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Julovi SM, Dao A, Trinh K, O'Donohue AK, Shu C, Smith S, Shingde M, Schindeler A, Rogers NM, Little CB. Disease-modifying interactions between chronic kidney disease and osteoarthritis: a new comorbid mouse model. RMD Open 2023; 9:e003109. [PMID: 37562858 PMCID: PMC10423836 DOI: 10.1136/rmdopen-2023-003109] [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: 02/26/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE The prevalence of comorbid chronic kidney disease (CKD) and osteoarthritis (OA) is increasing globally. While sharing common risk factors, the mechanism and consequences of concurrent CKD-OA are unclear. The aims of the study were to develop a preclinical comorbid model, and to investigate the disease-modifying interactions. METHODS Seventy (70) male 8-10 week-old C57BL/6 mice were subjected to 5/6 nephrectomy (5/6Nx)±destabilisation of medial meniscus (DMM) or sham surgery. OA pathology and CKD were assessed 12 weeks postinduction by blinded histology scoring, micro-CT, immunohistochemistry for osteoclast and matrix metalloproteinase (MMP)-13 activity, and serum analysis of bone metabolic markers. RESULTS The 5/6Nx model recapitulated characteristic features of CKD, with renal fibrosis and deranged serum alkaline phosphatase, calcium and phosphate. There was no histological evidence of cartilage pathology induced by 5/6Nx alone, however, synovial MMP-13 expression and subchondral bone osteoclastic activity were increased (p<0.05), with accompanying reductions (p<0.05) in subchondral trabecular bone, bone volume and mineral density. DMM significantly (p<0.05) increased tibiofemoral cartilage damage, subchondral bone sclerosis, marginal osteophytes and synovitis, in association with increased cartilage and synovial MMP-13. DMM alone induced (p<0.05) renal fibrosis, proteinuria and increased (p<0.05) 5/6Nx-induced serum urea. However, DMM in 5/6Nx-mice resulted in significantly reduced (p<0.05) cartilage pathology and marginal osteophyte development, in association with reduced subchondral bone volume and density, and inhibition of 5/6Nx-induced subchondral bone osteoclast activation. CONCLUSION This study assessed a world-first preclinical comorbid CKD-OA model. Our findings demonstrate significant bidirectional disease-modifying interaction between CKD and OA.
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Affiliation(s)
- Sohel M Julovi
- Kidney Injury Group, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Aiken Dao
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Bioengineering & Molecular Medicine (BAMM) Laboratory, the Children's Hospital at Westmead and the Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Katie Trinh
- Kidney Injury Group, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra K O'Donohue
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Bioengineering & Molecular Medicine (BAMM) Laboratory, the Children's Hospital at Westmead and the Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Cindy Shu
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Raymond Purves Bone and Joint Laboratory, Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Susan Smith
- Raymond Purves Bone and Joint Laboratory, Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Meena Shingde
- Department of Tissue Pathology and Diagnostic Oncology, Institute of Clinical Pathology and Medical Research, Wentworthville, New South Wales, Australia
| | - Aaron Schindeler
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Bioengineering & Molecular Medicine (BAMM) Laboratory, the Children's Hospital at Westmead and the Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Natasha M Rogers
- Kidney Injury Group, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher B Little
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Raymond Purves Bone and Joint Laboratory, Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Huang GS, Peng YJ, Hsu YJ, Lee HS, Chang YC, Chiang SW, Hsu YC, Liu YC, Lin MH, Wang CY. Hypoperfusion of the infrapatellar fat pad and its relationship to MRI T2* relaxation time changes in a 5/6 nephrectomy model. Sci Rep 2021; 11:9924. [PMID: 33976243 PMCID: PMC8113578 DOI: 10.1038/s41598-021-89336-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/22/2021] [Indexed: 11/28/2022] Open
Abstract
The purpose of present study was to longitudinally investigate the alterations in infrapatellar fat pad (IPFP) vascularity in 5/6 nephrectomized rats by using dynamic contrast enhanced (DCE) MRI and IPFP degeneration by using MRI T2* relaxation time. Twelve male Sprague–Dawley rats were assigned to a control group and a 5/6 nephrectomy CKD group. The right knees of all rats were longitudinally scanned by 4.7 T MRI, and serial changes in the IPFP were assessed at 0, 8, 16, 30, and 44 weeks by DCE-MRI (parameters A, kel and kep) and MRI T2* mapping. After MRI measurements, knee specimens were obtained and evaluated histologically. The CKD group had IPFPs with lower blood volume A and lower permeability kep values from 16 weeks (p < 0.05), lower venous washout kel value from 30 weeks (p < 0.001), and significantly higher T2* values reflecting adipocyte degeneration beginning at 16 weeks (p < 0.05). The histopathological results confirmed the MRI findings. Hypoperfusion and adipocytes degeneration related to CKD were demonstrated in a rodent 5/6 nephrectomy model. DCE parameters and MRI T2* can serve as imaging biomarkers of fat pad degeneration during CKD progression.
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Affiliation(s)
- Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Jen Peng
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Juei Hsu
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Herng-Sheng Lee
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei, Taiwan
| | - Shih-Wei Chiang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Chih Hsu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ying-Chun Liu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Huang Lin
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chao-Ying Wang
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei, 11490, Taiwan.
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Baumbach SF, Pfahler V, Bechtold-Dalla Pozza S, Feist-Pagenstert I, Fürmetz J, Baur-Melnyk A, Stumpf UC, Saller MM, Straube A, Schmidmaier R, Leipe J. How We Manage Bone Marrow Edema-An Interdisciplinary Approach. J Clin Med 2020; 9:jcm9020551. [PMID: 32085459 PMCID: PMC7074543 DOI: 10.3390/jcm9020551] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/21/2020] [Accepted: 02/03/2020] [Indexed: 12/11/2022] Open
Abstract
Bone marrow edema (BME) is a descriptive term for a common finding in magnetic resonance imaging (MRI). Although pain is the major symptom, BME differs in terms of its causal mechanisms, underlying disease, as well as treatment and prognosis. This complexity together with the lack of evidence-based guidelines, frequently makes the identification of underlying conditions and its management a major challenge. Unnecessary multiple consultations and delays in diagnosis as well as therapy indicate a need for interdisciplinary clinical recommendations. Therefore, an interdisciplinary task force was set up within our large osteology center consisting of specialists from internal medicine, endocrinology/diabetology, hematology/oncology, orthopedics, pediatrics, physical medicine, radiology, rheumatology, and trauma surgery to develop a consenus paper. After review of literature, review of practical experiences (expert opinion), and determination of consensus findings, an overview and an algorithm were developed with concise summaries of relevant aspects of the respective underlying disease including diagnostic measures, clinical features, differential diagnosis and treatment of BME. Together, our single-center consensus review on the management of BME may help improve the quality of care for these patients.
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Affiliation(s)
- Sebastian F. Baumbach
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Vanessa Pfahler
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Susanne Bechtold-Dalla Pozza
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of Pediatric Endocrinology and Diabetology, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstraße 4, 80337 Munich, Germany
| | - Isa Feist-Pagenstert
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Julian Fürmetz
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Andrea Baur-Melnyk
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of Radiology, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Ulla C. Stumpf
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
| | - Maximilian M. Saller
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Nussbaumstraße 20, 80336 Munich, Germany
- Experimental Surgery and Regenerative Medicine (ExperiMed), Department of General, Trauma and Reconstructive Surgery, Ludwig-Maximilians-University (LMU), Fraunhoferstraße 20, 82152 Planegg-Martinsried, Germany
| | - Andreas Straube
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Ralf Schmidmaier
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Department for Endocrinology and Diabetology, Department of Internal Medicine IV, Ludwig-Maximilians-University Munich, Ziemssenstraße 1, 80336 Munich, Germany
- Correspondence: (R.S.); (J.L.); Tel.: +49-89-4400-52101 (R.S.); Fax: +49-89-4400-54410 (R.S.)
| | - Jan Leipe
- Comprehensive Osteology Center Munich, University Hospital, Ludwig-Maximilians-University Munich, 80336 Munich, Germany; (S.F.B.); (V.P.); (S.B.-D.P.); (I.F.-P.); (J.F.); (A.B.-M.); (U.C.S.); (M.M.S.); (A.S.)
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig-Maximilians-University Munich, Ziemssenstraße 1, 80336 Munich, Germany
- Division of Rheumatology, Department of Medicine V, University Hospital Mannheim, Medical Faculty Mannheim of the University Heidelberg, Ludolf-Krehl-Straße 13–17, 68167 Mannheim, Germany
- Correspondence: (R.S.); (J.L.); Tel.: +49-89-4400-52101 (R.S.); Fax: +49-89-4400-54410 (R.S.)
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