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Zhang P, Chen H, Zhang Y, Liu Y, Zhu G, Zhao W, Shang Q, He J, Zhou Z, Shen G, Yu X, Zhang Z, Chen G, Yu F, Liang D, Tang J, Liu Z, Cui J, Jiang X, Ren H. Dry and wet experiments reveal diagnostic clustering and immune landscapes of cuproptosis patterns in patients with ankylosing spondylitis. Int Immunopharmacol 2024; 127:111326. [PMID: 38091828 DOI: 10.1016/j.intimp.2023.111326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024]
Abstract
Cuproptosis is a new manner of mitochondrial cell death induced by copper. There is evidence that serum copper has a crucial impact on ankylosing spondylitis (AS) by copper-induced inflammatory response. However, the molecular mechanisms of cuproptosis modulators in AS remain unknown. We aimed to use a bioinformatics-based method to comprehensively investigate cuproptosis-related subtype identification and immune microenvironment infiltration of AS. Additionally, we further verified the results by in vitro experiments, in which peripheral blood and fibroblast cells from AS patients were used to evaluate the functions of significant cuproptosis modulators on AS. Finally, eight significant cuproptosis modulators were identified by analysis of differences between controls and AS cases from GSE73754 dataset. Eight prognostic cuproptosis modulators (LIPT1, DLD, PDHA1, PDHB, SLC31A1, ATP7A, MTF1, CDKN2A) were identified using a random forest model for prediction of AS risk. A nomogram model of the 8 prognostic cuproptosis modulators was then constructed; the model could be beneficial in clinical settings, as indicated by decision curve analysis. Consensus clustering analysis was used to divide AS patients into two cuproptosis subtypes (clusterA & B) according to significant cuproptosis modulators. The cuproptosis score of each sample was calculated by principal component analysis to quantify cuproptosis subtypes. The cuproptosis scores were higher in clusterB than in clusterA. Additionally, cases in clusterA were closely associated with the immunity of activated B cells, Activated CD4 T cell, Type17 T helper cell and Type2 T helper cell, while cases in clusterB were linked to Mast cell, Neutrophil, Plasmacytoid dendritic cell immunity, indicating that clusterB may be more correlated with AS. Notably, key cuproptosis genes including ATP7A, MTF1, SLC31A1 detected by RT-qPCR with peripheral blood exhibited significantly higher expression levels in AS cases than controls; LIPT1 showed the opposite results; High MTF1 expression is correlated with increased osteogenic capacity. In general, this study of cuproptosis patterns may provide promising biomarkers and immunotherapeutic strategies for future AS treatment.
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Affiliation(s)
- Peng Zhang
- The Second Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou 510120, China
| | - Honglin Chen
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - You Zhang
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Yu Liu
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Guangye Zhu
- Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou 215007, China
| | - Wenhua Zhao
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Qi Shang
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Jiahui He
- The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou 510130, China
| | - Zelin Zhou
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Gengyang Shen
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China.
| | - Xiang Yu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zhida Zhang
- The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou 510130, China
| | - Guifeng Chen
- Shanghai 9th Peoples Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Fuyong Yu
- Qianxinan Autonomous Prefecture Hospital of TCM, Xingyi 562400, China
| | - De Liang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Jingjing Tang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Zhixiang Liu
- Affiliated Huadu Hospital, Southern Medical University, Guangzhou 510800, China
| | - Jianchao Cui
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - Xiaobing Jiang
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China.
| | - Hui Ren
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China.
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Yang X, Wang Q, Meng Z, Liu H, Wu H, Juma T, Pan L, Wang Y, Cao Y. A Femoral Neck Osteotomy for the Patients with Ankylosing Spondylitis and Thoracolumbar Kyphosis Combined with Hip Flexion Contracture. Orthop Surg 2024; 16:245-253. [PMID: 37975214 PMCID: PMC10782266 DOI: 10.1111/os.13906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/19/2023] [Accepted: 08/30/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE The surgical treatment of patients with ankylosing spondylitis and severe thoracolumbar kyphosis combined with hip flexion contracture is very difficult for all the surgeons. The femoral neck osteotomy (FNO) is the first step to break the ice. The evaluation of a new modified FNO method is very important to improve the curative effect. METHODS Five male patients with nine bone-fused hips who underwent the new femoral neck osteotomy were included from October 2021 to March 2022. The FNO was designed that the saw blade was manipulated from the lateral femoral neck base to the inferior part of the femoral head, keeping Pauwels' angle less than 30° on the coronal plane. On the transverse plane, the angle between the saw blade and the coronal plane was more than 15°. On the sagittal plane, the saw blade cut through the femoral neck. They accepted pedicle subtraction osteotomy (PSO) after FNO according to the patient' recovery. Then, 2 weeks later, the patients underwent total hip arthroplasty (THA). The visual analogue scale (VAS), Harris hip score (HHS) and passive hip flexion-extension range of motion (ROM) were used to evaluate hip function. The data were analyzed by paired t-test. RESULTS The average operation time and blood loss of FNO, the average interval between FNO and THA were collected. The average angle of the trunk and lower limb (ATL) was 36.33° ± 16.36° pre-FNO, 82.89° ± 13.51° post-FNO and 175.22° ± 3.42° post-THA. The average VAS scores were 0 pre-FNO, 5 ± 1.58 post-FNO and 2.6 ± 0.55 post-THA. The average HHS was 43.56 ± 1.59 preoperatively and 83.89 ± 2.21 postoperatively. The average hip extension ROM was 23.89° ± 12.69° pre-FNO, -22.67° ± 14.18° post-FNO and - 3.33° ± 2.50 post-THA°. The average hip flexion ROM was 23.89° ± 12.69° pre-FNO, 35.56° ± 12.11° post-FNO and 104.44° ± 5.27° post-THA. The differences among them were significant (p < 0.05). Only one hip (11.11%) displaced completely after FNO. CONCLUSION A new modified FNO was developed, which can provide osteotomy with a certain degree of stability and greater ease for performing PSO and THA.
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Affiliation(s)
- Xin Yang
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Qiwei Wang
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Zhicao Meng
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Heng Liu
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Hao Wu
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Talante Juma
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Liping Pan
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Yu Wang
- Department of OrthopaedicsPeking University First HospitalBeijingChina
| | - Yongping Cao
- Department of OrthopaedicsPeking University First HospitalBeijingChina
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Si G, Qiu W, Shen Q, Wang Y, Li W, Yu M, Wang Y. Mini-open Pedicle Subtraction Osteotomy versus Standard Posterior Approach for Ankylosing Spondylitis-related Spinal Kyphosis: A Comparative Study. Orthop Surg 2023; 15:2656-2664. [PMID: 37681279 PMCID: PMC10549849 DOI: 10.1111/os.13873] [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: 02/05/2023] [Revised: 07/19/2023] [Accepted: 07/29/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE Surgical strategy for spinal kyphosis in patients with ankylosing spondylitis (AS) has been challenging. Pedicle subtraction osteotomy (PSO) through a minimally invasive (MI) approach has been developed with promising clinical outcomes. We aimed to compare the effectiveness and safety of PSO via an MI approach and a standard posterior approach (SPA) for treating AS-related spinal kyphosis. METHODS A total of 41 patients with AS-related spinal kyphosis who underwent PSO through an MI approach (MI surgery [MIS] group: n = 25) or SPA (SPA group: n = 16) between January 2015 and July 2020 were retrospectively included. Spinopelvic parameters were evaluated before the surgery, immediately after the surgery, and at the 2-year follow-up. Clinical data including operative time, estimated blood loss, blood transfusion, level of fusion, incision length, bed rest period, length of hospitalization, and surgical complications were compared between the two groups. The Scoliosis Research Society outcomes instrument-22 (SRS-22) was administered to assess patients' quality of life at the latest follow-up. Comparisons between the two groups were performed using independent sample t-test or Chi-square test. RESULTS Characteristics and baseline kyphosis of the two groups were matched. At the 2-year follow-up, in the MIS group, the average correction values of the sagittal vertical axis and global kyphosis (GK) were 9.5 cm and 44.3°, respectively. Compared with the SPA group, the MIS group had similar correction values and correction losses after surgery. No obvious differences were observed in any radiographic parameters, except for GK, immediately after surgery and at the 2-year follow-up between the two groups (p > 0.05). The MIS group had a significantly shorter operative time, lesser blood loss, lesser transfusion volume, shorter fusion level, and lesser time to mobilization than did the SPA group. Higher average functional activity scores of SRS-22 were obtained in the MIS group than in the SPA group. CONCLUSION Mini-open PSO may be an effective alternative to the SPA for treating AS-related spinal kyphosis, with comparable correction effect, lesser surgical trauma and faster recovery. This comparative study may provide valuable guidance for surgical decision-making and patient counseling.
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Affiliation(s)
- Gao Si
- Peking University Third Hospital, Department of OrthopaedicsBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Weipeng Qiu
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
- Peking University Health Science CenterBeijingChina
| | - Qixian Shen
- Peking University Health Science CenterBeijingChina
| | - Yongqiang Wang
- Peking University Third Hospital, Department of OrthopaedicsBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Weishi Li
- Peking University Third Hospital, Department of OrthopaedicsBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Miao Yu
- Peking University Third Hospital, Department of OrthopaedicsBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yu Wang
- Peking University First Hospital, Department of OrthopaedicsBeijingChina
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Zhang W, Yin W, Cui X, Chai Z, Zheng G, Ding Y, Wang H, Zhai Y, Yu H. Operative strategies for ankylosing spondylitis-related thoracolumbar kyphosis: focus on the cervical stiffness, coronal imbalance and hip involvement. BMC Musculoskelet Disord 2023; 24:723. [PMID: 37697276 PMCID: PMC10494390 DOI: 10.1186/s12891-023-06810-2] [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: 12/03/2022] [Accepted: 08/18/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Cervical stiffness, coronal imbalance and limited hip movement all play crucial roles in designing the corrective surgery for ankylosing spondylitis-related thoracolumbar kyphosis (AS-TLK). However, a comprehensive classification and tailored strategies for directing clinical work are lacking. This study aims to investigate the types and surgical strategies for AS-TLK that consider cervical stiffness, coronal imbalance and hip involvement as the key factors. METHODS 25 consecutive AS-TLK patients were divided into three types according to their accompanying features: Type I: with a flexible cervical spine; Type IIA: with a stiff cervical spine; Type IIB: with coronal imbalance; Type IIC: with limited hip movement. Type III is the mixed type with at least two conditions of Type II. Individual strategies were given correspondingly. Spinal-pelvic-femoral parameters were measured, Scoliosis Research Society outcome instrument-22 (SRS-22) was used and complications were recorded and analysed. RESULTS All patients (Type I 10, Type II 8 and Type III 7) underwent surgery successfully. 13 cases with 16 complications were recorded and cured. The patients were followed up for 24-65 months with an average of 33.0 ± 9.6 months. Both the sagittal and coronal parameters were corrected and decreased significantly (all, p < 0.05). SRS-22 scores showed a satisfactory outcome. CONCLUSION Thoracolumbar kyphosis secondary to ankylosing spondylitis are complex and variable. Considering the factors of cervical stiffness, coronal imbalance and hip involvement assists in making decisions individually and achieving a desired surgical result.
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Affiliation(s)
- Wei Zhang
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Wen Yin
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Xilong Cui
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Zihao Chai
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Guohui Zheng
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Ya Ding
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Hongliang Wang
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Yunlei Zhai
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China
| | - Haiyang Yu
- Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China.
- Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China.
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Zhang B, Gong YN, Gao XC, Tang YG, Hao DJ, He BR, Qu ZC, Yan L. Relationship between degenerative scoliosis and lower extremity mechanical parameters based on EOS imaging system. Am J Transl Res 2022; 14:8703-8713. [PMID: 36628232 PMCID: PMC9827318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/29/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study aimed to assess the correlation between coronal imbalance and lower-limb physiological parameters in degenerative scoliosis using the biplanar whole body imaging system (EOS). MATERIALS AND METHODS A total of 101 successive EOS images were selected between January 2018 and December 2021. Of the selected images, 63 patients were in the degenerative scoliosis group (DSG) and 38 patients were in the control group (CG). Two independent observers performed measurements of the parameters and compared the two groups. RESULTS Among parameters examined, significant inter-group differences were found for coronal pelvic tilt angle (CPT), bilateral femoral length difference (ΔFL), and bilateral total lower limb length (ΔTL) difference. Additionally, the knee and ankle joints had more severe degeneration on the main curved side in patients with degenerative scoliosis. In the left curved group, 18 (42.86%) and 24 (57.1%) patients had more severe degeneration in the left knee and left ankle, respectively. In the right lateral bending group, 13 (61.9%) and 14 (66.7%) patients had more severe degeneration in the right knee and right ankle, respectively. Statistical differences were found in the degree of degeneration in both knee and ankle joints bilaterally. CONCLUSION This study showed that biomechanical parameters of the lower limbs are affected in cases of degenerative scoliosis with altered coronal balance. The lower limb on the main curve side became shorter compared to its counterpart, and joint degeneration of the knee and ankle joints became more severe.
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Affiliation(s)
- Bo Zhang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an, Shaanxi, China
| | - Yi-Ning Gong
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an, Shaanxi, China
| | - Xiang-Cheng Gao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an, Shaanxi, China
| | - Yong-Gang Tang
- Department of Radiology, Honghui Hospital, Xi’an Jiaotong UniversityXi’an, Shaanxi, China
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an, Shaanxi, China
| | - Bao-Rong He
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an, Shaanxi, China
| | - Ze-Chao Qu
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an, Shaanxi, China
| | - Liang Yan
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong UniversityXi’an, Shaanxi, China
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