
| | - Werner Vach
- Basel Academy for Quality and Research in Medicine, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Anna-Maria Liphardt
- Department of Internal Medicine 3 –Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christian Egloff
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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13
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Jayabalan P, Bergman R, Jauregui E, Hanaoka C, Stoker AM. Acute Physiological Effects of Continuous Versus Intermittent Walking During Golf in Individuals With Knee Osteoarthritis: A Pilot Study. Am J Phys Med Rehabil 2022; 101:460-467. [PMID: 34310345 PMCID: PMC8783928 DOI: 10.1097/phm.0000000000001855] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to compare the acute effects of walking the golf course versus using a golf cart during a round of golf on biological markers of joint disease, joint pain, and cardiovascular parameters in individuals with knee osteoarthritis. METHODS Participants with knee OA (n = 10) older than 50 yrs were recruited for this crossover designed study in which they completed two 18-hole rounds of golf: (1) walking the course and (2) using a golf cart. Five control participants (n = 5) performed the walking condition only. Step count, heart rate, rating of perceived exertion and pain using the Numeric Pain Rating Scale were measured during the round. Serum was collected at baseline, 9th hole (halfway), and 18th hole (completion) and tested for biomarkers associated with tissue turnover (cartilage oligomeric matrix protein), inflammation (tumor necrosis factor α, interleukin 1β, interleukin 6), and degradative enzyme production (matrix metalloproteinase 3, matrix metalloproteinase 13). RESULTS In knee OA participants, walking the course was associated with significantly higher step count and duration of moderate/vigorous physical activity (72.2% vs. 32.6% of the round) but did lead to a significant increase in knee joint pain (P < 0.05). Both conditions caused cartilage oligomeric matrix protein and matrix metalloproteinase 13 concentration increases from baseline to completion (P < 0.05), but inflammatory markers (tumor necrosis factor α, interleukin 6, and interleukin 1β, P < 0.05) only increased when walking the course. Biomarker concentrations did not increase in control participants. CONCLUSIONS Walking the course optimizes the duration of moderate/vigorous activity during a round of golf, but the golf cart is a beneficial option in those with exacerbated joint pain and inflammation that would otherwise limit participation.
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Affiliation(s)
- Prakash Jayabalan
- Shirley Ryan AbilityLab, Chicago, IL
- Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Rachel Bergman
- Shirley Ryan AbilityLab, Chicago, IL
- University of Michigan Medical School, Ann Arbor, MI
| | | | - Chad Hanaoka
- Shirley Ryan AbilityLab, Chicago, IL
- Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL
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14
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Dreiner M, Munk T, Zaucke F, Liphardt AM, Niehoff A. Relationship between different serum cartilage biomarkers in the acute response to running and jumping in healthy male individuals. Sci Rep 2022; 12:6434. [PMID: 35440750 PMCID: PMC9018733 DOI: 10.1038/s41598-022-10310-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/06/2022] [Indexed: 12/14/2022] Open
Abstract
The effect of physical activity on serum cartilage biomarkers is largely unknown. The purpose of the study was to systematically analyze the acute effect of two frequently used exercise interventions (running and jumping) on the correlation of seven serum biomarkers that reflect cartilage extracellular matrix metabolism. Fifteen healthy male volunteers (26 ± 4 years, 181 ± 4 cm, 77 ± 6 kg) participated in the repeated measurement study. In session 1, the participants accomplished 15 × 15 series of reactive jumps within 30 min. In session 2, they ran on a treadmill (2.2 m/s) for 30 min. Before and after both exercise protocols, four blood samples were drawn separated by 30 min intervals. Serum concentrations of seven biomarkers were determined: COMP, MMP-3, MMP-9, YKL-40, resistin, Coll2-1 and Coll2-1 NO2. All biomarkers demonstrated an acute response to mechanical loading. Both the COMP and MMP-3 responses were significantly (p = 0.040 and p = 0.007) different between running and jumping (COMP: jumping + 31%, running + 37%; MMP-3: jumping + 14%, running + 78%). Resistin increased only significantly (p < 0.001) after running, and Coll2-1 NO2 increased significantly (p = 0.001) only after jumping. Significant correlations between the biomarkers were detected. The relationships between individual serum biomarker concentrations may reflect the complex interactions between degrading enzymes and their substrates in ECM homeostasis.
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Affiliation(s)
- Maren Dreiner
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Tobias Munk
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
| | - Frank Zaucke
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopaedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Anna-Maria Liphardt
- Department of Internal Medicine 3 - Rheumatology and Immunology, Universitätsklinikum Erlangen and Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Anja Niehoff
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany. .,Faculty of Medicine, Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany.
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15
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Erhart-Hledik JC, Titchenal MR, Migliore E, Asay JL, Andriacchi TP, Chu CR. Cartilage oligomeric matrix protein responses to a mechanical stimulus associate with ambulatory loading in individuals with anterior cruciate ligament reconstruction. J Orthop Res 2022; 40:791-798. [PMID: 34185322 DOI: 10.1002/jor.25121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 01/07/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
Mechanical factors have been implicated in the development of osteoarthritis after anterior cruciate ligament (ACL) reconstruction. This study tested for associations between ambulatory joint loading (total joint moment [TJM] and vertical ground reaction force [vGRF]) and changes in serum levels of cartilage oligomeric matrix protein (COMP) in response to a mechanical stimulus (30-min walk) in individuals with ACL reconstruction. Twenty-five subjects (mean age: 34.5 ± 9.8 years; 2.2 ± 0.2 years post-surgery) with primary unilateral ACL reconstruction underwent gait analysis for assessment of peak vGRF and TJM first (TJM1) and second (TJM2) peaks. Serum COMP concentrations were measured by enzyme-linked immunosorbent assay immediately before, 3.5 h, and 5.5 h after a 30-min walk. Pearson correlation coefficients and backward stepwise multiple linear regression analysis, with adjustments for age, sex, body mass index, and between-limb speed difference, assessed associations between changes in COMP and between-limb differences in joint loading parameters. Greater TJM1 (R = 0.542, p = 0.005), TJM2 (R = 0.460, p = 0.021), and vGRF (R = 0.577, p = 0.003) in the ACL-reconstructed limb as compared to the contralateral limb were associated with higher COMP values 3.5 h following the 30-min walk. Change in COMP at 5.5 h became a significant predictor of the between-limb difference in TJM1 and vGRF in multivariate analyses after accounting for the between-limb speed difference. These results demonstrate that higher TJM and vGRF in the ACLR limb as compared to the contralateral limb are associated with higher relative COMP levels 3.5 and 5.5 h after a 30-min walk. Future work should investigate the effect of therapies to alter joint loading on the biological response in individuals after ACL reconstruction.
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Affiliation(s)
- Jennifer C Erhart-Hledik
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California, USA.,Palo Alto Veterans Hospital, Palo Alto, California, USA
| | - Matthew R Titchenal
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California, USA.,Palo Alto Veterans Hospital, Palo Alto, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Eleonora Migliore
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California, USA.,Palo Alto Veterans Hospital, Palo Alto, California, USA
| | - Jessica L Asay
- Palo Alto Veterans Hospital, Palo Alto, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Thomas P Andriacchi
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Constance R Chu
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California, USA.,Palo Alto Veterans Hospital, Palo Alto, California, USA
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16
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Östlind E, Eek F, Stigmar K, Sant’Anna A, Ekvall Hansson E, Struglics A. Associations Between Physical Activity, Self-reported Joint Function, and Molecular Biomarkers in Working Age Individuals With Hip and/or Knee Osteoarthritis. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2022; 15:11795441221081063. [PMID: 35342314 PMCID: PMC8950022 DOI: 10.1177/11795441221081063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/28/2022] [Indexed: 11/18/2022]
Abstract
Objective Previous research has suggested an association between physical activity (PA), joint function, and molecular biomarkers, but more studies are needed. The aim of this study was to explore the associations between PA or self-reported joint function and molecular biomarkers of cartilage and inflammation in individuals with hip and/or knee osteoarthritis (OA). Specific objectives were to explore the correlations between (1) the change over 3 months in self-reported PA/joint function and the change in molecular biomarkers (2) objectively measured PA and molecular biomarkers measured at 3-month follow-up. Design Working age participants (n = 91) were recruited from a cluster randomized controlled trial. Self-reported PA, joint function, and serum samples were collected at baseline and after 3 months. Serum concentrations of the inflammatory marker C-reactive protein (CRP) and the cartilage markers Alanine-Arginine-Glycine-Serine (ARGS)-aggrecan, cartilage oligomeric matrix protein (COMP), and type II collagen C2C were analyzed by immunoassays. Objectively measured PA (steps/day) was collected during 12 weeks from activity trackers used by 53 participants. Associations were analyzed with Spearman's rank correlation. Results There was a weak negative correlation between the change in self-reported PA and the change in COMP (r s = -0.256, P = .040) but not for the other molecular biomarkers. There were no correlations between the change in self-reported joint function and the change in molecular biomarkers or between the average steps/day and the molecular biomarkers at follow-up (r s ⩽ -0.206, P ⩾ .06). Conclusion In general, no or only weak associations were found between PA/joint function and molecular biomarkers. Future research recommends including participants with lower PA, extend the follow-up, and use a design that allows comparisons.
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Affiliation(s)
- Elin Östlind
- Research Group Physiotherapy, Division of Physiotherapy, Department of Health Sciences, Lund University, Lund, Sweden
- Dalby Healthcare Center, Region Skåne, Lund, Sweden
| | - Frida Eek
- Division of Physiotherapy, Department of Health Sciences, Lund University, Lund, Sweden
| | - Kjerstin Stigmar
- Division of Physiotherapy, Department of Health Sciences, Lund University, Lund, Sweden
- Skåne University Hospital, Lund, Sweden
| | | | - Eva Ekvall Hansson
- Division of Physiotherapy, Department of Health Sciences, Lund University, Lund, Sweden
- Skåne University Hospital, Lund, Sweden
| | - André Struglics
- Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden
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17
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Bjornsen E, Schwartz TA, Lisee C, Blackburn T, Lalush D, Nissman D, Spang J, Pietrosimone B. Loading during Midstance of Gait Is Associated with Magnetic Resonance Imaging of Cartilage Composition Following Anterior Cruciate Ligament Reconstruction. Cartilage 2022; 13:19476035211072220. [PMID: 35098719 PMCID: PMC9137315 DOI: 10.1177/19476035211072220] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE A complex association exists between aberrant gait biomechanics and posttraumatic knee osteoarthritis (PTOA) development. Previous research has primarily focused on the link between peak loading during the loading phase of stance and joint tissue changes following anterior cruciate ligament reconstruction (ACLR). However, the associations between loading and cartilage composition at other portions of stance, including midstance and late stance, is unclear. The objective of this study was to explore associations between vertical ground reaction force (vGRF) at each 1% increment of stance phase and tibiofemoral articular cartilage magnetic resonance imaging (MRI) T1ρ relaxation times following ACLR. DESIGN Twenty-three individuals (47.82% female, 22.1 ±4.1 years old) with unilateral ACLR participated in a gait assessment and T1ρ MRI collection at 12.25 ± 0.61 months post-ACLR. T1ρ relaxation times were calculated for the articular cartilage of the weightbearing medial and lateral femoral (MFC, LFC) and tibial (MTC, LTC) condyles. Separate bivariate, Pearson product moment correlation coefficients (r) were used to estimate strength of associations between T1ρ MRI relaxation times in the medial and lateral tibiofemoral articular cartilage with vGRF across the entire stance phase. RESULTS Greater vGRF during midstance (46%-56% of stance phase) was associated with greater T1ρ MRI relaxation times in the MFC (r ranging between 0.43 and 0.46). CONCLUSIONS Biomechanical gait profiles that include greater vGRF during midstance are associated with MRI estimates of lesser proteoglycan density in the MFC. Inability to unload the ACLR limb during midstance may be linked to joint tissue changes associated with PTOA development.
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Affiliation(s)
- Elizabeth Bjornsen
- Human Movement Science Curriculum, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Elizabeth Bjornsen, Human Movement Science Curriculum, The University of North Carolina at Chapel Hill, Fetzer Hall, 210 South Road, Chapel Hill, NC 27599, USA.
| | - Todd A. Schwartz
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caroline Lisee
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Troy Blackburn
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David Lalush
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel Nissman
- Department of Radiology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeffrey Spang
- Department of Orthopaedics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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18
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Chu CR. Can we afford to ignore the biology of joint healing and graft incorporation after ACL reconstruction? J Orthop Res 2022; 40:55-64. [PMID: 34314066 DOI: 10.1002/jor.25145] [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] [Received: 03/17/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) reconstruction is successful at restoring stability to return ACL injured patients to high-demand work, sports, and recreational activities. The development of posttraumatic osteoarthritis (OA) in roughly half of patients just 10-15 years after ACLR highlight the need to improve clinical care pathways. Graft failure and reinjury rates, which further increase OA risk, also remain high for younger and more active patients. The biological components of joint recovery and graft incorporation, therefore, impact short- and long-term clinical outcomes. Biochemical and magnetic resonance imaging (MRI) data show substantial compromise of articular cartilage metabolism and matrix composition after ACL injury and reconstructive surgery suggesting a potential need for activity modulation in early recovery. Furthermore, joint recovery is variable with compositional MRI studies showing progressive cartilage degeneration 1 and 2 years after ACLR. Biopsy and MRI studies also show high variability in ACL graft characteristics within the 1st year after ACLR followed by continued graft maturation into the 2nd year and beyond. To improve the care of ACL injured patients, there is a critical need for clinical attention and scientific inquiry into timing the reintroduction of higher load activities in relationship to neuromuscular recovery, joint biology, and graft maturation. In addition to symptomatic and mechanical recovery, development and validation of biological markers for joint and cartilage homeostasis as well as ACL graft healing are needed for personalized decision making on rehabilitation needs, reduction of OA risk, and resumption of athletic, recreational, and vocational activities.
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Affiliation(s)
- Constance R Chu
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Veterans Affairs Palo Alto Healthcare System, Livermore, California, USA
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19
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Oğuz R, Belviranlı M, Okudan N. Effects of Exercise Training Alone and in Combination With Kinesio Taping on Pain, Functionality, and Biomarkers Related to the Cartilage Metabolism in Knee Osteoarthritis. Cartilage 2021; 13:1791S-1800S. [PMID: 33870762 PMCID: PMC8808795 DOI: 10.1177/19476035211007895] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the effects of exercise training alone and in combination with kinesio taping on pain, functionality, and circulating cartilage oligomeric matrix protein (COMP), and matrix metalloproteinase (MMP)-1, and -3 at rest and immediately after walking exercise in knee osteoarthritis (OA). DESIGN A total of 22 female patients diagnosed with knee OA were randomly divided into the exercise training (ET) or exercise training plus kinesio taping (ET + KT) groups. The patients in the ET performed exercise training for 6 weeks. The patients in the ET + KT group were applied with kinesio tape in addition to the exercise training for 6 weeks. In both groups, 20 minutes of walking exercise were performed before and after the interventions. The pain and functional status of the patients were assessed using visual analogue scale (VAS) and Western Ontario McMasters Osteoarthritis Index (WOMAC) before and after the intervention at rest, respectively. Blood samples were taken at rest and immediately after the walking exercise before and after the interventions for the analysis of COMP, MMP-1, and MMP-3 levels. RESULTS In both groups, pain and functionality scores were significantly improved after the interventions (P < 0.05). COMP, MMP-1 and MMP-3 levels were higher immediately after walking exercise when compared with rest in both groups before and after the intervention (P < 0.05). CONCLUSIONS Exercise training and exercise training plus kinesio taping improved pain and physical function; however, the COMP, MMP-1, and MMP-3 levels did not change.
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Affiliation(s)
- Ramazan Oğuz
- Department of Physical Medicine and
Rehabilitation, Konya Numune Hospital, Konya, Turkey
| | - Muaz Belviranlı
- Department of Physiology, Division of
Sports Physiology, School of Medicine, Selçuk University, Konya, Turkey,Muaz Belviranlı, Department of Physiology,
Division of Sports Physiology, School of Medicine, Selçuk University, Konya,
42131, Turkey.
| | - Nilsel Okudan
- Department of Physiology, Division of
Sports Physiology, School of Medicine, Selçuk University, Konya, Turkey
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20
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Harkey MS, Blackburn JT, Hackney AC, Lewek MD, Schmitz RJ, Pietrosimone B. Sex-Specific Associations between Cartilage Structure and Metabolism at Rest and Acutely Following Walking and Drop-Landing. Cartilage 2021; 13:1772S-1781S. [PMID: 32954820 PMCID: PMC8808927 DOI: 10.1177/1947603520959386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Cartilage health is thought to be dependent on the relationship between mechanics, structure, and metabolism, rather than these individual components in isolation. Due to sex differences in cartilage health, there is need to determine if the relationships between these cartilage components separately for males and females. Therefore, we sought to determine the sex-specific associations between cartilage structure and metabolism at rest and their acute response following walking and drop-landing in healthy individuals. DESIGN A cartilage ultrasound assessment and an ante-cubital blood draw were performed before and after walking and drop-landing conditions in 20 males and 20 females. Cartilage structure was assessed via medial and lateral femoral cartilage cross-sectional area. Cartilage metabolism was quantified with serum cartilage oligomeric matrix protein (COMP) concentration. Percent change scores from pre- to postloading were used to calculate acute alterations in cross-sectional area and COMP. Correlational analyses were used to assess the association between cartilage structure and metabolism measures separately for males and females. RESULTS In females, greater resting COMP concentration was associated with less cartilage cross-sectional area in the medial(ρ = -0.50, P = 0.03) and lateral (ρ = -0.69, P = 0.001) femur. Resting cartilage measures were not associated among males. Following walking and drop-landing, percent change scores in cartilage structure and metabolism were not associated. CONCLUSIONS This study highlights that, in females, thinner anterior femoral cartilage is associated with greater resting serum COMP concentrations, a biomarker often linked to cartilage breakdown. Future studies into the relationships between various cartilage components should consider sex-specific analyses as these relationships are sex dependent.
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Affiliation(s)
- Matthew S. Harkey
- Department of Kinesiology, Michigan
State University, East Lansing, MI, USA,Matthew S. Harkey, Department of
Kinesiology, Michigan State University, 308 W. Circle Drive #112, East Lansing,
MI 48824, USA.
| | - J. Troy Blackburn
- Department of Exercise and Sports
Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony C. Hackney
- Department of Exercise and Sports
Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Department of Nutrition, School of
Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC,
USA
| | - Michael D. Lewek
- Division of Physical Therapy, University
of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Randy J. Schmitz
- Department of Kinesiology, University of
North Carolina at Greensboro, Greensboro, NC, USA
| | - Brian Pietrosimone
- Department of Exercise and Sports
Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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21
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Hernández-Hermoso JA, Nescolarde L, Roca E, Revuelta-López E, Ara J, Bayes-Genis A. Marathon Running Increases Synthesis and Decreases Catabolism of Joint Cartilage Type II Collagen Accompanied by High-Energy Demands and an Inflamatory Reaction. Front Physiol 2021; 12:722718. [PMID: 34707508 PMCID: PMC8542987 DOI: 10.3389/fphys.2021.722718] [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: 06/09/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To determine the effect of marathon running on serum levels of inflammatory, high energy, and cartilage matrix biomarkers and to ascertain whether these biomarkers levels correlate. Design: Blood samples from 17 Caucasian male recreational athletes at the Barcelona Marathon 2017 were collected at the baseline, immediately and 48 h post-race. Serum C reactive protein (CRP), creatin kinase (CK), and lactate dehydrogenase (LDH) were determined using an AU-5800 chemistry analyser. Serum levels of hyaluronan (HA), cartilage oligomeric matrix protein (COMP), aggrecan chondroitin sulphate 846 (CS846), glycoprotein YKL-40, human procollagen II N-terminal propeptide (PIINP), human type IIA collagen N-propeptide (PIIANP), and collagen type II cleavage (C2C) were measured by sandwich enzyme-linked immune-sorbent assay (ELISA). Results: Medians CK and sLDH levels increased (three-fold, two-fold) post-race [429 (332) U/L, 323 (69) U/L] (p < 0.0001; p < 0.0001) and (six-fold, 1.2-fold) 48 h post-race [658 (1,073) U/L, 218 (45) U/L] (p < 0.0001; p < 0.0001). Medians CRP increased (ten-fold) after 48 h post-race [6.8 (4.1) mg/L] (p < 0.0001). Mean sHA levels increased (four-fold) post-race (89.54 ± 53.14 ng/ml) (p < 0.0001). Means PIINP (9.05 ± 2.15 ng/ml) levels increased post-race (10.82 ± 3.44 ng/ml) (p = 0.053) and 48 h post-race (11.00 ± 2.96 ng/ml) (p = 0.001). Mean sC2C levels (220.83 ± 39.50 ng/ml) decreased post-race (188.67 ± 38.52 ng/ml) (p = 0.002). In contrast, means COMP, sCS846, sPIIANP, and median sYKL-40 were relatively stable. We found a positive association between sCK levels with sLDH pre-race (r = 0.758, p < 0.0001), post-race (r = 0.623, p = 0.008) and 48-h post-race (r = 0.842, p < 0.0001); sHA with sCRP post-race vs. 48 h post-race (r = 0.563, p = 0.019) and sPIINP with sCK pre-race vs. 48-h post-race (r = 0.499, p = 0.044) and with sLDH 48-h pre-race vs. post-race (r = 0.610, p = 0.009) and a negative correlation of sPIIANP with sCRP 48-h post-race (r = −0.570, p = 0.017). Conclusion: Marathon running is an exercise with high-energy demands (sCK and sLDH increase) that provokes a high and durable general inflammatory reaction (sCRP increase) and an immediately post-marathon mechanism to protect inflammation and cartilage (sHA increase). Accompanied by an increase in type II collagen cartilage fibrils synthesis (sPIINP increase) and a decrease in its catabolism (sC2C decrease), without changes in non-collagenous cartilage metabolism (sCOMP, sC846, and sYKL-40). Metabolic changes on sPIINP and sHA synthesis may be related to energy consumption (sCK, sLDH) and the inflammatory reaction (sCRP) produced.
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Affiliation(s)
- José A Hernández-Hermoso
- Department of Orthopedic Surgery and Traumatology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.,Department of Surgery, Faculty of Medicine, Universitat Autònoma Barcelona, Bellaterra, Spain
| | - Lexa Nescolarde
- Department of Electronic Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | | | - Elena Revuelta-López
- Research Program, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Jordi Ara
- Departament of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Antoni Bayes-Genis
- Research Program, Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain.,Departament of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
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22
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Chu CR, Williams AA, Erhart-Hledik JC, Titchenal MR, Qian Y, Andriacchi TP. Visualizing pre-osteoarthritis: Integrating MRI UTE-T2* with mechanics and biology to combat osteoarthritis-The 2019 Elizabeth Winston Lanier Kappa Delta Award. J Orthop Res 2021; 39:1585-1595. [PMID: 33788306 DOI: 10.1002/jor.25045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/03/2021] [Accepted: 03/24/2021] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) is a leading cause of pain and disability for which disease-modifying treatments remain lacking. This is because the symptoms and radiographic changes of OA occur after the onset of likely irreversible changes. Defining and treating earlier disease states are therefore needed to delay or to halt OA progression. Taking this concept a step further, studying OA pathogenesis before disease onset by characterizing potentially reversible markers of increased OA risk to identify a state of "pre-osteoarthritis (pre-OA)" shifts the paradigm towards OA prevention. The purpose of this review is to summarize the 42 studies comprising the 2019 Kappa Delta Elizabeth Lanier Award where conceptualization of a systems-based definition for "pre-osteoarthritis (pre-OA)" was followed by demonstration of potentially reversible markers of heightened OA risk in patients after anterior cruciate ligament (ACL) injury and reconstruction. In the process, these efforts contributed a new magnetic resonance imaging method of ultrashort echo time (UTE) enhanced T2* mapping to visualize joint tissue damage before the development of irreversible changes. The studies presented here support a transformative approach to OA that accounts for interactions between mechanical, biological, and structural markers of OA risk to develop and evaluate new treatment strategies that can delay or prevent the onset of clinical disease. This body of work was inspired by and performed for patients. Shifting the paradigm from attempting to modify symptomatic radiographic OA towards monitoring and reversing markers of "pre-OA" opens the door for transforming the clinical approach to OA from palliation to prevention.
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Affiliation(s)
- Constance R Chu
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Surgery, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Ashley A Williams
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Surgery, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | - Jennifer C Erhart-Hledik
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Surgery, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | | | - Yongxian Qian
- Center for Biomedical Imaging, New York University, New York, New York, USA
| | - Thomas P Andriacchi
- Department Orthopaedic Surgery, Stanford University, Stanford, California, USA.,Department of Mechanical Engineering, Stanford University, Stanford, California, USA
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23
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Bjerre-Bastos JJ, Nielsen HB, Andersen JR, Karsdal M, Bay-Jensen AC, Boesen M, Mackey AL, Byrjalsen I, Bihlet AR. Does moderate intensity impact exercise and non-impact exercise induce acute changes in collagen biochemical markers related to osteoarthritis? - An exploratory randomized cross-over trial. Osteoarthritis Cartilage 2021; 29:986-994. [PMID: 33676014 DOI: 10.1016/j.joca.2021.02.569] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate acute changes in biochemical markers of cartilage turnover in response to moderate intensity exercise with and without joint impact in humans with knee osteoarthritis. DESIGN We conducted a randomized, cross-over, exploratory clinical study. Twenty subjects with knee osteoarthritis (OA) were randomized, of which twenty completed 30 min of cycling and 15 completed 30 min of running on days 1 week apart. Fasting blood samples were taken before, immediately after and 1, 2, 3, and 24 h after activity was initiated. Midstream spot urine was sampled before and after activity. Serum samples were analyzed for concentrations of fragment of type II collagen degradation, C2M, fragment of type VI collagen degradation, C6M, cartilage oligomeric matrix protein, COMP, marker of type II collagen formation, PRO-C2, and urine for marker of crosslinked type II collagen degradation, CTX-II. To establish a reference, all subjects had similar samples taken during rest on a separate day. Data was analyzed in a restricted maximum likelihood based random effects linear mixed model. RESULTS C2M trended to increase after cycling compared running (13.49%, 95%CI: -0.36-27.34%) and resting (12.88%, 95%CI: 0.2-25.6%) and the type II collagen formation/degradation ratio switched towards degradation after cycling, but not running. C6M trended to decrease after cycling (-8.1%, 95%CI: -14.8 to -1.4%) and running (-6.8%, 95%CI: -14.16-0.55%). CONCLUSION In persons with knee OA moderate intensity exercise without joint impact may induce acute changes in circulating levels of biochemical markers reflecting type II and VI collagen degradation.
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Affiliation(s)
- J J Bjerre-Bastos
- Xlab, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Nordic Bioscience Clinical Development, Herlev, Denmark.
| | - H B Nielsen
- Department of Anesthesia, Zealand University Hospital Roskilde, Denmark; Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark.
| | - J R Andersen
- Nordic Bioscience Clinical Development, Herlev, Denmark.
| | | | | | - M Boesen
- Department of Radiology, Bispebjerg Hospital, Copenhagen, Denmark.
| | - A L Mackey
- Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark.
| | - I Byrjalsen
- Nordic Bioscience Clinical Development, Herlev, Denmark.
| | - A R Bihlet
- Nordic Bioscience Clinical Development, Herlev, Denmark.
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24
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Bjerre-Bastos JJ, Nielsen HB, Andersen JR, Karsdal M, Boesen M, Mackey AL, Byrjalsen I, Thudium CS, Bihlet AR. A biomarker perspective on the acute effect of exercise with and without impact on joint tissue turnover: an exploratory randomized cross-over study. Eur J Appl Physiol 2021; 121:2799-2809. [PMID: 34156534 DOI: 10.1007/s00421-021-04751-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 06/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate acute changes in biochemical markers of bone and cartilage turnover in response to moderate intensity exercise with and without joint impact in healthy human subjects. METHODS A randomized, cross-over, exploratory, clinical study was conducted. Twenty healthy subjects with no history of joint trauma completed 30 min interventions of standardized moderate intensity cycling and running as well as a resting intervention 1 week apart. Blood samples were taken immediately before, four times after exercise and again the next day. Urine was sampled, before, after and the next day. On the day of rest, samples were taken at timepoints similar to the days of exercise. Markers of type I (CTX-I), II (C2M, CTX-II) and VI (C6M) collagen degradation, cartilage oligomeric matrix protein (COMP) and procollagen C-2 (PRO-C2) was measured. TRIAL REGISTRATION NUMBER NCT04542655, 02 September 2020, retrospectively registered. RESULTS CTX-I was different from cycling (4.2%, 95%CI: 0.4-8.0%, p = 0.03) and resting (6.8%, 95%CI: 2.9-10.7%, p = 0.001) after running and the mean change in COMP was different from cycling (10.3%, 95%CI: 1.1-19.5%, p = 0.03), but not from resting (8.6%, 95%CI: - 0.7-17.8%, p = 0.07) after running. Overall, changes in other biomarkers were not different between interventions. CONCLUSION In this exploratory study, running, but not cycling, at a moderate intensity and duration induced acute changes in biomarkers of bone and cartilage extra-cellular matrix turnover.
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Affiliation(s)
- Jonathan J Bjerre-Bastos
- Xlab, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.
- Nordic Bioscience Clinical Development, Herlev, Denmark.
| | - Henning Bay Nielsen
- Sanos Clinic, Herlev, Denmark
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Mikael Boesen
- Department of Radiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Abigail L Mackey
- Xlab, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
- Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark
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25
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Longitudinal changes in tibial and femoral cartilage thickness are associated with baseline ambulatory kinetics and cartilage oligomeric matrix protein (COMP) measures in an asymptomatic aging population. Osteoarthritis Cartilage 2021; 29:687-696. [PMID: 33610822 DOI: 10.1016/j.joca.2021.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 01/07/2021] [Accepted: 02/02/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To address the need for early knee osteoarthritis (OA) markers by testing if longitudinal cartilage thickness changes are associated with specific biomechanical and biological measures acquired at a baseline test in asymptomatic aging subjects. DESIGN Thirty-eight asymptomatic subjects over age 45 years were studied at baseline and at an average of 7-9 year follow-up. Gait mechanics and knee MRI were measured at baseline and MRI was obtained at follow-up to assess cartilage thickness changes. A subset of the subjects (n = 12) also had serum cartilage oligomeric matrix protein measured at baseline in response to a mechanical stimulus (30-min walk) (mCOMP). Baseline measures, including the knee extension (KEM), flexion (KFM), adduction (KAM) moments and mCOMP, were tested for associations with cartilage thickness changes in specific regions of the knee. RESULTS Cartilage change in the full medial femoral condyle (p = 0.005) and external medial femoral region (p = 0.041) was negatively associated with larger early stance peak KEM. Similarly, cartilage change in the full medial femoral region (p = 0.009) and medial femoral external region (p = 0.043) was negatively associated with larger first peak KAM, while cartilage change in the anterior medial tibia was positively associated with larger first peak KAM (p = 0.003). Cartilage change in the anterior medial tibia was also significantly associated (p = 0.011) with mCOMP levels 5.5-h post-activity (percentage of pre-activity levels). CONCLUSIONS Interactions found between gait, mechanically-stimulated serum biomarkers, and cartilage thickness in an at-risk aging asymptomatic population suggest the opportunity for early detection of OA with new approaches that bridge across disciplines and scales.
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26
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McDonnell AC, Eiken O, Mekjavic IB, Žlak N, Drobnič M. The influence of a sustained 10-day hypoxic bed rest on cartilage biomarkers and subchondral bone in females: The FemHab study. Physiol Rep 2021; 8:e14413. [PMID: 32333524 PMCID: PMC7182690 DOI: 10.14814/phy2.14413] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 12/19/2022] Open
Abstract
This study assessed the influence of a 10‐day hypoxic bed rest on cartilage biomarkers and subchondral bone density across the patellofemoral joint (PFJ). Within clinical settings hypoxic tissue may arise in several types of disorders. Furthermore, a hypoxic environment is being considered for space flight habitats in the near future. Female participants (N = 12) participated in this study comprising three 10‐day interventions: hypoxic ambulation (HAMB), normoxic bed rest (NBR), and hypoxic bed rest (HBR). Venous samples were collected prior to (day −2: Pre) and during the intervention (days 2 and 5), immediately before reambulation (D11) and 24 hr post intervention (R1). Blood samples were analyzed for: aggrecan, hyaluronan, Type IIA procollagen amino terminal propeptide (PIIANP), and cartilage oligomeric matrix protein (COMP). Total bone mineral density (BMD) in eight regions (2 mm × 10 mm) across the PFJ was determined. The three interventions (HAMB, HBR, and NBR) did not induce any significant changes in the cartilage biomarkers of hyaluronan or PIIANP. Aggrecan increased during the HAMB trial to 2.02 fold the Pre value. COMP decreased significantly in both NBR & HBR compared to HAMB on D5. There were significant differences in BMD measured across the PFJ from cortical patellar bone (735 to 800 mg/cm3) to femur trabecular (195 to 226 mg/cm3). However, there were no significant changes in BMD from Pre to Post bed rest. These results indicate that there were no significant detectable effects of inactivity/unloading on subchondral bone density. The biomarker of cartilage, COMP, decreased on D5, whereas the addition of hypoxia to bed rest had no effect, it appears that hypoxia in combination with ambulation counteracted this decrease.
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Affiliation(s)
- Adam C McDonnell
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Ola Eiken
- Department of Environmental Physiology, Swedish Aerospace Physiology Centre, Royal Institute of Technology, Solna, Sweden
| | - Igor B Mekjavic
- Department of Environmental Physiology, Swedish Aerospace Physiology Centre, Royal Institute of Technology, Solna, Sweden.,Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Nik Žlak
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matej Drobnič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
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27
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Mean femoral cartilage thickness is higher in athletes as compared with sedentary individuals. Knee Surg Sports Traumatol Arthrosc 2021; 29:1206-1214. [PMID: 32671433 DOI: 10.1007/s00167-020-06146-7] [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: 01/21/2020] [Accepted: 07/10/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE It is unclear how high-intensity physical activity (HIPA) affects the knee joint, specifically the femoral cartilage (FC). Therefore, the aims of this study were to evaluate FC thickness via ultrasound among elite athletes involved in different types of HIPA, and to determine whether there is a correlation between serum cartilage oligomeric matrix protein (sCOMP) and rectus femoris (RF) thickness. METHOD A total of 132 male individuals participated in this study and were assigned to two groups, the sedentary (n = 43, 23.9 ± 3.7) and athlete groups (n = 89, 22.7 ± 4.6), which did not significantly differ in age. The athletes were elite and performed HIPA during sports such as volleyball (n = 20), soccer (n = 21), basketball (n = 28), and weightlifting (n = 20). RF thickness and three (mid-point) measurements were obtained for each knee. The mean FC thickness for each knee was defined as the sum of the medial, lateral condyles, and intercondylar areas. Blood samples for sCOMP analyses were also obtained. RESULTS All the measurements of the FC of both knees were significantly higher in the athletes than in the sedentary individuals (p < 0.001 and p = 0.001). The mean right and left FC values were also higher in the athletes (p < 0.001). Multiple linear regression analysis showed that participation in sporting activities was a significant predictor associated with the right and left mean FC thickness (p < 0.001 for both). No significant differences in the sCOMP levels were found between the two groups. CONCLUSION It was found that the mean FC was higher among athletes than among sedentary individuals. As a result, it is suggested that sports' participation is an independent factor associated with the right and left mean FC thickness. LEVEL OF EVIDENCE III.
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28
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Erhart-Hledik JC, Mahtani GB, Asay JL, Migliore E, Nguyen MM, Andriacchi TP, Chu CR. Changes in knee adduction moment wearing a variable-stiffness shoe correlate with changes in pain and mechanically stimulated cartilage oligomeric matrix levels. J Orthop Res 2021; 39:619-627. [PMID: 32497304 DOI: 10.1002/jor.24770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 04/27/2020] [Accepted: 06/01/2020] [Indexed: 02/04/2023]
Abstract
This study aimed to determine if changes in knee adduction moment (KAM) after 6 months of variable-stiffness shoe wear are associated with changes in symptoms or serum levels of cartilage oligomeric matrix protein (COMP) following a mechanical stimulus in subjects with medial knee osteoarthritis (OA). Twenty-five subjects were enrolled in the study and assigned a variable-stiffness shoe, and 19 subjects completed the 6-month follow-up. At baseline and follow-up subjects underwent gait analysis in control and variable-stiffness shoes, completed Western Ontario and McMaster Universities (WOMAC) questionnaires, and serum COMP concentrations were measured immediately before, 3.5 and 5.5 hours after a 30-minute walking activity. Relationships between changes in KAM (first peak and impulse) and changes in (a) COMP levels in response to the 30-minute walking activity and (b) WOMAC scores from baseline to 6-month follow-up were assessed by Pearson correlation coefficients. Changes in first peak KAM were associated with changes in COMP levels 5.5 hours postactivity from baseline to follow-up (R = .564, P = .045). Subjects with greater reductions in KAM had larger decreases in COMP (expressed as a percent of preactivity levels) at follow-up. Subjects with greater reductions in KAM impulse had significantly greater improvements in WOMAC Pain (R = -.56, P = .015) and Function (R = -.52, P = .028) scores at follow-up. The study results demonstrated the magnitude of reduction in the KAM wearing a variable-stiffness shoe is associated with decreases in mechanically stimulated COMP levels and pain/function. This work suggests that interactions between COMP and joint loading during walking should be further investigated in future studies of treatment outcomes in OA.
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Affiliation(s)
- Jennifer C Erhart-Hledik
- Department of Orthopaedic Surgery, Stanford University, Stanford, California.,VA Palo Alto Health Care System, Palo Alto, California
| | - Gordhan B Mahtani
- Department of Orthopaedic Surgery, Stanford University, Stanford, California.,VA Palo Alto Health Care System, Palo Alto, California
| | - Jessica L Asay
- VA Palo Alto Health Care System, Palo Alto, California.,Department of Mechanical Engineering, Stanford University, Stanford, CA
| | - Eleonora Migliore
- Department of Orthopaedic Surgery, Stanford University, Stanford, California.,VA Palo Alto Health Care System, Palo Alto, California
| | - Michelle M Nguyen
- VA Palo Alto Health Care System, Palo Alto, California.,Department of Radiology, Stanford University, Stanford, CA
| | - Thomas P Andriacchi
- VA Palo Alto Health Care System, Palo Alto, California.,Department of Mechanical Engineering, Stanford University, Stanford, CA
| | - Constance R Chu
- Department of Orthopaedic Surgery, Stanford University, Stanford, California.,VA Palo Alto Health Care System, Palo Alto, California
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Luc-Harkey BA, Franz J, Hackney AC, Blackburn JT, Padua DA, Schwartz T, Davis-Wilson H, Spang J, Pietrosimone B. Immediate Biochemical Changes After Gait Biofeedback in Individuals With Anterior Cruciate Ligament Reconstruction. J Athl Train 2020; 55:1106-1115. [PMID: 32966563 DOI: 10.4085/1062-6050-0372.19] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Gait biomechanics are linked to biochemical changes that contribute to the development of posttraumatic knee osteoarthritis in individuals with anterior cruciate ligament reconstruction (ACLR). It remains unknown if modifying peak loading during gait using real-time biofeedback will result in acute biochemical changes related to cartilage metabolism. OBJECTIVE To determine if acutely manipulating peak vertical ground reaction force (vGRF) during gait influences acute changes in serum cartilage oligomeric matrix protein concentration (sCOMP) among individuals with ACLR. DESIGN Crossover study. PATIENTS OR OTHER PARTICIPANTS Thirty individuals with unilateral ACLR participated (70% female, age = 20.43 ± 2.91 years old, body mass index = 24.42 ± 4.25, months post-ACLR = 47.83 ± 26.97). Additionally, we identified a subgroup of participants who demonstrated an increase in sCOMP after the control or natural loading condition (sCOMPCHANGE > 0 ng/mL, n = 22, 70% female, age = 20.32 ± 3.00 years old, body mass index = 24.73 ± 4.33, months post-ACLR = 47.27 ± 29.32). MAIN OUTCOME MEASURE(S) Serum was collected both prior to and immediately after each condition to determine sCOMPchange. INTERVENTION(S) All participants attended 4 sessions that involved 20 minutes of walking on a force-measuring treadmill consisting of a control condition (natural loading) followed by random ordering of 3 loading conditions with real-time biofeedback: (1) symmetric vGRF between limbs, (2) a 5% increase in vGRF (high loading) and (3) a 5% decrease in vGRF (low loading). A general linear mixed model was used to determine differences in sCOMPCHANGE between altered loading conditions and the control group in the entire cohort and the subgroup. RESULTS The sCOMPCHANGE was not different across loading conditions for the entire cohort (F3,29 = 1.34, P = .282). Within the subgroup, sCOMPCHANGE was less during high loading (1.95 ± 24.22 ng/mL, t21 = -3.53, P = .005) and symmetric loading (9.93 ± 21.45 ng/mL, t21 = -2.86, P = .025) compared with the control condition (25.79 ± 21.40 ng/mL). CONCLUSIONS Increasing peak vGRF during gait decreased sCOMP in individuals with ACLR who naturally demonstrated an increase in sCOMP after 20 minutes of walking. TRIAL REGISTRY ClinicalTrials.gov (NCT03035994).
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Affiliation(s)
| | - Jason Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh
| | - Anthony C Hackney
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - J Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Darin A Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Todd Schwartz
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Hope Davis-Wilson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Jeffrey Spang
- Department of Orthopaedics, MOTION Science Institute, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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Munsch AE, Pietrosimone B, Franz JR. The effects of knee extensor moment biofeedback on gait biomechanics and quadriceps contractile behavior. PeerJ 2020; 8:e9509. [PMID: 32714665 PMCID: PMC7353917 DOI: 10.7717/peerj.9509] [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: 03/06/2020] [Accepted: 06/18/2020] [Indexed: 12/20/2022] Open
Abstract
Individuals with knee joint pathologies exhibit quadriceps dysfunction that, during walking, manifests as smaller peak knee extensor moment (pKEM) and reduced knee flexion excursion. These changes persist despite muscle strengthening and may alter stance phase knee joint loading considered relevant to osteoarthritis risk. Novel rehabilitation strategies that more directly augment quadriceps mechanical output during functional movements are needed to reduce this risk. As an important first step, we tested the efficacy of real-time biofeedback during walking to prescribe changes of ±20% and ±40% of normal walking pKEM values in 11 uninjured young adults. We simultaneously recorded knee joint kinematics, ground reaction forces, and, via ultrasound, vastus lateralis (VL) fascicle length change behavior. Participants successfully responded to real-time biofeedback and averaged up to 55% larger and 51% smaller than normal pKEM values with concomitant and potentially favorable changes in knee flexion excursion. While the VL muscle-tendon unit (MTU) lengthened, VL fascicles accommodated weight acceptance during walking largely through isometric, or even slight concentric, rather than eccentric action as is commonly presumed. Targeted pKEM biofeedback may be a useful rehabilitative and/or scientific tool to elicit desirable changes in knee joint biomechanics considered relevant to the development of osteoarthritis.
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Affiliation(s)
- Amanda E Munsch
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States of America
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States of America
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Bjerre-Bastos JJ, Nielsen HB, Andersen JR, He Y, Karsdal M, Bay-Jensen AC, Boesen M, Mackey AL, Bihlet AR. Evaluation of serum ARGS neoepitope as an osteoarthritis biomarker using a standardized model for exercise-induced cartilage extra cellular matrix turnover. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100060. [DOI: 10.1016/j.ocarto.2020.100060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 01/03/2023] Open
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Bricca A, Struglics A, Larsson S, Steultjens M, Juhl CB, Roos EM. Impact of Exercise Therapy on Molecular Biomarkers Related to Cartilage and Inflammation in Individuals at Risk of, or With Established, Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Arthritis Care Res (Hoboken) 2020; 71:1504-1515. [PMID: 30320965 DOI: 10.1002/acr.23786] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/09/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate the impact of exercise therapy on molecular biomarkers related to cartilage and inflammation in individuals at risk of, or with established, knee osteoarthritis by conducting a systematic review of randomized controlled trials (RCTs). METHODS We conducted a literature search up to September 2017 in 5 major databases with no restriction on publication year or language. Data were extracted from the first available follow-up time point, and we performed a narrative synthesis for the effect of exercise therapy on molecular biomarkers related to cartilage and inflammation. A subset of studies reporting sufficient data was combined in a meta-analysis, using an adjusted random-effects model. RESULTS Twelve RCTs involving 57 study comparisons at 4 to 24 weeks following an exercise-therapy intervention were included. Exercise therapy decreased molecular biomarkers in 17 study comparisons (30%), had no effect in 36 (63%), and increased molecular biomarkers in 4 study comparisons (7%). Meta-analyses of 9 biomarkers showed that exercise therapy was associated with nonsignificant reductions of the C-reactive protein level, C-terminal crosslinking telopeptide of type II collagen, tumor necrosis factor (TNF), soluble TNF receptors 1 and 2, C2C neoepitope of type II collagen, and cartilage oligomeric matrix protein, compared to nonexercising control groups, and exercise therapy had no effect on interleukin-6 and soluble interleukin-6 receptor. CONCLUSION Exercise therapy is not harmful, because it does not increase the concentration of molecular biomarkers related to cartilage turnover and inflammation, implicated in osteoarthritis progression. The overall quality of evidence was downgraded to low because of the limited number of RCTs available.
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Affiliation(s)
- Alessio Bricca
- Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Carsten B Juhl
- University of Southern Denmark, Odense, and Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark
| | - Ewa M Roos
- Herlev and Gentofte Hospitals, University of Copenhagen, Copenhagen, Denmark
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Bjerre‐Bastos JJ, Karsdal MA, Boesen M, Bliddal H, Bay‐Jensen A, Andersen JR, Bihlet AR. The acute and long‐term impact of physical activity on biochemical markers and MRI measures in osteoarthritis—Perspectives for clinical osteoarthritis research. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jonathan Jetsmark Bjerre‐Bastos
- Nordic Bioscience Clinical Development Herlev Denmark
- Institute of Biomedical Sciences University of Copenhagen Copenhagen Denmark
| | | | - Mikael Boesen
- Department of Radiology University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
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Andriacchi TP, Griffin TM, Loeser RF, Chu CR, Roos EM, Hawker GA, Erhart-Hledik JC, Fischer AG. Bridging Disciplines as a pathway to Finding New Solutions for Osteoarthritis a collaborative program presented at the 2019 Orthopaedic Research Society and the Osteoarthritis Research Society International. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100026. [DOI: 10.1016/j.ocarto.2020.100026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/18/2019] [Accepted: 01/07/2020] [Indexed: 01/18/2023] Open
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35
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Selistre LFA, Gonçalves GH, Vasilceac FA, Serrão PRMDS, Nakagawa TH, Petrella M, Jones RK, Mattiello SM. The relationship between urinary C-Telopeptide fragments of type II collagen, knee joint load, pain, and physical function in individuals with medial knee osteoarthritis. Braz J Phys Ther 2020; 25:62-69. [PMID: 32151525 DOI: 10.1016/j.bjpt.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Considering the osteoarthritis (OA) model that integrates the biological, mechanical, and structural components of the disease, the present study aimed to investigate the association between urinary C-Telopeptide fragments of type II collagen (uCTX-II), knee joint moments, pain, and physical function in individuals with medial knee OA. METHODS Twenty-five subjects radiographically diagnosed with knee OA were recruited. Participants were evaluated through three-dimensional gait analysis, uCTX-II level, the WOMAC pain and physical function scores, and the 40m walk test. The association between these variables was investigated using Pearson's product-moment correlation, followed by a hierarchical linear regression, controlled by OA severity and body mass index (BMI). RESULTS No relationship was found between uCTX-II level and knee moments. A significant correlation between uCTX-II level and pain, physical function, and the 40m walk test was found. The hierarchical linear regression controlling for OA severity and BMI showed that uCTX-II level explained 9% of the WOMAC pain score, 27% of the WOMAC physical function score, and 7% of the 40m walk test. CONCLUSION Greater uCTX-II level is associated with higher pain and reduced physical function and 40m walk test performance in individuals with medial knee OA.
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Affiliation(s)
| | - Glaucia Helena Gonçalves
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | | | | | - Theresa Helissa Nakagawa
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Marina Petrella
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | | | - Stela Márcia Mattiello
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
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36
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A Stimulus-Response Framework to Investigate the Influence of Continuous Versus Interval Walking Exercise on Select Serum Biomarkers in Knee Osteoarthritis. Am J Phys Med Rehabil 2019; 98:287-291. [PMID: 30300230 DOI: 10.1097/phm.0000000000001068] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to compare changes in the concentration of serum biomarkers in response to continuous versus interval walking exercise in participants with knee osteoarthritis. DESIGN This study used a two-phase sequential design. Twenty-seven participants with unilateral knee osteoarthritis completed two separate treadmill walking sessions: (1) continuous 45-min walking exercise and (2) three 15-min bouts of walking exercise separated by 1-hr rest periods for a total of 45 mins in an interval format. Participants reported their knee pain using the numeric pain rating scale and serum levels of biomarkers associated with tissue turnover (cartilage oligomeric matrix protein), inflammation (tumor necrosis factor α), and pain (neuropeptide Y) were evaluated at baseline and every 15 mins for both conditions. RESULTS Continuous walking resulted in a cumulative increase in cartilage oligomeric matrix protein concentration up to 45 mins, whereas interval walking was associated with return of cartilage oligomeric matrix protein concentrations back to baseline at 45 mins. There were no significant changes in tumor necrosis factor α and neuropeptide Y concentration during walking. There was a significant increase in pain compared with baseline in the continuous walking regimen only. CONCLUSIONS Incorporating rest breaks in walking regimens may affect the potential deleterious effects of longer continuous bouts on the knee joint as well as limit pain during exercise.
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37
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Roberts HM, Law RJ, Thom JM. The time course and mechanisms of change in biomarkers of joint metabolism in response to acute exercise and chronic training in physiologic and pathological conditions. Eur J Appl Physiol 2019; 119:2401-2420. [PMID: 31650307 PMCID: PMC6858392 DOI: 10.1007/s00421-019-04232-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/14/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE The benefits of exercise across the lifespan and for a wide spectrum of health and diseases are well known. However, there remains less clarity as to the effects of both acute and chronic exercise on joint health. Serum biomarkers of joint metabolism are sensitive to change and have the potential to differentiate between normal and adverse adaptations to acute and chronic load. Therefore, the primary objective of this review is to evaluate how serum biomarkers can inform our understanding of how exercise affects joint metabolism. METHODS A comprehensive literature search was completed to identify joint biomarkers previously used to investigate acute and chronic exercise training. RESULTS Identified biomarkers included those related to joint cartilage, bone, synovium, synovial fluid, and inflammation. However, current research has largely focused on the response of serum cartilage oligomeric matrix protein (COMP) to acute loading in healthy young individuals. Studies demonstrate how acute loading transiently increases serum COMP (i.e., cartilage metabolism), which is mostly dependent on the duration of exercise. This response does not appear to be associated with any lasting deleterious changes, cartilage degradation, or osteoarthritis. CONCLUSION Several promising biomarkers for assessing joint metabolism exist and may in future enhance our understanding of the physiological response to acute and chronic exercise. Defining 'normal' and 'abnormal' biomarker responses to exercise and methodological standardisation would greatly improve the potential of research in this area to understand mechanisms and inform practice.
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Affiliation(s)
- Harry M Roberts
- School of Biosciences and Medicine, University of Surrey, The Leggett Building, Daphne Jackson Road, Guildford, GU2 7WG, UK.
| | - Rebecca-Jane Law
- North Wales Centre for Primary Care Research, School of Health Sciences, Bangor University, Bangor, UK
| | - Jeanette M Thom
- School of Medical Sciences, University of New South Wales, Sydney, Australia.,School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
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38
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Dolzani P, Assirelli E, Pulsatelli L, Meliconi R, Mariani E, Neri S. Ex vivo physiological compression of human osteoarthritis cartilage modulates cellular and matrix components. PLoS One 2019; 14:e0222947. [PMID: 31550275 PMCID: PMC6759151 DOI: 10.1371/journal.pone.0222947] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/10/2019] [Indexed: 01/05/2023] Open
Abstract
Mechanical stimulation appears to play a key role in cartilage homeostasis maintenance, but it can also contribute to osteoarthritis (OA) pathogenesis. Accumulating evidence suggests that cartilage loading in the physiological range contributes to tissue integrity maintenance, whereas excessive or reduced loading have catabolic effects. However, how mechanical stimuli can regulate joint homeostasis is still not completely elucidated and few data are available on human cartilage. We aimed at investigating human OA cartilage response to ex vivo loading at physiological intensity. Cartilage explants from ten OA patients were subjected to ex vivo controlled compression, then recovered and used for gene and protein expression analysis of cartilage homeostasis markers. Compressed samples were compared to uncompressed ones in presence or without interleukin 1β (IL-1β) or interleukin 4 (IL-4). Cartilage explants compressed in combination with IL-4 treatment showed the best histological scores. Mechanical stimulation was able to significantly modify the expression of collagen type II (collagen 2), aggrecan, SOX9 transcription factor, cartilage oligomeric matrix protein (COMP), collagen degradation marker C2C and vascular endothelial growth factor (VEGF). Conversely, ADAMTS4 metallopeptidase, interleukin 4 receptor alpha (IL4Rα), chondroitin sulfate 846 epitope (CS846), procollagen type 2 C-propeptide (CPII) and glycosaminoglycans (GAG) appeared not modulated. Our data suggest that physiological compression of OA human cartilage modulates the inflammatory milieu by differently affecting the expression of components and homeostasis regulators of the cartilage extracellular matrix.
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Affiliation(s)
- Paolo Dolzani
- Laboratorio di Immunoreumatologia e Rigenerazione Tissutale, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elisa Assirelli
- Laboratorio di Immunoreumatologia e Rigenerazione Tissutale, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lia Pulsatelli
- Laboratorio di Immunoreumatologia e Rigenerazione Tissutale, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Riccardo Meliconi
- Unità di Medicina e Reumatologia, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Erminia Mariani
- Laboratorio di Immunoreumatologia e Rigenerazione Tissutale, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Simona Neri
- Laboratorio di Immunoreumatologia e Rigenerazione Tissutale, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- * E-mail:
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39
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Chu CR. Concepts Important to Secondary Prevention of Posttraumatic Osteoarthritis. J Athl Train 2019; 54:987-988. [PMID: 31437015 DOI: 10.4085/1062-6050-54.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Constance R Chu
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA
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40
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Abstract
The classification and monitoring of individuals with early knee osteoarthritis (OA) are important considerations for the design and evaluation of therapeutic interventions and require the identification of appropriate outcome measures. Potential outcome domains to assess for early OA include patient-reported outcomes (such as pain, function and quality of life), features of clinical examination (such as joint line tenderness and crepitus), objective measures of physical function, levels of physical activity, features of imaging modalities (such as of magnetic resonance imaging) and biochemical markers in body fluid. Patient characteristics such as adiposity and biomechanics of the knee could also have relevance to the assessment of early OA. Importantly, research is needed to enable the selection of outcome measures that are feasible, reliable and validated in individuals at risk of knee OA or with early knee OA. In this Perspectives article, potential outcome measures for early symptomatic knee OA are discussed, including those measures that could be of use in clinical practice and/or the research setting.
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41
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DeFrate LE, Kim-Wang SY, Englander ZA, McNulty AL. Osteoarthritis year in review 2018: mechanics. Osteoarthritis Cartilage 2019; 27:392-400. [PMID: 30597275 PMCID: PMC6489451 DOI: 10.1016/j.joca.2018.12.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review recent biomechanics literature focused on the interactions between biomechanics and articular cartilage health, particularly focused on macro-scale and human studies. DESIGN A literature search was conducted in PubMed using the search terms (biomechanics AND osteoarthritis) OR (biomechanics AND cartilage) OR (mechanics AND osteoarthritis) OR (mechanics AND cartilage) for publications from April 2017 to April 2018. RESULTS Abstracts from the 559 articles generated from the literature search were reviewed. Due to the wide range of topics, 62 full texts with a focus on in vivo biomechanical studies were included for further discussion. Several overarching themes in the recent literature were identified and are summarized, including 1) new methods to detect early osteoarthritis (OA) development, 2) studies describing healthy and OA cartilage and biomechanics, 3) ACL injury and OA development, 4) meniscus injury and OA development, and 5) OA prevention, treatment, and management. CONCLUSIONS Mechanical loading is a critical factor in the maintenance of joint health. Abnormal mechanical loading can lead to the onset and progression of OA. Thus, recent studies have utilized various biomechanical models to better describe the etiology of OA development and the subsequent effects of OA on the mechanics of joint tissues and whole body biomechanics.
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Affiliation(s)
- Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Sophia Y. Kim-Wang
- Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Zoë A. Englander
- Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Amy L. McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA,Department of Pathology, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
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42
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Luc-Harkey BA, Franz JR, Hackney AC, Blackburn JT, Padua DA, Pietrosimone B. Lesser lower extremity mechanical loading associates with a greater increase in serum cartilage oligomeric matrix protein following walking in individuals with anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 2018; 60:13-19. [PMID: 30292062 DOI: 10.1016/j.clinbiomech.2018.09.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Aberrant mechanical loading during gait is hypothesized to contribute to the development of posttraumatic osteoarthritis following anterior cruciate ligament reconstruction. Our purpose was to determine if peak vertical ground reaction force and instantaneous vertical ground reaction force loading rate associate with the acute change in serum cartilage oligomeric matrix protein following a 20-minute bout of walking. METHODS We enrolled thirty individuals with a unilateral anterior cruciate ligament reconstruction. Peak vertical ground reaction force and instantaneous vertical ground reaction force loading rate were extracted from the first 50% of the stance phase of gait during a 60-second trial. Blood samples were collected immediately before and after 20 min of treadmill walking at self-selected speed. The change in serum cartilage oligomeric matrix protein from pre- to post-walking was calculated. Stepwise linear regression models were used to determine the association between each outcome of loading and the change in serum cartilage oligomeric matrix protein after accounting for sex, gait speed, time since anterior cruciate ligament reconstruction, graft type, and history of concomitant meniscal procedure (ΔR2). FINDINGS Lesser peak vertical ground reaction force (ΔR2 = 0.208; β = -0.561; P = 0.019) and instantaneous vertical ground reaction force loading rate (ΔR2 = 0.168; β = -0.519; P = 0.037) on the anterior cruciate ligament reconstructed limb associated with a greater increase in serum cartilage oligomeric matrix protein following 20 min of walking. INTERPRETATION Mechanical loading may be a future therapeutic target for altering the acute biochemical response to walking in individuals with an anterior cruciate ligament reconstruction.
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Affiliation(s)
- Brittney A Luc-Harkey
- Neurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston, MA, United States of America.
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States of America
| | - Anthony C Hackney
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - J Troy Blackburn
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Darin A Padua
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Edd SN, Omoumi P, Andriacchi TP, Jolles BM, Favre J. Modeling knee osteoarthritis pathophysiology using an integrated joint system (IJS): a systematic review of relationships among cartilage thickness, gait mechanics, and subchondral bone mineral density. Osteoarthritis Cartilage 2018; 26:1425-1437. [PMID: 30056214 DOI: 10.1016/j.joca.2018.06.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/08/2018] [Accepted: 06/26/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To introduce an integrated joint system (IJS) model of joint health and osteoarthritis (OA) pathophysiology through a systematic review of the cross-sectional relationships among three knee properties (cartilage thickness, gait mechanics, and subchondral bone mineral density). METHODS Searches using keywords associated with the three knee properties of interest were performed in PubMed, Scopus, and Ovid databases. English-language articles reporting cross-sectional correlations between at least two knee properties in healthy or tibiofemoral OA human knees were included. A narrative synthesis of the data was conducted. RESULTS Of the 5600 retrieved articles, 13 were included, eight of which reported relationships between cartilage thickness and gait mechanics. The 744 tested knees were separated into three categories based on knee health: 199 healthy, 340 at-risk/early OA, and 205 late OA knees. Correlations between knee adduction moment and medial-to-lateral cartilage thickness ratios were generally positive in healthy, inconclusive in at-risk/early OA, and negative in late OA knees. Knee adduction moment was positively correlated with medial-to-lateral tibial subchondral bone mineral density ratios in knees of all health categories. One study reported a positive correlation between lateral tibial subchondral bone mineral density and femoral cartilage thickness in at-risk/early OA knees. CONCLUSIONS The correlations identified between knee properties in this review agreed with the proposed relationship-based IJS model of OA pathophysiology. Accordingly, the IJS model could provide insights into overcoming current barriers to developing disease-modifying treatments by considering multiple aspects of OA disease, aspects that could be assessed simultaneously at an in vivo system level.
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Affiliation(s)
- S N Edd
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland.
| | - P Omoumi
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Diagnostic and Interventional Radiology, Lausanne, Switzerland.
| | - T P Andriacchi
- Department of Mechanical Engineering, Stanford, CA, USA; Palo Alto Veterans Affairs, Palo Alto, CA, USA; Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA.
| | - B M Jolles
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland; Ecole Polytechnique Fédérale de Lausanne (EPFL), Institute of Microengineering, Lausanne, Switzerland.
| | - J Favre
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Department of Musculoskeletal Medicine (DAL), Swiss BioMotion Lab, Lausanne, Switzerland.
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Nordquist E, LaHaye S, Nagel C, Lincoln J. Postnatal and Adult Aortic Heart Valves Have Distinctive Transcriptional Profiles Associated With Valve Tissue Growth and Maintenance Respectively. Front Cardiovasc Med 2018; 5:30. [PMID: 29740591 PMCID: PMC5928323 DOI: 10.3389/fcvm.2018.00030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/15/2018] [Indexed: 12/16/2022] Open
Abstract
Heart valves are organized connective tissues of high mechanical demand. They open and close over 100,000 times a day to preserve unidirectional blood flow by maintaining structure-function relationships throughout life. In affected individuals, structural failure compromises function and often leads to regurgitant blood flow and progressive heart failure. This is most common in degenerative valve disease due to age-related wear and tear, or congenital malformations. At present, the only effective treatment of valve disease is surgical repair or replacement and this is often impermanent and requires anti-coagulation therapy throughout life. Therefore, there is a critical need to discover new alternatives. A promising therapeutic area is tissue regeneration and in non-valvular tissues this requires a tightly regulated genetic “growth program” involving cell proliferation. To explore this in heart valves, we performed RNA-seq analysis to compare transcriptional profiles of aortic valve tissue isolated from mice during stages of growth (postnatal day (PND) 2) and adult maintenance (4 months). Data analysis reveals distinct mRNA profiles at each time point and pathway ontology identifies associated changes in biological functions. The PND2 aortic valve is characterized by extensive cell proliferation and expression of mRNAs related to the extracellular matrix (ECM). At 4 months, proliferation is not significant and a differential set of ECM-related genes are expressed. Interestingly there is enrichment of the defense response biological process at this later time point. Together, these data highlight the unique transcriptome of the postnatal valve during stages of growth and maturation, as well as biological functions associated with adult homeostatic valves. These studies create a platform for future work exploring the molecular programs altered in the onset of heart valve disease after birth and provide insights for the development of mechanistic-based therapies.
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Affiliation(s)
- Emily Nordquist
- Molecular Cellular and Developmental Biology Graduate Program, The Ohio State University, Columbus, OH, United States.,Center for Cardiovascular Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States.,The Heart Center, Nationwide Children's Hospital, Columbus, OH, United States
| | - Stephanie LaHaye
- The Institute for Genomic Medicine at Nationwide Children's Hospital, Columbus, OH, United States
| | - Casey Nagel
- Ocean Ridge Biosciences, Deerfield Beach, FL, United States
| | - Joy Lincoln
- Center for Cardiovascular Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States.,The Heart Center, Nationwide Children's Hospital, Columbus, OH, United States.,Department of Pediatrics, The Ohio State University, Columbus, OH, United States
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45
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Roberts HM, Moore JP, Thom JM. The effect of aerobic walking and lower body resistance exercise on serum COMP and hyaluronan, in both males and females. Eur J Appl Physiol 2018. [PMID: 29536174 DOI: 10.1007/s00421-018-3837-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the serum cartilage oligomeric matrix protein (COMP) and hyaluronan (HA) response to walking (high-repetition loading) and resistance training exercise (low-repetition loading) in males and females. METHODS 15 males (age: 28 ± 6 years; BMI: 24 ± 2; mean ± SD) and 15 females (age: 26 ± 4 years; BMI: 23 ± 2) completed both a 40-min walk at 80% of maximum heart rate and a 40-min lower body resistance training protocol, separated by a minimum of 48 h. Serum COMP and HA were determined at rest, immediately post, and 30-min post exercise. Resting femoral cartilage thickness was also measured using ultrasonography. RESULTS COMP increased following walking (28.9%; P < 0.001) and resistance training exercise (26.0%; P < 0.001), remaining above baseline post-exercise following walking (mean difference: +28.3 ng/ml; 95% CI 3.8-52.8 ng/ml; P = 0.02). Although the exercise response did not differ for gender, COMP concentrations were higher in males than in females at all time points (all, P < 0.001). In contrast, HA concentrations did not change following either modality of exercise. However, females demonstrated higher HA pre-exercise (37.7 ± 17.8 vs 26.2 ± 12.8 ng/ml; P = 0.006) and immediately post exercise (38.0 ± 19.0 vs 28.2 ± 15.5 ng/ml; P = 0.033) compared to men. Finally, following adjustment for body size, femoral cartilage thickness was greater in men compared to women (notch: 2.66 vs 1.74 mm, P < 0.001). CONCLUSION The effect of a single bout of lower body exercise on serum COMP and HA is independent of exercise modality in healthy men and women. Furthermore, having thicker femoral cartilage and higher baseline COMP in males does not appear to influence how the cartilage responds to exercise.
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Affiliation(s)
- Harry M Roberts
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK.
- School of Biosciences and Medicine, University of Surrey, The Leggett Building, Daphne Jackson Road, Guildford, GU2 7WG, UK.
| | - Jonathan P Moore
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Jeanette M Thom
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
- School of Medical Sciences, University of New South Wales, Sydney, Australia
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Chu CR, Sheth S, Erhart-Hledik JC, Do B, Titchenal MR, Andriacchi TP. Mechanically stimulated biomarkers signal cartilage changes over 5 years consistent with disease progression in medial knee osteoarthritis patients. J Orthop Res 2018; 36:891-897. [PMID: 28862360 PMCID: PMC6548432 DOI: 10.1002/jor.23720] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/29/2017] [Indexed: 02/04/2023]
Abstract
Using serum biomarkers to assess osteoarthritis (OA) disease state and risks of progression remain challenging. This study tested the hypothesis that changes to serum biomarkers in response to a mechanical stimulus in patients with medial knee OA signal cartilage thickness changes 5 years later. Specifically, serum concentrations of a collagen degradation marker (C1,2C) and a chondroitin sulfate synthesis marker (CS846) were measured 0.5 and 5.5 hours after a 30-min walk in 16 patients. Regional cartilage thickness changes measured from magnetic resonance images obtained at study entry and at 5-year follow-up were tested for correlations with baseline biomarker changes after mechanical stimulus, and for differences between groups stratified based on whether biomarker levels increased or decreased. Results showed that an increase in the degradation biomarker C1,2C correlated with cartilage thinning of the lateral tibia (R = -0.63, p = 0.009), whereas an increase in the synthesis marker CS846 correlated with cartilage thickening of the lateral femur (R = 0.76, p = 0.001). Changes in C1,2C and CS846 were correlated (R2 = 0.28, p = 0.037). Subjects with increased C1,2C had greater (p = 0.05) medial tibial cartilage thinning than those with decreased C1,2C. In conclusion, the mechanical stimulus appeared to metabolically link the biomarker responses where biomarker increases signaled more active OA disease states. The findings of medial cartilage thinning for patients with increases in the degradation marker and correlation of cartilage thickening in the less involved lateral femur with increases in the synthetic marker were consistent with progression of medial compartment OA. Thus, the mechanical stimulus facilitated assessing OA disease states using serum biomarkers. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:891-897, 2018.
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Affiliation(s)
- Constance R. Chu
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Shikha Sheth
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Jennifer C. Erhart-Hledik
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California,Veterans Affairs Palo Alto Health Care System, Palo Alto, California,Department of Mechanical Engineering, Stanford University, Building 520, Stanford 94305-4040, California
| | - Bao Do
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California,Veterans Affairs Palo Alto Health Care System, Palo Alto, California,Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Matthew R. Titchenal
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California,Veterans Affairs Palo Alto Health Care System, Palo Alto, California,Department of Mechanical Engineering, Stanford University, Building 520, Stanford 94305-4040, California
| | - Thomas P. Andriacchi
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California,Veterans Affairs Palo Alto Health Care System, Palo Alto, California,Department of Mechanical Engineering, Stanford University, Building 520, Stanford 94305-4040, California
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Ren G, Lutz I, Railton P, Wiley JP, McAllister J, Powell J, Krawetz RJ. Serum and synovial fluid cytokine profiling in hip osteoarthritis: distinct from knee osteoarthritis and correlated with pain. BMC Musculoskelet Disord 2018; 19:39. [PMID: 29402254 PMCID: PMC5800026 DOI: 10.1186/s12891-018-1955-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/25/2018] [Indexed: 12/01/2022] Open
Abstract
Background Inflammation is associated with the onset and progression of osteoarthritis in multiple joints. It is well known that mechanical properties differ between different joints, however, it remains unknown if the inflammatory process is similar/distinct in patients with hip vs. knee OA. Without complete understanding of the role of any specific cytokine in the inflammatory process, understanding the ‘profile’ of inflammation in a given patient population is an essential starting point. The aim of this study was to identify serum cytokine profiles in hip Osteoarthritis (OA), and investigate the association between cytokine concentrations and clinical measurements within this patient population and compare these findings to knee OA and healthy control cohorts. Methods In total, 250 serum samples (100 knee OA, 50 hip OA and 100 control) and 37 synovial fluid samples (8 knee OA, 14 hip OA and 15 control) were analyzed using a multiplex ELISA based approach. Synovial biopsies were also obtained and examined for specific cytokines. Pain, physical function and activity within the hip OA cohort were examined using the HOOS, SF-36, HHS and UCLA outcome measures. Results The three cohorts showed distinct serum cytokine profiles. EGF, FGF2, MCP3, MIP1α, and IL8 were differentially expressed between hip and knee OA cohorts; while FGF2, GRO, IL8, MCP1, and VEGF were differentially expressed between hip OA and control cohorts. Eotaxin, GRO, MCP1, MIP1β, VEGF were differentially expressed between knee OA and control cohorts. EGF, IL8, MCP1, MIP1β were differentially expressed in synovial fluid from a sub-set of patients from each cohort. Specifically within the hip OA cohort, IL-6, MDC and IP10 were associated with pain and were also found to be present in synovial fluid and synovial membrane (except IL-6) of patients with hip OA. Conclusion OA may include different inflammatory subtypes according to affected joints and distinct inflammatory processes may drive OA in these joints. IL6, MDC and IP10 are associated with hip OA pain and these proteins may be able to provide additional information regarding pain in hip OA patients. Electronic supplementary material The online version of this article (10.1186/s12891-018-1955-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Guomin Ren
- McCaig Institute for Bone and Joint Health, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada
| | - Ian Lutz
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | - J Preston Wiley
- McCaig Institute for Bone and Joint Health, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada.,Sports Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jenelle McAllister
- Sports Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - James Powell
- McCaig Institute for Bone and Joint Health, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Roman J Krawetz
- McCaig Institute for Bone and Joint Health, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada. .,Department of Surgery, University of Calgary, Calgary, Alberta, Canada. .,Department of Anatomy and Cell Biology, University of Calgary, Calgary, Alberta, Canada.
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Mündermann A, Klenk C, Billich C, Nüesch C, Pagenstert G, Schmidt-Trucksäss A, Schütz U. Changes in Cartilage Biomarker Levels During a Transcontinental Multistage Footrace Over 4486 km. Am J Sports Med 2017. [PMID: 28650691 DOI: 10.1177/0363546517712945] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cartilage turnover and load-induced tissue changes are frequently assessed by quantifying concentrations of cartilage biomarkers in serum. To date, information on the effects of ultramarathon running on articular cartilage is scarce. HYPOTHESIS Serum concentrations of cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP)-1, MMP-3, MMP-9, COL2-3/4C long mono (C2C), procollagen type II C-terminal propeptide (CPII), and C2C:CPII will increase throughout a multistage ultramarathon. STUDY DESIGN Descriptive laboratory study. METHODS Blood samples were collected from 36 runners (4 female; mean age, 49.0 ± 10.7 years; mean body mass index, 23.1 ± 2.3 kg/m2 [start] and 21.4 ± 1.9 kg/m2 [finish]) before (t0) and during (t1: 1002 km; t2: 2132 km; t3: 3234 km; t4: 4039 km) a 4486-km multistage ultramarathon. Serum COMP, MMP-1, MMP-3, MMP-9, C2C, and CPII levels were assessed using commercial enzyme-linked immunosorbent assays. Linear mixed models were used to detect significant changes in serum biomarker levels over time with the time-varying covariates of body weight, running speed, and daily running time. RESULTS Serum concentrations of COMP, MMP-9, and MMP-3 changed significantly throughout the multistage ultramarathon. On average, concentrations increased during the first measurement interval (MI1: t1-t0) by 22.5% for COMP (95% CI, 0.29-0.71 ng/mL), 22.3% for MMP-3 (95% CI, 0.24-15.37 ng/mL), and 95.6% for MMP-9 (95% CI, 81.7-414.5 ng/mL) and remained stable throughout MI2, MI3, and MI4. Serum concentrations of MMP-1, C2C, CPII, and C2C:CPII did not change significantly throughout the multistage ultramarathon. Changes in MMP-3 were statistically associated with changes in COMP throughout the ultramarathon race (MMP-3: Wald Z = 3.476, P = .001). CONCLUSION Elevated COMP levels indicate increased COMP turnover in response to extreme running, and the association between load-induced changes in MMP-3 and changes in COMP suggests the possibility that MMP-3 may be involved in the degradation of COMP. CLINICAL RELEVANCE These results suggest that articular cartilage is able to adapt even to extreme physical activity, possibly explaining why the risk of degenerative joint disease is not elevated in the running population.
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Affiliation(s)
- Annegret Mündermann
- Orthopaedics and Traumatology Clinic, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Christopher Klenk
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Christian Billich
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Corina Nüesch
- Orthopaedics and Traumatology Clinic, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Geert Pagenstert
- Orthopaedics and Traumatology Clinic, University of Basel Hospital, Basel, Switzerland
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Uwe Schütz
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany.,Orthopaedic and Pain Outpatient Center "Am Grünen Turm," Ravensburg, Germany
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Xin L, Wu Z, Qu Q, Wang R, Tang J, Chen L. Comparative study of CTX-II, Zn2+, and Ca2+ from the urine for knee osteoarthritis patients and healthy individuals. Medicine (Baltimore) 2017; 96:e7593. [PMID: 28796042 PMCID: PMC5556208 DOI: 10.1097/md.0000000000007593] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study was to explore the relationship between the concentration of C-telopeptide fragments of type II collagen (CTX-II), Zn, and Ca in urine and knee osteoarthritis (KOA).Eighty-two patients with KOA and 20 healthy volunteers were enrolled. Anteroposterior and lateral position x-rays of knee joints were collected. The images were classified according to Kellgren-Lawrence radiographic grading criterion. The patients were divided into group grade I, group grade II, group grade III, and grade IV. The concentration of CTX-II in the urine was detected by enzyme-linked immunosorbent assay. The concentration of Zn and Ca in urine was detected by inductively coupled plasma atomic emission spectrometry.Compared with the healthy individuals, the concentration of CTX-II was significantly higher in KOA patients. The concentration of CTX-II in KOA patients from high to low was as follows: group IV, group III, group II, and group I. There was no significant difference between group I and healthy individuals. The concentration of Zn and Ca in urine of KOA patients was higher than that in healthy individuals. There was no difference in each KOA group.The concentration of CTX-II is instrumental to diagnose the progress of KOA. The concentration of Zn and Ca in urine is helpful for early diagnosis of KOA.
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50
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Cattano NM, Driban JB, Barbe MF, Tierney R, Amin M, Sitler MR. Physical activity levels and quality of life relate to collagen turnover and inflammation changes after running. J Orthop Res 2017; 35:612-617. [PMID: 27035929 DOI: 10.1002/jor.23250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/29/2016] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to determine whether an association existed between self-reported symptom and function scores and tissue turnover or inflammatory biomarker changes after a running bout among individuals with and without an acute knee-injury history. A pre-test/post-test prospective cohort study design (Level II) of 22 participants was conducted. Eleven physically active individuals with a history of anterior cruciate ligament surgery and/or meniscus surgery within 4 years of study participation were matched to 11 healthy control participants. All participants completed self-reported outcome measures (Knee Osteoarthritis Outcomes Score and Tegner activity level) assessing knee symptoms and functional levels prior to the run. Blood samples were taken both pre- and post-30-minute run at a prescribed pace on a treadmill to determine serum biomarker concentration changes. Tegner activity levels were inversely related to type II collagen/type II collagen synthesis marker ratio biomarker changes after the run (r = -0.45, p = 0.01). Quality-of-life scores pre-exercise were inversely related to interleukin-1β changes after the run (r = -0.50, p = 0.02). No other correlation coefficients were statistically significant (r = -0.39 to 0.36). Ultimately, individuals with lower activity and quality-of-life scores experienced greater increases in collagen turnover and inflammation after a running bout, respectively. A gradual increase in activity (e.g., frequency, duration, intensity) may be warranted in this group prior to returning to activities that involve running. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:612-617, 2017.
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Affiliation(s)
- Nicole M Cattano
- Department of Sports Medicine, West Chester University of Pennsylvania, 855 S. New Street, 222L Sturzebecker HSC, West Chester, PA, 19383
| | - Jeffrey B Driban
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA, 02111
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, 3500 N. Broad Street, Philadelphia, PA, 19140
| | - Ryan Tierney
- Department of Kinesiology, Temple University, 259 Pearson Hall, Philadelphia, PA, 19122
| | - Mamta Amin
- Department of Anatomy and Cell Biology, Temple University School of Medicine, 3500 N. Broad Street, Philadelphia, PA, 19140
| | - Michael R Sitler
- College of Public Health, Temple University, Polett Walk, G20 Sullivan Hall, Philadelphia, PA, 19140
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