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Gillard KK, Bloedon L, Grady-Benson JC, Edwards A, Fahy S, Sasiela WJ, Louie MJ, Thompson PD. Prevalence of Tendon Rupture and Tendinopathies Among Patients with Atherosclerotic Cardiovascular Disease Derived From United States Administrative Claims Data. Cardiol Ther 2024:10.1007/s40119-024-00374-5. [PMID: 39003659 DOI: 10.1007/s40119-024-00374-5] [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: 03/04/2024] [Accepted: 06/06/2024] [Indexed: 07/15/2024] Open
Abstract
INTRODUCTION The prevalence of tendon rupture and tendinopathies (TRT) has not been determined in a large population of patients with atherosclerotic cardiovascular disease (ASCVD). We investigated TRT prevalence among patients with ASCVD and in the general population, using data from the Symphony Health Integrated Dataverse, a large US medical and pharmacy claims database. METHODS This retrospective, observational study included patients aged ≥ 19 years from the claims database during the identification period (January 2019 to December 2020) and 12 months of continuous enrollment. The primary outcome was evidence of TRT in the 12 months following the index date (first ASCVD diagnosis in the ASCVD cohort; first claim in the claims database in the overall population). Diagnostic codes (ICD-10 and/or CPT) were used to define ASCVD and TRT diagnosis. RESULTS The ASCVD cohort and overall population included 5,589,273 and 61,715,843 patients, respectively. In the ASCVD cohort, use of medications with a potential or known association with TRT was identified in 67.9% (statins), 17.7% (corticosteroids), and 16.7% (fluoroquinolones) of patients. Bempedoic acid use was reported in 1556 (< 0.1%) patients. TRT prevalence during 12-month follow-up was 3.4% (ASCVD cohort) and 1.9% (overall population). Among patients with ASCVD, 83.5% experienced TRT in only one region of the body. Factors most associated with TRT in the ASCVD cohort were increasing age, most notably in those aged 45-64 years (odds ratio [OR] 2.19; 95% confidence interval [CI] 2.07-2.32), obesity (OR 1.51; 95% CI 1.50-1.53), and rheumatoid arthritis (OR 1.47; 95% CI 1.45-1.79). Use of statins or bempedoic acid was not associated with increased TRT risk. CONCLUSION Patients with ASCVD may have greater risk of TRT than the general population, which may be driven by an increased prevalence of comorbidities and use of medications with a potential or known association with TRT.
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Affiliation(s)
- Kristin K Gillard
- Esperion Therapeutics Inc., Ann Arbor, MI, USA.
- , 245 Lindero Avenue, Long Beach, CA, 90803, USA.
| | | | - John C Grady-Benson
- Orthopedic Associates of Hartford PC, Hartford, CT, USA
- Department of Orthopedic Surgery, The Bone and Joint Institute at Hartford HealthCare, Hartford, CT, USA
| | | | - Sean Fahy
- Symphony Health, ICON Plc Company, Blue Bell, PA, USA
| | | | | | - Paul D Thompson
- Cardiovascular Institute, Hartford HealthCare, Hartford, CT, USA
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2
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Park SS, Cho W, Lim DS, Gwon HJ, Choi SW, Abd El-Aty AM, Aydemir HA, Jeong JH, Jung TW. AMPK/autophagy-mediated alleviation of tendinopathy by IL-38: A novel strategy for the treatment of obesity-related tendinopathy. Tissue Cell 2024; 88:102392. [PMID: 38643674 DOI: 10.1016/j.tice.2024.102392] [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: 03/07/2024] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 04/23/2024]
Abstract
The effect of interleukin-38 (IL-38), a recently identified member of the IL-1 family with potential applications in various inflammation-related conditions, on ER stress has not been explored. Furthermore, its role in obesity-associated tendinopathy has not been investigated. In this study, human primary tenocytes were treated with palmitate (200 or 400 μM) and palmitate plus IL-38 (0-50 ng/mL) for 24 h. Western blotting was used to assess ER stress and tendinopathogenic markers in tenocytes. Monodansylcadaverine (MDC) staining was used to evaluate autophagosomes. Apoptosis was determined by cell viability assays, caspase 3 activity assays and TUNEL assays. Cell migration was evaluated by a cell scratch assay. Small interfering (si) RNA transfection was used for target gene silencing. Treatment of tenocytes with IL-38 attenuated apoptosis, restored the balance between MMPs and TIMP-1, and alleviated ER stress under palmitate conditions. IL-38 treatment enhanced AMPK phosphorylation and promoted the expression of autophagy markers related to LC3 conversion, p62 degradation, and autophagosome formation in cultured tenocytes. The effects of IL-38 on ER stress, apoptosis, and MMP-9, MMP-13, and TIMP-1 expression in palmitate-treated tenocytes were abrogated by AMPK siRNA or 3-methyladenine (3MA). These results suggest that IL-38 alleviates ER stress through the AMPK/autophagy pathway, thereby reducing apoptosis and preventing extracellular matrix (ECM) degradation in tenocytes under hyperlipidemic conditions. This study provides a promising therapeutic avenue for treating obesity-related tendinopathy using an endogenous compound such as IL-38.
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Affiliation(s)
- Sung Su Park
- Department of Pharmacology, College of Medicine, Chung-Ang University, Seoul, the Republic of Korea
| | - Wonjun Cho
- Department of Pharmacology, College of Medicine, Chung-Ang University, Seoul, the Republic of Korea
| | - Do Su Lim
- Department of Pharmacology, College of Medicine, Chung-Ang University, Seoul, the Republic of Korea
| | - Hyeon Ji Gwon
- Department of Pharmacology, College of Medicine, Chung-Ang University, Seoul, the Republic of Korea
| | - Sung Woo Choi
- Department of Pharmacology, College of Medicine, Chung-Ang University, Seoul, the Republic of Korea
| | - A M Abd El-Aty
- Department of Pharmacology, Faculty of Veterinary Medicine, Cairo University, Giza 12211, Egypt; Department of Medical Pharmacology, Medical Faculty, Ataturk University, Erzurum 25240, Turkey.
| | - Hacı Ahmet Aydemir
- Dr. Filiz Dolunay Family Health Center, Unit Number:59, Yakutiye, Erzurum, Turkey
| | - Ji Hoon Jeong
- Department of Pharmacology, College of Medicine, Chung-Ang University, Seoul, the Republic of Korea; Department of Global Innovative Drugs, Graduate School of Chung-Ang University, Seoul, the Republic of Korea
| | - Tae Woo Jung
- Department of Pharmacology, College of Medicine, Chung-Ang University, Seoul, the Republic of Korea.
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3
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Yoon JP, Park SJ, Choi YS, Kim DH, Lee HJ, Park EJJ, Chung SW. Current research trends on the effect of diabetes mellitus on rotator cuff tendon healing/tendinopathy. Arch Orthop Trauma Surg 2024; 144:2491-2500. [PMID: 38698293 DOI: 10.1007/s00402-024-05350-1] [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: 02/15/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024]
Abstract
Rotator cuff tendon tears are a leading cause of shoulder pain. They are challenging to treat, and tendon-bone healing has a high failure rate despite successful surgery. Tendons connect the muscles and bones, which make them important for the body's overall mobility and stability. Metabolic diseases, including diabetes or high blood pressure, can affect the healing process after repair of a damaged tendon. With a global incidence of 9.3%, diabetes is considered as a significant risk factor for rotator cuff tendon healing because it causes structural, inflammatory, and vascular changes in the tendon. However, the mechanisms of how diabetes affects tendon healing remain unknown. Several factors have been suggested, including glycation product accumulation, adipokine dysregulation, increased levels of reactive oxygen species, apoptosis, inflammatory cytokines, imbalanced matrix-metalloproteinase-to-tissue-inhibitor ratio, and impaired angiogenesis and differentiation of the tendon sheath. Despite the effects of diabetes on tendon function and healing, few treatments are available to improve recovery in these patients. This review summarizes the current literature on the pathophysiological changes of the tendon in diabetes and hyperlipidemia. Preclinical and clinical evidence regarding the association between diabetes and tendon healing is presented. Moreover, current approaches to improve tendon healing in patients with diabetes are reviewed.
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Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Korea
| | - Sung-Jin Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Korea.
| | - Yoon Seong Choi
- Department of Carbon Hybrid Fiber Science, Kyungpook National University, Daegu, Korea
| | - Dong-Hyun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Korea
| | - Hyun Joo Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Korea
| | - Eugene Jae Jin Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-Ro, Jung-Gu, Daegu, 41944, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University Medical Center, Seoul, Korea
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Bedi A, Bishop J, Keener J, Lansdown DA, Levy O, MacDonald P, Maffulli N, Oh JH, Sabesan VJ, Sanchez-Sotelo J, Williams RJ, Feeley BT. Rotator cuff tears. Nat Rev Dis Primers 2024; 10:8. [PMID: 38332156 DOI: 10.1038/s41572-024-00492-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
Rotator cuff tears are the most common upper extremity condition seen by primary care and orthopaedic surgeons, with a spectrum ranging from tendinopathy to full-thickness tears with arthritic change. Some tears are traumatic, but most rotator cuff problems are degenerative. Not all tears are symptomatic and not all progress, and many patients in whom tears become more extensive do not experience symptom worsening. Hence, a standard algorithm for managing patients is challenging. The pathophysiology of rotator cuff tears is complex and encompasses an interplay between the tendon, bone and muscle. Rotator cuff tears begin as degenerative changes within the tendon, with matrix disorganization and inflammatory changes. Subsequently, tears progress to partial-thickness and then full-thickness tears. Muscle quality, as evidenced by the overall size of the muscle and intramuscular fatty infiltration, also influences symptoms, tear progression and the outcomes of surgery. Treatment depends primarily on symptoms, with non-operative management sufficient for most patients with rotator cuff problems. Modern arthroscopic repair techniques have improved recovery, but outcomes are still limited by a lack of understanding of how to improve tendon to bone healing in many patients.
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Affiliation(s)
- Asheesh Bedi
- Department of Orthopedic Surgery, University of Chicago, Chicago, IL, USA
- NorthShore Health System, Chicago, IL, USA
| | - Julie Bishop
- Department of Orthopedic Surgery, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Jay Keener
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Drew A Lansdown
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Peter MacDonald
- Department of Surgery, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Vani J Sabesan
- HCA Florida JFK Orthopaedic Surgery Residency Program, Atlantis Orthopedics, Atlantis, FL, USA
| | | | - Riley J Williams
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Brian T Feeley
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA.
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5
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Cho W, Oh H, Abd El-Aty AM, Hacimuftuoglu A, Jeong JH, Jung TW. Therapeutic potential of ginsenoside compound K in managing tenocyte apoptosis and extracellular matrix damage in diabetic tendinopathy. Tissue Cell 2024; 86:102275. [PMID: 37979397 DOI: 10.1016/j.tice.2023.102275] [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: 08/28/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023]
Abstract
The prevalence of tendinopathy in patients with diabetes is well documented. Despite efforts to improve diabetes management, there is a lack of research on therapeutic agents targeting the core features of tendinopathy, namely, tenocyte apoptosis and extracellular matrix (ECM) damage. In this study, we investigated the potential of ginsenoside compound K (CK), known for its antidiabetic properties, to mitigate tenocyte apoptosis, inflammation, oxidative stress, and the metalloproteinase (MMP) system under hyperglycemic conditions. Our research also aimed to unravel the molecular mechanism underlying the effects of CK. The assessment of apoptosis involved observing intracellular chromatin condensation and measuring caspase 3 activity. To gauge oxidative stress, we examined cellular ROS levels and hydrogen peroxide and malondialdehyde concentrations. Western blotting was employed to determine the expression of various proteins. Our findings indicate that CK treatment effectively countered high glucose-induced apoptosis, inflammation, and oxidative stress in cultured tenocytes. Furthermore, CK normalized the expression of MMP-9, MMP-13, and TIMP-1. Notably, CK treatment boosted the expression of PPARγ and antioxidant enzymes. We conducted small interfering (si) RNA experiments targeting PPARγ, revealing its role in mediating CK's effects on tendinopathy features in hyperglycemic tenocytes. In conclusion, these in vitro results offer valuable insights into the potential therapeutic role of CK in managing tendinopathy among individuals with diabetes. By addressing crucial aspects of tendinopathy, CK presents itself as a promising avenue for future research and treatment development in this domain.
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Affiliation(s)
- Wonjun Cho
- Department of Pharmacology, College of Medicine, Chung-Ang University, Seoul, the Republic of Korea
| | - Heeseung Oh
- Department of Pharmacology, College of Medicine, Chung-Ang University, Seoul, the Republic of Korea
| | - A M Abd El-Aty
- Department of Pharmacology, Faculty of Veterinary Medicine, Cairo University, 12211 Giza, Egypt; Department of Medical Pharmacology, Medical Faculty, Ataturk University, Erzurum 25240, Turkey.
| | - Ahmet Hacimuftuoglu
- Department of Medical Pharmacology, Medical Faculty, Ataturk University, Erzurum 25240, Turkey
| | - Ji Hoon Jeong
- Department of Pharmacology, College of Medicine, Chung-Ang University, Seoul, the Republic of Korea; Department of Global Innovative Drugs, Graduate School of Chung-Ang University, Seoul, the Republic of Korea
| | - Tae Woo Jung
- Department of Pharmacology, College of Medicine, Chung-Ang University, Seoul, the Republic of Korea.
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Trotta MC, Itro A, Lepre CC, Russo M, Guida F, Moretti A, Braile A, Tarantino U, D’Amico M, Toro G. Effects of adipose-derived mesenchymal stem cell conditioned medium on human tenocytes exposed to high glucose. Ther Adv Musculoskelet Dis 2024; 16:1759720X231214903. [PMID: 38204801 PMCID: PMC10775729 DOI: 10.1177/1759720x231214903] [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: 04/28/2023] [Accepted: 10/26/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction Diabetic tendinopathy is a common invalidating and challenging disease that may be treated using stem cells. However, the effects of adipose-derived mesenchymal stem cell conditioned medium (ASC-CM) in diabetic tendinopathy have never been explored. Objectives The present study evaluated the effects of ASC-CM on morphology, cell viability, structure, and scratch wound closure of human tenocytes (HTNC) exposed to high glucose (HG). Design Experimental study. Methods HTNC were exposed to HG (25 mM) for 7, 14 and 21 days with or without ASC-CM for the last 24 h. CM was collected from 4 × 105 ASCs, centrifuged for 10 min at 200 g and sterilized with 0.22 μm syringe filter. Results At 7 days, HG-HTNC had decreased cell viability [72 ± 2%, p < 0.01 versus normal glucose (NG)] compared to NG-HTNC (90 ± 5%). A further decrement was detected after 14 and 21 days (60 ± 4% and 60 ± 5%, both, p < 0.01 versus NG and p < 0.01 versus HG7). While NG-HTNC evidenced a normal fibroblast cell-like elongated morphology, HG-HTNC showed increased cell roundness. In contrast, HG-HTNC exposed to ASC-CM showed a significant increase in cell viability, an improved cell morphology and higher scratch wound closure at all HG time points. Moreover, the exposure to ASC-CM significantly increased thrombospondin 1 and transforming growth factor beta 1 (TGF-β1) content in HG-HTNC. The TGF-β1 elevation was paralleled by higher Collagen I and Vascular Endothelial Growth Factor in HG-HTNC. Conclusion ASC-CM may restore the natural morphology, cell viability and structure of HTNC, promoting their scratch wound closure through TGF-β1 increase.
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Affiliation(s)
- Maria Consiglia Trotta
- Department of Experimental Medicine, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Annalisa Itro
- PhD Course in Translational Medicine, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Caterina Claudia Lepre
- Department of Experimental Medicine, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Marina Russo
- Department of Experimental Medicine, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Francesca Guida
- Department of Experimental Medicine, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Antimo Moretti
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Adriano Braile
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
- Caterina ClaudiaLepre is also affiliated to PhD Course in Translational Medicine, University of Campania ‘Luigi Vanvitell’, Naples, Italy
| | - Michele D’Amico
- Department of Experimental Medicine, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Giuseppe Toro
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania ‘Luigi Vanvitelli’, Via L. De Crecchio 6, Naples 80138, Italy
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Yuan Z, Zhu X, Dai Y, Shi L, Feng Z, Li Z, Diao N, Guo A, Yin H, Ma L. Analysis of differentially expressed genes in torn rotator cuff tendon tissues in diabetic patients through RNA-sequencing. BMC Musculoskelet Disord 2024; 25:31. [PMID: 38172847 PMCID: PMC10763306 DOI: 10.1186/s12891-023-07149-4] [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: 06/15/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Rotator cuff tears (RCT) is a common musculoskeletal disorder in the shoulder which cause pain and functional disability. Diabetes mellitus (DM) is characterized by impaired ability of producing or responding to insulin and has been reported to act as a risk factor of the progression of rotator cuff tendinopathy and tear. Long non-coding RNAs (lncRNAs) are involved in the development of various diseases, but little is known about their potential roles involved in RCT of diabetic patients. METHODS RNA-Sequencing (RNA-Seq) was used in this study to profile differentially expressed lncRNAs and mRNAs in RCT samples between 3 diabetic and 3 nondiabetic patients. Gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis were performed to annotate the function of the differentially expressed genes (DEGs). LncRNA-mRNA co-expression network and competing endogenous RNA (ceRNA) network were constructed to elucidate the potential molecular mechanisms of DM affecting RCT. RESULTS In total, 505 lncRNAs and 388 mRNAs were detected to be differentially expressed in RCT samples between diabetic and nondiabetic patients. GO functional analysis indicated that related lncRNAs and mRNAs were involved in metabolic process, immune system process and others. KEGG pathway analysis indicated that related mRNAs were involved in ferroptosis, PI3K-Akt signaling pathway, Wnt signaling pathway, JAK-STAT signaling pathway and IL-17 signaling pathway and others. LncRNA-mRNA co-expression network was constructed, and ceRNA network showed the interaction of differentially expressed RNAs, comprising 5 lncRNAs, 2 mRNAs, and 142 miRNAs. TF regulation analysis revealed that STAT affected the progression of RCT by regulating the apoptosis pathway in diabetic patients. CONCLUSIONS We preliminarily dissected the differential expression profile of lncRNAs and mRNAs in torn rotator cuff tendon between diabetic and nondiabetic patients. And the bioinformatic analysis suggested some important RNAs and signaling pathways regarding inflammation and apoptosis were involved in diabetic RCT. Our findings offer a new perspective on the association between DM and progression of RCT.
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Affiliation(s)
- Ziyang Yuan
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
| | - Xu Zhu
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
- Department of Orthopaedics, Beijing Lu He Hospital, Capital Medical University, Beijing, 101149, China
| | - Yike Dai
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
| | - Lin Shi
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
| | - Ziyang Feng
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
| | - Zhiyao Li
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
| | - Naicheng Diao
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
| | - Ai Guo
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China.
| | - Heyong Yin
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China.
| | - Lifeng Ma
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China.
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Van Gulick L, Saby C, Mayer C, Fossier E, Jaisson S, Okwieka A, Gillery P, Chenais B, Mimouni V, Morjani H, Beljebbar A. Biochemical and morpho-mechanical properties, and structural organization of rat tail tendon collagen in diet-induced obesity model. Int J Biol Macromol 2024; 254:127936. [PMID: 37939767 DOI: 10.1016/j.ijbiomac.2023.127936] [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: 03/17/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/10/2023]
Abstract
We have investigated the impact of obesity on the structural organization, morpho-mechanical properties of collagen fibers from rat tail tendon fascicles (RTTFs). Polarized Raman microspectroscopy showed that the collagen bands 855, 875, 938, and 960 cm-1 as well as those 1631 and 1660 cm-1 were affected by diet. Mechanical properties exhibited an increase in the yield strength from control (CTRL) to high fat (HF) diet (9.60 ± 1.71 and 13.09 ± 1.81 MPa) (p < 0.01) and ultimate tensile strength (13.12 ± 2.37 and 18.32 ± 2.83 MPa) (p < 0.05) with no significant change in the Young's Modulus. During mechanical, the band at 875 cm-1 exhibited the most relevant frequency shift (2 cm-1). The intensity of those at 855, 875, and 938 cm-1 in HF collagen displayed a comparable response to mechanical stress as compared to CTRL collagen with no significant diet-related changes in the Full Width at Half Maximum. Second harmonic generation technique revealed i) similar fiber straightness (0.963 ± 0.004 and 0.965 ± 0.003) and ii) significant changes in fibers diameter (1.48 ± 0.07 and 1.52 ± 0.08 μm) (p < 0.05) and length (22.06 ± 2.38 and 29.00 ± 3.76 μm) (p < 0.001) between CTRL and HF diet, respectively. The quantification of advanced glycation end products (AGEs) revealed an increase in both carboxymethyl-lysine and total fluorescence AGEs from CTRL to HF RTTFs.
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Affiliation(s)
- Laurence Van Gulick
- Université de Reims Champagne-Ardenne, BioSpecT EA 7506, UFR de Pharmacie, 51096 Reims, France
| | - Charles Saby
- Université de Reims Champagne-Ardenne, BioSpecT EA 7506, UFR de Pharmacie, 51096 Reims, France
| | - Claire Mayer
- BiOSSE, Biology of Organisms, Stress, Health, Environment, Institut Universitaire de Technologie, Département Génie Biologique, Le Mans Université, 53020 Laval, France
| | - Emilie Fossier
- Université de Reims Champagne-Ardenne, BioSpecT EA 7506, UFR de Pharmacie, 51096 Reims, France
| | - Stéphane Jaisson
- Université de Reims Champagne-Ardenne, MEDyC CNRS UMR 7369, UFR de Médecine, 51097 Reims, France; Centre Hospitalo-Universitaire, Service de Biochimie-Pharmacologie-Toxicologie, Reims, France
| | - Anaïs Okwieka
- Université de Reims Champagne-Ardenne, MEDyC CNRS UMR 7369, UFR de Médecine, 51097 Reims, France
| | - Philippe Gillery
- Université de Reims Champagne-Ardenne, MEDyC CNRS UMR 7369, UFR de Médecine, 51097 Reims, France; Centre Hospitalo-Universitaire, Service de Biochimie-Pharmacologie-Toxicologie, Reims, France
| | - Benoît Chenais
- BiOSSE, Biology of Organisms, Stress, Health, Environment, UFR Sciences et Techniques, Le Mans Université, 72085 Le Mans, France
| | - Virginie Mimouni
- BiOSSE, Biology of Organisms, Stress, Health, Environment, Institut Universitaire de Technologie, Département Génie Biologique, Le Mans Université, 53020 Laval, France
| | - Hamid Morjani
- Université de Reims Champagne-Ardenne, BioSpecT EA 7506, UFR de Pharmacie, 51096 Reims, France
| | - Abdelilah Beljebbar
- Université de Reims Champagne-Ardenne, BioSpecT EA 7506, UFR de Pharmacie, 51096 Reims, France.
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9
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Niemiec P, Jarosz A, Balcerzyk-Matić A, Iwanicka J, Nowak T, Iwanicki T, Gierek M, Kalita M, Garczorz W, Francuz T, Górczyńska-Kosiorz S, Kania W, Szyluk K. Genetic Variability in VEGFA Gene Influences the Effectiveness of Tennis Elbow Therapy with PRP: A Two-Year Prospective Cohort Study. Int J Mol Sci 2023; 24:17292. [PMID: 38139123 PMCID: PMC10743422 DOI: 10.3390/ijms242417292] [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: 11/14/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Vascular endothelial growth factor (VEGF) is implicated in both the etiology of tendinopathy and its healing process. Polymorphic variants of the VEGFA gene exhibit varied expression, which can influence the phenotype and treatment effectiveness. The aim of the present study was to analyze the influence of VEGFA gene variants on the effectiveness of tennis elbow therapy using platelet-rich plasma (PRP), measured through common patient-reported outcome measures (PROMs). A cohort of 107 patients (132 elbows) with tennis elbow was prospectively analyzed, with a two-year follow-up (at weeks 2, 4, 8, 12, 24, 52, and 104 after PRP injection). PROMs values were compared between variants of five VEGFA gene polymorphisms (rs699947 A>C, rs2010963 C>G, rs1413711 C>T, rs3024998 C>T and rs3025021 C>T) at each follow-up point. Patients with genotypes GG (rs2010963) and CC (rs3024998) had better response to PRP therapy (significantly fewer symptoms and limitations in the upper limb compared to carriers of alleles C and T, respectively). Polymorphisms influenced also selected hematological parameters. VEGFA gene polymorphisms (rs2010963 and rs3024998) appear to be significant treatment modifiers for tendinopathy, and their genotyping may serve as an effective tool for personalized patient selection for PRP therapy.
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Affiliation(s)
- Paweł Niemiec
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, the Medical University of Silesia in Katowice, Medyków 18 Str., 40-752 Katowice, Poland; (P.N.); (A.B.-M.); (J.I.); (T.N.); (T.I.)
| | - Alicja Jarosz
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, the Medical University of Silesia in Katowice, Medyków 18 Str., 40-752 Katowice, Poland; (P.N.); (A.B.-M.); (J.I.); (T.N.); (T.I.)
| | - Anna Balcerzyk-Matić
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, the Medical University of Silesia in Katowice, Medyków 18 Str., 40-752 Katowice, Poland; (P.N.); (A.B.-M.); (J.I.); (T.N.); (T.I.)
| | - Joanna Iwanicka
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, the Medical University of Silesia in Katowice, Medyków 18 Str., 40-752 Katowice, Poland; (P.N.); (A.B.-M.); (J.I.); (T.N.); (T.I.)
| | - Tomasz Nowak
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, the Medical University of Silesia in Katowice, Medyków 18 Str., 40-752 Katowice, Poland; (P.N.); (A.B.-M.); (J.I.); (T.N.); (T.I.)
| | - Tomasz Iwanicki
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, the Medical University of Silesia in Katowice, Medyków 18 Str., 40-752 Katowice, Poland; (P.N.); (A.B.-M.); (J.I.); (T.N.); (T.I.)
| | - Marcin Gierek
- Center for Burns Treatment, Jana Pawła II Str., 41-100 Siemianowice Śląskie, Poland;
| | - Marcin Kalita
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 Str., 41-940 Piekary Śląskie, Poland; (M.K.); (K.S.)
| | - Wojciech Garczorz
- Department of Biochemistry, School of Medicine in Katowice, Medical University of Silesia in Katowice, Medyków 18 Str., 40-752 Katowice, Poland; (W.G.); (T.F.)
| | - Tomasz Francuz
- Department of Biochemistry, School of Medicine in Katowice, Medical University of Silesia in Katowice, Medyków 18 Str., 40-752 Katowice, Poland; (W.G.); (T.F.)
| | - Sylwia Górczyńska-Kosiorz
- Department of Internal Medicine, Diabetology and Nephrology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland;
| | - Wojciech Kania
- Department of Trauma and Orthopedic Surgery, Multidisciplinary Hospital in Jaworzno, Chełmońskiego 28 Str., 43-600 Jaworzno, Poland;
| | - Karol Szyluk
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 Str., 41-940 Piekary Śląskie, Poland; (M.K.); (K.S.)
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medyków 12 Str., 40-752 Katowice, Poland
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10
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Xu K, Zhang L, Wang T, Ren Z, Yu T, Zhang Y, Zhao X. Untargeted metabolomics reveals dynamic changes in metabolic profiles of rat supraspinatus tendon at three different time points after diabetes induction. Front Endocrinol (Lausanne) 2023; 14:1292103. [PMID: 38053726 PMCID: PMC10694349 DOI: 10.3389/fendo.2023.1292103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/01/2023] [Indexed: 12/07/2023] Open
Abstract
Objective To investigate the dynamic changes of metabolite composition in rat supraspinatus tendons at different stages of diabetes by untargeted metabolomics analysis. Methods A total of 80 Sprague-Dawley rats were randomly divided into normal (NG, n = 20) and type 2 diabetes mellitus groups (T2DM, n = 60) and subdivided into three groups according to the duration of diabetes: T2DM-4w, T2DM-12w, and T2DM-24w groups; the duration was calculated from the time point of T2DM rat model establishment. The three comparison groups were set up in this study, T2DM-4w group vs. NG, T2DM-12w group vs. T2DM-4w group, and T2DM-24w group vs. T2DM-12w group. The metabolite profiles of supraspinatus tendon were obtained using tandem mass spectrometry. Metabolomics multivariate statistics were used for metabolic data analysis and differential metabolite (DEM) determination. The intersection of the three comparison groups' DEMs was defined as key metabolites that changed consistently in the supraspinatus tendon after diabetes induction; then, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was performed. Results T2DM-4w group vs. NG, T2DM-12w group vs. T2DM-4w group, and T2DM-24w group vs. T2DM-12w group detected 94 (86 up-regulated and 8 down-regulated), 36 (13 up-regulated and 23 down-regulated) and 86 (24 up-regulated and 62 down-regulated) DEMs, respectively. Seven key metabolites of sustained changes in the supraspinatus tendon following induction of diabetes include D-Lactic acid, xanthine, O-acetyl-L-carnitine, isoleucylproline, propoxycarbazone, uric acid, and cytidine, which are the first identified biomarkers of the supraspinatus tendon as it progresses through the course of diabetes. The results of KEGG pathway enrichment analysis showed that the main pathway of supraspinatus metabolism affected by diabetes (p < 0.05) was purine metabolism. The results of the KEGG metabolic pathway vs. DEMs correlation network graph revealed that uric acid and xanthine play a role in more metabolic pathways. Conclusion Untargeted metabolomics revealed the dynamic changes of metabolite composition in rat supraspinatus tendons at different stages of diabetes, and the newly discovered seven metabolites, especially uric acid and xanthine, may provide novel research to elucidate the mechanism of diabetes-induced tendinopathy.
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Affiliation(s)
- Kuishuai Xu
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Liang Zhang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tianrui Wang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhongkai Ren
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tengbo Yu
- Department of Sports Medicine, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Yingze Zhang
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xia Zhao
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
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11
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Rodrigues da Silva Barros B, Dal’Ava Augusto D, de Medeiros Neto JF, Michener LA, Silva RS, Sousa CDO. Isometric versus isotonic exercise in individuals with rotator cuff tendinopathy-Effects on shoulder pain, functioning, muscle strength, and electromyographic activity: A protocol for randomized clinical trial. PLoS One 2023; 18:e0293457. [PMID: 37956135 PMCID: PMC10642785 DOI: 10.1371/journal.pone.0293457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/08/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Rotator cuff tendinopathy is a common shoulder disorder in which the primary treatment is resistance exercises. Isometric exercises are being studied for lower limb tendinopathies but not for rotator cuff tendinopathy. This protocol for a randomized clinical trial aims to compare the effects of two types of exercise (isometric and isotonic) on shoulder pain, functioning, muscle strength, and electromyographic activity in individuals with rotator cuff tendinopathy. METHODS Forty-six individuals (18 to 60 years old) with shoulder pain for more than three months and unilateral supraspinatus and/or infraspinatus tendinopathy will participate in this trial. Individuals will be randomized into two exercise groups: isometric or isotonic. The following outcomes will be evaluated before and after the first session and after six weeks of intervention: shoulder pain and functioning; isometric strength of shoulder elevation and lateral and medial rotation; and electromyographic activity of medial deltoid, infraspinatus, serratus anterior, and lower trapezius. Groups will perform stretching and strengthening of periscapular muscles. The isometric group will perform three sets of 32 s, at 70% of maximal isometric strength. The isotonic group will perform concentric and eccentric exercises (2 s for each phase) in three sets of eight repetitions at a load of eight repetition maximum. The total time under tension of 96 s will be equal for both groups, and load will be adjusted in weeks three and five of the protocol. Treatment effect between groups will be analyzed using linear mixed model. TRIAL REGISTRATION Trial registration number: Universal Trial Number (UTN) code U1111-1284-7528 and Brazilian Clinical Trials Registry platform-RBR-3pvdvfk.
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Affiliation(s)
- Bianca Rodrigues da Silva Barros
- Department of Physical Therapy, Postgraduate Program of Physical Therapy, Federal University of Rio Grande do Norte, Natal, State of Rio Grande do Norte, Brazil
| | - Denise Dal’Ava Augusto
- Department of Physical Therapy, Postgraduate Program of Physical Therapy, Federal University of Rio Grande do Norte, Natal, State of Rio Grande do Norte, Brazil
| | | | - Lori Ann Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, United States of America
| | - Rodrigo Scattone Silva
- Faculty of Health Sciences of Trairi, Postgraduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte, Santa Cruz, State of Rio Grande do Norte, Brazil
| | - Catarina de Oliveira Sousa
- Department of Physical Therapy, Postgraduate Program of Physical Therapy, Federal University of Rio Grande do Norte, Natal, State of Rio Grande do Norte, Brazil
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12
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Kwan KYC, Ng KWK, Rao Y, Zhu C, Qi S, Tuan RS, Ker DFE, Wang DM. Effect of Aging on Tendon Biology, Biomechanics and Implications for Treatment Approaches. Int J Mol Sci 2023; 24:15183. [PMID: 37894875 PMCID: PMC10607611 DOI: 10.3390/ijms242015183] [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: 08/01/2023] [Revised: 09/07/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
Tendon aging is associated with an increasing prevalence of tendon injuries and/or chronic tendon diseases, such as tendinopathy, which affects approximately 25% of the adult population. Aged tendons are often characterized by a reduction in the number and functionality of tendon stem/progenitor cells (TSPCs), fragmented or disorganized collagen bundles, and an increased deposition of glycosaminoglycans (GAGs), leading to pain, inflammation, and impaired mobility. Although the exact pathology is unknown, overuse and microtrauma from aging are thought to be major causative factors. Due to the hypovascular and hypocellular nature of the tendon microenvironment, healing of aged tendons and related injuries is difficult using current pain/inflammation and surgical management techniques. Therefore, there is a need for novel therapies, specifically cellular therapy such as cell rejuvenation, due to the decreased regenerative capacity during aging. To augment the therapeutic strategies for treating tendon-aging-associated diseases and injuries, a comprehensive understanding of tendon aging pathology is needed. This review summarizes age-related tendon changes, including cell behaviors, extracellular matrix (ECM) composition, biomechanical properties and healing capacity. Additionally, the impact of conventional treatments (diet, exercise, and surgery) is discussed, and recent advanced strategies (cell rejuvenation) are highlighted to address aged tendon healing. This review underscores the molecular and cellular linkages between aged tendon biomechanical properties and the healing response, and provides an overview of current and novel strategies for treating aged tendons. Understanding the underlying rationale for future basic and translational studies of tendon aging is crucial to the development of advanced therapeutics for tendon regeneration.
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Affiliation(s)
- Ka Yu Carissa Kwan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Wai Kerry Ng
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ying Rao
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chenxian Zhu
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shengcai Qi
- Department of Prosthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai 200040, China;
| | - Rocky S. Tuan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dai Fei Elmer Ker
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dan Michelle Wang
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (K.Y.C.K.); (K.W.K.N.); (Y.R.); (C.Z.); (R.S.T.); (D.F.E.K.)
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Neuromusculoskeletal Restorative Medicine, Hong Kong Science Park, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Ministry of Education Key Laboratory for Regenerative Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
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Zhou M, Archibeck ES, Feteih Y, Abubakr Y, O'Connell GD. Non-enzymatic glycation increases the failure risk of annulus fibrosus by predisposing the extrafibrillar matrix to greater stresses. Acta Biomater 2023; 168:223-234. [PMID: 37433360 DOI: 10.1016/j.actbio.2023.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/13/2023] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Abstract
Growing clinical evidence suggests a correlation between diabetes and more frequent and severe intervertebral disc failure, partially attributed to accelerated advanced glycation end-products (AGE) accumulation in the annulus fibrosus (AF) through non-enzymatic glycation. However, in vitro glycation (i.e., crosslinking) reportedly improved AF uniaxial tensile mechanical properties, contradicting clinical observations. Thus, this study used a combined experimental-computational approach to evaluate the effect of AGEs on anisotropic AF tensile mechanics, applying finite element models (FEMs) to complement experimental testing and examine difficult-to-measure subtissue-level mechanics. Methylglyoxal-based treatments were applied to induce three physiologically relevant AGE levels in vitro. Models incorporated crosslinks by adapting our previously validated structure-based FEM framework. Experimental results showed that a threefold increase in AGE content resulted in a ∼55% increase in AF circumferential-radial tensile modulus and failure stress and a 40% increase in radial failure stress. Failure strain was unaffected by non-enzymatic glycation. Adapted FEMs accurately predicted experimental AF mechanics with glycation. Model predictions showed that glycation increased stresses in the extrafibrillar matrix under physiologic deformations, which may increase tissue mechanical failure or trigger catabolic remodeling, providing insight into the relationship between AGE accumulation and increased tissue failure. Our findings also added to the existing literature regarding crosslinking structures, indicating that AGEs had a greater effect along the fiber direction, while interlamellar radial crosslinks were improbable in the AF. In summary, the combined approach presented a powerful tool for examining multiscale structure-function relationships with disease progression in fiber-reinforced soft tissues, which is essential for developing effective therapeutic measures. STATEMENT OF SIGNIFICANCE: Increasing clinical evidence correlates diabetes with premature intervertebral disc failure, likely due to advanced glycation end-products (AGE) accumulation in the annulus fibrosus (AF). However, in vitro glycation reportedly increases AF tensile stiffness and toughness, contradicting clinical observations. Using a combined experimental-computational approach, our work shows that increases in AF bulk tensile mechanical properties with glycation are achieved at the risk of exposing the extrafibrillar matrix to increased stresses under physiologic deformations, which may increase tissue mechanical failure or trigger catabolic remodeling. Computational results indicate that crosslinks along the fiber direction account for 90% of the increased tissue stiffness with glycation, adding to the existing literature. These findings provide insight into the multiscale structure-function relationship between AGE accumulation and tissue failure.
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Affiliation(s)
- Minhao Zhou
- Department of Mechanical Engineering, University of California, Berkeley, 2162 Etcheverry Hall, #1740, Berkeley, CA 94720-1740, USA
| | - Erin S Archibeck
- Department of Mechanical Engineering, University of California, Berkeley, 2162 Etcheverry Hall, #1740, Berkeley, CA 94720-1740, USA
| | - Yarah Feteih
- Department of Mechanical Engineering, University of California, Berkeley, 2162 Etcheverry Hall, #1740, Berkeley, CA 94720-1740, USA
| | - Yousuf Abubakr
- Department of Mechanical Engineering, University of California, Berkeley, 2162 Etcheverry Hall, #1740, Berkeley, CA 94720-1740, USA
| | - Grace D O'Connell
- Department of Mechanical Engineering, University of California, Berkeley, 5122 Etcheverry Hall, #1740, Berkeley, CA 94720-1740, USA; Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, USA.
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14
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Luo J, Wang Z, Tang C, Yin Z, Huang J, Ruan D, Fei Y, Wang C, Mo X, Li J, Zhang J, Fang C, Li J, Chen X, Shen W. Animal model for tendinopathy. J Orthop Translat 2023; 42:43-56. [PMID: 37637777 PMCID: PMC10450357 DOI: 10.1016/j.jot.2023.06.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/18/2023] [Accepted: 06/30/2023] [Indexed: 08/29/2023] Open
Abstract
Background Tendinopathy is a common motor system disease that leads to pain and reduced function. Despite its prevalence, our mechanistic understanding is incomplete, leading to limited efficacy of treatment options. Animal models contribute significantly to our understanding of tendinopathy and some therapeutic options. However, the inadequacies of animal models are also evident, largely due to differences in anatomical structure and the complexity of human tendinopathy. Different animal models reproduce different aspects of human tendinopathy and are therefore suitable for different scenarios. This review aims to summarize the existing animal models of tendinopathy and to determine the situations in which each model is appropriate for use, including exploring disease mechanisms and evaluating therapeutic effects. Methods We reviewed relevant literature in the PubMed database from January 2000 to December 2022 using the specific terms ((tendinopathy) OR (tendinitis)) AND (model) AND ((mice) OR (rat) OR (rabbit) OR (lapin) OR (dog) OR (canine) OR (sheep) OR (goat) OR (horse) OR (equine) OR (pig) OR (swine) OR (primate)). This review summarized different methods for establishing animal models of tendinopathy and classified them according to the pathogenesis they simulate. We then discussed the advantages and disadvantages of each model, and based on this, identified the situations in which each model was suitable for application. Results For studies that aim to study the pathophysiology of tendinopathy, naturally occurring models, treadmill models, subacromial impingement models and metabolic models are ideal. They are closest to the natural process of tendinopathy in humans. For studies that aim to evaluate the efficacy of possible treatments, the selection should be made according to the pathogenesis simulated by the modeling method. Existing tendinopathy models can be classified into six types according to the pathogenesis they simulate: extracellular matrix synthesis-decomposition imbalance, inflammation, oxidative stress, metabolic disorder, traumatism and mechanical load. Conclusions The critical factor affecting the translational value of research results is whether the selected model is matched with the research purpose. There is no single optimal model for inducing tendinopathy, and researchers must select the model that is most appropriate for the study they are conducting. The translational potential of this article The critical factor affecting the translational value of research results is whether the animal model used is compatible with the research purpose. This paper provides a rationale and practical guide for the establishment and selection of animal models of tendinopathy, which is helpful to improve the clinical transformation ability of existing models and develop new models.
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Affiliation(s)
- Junchao Luo
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Zetao Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Chenqi Tang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Binjiang Institute of Zhejiang University, Hangzhou, Zhejiang, China
| | - Zi Yin
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Jiayun Huang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Dengfeng Ruan
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Yang Fei
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Canlong Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Xianan Mo
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Jiajin Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
| | - Jun Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Department of Orthopedics, Longquan People's Hospital, Zhejiang, 323799, China
| | - Cailian Fang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
| | - Jianyou Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Zhejiang University Huzhou Hospital, 313000, Huzhou, Zhejiang, China
| | - Xiao Chen
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Weiliang Shen
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
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15
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Escriche-Escuder A, Nijs J, Silbernagel KG, van Wilgen CP, Plinsinga ML, Casaña J, Cuesta-Vargas AI. Pain neuroscience education in persistent painful tendinopathies: A scoping review from the Tendon PNE Network. Phys Ther Sport 2023; 63:38-49. [PMID: 37499463 DOI: 10.1016/j.ptsp.2023.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE to conduct and report a scoping review of the available evidence of the effects and content of pain neuroscience education for patients with persistent painful tendinopathies. METHODS PubMed, Embase, Web of Science, CINAHL, SPORTDiscus, and grey literature databases were searched from database inception to May 2022. Randomised and non-randomised controlled trials, non-controlled clinical trials, cohort studies, case series, case studies including people with persistent painful tendinopathy aged ≥18 years, a pain education intervention, and in English were included. Studies were excluded if they were cross-sectional studies, reviews, editorials, abstracts, or full-text not available or if included heterogeneous study cohorts, patients with tendon rupture, or patients with systemic diseases. RESULTS five studies (n = 164) were included. Pain neuroscience education entailed face-to-face discussion sessions or educational materials including videos, brochures, paper drawings, and review questions. All studies used pain neuroscience education in conjunction with other interventions, obtaining significant benefits in outcomes related to pain, physical performance, or self-reported function, among others. CONCLUSIONS The application of pain neuroscience education in conjunction with other interventions seemed to improve several outcomes. However, considering the current knowledge about tendon pain and the scarcity of well-designed trials studying pain neuroscience education in tendinopathy, additional research is needed.
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Affiliation(s)
- Adrian Escriche-Escuder
- Department of Physiotherapy, University of Malaga, Malaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium; Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - C Paul van Wilgen
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Transcare Transdisciplinary Pain Management Center, Groningen, the Netherlands
| | - Melanie L Plinsinga
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Antonio I Cuesta-Vargas
- Department of Physiotherapy, University of Malaga, Malaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain; School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
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16
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Patel SH, Carroll CC. Impact of elevated serum advanced glycation end products and exercise on intact and injured murine tendons. Connect Tissue Res 2023; 64:161-174. [PMID: 36282002 PMCID: PMC9992287 DOI: 10.1080/03008207.2022.2135508] [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: 03/08/2022] [Accepted: 10/09/2022] [Indexed: 02/03/2023]
Abstract
OVERVIEW Delayed tendon healing is a significant clinical challenge for those with diabetes. We explored the role of advanced glycation end-products (AGEs), a protein modification present at elevated levels in serum of individuals with diabetes, on injured and intact tendons using a mouse model. Cell proliferation following tissue injury is a vital component of healing. Based on our previous work demonstrating that AGEs limit cell proliferation, we proposed that AGEs are responsible for the delayed healing process commonly observed in diabetic patients. Further, in pursuit of interventional strategies, we suggested that moderate treadmill exercise may support a healing environment in the presence of AGEs as exercise has been shown to stimulate cell proliferation in tendon tissue. MATERIALS AND METHODS Mice began receiving daily intraperitoneal injections of bovine serum albumin (BSA)-Control or AGE-BSA injections (200μg/ml) at 16-weeks of age. A tendon injury was created in the central third of both patellar tendons. Animals assigned to an exercise group began a moderate treadmill protocol one week following injury. The intact Achilles tendon and soleus muscle were also evaluated to assess the effect of BSA and AGE-BSA on un-injured muscle and tendon. RESULTS We demonstrate that our injection dosing and schedule lead to an increase in serum AGEs. Our findings imply that AGEs indeed modulate gene expression following a patellar tendon injury and have modest effects on gene expression in intact muscle and tendon. CONCLUSIONS While additional biomechanical analysis is warranted, these data suggest that elevated serum AGEs in persons with diabetes may impact tendon health.
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Affiliation(s)
- Shivam H. Patel
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Chad C. Carroll
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
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17
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Manfredi JM, Jacob S, Norton E. A one-health lens offers new perspectives on the importance of endocrine disorders in the equine athlete. J Am Vet Med Assoc 2023; 261:153-164. [PMID: 36595370 DOI: 10.2460/javma.22.11.0485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Endocrine disorders are associated with joint pain and tendon injury in humans, but the effects in the horse are only starting to be understood. Similar patterns of clinical signs and injury appear to affect horses and humans for both orthopedic and endocrine disorders, supporting the use of a one-health approach to tackle these issues. In this Currents in One Health, we will discuss common equine endocrinopathies, current testing recommendations, dietary management, genetic predispositions, and endocrine disorders' effects on performance. Our aim is to use a one-health lens to describe current comparative research so that veterinarians can employ cutting-edge preventative, diagnostic, and therapeutic recommendations. Identified key gaps in knowledge include whether equine metabolic osteoarthritis exists, if steroid joint injections are safe in horses with endocrine disorders, and if the return to performance percentage improves with concurrent treatment of endocrine and musculoskeletal disorders. Key takeaways include that the relationship between endocrine disorders and musculoskeletal disease in the horse goes beyond laminitis to include lameness, muscle atrophy, suspensory ligament degeneration, osteochondritis dissecans, and potentially metabolic osteoarthritis. Approaches learned from human and equine comparative studies can offer insight into injury recognition and management, thus mitigating the impact of endocrine disorders on performance in both species. Readers interested in an in-depth description of current and future research involving pathophysiology, novel interventions, and multiomic approaches to identify individuals with athletic limitations induced by endocrine disorders are invited to read the companion Currents in One Health by Manfredi et al, AJVR, February 2023.
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Affiliation(s)
- Jane M Manfredi
- 1Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI
| | - Sarah Jacob
- 1Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI
| | - Elaine Norton
- 2Department of Animal and Comparative Biomedical Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ
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18
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Huang YT, Wu YF, Wang HK, Yao CCJ, Chiu YH, Sun JS, Chao YH. Cyclic mechanical stretch regulates the AMPK/Egr1 pathway in tenocytes via Ca2+-mediated mechanosensing. Connect Tissue Res 2022; 63:590-602. [PMID: 35229695 DOI: 10.1080/03008207.2022.2044321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Mechanical stimuli are essential for the maintenance of tendon tissue homeostasis. The study aims to elucidate the mechanobiological mechanisms underlying the maintenance of tenocyte homeostasis by cyclic mechanical stretch under high-glucose (HG) condition. MATERIALS AND METHODS Primary tenocytes were isolated from rat Achilles tendon and 2D-cultured under HG condition. The in vitro effects of a single bout, 2-h cyclic biaxial stretch session (1 Hz, 8%) on primary rat tenocytes were explored through Flexcell system. Cell viability, tenogenic gene expression, intracellular calcium concentration, focal adhesion kinase (FAK) expression, and signaling pathway activation were analyzed in tenocytes with or without mechanical stretch. RESULTS Mechanical stretch increased tenocyte proliferation and upregulated early growth response protein 1 (Egr1) expression. An increase in intracellular calcium was observed after 30 min of stretching. Mechanical stretch phosphorylated FAK, calmodulin-dependent protein kinase kinase 2 (CaMKK2), and 5' adenosine monophosphate-activated protein kinase (AMPK) in a time-dependent manner, and these effects were abrogated after blocking intracellular calcium. Inhibition of FAK, CaMKK2, and AMPK downregulated the expression of Egr1. In addition, mechanical stretch reinforced cytoskeletal organization via calcium (Ca2+)/FAK signaling. CONCLUSIONS Our study demonstrated that mechanical stretch-induced calcium influx activated CaMKK2/AMPK signaling and FAK-cytoskeleton reorganization, thereby promoting the expression of Egr1, which may help maintain tendon cell characteristics and homeostasis in the context of diabetic tendinopathy.
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Affiliation(s)
- Yu-Ting Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Fu Wu
- Department of Kinesiology and Community Health, College of Applied Health Science, University of Illinois Urbana-Champaign, Illinois, USA
| | - Hsing-Kuo Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Chen Jane Yao
- Graduate Institute of Clinical Dentistry and Department of Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan.,Dental Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Heng Chiu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jui-Sheng Sun
- Department of Orthopedics, School of Medicine, China Medical University, Tai-Chung, Taiwan
| | - Yuan-Hung Chao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
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19
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Habechian FAP, Flores Quezada ME, Cools AM, Kjaer BH, Cuevas Cid RI, Zanca GG. Shoulder-specific rehabilitation combined with aerobic exercises versus solely shoulder-specific rehabilitation in patients with type 2 diabetes mellitus: study protocol for a randomized controlled superiority trial. Trials 2022; 23:678. [PMID: 35978380 PMCID: PMC9387007 DOI: 10.1186/s13063-022-06647-5] [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: 11/22/2021] [Accepted: 08/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background Musculoskeletal disorders are very common in patients with diabetes mellitus (DM). The upper limb is one of the regions that is most frequently affected generally presenting limited joint mobility, pain, and a decreased muscle strength. Most clinical trials with a focus on shoulder musculoskeletal rehabilitation are carried out in patients who do not present DM. Thus, the purpose of the present study is to compare the effects of two distinct treatment protocols (conventional shoulder musculoskeletal rehabilitation combined with aerobic exercises versus solely conventional shoulder musculoskeletal rehabilitation) on shoulder pain, function, strength, kinematics, and supraspinatus tendon thickness in patients with type 2 DM after 12 weeks of intervention and a subsequent follow-up at week 20. Methods A randomized controlled superiority trial will be conducted. Participants with a clinical diagnosis of type 2 DM of both sexes, age between 40 and 70 years, presenting shoulder pain will be randomly assigned to one of the following groups: (1) conventional shoulder musculoskeletal rehabilitation combined with aerobic exercises; (2) solely conventional shoulder musculoskeletal rehabilitation. All individuals will be evaluated before starting the treatment protocol (baseline) and at the end of treatment (post 12 weeks) and as a follow-up at 20 weeks. The shoulder function assessed by the SPADI (Shoulder Pain and Disability Index) questionnaire will be considered as primary outcome; the secondary outcome will be shoulder pain, measured with NPRS scales. Other outcomes will include range of motion, measured using a digital inclinometer; isometric shoulder muscle strength, measured using a manual muscle dynamometer; shoulder kinematics, measured using three-dimensional inertial units measurement; supraspinatus tendon thickness, measured using an ultrasound; AGE accumulation, using a skin autofluorescence measurement; and HbA1c (hemoglobin a1c), fasting glucose and lipid profile measured by a simple blood test. Discussion DM is a highly prevalent disease and a public health problem worldwide, and the upper extremity musculoskeletal disorders in DM are barely recognized and largely underestimated. In this way, it would be interesting to analyze if the combination of aerobic exercises with conventional musculoskeletal rehabilitation protocols could generate better results in the functionality, pain, mobility and an improvement in the biochemical aspects related to the hyperglycemia of these patients compared to solely the conventional musculoskeletal rehabilitation. Trial registration ClinicalTrials.gov NCT04817514. Registered on March 26, 2021.
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Affiliation(s)
- Fernanda A P Habechian
- Laboratory of Clinical Research in Kinesiology, Department of Kinesiology, Universidad Católica del Maule, Casa Central: Avda. San Miguel, 3605, Talca, Chile.
| | - Mauricio E Flores Quezada
- Laboratory of Clinical Research in Kinesiology, Department of Kinesiology, Universidad Católica del Maule, Casa Central: Avda. San Miguel, 3605, Talca, Chile
| | - Ann M Cools
- Faculty Medicine and Health Sciences, Department of Rehabilitation Science and Physiotherapy, Ghent University, Campus Heymans (UZ Ghent), Building B3 - Second floor, De Pintelaan 185, 9000, Ghent, Belgium
| | - Birgitte Hougs Kjaer
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg University Hospitals, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark
| | - Rodrigo I Cuevas Cid
- Laboratory of Clinical Research in Kinesiology, Department of Kinesiology, Universidad Católica del Maule, Casa Central: Avda. San Miguel, 3605, Talca, Chile
| | - Gisele G Zanca
- Postgraduate Program in Aging Sciences and Postgraduate Program in Physical Education, São Judas Tadeu University, Rua Taquari, 546. Mooca, São Paulo, 03166-000, Brazil
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20
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Chang R, Tu TY, Hung YM, Huang JY, Chou MC, Wei JCC. Metformin use is associated with a lower risk of rotator cuff disease in patients with type 2 diabetes mellitus. DIABETES & METABOLISM 2022; 48:101368. [PMID: 35760373 DOI: 10.1016/j.diabet.2022.101368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022]
Abstract
AIMS - Metformin has been mentioned to be protective against inflammation, degeneration, and oxidative stress, conditions that are associated with rotator cuff disease. To access the association between metformin use and risk of rotator cuff disease in patients with type 2 diabetes mellitus (DM). METHODS - This was a retrospective cohort study utilizing Taiwan National Health Insurance Research Database between January 1, 2000, and December 31, 2012 to retrieved participants. Metformin and propensity score matched never metformin users were determined at baseline (between the date of onset of DM and the index date), and followed to December 31, 2013. Propensity scores were adopted to address measurable confounders (including demographic variables, Diabetes Complications Severity Index, and relevant comorbidities and co-medication). A multivariable Cox proportional hazards regression model was applied to estimate the adjusted hazard ratios (HRs) for the risk of the first diagnosis of rotator cuff disease on the full cohort and on the propensity score matched cohort. RESULTS - In the propensity score matched cohort, a total of 34,964 individuals (19,416 [55.5%] men), 17,482 individuals were taking metformin, 559 [3.2%] of whom developed rotator cuff disease. Incidence of rotator cuff disease was 4.51 per 10,000 person-months in the metformin users and 5.11 in the controls. Among metformin group, the aHR (95% CI) was 0.879 (0.784-0.984) after full adjustment. The potential beneficial effect on the risk of rotator cuff disease was consistently observed across all subgroups, including sex, age, concomitant other glucose lowering drugs, and level of Diabetes Complications Severity Index (all P for interaction > 0.050). CONCLUSION - Metformin use was associated with a lower risk of rotator cuff disease in patients with type 2 DM.
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Affiliation(s)
- Renin Chang
- Department of Recreation and Sports Management, Tajen University, Pingtung, Taiwan; Department of Emergency, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| | - Ting-Yu Tu
- Department of Orthopedic, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| | - Yao-Min Hung
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; College of Health and Nursing, Meiho University, Pingtung, Taiwan.
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Research, Chung Shan Medical University Hospital, Taichung City, Taiwan.
| | - Mei-Chia Chou
- Department of Recreation and Sports Management, Tajen University, Pingtung, Taiwan; Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Pingtung Branch, Pingtung, Taiwan.
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
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21
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Veronez A, Pires LA, de Aro AA, do Amaral MEC, Marretto Esquisatto MA. Effect of exercising in water on the fibrocartilage of the deep digital flexor tendon in rats with induced diabetes. Tissue Cell 2022; 76:101764. [DOI: 10.1016/j.tice.2022.101764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/19/2022] [Accepted: 02/20/2022] [Indexed: 11/29/2022]
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22
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Trivedi NN, Varshneya K, Calcei JB, Lin K, Sochaki KR, Voos JE, Safran MR, Calcei JG. Achilles Tendon Repairs: Identification of Risk Factors for and Economic Impact of Complications and Reoperation. Sports Health 2022; 15:124-130. [PMID: 35635017 PMCID: PMC9808838 DOI: 10.1177/19417381221087246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Compared with nonoperative management, Achilles tendon repair is associated with increased rates of complications and increased initial healthcare cost. However, data are currently lacking on the risk factors for these complications and the added healthcare cost associated with common preoperative comorbidities. HYPOTHESIS Identify the independent risk factors for complications and reoperation after acute Achilles tendon repair and calculate the added cost of care associated with having each preoperative risk factor. STUDY DESIGN Retrospective cohort study. LEVEL OF EVIDENCE Level 3. METHODS A retrospective review of a large commercial claims database was performed to identify patients who underwent primary operative management for Achilles tendon rupture between 2007 and 2016. The primary outcome measures of the study were risk factors for (1) postoperative complications, (2) revision surgery, and (3) increased healthcare resource utilization. RESULTS A total of 50,279 patients were included. The overall complication rate was 2.7%. The most common 30-day complication was venous thromboembolism (1.2%). The rate of revision surgery was 2.5% at 30 days and 4.3% at 2 years. Independent risk factors for 30-day complications in our cohort included increasing age, hyperlipidemia, hypertension, female sex, obesity, and diabetes. Independent risk factors for revision surgery within 2 years included female sex, tobacco use, hypertension, obesity, and the presence of any postoperative complication. The average 5-year cost of operative intervention was $17,307. The need for revision surgery had the largest effect on 5-year overall cost, increasing it by $6776.40. This was followed by the presence of a postoperative complication ($3780), female sex ($3207.70), and diabetes ($3105). CONCLUSION Achilles tendon repair is a relatively low-risk operation. Factors associated with postoperative complications include increasing age, hyperlipidemia, hypertension, female sex, obesity, and diabetes. Factors associated with the need for revision surgery include female sex, hypertension, obesity, and the presence of any postoperative complication. Female sex, diabetes, the presence of any complication, and the need for revision surgery had the largest added costs associated with them. CLINICAL RELEVANCE Surgeons can use this information for preoperative decision-making and during the informed consent process.
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Affiliation(s)
| | | | | | | | | | | | | | - Jacob G. Calcei
- Jacob G. Calcei, MD,
Assistant Professor, Department of Orthopaedic Surgery, University Hospitals,
Cleveland Medical Center, Case Western Reserve University School of Medicine,
Cleveland, OH 44106 ()
(Twitter: @drcalcei)
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23
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Roles of Oxidative Stress in Acute Tendon Injury and Degenerative Tendinopathy-A Target for Intervention. Int J Mol Sci 2022; 23:ijms23073571. [PMID: 35408931 PMCID: PMC8998577 DOI: 10.3390/ijms23073571] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 02/06/2023] Open
Abstract
Both acute and chronic tendon injuries are disabling sports medicine problems with no effective treatment at present. Sustained oxidative stress has been suggested as the major factor contributing to fibrosis and adhesion after acute tendon injury as well as pathological changes of degenerative tendinopathy. Numerous in vitro and in vivo studies have shown that the inhibition of oxidative stress can promote the tenogenic differentiation of tendon stem/progenitor cells, reduce tissue fibrosis and augment tendon repair. This review aims to systematically review the literature and summarize the clinical and pre-clinical evidence about the potential relationship of oxidative stress and tendon disorders. The literature in PubMed was searched using appropriate keywords. A total of 81 original pre-clinical and clinical articles directly related to the effects of oxidative stress and the activators or inhibitors of oxidative stress on the tendon were reviewed and included in this review article. The potential sources and mechanisms of oxidative stress in these debilitating tendon disorders is summarized. The anti-oxidative therapies that have been examined in the clinical and pre-clinical settings to reduce tendon fibrosis and adhesion or promote healing in tendinopathy are reviewed. The future research direction is also discussed.
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24
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Pansiere ST, Oliveira ACD, Pochini ADC, Ejnisman B, Belangero PS, Andreoli CV. Lesão do manguito rotador e obesidade: Uma avaliação demográfica e metabólica. Rev Bras Ortop 2022; 57:282-288. [PMID: 35652021 PMCID: PMC9142253 DOI: 10.1055/s-0041-1729937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 12/01/2020] [Indexed: 11/26/2022] Open
Abstract
Objective
To analyze the relationship between the presence and severity of rotator cuff (RC) injury with obesity and the time of exposure to obesity. Secondarily, to evaluate the relationship and prevalence of demographic and metabolic factors in obese individuals with RC injury.
Methods
This is a cross-sectional study with 235 obese patients (body mass index [BMI] ≥ 30 kg/m
2
). Demographic data (age and gender), metabolic data (hypertension, diabetes mellitus, lipid profile, and time of exposure to obesity), physical examination (weight, height, waist circumference, and clinical tests), and musculoskeletal ultrasound examination were used to analyze the results.
Results
There was no evidence of an association between RC injury and BMI (
p
= 0.82), time of exposure to obesity (
p
= 0.29), or abdominal circumference (
p
= 0.52). In the subgroup with injury, age (
p
< 0.001), presence of diabetes mellitus (
p
= 0.013), hypertension (
p
< 0.001), level of high-density lipoprotein (HDL) (
p
= 0.026), and time of exposure to obesity (
p
< 0.001) were significantly greater compared to the subgroup without injury. In the search for other parameters independently associated with RC injury, associations were observed with age (
p
= 0.0003) and hypertension (
p
= 0.004).
Conclusion
We did not evidence an association between obesity and the time of exposure to it with the occurrence and severity of RC injury. However, individuals with injury had a longer time of exposure to obesity and prevalence of metabolic disorders than individuals without RC injury. In addition, our findings suggest an association between systemic arterial hypertension (SAH) and advanced age with RC injury.
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Affiliation(s)
- Saulo Teixeira Pansiere
- Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE-HOME), Brasília, DF, Brasil
- Centro de Traumato-ortopedia do Esporte (Cete), Universidade Federal de São Paulo (Unifesp), São Paulo, Brasil
| | - Arlane Carvalho de Oliveira
- Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE-HOME), Brasília, DF, Brasil
| | - Alberto de Castro Pochini
- Centro de Traumato-ortopedia do Esporte (Cete), Universidade Federal de São Paulo (Unifesp), São Paulo, Brasil
| | - Benno Ejnisman
- Centro de Traumato-ortopedia do Esporte (Cete), Universidade Federal de São Paulo (Unifesp), São Paulo, Brasil
| | - Paulo Santoro Belangero
- Centro de Traumato-ortopedia do Esporte (Cete), Universidade Federal de São Paulo (Unifesp), São Paulo, Brasil
| | - Carlos Vicente Andreoli
- Centro de Traumato-ortopedia do Esporte (Cete), Universidade Federal de São Paulo (Unifesp), São Paulo, Brasil
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25
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Lui PPY, Yung PSH. Inflammatory mechanisms linking obesity and tendinopathy. J Orthop Translat 2022; 31:80-90. [PMID: 34976728 PMCID: PMC8666605 DOI: 10.1016/j.jot.2021.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/09/2021] [Accepted: 10/10/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic tendinopathy is a debilitating tendon disorder with disappointing treatment outcomes. This review focuses on the potential roles of chronic low-grade inflammation in promoting tendinopathy in obesity. A systematic literature search was performed to identify all clinical studies supporting the actions of obesity-associated inflammatory mediators in the development of tendinopathy. The mechanisms of obesity-induced chronic inflammation in adipose tissue are firstly reviewed. Common inflammatory mediators potentially linking obesity and the development of tendinopathy, and their association with mechanical overuse, are discussed, along with pre-clinical evidences and a systematic literature search on clinical studies. The potential contribution of local adipose tissues in the promotion of inflammation, pain and tendon degeneration is then discussed. The future research directions are proposed. Translational potential statement Better understanding of the roles of obesity-associated inflammatory mediators on tendons will clarify the pathophysiological drivers of tendinopathy in patients with obesity and identify possible treatment targets. Further studies on the mechanisms of obesity-induced chronic inflammation on tendon are a promising direction for the treatment of tendinopathy.
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Affiliation(s)
- Pauline Po Yee Lui
- Corresponding author. Room 74037, 5/F, Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, China.
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Lehner C, Spitzer G, Langthaler P, Jakubecova D, Klein B, Weissenbacher N, Wagner A, Gehwolf R, Trinka E, Iglseder B, Paulweber B, Aigner L, Couillard-Després S, Weiss R, Tempfer H, Traweger A. Allergy-induced systemic inflammation impairs tendon quality. EBioMedicine 2022; 75:103778. [PMID: 35007819 PMCID: PMC8749446 DOI: 10.1016/j.ebiom.2021.103778] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 02/04/2023] Open
Abstract
Background Treatment of degenerating tendons still presents a major challenge, since the aetiology of tendinopathies remains poorly understood. Besides mechanical overuse, further known predisposing factors include rheumatoid arthritis, diabetes, obesity or smoking all of which combine with a systemic inflammation. Methods To determine whether the systemic inflammation accompanying these conditions contributes to the onset of tendinopathy, we studied the effect of a systemic inflammation induced by an allergic episode on tendon properties. To this end, we induced an allergic response in mice by exposing them to a timothy grass pollen allergen and subsequently analysed both their flexor and Achilles tendons. Additionally, we analysed data from a health survey comprising data from more than 10.000 persons for an association between the occurrence of an allergy and tendinopathy. Findings Biomechanical testing and histological analysis revealed that tendons from allergic mice not only showed a significant reduction of both elastic modulus and tensile stress, but also alterations of the tendon matrix. Moreover, treatment of 3D tendon-like constructs with sera from allergic mice resulted in a matrix-remodelling expression profile and the expression of macrophage-associated markers and matrix metalloproteinase 2 (MMP2) was increased in allergic Achilles tendons. Data from the human health study revealed that persons suffering from an allergy have an increased propensity to develop a tendinopathy. Interpretation Our study demonstrates that the presence of a systemic inflammation accompanying an allergic condition negatively impacts on tendon structure and function. Funding This study was financially supported by the Fund for the Advancement of Scientific Research at Paracelsus Medical University (PMU-FFF E-15/22/115-LEK), by the Land Salzburg, the Salzburger Landeskliniken (SALK, the Health Care Provider of the University Hospitals Landeskrankenhaus and Christian Doppler Klinik), the Paracelsus Medical University, Salzburg and by unrestricted grants from Bayer, AstraZeneca, Sanofi-Aventis, Boehringer-Ingelheim.
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Affiliation(s)
- Christine Lehner
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - Gabriel Spitzer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Patrick Langthaler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Affiliated member of the European Reference Network EpiCARE, Austria; Department of Mathematics, Paris Lodron University of Salzburg, Salzburg, Austria; Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Dominika Jakubecova
- Institute of Experimental Neuroregeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Barbara Klein
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Nadja Weissenbacher
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andrea Wagner
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Renate Gehwolf
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Affiliated member of the European Reference Network EpiCARE, Austria; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria; Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience Salzburg, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Paulweber
- Department of Internal Medicine, St. Johanns University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Ludwig Aigner
- Austrian Cluster for Tissue Regeneration, Vienna, Austria; Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Sebastien Couillard-Després
- Austrian Cluster for Tissue Regeneration, Vienna, Austria; Institute of Experimental Neuroregeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Richard Weiss
- Department of Biosciences, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
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Stark J. Spontaneous iliopsoas tendon rupture: a case report and brief review. Arch Orthop Trauma Surg 2021; 141:1633-1637. [PMID: 32797293 DOI: 10.1007/s00402-020-03523-2] [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] [Received: 06/16/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This report aims to describe the epidemiology, clinical presentation, diagnostic workup, treatment, and rehabilitation, natural course, and possible risk factors of the rare entity spontaneous iliopsoas tendon rupture. METHODS One case of spontaneous iliopsoas tendon rupture was encountered. The patient was followed during the hospital stay, her journal was later reviewed, and one telephone follow-up after 90 days was performed. Structured reviews of the literature in the PudMed and Micromedex databases were performed. RESULTS The patient recovered fully within 6 weeks of conservative treatment with small doses of acetaminophen and opioid. The literature reviews yielded 14 previously reported spontaneous iliopsoas tendon ruptures but no strong evidence regarding possible risk factors. CONCLUSION Spontaneous iliopsoas tendon rupture is a rare event, typically occurring in the elderly female. MRI is generally diagnostic, but signs are also often present on CT scans and sometimes even on plain X-ray. Conservative treatment has an excellent prognosis of full recovery within 6 weeks. The evidence on possible risk factors is scarce and conflicting.
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Affiliation(s)
- Joachim Stark
- Department of Geriatrics, Region Jönköping County, Jönköping, Sweden. .,Department of Health, Medicine and Caring, Linköping University, Linköping, Sweden.
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28
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Shi L, Lu PP, Dai GC, Li YJ, Rui YF. Advanced glycation end productions and tendon stem/progenitor cells in pathogenesis of diabetic tendinopathy. World J Stem Cells 2021; 13:1338-1348. [PMID: 34630866 PMCID: PMC8474716 DOI: 10.4252/wjsc.v13.i9.1338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/26/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023] Open
Abstract
Tendinopathy is a challenging complication observed in patients with diabetes mellitus. Tendinopathy usually leads to chronic pain, limited joint motion, and even ruptured tendons. Imaging and histological analyses have revealed pathological changes in various tendons of patients with diabetes, including disorganized arrangement of collagen fibers, microtears, calcium nodules, and advanced glycation end product (AGE) deposition. Tendon-derived stem/ progenitor cells (TSPCs) were found to maintain hemostasis and to participate in the reversal of tendinopathy. We also discovered the aberrant osteochondrogenesis of TSPCs in vitro. However, the relationship between AGEs and TSPCs in diabetic tendinopathy and the underlying mechanism remain unclear. In this review, we summarize the current findings in this field and hypothesize that AGEs could alter the properties of tendons in patients with diabetes by regulating the proliferation and differentiation of TSPCs in vivo.
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Affiliation(s)
- Liu Shi
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Pan-Pan Lu
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Guang-Chun Dai
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Ying-Juan Li
- Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Yun-Feng Rui
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
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29
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Cannata F, Vadalà G, Ambrosio L, Napoli N, Papalia R, Denaro V, Pozzilli P. The impact of type 2 diabetes on the development of tendinopathy. Diabetes Metab Res Rev 2021; 37:e3417. [PMID: 33156563 DOI: 10.1002/dmrr.3417] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/29/2022]
Abstract
Tendinopathy is a chronic and often painful condition affecting both professional athletes and sedentary subjects. It is a multi-etiological disorder caused by the interplay among overload, ageing, smoking, obesity (OB) and type 2 diabetes (T2D). Several studies have identified a strong association between tendinopathy and T2D, with increased risk of tendon pain, rupture and worse outcomes after tendon repair in patients with T2D. Moreover, consequent immobilization due to tendon disorder has a strong impact on diabetes management by reducing physical activity and worsening the quality of life. Multiple investigations have been performed to analyse the causal role of the individual metabolic factors occurring in T2D on the development of tendinopathy. Chronic hyperglycaemia, advanced glycation end-products, OB and insulin resistance have been shown to contribute to the development of diabetic tendinopathy. This review aims to explore the relationship between tendinopathy and T2D, in order to define the contribution of metabolic factors involved in the degenerative process and to discuss possible strategies for the clinical management of diabetic tendinopathy.
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Affiliation(s)
- Francesca Cannata
- Department of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Nicola Napoli
- Department of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Paolo Pozzilli
- Department of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
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30
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Şenlikci HB, Afşar Sİ, Özen S, Sayın CB. Factors associated with hip pain in end-stage renal disease patients on prevalent hemodialysis: a cross-sectional study. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-021-00075-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hemodialysis (HD) patients suffer from musculoskeletal disorders. The most reported musculoskeletal problem is arthralgia. Hip arthralgia has been commonly reported in patients undergoing HD. Hip pain can lead to a decrease in levels of physical activity, limitation in joint range of motion, and consequently difficulties in performing activities of daily living (ADL) and impair the quality of life (QoL). The aim of the study is to reveal the prevalence of hip pain and related factors in HD patients. This cross-sectional study included 73 patients on prevalent HD whose ages ranged from 25 to 65 years and who were on HD for more than 6 months. Physical examination and radiological imaging were done to every patient. Visual analog scale, Barthel Index, and Short Form-36 were used to evaluate pain, ADL, and QoL, respectively.
Results
Hip arthralgia was detected in 32 patients. Around 43% of which were diagnosed hip osteoarthritis, 34% greater trochanteric pain syndrome, 15% femoroacetabular impingement, and 6% soft tissue calcifications. Diabetes mellitus and hemodialysis duration were found to be significantly different between the groups of hip pain and without hip pain. Diabetes mellitus was identified as an independent risk factor for hip pain in hemodialysis patients. ADL and QoL were significantly lower in patients with hip pain compared to those without (p < 0.01; p < 0.05, respectively).
Conclusions
The results of our research show that HD patients should be screened for the presence of hip pain and other musculoskeletal disorders and that this is an area which requires further consideration and medical research.
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Mukohara S, Mifune Y, Inui A, Nishimoto H, Kurosawa T, Yamaura K, Yoshikawa T, Kuroda R. In vitro and in vivo tenocyte-protective effectiveness of dehydroepiandrosterone against high glucose-induced oxidative stress. BMC Musculoskelet Disord 2021; 22:519. [PMID: 34090401 PMCID: PMC8180149 DOI: 10.1186/s12891-021-04398-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dehydroepiandrosterone (DHEA), an adrenal steroid, has a protective role against diabetes. This study aimed to investigate the in vitro and in vivo protective effects of DHEA against high glucose-induced oxidative stress in tenocytes and tendons. METHODS Tenocytes from normal Sprague-Dawley rats were cultured in low-glucose (LG) or high-glucose (HG) medium with or without DHEA. The experimental groups were: control group (LG without DHEA), LG with DHEA, HG without DHEA, and HG with DHEA. Reactive oxygen species (ROS) production, apoptosis, and messenger RNA (mRNA) expression of NADPH oxidase (NOX) 1 and 4, and interleukin-6 (IL-6) were determined. Further, diabetic rats were divided into a control group and a DHEA-injected group (DHEA group). NOX1 and NOX4 protein expression and mRNA expression of NOX1, NOX4, IL-6, matrix metalloproteinase (MMP)-2, tissue inhibitors of matrix metalloproteinase (TIMP)-2, and type I and III collagens in the Achilles tendon were determined. RESULTS In rat tenocytes, DHEA decreased the expression of NOX1 and IL-6, ROS accumulation, and apoptotic cells. In the diabetic rat Achilles tendon, NOX1 protein expression and mRNA expression of NOX1, IL-6, MMP-2, TIMP-2, and type III collagen were significantly lower while type I collagen expression was significantly higher in the DHEA group than in the control group. CONCLUSIONS DHEA showed antioxidant and anti-inflammatory effects both in vitro and in vivo. Moreover, DHEA improved tendon matrix synthesis and turnover, which are affected by hyperglycemic conditions. DHEA is a potential preventive drug for diabetic tendinopathy.
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Affiliation(s)
- Shintaro Mukohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan.
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan
| | - Hanako Nishimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan
| | - Takashi Kurosawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan
| | - Kohei Yamaura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan
| | - Tomoya Yoshikawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan
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Lu PP, Chen MH, Dai GC, Li YJ, Shi L, Rui YF. Understanding cellular and molecular mechanisms of pathogenesis of diabetic tendinopathy. World J Stem Cells 2020; 12:1255-1275. [PMID: 33312397 PMCID: PMC7705468 DOI: 10.4252/wjsc.v12.i11.1255] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/19/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023] Open
Abstract
There is accumulating evidence of an increased incidence of tendon disorders in people with diabetes mellitus. Diabetic tendinopathy is an important cause of chronic pain, restricted activity, and even tendon rupture in individuals. Tenocytes and tendon stem/progenitor cells (TSPCs) are the dominant cellular components associated with tendon homeostasis, maintenance, remodeling, and repair. Some previous studies have shown alterations in tenocytes and TSPCs in high glucose or diabetic conditions that might cause structural and functional variations in diabetic tendons and even accelerate the development and progression of diabetic tendinopathy. In this review, the biomechanical properties and histopathological changes in diabetic tendons are described. Then, the cellular and molecular alterations in both tenocytes and TSPCs are summarized, and the underlying mechanisms involved are also analyzed. A better understanding of the underlying cellular and molecular pathogenesis of diabetic tendinopathy would provide new insight for the exploration and development of effective therapeutics.
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Affiliation(s)
- Pan-Pan Lu
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Min-Hao Chen
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Guang-Chun Dai
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Ying-Juan Li
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- China Orthopedic Regenerative Medicine Group, Hangzhou 310000, Zhejiang Province, China
| | - Liu Shi
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- China Orthopedic Regenerative Medicine Group, Hangzhou 310000, Zhejiang Province, China
| | - Yun-Feng Rui
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- China Orthopedic Regenerative Medicine Group, Hangzhou 310000, Zhejiang Province, China
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Suzuki A, Yabu A, Nakamura H. Advanced glycation end products in musculoskeletal system and disorders. Methods 2020; 203:179-186. [PMID: 32987130 DOI: 10.1016/j.ymeth.2020.09.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023] Open
Abstract
The human population is ageing globally, and the number of old people is increasing yearly. Diabetes is common in the elderly, and the number of diabetic patients is also increasing. Elderly and diabetic patients often have musculoskeletal disorder, which are associated with advanced glycation end products (AGEs). AGEs are heterogeneous molecules derived from non-enzymatic products of the reaction of glucose or other sugar derivatives with proteins or lipids, and many different types of AGEs have been identified. AGEs are a biomarker for ageing and for evaluating disease conditions. Fluorescence, spectroscopy, mass spectrometry, chromatography, and immunological methods are commonly used to measure AGEs, but there is no standardized evaluation method because of the heterogeneity of AGEs. The formation of AGEs is irreversible, and they accumulate in tissue, eventually causing damage. AGE accumulation has been confirmed in neuromusculoskeletal tissues, including bones, cartilage, muscles, tendons, ligaments, and nerves, where they adversely affect biomechanical properties by causing charge changes and forming cross-linkages. AGEs also bind to receptors, such as the receptor for AGEs (RAGE), and induce inflammation by intracellular signal transduction. These mechanisms cause many varied aging and diabetes-related pathological conditions, such as osteoporosis, osteoarthritis, sarcopenia, tendinopathy, and neuropathy. Understanding of AGEs related pathomechanism may lead to develop novel methods for the prevention and therapy of such disorders which affect patients' quality of life. Herein, we critically review the current methodology used for detecting AGEs, and present potential mechanisms by which AGEs cause or exacerbate musculoskeletal disorders.
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Affiliation(s)
- Akinobu Suzuki
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Japan.
| | - Akito Yabu
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, Japan
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35
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Fernandez-Jaén T, Sanz-Zapata F, Cortés JM, Balius-Mata R, Alvarez-Rey G, Garrido-Gonzalez JI, Colmenero-Rolon C, Recio-Alvarez I, Guillen-Garcia P. Proposal for a Clinical Analysis of Patellar Tendon Pathologies: In Search of Efficient Therapeutic Indications. Orthop J Sports Med 2020; 8:2325967120946312. [PMID: 32944587 PMCID: PMC7466895 DOI: 10.1177/2325967120946312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 01/30/2023] Open
Abstract
Development and advances in our understanding of basic sciences such as anatomy, biochemistry, histology, and biomechanics have led to a better knowledge of tendon injuries. Likewise, technological advances in available therapies have conditioned the rise of new therapeutic techniques, turning both diagnosis and therapeutic indications into the foundation of treatment for patellar tendon disorders. Furthermore, we often find no correlation between patellar tendon function and structure, as studied and diagnosed from images taken and referred symptoms. This statement proposes an analytic procedure that ensures a specific therapeutic goal instead of applying a specific drug or therapeutic technique, with the aim of establishing parameters that define the kind of tendinopathy clinicians see, taking into account all conditioning factors that may affect a patellar tendinopathy. These include etiological factors, systemic illnesses affecting tendons, local mechanical causes and clinical presentation, range of clinical presentations, symptom persistence, and pain location, as well as those factors described by echography, with or without the presence of neoangiogenesis and location of the pathology, and magnetic resonance imaging. Diagnosing patellar tendinopathies requires deployment of a complex and thorough assessment process for each individual case and should include all variables that basic sciences have provided. Once a diagnosis has been made, a therapeutic strategy that includes all existing variables should be established. The more precise a diagnosis is, the more selective the treatment options become.
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Affiliation(s)
- Tomas Fernandez-Jaén
- Sports Medicine and Trauma Unit, Clínica CEMTRO, Madrid, Spain.,Sports Traumatology School, Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain
| | | | | | - Ramon Balius-Mata
- Consell Català de l'Esport, Generalitat de Catalunya, Barcelona, Spain.,Sports Medicine and Clínical Ultrasound Department, Clínica Diagonal, Barcelona, Spain
| | - Guillermo Alvarez-Rey
- AMS Medical Centre for Physical Exercise, Málaga, Spain.,Sonosurgery, Hospital Vithas, Málaga, Spain
| | | | | | | | - Pedro Guillen-Garcia
- Orthopaedic Surgery and Traumatology Service, Clínica CEMTRO, Madrid, Spain.,Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain
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36
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Dede Eren A, Sinha R, Eren ED, Huipin Y, Gulce-Iz S, Valster H, Moroni L, Foolen J, de Boer J. Decellularized Porcine Achilles Tendon Induces Anti-inflammatory Macrophage Phenotype In Vitro and Tendon Repair In Vivo. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.regen.2020.100027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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37
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Borton Z, Shivji F, Simeen S, Williams R, Tambe A, Espag M, Cresswell T, Clark D. Diabetic patients are almost twice as likely to experience complications from arthroscopic rotator cuff repair. Shoulder Elbow 2020; 12:109-113. [PMID: 32313560 PMCID: PMC7153207 DOI: 10.1177/1758573219831691] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/25/2019] [Indexed: 11/15/2022]
Abstract
AIMS Large population-based studies have demonstrated increased prevalence of rotator cuff disease amongst diabetics. Recent studies have suggested comparable clinical outcomes from rotator cuff repair despite suggestions of increased complication rates amongst diabetics. However, there is a relative paucity of studies considering the effect of diabetes upon complication rate. We aim to report and quantify the effect of diabetes on complication rates following arthroscopic rotator cuff repair. MATERIALS AND METHODS A retrospective review of a consecutive series of patients undergoing arthroscopic rotator cuff repair between January 2011 and December 2014 was performed. Diabetic status and complication data defined as infection, frozen shoulder, re-tear or re-operation were collected and interrogated. RESULTS A total of 462 patients were included at median follow-up of 5.6 years. Diabetics were significantly more likely to experience frozen shoulder (15.8% vs. 4.4%, p = 0.001), re-tear (26.3% vs. 15.6%, p = 0.042) or at least one complication following surgery (35.1% vs. 22.7%, p = 0.041) compared to non-diabetics. These equated to odds ratios of 4.03, 1.94 and 1.84, respectively. CONCLUSIONS Diabetic patients are almost twice as likely to experience complications following arthroscopic rotator cuff repair, including double the risk of repair failure and more than four times the risk of frozen shoulder.
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Affiliation(s)
- Z Borton
- Z Borton, C/o Mr D Clark, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
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Xu L, Xu K, Wu Z, Chen Z, He Y, Ma C, Moqbel SAA, Ran J, Zhang C, Wu L, Xiong Y. Pioglitazone attenuates advanced glycation end products-induced apoptosis and calcification by modulating autophagy in tendon-derived stem cells. J Cell Mol Med 2020; 24:2240-2251. [PMID: 31957239 PMCID: PMC7011144 DOI: 10.1111/jcmm.14901] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/29/2019] [Accepted: 11/22/2019] [Indexed: 12/17/2022] Open
Abstract
Diabetes mellitus (DM) is one of the prominent risk factors for pathological development and progression of tendinopathy. One feature of DM-related changes in tendinopathy is accumulation of advanced glycation end products (AGEs) in affected tendons. Pioglitazone (Pio), a peroxisome proliferator-activated receptor γ agonist, performs a protective effect against AGEs. The present study aimed to investigate the pathogenetic role of AGEs on tendon-derived stem cells (TDSCs) and to determine the effect of Pio on AGEs-induced TDSC dysfunctions. Results indicated that AGEs induced TDSC apoptosis as well as compensatory activation of autophagy. Pharmacologic activation/inhibition of autophagy leaded to alleviate/exacerbate apoptosis induced by AGEs. We further confirmed the effect of Pio on autophagy, which ameliorated apoptosis and abnormal calcification caused by AGEs both in vitro and in vivo. Thus, we suggest that Pio ameliorates the dysfunctions of TDSCs against AGEs by promoting autophagy, and we also reveal that Pio is a potential pharmacological choice for tendinopathy.
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Affiliation(s)
- Langhai Xu
- Department of Orthopedics SurgeryThe 2nd Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Kai Xu
- Department of Orthopedics SurgeryThe 2nd Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Zhipeng Wu
- Department of Orthopedics SurgeryThe 2nd Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Zhonggai Chen
- Department of Orthopedics SurgeryThe 2nd Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Yuzhe He
- Department of Orthopedics SurgeryThe 2nd Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Chiyuan Ma
- Department of Orthopedics SurgeryThe 2nd Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Safwat A. A. Moqbel
- Department of Orthopedics SurgeryThe 2nd Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Jisheng Ran
- Department of Orthopedics SurgeryThe 2nd Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Caihua Zhang
- Department of Orthopedics SurgeryThe 2nd Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Lidong Wu
- Department of Orthopedics SurgeryThe 2nd Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Yan Xiong
- Department of Orthopedics SurgeryThe 2nd Affiliated HospitalZhejiang University School of MedicineHangzhouChina
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Lui PPY, Wong CM. Biology of Tendon Stem Cells and Tendon in Aging. Front Genet 2020; 10:1338. [PMID: 32010194 PMCID: PMC6976534 DOI: 10.3389/fgene.2019.01338] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 12/09/2019] [Indexed: 12/22/2022] Open
Abstract
Both tendon injuries and tendinopathies, particularly rotator cuff tears, increase with tendon aging. Tendon stem cells play important roles in promoting tendon growth, maintenance, and repair. Aged tendons show a decline in regenerative potential coupled with a loss of stem cell function. Recent studies draw attention to aging primarily a disorder of stem cells. The micro-environment (“niche”) where stem cells resided in vivo provides signals that direct them to metabolize, self-renew, differentiate, or remain quiescent. These signals include receptors and secreted soluble factors for cell-cell communication, extracellular matrix, oxidative stress, and vascularity. Both intrinsic cellular deficits and aged niche, coupled with age-associated systemic changes of hormonal and metabolic signals can inhibit or alter the functions of tendon stem cells, resulting in reduced fitness of these primitive cells and hence more frequent injuries and poor outcomes of tendon repair. This review aims to summarize the biological changes of aged tendons. The biological changes of tendon stem cells in aging are reviewed after a systematic search of the PubMed. Relevant factors of stem cell aging including cell-intrinsic factors, changes of microenvironment, and age-associated systemic changes of hormonal and metabolic signals are examined, with findings related to tendon stem cells highlighted when literature is available. Future research directions on the aging mechanisms of tendon stem cells are discussed. Better understanding of the molecular mechanisms underlying the functional decline of aged tendon stem cells would provide insight for the rational design of rejuvenating therapies.
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Affiliation(s)
| | - Chi Ming Wong
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
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Patel SH, Yue F, Saw SK, Foguth R, Cannon JR, Shannahan JH, Kuang S, Sabbaghi A, Carroll CC. Advanced Glycation End-Products Suppress Mitochondrial Function and Proliferative Capacity of Achilles Tendon-Derived Fibroblasts. Sci Rep 2019; 9:12614. [PMID: 31471548 PMCID: PMC6717202 DOI: 10.1038/s41598-019-49062-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/16/2019] [Indexed: 02/07/2023] Open
Abstract
Debilitating cases of tendon pain and degeneration affect the majority of diabetic individuals. The high rate of tendon degeneration persists even when glucose levels are well controlled, suggesting that other mechanisms may drive tendon degeneration in diabetic patients. The purpose of this study was to investigate the impact of advanced glycation end-products on tendon fibroblasts to further our mechanistic understanding of the development and progression of diabetic tendinopathy. We proposed that advanced glycation end-products would induce limitations to mitochondrial function and proliferative capacity in tendon-derived fibroblasts, restricting their ability to maintain biosynthesis of tendon extracellular matrix. Using an in-vitro cell culture system, rat Achilles tendon fibroblasts were treated with glycolaldehyde-derived advanced glycation end-products (0, 50, 100, and 200 μg/ml) for 48 hours in normal glucose (5.5 mM) and high glucose (25 mM) conditions. We demonstrate that tendon fibroblasts treated with advanced glycation end-products display reduced ATP production, electron transport efficiency, and proliferative capacity. These impairments were coupled with alterations in mitochondrial DNA content and expression of genes associated with extracellular matrix remodeling, mitochondrial energy metabolism, and apoptosis. Our findings suggest that advanced glycation end-products disrupt tendon fibroblast homeostasis and may be involved in the development and progression of diabetic tendinopathy.
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Affiliation(s)
- Shivam H Patel
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Feng Yue
- Department of Animal Sciences, Purdue University, West Lafayette, IN, USA
| | - Shannon K Saw
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA
| | - Rachel Foguth
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
- Purdue Institute for Integrative Neuroscience, West Lafayette, IN, USA
| | - Jason R Cannon
- School of Health Sciences, Purdue University, West Lafayette, IN, USA
- Purdue Institute for Integrative Neuroscience, West Lafayette, IN, USA
| | | | - Shihuan Kuang
- Department of Animal Sciences, Purdue University, West Lafayette, IN, USA
| | - Arman Sabbaghi
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Chad C Carroll
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA.
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA.
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Tendinopathy in type 2 diabetes: a condition between specialties? Br J Gen Pract 2019; 68:593-594. [PMID: 30498162 DOI: 10.3399/bjgp18x700169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/02/2018] [Indexed: 10/31/2022] Open
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Tibialis anterior tendinosis: Clinical characterization and surgical treatment. Foot (Edinb) 2019; 39:79-84. [PMID: 30978661 DOI: 10.1016/j.foot.2019.02.006] [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: 11/22/2018] [Revised: 02/06/2019] [Accepted: 02/10/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Tibialis anterior (TA) tendinosis is rarely reported on in the literature. It is seen in patients older than 45 and causes weakness in dorsiflexion. This paper aims to describe surgical treatment and clinical outcomes. METHODS Between 2015 and 2018, nine patients (six females, three males) with severe TA tendinosis with no tear (2), partial (1), or complete (6) underwent operative treatment. Patients underwent debridement and direct repair without augmentation, direct repair with fiber tape augmentation, tibialis posterior tendon (PTT) transfer, or tibialis anterior tendon (TAT) augmentation with a tendon autograft (n=4). Autografts consisted of extensor digitalis longus (EDL) tendon, plantaris tendon, or both. RESULTS Mean postoperative follow-up was 21.3 (range 8-31) months. All patients had a concomitant gastrocnemius recession, and three had hindfoot arthrodesis. Preoperative dorsiflexion strength was 0/5 for all and improved to 5/5 postoperatively in seven. The only current smoker developed wound dehiscence 2 weeks postoperatively and healed by 4. One developed marginal skin necrosis 3 weeks postoperatively and was treated successfully with casting. CONCLUSION Surgery reestablished function in individuals with TA tendinosis and allowed high level of satisfaction. Direct repair is possible. If the tendon gap is too large an autograft of EDL and plantaris tendon can be utilized. LEVEL OF EVIDENCE Level III Retrospective Comparative Study.
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Izumi S, Otsuru S, Adachi N, Akabudike N, Enomoto-Iwamoto M. Control of glucose metabolism is important in tenogenic differentiation of progenitors derived from human injured tendons. PLoS One 2019; 14:e0213912. [PMID: 30883580 PMCID: PMC6422258 DOI: 10.1371/journal.pone.0213912] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/04/2019] [Indexed: 02/06/2023] Open
Abstract
Glucose metabolism is altered in injured and healing tendons. However, the mechanism by which the glucose metabolism is involved in the pathogenesis of tendon healing process remains unclear. Injured tendons do not completely heal, and often induce fibrous scar and chondroid lesion. Because previous studies have shown that tendon progenitors play roles in tendon repair, we asked whether connective tissue progenitors appearing in injured tendons alter glucose metabolism during tendon healing process. We isolated connective tissue progenitors from the human injured tendons, obtained at the time of primary surgical repair of rupture or laceration. We first characterized the change in glucose metabolism by metabolomics analysis using [1,2-13C]-glucose using the cells isolated from the lacerated flexor tendon. The flux of glucose to the glycolysis pathway was increased in the connective tissue progenitors when they proceeded toward tenogenic and chondrogenic differentiation. The influx of glucose to the tricarboxylic acid (TCA) cycle and biosynthesis of amino acids from the intermediates of the TCA cycle were strongly stimulated toward chondrogenic differentiation. When we treated the cultures with 2-deoxy-D-glucose (2DG), an inhibitor of glycolysis, 2DG inhibited chondrogenesis as characterized by accumulation of mucopolysaccharides and expression of AGGRECAN. Interestingly, 2DG strongly stimulated expression of tenogenic transcription factor genes, SCLERAXIS and MOHAWK under both chondrogenic and tenogenic differentiation conditions. The findings suggest that control of glucose metabolism is beneficial for tenogenic differentiation of connective tissue progenitors.
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Affiliation(s)
- Soutarou Izumi
- Department of Orthopaedics, University of Maryland, Baltimore, Baltimore, Maryland, United States of America
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Satoru Otsuru
- Department of Orthopaedics, University of Maryland, Baltimore, Baltimore, Maryland, United States of America
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
| | - Ngozi Akabudike
- Department of Orthopaedics, University of Maryland, Baltimore, Baltimore, Maryland, United States of America
- * E-mail: (MEI); (NA)
| | - Motomi Enomoto-Iwamoto
- Department of Orthopaedics, University of Maryland, Baltimore, Baltimore, Maryland, United States of America
- * E-mail: (MEI); (NA)
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Costa-Almeida R, Reis RL, Gomes ME. Metabolic Disease Epidemics: Emerging Challenges in Regenerative Medicine. Trends Endocrinol Metab 2019; 30:147-149. [PMID: 30704823 DOI: 10.1016/j.tem.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/11/2018] [Accepted: 01/03/2019] [Indexed: 12/11/2022]
Abstract
The interplay between cell/tissue damage caused by metabolic dysfunction and regenerative potential remains elusive. The tissue engineering and regenerative medicine (TERM) field is now facing a worldwide epidemic of obesity. This Forum article uncovers prospective questions to be addressed in TERM toward the development of effective regenerative therapies adjusted to these new demands.
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Affiliation(s)
- Raquel Costa-Almeida
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, 4805-017 Barco, Guimarães, Portugal
| | - Manuela E Gomes
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, 4805-017 Barco, Guimarães, Portugal.
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The increasing incidence of surgically treated quadriceps tendon ruptures. Knee Surg Sports Traumatol Arthrosc 2019; 27:3644-3649. [PMID: 30919003 PMCID: PMC6800863 DOI: 10.1007/s00167-019-05453-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/27/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Due to increased life expectancy and a more active life style of the older people, we hypothesised that the incidence of quadriceps tendon rupture (QTR) is higher than previously reported. The objective of this nationwide population-based study was to investigate the annual incidence of QTR in patients who underwent operative treatment in Finland between 1997 and 2014. METHODS The Finnish National Hospital Discharge Register was searched for all adult patients who had undergone surgical treatment for QTR during the study period. Population-based annual incidence and incidence trends for surgically treated QTR were calculated. RESULTS During the study period, 1343 QTR surgeries were performed. Of these, 90% were performed on male patients. The incidence of QTR increased by 411% from 0.55 to 2.82 per 100,000 person-years from 1997 to 2014. The average yearly increase in the number of surgeries was 9.0%. In male patients, the incidence of QTR increased by 490% and in female patients by 121%. The mean age of the male patients increased during the study period from 50 to 59 years. CONCLUSIONS Based on the data from the Finnish National Hospital Discharge Register, the annual incidence of QTR increased by over 400% during the 18-year study period. The average age of the patients also increased. Because QTR is only very rarely treated without surgery, the results of our study can be considered to be a reliable estimate of the increase in the incidence of this condition. There is an urgent need to establish the risk factors associated with QTR and to also establish the optimal surgical technique. LEVEL OF EVIDENCE IV.
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Humbyrd CJ, Bae S, Kucirka LM, Segev DL. Incidence, Risk Factors, and Treatment of Achilles Tendon Rupture in Patients With End-Stage Renal Disease. Foot Ankle Int 2018; 39:821-828. [PMID: 29582683 PMCID: PMC6023765 DOI: 10.1177/1071100718762089] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Dialysis-dependent patients and kidney transplant recipients may be at increased risk for Achilles tendon rupture (ATR). METHODS We studied Medicare patients with end-stage renal disease (ESRD) from 1999 through 2013. Patients were categorized as waitlisted for a transplant, not waitlisted, or received a transplant. We performed multivariate negative binomial regression using demographic characteristics, comorbidities, and year of study entry to estimate adjusted incidence rate ratios (aIRRs), identify ATR risk factors, and determine treatment patterns and outcomes. RESULTS We identified 1091 ATRs (incidence, 3.80/10 000 person-years; 95% confidence interval [CI], 3.58-4.03). Compared with transplant recipients, nonwaitlisted patients had a lower incidence (aIRR, 0.44; 95% CI, 0.37-0.53), and waitlisted patients had a similar incidence (aIRR, 0.94; 95% CI, 0.78-1.12) of ATR. ATR incidence was higher among patients taking fluoroquinolones (aIRR, 1.65; 95% CI, 1.32-1.84) and corticosteroids (aIRR, 1.72; 95% CI, 1.44-2.05) compared with those who did not. Patients with ATR were younger, had higher mean body mass index, and had fewer comorbidities than patients without ATR. Seventeen percent of patients received operative treatment within 14 days of ATR diagnosis. The 30-day cumulative incidence of operative site infections was 6.5%. CONCLUSION The incidence of ATR was higher among transplant recipients and waitlisted patients compared with nonwaitlisted patients. Younger age, higher body mass index, fewer comorbidities, fluoroquinolone use, and corticosteroid use were risk factors for ATR. Patients were more likely to receive nonoperative than operative treatment for ATR. Those who underwent operative treatment had a low incidence of operative site infection. LEVEL OF EVIDENCE Prognostic level III, comparative study.
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Affiliation(s)
- Casey Jo Humbyrd
- Department of Orthopaedic Surgery, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Sunjae Bae
- Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD,Department of Epidemiology, The Johns Hopkins School of Public Health, Baltimore, MD
| | - Lauren M. Kucirka
- Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD
| | - Dorry L. Segev
- Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD,Department of Epidemiology, The Johns Hopkins School of Public Health, Baltimore, MD
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