1
|
Wang S, Sha P, Zhao X, Tao Z, Liu S. Peritendinous adhesion: Therapeutic targets and progress of drug therapy. Comput Struct Biotechnol J 2024; 23:251-263. [PMID: 38173878 PMCID: PMC10762322 DOI: 10.1016/j.csbj.2023.11.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Peritendinous adhesion (PA) is one of the most common complications following hand surgery and characterized with abnormal hyperplasia of connective tissue and excessive deposition of extracellular matrix. Subsequently, various clinical symptoms such as chronic pain, limb dyskinesia and even joint stiffness occur and patients are always involved in the vicious cycle of "adhesion - release - re-adhesion", which seriously compromise the quality of life. Until present, the underlying mechanism remains controversial and lack of specific treatment, with symptomatic treatment being the only option to relieve symptoms, but not contributing no more to the fundamentally rehabilitation of basic structure and function. Recently, novel strategies have been proposed to inhibit the formation of adhesion tissues including implantation of anti-adhesion barriers, anti-inflammation, restraint of myofibroblast transformation and regulation of collagen overproduction. Furthermore, gene therapy has also been considered as a promising anti-adhesion treatment. In this review, we provide an overview of anti-adhesion targets and relevant drugs to summarize the potential pharmacological roles and present subsequent challenges and prospects of anti-adhesion drugs.
Collapse
Affiliation(s)
| | | | | | - Zaijin Tao
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Hanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Shen Liu
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Hanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| |
Collapse
|
2
|
Kim JG, Sharma AR, Lee YH, Chatterjee S, Choi YJ, Rajvansh R, Chakraborty C, Lee SS. Therapeutic Potential of Quercetin as an Antioxidant for Bone-Muscle-Tendon Regeneration and Aging. Aging Dis 2024:AD.2024.0282. [PMID: 39012676 DOI: 10.14336/ad.2024.0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/24/2024] [Indexed: 07/17/2024] Open
Abstract
Quercetin (QC), a naturally occurring bioflavonoid found in various fruits and vegetables, possesses many potential health benefits, primarily attributed to its robust antioxidant properties. The generation of oxidative stress in bone cells is a key modulator of their physiological behavior. Moreover, oxidative stress status influences the pathophysiology of mineralized tissues. Increasing scientific evidence demonstrates that manipulating the redox balance in bone cells might be an effective technique for developing bone disease therapies. The QC antioxidant abilities in skeletal muscle significantly enhance muscle regeneration and reduce muscle atrophy. In addition, QC has been shown to have protective effects against oxidative stress, inflammation, apoptosis, and matrix degradation in tendons, helping to maintain the structural integrity and functionality of tendons. Thus, the antioxidant properties of QC might be crucial for addressing age-related musculoskeletal disorders like osteoporosis, sarcopenia, and tendon-related inflammatory conditions. Understanding how QC influences redox signaling pathways involved in musculoskeletal disorders, including their effect on bone, muscle, and tendon differentiation, might provide insights into the diverse advantages of QC in promoting tissue regeneration and preventing cellular damage. Therefore, this study reviewed the intricate relationship among oxidative stress, inflammation, and tissue repair, affected by the antioxidative abilities of QC, in age-related musculoskeletal tissues to improve the overall health of bones, muscles, and tendons of the skeletal system. Also, reviewing the ongoing clinical trials of QC for musculoskeletal systems is encouraging. Given the positive effect of QC on musculoskeletal health, further scientific investigations and controlled human intervention studies are necessary to explore the therapeutic potential to its optimum strength.
Collapse
Affiliation(s)
- Jae Gyu Kim
- Institute for Skeletal Aging &;amp Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon-si, 24252, Gangwon-do, Korea
| | - Ashish Ranjan Sharma
- Institute for Skeletal Aging &;amp Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon-si, 24252, Gangwon-do, Korea
| | - Yeon-Hee Lee
- Institute for Skeletal Aging &;amp Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon-si, 24252, Gangwon-do, Korea
| | - Srijan Chatterjee
- Institute for Skeletal Aging &;amp Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon-si, 24252, Gangwon-do, Korea
| | - Yean Jung Choi
- Department of Food and Nutrition, Sahmyook University, Seoul 01795, Korea
| | - Roshani Rajvansh
- Institute for Skeletal Aging &;amp Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon-si, 24252, Gangwon-do, Korea
| | - Chiranjib Chakraborty
- Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Barasat-Barrackpore Road, Kolkata, West Bengal 700126, India
| | - Sang-Soo Lee
- Institute for Skeletal Aging &;amp Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon-si, 24252, Gangwon-do, Korea
| |
Collapse
|
3
|
Xiao Y, Tao Z, Ju Y, Huang X, Zhang X, Liu X, Volotovski PA, Huang C, Chen H, Zhang Y, Liu S. Diamond-Like Carbon Depositing on the Surface of Polylactide Membrane for Prevention of Adhesion Formation During Tendon Repair. NANO-MICRO LETTERS 2024; 16:186. [PMID: 38687411 PMCID: PMC11061095 DOI: 10.1007/s40820-024-01392-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/08/2024] [Indexed: 05/02/2024]
Abstract
Post-traumatic peritendinous adhesion presents a significant challenge in clinical medicine. This study proposes the use of diamond-like carbon (DLC) deposited on polylactic acid (PLA) membranes as a biophysical mechanism for anti-adhesion barrier to encase ruptured tendons in tendon-injured rats. The results indicate that PLA/DLC composite membrane exhibits more efficient anti-adhesion effect than PLA membrane, with histological score decreasing from 3.12 ± 0.27 to 2.20 ± 0.22 and anti-adhesion effectiveness increasing from 21.61% to 44.72%. Mechanistically, the abundant C=O bond functional groups on the surface of DLC can reduce reactive oxygen species level effectively; thus, the phosphorylation of NF-κB and M1 polarization of macrophages are inhibited. Consequently, excessive inflammatory response augmented by M1 macrophage-originated cytokines including interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) is largely reduced. For biocompatibility evaluation, PLA/DLC membrane is slowly absorbed within tissue and displays prolonged barrier effects compared to traditional PLA membranes. Further studies show the DLC depositing decelerates the release of degradation product lactic acid and its induction of macrophage M2 polarization by interfering esterase and PLA ester bonds, which further delays the fibrosis process. It was found that the PLA/DLC membrane possess an efficient biophysical mechanism for treatment of peritendinous adhesion.
Collapse
Affiliation(s)
- Yao Xiao
- Department of Orthopaedics, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, People's Republic of China
| | - Zaijin Tao
- Department of Orthopaedics, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, People's Republic of China
| | - Yufeng Ju
- Shanghai Tongji Hospital, 389 Xincun Rd, Shanghai, 200065, People's Republic of China
| | - Xiaolu Huang
- Key Laboratory for Thin Film and Microfabrication of Ministry of Education, Research Institute of Micro/Nano Science and Technology, Shanghai Jiao Tong University, Shanghai, 200240, People's Republic of China
| | - Xinshu Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, People's Republic of China
| | - Xiaonan Liu
- Department of Orthopaedics, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, People's Republic of China
| | - Pavel A Volotovski
- Orthopedic Trauma Department, Belarus Republic Scientific and Practical Center for Traumatology and Orthopedics, Kizhevatova str., 60/4, 220024, Minsk, Belarus
| | - Chao Huang
- Shanghai Haohai Biological Technology Limited Liability Company, 1386 Hongqiao Rd, Shanghai, 200336, People's Republic of China
| | - Hongqi Chen
- Department of General Surgery, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, People's Republic of China.
| | - Yaozhong Zhang
- Shanghai Key Laboratory for High Temperature Materials and Precision Forming, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, 200240, People's Republic of China.
| | - Shen Liu
- Department of Orthopaedics, Shanghai Jiao Tong University School of Medicine Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai, 200233, People's Republic of China.
| |
Collapse
|
4
|
Zhou Z, Li S, Gong X. Polydopamine Nanoparticles-Based Photothermal Effect Against Adhesion Formation in a Rat Model of Achilles Tendon Laceration Repair. Int J Nanomedicine 2023; 18:1765-1776. [PMID: 37038441 PMCID: PMC10082603 DOI: 10.2147/ijn.s393454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/21/2023] [Indexed: 04/05/2023] Open
Abstract
Background Adhesion formation after tendon surgery is a major obstacle to repair of tendon ruptures, and there is still no effective clinical anti-adhesion method. Myofibroblasts expressing α-smooth muscle actin (α-SMA) play a crucial role in adhered fibrous tissue. Heat shock protein (Hsp) 72 can selectively prevent the activation of c-Jun N-terminal kinase (JNK), which mediates the conversion from fibroblasts to myofibroblasts. The purpose of this study was to investigate for the first time whether polydopamine nanoparticles (PDA NPs)-based photothermal effect would attenuate adhesion formation in a rat model of Achilles tendon laceration repair. Materials and Methods Forty-five adult male Sprague-Dawley rats were randomly assigned to the photothermal group, the control group and the PDA NPs group (n = 15 per group). The primary outcome measure was the adhesion scores at two weeks after surgery according to the grading of Tang et al. The secondary outcomes included the expressions of Hsp 72, JNK, phosphorylated JNK and α-SMA, which were measured by immunohistochemistry or Western blot. Results The average adhesion score was significantly lower in the photothermal group (4.25 ± 0.21) than that in the control group (5.29 ± 0.12) (p = 0.005) and the PDA NPs group (5.29 ± 0.20) (p = 0.005). Relative to the control group and PDA NPs group, Hsp 72 in the photothermal group was significantly increased whereas α-SMA and p-JNK was significantly decreased, but JNK was not found to be different across the three groups. Conclusion The photothermal effect produced by PDA NPs could reduce tendon adhesion formation in rats by inhibiting myocyte fibrosis, which may have potential in developing endogenous heating for postsurgical tissue adhesions.
Collapse
Affiliation(s)
- Zekun Zhou
- Department of Hand and Podiatric Surgery, Orthopedics Center, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China
- Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China
| | - Shaoyan Li
- Department of Hand and Podiatric Surgery, Orthopedics Center, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China
- Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China
| | - Xu Gong
- Department of Hand and Podiatric Surgery, Orthopedics Center, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China
- Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China
- Correspondence: Xu Gong, Department of Hand and Podiatric Surgery, Orthopedics Center, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China, Tel +86 13944099151, Email
| |
Collapse
|
5
|
Li S, Gong F, Zhou Z, Gong X. Combined Verapamil-Polydopamine Nanoformulation Inhibits Adhesion Formation in Achilles Tendon Injury Using Rat Model. Int J Nanomedicine 2023; 18:115-126. [PMID: 36636643 PMCID: PMC9831089 DOI: 10.2147/ijn.s377600] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/23/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Topical verapamil has been demonstrated to reduce the fibroproliferative scar. Therefore, it was hypothesized that topical verapamil could reduce adhesion formation after tendon repair. The current study aimed to examine the effects of verapamil-loaded polydopamine nanoparticles (VP-PDA NPs) on the adhesion formation of Achilles tendon laceration and repair in a rat model. Methods We randomly assigned 72 male Sprague-Dawley rats to the control, the PDA NPs, and the VP-PDA NPs groups (n = 24 per group). The quality of tendon healing was evaluated by the maximal tensile strength four and six weeks after surgery. The degree of tendon adhesion was scored on days 4, 15, 29, and 43 after surgery. The expressions of transforming growth factor-beta 1 (TGF-β1), vimentin, α-smooth muscle actin (α-SMA), and collagens type I and III were detected through Western blotting or immunohistochemistry at four weeks after surgery. Results In vitro release tests revealed that 61.3% of verapamil was released from VP-PDA NPs in four weeks. There was a significant increase in average failure to load in the VP-PDA NPs group (89.27 ± 5.09 N) compared with the PDA NPs group (65.52 ± 2.04 N) (p = 0.003) and the control group (74.52 ± 4.24 N) (p = 0.029). Adhesion scores were significantly reduced in the VP-PDA NPs group at six weeks (3.175 ± 0.08) and four weeks (3.35 ± 0.25) compared with the other groups. Moreover, VP-PDA NPs significantly reduced the expression of vimentin, α-SMA, TGF-β1, and collagens type I and III. Conclusion These data suggest that VP-PDA NPs reduced adhesion formation and enhanced tendon healing during rat tendon injury. Since topical verapamil has been used in clinics without side effects, VP-PDA NPs would have direct translation implications. However, its anti-adhesive effects on intrasynovial tendon injury must be examined.
Collapse
Affiliation(s)
- Shaoyan Li
- Department of Hand and Podiatric Surgery, Orthopedics Center, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China,Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China
| | - Fengyan Gong
- Department of Hand and Podiatric Surgery, Orthopedics Center, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China,Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China
| | - Zekun Zhou
- Department of Hand and Podiatric Surgery, Orthopedics Center, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China,Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China
| | - Xu Gong
- Department of Hand and Podiatric Surgery, Orthopedics Center, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China,Jilin Province Key Laboratory on Tissue Repair, Reconstruction and Regeneration, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China,Correspondence: Xu Gong, Department of Hand and Podiatric Surgery, Orthopedics center, The First Hospital of Jilin University, Changchun, 130021, People’s Republic of China, Tel +86-13944099151, Email
| |
Collapse
|
6
|
Chao W, Hui H, Shuchun W, Changsuo X, Rongrong D, Chenlei X. Mannose-6-Phosphate Reduces Expression of Transforming Growth Factor β and Receptors in Rabbit Flexor Tendon Tenocytes. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.3041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Transforming growth factor β (TGF-β) plays an important role in tendon healing and adhesion formation. Inhibiting expression of TGF-β and receptors might prevent adhesion after tendon injury and/or opening surgeries. Here, we aimed to examine the
effects of mannose-6-phosphate (M6P), an inhibitor of TGF-β as a natural plant compound, on expression of TGF-β and receptors in tendon sheath fibroblasts, epitenon tenocytes, and endotenon tenocytes that were isolated from rabbit flexor toes. We enriched tendon sheath
fibroblasts, epitenon tenocytes, as well as endotenon tenocytes from rabbit flexor tendons, and subsequently cultured these cell types individually. All 3 cell types were grouped into 2 groups randomly: the experiment group supplemented with M6P (the M6P Group), and the Control Group treated
with vehicle. Expression of TGF-β and receptors was assessed with enzyme-linked immunosorbent assays. TGF-β1 expression in the mRNA level was also assessed by in situ hybridization and immunohistochemistry. Expression of TGF-β and receptors in the
M6P Group was remarkably lower than that in the Control Group across all 3 cell types (P < 0.05). In the M6P Group, the expression ratio of TGF-β1 mRNA and the expression level of intracellular TGF-β1 mRNA in 3 cell types were significantly decreased than
those in the Control Group (P < 0.05). Therefore, expression of TGF-β1 was significantly lower in all three types of tendon cell treated with M6P. Collectively, M6P is a negative regulator of TGF-β and receptors in cultured rabbit tendon sheath fibroblasts,
epitenon tenocytes, and endotenon tenocytes.
Collapse
Affiliation(s)
- Wan Chao
- Department of Orthopaedics, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Huang Hui
- Department of Orthopaedics, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Wang Shuchun
- Department of Orthopaedics, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Xia Changsuo
- Department of Orthopaedics, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Dou Rongrong
- Department of Orthopaedics, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Xia Chenlei
- Center of Stomatology, The Affiliated Qingdao Municipal Hospital of Qingdao University, Qingdao, 266003, China
| |
Collapse
|
7
|
Brebels J, Mignon A. Polymer-Based Constructs for Flexor Tendon Repair: A Review. Polymers (Basel) 2022; 14:867. [PMID: 35267690 PMCID: PMC8912457 DOI: 10.3390/polym14050867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 02/04/2023] Open
Abstract
A flexor tendon injury is acquired fast and is common for athletes, construction workers, and military personnel among others, treated in the emergency department. However, the healing of injured flexor tendons is stretched over a long period of up to 12 weeks, therefore, remaining a significant clinical problem. Postoperative complications, arising after traditional tendon repair strategies, include adhesion and tendon scar tissue formation, insufficient mechanical strength for early active mobilization, and infections. Various researchers have tried to develop innovative strategies for developing a polymer-based construct that minimalizes these postoperative complications, yet none are routinely used in clinical practice. Understanding the role such constructs play in tendon repair should enable a more targeted approach. This review mainly describes the polymer-based constructs that show promising results in solving these complications, in the hope that one day these will be used as a routine practice in flexor tendon repair, increasing the well-being of the patients. In addition, the review also focuses on the incorporation of active compounds in these constructs, to provide an enhanced healing environment for the flexor tendon.
Collapse
Affiliation(s)
| | - Arn Mignon
- Surface and Interface Engineered Materials, Campus Group T, KU Leuven, Andreas Vesaliusstraat 13, 3000 Leuven, Belgium;
| |
Collapse
|
8
|
Chen WF, Kim BS, Lin YT. Penrose Drain Interposition - A Novel Approach to Preventing Adhesion Formation after Tenolysis. J Hand Surg Asian Pac Vol 2022; 27:174-177. [PMID: 35135418 DOI: 10.1142/s2424835522720031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Peritendinous adhesions represent a common problem without a satisfactory solution despite several studies. We have been using a conventional silicone Penrose drain in patients undergoing tenolysis in the hand since 2006. The Penrose drain is wrapped around the segment of the tendon after tenolysis. Therapy is started on the second post-operative day and the Penrose drain removed after one week in the outpatient clinic. We have had good outcomes with this technique. It is inexpensive, readily available and effective. Level of Evidence: Level V (Therapeutic).
Collapse
Affiliation(s)
- Wei F Chen
- Division of Reconstructive Microsurgery, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Center for Lymphedema Research and Reconstruction, Department of Plastic and Reconstructive Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Bong-Sung Kim
- Division of Reconstructive Microsurgery, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Yu-Te Lin
- Division of Reconstructive Microsurgery, Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| |
Collapse
|
9
|
Li P, Zhou H, Tu T, Lu H. Dynamic exacerbation in inflammation and oxidative stress during the formation of peritendinous adhesion resulted from acute tendon injury. J Orthop Surg Res 2021; 16:293. [PMID: 33952274 PMCID: PMC8097959 DOI: 10.1186/s13018-021-02445-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 04/22/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Peritendinous adhesion is among the common complications after tendon injury. Numerous studies have been carried out to prevent its formation, including modifications of surgical procedures, postoperative cares, application of medicines, etc. This study dynamically monitored fluctuations of inflammation, state of oxidative stress, and histopathologic changes around injured tendon to provide theoretical basis for further exploration in mechanisms of peritendinous adhesion formation. METHODS Eighteen mature Sprague-Dawley male rats were randomly allocated into 6 equal groups. Compared with control and sham group, every rat's right hind Achilles tendon in experimental groups was cut and repaired by the modified Kessler technique. Besides control and sham group, samples of tendon margin and serum were collected at different time points after the surgery. Content of TNF-α, IL-1β, and TGF-β were assayed in harvested serum. Reactive oxygen species (ROS) were detected, expression levels of related genes (IL-1β, IL-6, SOD1, SOD2, COL1, HIF1A) were quantified by qPCR, and various histopathological evaluations were performed. RESULTS Indicators (TNF-α, IL-1β, TGF-β1, ROS) were noticed to have a similar trend of significant rising 24 h after the surgery except TGF-β which was rising 72 h later. So were the expression trends of IL-1β, IL-6, SOD1, SOD2, and COL1. HIF1A, inversely correlated with SOD2, showed the progressive relief of regional tissue hypoxia. Histological evaluation showed the same tendency that fibrosis and inflammation were getting serious 48 h later after the surgery. CONCLUSIONS Inflammation, oxidative stress in injured tendon resulted from acute trauma, would be getting intense in 24 h. Peritendinous adhesion emerges and aggravates after 48 h. Thus, prompt efficient measures are advised to be taken after the injury as soon as possible.
Collapse
Affiliation(s)
- Pengfei Li
- Department of Plastic and Aesthetic Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003 Zhejiang Province China
| | - Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003 Zhejiang Province China
| | - Tian Tu
- Department of Plastic and Aesthetic Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003 Zhejiang Province China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003 Zhejiang Province China
| |
Collapse
|
10
|
Liang Y, Xu K, Zhang P, Zhang J, Chen P, He J, Fang Y, Zhou Y, Wang J, Bai J. Quercetin reduces tendon adhesion in rat through suppression of oxidative stress. BMC Musculoskelet Disord 2020; 21:608. [PMID: 32917186 PMCID: PMC7488677 DOI: 10.1186/s12891-020-03618-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/31/2020] [Indexed: 11/27/2022] Open
Abstract
Background Tendon adhesion is one of the most common clinical problems, which poses a considerable challenge to orthopedics doctors. Quercetin (QUE) as a popular drug at present, it has various biological functions, including anti-inflammatory, anti-ischemic, anti-peroxidation, and antioxidant. The purpose of this study was to investigate the effect of quercetin on tendon adhesion and whether quercetin can inhibit oxidative stress. Method Thirty-six rats were randomly divided into three groups, including control group, low QUE (50 mg/kg/day) group, and high QUE (100 mg/kg/day) group. After 1 week, the levels of SOD, MDA and GPx were measured. The degree of tendon adhesion was assessed by macroscopic evaluation and histological evaluation. After 4 weeks. Besides, the pharmacological toxicity of quercetin to main organs were evaluated by histological analysis. Results The extent of superoxide dismutase (SOD) and glutathione peroxidase (GPx) of tendon tissue in high QUE group was significantly higher than those of low QUE group and control group. And the extent of malondialdehyde (MDA) of tendon tissue in high QUE group was significantly lower than that of low QUE group and control group. By macroscopic evaluation and histological analysis, the extent of tendon adhesion in high QUE group was lower than low QUE group and control group. However, there were no significant changes of the major organs through histological analysis. Conclusions Quercetin may be a good and safe strategy in preventing tendon adhesion. But further clinical research is needed before its recommendation in the prevention and treatment of tendon adhesion.
Collapse
Affiliation(s)
- Yuan Liang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital, Nantong West Road 98, Yangzhou, 225001, China
| | - Keteng Xu
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital, Nantong West Road 98, Yangzhou, 225001, China
| | - Pei Zhang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jiale Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital, Nantong West Road 98, Yangzhou, 225001, China
| | - Pengtao Chen
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital, Nantong West Road 98, Yangzhou, 225001, China
| | - Jinshan He
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital, Nantong West Road 98, Yangzhou, 225001, China
| | - Yongchao Fang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital, Nantong West Road 98, Yangzhou, 225001, China
| | - Yuelai Zhou
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital, Nantong West Road 98, Yangzhou, 225001, China
| | - Jingcheng Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital, Nantong West Road 98, Yangzhou, 225001, China.
| | - Jianzhong Bai
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China.
| |
Collapse
|
11
|
Alimohammadi M, Aghli Y, Fakhraei O, Moradi A, Passandideh-Fard M, Ebrahimzadeh MH, Khademhosseini A, Tamayol A, Mousavi Shaegh SA. Electrospun Nanofibrous Membranes for Preventing Tendon Adhesion. ACS Biomater Sci Eng 2020; 6:4356-4376. [PMID: 33455173 DOI: 10.1021/acsbiomaterials.0c00201] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Tendon injuries are frequent, and surgical interventions toward their treatment might result in significant clinical complications. Pretendinous adhesion results in the disruption of the normal gliding mechanism of a damaged tendon, painful movements, and an increased chance of rerupture in the future. To alleviate postsurgical tendon-sheath adhesions, many investigations have been directed toward the development of repair approaches using electrospun nanofiber scaffolds. Such methods mainly take advantage of nanofibrous membranes (NFMs) as physical barriers to prevent or minimize adhesion of a repaired tendon to its surrounding sheath. In addition, these nanofibers can also locally deliver antiadhesion and anti-inflammatory agents to reduce the risk of tendon adhesion. This article reviews recent advances in the design, fabrication, and characterization of nanofibrous membranes developed to serve as (i) biomimetic tendon sheaths and (ii) physical barriers. Various features of the membranes are discussed to present insights for further development of repair methods suitable for clinical practice.
Collapse
Affiliation(s)
- Mahdieh Alimohammadi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Mechanical Engineering, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Yasaman Aghli
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,LadHyx, École Polytechnique, Palaiseau, France
| | - Omid Fakhraei
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | - Ali Khademhosseini
- Department of Bioengineering, University of California-Los Angeles, Los Angeles, California 90095, United States of America.,Center for Minimally invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, California 90095, United States of America.,Department of Radiology, University of California-Los Angeles, Los Angeles, California 90095, United States of America.,Department of Chemical and Biomolecular Engineering, University of California-Los Angeles, Los Angeles, California 90095, United States of America.,Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States of America
| | - Ali Tamayol
- University of Connecticut Health Center, Farmington, Connecticut 06030, United States of America
| | - Seyed Ali Mousavi Shaegh
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
12
|
Does methylene blue reduce adhesion during the healing process after tendon repair? Jt Dis Relat Surg 2020; 31:246-254. [PMID: 32584721 PMCID: PMC7489185 DOI: 10.5606/ehc.2020.74405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/15/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study aims to biomechanically and histopathologically investigate the effects of methylene blue (MB) on preventing postoperative adhesion in chickens undergoing full- thickness flexor tendon incision. MATERIALS AND METHODS This study was performed between June 2017 and June 2018 on Hubbard JA 57 type chickens (age, 6 months; weight, 2.2±0.3 kg). Sixty-four tendons were studied in 32 chickens, including 16 in the control group and 16 in the experimental group. The second and third finger flexor digitorum profundus tendons of the left foot of each chicken were repaired primarily after a full-thickness incision approximately 1 cm proximal to the distal adhesion area. In the control (n=32) and experimental groups (n=32), 0.25 mL of normal saline and 0.25 mL of 1% MB solutions were applied locally to the surgical site, respectively. The operated limb was immobilized using a circular cast. 16 chickens were randomly selected in each group and examined at the fourth week, and the remaining 16 chickens were examined at the sixth week. Thirty-two of these tendons were evaluated using the Tang histopathological adhesion classification system, and the other 32 were evaluated with a biomechanical pull system. RESULTS Adhesion was found to be less in the experimental group compared to the control group at the end of the fourth and sixth weeks both histopathologically and biomechanically. Furthermore, adhesion was significantly less in the experimental group at the end of the sixth week compared to the fourth week both histopathologically and biomechanically. CONCLUSION Histopathological and biomechanical results show that MB, which has anti-inflammatory, antiseptic, antimicrobial and antioxidant effects, reduces adhesion during the healing process after tendon repair. We think that local MB application, particularly in surgeries performed after this type of injury, will be beneficial on early rehabilitation and functional results.
Collapse
|
13
|
Nazifi O, Stuart AL, Nikkhah D. The use of 5-fluorouracil in the prevention of tendon adhesions: A systematic review. Animal Model Exp Med 2020; 3:87-92. [PMID: 32318664 PMCID: PMC7167231 DOI: 10.1002/ame2.12110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This systematic review aims to study the effectiveness of 5-fluorouracil (5FU) in the reduction of tendon adhesions postsurgical repair. METHOD A systematic review was performed involving four databases, Cochrane, PubMed, MEDLINE, and Embase, looking for evidence of at least Level I or Level II (according to NHMRC) in the use of 5FU in tendon repairs in human or animal studies. RESULTS Across the four databases 546 articles were identified. Of these 12 were identified as relevant, with a further two being excluded after in depth review. CONCLUSIONS Nine of the 10 studies showed that 5FU was effective at reducing tendon adhesions in their respective animal studies. One of the 10 studies showed no significant change compared to the control group.
Collapse
Affiliation(s)
| | | | - Dariush Nikkhah
- Locum Consultant Plastic SurgeonDepartment of Plastic and Reconstructive SurgeryRoyal Free London NHS Foundation TrustLondonUK
| |
Collapse
|
14
|
Abstract
Extensor tendon injuries are common and require a complex treatment strategy to appropriately manage them, including initial repair, revision/reconstruction options, and postoperative protocols. Intrinsic and extrinsic components of the extensor mechanism contribute to a complex anatomic apparatus but also allow for numerous reconstructive options. Tenolysis, tendon grafting, and local tissue reconstruction are all options that can be used to treat complex extensor tendon injuries, but the type of repair is dependent on which of the eight extensor zones and accompanying structures are injured. To adequately assess and treat these injuries, a working knowledge of the anatomy, reconstructive techniques, and rehabilitation is imperative.
Collapse
|
15
|
Liu S, Wu F, Gu S, Wu T, Chen S, Chen S, Wang C, Huang G, Jin T, Cui W, Sarmento B, Deng L, Fan C. Gene Silencing via PDA/ERK2-siRNA-Mediated Electrospun Fibers for Peritendinous Antiadhesion. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2019; 6:1801217. [PMID: 30693181 PMCID: PMC6343062 DOI: 10.1002/advs.201801217] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/30/2018] [Indexed: 05/04/2023]
Abstract
Sustained delivery of small interfering RNA (siRNA) is a challenge in gene silencing for managing gene-related disorders. Although nanoparticle-mediated electrospun fibers enable sustainable gene silencing, low efficiency, loss of biological activity, toxicity issues, and complex electrospinning techniques are all bottlenecks of these systems. Preventing peritendinous adhesion is crucial for their successful use, which involves blocking cellular signaling via physical barriers. Here, a multifunctional, yet structurally simple, cationic 2,6-pyridinedicarboxaldehyde-polyethylenimine (PDA)-mediated extracellular signal-regulated kinase (ERK)2-siRNA polymeric delivery system is reported, in the form of peritendinous antiadhesion electrospun poly-l-lactic acid/hyaluronan membranes (P/H), with the ability to perform sustained release of bioactive siRNA for long-term prevention of adhesions and ERK2 silencing. After 4 days of culture, the cell area and proliferation rate of chicken embryonic fibroblasts on siRNA+PDA+P/H membrane are significantly less than those on P/H and siRNA+P/H membranes. The in vivo results of average optical density of collagen type III (Col III) and gene expression of ERK2 and its downstream SMAD3 in the siRNA+PDA+P/H group are less than those of P/H and siRNA+P/H groups. Consequently, siRNA+PDA+P/H electrospun membrane can protect the bioactivity of ERK2-siRNA and release it in a sustained manner. Moreover, adhesion formation is inhibited by reducing fibroblast proliferation and Col III deposition, and downregulating ERK2 and its downstream SMAD3.
Collapse
Affiliation(s)
- Shen Liu
- Department of OrthopaedicsShanghai Jiao Tong UniversityAffiliated Sixth People's Hospital600 Yishan RoadShanghai200233China
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint DiseasesShanghai Institute of Traumatology and OrthopaedicsRuijin HospitalShanghai Jiao Tong University School of Medicine197 Ruijin 2nd RoadShanghai200025China
| | - Fei Wu
- School of PharmacyShanghai Jiao Tong University800 Dongchuan RoadShanghai200240China
| | - Shanshan Gu
- School of PharmacyShanghai Jiao Tong University800 Dongchuan RoadShanghai200240China
| | - Tianyi Wu
- Department of OrthopaedicsShanghai Jiao Tong UniversityAffiliated Sixth People's Hospital600 Yishan RoadShanghai200233China
| | - Shun Chen
- Department of OrthopaedicsShanghai Jiao Tong UniversityAffiliated Sixth People's Hospital600 Yishan RoadShanghai200233China
| | - Shuai Chen
- School of PharmacyShanghai Jiao Tong University800 Dongchuan RoadShanghai200240China
| | - Chongyang Wang
- Department of OrthopaedicsShanghai Jiao Tong UniversityAffiliated Sixth People's Hospital600 Yishan RoadShanghai200233China
| | - Guanlan Huang
- Department of Pharmaceutical Sciences LaboratoryÅbo Akademi University20520TurkuFinland
| | - Tuo Jin
- School of PharmacyShanghai Jiao Tong University800 Dongchuan RoadShanghai200240China
| | - Wenguo Cui
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint DiseasesShanghai Institute of Traumatology and OrthopaedicsRuijin HospitalShanghai Jiao Tong University School of Medicine197 Ruijin 2nd RoadShanghai200025China
- State Key Laboratory of Molecular Engineering of PolymersFudan UniversityNo. 220 Handan RoadShanghai200433China
| | - Bruno Sarmento
- I3S—Instituto de Investigação e Inovação em SaúdeUniversidade do PortoRua Alfredo Allen, 208Porto4200‐135Portugal
- INEB—Instituto de Engenharia BiomédicaUniversidade do PortoRua Alfredo Allen, 208Porto4200‐135Portugal
- CESPU—Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da SaúdeRua Central de Gandra 1317Gandra4585‐116Portugal
| | - Lianfu Deng
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint DiseasesShanghai Institute of Traumatology and OrthopaedicsRuijin HospitalShanghai Jiao Tong University School of Medicine197 Ruijin 2nd RoadShanghai200025China
| | - Cunyi Fan
- Department of OrthopaedicsShanghai Jiao Tong UniversityAffiliated Sixth People's Hospital600 Yishan RoadShanghai200233China
| |
Collapse
|