Pulsed electromagnetic fields influence hyaline cartilage extracellular matrix composition without affecting molecular structure

Pulsed Electromagnetic Field Enhances Healing of a Meniscal Tear and Mitigates Posttraumatic Osteoarthritis in a Rat Model

BACKGROUND

Meniscal tears in the avascular region are thought to rarely heal and are a considerable challenge to treat. Although the therapeutic effects of a pulsed electromagnetic field (PEMF) have been extensively studied in a variety of orthopaedic disorders, the effect of a PEMF on meniscal healing has not been reported.

HYPOTHESIS

PEMF treatment would promote meniscal healing and prevent osteoarthritis progression.

STUDY DESIGN

Controlled laboratory study.

METHODS

A total of 72 twelve-week-old male Sprague-Dawley rats with full-thickness longitudinal medial meniscal tears in the avascular region were divided into 3 groups: control (G_con), treatment with a classic signal PEMF (G_classic), and treatment with a high-slew rate signal PEMF (G_HSR). Macroscopic observation and histological analysis of the meniscus and articular cartilage were performed to evaluate the meniscal healing and progression of osteoarthritis. The synovium was harvested for histological and immunofluorescent analysis to evaluate the intra-articular inflammation. Meniscal healing, articular cartilage degeneration, and synovitis were quantitatively evaluated according to their scoring systems.

RESULTS

Dramatic degenerative changes of the meniscus and articular cartilage were noticed during gross observation and histological evaluation in G_con at 8 weeks. However, the menisci in the 2 treatment groups were restored to normal morphology, with a smooth surface and shiny white color. Particularly, the HSR signal remarkably enhanced the fibrochondrogenesis and accelerated the remodeling process of the regenerated tissue. The meniscal healing scores of the PEMF treatment groups were significantly higher than those in G_con at 8 weeks. Specifically, the HSR signal showed a significantly higher meniscal repair score than did the classic signal at week 8 (P < .01). Additionally, the HSR signal significantly downregulated the secretion levels of interleukin 1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) in the meniscus and synovium as compared with the control group. When compared with the 2 treatment groups, G_con had significantly higher degeneration scores (G_con vs G_classic, P < .0001; G_con vs G_HSR, P < .0001). The HSR signal also exhibited significantly lower synovitis scores compared with the other two groups (G_con vs G_classic, P < .0001; G_classic vs G_HSR, P = .0002).

CONCLUSION

A PEMF promoted the healing of meniscal tears in the avascular region and restored the injured meniscus to its structural integrity in a rat model. As compared with the classic signal, the HSR signal showed increased capability to promote fibrocartilaginous tissue formation and modulate the inflammatory environment, therefore protecting the knee joint from posttraumatic osteoarthritis development.

CLINICAL RELEVANCE

Adjuvant PEMF therapy may offer a new approach for the treatment of meniscal tears attributed to the enhanced meniscal repair and ameliorated osteoarthritis progression.

Histological Analysis of Bone Callus in Delayed Union Model Fracture Healing Stimulated with Pulsed Electromagnetic Fields (PEMF)

Delayed union and nonunion fractures are clinical challenges for orthopedic surgeons. The development of fracture complications, such as delayed union and nonunion fractures, is still difficult to predict. Various methods are being investigated to improve fracture healing and prevent complications in patients. There are various methods to promote fracture healing, broadly divided into biological, chemical, and physical methods. One of the most widely used physical methods to promote fracture healing is the pulsed electromagnetic field (PEMF). This study aimed to evaluate the healing process of delayed union fracture after being stimulated by PEMF. Twenty-four rats were randomly divided into two groups: the control group (n = 12) and the PEMF group (n = 12). Delayed union fracture was performed on the left femur of all rats. Subsequently, the PEMF group was given PEMF stimulus with a magnetic field intensity of 1.6 mT and a frequency of 50 Hz for 4 hours/day and 7 days/week. The fracture healing process was evaluated on days 5, 10, 18, and 28 based on the bone callus histology using safranin O fast green (SOFG) staining. The results of the histological analysis showed that bone cartilage was higher in the PEMF group than in the control group throughout the observation period. In addition, the PEMF group had less fibrous tissue at the beginning of the healing. This finding indicates PEMF stimulation has an effect on inducing osteogenesis on fracture healing and reducing the risk of delayed union.

In Vitro Evaluation of the Effect of Stimulation with Magnetic Fields on Chondrocytes

Magnetic fields (MFs) have been used as an external stimulus to increase cell proliferation in chondrocytes and extracellular matrix (ECM) synthesis of articular cartilage. However, previously published studies have not shown that MFs are homogeneous through cell culture systems. In addition, variables such as stimulation times and MF intensities have not been standardized to obtain the best cellular proliferative rate or an increase in molecular synthesis of ECM. In this work, a stimulation device, which produces homogeneous MFs to stimulate cell culture surfaces was designed and manufactured using a computational model. Furthermore, an in vitro culture of primary rat chondrocytes was established and stimulated with two MF schemes to measure both proliferation and ECM synthesis. The best proliferation rate was obtained with an MF of 2 mT applied for 3 h, every 6 h for 8 days. In addition, the increase in the synthesis of glycosaminoglycans was statistically significant when cells were stimulated with an MF of 2 mT applied for 5 h, every 6 h for 8 days. These findings suggest that a stimulation with MFs is a promising tool that could be used to improve in vitro treatments such as autologous chondrocyte implantation, either to increase cell proliferation or stimulate molecular synthesis. Bioelectromagnetics. 2020;41:41-51 © 2019 Bioelectromagnetics Society.

Clinical results of pulsed signal therapy on patellofemoral syndrome with patellar chondropathy

This study was designed to evaluate the effect of pulsed signal therapy (PST) on patellofemoral pain syndrome associated with patellar chondropathy. A prospective randomized double-blind placebo controlled trial included 25 patients (41 knees) between 20 and 50 years with pain due to isolated patellofemoral syndrome with chondropathy. PST group received nine 60-min daily sessions of PST treatment. Control group received the same protocol of blinded placebo treatment. The main outcome was change from baseline Kujala score at 3 months. After 3 months, patients in the control group received effective treatment (placebo post-treatment). All patients were then followed, for up to 12 months. Seventeen knees (5 males and 12 females, mean age 36.7 ± 7.9) received placebo and 24 knees (8 males and 16 females, mean age 35.5 ± 8.9) received PST. By the third month, PST group exhibited a mean change from baseline of 9.63 ± 7.5 Kujala points, compared to 0.53 ± 1.8 in the placebo group (P < 0.001). A significant progressive improvement was seen in the PST group between the 3rd and 6th and between the 6th and 12th month (P < 0.016). Patients initially allocated in the control group also improved at 3 months (P < 0.001) and 6 months (P = 0.005) post-effective treatment. In conclusion, PST in patellofemoral pain syndrome with chondropathy was effective compared to placebo at 3 months, showing an important improvement of Kujala score. The improvement was progressive and maintained up to 12 months. PST is safe and should be considered as a non-invasive option for management of this condition. Bioelectromagnetics. 40:83-90, 2019. © 2019 Bioelectromagnetics Society.

A New Approach of Short Wave Protection against Middle Cerebral Artery Occlusion/Reperfusion Injury via Attenuation of Golgi Apparatus Stress by Inhibition of Downregulation of Secretory Pathway Ca(2+)-ATPase Isoform 1 in Rats

BACKGROUND

Short wave (SW), a pattern of electromagnetic therapy, achieves an oscillating electromagnetic field. It has been reported that it may have a potential effect on cerebral injury. The present study was designed to investigate the potential role and possible mechanism of SW in focal cerebral ischemia/reperfusion (I/R) injury in rats. Secretory pathway Ca(2+)/Mn(2+) ATPase isoform 1 is a major component of Golgi apparatus stress. It has been reported as representative of Golgi apparatus stress.

METHODS

Up to 120 minutes of middle cerebral artery occlusion (MCAO) and reperfusion injury was induced in male Sprague-Dawley rats. Different sessions of SW daily were administered over head after reperfusion from day 1 to day 7. Functional recovery scores, survival rates, infarct volume analysis, electron microscope test, and western blotting studies were used to analyze the therapy.

RESULTS

SW protected against neuronal death and apoptosis in cornu ammon 1 region of hippocampus by reducing neuronal deficit, infarct volume, and ultrastructure. SW partly inhibited upregulation of caspase3. In addition, the expression of secretory pathway Ca(2+)-ATPase isoform 1 (SPCA1) was upregulated by SW.

CONCLUSIONS

Our data indicate that SW can be protected against focal cerebral I/R injury, and the influence on Golgi apparatus stress might provide us a new perspective in further study. To the authors' knowledge, this is the first report using SW to increase expression of SPCA1 indicating modulate Golgi apparatus stress in MCAO and reperfusion model.

Effects of microcurrent therapy on excisional elastic cartilage defects in young rats

The effects of microcurrent application on the elastic cartilage defects in the outer ear of young animals were analyzed. Sixty male Wistar rats were divided into a control (CG) and a treated group (TG). An excisional lesion was created in the right outer ear of each animal. Daily treatment was started after 24h and consisted of the application of a low-intensity (20μA) continuous electrical current to the site of injury for 5min. The animals were euthanized after 7, 14 and 28 days of injury and the samples were submitted to analyses. In CG, areas of newly formed cartilage and intense basophilia were seen at 28 days, while in TG the same observations were made already at 14 days. The percentage of birefringent collagen fibers was higher in CG at 28 days. The number of connective tissue cells and granulocytes was significantly higher in TG. Ultrastructural analysis revealed the presence of chondrocytes in TG at 14 days, while these cells were observed in CG only at 28 days. Cuprolinic blue staining and the amount of glycosaminoglycans were significantly higher in TG at 14 days and 28 days. The amount of hydroxyproline was significantly higher in TG at all time points studied. The active isoform of MMP-2 was higher activity in TG at 14 days. Immunoblotting for type II collagen and decorin was positive in both groups and at all time points. The treatment stimulated the proliferation and differentiation of connective tissue cells, the deposition of glycosaminoglycans and collagen, and the structural reorganization of these elements during elastic cartilage repair.

Influence of extremely low frequency, low energy electromagnetic fields and combined mechanical stimulation on chondrocytes in 3-D constructs for cartilage tissue engineering

Articular cartilage, once damaged, has very low regenerative potential. Various experimental approaches have been conducted to enhance chondrogenesis and cartilage maturation. Among those, non-invasive electromagnetic fields have shown their beneficial influence for cartilage regeneration and are widely used for the treatment of non-unions, fractures, avascular necrosis and osteoarthritis. One very well accepted way to promote cartilage maturation is physical stimulation through bioreactors. The aim of this study was the investigation of combined mechanical and electromagnetic stress affecting cartilage cells in vitro. Primary articular chondrocytes from bovine fetlock joints were seeded into three-dimensional (3-D) polyurethane scaffolds and distributed into seven stimulated experimental groups. They either underwent mechanical or electromagnetic stimulation (sinusoidal electromagnetic field of 1 mT, 2 mT, or 3 mT; 60 Hz) or both within a joint-specific bioreactor and a coil system. The scaffold-cell constructs were analyzed for glycosaminoglycan (GAG) and DNA content, histology, and gene expression of collagen-1, collagen-2, aggrecan, cartilage oligomeric matrix protein (COMP), Sox9, proteoglycan-4 (PRG-4), and matrix metalloproteinases (MMP-3 and -13). There were statistically significant differences in GAG/DNA content between the stimulated versus the control group with highest levels in the combined stimulation group. Gene expression was significantly higher for combined stimulation groups versus static control for collagen 2/collagen 1 ratio and lower for MMP-13. Amongst other genes, a more chondrogenic phenotype was noticed in expression patterns for the stimulated groups. To conclude, there is an effect of electromagnetic and mechanical stimulation on chondrocytes seeded in a 3-D scaffold, resulting in improved extracellular matrix production.

Low-frequency electromagnetic field exposure accelerates chondrocytic phenotype expression on chitosan substrate

To find whether low-frequency pulsed electromagnetic fields help repair larger cartilage defects with the assistance of tissue-engineered scaffolds, we tested their effect on the behavior of chondrocyte cells cultured on chitosan films. Primary porcine chondrocytes growing on chitosan films were exposed to low-frequency pulsed electromagnetic fields (frequency=75 Hz; impulse width=1.3 ms; strength=1.8-3 mT) 2 hours a day for 3 weeks. The cells that were not exposed to low-frequency pulsed electromagnetic fields served as controls. For 3 weeks, cell proliferation, viability, and expressions of type II collagen and glycosaminoglycan were measured weekly. Cell morphology and histological stains of glycosaminoglycan and type II collagen were performed at the end of the test. The cell proliferation and viability of the low-frequency pulsed electromagnetic fields group and the control were similar each week. By the end of the third week, cells in the low-frequency pulsed electromagnetic fields group deposited 28% more glycosaminoglycan than the control cells. The amounts of type II collagen deposited in the low-frequency pulsed electromagnetic fields group were 24% and 27% higher than those of the control group by week 2 and 3, respectively. Histological and immunohistochemical analyses confirmed the releases of glycosaminoglycan and type II collagen. Cells from both groups grew in aggregates and possessed a spherical shape after 3 weeks. These results suggest that low-frequency pulsed electromagnetic fields can enhance extracellular matrix production on chitosan substrate. Combining tissue engineering and low-frequency pulsed electromagnetic fields could further accelerate cartilage repair.

Retention of structural and biochemical integrity in a biological mesh supports tissue remodeling in a primate abdominal wall model

AIM

Suboptimal clinical outcome following the implantation of porcine-derived tissue matrices may be due to the method of processing the material to achieve an acellular graft and to reduce the immune response to xenogeneic epitopes. The ability to produce a porcine-based graft material that retains the structural integrity of the extracellular matrix and minimizes the potential antigenic response to the galactose-alpha(1,3)-galactose terminal disaccharide (alpha-Gal) may allow the scaffold to support regeneration of native tissue.

MATERIALS & METHODS

Porcine dermal tissue was processed to remove cells and DNA, and minimize the presence of alpha-Gal via specific enzymatic cleavage. In vivo performance was evaluated by implantation into the abdominal wall of an Old World primate exisional repair model. Grafts were explanted at 0.5, 1, 3 and 6 months and assessed for cellular repopulation and vascularization, for localized immune response by presence of T cells, B cells and macrophages, and systemic immune response by anti-alpha-Gal IgG by ELISA.

RESULTS

Animals tolerated implants well and exhibited no clinical signs of inflammation, laxity, hernia or visceral tissue attachment. Histological evaluation revealed marked host fibroblast repopulation and neoangiogenesis as early as 2 weeks postimplant. Cellular repopulation and maturation of vascular structures reached a plateau at 3 months. Immunological evaluation of immune cell infiltration demonstrated an early, mixed cellular inflammatory response at 2 weeks. This cellular immune response was transient and diminished to baseline levels by 3 months postimplant.

CONCLUSION

The combination of a nondamaging process, successful removal of cells, and reduction of the xenogeneic alpha-Gal antigens from the porcine dermal matrix, while maintaining an intact extracellular matrix, is critical to its ability to remodel and integrate into host tissue, leading to its overall acceptance.

Electromagnetic effects - From cell biology to medicine

In this review we compile and discuss the published plethora of cell biological effects which are ascribed to electric fields (EF), magnetic fields (MF) and electromagnetic fields (EMF). In recent years, a change in paradigm took place concerning the endogenously produced static EF of cells and tissues. Here, modern molecular biology could link the action of ion transporters and ion channels to the "electric" action of cells and tissues. Also, sensing of these mainly EF could be demonstrated in studies of cell migration and wound healing. The triggers exerted by ion concentrations and concomitant electric field gradients have been traced along signaling cascades till gene expression changes in the nucleus. Far more enigmatic is the way of action of static MF which come in most cases from outside (e.g. earth magnetic field). All systems in an organism from the molecular to the organ level are more or less in motion. Thus, in living tissue we mostly find alternating fields as well as combination of EF and MF normally in the range of extremely low-frequency EMF. Because a bewildering array of model systems and clinical devices exits in the EMF field we concentrate on cell biological findings and look for basic principles in the EF, MF and EMF action. As an outlook for future research topics, this review tries to link areas of EF, MF and EMF research to thermodynamics and quantum physics, approaches that will produce novel insights into cell biology.

Effect of pulsed electromagnetic field stimulation on knee cartilage, subchondral and epyphiseal trabecular bone of aged Dunkin Hartley guinea pigs

It has been demonstrated that pulsed electromagnetic field (PEMF) stimulation has a chondroprotective effect on osteoarthritis (OA) progression in the knee joints of the 12-month-old guinea pigs. The aim of the present study was to discover whether the therapeutic efficacy of PEMFs was maintained in older animals also in more severe OA lesions. PEMFs were administered daily (6 h/day for 6 months) to 15-month-old guinea pigs. The knee joints (medial and lateral tibial plateaus, medial and lateral femoral condyles) were evaluated by means of a histological/histochemical Mankin modified by Carlsson grading score and histomorphometric measurements of cartilage thickness (CT), fibrillation index (FI), subchondral bone thickness (SBT) and epiphyseal bone microarchitecture (bone volume: BV/TV; trabecular thickness: Tb.Th; trabecular number: Tb.N; trabecular separation: Tb.SP). Periarticular knee bone was also evaluated with dual X-ray absorptiometry (DXA). PEMF stimulation significantly changed the progression of OA lesions in all examined knee areas. In the most affected area of the knee joint (medial tibial plateau), significant lower histochemical score (p<0.0005), FI (p<0.005), SBT (p<0.05), BV/TV (p<0.0005), Tb.Th (p<0.05) and Tb.N (p<0.05) were observed while CT (p<0.05) and Tb.Sp (p<0.0005) were significantly higher than in SHAM-treated animals. DXA confirmed the significantly higher bone density in SHAM-treated animals. Even in the presence of severe OA lesions PEMFs maintained a significant efficacy in reducing lesion progression.

Proteoglycan synthesis in bovine articular cartilage explants exposed to different low-frequency low-energy pulsed electromagnetic fields

OBJECTIVE

To investigate the role of pulsed electromagnetic field (PEMF) exposure parameters (exposure length, magnetic field peak amplitude, pulse frequency) in the regulation of proteoglycan (PG) synthesis of bovine articular cartilage explants.

METHODS

Bovine articular cartilage explants were exposed to a PEMF (75 Hz; 2 mT) for different time periods: 1, 4, 9, 24 h. Then, cartilage explants were exposed for 24 h to PEMFs of different magnetic field peak amplitudes (0.5, 1, 1.5, 2 mT) and different frequencies (2, 37, 75, 110 Hz). PG synthesis of control and exposed explants was determined by Na2-35SO4 incorporation.

RESULTS

PEMF exposure significantly increased PG synthesis ranging from 12% at 4 h to 17% at 24 h of exposure. At all the magnetic field peak amplitude values, a significant PG synthesis increase was measured in PEMF-exposed explants compared to controls, with maximal effect at 1.5 mT. No effect of pulse frequency was observed on PG synthesis stimulation.

CONCLUSIONS

The results of this study show the range of exposure length, PEMF amplitude, pulse frequency which can stimulate cartilage PG synthesis, and suggest optimal exposure parameters which may be useful for cartilage repair in in vivo experiments and clinical application.

Effect of pulsed electromagnetic fields on proteoglycan biosynthesis of articular cartilage is age dependent

OBJECTIVE

To investigate the effects of a pulsed electromagnetic field (EMF) on articular cartilage matrix biosynthesis with regard to age and cartilage damage using a matrix depleted cartilage explant model.

METHODS

Cartilage explants were obtained from metacarpophalangeal joints of calves and adult cows. After depletion of the extracellular matrix by trypsin digestion, samples were maintained in serum-free basal medium with and without the addition of interleukin 1beta (IL1beta). Half the samples were subjected to an EMF for 24 minutes daily; the other half were left untreated. Undigested and untreated explants served as negative controls. After 7 days, biosynthesis of matrix macromolecules was assessed by [35S]sulphate incorporation and values were normalised to hydroxyproline content.

RESULTS

The EMF increased matrix macromolecule synthesis in undigested, untreated explants (p<0.009). In matrix depleted samples the EMF had no stimulatory effect on proteoglycan biosynthesis. IL1beta significantly decreased the de novo synthesis of matrix macromolecules (p<0.00004) in young and adult samples, but an EMF partly counteracted this inhibitory effect in cartilage samples from young, but not old animals.

CONCLUSION

EMF promoted matrix macromolecule biosynthesis in intact tissue explants but had no stimulatory effect on damaged articular cartilage. The supressive effects of IL1beta were partially counteracted by EMF exposure, exclusively in cartilage derived from young animals. An EMF has age dependent chondroprotective but not structure modifying properties when cartilage integrity is compromised.

Exposure of mouse preosteoblasts to pulsed electromagnetic fields reduces the amount of mature, type I collagen in the extracellular matrix

We tested the hypothesis that exposure of a mouse preosteoblast cell line to pulsed electromagnetic fields (PEMF) would affect components of the extracellular matrix. We report that exposure of MC3T3-E1 cells to a single PEMF waveform significantly reduced the amount of mature, alpha1(I) collagen in the extracellular matrix (ECM) and the conditioned medium, without affecting the amount of total ECM protein. This decrease was not due to changes in the steady-state level of Col1A1 mRNA or to degradation of mature collagen. We then tested the effect of three distinct PEMF waveforms, two orthogonal coil orientations, and two waveform amplitude levels on the amount of alpha1(I) collagen in the conditioned medium. A sequence of factorial ANOVAs and stepwise regression modeling revealed that the period (duration) of the individual pulses accounted for a significant proportion of the variance associated with the amount of alpha1(I) collagen in the conditioned medium. The total variance accounted for, however, was small (R(2)=0.155, p<0.001 and R(2)=0.172, p<0.001, in the horizontal and vertical orientations, respectively). The positive and negative regression coefficients for the coil orientations revealed that the influence of pulse period was significantly different for the orthogonal coil orientations (p<0.001). The findings imply that the dominant influence of PEMF on the amount of mature, alpha1(I) collagen in the ECM is related to variables other than those expressed in the time-amplitude domain. The results provide objective direction toward identifying waveform characteristics that contribute to the observed between-waveform differences with regard to collagen. Advances in this area may lead toward improving waveforms and waveform delivery protocols.

Exposure of murine cells to pulsed electromagnetic fields rapidly activates the mTOR signaling pathway

Murine pre-osteoblasts and fibroblast cell lines were used to determine the effect of pulsed electromagnetic field (PEMF) exposure on the production of autocrine growth factors and the activation of early signal transduction pathways. Exposure of pre-osteoblast cells to PEMF minimally increased the amount of secreted TGF-beta after 1 day, but had no significant effects thereafter. PEMF exposure of pre-osteoblast cells also had no effect on the amount of prostaglandin E(2) in the conditioned medium. Exposure of both pre-osteoblasts and fibroblasts to PEMF rapidly activated the mTOR signaling pathway, as evidenced by increased phosphorylation of mTOR, p70 S6 kinase, and the ribosomal protein S6. Inhibition of PI3-kinase activity with the chemical inhibitor LY294002 blocked PEMF-dependent activation of mTOR in both the pre-osteoblast and fibroblast cell lines. These findings suggest that PEMF exposure might function in a manner analogous to soluble growth factors by activating a unique set of signaling pathways, inclusive of the PI-3 kinase/mTOR pathway.

Effects of pulsed electromagnetic fields on articular hyaline cartilage: review of experimental and clinical studies

Osteoarthritis (OA) is the most common disorder of the musculoskeletal system and is a consequence of mechanical and biological events that destabilize tissue homeostasis in articular joints. Controlling chondrocyte death and apoptosis, function, response to anabolic and catabolic stimuli, matrix synthesis or degradation and inflammation is the most important target of potential chondroprotective treatment, aimed to retard or stabilize the progression of OA. Although many drugs or substances have been recently introduced for the treatment of OA, the majority of them relieve pain and increase function, but do not modify the complex pathological processes that occur in these tissues. Pulsed electromagnetic fields (PEMFs) have a number of well-documented physiological effects on cells and tissues including the upregulation of gene expression of members of the transforming growth factor beta super family, the increase in glycosaminoglycan levels, and an anti-inflammatory action. Therefore, there is a strong rationale supporting the in vivo use of biophysical stimulation with PEMFs for the treatment of OA. In the present paper some recent experimental in vitro and in vivo data on the effect of PEMFs on articular cartilage were reviewed. These data strongly support the clinical use of PEMFs in OA patients.

A multicenter clinical trial on the use of pulsed electromagnetic fields in the treatment of temporomandibular disorders

STATEMENT OF THE PROBLEM

Pulsed electromagnetic fields have shown therapeutic benefit in the treatment of numerous forms of osteoarthritis but have not been evaluated for their effects on the temporomandibular joint (TMJ).

PURPOSE

The aim of this study was to examine the effects of pulsed electromagnetic fields in the treatment of patients with temporomandibular disorders (TMD).

MATERIALS AND METHODS

A multicenter clinical trial compared active treatment of 36 patients using pulsed electromagnetic fields to placebo treatment of 42 patients with TMD with pain in 1 or both TMJs and/or limited opening of less than 40 mm. Subjective parameters including pain intensity, pain frequency, degree of limitation, restriction of daily life, and intensity and frequency of joint noises were evaluated using a visual analog scale. Trained, blinded examiners assessed the clinical parameters according to Research Diagnostic Criteria for temporomandibular disorders before treatment (baseline), directly after nine 1-hour treatments on consecutive working days, 6 weeks after treatment, and 4 months after treatment. Statistical evaluation was done using the Friedman test, and by paired comparison between baseline and follow-up examinations using the U test (P < .05).

RESULTS

Seventy-six patients completed the study. For both the active and placebo treatment, significant improvements were seen in the subjective data (P < .01). Patients with anterior disk displacement without reduction also showed significant improvements in active mouth opening (P = .015), patients with ostheoarthritis only showed improvements in some of the subjective parameters (P < .03), and patients with anterior disk displacement with reduction showed no improvement at all.

CONCLUSIONS

Pulsed electromagnetic fields had no specific treatment effects in patients with temporomandibular disorders.

Calculation of electric fields induced in the human knee by a coil applicator

Calculations are presented of the induced electric fields and current densities in the cartilage of the knee produced by a coil applicator developed for applying pulsed magnetic fields to osteoarthritic knees. This applicator produces a sawtooth-like magnetic field waveform composed of a series of 260-micros pulses with a peak to peak magnitude of approximately 0.12 mT in the cartilage region. The simulations were performed using a recently developed 3 dimensional finite difference frequency domain technique for solving Maxwell's equations with an equivalent circuit model. The tissue model was obtained from the anatomically segmented human body model of Gandhi. The temporal peak electric field magnitude was found to be -153 mV/m, averaged within the medial cartilage of the knee for the typical dB/dt excitation levels of this coil. The technique can be extended to analyze other excitation waveforms and applicator designs.

Electromagnetic fields and magnets. Investigational treatment for musculoskeletal disorders

Certain pulsed electromagnetic fields (PEMF) affect the growth of bone and cartilage in vitro, with potential application as an arthritis treatment. PEMF stimulation is already a proven remedy for delayed fractures, with potential clinical application for osteoarthritis, osteonecrosis of bone, osteoporosis, and wound healing. Static magnets may provide temporary pain relief under certain circumstances. In both cases, the available data is limited. The mechanisms underlying the use of PEMF and magnets are discussed.

The macromolecular characteristics of cartilage proteoglycans do not change when synthesis is up-regulated by link protein peptide

Previous studies have shown that a synthetic, unglycosylated analogue of the N-terminal peptide from link protein can function as a growth factor and up-regulate proteoglycan biosynthesis in explant cultures of normal human articular cartilage from a wide age range of subjects (McKenna et al., Arthritis Rheum. 41 (1998) 157-162). The present work further shows that link peptide increased proteoglycan synthesis by cartilage cultured in both the presence and absence of serum, suggesting that the mechanism of up-regulation may be different from that of insulin-like growth factors. The proteoglycans synthesised during stimulation with link peptide were of normal hydrodynamic size and the ratio of core protein to glycosaminoglycan side chains and the proportions of the large proteoglycan aggrecan to the small proteoglycans, decorin and biglycan, remained constant. Aggrecan molecules were equally capable of forming aggregates as those from control tissues and the relative proportions of decorin and biglycan were unchanged showing that both were co-ordinately up-regulated. These results confirmed that this novel peptide is a potent stimulator of proteoglycan synthesis by articular cartilage and showed that the newly synthesised proteoglycans were of normal composition.

Metabolic kinetics of proteoglycans by embryonic chick sternal cartilage in culture

Explant cultures of embryonic chick sternum have been widely studied, but the kinetics of biosynthesis of proteoglycans by this tissue in culture has not been characterized. Caudal cartilaginous portions of 16-day-old embryonic chick sterna were cultured for 8 days. Histological examination showed that the fresh cartilage contained morphologically homogenous chondrocytes, which were embedded in a uniform extracellular matrix. After culture for 8 days, the histological appearance of the explant remained unchanged but the tissue increased in size with time as indicated by a progressive increase in DNA content and in the content of glycosaminoglycan and collagen. Rates of degradation and release from the tissue of proteoglycans labeled in ovo with 35S were first order during culture, as were the unlabeled proteoglycans. Proteoglycan synthesis was high during the first 2 days of culture, and this then gradually decreased from this high level during the following 2 days. Synthesis was then maintained at a constant level for the remainder of the culture period. After culture for 2 and 7 days, the proteoglycans synthesized by the explants were identical to the preexisting proteoglycans in hydrodynamic size, glycosaminoglycan chain size, and ability to form aggregates. These findings suggest that the embryonic chick sterna maintained a stable cartilage phenotype during the extended culture periods. The initial rapid rate of matrix turnover was probably attributable to an adaptation of the tissue to ex ovo culture conditions and the subsequent maintenance of cellular activities at a lower level indicated the establishment of a steady-state rate of metabolism.

Re-expression of differentiated proteoglycan phenotype by dedifferentiated human chondrocytes during culture in alginate beads

The proteoglycans (PGs) synthesised by normal human articular chondrocytes and a chondrocyte cell line cultured in monolayer and alginate beads were compared. Chondrocytes became dedifferentiated after serial subcultures in monolayer, exhibited a fibroblastic morphology and synthesised a large proportion of lower molecular weight, dermatan sulphate containing PGs. When transferred into alginate beads, the cells quickly regained their spherical shape and actively incorporated [3H]thymidine and [35S]sulphate during 70 days of culture. This resulted in a continuous increase in their DNA content and a rapid deposition of PGs for the first 25 days of culture, which then remained stable. Immediately after dedifferentiated chondrocytes were encapsulated into alginate beads, they began to synthesise a population of PGs with normal monomer size and an increased ability to form aggregates. The monomer size of newly synthesised PGs remained unchanged during extended periods of culture, but their ability to form aggregates and the ratios of chondroitin-6-sulphate to chondroitin-4-sulphate in their glycosaminoglycan chains gradually increased for the first 25 days before reaching normal values. Parallel experiments with HCS-2/8 cells, derived from a human chondrosarcoma, showed that they followed a similar pattern of development in alginate culture. The ability of their newly synthesised PGs to form aggregates increased with time and their sulphation pattern also gradually became normal. These results showed that culture in alginate promoted redifferentiation of dedifferentiated articular chondrocytes and assisted differentiation of HCS-2/8 chondrocytes. However, complete redifferentiation took a period of several weeks, after which synthesis of normal aggregating PGs was maintained.

Expression of proteoglycans by cultured chick sternal chondrocytes

Chondrocytes isolated from the caudal and cephalic ends of the sterna of embryonic chicks were cultured in collagen gels. Differences were found, histochemically, between the proteoglycans produced by the "caudal" and "cephalic" cultures and with length of time in culture. The cultures were labelled with [14C]galactose and [35S]sulphate at 7 and 21 days in culture and labelled compounds from media, and cell and matrix extracts analysed with Sepharose CL-2B. A large aggrecan-like proteoglycan was detected in the media with some aggregated proteoglycans found in the cell extracts even under the dissociating conditions used. One group of 14C-labelled compounds, found in the cell and matrix extracts, was equivalent in size to chick aggrecan core protein. Smaller proteoglycans and glycoprotein glycans were present. The types and proportions of these proteoglycans varied between the two cell types demonstrating biosynthetic commitment.

Non-pharmacological therapies in osteoarthritis

Non-pharmacological therapies are very important in osteoarthritis. Each form of this treatment should be individually devised, taking into account the anatomical distribution, the phase and the progression rate of the disease. Indications, contraindications, dosage and precautions are as important in non-pharmacological therapy as they are in drug treatment. Therapeutic exercises decrease pain, increase muscle strength and range of joint motion as well as improve endurance and aerobic capacity. Exercise programmes should be designed, conducted and regularly supervised by professionally trained physiotherapists. Weight reduction is of proven benefit in obese patients with osteoarthritis of the knee. Walking aids, crutches, shoe insoles, braces and patellar taping are useful tools in some form of osteoarthritis. Patient education and the management of the psychosocial consequences are priority tasks. Therapeutic heat and cold, electrotherapy, ultrasound, acupuncture, hydrotherapy and spa treatment are widely used, although the effects and benefits have not been fully established. Non-pharmacological therapies should undergo rigorous randomized controlled trials in a similar manner to pharmacological studies.

Pulsed electromagnetic fields preserve proteoglycan composition of extracellular matrix in embryonic chick sternal cartilage

The influence of pulsed electromagnetic fields (PEMF) on proteoglycan composition in cartilage extracellular matrix has been investigated. Day 16 embryonic chick sternal cartilage was explanted to culture and exposed for 3 h per day for 2 days to a repetitive single-pulse PEMF with frequency of 15 Hz and peak magnetic field of 1.25 G. PEMF treatment did not affect cell proliferation, as indicated by [3H]thymidine incorporation, but significantly stimulated the retention of glycosaminoglycans in the explants and reduced the release of glycosaminoglycans into the media. Determination of incorporation of [35S]sulfate and [3H]N-acetylglucosamine into proteoglycans in vitro and breakdown of in ovo labelled [35S]sulfated proteoglycans in vitro showed that PEMF treatment significantly suppressed the synthesis of proteoglycans and the degradation of both newly synthesized and pre-existing proteoglycans. Sepharose CL-2B chromatography demonstrated that PEMF did not affect either the size distribution of newly synthesized and pre-existing [35S]sulfated proteoglycans or their ability to aggregate with hyaluronate. Sepharose CL-6B chromatography followed by cellulose acetate electrophoresis revealed that the chain length and degree of sulfation of [35S]sulfated glycosaminoglycans were identical in control and PEMF-treated cultures. It is concluded that PEMF treatment preserved extracellular matrix integrity of cultured cartilage explants by down-regulating proteoglycan synthesis and degradation in a co-ordinated manner without affecting their gross structural nature.