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Wang H, Weng X, Chen Y, Mao S, Gao Y, Wu Q, Huang Y, Guan X, Xu Z, Lai Y. Biomimetic concentric microgrooved titanium surfaces influence bone marrow-derived mesenchymal stem cell osteogenic differentiation via H3K4 trimethylation epigenetic regulation. Dent Mater J 2024; 43:683-692. [PMID: 39135261 DOI: 10.4012/dmj.2023-327] [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: 10/01/2024]
Abstract
Material surface micromorphology can modulate cellular behavior and promote osteogenic differentiation through cytoskeletal rearrangement. Bone reconstruction requires precise regulation of gene expression in cells, a process governed by epigenetic mechanisms such as histone modifications, DNA methylation, and chromatin remodeling. We constructed osteon-mimetic concentric microgrooved titanium surfaces with different groove sizes and cultured bone marrow-derived mesenchymal stem cells (BMSCs) on the material surfaces to study how they regulate cell biological behavior and osteogenic differentiation through epigenetics. We found that the cells arranged in concentric circles along the concentric structure in the experimental group, and the concentric microgrooved surface did not inhibit cell proliferation. The results of a series of osteogenic differentiation experiments showed that the concentric microgrooves facilitated calcium deposition and promoted osteogenic differentiation of the BMSCs. Concentric microgrooved titanium surfaces that were 30 μm wide and 10 μm deep promoted osteogenic differentiation of BMSC by increasing WDR5 expression via H3K4 trimethylation upregulation.
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Affiliation(s)
- Hong Wang
- Department of Stomatology, Engineering Research Center of Fujian University for Stomatological Biomaterials, Xiamen Medical College
- Stomatological Hospital of Xiamen Medical college
| | - Xinze Weng
- Department of Stomatology, Engineering Research Center of Fujian University for Stomatological Biomaterials, Xiamen Medical College
| | - Yan Chen
- Department of Stomatology, Engineering Research Center of Fujian University for Stomatological Biomaterials, Xiamen Medical College
| | - Shunjie Mao
- Department of Stomatology, Engineering Research Center of Fujian University for Stomatological Biomaterials, Xiamen Medical College
| | - Yuerong Gao
- Department of Stomatology of The Third Affiliated Hospital of Xi'an Medical University
| | - Qinglin Wu
- Department of Stomatology, Engineering Research Center of Fujian University for Stomatological Biomaterials, Xiamen Medical College
| | - Yanling Huang
- Department of Stomatology, Engineering Research Center of Fujian University for Stomatological Biomaterials, Xiamen Medical College
| | - Xin Guan
- Department of Stomatology, Engineering Research Center of Fujian University for Stomatological Biomaterials, Xiamen Medical College
| | - Zhiqiang Xu
- Department of Stomatology, Affiliated Hospital of Putian University
| | - Yingzhen Lai
- Department of Stomatology, Engineering Research Center of Fujian University for Stomatological Biomaterials, Xiamen Medical College
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Mesa-Restrepo A, Byers E, Brown JL, Ramirez J, Allain JP, Posada VM. Osteointegration of Ti Bone Implants: A Study on How Surface Parameters Control the Foreign Body Response. ACS Biomater Sci Eng 2024; 10:4662-4681. [PMID: 39078702 DOI: 10.1021/acsbiomaterials.4c00114] [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: 08/13/2024]
Abstract
The integration of titanium (Ti)-based implants with bone is limited, resulting in implant failure. This lack of osteointegration is due to the foreign body response (FBR) that occurs after the implantation of biodevices. The process begins with protein adsorption, which is governed by implant surface properties, e.g., chemistry, charge, wettability, and/or topography. The distribution and composition of the protein layer in turn influence the recruitment, differentiation, and modulation of immune and bone cells. The subsequent events that occur at the bone-material interface will ultimately determine whether the implant is encapsulated or will integrate with bone. Despite the numerous studies evaluating the influence of surface properties in the various stages of the FBR, the factors that affect tissue-material interactions are often studied in isolation or in small correlations due to the technical challenges involved in assessing them in vitro or in vivo. Consequently, the influence of protein conformation on the Ti bone implant surface design remains an unresolved research question. The objective of this review is to comprehensively evaluate the existing literature on the effect of surface parameters of Ti and its alloys in the stages of FBR, with a particular focus on protein adsorption and osteoimmunomodulation. This evaluation aims to systematically describe these effects on bone formation.
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Affiliation(s)
- Andrea Mesa-Restrepo
- Department of Biomedical Engineering, Pennsylvania State University, State College, Pennsylvania 16802, United States
| | - Elizabeth Byers
- Department of Biomedical Engineering, Pennsylvania State University, State College, Pennsylvania 16802, United States
| | - Justin L Brown
- Department of Biomedical Engineering, Pennsylvania State University, State College, Pennsylvania 16802, United States
| | - Juan Ramirez
- Departamento de Ingeniería Mecánica, Universidad Nacional de Colombia, Cra 64C nro 73-120, 050024 Medellin, Colombia
| | - Jean Paul Allain
- Department of Biomedical Engineering, Pennsylvania State University, State College, Pennsylvania 16802, United States
- Ken and Mary Alice Lindquist Department of Nuclear Engineering, Pennsylvania State University, State College, Pennsylvania 16802, United States
- Department of Materials Science and Engineering, Pennsylvania State University, State College, Pennsylvania 16802, United States
| | - Viviana M Posada
- Ken and Mary Alice Lindquist Department of Nuclear Engineering, Pennsylvania State University, State College, Pennsylvania 16802, United States
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Wei X, Wan C, Peng X, Luo Y, Hu M, Cheng C, Feng S, Yu X. Copper-based carbon dots modified hydrogel with osteoimmunomodulatory and osteogenesis for bone regeneration. J Mater Chem B 2024; 12:5734-5748. [PMID: 38771222 DOI: 10.1039/d4tb00526k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Biomaterials with dual functions of osteoimmunomodulation and bone repair are very promising in the field of orthopedic materials. For this purpose, we prepared copper-based carbon dots (CuCDs) and doped them into oxychondroitin sulfate/poly-acrylamide hydrogel (OPAM) to obtain a hybrid hydrogel (CuCDs/OPAM). We evaluated its osteoimmunomodulatory and bone repair properties in vitro and in vivo. The obtained CuCDs/OPAM exhibited good rBMSCs-cytocompatibility and anti-inflammatory properties in vitro. It also could effectively promote rBMSCs differentiation and the expression of osteogenic differentiation factors from rBMSCs under an inflammatory environment. Moreover, CuCDs/OPAM could induce macrophage phenotype switching (from M1-type macrophages to M2-type macrophages) in vivo, which is beneficial for anti-inflammatory action and presents good osteoimmunomodulation capability to induce a bone immune microenvironment to promote the differentiation of rBMSCs. In conclusion, CuCDs/OPAM hydrogel has dual functions of osteoimmunomodulatory and bone repair and is a promising bone filling and repair material.
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Affiliation(s)
- Xu Wei
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P. R. China.
| | - Chang Wan
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P. R. China.
| | - Xu Peng
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P. R. China.
- Experimental and Research Animal Institute, Sichuan University, Chengdu 610065, P. R. China
| | - Yihao Luo
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P. R. China.
| | - Mengyue Hu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P. R. China.
| | - Can Cheng
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P. R. China.
| | - Shaoxiong Feng
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P. R. China.
| | - Xixun Yu
- College of Polymer Science and Engineering, Sichuan University, Chengdu 610065, P. R. China.
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Li S, Deng Q, Si Q, Li J, Zeng H, Chen S, Guo T. TiO 2nanotubes promote osteogenic differentiation of human bone marrow stem cells via epigenetic regulation of RMRP/ DLEU2/EZH2 pathway. Biomed Mater 2023; 18:055027. [PMID: 37437580 DOI: 10.1088/1748-605x/ace6e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 07/12/2023] [Indexed: 07/14/2023]
Abstract
TiO2nanotubes (TNTs) significantly promote osteogenic differentiation and bone regeneration of cells. Nevertheless, the biological processes by which they promote osteogenesis are currently poorly understood. Long non-coding RNAs (lncRNAs) are essential for controlling osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). Epigenetic chromatin modification is one of the pathways in which lncRNAs regulate osteogenic differentiation. Here, we reported that TNTs could upregulate lncRNARMRP, and inhibition of lncRNARMRPin human BMSCs (hBMSCs) grown on TNTs could decrease runt-related transcription factor 2 (RUNX2), alkaline phosphatase, osteopontin, and osteocalcin (OCN) expression. Furthermore, we discovered that inhibiting lncRNARMRPelevated the expression of lncRNADLEU2, and lncRNADLEU2knockdown promoted osteogenic differentiation in hBMSCs. RNA immunoprecipitation experiments showed that lncRNADLEU2could interact with EZH2 to induce H3K27 methylation in the promoter regions of RUNX2 and OCN, suppressing gene expression epigenetically. According to these results, lncRNARMRPis upregulated by TNTs to promote osteogenic differentiation throughDLEU2/EZH2-mediated epigenetic modifications.
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Affiliation(s)
- Shuangqin Li
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu 610031, Sichuan, People's Republic of China
| | - Qing Deng
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu 610031, Sichuan, People's Republic of China
| | - Qiqi Si
- School of Life and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031, People's Republic of China
| | - JinSheng Li
- Key Laboratory of Advanced Technologies of Materials Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, People's Republic of China
| | - Huanghe Zeng
- School of Life and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031, People's Republic of China
| | - Song Chen
- Department of Orthopedics of the General Hospital of Western Theater Command, Chengdu, Sichuan 610086, People's Republic of China
| | - Tailin Guo
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu 610031, Sichuan, People's Republic of China
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Mao Y, Chen Y, Cai W, Jiang W, Sun X, Zeng J, Wang H, Wang X, Dong W, Ma J, Jaspers RT, Huang S, Wu G. CypD-mediated mitochondrial dysfunction contributes to titanium ion-induced MC3T3-E1 cell injury. Biochem Biophys Res Commun 2023; 644:15-24. [PMID: 36621148 DOI: 10.1016/j.bbrc.2022.12.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 11/23/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023]
Abstract
Titanium (Ti) ion can stimulate osteoblast apoptosis and therefore have a high potential to play a negative role in the aseptic loosening of implants. Mitochondrial abnormalities are closely related to osteoblast dysfunction. However, the mitochondrial molecular mechanism of Ti ion induced osteoblastic cell apoptosis is still unclear. This study investigated in vitro mitochondrial oxidative stress (mtROS) mediated mitochondrial dysfunction involved in Ti ion-induced apoptosis of murine MC3T3-E1 osteoblastic cells. In addition to reducing mitochondrial membrane potential (MMP) and decreasing adenosine triglyceride production, exposure to Ti ions increased mitochondrial oxidative stress. Moreover, mitochondrial abnormalities significantly contributed to Ti ion induction of osteoblastic cellular apoptosis. A mitochondria-specific antioxidant, mitoquinone (MitoQ), alleviated Ti ion-induced mitochondrial dysfunction and apoptosis in osteoblastic cells, indicating that Ti ion mainly induces mitochondrial oxidative stress to produce a cytotoxic effect on osteoblasts. Here we show that the primary regulator of mitochondrial permeability transition pore (mPTP), cyclophilin D (CypD), is involved in mitochondrial dysfunction and osteoblast cell apoptosis induced by Ti ion. Overexpression of CypD exacerbates osteoblast apoptosis and impairs osteogenic function. Moreover, detrimental effects of CypD were rescued by cyclosporin A (CsA), an inhibitor of CypD, which shows its protective effect on mitochondrial and osteogenic osteoblast functions. Based on new insights into the mitochondrial mechanisms underlying Ti ion-induced apoptosis of osteoblastic cells, the findings of this study lay the foundation for the clinical use of CypD inhibitors to prevent or treat implant failure.
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Affiliation(s)
- Yixin Mao
- Department of Prosthodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, China; Institute of Stomatology, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, China; Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam (VUA), Amsterdam Movement Sciences, Amsterdam, 1081, HZ, Netherlands
| | - Yang Chen
- Department of Prosthodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, China; Institute of Stomatology, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, China
| | - Wenjin Cai
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310000, China
| | - Wanying Jiang
- Institute of Stomatology, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, China
| | - Xiaoyu Sun
- Institute of Stomatology, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, China
| | - Jun Zeng
- Institute of Stomatology, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, China
| | - Hongning Wang
- Institute of Stomatology, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, China
| | - Xia Wang
- Institute of Stomatology, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, China
| | - Wenmei Dong
- Institute of Stomatology, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, China
| | - Jianfeng Ma
- Department of Prosthodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, China; Institute of Stomatology, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, China
| | - Richard T Jaspers
- Laboratory for Myology, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam (VUA), Amsterdam Movement Sciences, Amsterdam, 1081, HZ, Netherlands
| | - Shengbin Huang
- Department of Prosthodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, China; Institute of Stomatology, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, China.
| | - Gang Wu
- Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam (VUA), Amsterdam Movement Science, Amsterdam, the Netherlands; Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam (UvA), Vrije Universiteit Amsterdam (VU), Amsterdam, the Netherlands
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Effects of Modulation of the Hedgehog and Notch Signaling Pathways on Osteoblast Differentiation Induced by Titanium with Nanotopography. J Funct Biomater 2023; 14:jfb14020079. [PMID: 36826878 PMCID: PMC9968096 DOI: 10.3390/jfb14020079] [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: 12/16/2022] [Revised: 01/14/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The events of bone formation and osteoblast/titanium (Ti) interactions may be affected by Hedgehog and Notch signalling pathways. Herein, we investigated the effects of modulation of these signalling pathways on osteoblast differentiation caused by the nanostructured Ti (Ti-Nano) generated by H2SO4/H2O2. METHODS Osteoblasts from newborn rat calvariae were cultured on Ti-Control and Ti-Nano in the presence of the Hedgehog agonist purmorphamine or antagonist cyclopamine and of the Notch antagonist N-(3,5-Difluorophenacetyl)-L-alanyl]-S-phenylglycine t-butyl ester (DAPT) or agonist bexarotene. Osteoblast differentiation was evaluated by alkaline phosphatase activity and mineralization, and the expression of Hedgehog and Notch receptors was also evaluated. RESULTS In general, purmorphamine and DAPT increased while cyclopamine and bexarotene decreased osteoblast differentiation and regulated the receptor expression on both Ti surfaces, with more prominent effects on Ti-Nano. The purmorphamine and DAPT combination exhibited synergistic effects on osteoblast differentiation that was more intense on Ti-Nano. CONCLUSION Our results indicated that the Hedgehog and Notch signalling pathways drive osteoblast/Ti interactions more intensely on nanotopography. We also demonstrated that combining Hedgehog activation with Notch inhibition exhibits synergistic effects on osteoblast differentiation, especially on Ti-Nano. The uncovering of these cellular mechanisms contributes to create strategies to control the process of osseointegration based on the development of nanostructured surfaces.
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Zhu L, Kong W, Ma J, Zhang R, Qin C, Liu H, Pan S. Applications of carbon dots and its modified carbon dots in bone defect repair. J Biol Eng 2022; 16:32. [PMID: 36419160 PMCID: PMC9682789 DOI: 10.1186/s13036-022-00311-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022] Open
Abstract
Bone defect repair is a continual and complicated process driven by a variety of variables. Because of its bright multicolor luminescence, superior biocompatibility, water dispersibility, and simplicity of synthesis from diverse carbon sources, carbon dots (CDs) have received a lot of interest. It has a broad variety of potential biological uses, including bone defect repair, spinal cord injury, and wound healing. Materials including CDs as the matrix or major component have shown considerable benefits in enabling bone defect healing in recent years. By altering the carbon dots or mixing them with other wound healing-promoting agents or materials, the repair effect may be boosted even further. The report also shows and discusses the use of CDs to heal bone abnormalities. The study first presents the fundamental features of CDs in bone defect healing, then provides CDs manufacturing techniques that should be employed in bone defect repair, and lastly examines their development in the area of bioengineering, particularly in bone defect repair. In this work, we look at how carbon dots and their alteration products may help with bone defect healing by being antibacterial, anti-infective, osteogenic differentiation-promoting, and gene-regulating.
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Affiliation(s)
- Longchuan Zhu
- grid.452829.00000000417660726Department of Orthopedic Surgery, Second Hospital Jilin University, Ziqiang St 218, 130041 Changchun, People’s Republic of China
| | - Weijian Kong
- grid.452829.00000000417660726Department of Orthopedic Surgery, Second Hospital Jilin University, Ziqiang St 218, 130041 Changchun, People’s Republic of China
| | - Jijun Ma
- Department of Orthopedic Surgery, Baicheng Hospital Traditional Chinese Medicine, Jilin, People’s Republic of China
| | - Renfeng Zhang
- grid.452829.00000000417660726Department of Orthopedic Surgery, Second Hospital Jilin University, Ziqiang St 218, 130041 Changchun, People’s Republic of China
| | - Cheng Qin
- grid.452829.00000000417660726Department of Orthopedic Surgery, Second Hospital Jilin University, Ziqiang St 218, 130041 Changchun, People’s Republic of China
| | - Hao Liu
- grid.452829.00000000417660726Department of Orthopedic Surgery, Second Hospital Jilin University, Ziqiang St 218, 130041 Changchun, People’s Republic of China
| | - Su Pan
- grid.452829.00000000417660726Department of Orthopedic Surgery, Second Hospital Jilin University, Ziqiang St 218, 130041 Changchun, People’s Republic of China
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Cheng F, Li H, Liu J, Yan F, Chen Y, Hu H. EZH2 regulates the balance between osteoclast and osteoblast differentiation to inhibit arthritis-induced bone destruction. Genes Immun 2022; 23:141-148. [PMID: 35581496 DOI: 10.1038/s41435-022-00174-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/09/2022]
Abstract
Enhancer of zeste homolog 2 (EZH2) has been noted to contribute to the pathogenesis of autoimmune diseases. This study sought to investigate the mechanism of EZH2 in osteoclast (OCL) and osteoblast (OBL) differentiation (OCLD/OBLD) and bone destruction in RA. The animal model of collagen-induced arthritis (CIA) was established, followed by arthritis index (AI) scoring and histological staining, and measurements of inflammatory cytokines levels. The number of OCLs was detected via Tartrate-resistant acid phosphatase (TRAP) staining, and levels of OBL markers were determined by Western blot analysis. Trimethylated histone H3 at lysine 27 (H3K27me3) expression and its enrichment in the Ndrg2 promoter were detected. Collaborative experiments were performed with GSK-J1 or sh-Ndrg2 in CIA mice with EZH2 knockdown. EZH2 was upregulated while Ndrg2 was downregulated in knee joint tissues of CIA mice. Silencing EZH2 reduced AI scores, pathological injury of the knee joint, levels of inflammatory cytokines, and TRAP-positive cells, and increased protein levels of RUNX2 and BMP2. EZH2 promoted H3K27me3 level in the Ndrg2 promoter to inhibit Ndrg2 transcription. H3K27me3 upregulation or Ndrg2 downregulation reversed the role of silencing EZH2 in bone destruction. Overall, EZH2 repressed OBLD and promoted OCLD to aggravate bone destruction in CIA mice through H3K27me3/Ndrg2.
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Affiliation(s)
- Fang Cheng
- Department of Anesthesiology and Pain Clinic, The Affiliated Lianyungang Oriental Hospital of Kangda College of Nanjing Medical University, Lianyungang, 222042, Jiangsu, China
| | - Huimin Li
- Department of Traditional Chinese and Western Medicine, Lianyungang Oriental Hospital, Lianyungang, 222042, Jiangsu, China
| | - Jing Liu
- Department of Anesthesiology and Pain Clinic, The Affiliated Lianyungang Oriental Hospital of Kangda College of Nanjing Medical University, Lianyungang, 222042, Jiangsu, China
| | - Fengfeng Yan
- Department of Anesthesiology and Pain Clinic, The Affiliated Lianyungang Oriental Hospital of Kangda College of Nanjing Medical University, Lianyungang, 222042, Jiangsu, China
| | - Yu Chen
- Department of Anesthesiology and Pain Clinic, The Affiliated Lianyungang Oriental Hospital of Kangda College of Nanjing Medical University, Lianyungang, 222042, Jiangsu, China
| | - Haiyan Hu
- Department of Traditional Chinese and Western Medicine, Lianyungang Oriental Hospital, Lianyungang, 222042, Jiangsu, China.
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