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De Marziani L, Orazi S, Boffa A, Andriolo L, Di Martino A, Zaffagnini S, Filardo G. Knee temperature remains abnormal in patients successfully treated with anterior cruciate ligament reconstruction: An infrared thermography analysis. J Exp Orthop 2024; 11:e70012. [PMID: 39253542 PMCID: PMC11382133 DOI: 10.1002/jeo2.70012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 09/11/2024] Open
Abstract
Purpose The aim of this study was to evaluate if the operated knee environment remains abnormal in patients successfully treated with anterior cruciate ligament reconstruction (ACL-R). Methods Thirty asymptomatic patients were enrolled (28 men, 2 women, age 28.6 ± 6.54 years, body mass index: 24.9 ± 3.0 kg/m2) and evaluated at 42.2 ± 12.5 months after surgery. Patients were assessed with patient-reported outcome measurements and with a triaxial accelerometer. The temperature of the knees as well as four regions of interest were evaluated with an infrared thermographic camera FLIR T1020 (FLIR® Systems) according to a standardised protocol including a baseline evaluation and further evaluations immediately after exercise and after 5, 10 and 20 min. The temperature of the ACL-R knee was compared to that of the contralateral healthy knee for the purpose of the study. Results The mean temperature of the knee was higher (p = 0.010) for the ACL-R knees (31.4 ± 1.4°C) compared to the healthy knees (31.1 ± 1.6°C), as well as for the patellar area (p = 0.005), the lateral area (p = 0.016) and the medial area (p = 0.014). The analysis of the response to the exercises of the ACL-R knees showed similar trends to the healthy knees but higher temperature values at all time points (p < 0.05). Patients who underwent ACL-R with concomitant meniscal treatment showed higher knee temperatures compared to ACL-R knees without concomitant meniscal treatment after 5 (p = 0.047), 10 (p = 0.027) and 20 min (p = 0.048). Conclusions The temperature of asymptomatic knees previously treated with ACL-R is higher than the contralateral healthy knee, both at rest and after exercise, with a further increase in knees that underwent both ACL-R and meniscal treatment. These results suggest an inflammatory state persisting years after the surgery, which could predispose to the early onset of knee degeneration. Level of Evidence III, Case-control study.
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Affiliation(s)
- Luca De Marziani
- Clinica Ortopedica e Traumatologica 2 IRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | - Simone Orazi
- Clinica Ortopedica e Traumatologica 2 IRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | - Angelo Boffa
- Clinica Ortopedica e Traumatologica 2 IRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2 IRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | - Alessandro Di Martino
- Clinica Ortopedica e Traumatologica 2 IRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2 IRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | - Giuseppe Filardo
- Applied and Translational Research (ATR) Center IRCCS Istituto Ortopedico Rizzoli Bologna Italy
- Faculty of Biomedical Sciences Università della Svizzera Italiana Lugano Switzerland
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Codazza S, Ferrara PE, Ariani M, Ferriero G, Ronconi G. The Management of Knee Osteoarthritis in the Real World: An Italian National Survey. J Clin Med 2024; 13:3704. [PMID: 38999270 PMCID: PMC11242218 DOI: 10.3390/jcm13133704] [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: 04/22/2024] [Revised: 06/11/2024] [Accepted: 06/18/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Knee osteoarthritis is a degenerative and inflammatory disease causing pain and worsening patients' quality of life. Various conservative treatment options exist, but a gap between scientific evidence and clinical practice is still present. The aim of this prospective multicenter observational study is to describe the real outpatient territorial management of patients with knee osteoarthritis and to analyze the correlation between the anthropometric and clinical characteristics of the population of patients suffering from symptomatic knee osteoarthritis who were screened in the national survey. Methods: The educational national project was divided into three modules: the first and the last through webinars; and the second held in daily practice. The participants had to register structured observations, which were then stored in a national database and analyzed in order to identify correlations. The subgroups were stratified by body composition, radiological severity of knee osteoarthritis, pain, and functional ability. Results: The project has been joined by 155 physicians, and 2.656 observations about real-world outpatients being treated for knee osteoarthritis in Italy were collected. Data relating to real-world pharmacological and rehabilitation therapies in correlation with body composition, the radiological severity of knee osteoarthritis, pain, and functional ability were reported. Conclusions: Currently, there are no standardized protocols using effective combinations of therapeutic exercises, physical agents, and medications to control the progression of knee osteoarthritis. This real-word national survey proved to be useful for describing the current state of the art of therapeutic management of knee osteoarthritis and for emphasizing the need to fill the gap between scientific evidence and clinical practice.
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Affiliation(s)
- Sefora Codazza
- University Polyclinic Foundation A. Gemelli IRCCS, 00168 Rome, Italy
| | | | - Mariantonietta Ariani
- Department of Neurosciences, Sense Organs and Thorax, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giorgio Ferriero
- Unit of Physical and Rehabilitation Medicine, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy
- Department of Biotechnology and Life Sciences, University of Insubria, 21110 Varese, Italy
| | - Gianpaolo Ronconi
- Department of Rehabilitation, Catholic University of the Sacred Heart, 00168 Rome, Italy
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Rich MJ, Burnash S, Krishnan RR, Chubinskaya S, Loeser RF, Polacheck WJ, Diekman BO. Use of a novel magnetically actuated compression system to study the temporal dynamics of axial and lateral strain in human osteochondral plugs. J Biomech 2024; 162:111887. [PMID: 38128469 PMCID: PMC10872462 DOI: 10.1016/j.jbiomech.2023.111887] [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: 06/03/2023] [Revised: 10/23/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
The high water content of articular cartilage allows this biphasic tissue to withstand large compressive loads through fluid pressurization. The system presented here, termed the "MagnaSquish", provides new capabilities for quantifying the effect of rehydration on cartilage behavior during cyclic loading. An imbalanced rate of fluid exudation during load and fluid re-entry during recovery can lead to the accumulation of strain during successive loading cycles - a phenomenon known as ratcheting. Typical experimental systems for cartilage biomechanics use continuous contact between the platen and sample, which may affect tissue rehydration by compressing the top layer of cartilage and slowing fluid re-entry. To address this limitation, we developed a magnetically actuated device that provides full lift-off of the platen in between loading cycles. We investigated strain accumulation in cadaveric human osteochondral plugs during 750 loading cycles, with two dimensional profiles of the cartilage captured at 30 frames per second throughout loading and 10 min of additional free swelling recovery. Axial and lateral strain measurements were extracted from the tissue profiles using a UNet-based deep learning algorithm to circumvent manual tracing. We observed increased axial strain accumulation with shorter inter-cycle recovery, with static loading serving as the extreme case of zero recovery. The loading waveform during the 750 cycles dictated the pace of the recovery during the extended free swelling period, as shorter inter-cycle recovery led to more persistent axial strain accumulation for up to five minutes. This work showcases the importance of fluid re-entry in resisting strain accumulation during cyclical compression.
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Affiliation(s)
- Matthew J Rich
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, United States; Joint Department of Biomedical Engineering, UNC and North Carolina State University, Raleigh, NC, United States
| | - Sarah Burnash
- Joint Department of Biomedical Engineering, UNC and North Carolina State University, Raleigh, NC, United States
| | - Rohan R Krishnan
- Joint Department of Biomedical Engineering, UNC and North Carolina State University, Raleigh, NC, United States
| | - Susan Chubinskaya
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States
| | - Richard F Loeser
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, United States; Department of Cell Biology and Physiology, UNC, United States; Division of Rheumatology, Allergy, and Immunology, UNC, United States
| | - William J Polacheck
- Joint Department of Biomedical Engineering, UNC and North Carolina State University, Raleigh, NC, United States; Department of Cell Biology and Physiology, UNC, United States; McAllister Heart Institute, UNC, United States
| | - Brian O Diekman
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, United States; Joint Department of Biomedical Engineering, UNC and North Carolina State University, Raleigh, NC, United States; Department of Cell Biology and Physiology, UNC, United States.
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4
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Albee ME. Take a load off: skeletal implications of sedentism in the feet of modern body donors. Evol Med Public Health 2023; 11:485-501. [PMID: 38162252 PMCID: PMC10756057 DOI: 10.1093/emph/eoad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/13/2023] [Indexed: 01/03/2024] Open
Abstract
Background and Objectives Modern biocultural environments continue to place selective pressures on our skeletons. In the past century, a major cultural pressure has been the rise in sedentism. However, studies considering the effects of sedentism on the foot have largely considered pathological changes to the gross foot without particular regard for the pedal skeleton. To address this gap in the literature, temporal trends in the development of osteoarthritis and entheseal changes on the tarsals and metatarsals were analyzed in the context of biodemographic data for recent modern humans. Methodology The sample utilized for this project is comprised of 71 individuals from the William M. Bass Donated Skeletal Collection, with birth years ranging from 1909 to 1993. Temporal trends in osteoarthritis and entheseal changes were determined via ANCOVA, using year of birth as the explanatory variable and biodemographic variables (age, sex, stature, body mass index and tibial robusticity) as covariates. Results Results indicate that entheseal changes and osteoarthritis have decreased over time, and these trends are statistically significant. Temporal trends in pedal entheseal changes and osteoarthritis vary by sex. Conclusions and Implications The increase in sedentary behavior over time has usually been framed as a net negative for human health and well-being. However, considered in isolation, the decrease in entheseal changes and osteoarthritis presented here might be considered a positive development as they suggest overall less stress on the modern human foot. This study also has the potential to inform the health sciences and general public about biocultural contributors to modern foot health.
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Affiliation(s)
- Malorie E Albee
- Department of Sociology and Anthropology, Northern Michigan University, Marquette, MI, USA
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Copp ME, Shine J, Brown HL, Nimmala KR, Hansen OB, Chubinskaya S, Collins JA, Loeser RF, Diekman BO. Sirtuin 6 activation rescues the age-related decline in DNA damage repair in primary human chondrocytes. Aging (Albany NY) 2023; 15:13628-13645. [PMID: 38078876 PMCID: PMC10756124 DOI: 10.18632/aging.205394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023]
Abstract
While advanced age is widely recognized as the greatest risk factor for osteoarthritis (OA), the biological mechanisms behind this connection remain unclear. Previous work has demonstrated that chondrocytes from older cadaveric donors have elevated levels of DNA damage as compared to chondrocytes from younger donors. The purpose of this study was to determine whether a decline in DNA repair efficiency is one explanation for the accumulation of DNA damage with age, and to quantify the improvement in repair with activation of Sirtuin 6 (SIRT6). After acute damage with irradiation, DNA repair was shown to be more efficient in chondrocytes from young (≤45 years old) as compared to middle-aged (50-65 years old) or older (>70 years old) cadaveric donors. Activation of SIRT6 with MDL-800 improved the repair efficiency, while inhibition with EX-527 reduced the rate of repair and increased the percentage of cells that retain high levels of damage. In addition to affecting repair after acute damage, treating chondrocytes from older donors with MDL-800 for 48 hours significantly reduced the amount of baseline DNA damage. Chondrocytes isolated from the knees of mice between 4 months and 22 months of age revealed both an increase in DNA damage with aging, and a decrease in DNA damage following MDL-800 treatment. Lastly, treating murine cartilage explants with MDL-800 lowered the percentage of chondrocytes with high p16 promoter activity, which supports the concept that using SIRT6 activation to maintain low levels of DNA damage may prevent the initiation of senescence.
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Affiliation(s)
- Michaela E. Copp
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, NC 27606, USA
| | - Jacqueline Shine
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Hannon L. Brown
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, NC 27606, USA
| | - Kirti R. Nimmala
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, NC 27606, USA
| | - Oliver B. Hansen
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Susan Chubinskaya
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA
| | - John A. Collins
- Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA 19144, USA
| | - Richard F. Loeser
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Division of Rheumatology, Allergy, and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Brian O. Diekman
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, NC 27606, USA
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Chantrain VA, Foubert A, Meeus M, Lambert C, Lobet S, Maes P, Fransen E, Durnez L, Hermans C, Roussel NA. Joint status, pain and quality of life in elderly people with haemophilia: A case-control study. Haemophilia 2023; 29:1621-1632. [PMID: 37861076 DOI: 10.1111/hae.14890] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Elderly people with haemophilia (PwH) develop haemophilic arthropathy, pain, and reduced health-related quality of life (HR-QoL). The condition of elderly mild haemophilia patients have rarely been evaluated. This study aimed to compare joint status, pain, and HR-QoL between elderly with mild, moderate/severe haemophilia and healthy elderlies. METHODS Knee/ankle abnormalities were assessed by ultrasound (HEAD-US) and physical examination (HJHS 2.1). Pain severity and pain interference were investigated using the Brief Pain Inventory. Pressure pain thresholds (PPTs) were obtained at knees/ankles and forehead. Functional limitations were evaluated using the 2-Minute-Walking-Test, Timed-Up-and-Go and HAL. The EQ-5D-5L questionnaire evaluated HR-QoL. Healthy controls (HCs) and elderly individuals with moderate/severe and mild haemophilia were compared using Kruskal-Wallis and Mann-Whitney U tests. RESULTS From the 46 elderly PwH approached, 40 individuals (≥60 years) with haemophilia A/B (17 moderate/severe; 23 mild) and 20 age-matched HCs were recruited. Moderate/severe PwH displayed worse joint status, lower PPTs, and poorer HR-QoL than mild PwH and HCs (p-value = .010-<.001). HEAD-US abnormalities were observed in 100% of knees and 94% of ankles in moderate/severe PwH, versus 50% of knees and 61% of ankles in mild PwH. Pain was reported by 80% and 57% of moderate/severe and mild PwH, respectively. Low PPTs, functional limitations, and poor HR-QoL scores were likewise observed in some mild PwH, yet without significantly differing from HCs. CONCLUSION This study highlights poor joint/functional status, pain, and HR-QoL outcomes in elderly with moderate/severe haemophilia. A few mild haemophilia subjects presented joint abnormalities, pain, functional limitations, and poor HR-QoL, without significantly differing from HCs. HIGHLIGHTS Elderly individuals with mild haemophilia have not yet been extensively studied, whereas moderate/severe haemophilia individuals have proven to suffer from haemophilic arthropathy, pain, and poor health-related quality of life (HR-QoL). Using a case-control design, joint status, pain, and HR-QoL outcomes were examined in elderly haemophilia individuals and compared with those of healthy controls (HCs). Elderly moderate/severe haemophilia individuals exhibited worse joint status, increased joint pain sensitivity, and reduced HR-QoL compared with both mild haemophilia subjects and HCs. A subset of mild haemophilia subjects exhibited poor joint status, pain, and HR-QoL outcomes, without any differences noted when compared with HCs.
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Affiliation(s)
- Valérie-Anne Chantrain
- Faculty of Medicines and Health Sciences, Research Group (MOVANT), Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion, International Research Group, Brussel, Belgium
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
- Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Anthe Foubert
- Faculty of Medicines and Health Sciences, Research Group (MOVANT), Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion, International Research Group, Brussel, Belgium
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Mira Meeus
- Faculty of Medicines and Health Sciences, Research Group (MOVANT), Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion, International Research Group, Brussel, Belgium
| | - Catherine Lambert
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Sébastien Lobet
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
- Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
- Secteur de Kinésithérapie, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Philip Maes
- Haemostasis and Thrombosis Unit, Division of Paediatric Haematology, University Hospital Antwerp, Antwerp, Belgium
| | - Erik Fransen
- Centre of Medical Genetics, University of Antwerp and Antwerp University Hospital, Edegem, Belgium
| | - Lies Durnez
- Faculty of Medicines and Health Sciences, Research Group (MOVANT), Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
| | - Cedric Hermans
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Nathalie Anne Roussel
- Faculty of Medicines and Health Sciences, Research Group (MOVANT), Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
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Miao MZ, Su QP, Cui Y, Bahnson EM, Li G, Wang M, Yang Y, Collins JA, Wu D, Gu Q, Chubinskaya S, Diekman BO, Yamada KM, Loeser RF. Redox-active endosomes mediate α5β1 integrin signaling and promote chondrocyte matrix metalloproteinase production in osteoarthritis. Sci Signal 2023; 16:eadf8299. [PMID: 37906629 PMCID: PMC10666734 DOI: 10.1126/scisignal.adf8299] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 10/10/2023] [Indexed: 11/02/2023]
Abstract
Mechanical cues sensed by integrins induce cells to produce proteases to remodel the extracellular matrix. Excessive protease production occurs in many degenerative diseases, including osteoarthritis, in which articular cartilage degradation is associated with the genesis of matrix protein fragments that can activate integrins. We investigated the mechanisms by which integrin signals may promote protease production in response to matrix changes in osteoarthritis. Using a fragment of the matrix protein fibronectin (FN) to activate the α5β1 integrin in primary human chondrocytes, we found that endocytosis of the integrin and FN fragment complex drove the production of the matrix metalloproteinase MMP-13. Activation of α5β1 by the FN fragment, but not by intact FN, was accompanied by reactive oxygen species (ROS) production initially at the cell surface, then in early endosomes. These ROS-producing endosomes (called redoxosomes) contained the integrin-FN fragment complex, the ROS-producing enzyme NADPH oxidase 2 (NOX2), and SRC, a redox-regulated kinase that promotes MMP-13 production. In contrast, intact FN was endocytosed and trafficked to recycling endosomes without inducing ROS production. Articular cartilage from patients with osteoarthritis showed increased amounts of SRC and the NOX2 complex component p67phox. Furthermore, we observed enhanced localization of SRC and p67phox at early endosomes, suggesting that redoxosomes could transmit and sustain integrin signaling in response to matrix damage. This signaling mechanism not only amplifies the production of matrix-degrading proteases but also establishes a self-perpetuating cycle that contributes to the ongoing degradation of cartilage matrix in osteoarthritis.
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Affiliation(s)
- Michael Z. Miao
- Division of Rheumatology, Allergy, and Immunology and the Thurston Arthritis Research Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Division of Oral & Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Curriculum in Oral and Craniofacial Biomedicine, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Cell Biology Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Qian Peter Su
- School of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Yang Cui
- Division of Rheumatology, Allergy, and Immunology and the Thurston Arthritis Research Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Edward M. Bahnson
- Department of Cell Biology and Physiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Gang Li
- Department of Genome Sciences, University of Washington, Seattle, WA, 98195, USA
- eScience Institute, University of Washington, Seattle, WA, 98195, USA
| | - Menglin Wang
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Yuchen Yang
- State Key Laboratory of Biocontrol, School of Ecology, Sun Yat-sen University, Guangzhou, 510275, China
| | - John A. Collins
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Di Wu
- Division of Oral & Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, NC, 27599, USA
| | - Qisheng Gu
- Shanghai Institute of Immunity and Infection, Chinese Academy of Sciences, Shanghai, 200031, China
- Department of Immunology, Université Paris Cité, Paris, 75006, France
| | - Susan Chubinskaya
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Brian O. Diekman
- Division of Rheumatology, Allergy, and Immunology and the Thurston Arthritis Research Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, 27695, USA
| | - Kenneth M. Yamada
- Cell Biology Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Richard F. Loeser
- Division of Rheumatology, Allergy, and Immunology and the Thurston Arthritis Research Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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Cui Y, Miao MZ, Wang M, Su QP, Qiu K, Arbeeva L, Chubinskaya S, Diekman BO, Loeser RF. Yes-associated protein nuclear translocation promotes anabolic activity in human articular chondrocytes. Osteoarthritis Cartilage 2023; 31:1078-1090. [PMID: 37100374 PMCID: PMC10524185 DOI: 10.1016/j.joca.2023.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 03/27/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE Yes-associated protein (YAP) has been widely studied as a mechanotransducer in many cell types, but its function in cartilage is controversial. The aim of this study was to identify the effect of YAP phosphorylation and nuclear translocation on the chondrocyte response to stimuli relevant to osteoarthritis (OA). DESIGN Cultured normal human articular chondrocytes from 81 donors were treated with increased osmolarity media as an in vitro model of mechanical stimulation, fibronectin fragments (FN-f) or IL-1β as catabolic stimuli, and IGF-1 as an anabolic stimulus. YAP function was assessed with gene knockdown and inhibition by verteporfin. Nuclear translocation of YAP and its transcriptional co-activator TAZ and site-specific YAP phosphorylation were determined by immunoblotting. Immunohistochemistry and immunofluorescence to detect YAP were performed on normal and OA human cartilage with different degrees of damage. RESULTS Chondrocyte YAP/TAZ nuclear translocation increased under physiological osmolarity (400 mOsm) and IGF-1 stimulation, which was associated with YAP phosphorylation at Ser128. In contrast, catabolic stimulation decreased the levels of nuclear YAP/TAZ through YAP phosphorylation at Ser127. Following YAP inhibition, anabolic gene expression and transcriptional activity decreased. Additionally, YAP knockdown reduced proteoglycan staining and levels of type II collagen. Total YAP immunostaining was greater in OA cartilage, but YAP was sequestered in the cytosol in cartilage areas with more severe damage. CONCLUSIONS YAP chondrocyte nuclear translocation is regulated by differential phosphorylation in response to anabolic and catabolic stimuli. Decreased nuclear YAP in OA chondrocytes may contribute to reduced anabolic activity and promotion of further cartilage loss.
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Affiliation(s)
- Y Cui
- Xiangya International Medical Center, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, China; Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA.
| | - M Z Miao
- Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA; Division of Oral & Craniofacial Health Sciences, University of North Carolina Adams School of Dentistry, Chapel Hill, NC, 27599, USA.
| | - M Wang
- Division of Pharmacoengineering and Molecular Pharmaceutics, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, 27599, USA.
| | - Q P Su
- School of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, 2007, Australia.
| | - K Qiu
- Division of Pharmacoengineering and Molecular Pharmaceutics, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, 27599, USA.
| | - L Arbeeva
- Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA.
| | - S Chubinskaya
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, 60612, USA.
| | - B O Diekman
- Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA; Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, 27599, USA.
| | - R F Loeser
- Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA.
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9
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Szapary HJ, Flaman L, Frank E, Chubinskaya S, Dwivedi G, Grodzinsky AJ. Effects of dexamethasone and dynamic loading on cartilage of human osteochondral explants challenged with inflammatory cytokines. J Biomech 2023; 149:111480. [PMID: 36791513 DOI: 10.1016/j.jbiomech.2023.111480] [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: 11/05/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Post-traumatic osteoarthritis (PTOA), characterized by articular cartilage degradation initiated in an inflammatory environment after traumatic joint injury, can lead to alterations in cartilage biomechanical properties. Low dose dexamethasone (Dex) shows chondroprotection in cartilage challenged with inflammatory cytokines, but little is known about the structural biomechanical response of human cartilage to Dex in such a diseased state. This study examined changes in the biomechanical properties and biochemical composition of the cartilage within human osteochondral explants in response to treatment with exogenous cytokines, Dex, and a regimen of cyclic loading at the start and end of culture. Osteochondral explants were harvested from five pairs of human ankle talocrural joints (Collins grade 0-1) and cultured for 10 days with/without exogenous cytokines (100 ng/mL TNFα, 50 ng/mL IL-6, 250 ng/mL sIL-6R) ± Dex (100 nM). Biomechanical testing on day-0 and day-10 enabled estimation of the unconfined compression equilibrium modulus (Ey), dynamic stiffness (Ed) and hydraulic permeability (kp) of cartilage excised from bone, accompanied by biochemical assessment of media and cartilage tissue. Dex preserved chondrocyte cell viability and decreased sulfated glycosaminoglycan (sGAG) loss and nitric oxide release, but did not alter Ey, Ed and kp (before or after loading) on day-10. In the cytokine/cytokine+Dex treated groups, sGAG content exhibited a weaker correlation with Ey and Ed than at baseline, suggesting an important role for structural rather than biochemical changes in producing biomechanical alterations in response to cytokines and Dex. These findings aid in forming a more complete profile of potential clinical effects of Dex for use in OA/PTOA treatment regimens.
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Affiliation(s)
- Hannah J Szapary
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Health Sciences and Technology, Harvard Medical School, Boston, MA 02115, USA.
| | - Lisa Flaman
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Eliot Frank
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Susan Chubinskaya
- Departments of Pediatrics, Orthopedic Surgery and Medicine (Section of Rheumatology), Rush University Medical Center, Chicago, IL 60612, USA.
| | - Garima Dwivedi
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alan J Grodzinsky
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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10
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Copp ME, Shine J, Brown HL, Nimmala KR, Chubinskaya S, Collins JA, Loeser RF, Diekman BO. SIRT6 activation rescues the age-related decline in DNA damage repair in primary human chondrocytes. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.27.530205. [PMID: 36909504 PMCID: PMC10002640 DOI: 10.1101/2023.02.27.530205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
While advanced age has long been recognized as the greatest risk factor for osteoarthritis (OA), the biological mechanisms behind this connection remain unclear. Previous work has demonstrated that chondrocytes from older cadaveric donors have elevated levels of DNA damage as compared to chondrocytes from younger donors. The purpose of this study was to determine whether a decline in DNA repair efficiency is one explanation for the accumulation of DNA damage with age, and to quantify the improvement in repair with activation of Sirtuin 6 (SIRT6). Using an acute irradiation model to bring the baseline level of all donors to the same starting point, this study demonstrates a decline in repair efficiency during aging when comparing chondrocytes from young (≤45 years old), middle-aged (50-65 years old), or older (>70 years old) cadaveric donors with no known history of OA or macroscopic cartilage degradation at isolation. Activation of SIRT6 in middle-aged chondrocytes with MDL-800 (20 μM) improved the repair efficiency, while inhibition with EX-527 (10 μM) inhibited the rate of repair and the increased the percentage of cells that retained high levels of damage. Treating chondrocytes from older donors with MDL-800 for 48 hours significantly reduced the amount of DNA damage, despite this damage having accumulated over decades. Lastly, chondrocytes isolated from the proximal femurs of mice between 4 months and 22 months of age revealed both an increase in DNA damage with aging, and a decrease in DNA damage following MDL-800 treatment.
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Affiliation(s)
- Michaela E Copp
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, NC
| | - Jacqueline Shine
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hannon L Brown
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, NC
| | - Kirti R Nimmala
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, NC
| | - Susan Chubinskaya
- Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - John A Collins
- Department of Orthopedic Surgery, Thomas Jefferson University
| | - Richard F Loeser
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Rheumatology, Allergy, and Immunology, University of North Carolina
| | - Brian O Diekman
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, NC
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11
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Advances in the Clinical Application of Platelet-Rich Plasma in the Foot and Ankle: A Review. J Clin Med 2023; 12:jcm12031002. [PMID: 36769649 PMCID: PMC9917505 DOI: 10.3390/jcm12031002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/31/2023] Open
Abstract
Autologous and recombinant biologic substances have been generated as a result of the research into the cellular features of the healing process. Orthobiologics are increasingly being used in sports medicine and musculoskeletal surgery. Nevertheless, clinical data are limited; consequently, further studies are required, particularly in foot and ankle pathologies. This review aims to provide evidence of the most recent literature results and ignite the interest of orthopedic specialists eager for an update about the most current discussion on platelet-rich plasma (PRP) clinical applications in the foot and ankle fields. Previous studies have shown that platelet-rich plasma can be beneficial in treating various conditions, such as chronic foot ulcers, osteoarthritis, Achilles tendinopathy, etc. Despite the positive effects of PRP on various musculoskeletal conditions, more prospective studies are needed to confirm its effectiveness at treating ankle and foot pathologies. In addition to clinical trials, other factors, such as the quality of the research and the procedures involved, must be considered before they can be used in patients. More long-term evaluations are needed to support or oppose its application in treating foot and ankle disorders. We present the most extensive review of PRP's clinical applications in the foot and ankle field.
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12
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Khemani S, Shah S, Mhase S, Khan SN, Nimje AM, Patil MS. Pragmatic Effect of Lower Limb McKenzie in Grade One Osteoarthritis: A Novel Case Report. Cureus 2022; 14:e29945. [DOI: 10.7759/cureus.29945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022] Open
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13
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Predicting Transport of Intra-Articularly Injected Growth Factor Fusion Proteins into Human Knee Joint Cartilage. Acta Biomater 2022; 153:243-259. [DOI: 10.1016/j.actbio.2022.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022]
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14
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Dwivedi G, Flaman L, Alaybeyoglu B, Struglics A, Frank EH, Chubinskya S, Trippel SB, Rosen V, Cirit M, Grodzinsky AJ. Inflammatory cytokines and mechanical injury induce post-traumatic osteoarthritis-like changes in a human cartilage-bone-synovium microphysiological system. Arthritis Res Ther 2022; 24:198. [PMID: 35982461 PMCID: PMC9386988 DOI: 10.1186/s13075-022-02881-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/23/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Traumatic knee injuries in humans trigger an immediate increase in synovial fluid levels of inflammatory cytokines that accompany impact damage to joint tissues. We developed a human in vitro cartilage-bone-synovium (CBS) coculture model to study the role of mechanical injury and inflammation in the initiation of post-traumatic osteoarthritis (PTOA)-like disease. METHODS Osteochondral plugs (cartilage-bone, CB) along with joint capsule synovium explants (S) were harvested from 25 cadaveric distal femurs from 16 human donors (Collin's grade 0-2, 23-83years). Two-week monocultures (cartilage (C), bone (B), synovium (S)) and cocultures (CB, CBS) were established. A PTOA-like disease group was initiated via coculture of synovium explants with mechanically impacted osteochondral plugs (CBS+INJ, peak stress 5MPa) with non-impacted CB as controls. Disease-like progression was assessed through analyses of changes in cell viability, inflammatory cytokines released to media (10-plex ELISA), tissue matrix degradation, and metabolomics profile. RESULTS Immediate increases in concentrations of a panel of inflammatory cytokines occurred in CBS+INJ and CBS cocultures and cultures with S alone (IL-1, IL-6, IL-8, and TNF-α among others). CBS+INJ and CBS also showed increased chondrocyte death compared to uninjured CB. The release of sulfated glycosaminoglycans (sGAG) and associated ARGS-aggrecan neoepitope fragments to the medium was significantly increased in CBS and CBS+INJ groups. Distinct metabolomics profiles were observed for C, B, and S monocultures, and metabolites related to inflammatory response in CBS versus CB (e.g., kynurenine, 1-methylnicotinamide, and hypoxanthine) were identified. CONCLUSION CBS and CBS+INJ models showed distinct cellular, inflammatory, and matrix-related alterations relevant to PTOA-like initiation/progression. The use of human knee tissues from donors that had no prior history of OA disease suggests the relevance of this model in highlighting the role of injury and inflammation in earliest stages of PTOA progression.
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Affiliation(s)
- Garima Dwivedi
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA USA
| | - Lisa Flaman
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
| | - Begum Alaybeyoglu
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
- Javelin Biotech, Woburn, MA USA
| | - André Struglics
- Department of Clinical Sciences Lund, Orthopaedics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Eliot H. Frank
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
| | - Susan Chubinskya
- Departments of Pediatrics, Orthopedic Surgery and Medicine (Section of Rheumatology), Rush University Medical Center, Chicago, IL USA
| | - Stephen B. Trippel
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN USA
| | - Vicki Rosen
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA USA
| | | | - Alan J. Grodzinsky
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, NE47-377, 500 Technology Square, Cambridge, MA 02139 USA
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15
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Kaspiris A, Chronopoulos E, Vasiliadis E, Khaldi L, Melissaridou D, Iliopoulos ID, Savvidou OD. Sex, but not age and bone mass index positively impact on the development of osteochondral micro‐defects and the accompanying cellular alterations during osteoarthritis progression. Chronic Dis Transl Med 2022; 8:41-50. [PMID: 35620158 PMCID: PMC9128565 DOI: 10.1002/cdt3.16] [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: 07/15/2021] [Accepted: 12/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Osteoarthritis (ΟΑ) is characterized by cartilage breakdown and subchondral sclerosis. Micro‐fractures of the calcified tissues have been, also, detected, but their exact role has not been elucidated yet. This study was to examine the frequency of cracks during OA progression and to correlate them with the underlying cellular modifications and matrix metalloproteinase‐2 (MMP‐2) expression using histological/immunohistological methods. Methods Overall, 20 patients and 3 controls (9 specimens per patient), aged 60–89 years, diagnosed with hip/knee OA were included. The development of cracks was examined in 138 sections, whereas the expression of MMP‐2 was examined in 69 additional sections. Results Based on Mankin score, three groups of OA severity were analyzed: Group I (mild) was constituted of sections with score 1–5 while Groups II (moderate) and III (severe) with score 6–7 and greater or equal to 8, respectively. Demographic characteristics did not reveal any association between the number of microdefects and age or body mass index (BMI). Cartilage micro‐cracks were increased during moderate and severe OA, while bone cracks were increased during mild and severe OA. In knee OA, cartilage cracks were not correlated with Mankin score, whereas in hip OA they appeared association with severity score. Bone cracks were positively correlated with matrix apoptotic osteocytes and osteoblastic cells, but not with osteoclasts. MMP‐2 immunostaining was increasing by OA severity in the osteochondral unit. Similarly, MMP‐2 was expressed on the microcracks’ wall mainly in Group III. Conclusion Our data displayed that bone cracks during primary OA stages, represent an early adaptative mechanism aiming to maintain cartilage integrity. Accumulation of bone defects and concomitant increase of apoptotic osteocytes activated an abnormal remodeling due to osteoblastic activity, in which MMP‐2 played a pivotal role, leading to subchondral sclerosis promoting further osteochondral deformities.
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Affiliation(s)
- Angelos Kaspiris
- Laboratory of Molecular Pharmacology, Division for Orthopaedic Research, School of Health Sciences University of Patras Patras Greece
| | - Efstathios Chronopoulos
- Second Department of Orthopaedic Surgery, School of Medicine National and Kapodistrian University of Athens, “Konstantopoulio” General Hospital Athens Greece
| | - Elias Vasiliadis
- Third Department of Orthopaedic Surgery “KAT” General Hospital and Medical School University of Athens Athens Greece
| | - Lubna Khaldi
- Department of Pathology “Agios Savvas” Athens Cancer Hospital–NHS Athens Greece
| | - Dimitra Melissaridou
- First Department of Orthopaedic Surgery, School of Medicine National and Kapodistrian University of Athens, “ATTIKON” University General Hospital Athens Greece
| | - Ilias D. Iliopoulos
- Department of Orthopaedic Surgery, “Rion” University Hospital and Medical School, School of Health Sciences University of Patras Patras Greece
| | - Olga D. Savvidou
- First Department of Orthopaedic Surgery, School of Medicine National and Kapodistrian University of Athens, “ATTIKON” University General Hospital Athens Greece
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16
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Hernigou P, Safar A, Hernigou J, Ferre B. Subtalar axis determined by combining digital twins and artificial intelligence: influence of the orientation of this axis for hindfoot compensation of varus and valgus knees. INTERNATIONAL ORTHOPAEDICS 2022; 46:999-1007. [PMID: 35138455 DOI: 10.1007/s00264-022-05311-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Previous studies evaluating hindfoot and knee alignment have suggested compensation between the knee and the hindfoot deformities. However, these studies did not investigate the influence of the orientation of the subtalar axis on the results. MATERIAL AND METHODS Using computed tomography data of patients without osteoarthritis, digital twins, and artificial intelligence, we identified the orientation of the axis of the subtalar joint. Compensation was evaluated in the subtalar joint according to angular knee deformity and subtalar axis direction. RESULTS With the inclination angle defined as the angle between the axis and the XY plane (horizontal) and the deviation angle defined as the angle between the projection of axis on the XZ plane, the inclination angle of the subtalar helical axis showed an average angle of 35.3° (range 5° to 48°). The mean deviation angle for the helical axis was 6.4° (range - 4° to + 12°). Our findings indicated that an increase of the inclination angle of the subtalar axis tends to limit adjustment in the hindfoot alignment toward re-balance of the whole lower limb toward a neutral weight-bearing axis when malalignment of the knee occurs. CONCLUSION Malalignment of the knee and different compensations in the hindfoot contribute to various combined deformities in the population: associated valgus or varus deformities and inverse associations of varus/valgus deformities.
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Affiliation(s)
- Philippe Hernigou
- Orthopedic Department, Henri Mondor Hospital, University Paris East, Paris, France.
| | - Adonis Safar
- Orthopedic Department, EpiCURA Baudour Hornu Hospital, Mons, Belgium
| | - Jacques Hernigou
- Orthopedic Department, EpiCURA Baudour Hornu Hospital, Mons, Belgium
| | - Bruno Ferre
- Institut Monégasque de Médecine & Chirurgie Sportive, 98000, Monaco, Monaco
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17
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Black RM, Wang Y, Struglics A, Lorenzo P, Chubinskaya S, Grodzinsky AJ, Önnerfjord P. Proteomic clustering reveals the kinetics of disease biomarkers in bovine and human models of post-traumatic osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3. [DOI: 10.1016/j.ocarto.2021.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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18
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Chubinskaya S, Cotter EJ, Frank RM, Hakimiyan AA, Yanke AB, Cole BJ. Biologic Characteristics of Shoulder Articular Cartilage in Comparison to Knee and Ankle Articular Cartilage From Individual Donors. Cartilage 2021; 12:456-467. [PMID: 31088162 PMCID: PMC8461154 DOI: 10.1177/1947603519847740] [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] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To describe histological and metabolic characteristics of glenohumeral joint (GHJ) articular cartilage and compare to knee and ankle joints. DESIGN Macroscopically healthy human humeral head, glenoid, knee, and ankle articular cartilage were obtained from tissue donors (N = 16, 9 males, 7 females; age 45-78 years), within 24 hours of death. Gross morphology of each joint was assessed using Collins grading. Cartilage explants were removed from the entire surface of each joint, cultured for 48 hours with or without interleukin-1β and processed for histology with Safranin O, proteoglycan (PG) synthesis/content, and polymerase chain reaction for collagen II, aggrecan, and SOX9. Results were compared between uncultured and cultured controls and across all 3 joints. RESULTS Structural differences were seen on histology between GHJ cartilage and knee and ankle cartilage of the same Collins grade, specifically, depletion of Safranin O staining in the extracellular matrix. Treatment of glenoid and humerus specimens with IL-1β demonstrated a trend toward decreased PG synthesis in each explant but this decrease did not reach significance. There was no significant difference in PG synthesis between humerus, glenoid, knee, and ankle samples at baseline, day-0 control, 48-hour control, and 48 hours after treatment with 0.1 ng or 10 ng of IL-1β. There were no significant increases in collagen II, SOX9, and aggrecan expression in glenoid and humeral head cartilage samples treated with IL-1β compared to baseline controls. CONCLUSIONS GHJ articular cartilage did not significantly differ from ankle or knee cartilage with regard to PG synthesis and gene expression. However, it did differ in its histological appearance in normal state.
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Affiliation(s)
| | - Eric J. Cotter
- Department of Orthopaedic Surgery, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Rachel M. Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Adam B. Yanke
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian J. Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA,Brian J. Cole, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Suite 300, Chicago, IL 60612, USA.
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19
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Tsokanos A, Livieratou E, Billis E, Tsekoura M, Tatsios P, Tsepis E, Fousekis K. The Efficacy of Manual Therapy in Patients with Knee Osteoarthritis: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:696. [PMID: 34356977 PMCID: PMC8304320 DOI: 10.3390/medicina57070696] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 11/23/2022]
Abstract
Background and objectives: Osteoarthritis (OA) is among the most common degenerative diseases that induce pain, stiffness and reduced functionality. Various physiotherapy techniques and methods have been used for the treatment of OA, including soft tissue techniques, therapeutic exercises, and manual techniques. The primary aim of this systemic review was to evaluate the short-and long-term efficacy of manual therapy (MT) in patients with knee OA in terms of decreasing pain and improving knee range of motion (ROM) and functionality. Materials and Methods: A computerised search on the PubMed, PEDro and CENTRAL databases was performed to identify controlled randomised clinical trials (RCTs) that focused on MT applications in patients with knee OA. The keywords used were 'knee OA', 'knee arthritis', 'MT', 'mobilisation', 'ROM' and 'WOMAC'. Results: Six RCTs and randomised crossover studies met the inclusion criteria and were included in the final analysis. The available studies indicated that MT can induce a short-term reduction in pain and an increase in knee ROM and functionality in patients with knee OA. Conclusions: MT techniques can contribute positively to the treatment of patients with knee OA by reducing pain and increasing functionality. Further research is needed to strengthen these findings by comparing the efficacy of MT with those of other therapeutic techniques and methods, both in the short and long terms.
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Affiliation(s)
- Alexios Tsokanos
- Therapeutic Exercise and Sports Rehabilitation Laboratory, Physiotherapy Department, University of Patras, 25100 Egio, Greece; (A.T.); (E.L.); (E.B.); (M.T.); (E.T.)
| | - Elpiniki Livieratou
- Therapeutic Exercise and Sports Rehabilitation Laboratory, Physiotherapy Department, University of Patras, 25100 Egio, Greece; (A.T.); (E.L.); (E.B.); (M.T.); (E.T.)
| | - Evdokia Billis
- Therapeutic Exercise and Sports Rehabilitation Laboratory, Physiotherapy Department, University of Patras, 25100 Egio, Greece; (A.T.); (E.L.); (E.B.); (M.T.); (E.T.)
| | - Maria Tsekoura
- Therapeutic Exercise and Sports Rehabilitation Laboratory, Physiotherapy Department, University of Patras, 25100 Egio, Greece; (A.T.); (E.L.); (E.B.); (M.T.); (E.T.)
| | - Petros Tatsios
- Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, University of West Attica (UNIWA), 12243 Athens, Greece;
| | - Elias Tsepis
- Therapeutic Exercise and Sports Rehabilitation Laboratory, Physiotherapy Department, University of Patras, 25100 Egio, Greece; (A.T.); (E.L.); (E.B.); (M.T.); (E.T.)
| | - Konstantinos Fousekis
- Therapeutic Exercise and Sports Rehabilitation Laboratory, Physiotherapy Department, University of Patras, 25100 Egio, Greece; (A.T.); (E.L.); (E.B.); (M.T.); (E.T.)
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20
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Hybrid fluorescence-AFM explores articular surface degeneration in early osteoarthritis across length scales. Acta Biomater 2021; 126:315-325. [PMID: 33753314 DOI: 10.1016/j.actbio.2021.03.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/06/2021] [Accepted: 03/14/2021] [Indexed: 12/21/2022]
Abstract
Atomic force microscopy (AFM) has become a powerful tool for the characterization of materials at the nanoscale. Nevertheless, its application to hierarchical biological tissue like cartilage is still limited. One reason is that such samples are usually millimeters in size, while the AFM delivers much more localized information. Here a combination of AFM and fluorescence microscopy is presented where features on a millimeter sized tissue sample are selected by fluorescence microscopy on the micrometer scale and then mapped down to nanometer precision by AFM under native conditions. This served us to show that local changes in the organization of fluorescent stained cells, a marker for early osteoarthritis, correlate with a significant local reduction of the elastic modulus, local thinning of the collagen fibers, and a roughening of the articular surface. This approach is not only relevant for cartilage, but in general for the characterization of native biological tissue from the macro- to the nanoscale. STATEMENT OF SIGNIFICANCE: Different length scales have to be studied to understand the function and dysfunction of hierarchically organized biomaterials or tissues. Here we combine a highly stable AFM with fluorescence microscopy and precisely motorized movement to correlate micro- and nanoscopic properties of articular cartilage on a millimeter sized sample under native conditions. This is necessary for unraveling the relationship between microscale organization of chondrocytes, micrometer scale changes in articular cartilage properties and nanoscale organization of collagen (including D-banding). We anticipate that such studies pave the way for a guided design of hierarchical biomaterials.
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21
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Collins JA, Kapustina M, Bolduc JA, Pike JFW, Diekman BO, Mix K, Chubinskaya S, Eroglu E, Michel T, Poole LB, Furdui CM, Loeser RF. Sirtuin 6 (SIRT6) regulates redox homeostasis and signaling events in human articular chondrocytes. Free Radic Biol Med 2021; 166:90-103. [PMID: 33600943 PMCID: PMC8009856 DOI: 10.1016/j.freeradbiomed.2021.01.054] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 12/30/2022]
Abstract
The nuclear localized protein deacetylase, SIRT6, has been identified as a crucial regulator of biological processes that drive aging. Among these processes, SIRT6 can promote resistance to oxidative stress conditions, but the precise mechanisms remain unclear. The objectives of this study were to examine the regulation of SIRT6 activity by age and oxidative stress and define the role of SIRT6 in maintaining redox homeostasis in articular chondrocytes. Although SIRT6 levels did not change with age, SIRT6 activity was significantly reduced in chondrocytes isolated from older adults. Using dimedone-based chemical probes that detect oxidized cysteines, we identified that SIRT6 is oxidized in response to oxidative stress conditions, an effect that was associated with reduced SIRT6 activity. Enhancement of SIRT6 activity through adenoviral SIRT6 overexpression specifically increased the basal levels of two antioxidant proteins, peroxiredoxin 1 (Prx1) and sulfiredoxin (Srx) and decreased the levels of an inhibitor of antioxidant activity, thioredoxin interacting protein (TXNIP). Conversely, in chondrocytes derived from mice with cartilage specific Sirt6 knockout, Sirt6 loss decreased Prx1 levels and increased TXNIP levels. SIRT6 overexpression decreased nuclear-generated H2O2 levels and oxidative stress-induced accumulation of nuclear phosphorylated p65. Our data demonstrate that SIRT6 activity is altered with age and oxidative stress conditions associated with aging. SIRT6 contributes to chondrocyte redox homeostasis by regulating specific members of the Prx catalytic cycle. Targeted therapies aimed at preventing the age-related decline in SIRT6 activity may represent a novel strategy to maintain redox balance in joint tissues and decrease catabolic signaling events implicated in osteoarthritis (OA).
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Affiliation(s)
- John A Collins
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Maryna Kapustina
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jesalyn A Bolduc
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Brussels Center for Redox Biology, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussel, Belgium
| | - James F W Pike
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian O Diekman
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC and North Carolina State University, Raleigh, NC, USA
| | - Kimberlee Mix
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Biological Sciences, Loyola University New Orleans, New Orleans, LA, USA
| | - Susan Chubinskaya
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA
| | - Emrah Eroglu
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA; Sabanci University, Faculty of Engineering and Natural Sciences, Genetics and Bioengineering Program, Nanotechnology Research and Application Center, Istanbul, Turkey
| | - Thomas Michel
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston MA, USA
| | - Leslie B Poole
- Department of Biochemistry, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Cristina M Furdui
- Department of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Richard F Loeser
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Ryman V, van der Esch M, Dekker J, Roorda L, van Dieën J, Twisk J, Verberne S, Huijbrechts E, Lems W, van der Leeden M. Determinants of pain and activity limitations in foot osteoarthritis: An exploratory cross-sectional study in the Amsterdam-foot cohort. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100134. [DOI: 10.1016/j.ocarto.2020.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/22/2020] [Accepted: 12/31/2020] [Indexed: 11/29/2022] Open
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The combination of mitogenic stimulation and DNA damage induces chondrocyte senescence. Osteoarthritis Cartilage 2021; 29:402-412. [PMID: 33227437 PMCID: PMC7925350 DOI: 10.1016/j.joca.2020.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 10/23/2020] [Accepted: 11/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Cellular senescence is a phenotypic state characterized by stable cell-cycle arrest, enhanced lysosomal activity, and the secretion of inflammatory molecules and matrix degrading enzymes. Senescence has been implicated in osteoarthritis (OA) pathophysiology; however, the mechanisms that drive senescence induction in cartilage and other joint tissues are unknown. While numerous physiological signals are capable of initiating senescence, one emerging theme is that damaged cells convert to senescence in response to sustained mitogenic stimulation. The goal of this study was to develop an in vitro articular cartilage explant model to investigate the mechanisms of senescence induction. DESIGN This study utilized healthy cartilage derived from cadaveric equine stifles and human ankles. Explants were irradiated to initiate DNA damage, and mitogenic stimulation was provided through serum-containing medium and treatment with transforming growth factor β1 and basic fibroblastic growth factor. Readouts of senescence were a quantitative flow cytometry assay to detect senescence-associated β galactosidase activity (SA-β-gal), immunofluorescence for p16 and γH2AX, and qPCR for the expression of inflammatory genes. RESULTS Human cartilage explants required both irradiation and mitogenic stimulation to induce senescence as compared to baseline control conditions (7.16% vs 2.34% SA-β-gal high, p = 0.0007). These conditions also resulted in chondrocyte clusters within explants, a persistent DNA damage response, increased p16, and gene expression changes. CONCLUSIONS Treatment of cartilage explants with mitogenic stimuli in the context of cellular damage reliably induces high levels of SA-β-gal activity and other senescence markers, which provides a physiologically relevant model system to investigate the mechanisms of senescence induction.
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Tschaikowsky M, Selig M, Brander S, Balzer BN, Hugel T, Rolauffs B. Proof-of-concept for the detection of early osteoarthritis pathology by clinically applicable endomicroscopy and quantitative AI-supported optical biopsy. Osteoarthritis Cartilage 2021; 29:269-279. [PMID: 33220445 DOI: 10.1016/j.joca.2020.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 09/30/2020] [Accepted: 10/14/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Clinical trials for osteoarthritis (OA), the leading cause of global disability, are unable to pinpoint the early, potentially reversible disease with clinical technology. Hence, disease-modifying drug candidates cannot be tested early in the disease. To overcome this obstacle, we asked whether early OA-pathology detection is possible with current clinical technology. METHODS We determined the relationship between two sensitive early OA markers, atomic force microscopy (AFM)-measured human articular cartilage (AC) surface stiffness, and location-matched superficial zone chondrocyte spatial organizations (SCSOs), asking whether a significant loss of surface stiffness can be detected in early OA SCSO stages. We then tested whether current clinical technology can visualize and accurately diagnose the SCSOs using an approved probe-based confocal laser-endomicroscope and a random forest (RF) model. RESULTS We demonstrated a correlation between AC surface stiffness and the SCSO (rrm = -0.91; 95%CI: -0.97, -0.73), and an extensive loss of surface stiffness specifically in those ACs with early OA-typical SCSO (95%CIs: string SCSO: 269-173 kPa, double string SCSO: 77-46 kPa). This established the SCSO as a visualizable, functionally relevant surrogate marker of early OA AC surface pathology. Moreover, SCSO-based stiffness discrimination worked well in each patient's AC. We then demonstrated feasibility of visualizing the SCSO by clinical laser-endomicroscopy and, importantly, accurate SCSO diagnosis using RF. CONCLUSION We present the proof-of-concept of early OA-pathology detection with available clinical technology, introducing a future-oriented, AI-supported, non-destructive quantitative optical biopsy for early disease detection. Operationalizing SCSO recognition, this approach allows testing for correlations between local tissue architectures with other experimental and clinical read-outs, but needs clinical validation and a larger sample size for defining diagnostic thresholds.
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Affiliation(s)
- M Tschaikowsky
- Institute of Physical Chemistry, Albert-Ludwigs-University Freiburg, Albertstr. 21, 79104, Freiburg, Germany; G.E.R.N. Research Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany
| | - M Selig
- G.E.R.N. Research Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany
| | - S Brander
- Institute of Physical Chemistry, Albert-Ludwigs-University Freiburg, Albertstr. 21, 79104, Freiburg, Germany
| | - B N Balzer
- Institute of Physical Chemistry, Albert-Ludwigs-University Freiburg, Albertstr. 21, 79104, Freiburg, Germany; Cluster of Excellence LivMatS @ FIT - Freiburg Center for Interactive Materials and Bioinspired Technologies, Freiburg, Germany
| | - T Hugel
- Institute of Physical Chemistry, Albert-Ludwigs-University Freiburg, Albertstr. 21, 79104, Freiburg, Germany; Cluster of Excellence LivMatS @ FIT - Freiburg Center for Interactive Materials and Bioinspired Technologies, Freiburg, Germany.
| | - B Rolauffs
- G.E.R.N. Research Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany.
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Collins AT, Kulvaranon M, Spritzer CE, McNulty AL, DeFrate LE. The Influence of Obesity and Meniscal Coverage on In Vivo Tibial Cartilage Thickness and Strain. Orthop J Sports Med 2020; 8:2325967120964468. [PMID: 33330731 PMCID: PMC7720327 DOI: 10.1177/2325967120964468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background Obesity, which potentially increases loading at the knee, is a common and modifiable risk factor for the development of knee osteoarthritis. The menisci play an important role in distributing joint loads to the underlying cartilage. However, the influence of obesity on the role of the menisci in cartilage load distribution in vivo is currently unknown. Purpose To measure tibial cartilage thickness and compressive strain in response to walking in areas covered and uncovered by the menisci in participants with normal body mass index (BMI) and participants with high BMI. Study Design Controlled laboratory study. Methods Magnetic resonance (MR) images of the right knees of participants with normal BMI (<25 kg/m2; n = 8) and participants with high BMI (>30 kg/m2; n = 7) were obtained before and after treadmill walking. The outer margins of the tibia, the medial and lateral cartilage surfaces, and the meniscal footprints were segmented on each MR image to create 3-dimensional models of the joint. Cartilage thickness was measured before and after walking in areas covered and uncovered by the menisci. Cartilage compressive strain was then determined from changes in thickness resulting from the walking task. Results Before exercise, medial and lateral uncovered cartilage of the tibial plateau was significantly thicker than covered cartilage in both BMI groups. In the uncovered region of the lateral tibial plateau, participants with high BMI had thinner preexercise cartilage than those with a normal BMI. Cartilage compressive strain was significantly greater in medial and lateral cartilage in participants with high BMI compared with those with normal BMI in both the regions covered and those uncovered by the menisci. Conclusion Participants with high BMI experienced greater cartilage strain in response to walking than participants with normal BMI in both covered and uncovered regions of cartilage, which may indicate that the load-distributing function of the meniscus is not sufficient to moderate the effects of obesity. Clinical Relevance These findings demonstrate the critical effect of obesity on cartilage function and thickness in regions covered and uncovered by the menisci.
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Affiliation(s)
- Amber T Collins
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Micaela Kulvaranon
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Physics, Duke University, Durham, North Carolina, USA
| | - Charles E Spritzer
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amy L McNulty
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Pathology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Biomedical Engineering, Duke University, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, North Carolina, USA
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26
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Tan L, Register TC, Yammani RR. Age-Related Decline in Expression of Molecular Chaperones Induces Endoplasmic Reticulum Stress and Chondrocyte Apoptosis in Articular Cartilage. Aging Dis 2020; 11:1091-1102. [PMID: 33014525 PMCID: PMC7505268 DOI: 10.14336/ad.2019.1130] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/30/2019] [Indexed: 12/27/2022] Open
Abstract
Aging is a major risk factor for the development of osteoarthritis (OA). One hallmark of aging is loss of proteostasis resulting in increased cellular stress and cell death. However, its effect on the development of OA is not clear. Here, using knee articular cartilage tissue from young and old cynomolgus monkeys (Macaca fascicularis), we demonstrate that with aging there is loss of molecular chaperone expression resulting in endoplasmic reticulum (ER) stress and cell death. Chondrocytes from aged articular cartilage showed decreased expression of molecular chaperones, including protein disulfide isomerase, calnexin, and Ero1-like protein alpha, and increased immunohistochemical staining for ER stress markers (phosphorylated IRE1 alpha, spliced X-box binding protein-1, activating transcription factor 4 and C/EBP homologous protein), and apoptotic markers [cleaved caspase 3 and cleaved poly(ADP-ribose) polymerase], suggesting that decreased expression of molecular chaperone during aging induces ER stress and chondrocyte apoptosis in monkey articular cartilage. Apoptosis induced by aging-associated ER stress was further confirmed by TUNEL staining. Aged monkey cartilage also showed increased expression of nuclear protein 1 (Nupr1) and tribbles related protein-3 (TRB3), known regulators of apoptosis and cell survival pathways. Treatment of cultured monkey chondrocytes with a small molecule chemical chaperone, 4-phenylbutyric acid (PBA, a general ER stress inhibitor) or PERK Inhibitor I (an ER stress inhibitor specifically targeting the PERK branch of the unfolded protein response pathway), decreased the expression of ER stress and apoptotic markers and reduced the expression of Nupr1 and TRB3. Consistent with the above finding, knockdown of calnexin expression induces ER stress and apoptotic markers in normal human chondrocytes in vitro. Taken together, our study clearly demonstrates that aging promotes loss of proteostasis and induces ER stress and chondrocyte apoptosis in articular cartilage. Thus, restoring proteostasis using chemical/molecular chaperone or ER stress inhibitor could be a therapeutic option to treat aged-linked OA.
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Affiliation(s)
- Li Tan
- Section of Molecular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Thomas C Register
- Departments of Pathology and Comparative Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Raghunatha R Yammani
- Section of Molecular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
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27
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Abstract
Ankle arthritis occurs primarily because of trauma and has a huge impact on patient's quality of life. Ankle arthrodesis is indicated for patients with end-stage ankle arthritis who fail conservative management. High rates of fusion can be achieved through an anterior approach. This video demonstrates an ankle arthrodesis using an anterior approach to the ankle in a patient with posttraumatic ankle arthritis.
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Warner SC, Nair A, Marpadga R, Chubinskaya S, Doherty M, Valdes AM, Scanzello CR. IL-15 and IL15RA in Osteoarthritis: Association With Symptoms and Protease Production, but Not Structural Severity. Front Immunol 2020; 11:1385. [PMID: 32793194 PMCID: PMC7390829 DOI: 10.3389/fimmu.2020.01385] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/29/2020] [Indexed: 01/30/2023] Open
Abstract
Objective: Interleukin-15 (IL-15) is a pro-inflammatory cytokine that is increased in joint fluids of early-stage osteoarthritis (OA) patients, and has been associated with expression of proteases that can damage cartilage, and the development of neuropathic pain-like symptoms (NP) after nerve injury. The objective of this study was to further explore the role of IL-15 in the pathogenesis of OA cartilage degeneration and test genetic variation in the IL-15 receptor α gene (IL15RA) for an association with OA with radiographic severity and symptoms. Methods: Cartilage samples from donors (n = 10) were analyzed for expression of the IL15 receptor α-chain using immunohistochemistry, and for responses to IL-15 in vitro using explant cultures. Data from two independent Nottinghamshire-based studies (n = 795 and n = 613) were used to test genetic variants in the IL15RA gene (rs2228059 and rs7097780) for an association with radiographic severity, symptomatic vs. asymptomatic OA and NP. Results: IL-15Rα was expressed in chondrocytes from cartilage obtained from normal and degenerative knees. IL-15 significantly increased the release of matrix metalloproteinase-1 and -3 (MMP-1 and -3), but did not affect loss of proteoglycan from the articular matrix. Genetic variants in the IL15RA gene are associated with risk of symptomatic vs. asymptomatic OA (rs7097780 OR = 1.48 95% 1.10-1.98 p < 0.01) and with the risk of NP post-total joint replacement (rs2228059 OR = 0.76 95% 0.63-0.92 p < 0.01) but not with radiographic severity. Conclusions: In two different cohorts of patients, we show an association between genetic variation at the IL15 receptor and pain. Although ex vivo cartilage explants could respond to IL-15 with increased protease production, we found no effect of IL-15 on cartilage matrix loss and no association between IL15RA variants and radiographic severity. Together, these results suggest that IL-15 signaling may be a target for pain, but may not impact structural progression, in OA.
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Affiliation(s)
- Sophie C Warner
- Academic Rheumatology, Nottingham City Hospital, Nottingham, United Kingdom
| | - Anjali Nair
- Section of Rheumatology, Rush University Medical Center, Chicago, IL, United States
| | - Rahul Marpadga
- Section of Rheumatology, Rush University Medical Center, Chicago, IL, United States
| | - Susan Chubinskaya
- Division of Pediatrics, Rush University Medical Center, Chicago, IL, United States
| | - Michael Doherty
- Academic Rheumatology, Nottingham City Hospital, Nottingham, United Kingdom.,Arthritis Research UK Pain Centre and National Institutes for Health Research Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Ana M Valdes
- Academic Rheumatology, Nottingham City Hospital, Nottingham, United Kingdom.,Arthritis Research UK Pain Centre and National Institutes for Health Research Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Carla R Scanzello
- Translational Musculoskeletal Research Center & Section of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States.,Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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29
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Quantifying the biochemical state of knee cartilage in response to running using T1rho magnetic resonance imaging. Sci Rep 2020; 10:1870. [PMID: 32024873 PMCID: PMC7002650 DOI: 10.1038/s41598-020-58573-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/16/2020] [Indexed: 12/16/2022] Open
Abstract
Roughly 20% of Americans run annually, yet how this exercise influences knee cartilage health is poorly understood. To address this question, quantitative magnetic resonance imaging (MRI) can be used to infer the biochemical state of cartilage. Specifically, T1rho relaxation times are inversely related to the proteoglycan concentration in cartilage. In this study, T1rho MRI was performed on the dominant knee of eight asymptomatic, male runners before, immediately after, and 24 hours after running 3 and 10 miles. Overall, (mean ± SEM) patellar, tibial, and femoral cartilage T1rho relaxation times significantly decreased immediately after running 3 (65 ± 3 ms to 62 ± 3 ms; p = 0.04) and 10 (69 ± 4 ms to 62 ± 3 ms; p < 0.001) miles. No significant differences between pre-exercise and recovery T1rho values were observed for either distance (3 mile: p = 0.8; 10 mile: p = 0.08). Percent decreases in T1rho relaxation times were significantly larger following 10 mile runs as compared to 3 mile runs (11 ± 1% vs. 4 ± 1%; p = 0.02). This data suggests that alterations to the relative proteoglycan concentration of knee cartilage due to water flow are mitigated within 24 hours of running up to 10 miles. This information may inform safe exercise and recovery protocols in asymptomatic male runners by characterizing running-induced changes in knee cartilage composition.
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30
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Abstract
Evidence-based medicine continues to guide our treatment of patients. Owing to the unique characteristics of the first metatarsophalangeal joint (1st MTPJ) with its small surface area and the significant amount of multiplanar force that affects it, finding the perfect implant to allow motion and alleviate pain is still the ultimate goal. While some of the older metallic implants and silastic spacers may still be providing pain relief and function to patients, the majority have failed and caused significant bone loss along the way. The HemiCap implants have shown some promise in select patients and may still be a viable option in patients desiring maintenance of 1st MTPJ motion.
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Affiliation(s)
- Michelle L Butterworth
- Williamsburg Regional Hospital, 500 Thurgood Marshall Hwy, Suite B, Kingstree, SC 29556, USA.
| | - Maria Ugrinich
- Penn Presbyterian Medical Center, 1317 Lombard Street, Philadelphia, PA 19147, USA
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Maier F, Lewis CG, Pierce DM. Through-thickness patterns of shear strain evolve in early osteoarthritis. Osteoarthritis Cartilage 2019; 27:1382-1391. [PMID: 31121293 DOI: 10.1016/j.joca.2019.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 04/04/2019] [Accepted: 04/27/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Given the structural changes associated with the progression of Osteoarthritis (OA), we hypothesized that patterns of through-thickness, large-strain shear evolve with early-stage OA. We therefore aimed to determine whether and how patterns of shear strains change during early-stage OA to 1) gain insight into the progression of OA by quantifying changes in local deformations; 2) gauge the potential of patterns in shear strain to serve as image-based biomarkers of early-stage OA; and 3) provide high-resolution, through-thickness data for proposing, fitting, and validating constitutive models for cartilage. DESIGN We completed displacement-driven, large-strain shear tests (5, 10, 15%) on 44 specimens of variably advanced osteoarthritic human articular cartilage as determined by both Osteoarthritis Research Society International (OARSI) grade and PLM-CO score. We recorded the through-thickness deformations with a stereo-camera system and processed these data using digital image correlation (DIC) to determine full-thickness patterns of strains and relative zonal recruitments, i.e., the average shear strain in a through-thickness zone weighted by its relative thickness and normalized by the applied strain. RESULTS We observed three general shapes for the curves of averaged through-thickness, Green-Lagrange shear strains during progression of OA. We also observed that during the progression of OA only the deep zone is recruited differently under shear in a statistically significant way. CONCLUSIONS We propose that changes in through-thickness patterns of shear strain could provide sensitive biomarkers for early clinical detection of OA. The relative zonal recruitment of the deep zone decreases with progressing OA (OARSI grade) and microstructural remodeling (PLM-CO score), which do not consistently affect recruitment of the superficial and middle zones.
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Affiliation(s)
- F Maier
- University of Connecticut, Department of Mechanical Engineering, Storrs, CT, USA
| | - C G Lewis
- Hartford Healthcare, Bone & Joint Institute, Hartford, CT, USA
| | - D M Pierce
- University of Connecticut, Department of Mechanical Engineering, Storrs, CT, USA; University of Connecticut, Department of Biomedical Engineering, Storrs, CT, USA.
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32
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Takahashi I, Matsuzaki T, Kuroki H, Hoso M. Joint unloading inhibits articular cartilage degeneration in knee joints of a monosodium iodoacetate-induced rat model of osteoarthritis. Osteoarthritis Cartilage 2019; 27:1084-1093. [PMID: 30890456 DOI: 10.1016/j.joca.2019.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/10/2019] [Accepted: 03/11/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of the study was to examine how mechanical unloading affects articular cartilage degeneration in the patellofemoral (PF) and tibiofemoral (TF) joints of a monosodium iodoacetate (MIA)-induced rat model of osteoarthritis (OA). DESIGN The study involved 60 male rats. OA was induced by intra-articular injecting MIA into both knee joints. All animals were equally divided into two groups: sedentary (SE) and hindlimb unloading (HU) groups. Histopathological changes in the articular cartilage of the PF and TF joints were evaluated using the Osteoarthritis Research Society International (OARSI) score and modified Mankin score at 2 and 4 weeks after MIA injection. RESULTS In the SE and HU groups, representative histopathological changes in OA were detected in the PF and TF joints. The OARSI and modified Mankin scores for the PF and TF joints tended to increase over time after the injection of 0.2 mg or 1.0 mg of MIA in the SE and HU groups. Both the scores for the HU group were significantly lower than those for the SE group [OARSI score: P < 0.0001 (1.0-mg injection at 4 weeks); modified Mankin score: P = 0.0116 (0.2-mg injection at 4 weeks); P = 0.0004 and < 0.0001 (1.0-mg injection at 2 and 4 weeks, respectively)]. CONCLUSION This study revealed new histological evidence that indicates that unloading condition suppresses articular cartilage degeneration and is beneficial in many areas of basal and clinical research involving OA.
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Affiliation(s)
- I Takahashi
- Section of Rehabilitation, Kanazawa University Hospital, Ishikawa, Japan; Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - T Matsuzaki
- School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan.
| | - H Kuroki
- Department of Motor Function Analysis, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - M Hoso
- School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan.
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Misir A, Yildiz KI, Kizkapan TB. Wider femoral and mediolaterally narrower tibial components are required for total knee arthroplasty in Turkish patients. Knee Surg Sports Traumatol Arthrosc 2019; 27:2155-2166. [PMID: 30824980 DOI: 10.1007/s00167-019-05448-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/25/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the knee morphologic parameters in the Turkish population, compare them with known data, and identify new morphologic parameters. METHODS Magnetic resonance (MR) images of 1000 healthy subjects aged 18-50 years were included. One orthopedic surgeon and one experienced musculoskeletal radiologist reviewed MR images and measured 22 morphologic parameters. Sex and side differences were evaluated. Correlations between age and measurement parameters were assessed. The measured parameters were compared with known data. Femoral and tibial condylar height differences were identified. RESULTS A strong correlation was found among regarding all measurement parameters (p = 0.000 and k > 0.985 for all measurements) by both observers. A significant difference between the female and male subjects regarding the measurement parameters (p = 0.000) was found, except for the tibial coronal slope, posterior condylar angle (PCA), medial and lateral tibial slopes (MTS and LTS), and medial plateau depth. No measurement parameter was significantly correlated with age (n.s.). The femur surface ratio in male and female subjects was 1.29 ± 1.04 and 1.28 ± 1.12, respectively (n.s.). The tibial plateau aspect ratio was 61.4 ± 1.09 in males and 59.8 ± 1.57 in females (p = 0.004). The mean medial and lateral femoral condylar cartilage and bone height differences were 3.3 ± 1.1 and 3.1 ± 0.9 mm, respectively. The mean medial and lateral tibial condylar cartilage and bone height differences were 2.3 ± 0.3 and 1.6 ± 0.1 mm, respectively. CONCLUSION Compared to current designs, wider femoral and mediolaterally narrower tibial components are needed to provide well-fitting prosthesis and improve functional outcomes, especially in women. The data on femoral and tibial condylar height differences will be useful for future research on component design. In the clinical practice, the components developed based on these findings will have a substantial effect on postoperative outcomes and patient satisfaction. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Abdulhamit Misir
- Şanlıurfa Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Bölümü, Akpıyar mah. 4061. Sk. Yaşamkent Park evleri no:29 B blok d:21, Karaköprü, Şanlıurfa, Turkey.
| | - Kadir Ilker Yildiz
- Metin Sabancı Baltalimanı Kemik Hastalıkları Eğitim ve Araştırma Hastanesi, Istanbul, Turkey
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Maier F, Lewis CG, Pierce DM. The evolving large-strain shear responses of progressively osteoarthritic human cartilage. Osteoarthritis Cartilage 2019; 27:810-822. [PMID: 30660720 DOI: 10.1016/j.joca.2018.12.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/22/2018] [Accepted: 12/28/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The composition and structure of articular cartilage evolves during the development and progression of osteoarthritis (OA) resulting in changing mechanical responses. We aimed to assess the evolution of the intrinsic, large-strain mechanics of human articular cartilage-governed by collagen and proteoglycan and their interactions-during the progression of OA. DESIGN We completed quasi-static, large-strain shear tests on 64 specimens from ten donors undergoing total knee arthroplasty (TKA), and quantified the corresponding state of OA (OARSI grade), structural integrity (PLM score), and composition (glycosaminoglycan and collagen content). RESULTS We observed nonlinear stress-strain relationships with distinct hystereses for all magnitudes of applied strain where stiffnesses, nonlinearities, and hystereses all reduced as OA advanced. We found a reduction in energy dissipation density up to 80% in severely degenerated (OARSI grade 4, OA-4) vs normal (OA-1) cartilage, and more importantly, we found that even cartilage with a normal appearance in structure and composition (OA-1) dissipated 50% less energy than healthy (control) load-bearing cartilage (HL0). Changes in stresses and stiffnesses were in general less pronounced and did not allow us to distinguish between healthy load-bearing controls and very early-stage OA (OA-1), or to distinguish consistently among different levels of degeneration, i.e., OARSI grades. CONCLUSIONS Our results suggest that reductions in energy dissipation density can be detected by bulk-tissue testing, and that these reductions precede visible signs of degeneration. We highlight the potential of energy dissipation, as opposed to stress- or stiffness-based measures, as a marker to diagnose early-stage OA.
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Affiliation(s)
- F Maier
- University of Connecticut, Department of Mechanical Engineering, Storrs, CT, USA
| | - C G Lewis
- Hartford Healthcare, Bone & Joint Institute, Hartford, CT, USA
| | - D M Pierce
- University of Connecticut, Department of Mechanical Engineering, Storrs, CT, USA; University of Connecticut, Department of Biomedical Engineering, Storrs, CT, USA.
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Nupr1 regulates palmitate-induced apoptosis in human articular chondrocytes. Biosci Rep 2019; 39:BSR20181473. [PMID: 30674641 PMCID: PMC6379229 DOI: 10.1042/bsr20181473] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/04/2019] [Accepted: 01/09/2019] [Indexed: 12/18/2022] Open
Abstract
Obesity, a major risk factor for the development of osteoarthritis (OA), is associated with increased circulating levels of free fatty acids (FFA). However, the role of these FFAs in OA pathophysiology is not clearly understood. In the present study, we found that palmitate treatment of human primary articular chondrocytes increased the expression of ER stress markers [activating transcription factor 4 (ATF4), C/EBP homologous protein (CHOP)] and apoptosis markers [cytochrome c and cleaved caspase-3 (CC3)]. Palmitate treatment also increased the expression of Nuclear protein 1 (Nupr1) and tribbles related protein 3 (TRB3), which are known negative regulators of cell survival pathways. Knockdown of Nupr1 or CHOP expression inhibited palmitate mediated increased expression of TRB3 and CC3, indicating that Nupr1 and CHOP cooperate to regulate cell survival and apoptotic pathways in human chondrocytes. Nupr1 knockdown had no effect on CHOP expression whereas CHOP knockdown abolished the palmitate-mediated Nupr1 expression, indicating that CHOP is functional upstream to Nupr1 in this pathway. Moreover, overexpression of Nupr1 markedly increased the basal expression of pro-apoptotic molecules, including cytochrome c and CC3. Taken together, our study demonstrates that Nupr1 plays a crucial role in palmitate-induced apoptosis in human chondrocytes and Nupr1 as a potential novel drug target for the treatment of OA.
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Taylor KA, Collins AT, Heckelman LN, Kim SY, Utturkar GM, Spritzer CE, Garrett WE, DeFrate LE. Activities of daily living influence tibial cartilage T1rho relaxation times. J Biomech 2019; 82:228-233. [PMID: 30455059 PMCID: PMC6492554 DOI: 10.1016/j.jbiomech.2018.10.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 09/06/2018] [Accepted: 10/23/2018] [Indexed: 12/20/2022]
Abstract
Quantitative T1rho magnetic resonance imaging (MRI) can potentially help identify early-stage osteoarthritis (OA) by non-invasively assessing proteoglycan concentration in articular cartilage. T1rho relaxation times are negatively correlated with proteoglycan concentration. Cartilage compresses in response to load, resulting in water exudation, a relative increase in proteoglycan concentration, and a decrease in the corresponding T1rho relaxation times. To date, there is limited information on changes in cartilage composition resulting from daily activity. Therefore, the objective of this study was to quantify changes in tibial cartilage T1rho relaxation times in healthy human subjects following activities of daily living. It was hypothesized that water exudation throughout the day would lead to decreased T1rho relaxation times. Subjects underwent MR imaging in the morning and afternoon on the same day and were free to go about their normal activities between scans. Our findings confirmed the hypothesis that tibial cartilage T1rho relaxation times significantly decreased (by 7%) over the course of the day with loading, which is indicative of a relative increase in proteoglycan concentration. Additionally, baseline T1rho values varied with position within the cartilage, supporting a need for site-specific measurements of T1rho relaxation times. Understanding how loading alters the proteoglycan concentration in healthy cartilage may hold clinical significance pertaining to cartilage homeostasis and potentially help to elucidate a mechanism for OA development. These results also indicate that future studies using T1rho relaxation times as an indicator of cartilage health should control the loading history prior to image acquisition to ensure the appropriate interpretation of the data.
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Affiliation(s)
- Kevin A Taylor
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Amber T Collins
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Lauren N Heckelman
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Sophia Y Kim
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | | | | | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
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Krishnan Y, Rees HA, Rossitto CP, Kim SE, Hung HHK, Frank EH, Olsen BD, Liu DR, Hammond PT, Grodzinsky AJ. Green fluorescent proteins engineered for cartilage-targeted drug delivery: Insights for transport into highly charged avascular tissues. Biomaterials 2018; 183:218-233. [PMID: 30173104 PMCID: PMC6141342 DOI: 10.1016/j.biomaterials.2018.08.050] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 01/04/2023]
Abstract
Osteoarthritis (OA), the most common form of arthritis, is a multi-factorial disease that primarily affects cartilage as well as other joint tissues such as subchondral bone. The lack of effective drug delivery, due to the avascular nature of cartilage and the rapid clearance of intra-articularly delivered drugs via the synovium, remains a major challenge in the development of disease modifying drugs for OA. Cationic delivery carriers can significantly enhance the uptake, penetration and retention of drugs in cartilage by interacting with negatively charged matrix proteoglycans. In this study, we used "supercharged" green fluorescent proteins (GFPs), engineered to have a wide range of net positive charge and surface charge distributions, to characterize the effects of carrier charge on transport into cartilage in isolation of other factors such as carrier size and shape. We quantified the uptake, extent of cartilage penetration and cellular uptake of the GFP variants into living human knee cartilage and bovine cartilage explants. Based on these results, we identified optimal net charges of GFP carriers for potential drug targets located within cartilage extracellular matrix as well as the resident live chondrocytes. These cationic GFPs did not have adverse effects on cartilage in terms of measured cell viability and metabolism, cartilage cell biosynthesis and matrix degradation at doses needed for drug delivery. In addition to quantifying the kinetics of GFP uptake, we developed a predictive mathematical model for transport of the GFP variants that exhibited the highest uptake and penetration into cartilage. This model was further used to predict the transport behavior of GFPs during scale-up to in vivo applications such as intra-articular injection into human knees. The insights gained from this study set the stage for development of cartilage-targeted delivery systems to prevent cartilage degeneration, improve tissue regeneration and reduce inflammation that may cause degradation of other joint tissues affected by OA.
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Affiliation(s)
- Yamini Krishnan
- Department of Chemical Engineering, MIT, Cambridge, MA 02139, USA
| | - Holly A Rees
- Merkin Institute of Transformative Technologies in Healthcare, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Chemistry & Chemical Biology, Harvard University, Cambridge, MA 02138, USA; Howard Hughes Medical Institute, Harvard University, Cambridge, MA 02138, USA
| | | | - Si-Eun Kim
- Department of Chemical Engineering, MIT, Cambridge, MA 02139, USA
| | - Han-Hwa K Hung
- Department of Biological Engineering, MIT, Cambridge, MA 02139, USA
| | - Eliot H Frank
- Department of Biological Engineering, MIT, Cambridge, MA 02139, USA
| | - Bradley D Olsen
- Department of Chemical Engineering, MIT, Cambridge, MA 02139, USA
| | - David R Liu
- Merkin Institute of Transformative Technologies in Healthcare, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Chemistry & Chemical Biology, Harvard University, Cambridge, MA 02138, USA; Howard Hughes Medical Institute, Harvard University, Cambridge, MA 02138, USA
| | - Paula T Hammond
- Department of Chemical Engineering, MIT, Cambridge, MA 02139, USA; Koch Institute of Integrative Cancer Research, MIT, Cambridge, MA 02139, USA
| | - Alan J Grodzinsky
- Department of Biological Engineering, MIT, Cambridge, MA 02139, USA; Department of Mechanical Engineering, MIT, Cambridge, MA 02139, USA; Department of Electrical Engineering and Computer Science, MIT, Cambridge, MA 02139, USA.
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Abstract
PURPOSE OF REVIEW Platelet-rich plasma has become an increasingly popular treatment option within the orthopedic community to biologically enhance and stimulate difficult-to-heal musculoskeletal tissues. This review evaluates the recent literature on platelet-rich plasma use in the treatment of foot and ankle pathologies. RECENT FINDINGS Recent literature has demonstrated platelet-rich plasma to have a possible benefit in the treatment of Achilles pathology, chronic plantar fasciitis, osteochondral lesions of the talus, ankle osteoarthritis, and diabetic foot ulcers. However, given the lack of standardization of platelet-rich plasma preparations and protocols and the predominance of low-quality studies, no definitive treatment indications exist. Platelet-rich plasma is a promising treatment option, but at present, there is only limited clinical evidence supporting its use in foot and ankle applications.
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Affiliation(s)
- Peter R Henning
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, 1400 S. Germantown Rd, Germantown, 38138, TN, USA
| | - Benjamin J Grear
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, 1400 S. Germantown Rd, Germantown, 38138, TN, USA.
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Murray C, Marshall M, Rathod T, Bowen CJ, Menz HB, Roddy E. Population prevalence and distribution of ankle pain and symptomatic radiographic ankle osteoarthritis in community dwelling older adults: A systematic review and cross-sectional study. PLoS One 2018; 13:e0193662. [PMID: 29708977 PMCID: PMC5927448 DOI: 10.1371/journal.pone.0193662] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/15/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To identify by systematic review published prevalence estimates of radiographic ankle osteoarthritis (OA) and to subsequently estimate the prevalence of ankle pain and symptomatic, radiographic ankle OA within community-dwelling older adults from North Staffordshire, UK. METHODS Electronic databases were searched using terms for ankle, osteoarthritis and radiography. Data regarding population, radiographic methods, definitions and prevalence estimates of ankle OA were extracted from papers meeting predetermined selection criteria. Adults aged ≥50 years and registered with four general practices in North Staffordshire were mailed a health questionnaire. Ankle pain in the previous month was determined using a foot and ankle pain manikin. Respondents reporting pain in or around the foot in the last 12 months were invited to attend a research clinic where weight-bearing, antero-posterior and lateral ankle radiographs were obtained and scored for OA using a standardised atlas. Prevalence estimates for ankle pain and symptomatic, radiographic ankle OA were calculated using multiple imputation and weighted logistic regression, and stratified by age, gender and socioeconomic status. RESULTS Eighteen studies were included in the systematic review. The methods of radiographic classification of ankle OA were poorly reported and showed heterogeneity. No true general population prevalence estimates of radiographic ankle OA were found, estimates in select sporting and medical community-dwelling populations ranged from 0.0-97.1%. 5109 participants responded to the health survey questionnaire (adjusted response 56%). Radiographs were obtained in 557 participants. The prevalence of ankle pain was 11.7% (10.8,12.6) and symptomatic, radiographic ankle OA grade≥2 was 3.4% (2.3, 4.5) (grade≥1: 8.8% (7.9,9.8); grade = 3: 1.9% (1.0,2.7). Prevalence was higher in females, younger adults (50-64 years) and those with routine/manual occupations. CONCLUSION No general population prevalence estimates of radiographic ankle OA were identified in the published literature. Our prevalence study found that ankle pain was common in community-dwelling older adults, whereas moderate to severe symptomatic, radiographic ankle OA occurred less frequently. Further investigations of the prevalence of ankle OA using more sensitive imaging modalities are warranted.
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Affiliation(s)
- Charlotte Murray
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
| | - Michelle Marshall
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
- * E-mail:
| | - Trishna Rathod
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
| | - Catherine J. Bowen
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Hylton B. Menz
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
- School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Edward Roddy
- Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
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40
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Sambamurthy N, Nguyen V, Smalley R, Xiao R, Hankenson K, Gan J, Miller RE, Malfait AM, Dodge GR, Scanzello CR. Chemokine receptor-7 (CCR7) deficiency leads to delayed development of joint damage and functional deficits in a murine model of osteoarthritis. J Orthop Res 2018; 36:864-875. [PMID: 28767178 PMCID: PMC5920778 DOI: 10.1002/jor.23671] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 07/24/2017] [Indexed: 02/04/2023]
Abstract
Elevated chemokine receptor Ccr7 is observed in knee osteoarthritis (OA) and associated with severity of symptoms. In this study, we confirmed that CCR7 protein expression is elevated in synovial tissue from OA patients by immunohistochemical staining. We then investigated whether Ccr7 deficiency impacted structural and functional joint degeneration utilizing a murine model of OA. OA-like disease was induced in male C57BL/6 and Ccr7-deficient (Ccr7-/- ) mice by destabilization of the medial meniscus (DMM). Functional deficits were measured by computer integrated monitoring of spontaneous activity every 4 weeks after DMM surgery up 16 weeks. Joint degeneration was evaluated at 6 and 19 weeks post-surgery by histopathology, and subchondral bone changes analyzed by microCT. Results showed reduction in locomotor activities in DMM-operated C57BL/6 mice by 8 weeks, while activity decreases in Ccr7-/- mice were delayed until 16 weeks. Histopathologic evaluation showed minimal protection from early cartilage degeneration (p = 0.06) and osteophytosis (p = 0.04) in Ccr7-/- mice 6 weeks post-DMM compared to C57BL/6 controls, but not at 19 weeks. However, subchondral bone mineral density (p = 0.03) and histologic sclerosis (p = 0.02) increased in response to surgery in C57BL/6 mice at 6 weeks, while Ccr7-/- mice were protected from these changes. Our results are the first to demonstrate a role for Ccr7 in early development of functional deficits and subchondral bone changes in the DMM model. Understanding the mechanism of Ccr7 receptor signaling in the initiation of joint pathology and disability will inform the development of innovative therapies to slow symptomatic OA development after injury. Published 2017. This article is a U.S. Government work and is in the public domain in the USA. J Orthop Res 36:864-875, 2018.
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Affiliation(s)
- Nisha Sambamurthy
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania,Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Vu Nguyen
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania,Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ryan Smalley
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania,Department of Orthopedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rui Xiao
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kurt Hankenson
- Department of Orthopedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania,Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Justin Gan
- Division of Rheumatology, Rush University Medical Center, Chicago, Illinois
| | - Rachel E. Miller
- Division of Rheumatology, Rush University Medical Center, Chicago, Illinois
| | - Anne-Marie Malfait
- Division of Rheumatology, Rush University Medical Center, Chicago, Illinois
| | - George R. Dodge
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania,Department of Orthopedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Carla R. Scanzello
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania,Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania,Department of Orthopedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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41
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Brand A, Klöpfer-Krämer I, Morgenstern M, Kröger I, Michel B, Thannheimer A, Müßig JA, Augat P. Effects of knee orthosis adjustment on biomechanical performance and clinical outcome in patients with medial knee osteoarthritis. Prosthet Orthot Int 2017; 41:587-594. [PMID: 29214918 DOI: 10.1177/0309364617691623] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Valgus bracing in medial knee osteoarthritis aims to improve gait function by reducing the loading of the medial compartment. Orthosis composition and optimal adjustment is essential to achieve biomechanical and clinical effectiveness. OBJECTIVES To investigate biomechanical functionality during gait, pain relief and compliance in patients with knee osteoarthritis using a lightweight adjustable knee unloader orthosis. STUDY DESIGN Prospective observational clinical trial. METHODS Instrumented gait analysis in 22 patients with unilateral medial knee osteoarthritis was performed after a 2-week orthosis acclimatisation period. Kinematics and kinetics during gait as well as force transmission from the orthosis to the knee were analysed. Measurements were performed without, at individualised and at reduced orthosis setting. The assessment was supplemented by patient-related pain sensation and compliance questionnaires. RESULTS Orthosis wear significantly reduced the knee adduction moment by up to 20% depending on orthosis adjustment, whereas pain sensation was significantly reduced by 16%. A significant positive correlation was found between force transmissions and knee adduction moment as well as for frontal knee angle. Compliance was good with a main daily use of 2-6 h. CONCLUSION The orthosis provides significant biomechanical improvements, pain relief and good patient compliance. Patients had a biomechanical benefit for the individualised and reduced orthosis adjustments. Clinical relevance In patients with medial knee osteoarthritis, a lightweight medial unloader orthosis effectively reduced external knee adduction moment and pain sensation during daily activities. Thus, use of lightweight orthoses effectively supports conservative treatment in medial knee osteoarthritis.
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Affiliation(s)
- Andreas Brand
- 1 Institute of Biomechanics, Trauma Center Murnau, Germany
- 2 Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Isabella Klöpfer-Krämer
- 1 Institute of Biomechanics, Trauma Center Murnau, Germany
- 2 Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Mario Morgenstern
- 3 Trauma Center Murnau, Germany
- 4 University Hospital Basel, Switzerland
| | - Inga Kröger
- 1 Institute of Biomechanics, Trauma Center Murnau, Germany
- 2 Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Björn Michel
- 5 Endogap Hospital and Clinics Garmisch-Partenkirchen, Germany
| | | | - Janina Anna Müßig
- 1 Institute of Biomechanics, Trauma Center Murnau, Germany
- 2 Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Peter Augat
- 1 Institute of Biomechanics, Trauma Center Murnau, Germany
- 2 Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
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Newton MD, Osborne J, Gawronski K, Baker KC, Maerz T. Articular cartilage surface roughness as an imaging-based morphological indicator of osteoarthritis: A preliminary investigation of osteoarthritis initiative subjects. J Orthop Res 2017; 35:2755-2764. [PMID: 28460415 DOI: 10.1002/jor.23588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 04/24/2017] [Indexed: 02/04/2023]
Abstract
Current imaging-based morphometric indicators of osteoarthritis (OA) using whole-compartment mean cartilage thickness (MCT) and volume changes can be insensitive to mild degenerative changes of articular cartilage (AC) due to areas of adjacent thickening and thinning. The purpose of this preliminary study was to evaluate cartilage thickness-based surface roughness as a morphometric indicator of OA. 3D magnetic resonance imaging (MRI) datasets were collected from osteoarthritis initiative (OAI) subjects with Kellgren-Lawrence (KL) OA grades of 0, 2, and 4 (n = 10/group). Femoral and tibial AC volumes were converted to two-dimensional thickness maps, and MCT, arithmetic surface roughness (Sa ), and anatomically normalized Sa (normSa ) were calculated. Thickness maps enabled visualization of degenerative changes with increasing KL grade, including adjacent thinning and thickening on the femoral condyles. No significant differences were observed in MCT between KL grades. Sa was significantly higher in KL4 compared to KL0 and KL2 in the whole femur (KL0: 0.55 ± 0.10 mm, KL2: 0.53 ± 0.09 mm, KL4: 0.79 ± 0.18 mm), medial femoral condyle (KL0: 0.42 ± 0.07 mm, KL2: 0.48 ± 0.07 mm, KL4: 0.76 ± 0.22 mm), and medial tibial plateau (KL0: 0.42 ± 0.07 mm, KL2: 0.43 ± 0.09 mm, KL4: 0.68 ± 0.27 mm). normSa was significantly higher in KL4 compared to KL0 and KL2 in the whole femur (KL0: 0.22 ± 0.02, KL2: 0.22 ± 0.02, KL4: 0.30 ± 0.03), medial condyle (KL0: 0.17 ± 0.02, KL2: 0.20 ± 0.03, KL4: 0.29 ± 0.06), whole tibia (KL0: 0.34 ± 0.04, KL2: 0.33 ± 0.05, KL4: 0.48 ± 0.11) and medial plateau (KL0: 0.23 ± 0.03, KL2: 0.24 ± 0.04, KL4: 0.40 ± 0.10), and significantly higher in KL2 compared to KL0 in the medial femoral condyle. Surface roughness metrics were sensitive to degenerative morphologic changes, and may be useful in OA characterization and early diagnosis. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2755-2764, 2017.
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Affiliation(s)
- Michael D Newton
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, Michigan
| | - Jeffrey Osborne
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, Michigan
| | - Karissa Gawronski
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, Michigan
| | - Kevin C Baker
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, Michigan.,Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, Rochester Hills, Michigan
| | - Tristan Maerz
- Orthopaedic Research Laboratory, Beaumont Health, Royal Oak, Michigan.,Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, Rochester Hills, Michigan.,Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, Michigan, 48106
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Wnt5a induces catabolic signaling and matrix metalloproteinase production in human articular chondrocytes. Osteoarthritis Cartilage 2017; 25:1505-1515. [PMID: 28587781 PMCID: PMC5565712 DOI: 10.1016/j.joca.2017.05.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 05/19/2017] [Accepted: 05/29/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Aberrant Wnt signaling may contribute to osteoarthritis (OA) but the Wnt family members involved have not been fully identified. The purpose of this study was to investigate the role of Wnt5a as a potential mediator of cartilage destruction in OA. DESIGN Immunohistochemistry to detect Wnt5a was performed using normal and OA human articular cartilage. Cultured normal human chondrocytes were treated with fibronectin fragments (FN-f) as a catabolic stimulus or recombinant Wnt5a protein with or without pretreatment using a panel of signaling inhibitors. Expression of Wnt5a, anabolic genes and catabolic genes were determined by quantitative real-time PCR. Production of Wnt5a protein and matrix metalloproteinases (MMPs) as well as activation of signaling proteins were analyzed by immunoblotting. RESULTS Wnt5a was present in human articular cartilage with OA changes and its expression and secretion were increased in FN-f stimulated chondrocytes. FN-f stimulated Wnt5a production through the c-Jun N-terminal kinase (JNK) and extracellular signal-related kinase (ERK) pathways. Wnt5a reduced aggrecan gene expression after 48 h of treatment. Wnt5a seemed to promote MMP1, -3, and -13 expression as well as MMP1 and MMP13 protein production in normal human chondrocytes. Wnt5a inhibitor peptides did not affect FN-f induced MMP production. Wnt5a activated β-catenin independent signaling including calmodulin-dependent protein kinase II (CaMKII), JNK, p38, ERK1/2, p65 and Akt. Inhibition of JNK, p38, ERK, PI-3 kinase and CaMKII by specific signaling inhibitors suppressed Wnt5a mediated MMP1 and MMP13 production. CONCLUSIONS Wnt5a is present in human OA cartilage and can promote chondrocyte catabolic activity through non-canonical Wnt signaling, which suggests a potential role in OA.
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Alfaro Santafé JJ, Gómez Bernal A, Lanuza Cerzócimo C, Sempere Bonet C, Barniol Mercade A, Alfaro Santafé JV. Results of the weight-bearing Lunge test on patients with functional hallux limitus: A cross sectional case–control study. REVISTA ESPAÑOLA DE PODOLOGÍA 2017. [DOI: 10.1016/j.repod.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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45
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Alfaro Santafé JJ, Gómez Bernal A, Lanuza Cerzócimo C, Sempere Bonet C, Barniol Mercade A, Alfaro Santafé JV. Resultados del test de Lunge en pacientes con hallux limitus funcional: estudio transversal de casos y controles. REVISTA ESPAÑOLA DE PODOLOGÍA 2017. [DOI: 10.1016/j.repod.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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46
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Repetto I, Biti B, Cerruti P, Trentini R, Felli L. Conservative Treatment of Ankle Osteoarthritis: Can Platelet-Rich Plasma Effectively Postpone Surgery? J Foot Ankle Surg 2017; 56:362-365. [PMID: 28231968 DOI: 10.1053/j.jfas.2016.11.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Indexed: 02/03/2023]
Abstract
Osteoarthritis is the most common and disabling of the orthopedic diseases. Currently, the conservative treatment of osteoarthritis is limited to symptomatic treatment, whose goal is to improve function and pain control. Ankle osteoarthritis is relatively uncommon, in contrast to osteoarthritis of the hip and knee, and the therapeutic options (both pharmacologic and surgical) are limited, with surgery providing poorer and less predictable results. The effectiveness of platelet-rich plasma injections for osteoarthritis is still controversial, especially so for ankle arthritis, owing to the lack of evidence in the present data. We retrospectively evaluated the mid- to long-term clinical results (mean follow-up of 17.7 months) for platelet-rich plasma injections in 20 patients (20 ankles) with ankle osteoarthritis. We evaluated the presence of pain using the visual analog scale, function using the Foot and Ankle Disability Index, and subjective satisfaction. The pre- and post-treatment scores, obtained from the clinical records and from telephone interviews during the follow-up period, were compared using the Student t test. We found a strong positive effect for 4 platelet-rich plasma injections (injected once a week) on pain (p = .0001) and function (p = .001), with 80% of patients very satisfied and satisfied, and only 2 patients (10%) required surgery because of early treatment failure. These results suggest that the use of platelet-rich plasma injection is a valid and safe alternative to postpone the need for surgery.
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Affiliation(s)
- Ilaria Repetto
- Orthopedist, Department of Surgical Sciences, Orthopaedic and Traumatologic Clinic, University of Genoa, IRCCS University Hospital San Martino IST, National Institute for Cancer Research, Genoa, Italy.
| | - Besmir Biti
- Orthopedist, Department of Surgical Sciences, Orthopaedic and Traumatologic Clinic, University of Genoa, IRCCS University Hospital San Martino IST, National Institute for Cancer Research, Genoa, Italy
| | - Paola Cerruti
- Orthopedist, Department of Surgical Sciences, Orthopaedic and Traumatologic Clinic, University of Genoa, IRCCS University Hospital San Martino IST, National Institute for Cancer Research, Genoa, Italy
| | - Roberto Trentini
- Orthopedist, Department of Surgical Sciences, Orthopaedic and Traumatologic Clinic, University of Genoa, IRCCS University Hospital San Martino IST, National Institute for Cancer Research, Genoa, Italy
| | - Lamberto Felli
- Professor, Department of Surgical Sciences, Orthopaedic and Traumatologic Clinic, University of Genoa, IRCCS University Hospital San Martino IST, National Institute for Cancer Research, Genoa, Italy
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47
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Quantitative proteomics analysis of cartilage response to mechanical injury and cytokine treatment. Matrix Biol 2016; 63:11-22. [PMID: 27988350 DOI: 10.1016/j.matbio.2016.12.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/09/2016] [Accepted: 12/09/2016] [Indexed: 01/15/2023]
Abstract
Mechanical damage at the time of joint injury and the ensuing inflammatory response associated with elevated levels of pro-inflammatory cytokines in the synovial fluid, are reported to contribute to the progression to osteoarthritis after injury. In this exploratory study, we used a targeted proteomics approach to follow the progression of matrix degradation in response to mechanical damage and cytokine treatment of human knee cartilage explants, and thereby to study potential molecular biomarkers. This proteomics approach allowed us to unambiguously identify and quantify multiple peptides and proteins in the cartilage medium and explants upon treatment with ±injurious compression ±cytokines, treatments that mimic the earliest events in post-traumatic OA. We followed degradation of different protein domains, e.g., G1/G2/G3 of aggrecan, by measuring representative peptides of matrix proteins released into the medium at 7 time points throughout the 21-day culture period. COMP neo-epitopes, which were previously identified in the synovial fluid of knee injury/OA patients, were also released by these human cartilage explants treated with cyt and cyt+inj. The absence of collagen pro-peptides and elevated levels of specific COMP and COL3A1 neo-epitopes after human knee trauma may be relevant as potential biomarkers for post-traumatic OA. This model system thereby enables study of the kinetics of cartilage degradation and the identification of biomarkers within cartilage explants and those released to culture medium. Discovery proteomics revealed that candidate proteases were identified after specific treatment conditions, including MMP1, MMP-3, MMP-10 and MMP-13.
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48
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Diagnostic Value of CT Arthrography for Evaluation of Osteochondral Lesions at the Ankle. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3594253. [PMID: 27891511 PMCID: PMC5116491 DOI: 10.1155/2016/3594253] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/18/2016] [Indexed: 11/18/2022]
Abstract
Background. To retrospectively determine the diagnostic value of computed tomography arthrography (CTA) of the ankle in the evaluation of (osteo)chondral lesions in comparison to conventional magnetic resonance imaging (MRI) and intraoperative findings. Methods. A total of N = 79 patients had CTAs and MRI of the ankle; in 17/79 cases surgical reports with statements on cartilage integrity were available. Cartilage lesions and bony defects at talus and tibia were scored according to defect depth and size by two radiologists. Statistical analysis included sensitivity analyses and Cohen's kappa calculations. Results. On CTA, 41/79 and 31/79 patients had full thickness cartilage defects at the talus and at the tibia, respectively. MRI was able to detect 54% of these defects. For the detection of full thickness cartilage lesions, interobserver agreement was substantial (0.72 ± 0.05) for CTA and moderate (0.55 ± 0.07) for MRI. In surgical reports, 88–92% and 46–62% of full thickness defects detected by CTA and MRI were described. CTA findings changed the further clinical management in 15.4% of cases. Conclusions. As compared to conventional MRI, CTA improves detection and visualization of cartilage defects at the ankle and is a relevant tool for treatment decisions in unclear cases.
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49
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Brock AK, Tan EW, Shafiq B. Post-Traumatic Periprosthetic Tibial and Fibular Fracture After Total Ankle Arthroplasty: A Case Report. J Foot Ankle Surg 2016; 56:196-200. [PMID: 26946999 DOI: 10.1053/j.jfas.2016.01.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Indexed: 02/03/2023]
Abstract
Periprosthetic fractures after total ankle arthroplasty are uncommon, with most cases occurring intraoperatively. We describe a post-traumatic periprosthetic fracture of the distal tibia and fibula after total ankle arthroplasty that was treated with minimally invasive plate osteosynthesis. It is important for orthopedic surgeons not only to recognize the risk factors for postoperative periprosthetic total ankle arthroplasty fractures, but also to be familiar with the treatment options available to maximize function and minimize complications. The design of the tibial prosthesis and surgical techniques required to prepare the ankle joint for implantation are important areas of future research to limit the risk of periprosthetic fractures.
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Affiliation(s)
- Amanda K Brock
- Medical Student, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Eric W Tan
- Orthopedic Surgeon, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Babar Shafiq
- Assistant Professor, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
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50
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Abstract
End-stage arthritis of the tibiotalar joint is disabling and causes substantial functional impairment. Most often it is the residual effect of a previous traumatic injury. Nonsurgical treatment of end-stage arthritis of the ankle includes bracing, shoe-wear modifications, and selective joint injections. For patients who fail to respond to nonsurgical modalities, the two primary treatment options are arthroplasty and arthrodesis. Each has its proponents. Although no ideal treatment of ankle arthritis exists, high-quality studies can help guide treatment in patients of varying demographics. Inherent risks are linked with each treatment option, but those of greatest concern are early implant loosening that requires revision following arthroplasty and the acceleration of adjacent joint degeneration associated with arthrodesis.
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