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Patron M, Neset M, Mielkozorova M, Bisson DG, Vigouroux M, Cata JP, Ingelmo PM, Ouellet JA, Haglund L, Komarova SV. Markers of Tissue Deterioration and Pain on Earth and in Space. J Pain Res 2024; 17:1683-1692. [PMID: 38742243 PMCID: PMC11089065 DOI: 10.2147/jpr.s450180] [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: 11/16/2023] [Accepted: 04/25/2024] [Indexed: 05/16/2024] Open
Abstract
Purpose Pain is an understudied physiological effect of spaceflight. Changes in inflammatory and tissue degradation markers are often associated with painful conditions. Our aim was to evaluate the changes in markers associated with tissue deterioration after a short-term spaceflight. Patients and Methods Plasma levels of markers for systemic inflammation and tissue degeneration markers were assessed in two astronauts before and within 24 h after the 17-day Axiom Space AX-1 mission. Results After the spaceflight, C-reactive protein (CRP) was reduced in both astronauts, while INFγ, GM-CSF, TNFα, BDNF, and all measured interleukins were consistently increased. Chemokines demonstrated variable changes, with consistent positive changes in CCL3, 4, 8, 22 and CXCL8, 9, 10, and consistent negative change in CCL8. Markers associated with tissue degradation and bone turnover demonstrated consistent increases in MMP1, MMP13, NTX and OPG, and consistent decreases in MMP3 and MMP9. Conclusion Spaceflight induced changes in the markers of systemic inflammation, tissue deterioration, and bone resorption in two astronauts after a short, 17-day, which were often consistent with those observed in painful conditions on Earth. However, some differences, such as a consistent decrease in CRP, were noted. All records for the effect of space travel on human health are critical for improving our understanding of the effect of this unique environment on humans.
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Affiliation(s)
- Madalina Patron
- Shriners Hospital for Children, Montreal, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Mattias Neset
- Shriners Hospital for Children, Montreal, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Mariia Mielkozorova
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Daniel G Bisson
- Shriners Hospital for Children, Montreal, Canada
- Orthopaedic Research Laboratory, Department of Surgery, McGill University, Montreal, Canada
| | - Marie Vigouroux
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada
| | - Juan Pablo Cata
- Department of Anesthesia and Perioperative Medicine, The University of Texas – MD Anderson Cancer Center, Houston, TX, USA
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Pablo M Ingelmo
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
- Research Institute, McGill University Health Center, Montreal, Canada
| | - Jean A Ouellet
- Shriners Hospital for Children, Montreal, Canada
- Orthopaedic Research Laboratory, Department of Surgery, McGill University, Montreal, Canada
| | - Lisbet Haglund
- Shriners Hospital for Children, Montreal, Canada
- Orthopaedic Research Laboratory, Department of Surgery, McGill University, Montreal, Canada
| | - Svetlana V Komarova
- Shriners Hospital for Children, Montreal, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
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Wang Q, Shao G, Zhao X, Wong HH, Chin K, Zhao M, Bai A, Bloom MS, Love ZZ, Chu CR, Cheng Z, Robinson WH. Dysregulated fibrinolysis and plasmin activation promote the pathogenesis of osteoarthritis. JCI Insight 2024; 9:e173603. [PMID: 38502232 PMCID: PMC11141881 DOI: 10.1172/jci.insight.173603] [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: 07/14/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
Joint injury is associated with risk for development of osteoarthritis (OA). Increasing evidence suggests that activation of fibrinolysis is involved in OA pathogenesis. However, the role of the fibrinolytic pathway is not well understood. Here, we showed that the fibrinolytic pathway, which includes plasminogen/plasmin, tissue plasminogen activator, urokinase plasminogen activator (uPA), and the uPA receptor (uPAR), was dysregulated in human OA joints. Pharmacological inhibition of plasmin attenuated OA progression after a destabilization of the medial meniscus in a mouse model whereas genetic deficiency of plasmin activator inhibitor, or injection of plasmin, exacerbated OA. We detected increased uptake of uPA/uPAR in mouse OA joints by microPET/CT imaging. In vitro studies identified that plasmin promotes OA development through multiple mechanisms, including the degradation of lubricin and cartilage proteoglycans and induction of inflammatory and degradative mediators. We showed that uPA and uPAR produced inflammatory and degradative mediators by activating the PI3K, 3'-phosphoinositide-dependent kinase-1, AKT, and ERK signaling cascades and activated matrix metalloproteinases to degrade proteoglycan. Together, we demonstrated that fibrinolysis contributes to the development of OA through multiple mechanisms and suggested that therapeutic targeting of the fibrinolysis pathway can prevent or slow development of OA.
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Affiliation(s)
- Qian Wang
- Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Guoqiang Shao
- Molecular Imaging Program at Stanford, Canary Center at Stanford for Cancer Early Detection
- Department of Radiology, Stanford Bio-X Program, and
| | - Xiaoyi Zhao
- Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Heidi H Wong
- Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Kate Chin
- Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Mackenzie Zhao
- Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Audrey Bai
- Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Michelle S Bloom
- Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Zelda Z Love
- Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Constance R Chu
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, California, USA
| | - Zhen Cheng
- Molecular Imaging Program at Stanford, Canary Center at Stanford for Cancer Early Detection
- Department of Radiology, Stanford Bio-X Program, and
| | - William H Robinson
- Division of Immunology & Rheumatology, Stanford School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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Neelapala YVR, Neogi T, Kumar D, Jarraya M, Macedo L, Kobsar D, Hanna S, Frey-Law LA, Lewis CE, Nevitt M, Appleton T, Birmingham T, Carlesso LC. Exploring different models of pain phenotypes and their association with pain worsening in people with early knee osteoarthritis: The MOST cohort study. Osteoarthritis Cartilage 2024; 32:210-219. [PMID: 37709187 PMCID: PMC10903761 DOI: 10.1016/j.joca.2023.09.003] [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: 06/07/2023] [Revised: 08/21/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To determine i) pain phenotypes (PP) in people with early-stage knee osteoarthritis (EKOA); ii) the longitudinal association between the phenotypes and pain worsening at two years. DESIGN We studied participants with EKOA from the Multicenter Osteoarthritis Study defined as pain intensity ≤3/10, Kellgren and Lawrence grade ≤2, intermittent pain none to sometimes, and no constant pain. Two models of PP were explored. Model A included pressure pain thresholds, temporal summation, conditioned pain modulation, pain catastrophizing, sleep quality, depression, and widespread pain (WSP). In Model B, gait characteristics, quadriceps strength, comorbidities, and magnetic resonance imaging features were added to Model A. Latent Class Analysis was used to create phenotypes, and logistic regression was used to determine their association with pain worsening. RESULTS 750 individuals (60% females), mean age [standard deviation (SD)]: 60.3 (9.4) were included in Model A and 333 individuals (60% females), mean age (SD): 59.4 (8.1) in Model B. 3-class and 4-class solutions were chosen for Model A and Model B. In Model A, the most "severe" phenotype was dominated by psychosocial factors, WSP, and measures of nervous system sensitization. Similarly in Model B, the Model A phenotype plus gait variables, quadriceps strength, and comorbidities were dominant. Surprisingly, none of the phenotypes in either model had a significant relationship with pain worsening. CONCLUSION Phenotypes based upon various factors thought to be important for the pain experience were identified in those with EKOA but were not significantly related to pain worsening. These phenotypes require validation with clinically relevant endpoints.
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Affiliation(s)
| | - Tuhina Neogi
- Department of Medicine, Chobanian & Avedisian Boston University School of Medicine, United States.
| | - Deepak Kumar
- Boston University College of Health & Rehabilitation Sciences, Sargent College, United States.
| | - Mohamed Jarraya
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, United States.
| | - Luciana Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.
| | - Dylan Kobsar
- Department of Kinesiology, McMaster University, Hamilton, Canada.
| | - Steven Hanna
- Department of Health Research Methods, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
| | - Laura A Frey-Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, United States.
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, United States.
| | - Michael Nevitt
- Epidemiology & Biostatistics, University of California San Francisco, United States.
| | - Tom Appleton
- Department of Medicine and Physiology & Pharmacology, Western University, Canada.
| | | | - Lisa C Carlesso
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.
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4
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Singh A, Venn A, Blizzard L, March L, Eckstein F, Jones G, Wirth W, Cicuttini F, Ding C, Antony B. Association between knee magnetic resonance imaging markers and knee symptoms over 6-9 years in young adults. Rheumatology (Oxford) 2024; 63:436-445. [PMID: 37202358 PMCID: PMC10836990 DOI: 10.1093/rheumatology/kead227] [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: 11/17/2022] [Revised: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVES To describe associations between MRI markers with knee symptoms in young adults. METHODS Knee symptoms were assessed using the WOMAC scale during the Childhood Determinants of Adult Health Knee Cartilage study (CDAH-knee; 2008-2010) and at the 6- to 9-year follow-up (CDAH-3; 2014-2019). Knee MRI scans obtained at baseline were assessed for morphological markers (cartilage volume, cartilage thickness, subchondral bone area) and structural abnormalities [cartilage defects and bone marrow lesions (BMLs)]. Univariable and multivariable (age, sex, BMI adjusted) zero-inflated Poisson (ZIP) regression models were used for analysis. RESULTS The participants' mean age in CDAH-knee and CDAH-3 were 34.95 (s.d. 2.72) and 43.27 (s.d. 3.28) years, with 49% and 48% females, respectively. Cross-sectionally, there was a weak but significant negative association between medial femorotibial compartment (MFTC) [ratio of the mean (RoM) 0.99971084 (95% CI 0.9995525, 0.99986921), P < 0.001], lateral femorotibial compartment (LFTC) [RoM 0.99982602 (95% CI 0.99969915, 0.9999529), P = 0.007] and patellar cartilage volume [RoM 0.99981722 (95% CI 0.99965326, 0.9999811), P = 0.029] with knee symptoms. Similarly, there was a negative association between patellar cartilage volume [RoM 0.99975523 (95% CI 0.99961427, 0.99989621), P = 0.014], MFTC cartilage thickness [RoM 0.72090775 (95% CI 0.59481806, 0.87372596), P = 0.001] and knee symptoms assessed after 6-9 years. The total bone area was negatively associated with knee symptoms at baseline [RoM 0.9210485 (95% CI 0.8939677, 0.9489496), P < 0.001] and 6-9 years [RoM 0.9588811 (95% CI 0.9313379, 0.9872388), P = 0.005]. The cartilage defects and BMLs were associated with greater knee symptoms at baseline and 6-9 years. CONCLUSION BMLs and cartilage defects were positively associated with knee symptoms, whereas cartilage volume and thickness at MFTC and total bone area were weakly and negatively associated with knee symptoms. These results suggest that the quantitative and semiquantitative MRI markers can be explored as a marker of clinical progression of OA in young adults.
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Affiliation(s)
- Ambrish Singh
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TS, Australia
| | - Alison Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TS, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TS, Australia
| | - Lyn March
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Florance and Cope Professorial Rheumatology Department, University of Sydney Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia
| | - Felix Eckstein
- Chondrometrics GmbH, Ainring, Germany
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TS, Australia
| | - Wolfgang Wirth
- Chondrometrics GmbH, Ainring, Germany
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Changhai Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TS, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TS, Australia
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5
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Xu R, Du Y, Li X, Mao X, Zheng L, Zhao M. Differences between soluble and insoluble undenatured type II collagen in improving osteoarthritis in rats and their potential mechanisms. Food Funct 2023; 14:10240-10251. [PMID: 37921641 DOI: 10.1039/d3fo02954a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Our previous research showed that soluble (SC II) and insoluble (IC II) undenatured type II collagen had significant differences during gastrointestinal digestion in vitro, and SC II exposed more type II collagen with triple helix structure. However, the differences in their in vivo digestive characteristics, improvement on osteoarthritis (OA), and possible mechanisms have not been elucidated. The aim of this study was to explore these issues. After oral administration of SC II and IC II, the joint swelling of OA rats significantly reduced, and the weight bearing ratio of right hind limb significantly increased, especially in SC II group (raised to 48%). The Mankin and OARSI scores decreased by 35% and 48% in SC II group, respectively. SC II and IC II increased the mRNA expression of anti-inflammatory factors and the proportion of regulatory T cells (Treg). Importantly, type II collagen released by IC II during in vivo gastrointestinal digestion was far less than SC II, which explained the higher ability of SC II to induce immune tolerance in small intestine than IC II. Bioinformatics analysis showed that the differential genes between model and control were significantly enriched in PI3K/AKT, PPAR and AMPK signalling pathways, and 24 hub genes were analyzed. SC II significantly down-regulated the mRNA expression of Il6, Ccl7, NF-κB, AKT and up-regulated the mRNA expression of Scd1. These results showed that SC II was superior to IC II in improving OA by inducing immune tolerance and could regulate key biomarkers and signalling pathways in OA rats.
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Affiliation(s)
- Rong Xu
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510640, China.
| | - Yulan Du
- Perfect (China) Co., Ltd, Zhongshan, 528400, China
- Perfect Life and Health Sciences Co., Ltd, 528451, China
| | - Xiaomin Li
- Perfect (China) Co., Ltd, Zhongshan, 528400, China
- Perfect Life and Health Sciences Co., Ltd, 528451, China
| | - Xinliang Mao
- Perfect (China) Co., Ltd, Zhongshan, 528400, China
- Perfect Life and Health Sciences Co., Ltd, 528451, China
| | - Lin Zheng
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510640, China.
| | - Mouming Zhao
- School of Food Science and Engineering, South China University of Technology, Guangzhou, 510640, China.
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6
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Johnson PA, Ackerman JE, Kurowska-Stolarska M, Coles M, Buckley CD, Dakin SG. Three-dimensional, in-vitro approaches for modelling soft-tissue joint diseases. THE LANCET. RHEUMATOLOGY 2023; 5:e553-e563. [PMID: 38251499 DOI: 10.1016/s2665-9913(23)00190-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 01/23/2024]
Abstract
Diseases affecting the soft tissues of the joint represent a considerable global health burden, causing pain and disability and increasing the likelihood of developing metabolic comorbidities. Current approaches to investigating the cellular basis of joint diseases, including osteoarthritis, rheumatoid arthritis, tendinopathy, and arthrofibrosis, involve well phenotyped human tissues, animal disease models, and in-vitro tissue culture models. Inherent challenges in preclinical drug discovery have driven the development of state-of-the-art, in-vitro human tissue models to rapidly advance therapeutic target discovery. The clinical potential of such models has been substantiated through successful recapitulation of the pathobiology of cancers, generating accurate predictions of patient responses to therapeutics and providing a basis for equivalent musculoskeletal models. In this Review, we discuss the requirement to develop physiologically relevant three-dimensional (3D) culture systems that could advance understanding of the cellular and molecular basis of diseases that affect the soft tissues of the joint. We discuss the practicalities and challenges associated with modelling the complex extracellular matrix of joint tissues-including cartilage, synovium, tendon, and ligament-highlighting the importance of considering the joint as a whole organ to encompass crosstalk across tissues and between diverse cell types. The design of bespoke in-vitro models for soft-tissue joint diseases has the potential to inform functional studies of the cellular and molecular mechanisms underlying disease onset, progression, and resolution. Use of these models could inform precision therapeutic targeting and advance the field towards personalised medicine for patients with common musculoskeletal diseases.
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Affiliation(s)
- Peter A Johnson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jessica E Ackerman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Mark Coles
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Christopher D Buckley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stephanie G Dakin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
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7
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Lampen N, Su H, Chan DD, Yan P. Finite element modeling with subject-specific mechanical properties to assess knee osteoarthritis initiation and progression. J Orthop Res 2023; 41:72-83. [PMID: 35438803 DOI: 10.1002/jor.25338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 03/14/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023]
Abstract
Finite element models of the knee can be used to identify regions at risk of mechanical failure in studies of osteoarthritis. Models of the knee often implement joint geometry obtained from magnetic resonance imaging (MRI) or gait kinematics from motion capture to increase model specificity for a given subject. However, differences exist in cartilage material properties regionally as well as between subjects. This paper presents a method to create subject-specific finite element models of the knee that assigns cartilage material properties from T2 relaxometry. We compared our T2 -refined model to identical models with homogeneous material properties. When tested on three subjects from the Osteoarthritis Initiative data set, we found the T2 -refined models estimated higher principal stresses and shear strains in most cartilage regions and corresponded better to increases in KL grade in follow-ups compared to their corresponding homogeneous material models. Measures of cumulative stress within regions of a T2 -refined model also correlated better with the region's cartilage morphology MRI Osteoarthritis Knee Score as compared with the homogeneous model. We conclude that spatially heterogeneous T2 -refined material properties improve the subject-specificity of finite element models compared to homogeneous material properties in osteoarthritis progression studies. Statement of Clinical Significance: T2 -refined material properties can improve subject-specific finite element model assessments of cartilage degeneration.
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Affiliation(s)
- Nathan Lampen
- Department of Biomedical Engineering, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Haoyun Su
- Department of Biomedical Engineering, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York, USA
| | - Deva D Chan
- Department of Biomedical Engineering, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York, USA.,Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Pingkun Yan
- Department of Biomedical Engineering, Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York, USA
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8
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van Berkel AC, van Spil WE, Schiphof D, Runhaar J, van Ochten JM, Bindels PJE, Bierma-Zeinstra SMA. Associations between biomarkers of matrix metabolism and inflammation with pain and fatigue in participants suspected of early hip and or knee osteoarthritis: data from the CHECK study. Osteoarthritis Cartilage 2022; 30:1640-1646. [PMID: 36115527 DOI: 10.1016/j.joca.2022.08.013] [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] [Received: 04/28/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess the associations of biomarkers in serum [highsensitivity C-reactive protein (hs-CRP), serum cartilage oligomeric protein (sCOMP), serum propeptide of type I procollagen (sPINP) and serum osteocalcin (sOC)] and urine [urinary type II collagen telopeptide (uCTX-2)] with the extent and progression of nocturnal pain, pain while walking, and fatigue in participants with hip and/or knee pain suspected to be early stage osteoarthritis (OA). METHODS hs-CRP, uCTX-2, sCOMP, sPINP and sOC were measured at baseline in 1,002 participants of the Cohort Hip and Cohort Knee (CHECK). Nocturnal pain, pain while walking and fatigue were assessed by self-reported questionnaires at baseline and 2-year follow-up. Associations between these biomarkers and symptoms were examined using logistic and linear regression analyses. RESULTS hs-CRP was significantly associated with mild nocturnal pain (OR 1.18 95% CI 1.01-1.37), with mild and moderate pain while walking (OR 1.17 95% CI 1.01-1.35 and OR 1.56 95% CI 1.29-1.90, respectively) and with progression of nocturnal pain (OR 1.25 95% CI 1.07-1.46). uCTX-2 was associated with mild nocturnal pain (OR 1.40 95% CI 1.05-1.85) and with mild and severe-extreme pain while walking (OR 1.35 95% CI 1.04-1.75 and OR 2.55 95% CI 1.03-6.34, respectively). sPINP was associated with severe-extreme nocturnal pain (OR 0.45 95% CI 0.25-0.82). No significant associations were found for sCOMP and sOC, nor for any of the biomarkers and fatigue. CONCLUSION This study of biomarkers in a large cohort of participants with hip and/or knee pain suspected to reflect early stage hip and/or knee OA suggests that inflammation and cartilage matrix degeneration play a role in pain, but not in fatigue.
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Affiliation(s)
- A C van Berkel
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - W E van Spil
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, the Netherlands; Department of Rheumatology, Dijklander Hospital, Hoorn, the Netherlands
| | - D Schiphof
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J M van Ochten
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - P J E Bindels
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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9
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Ishijima M, Nakamura T, Shimizu K, Hayashi K, Kikuchi H, Soen S, Omori G, Yamashita T, Uchio Y, Chiba J, Ideno Y, Kubota M, Kaneko H, Kurosawa H, Kaneko K. Different changes in the biomarker C-terminal telopeptides of type II collagen (CTX-II) following intra-articular injection of high molecular weight hyaluronic acid and oral non-steroidal anti-inflammatory drugs in patients with knee osteoarthritis: a multi-center randomized controlled study. Osteoarthritis Cartilage 2022; 30:852-861. [PMID: 35331859 DOI: 10.1016/j.joca.2022.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We previously reported, based on a multicenter randomized-control study, that the efficacy of intra-articular injections of hyaluronic acid (IA-HA) was not inferior to that of oral non-steroidal anti-inflammatory drugs (NSAIDs) in patients with knee osteoarthritis (OA). However, the molecular effects on the pathophysiology of knee OA remain unclear. C-terminal telopeptides of type II collagen (CTX-II) is reported to primarily originate from the interface between articular cartilage and subchondral bone, which is a site of potential remodeling in OA. We performed a predefined sub-analysis of the previous study to compare the changes of urinary CTX-II (uCTX-II) in response to IA-HA to those in response to NSAID for knee OA. DESIGN A total of 200 knee OA patients were registered from 20 hospitals and randomized to receive IA-HA (2,700 kDa HA, 5 times at 1-week intervals) or NSAID (loxoprofen sodium, 180 mg/day) for 5 weeks. The uCTX-II levels were measured before and after treatment. RESULTS The uCTX-II levels were significantly increased by IA-HA treatment (337.7 ± 193.8 to 370.7 ± 234.8 ng/μmol Cr) and were significantly reduced by NSAID treatment (423.2 ± 257.6 to 370.3 ± 250.9 ng/μmol Cr). The %changes of uCTX-II induced by IA-HA (11.6 ± 29.5%) and NSAID (-9.0 ± 26.7%) was significantly different (between-group difference: 20.6, 95% confidence intervals: 10.6 to 30.6). CONCLUSIONS While both IA-HA and NSAID improved symptoms of knee OA, uCTX-II levels were increased by IA-HA and reduced by NSAIDs treatment, suggesting these treatments may improve symptoms of knee OA through different modes of action.
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Affiliation(s)
- M Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - T Nakamura
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Fukuoka, Japan.
| | - K Shimizu
- Department of Orthopaedic Surgery, Gifu University, School of Medicine, Gifu, Japan.
| | - K Hayashi
- Department of Laboratory Sciences, School of Health Sciences, Faculty of Medicine, Gunma University, Gunma, Japan.
| | - H Kikuchi
- Department of Orthopaedic Surgery, Kinki University Sakai Hospital, Osaka, Japan.
| | - S Soen
- Department of Orthopaedic Surgery and Rheumatology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan; Department of Laboratory Sciences, School of Health Sciences, Faculty of Medicine, Gunma University, Gunma, Japan.
| | - G Omori
- Center of Transdisciplinary Research, Institute for Research Promotion, Niigata University, Niigata, Japan.
| | - T Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Hokkaido, Japan.
| | - Y Uchio
- Department of Orthopaedic Surgery, Faculty of Medicine, Shimane University School of Medicine, Shimane, Japan.
| | - J Chiba
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan.
| | - Y Ideno
- Center of Mathematics and Data Sciences, Gunma University, Maebashi, Japan.
| | - M Kubota
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - H Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - H Kurosawa
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - K Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
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10
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Papaneophytou C, Alabajos-Cea A, Viosca-Herrero E, Calvis C, Costa M, Christodoulides AE, Kroushovski A, Lapithis A, Lapithi VM, Papayiannis I, Christou A, Messeguer R, Giannaki C, Felekkis K. Associations between serum biomarkers of cartilage metabolism and serum hyaluronic acid, with risk factors, pain categories, and disease severity in knee osteoarthritis: a pilot study. BMC Musculoskelet Disord 2022; 23:195. [PMID: 35236298 PMCID: PMC8889762 DOI: 10.1186/s12891-022-05133-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Specific serum biomarkers of cartilage metabolism such as cartilage oligomeric matrix protein (sCOMP) and procollagen type II C-terminal propeptide (sPIICP) as well as hyaluronan (sHA), a biomarker of synovitis, have been implicated in the pathophysiology of knee osteoarthritis (OA). However, the associations of these biomarkers with the severity of the disease and OA risk factors, including age and obesity remain inconclusive. This analysis examines the associations between these serum biomarkers and the radiographic severity of OA and knee pain, as wells as obesity, the age and gender of the participants, and other OA risk factors. METHODS From 44 patients with early knee OA and 130 patients with late knee OA we analyzed the radiographic severity of the disease using the Kellgren and Lawrence (KL) grading system. Moreover, 38 overweight healthy individuals were used as a control group. Specific information was collected from all participants during their recruitment. The levels of the three serum biomarkers were quantified using commercially available ELISA kits. Serum biomarkers were analyzed for associations with the average KL scores and pain in both knees, as well as with specific OA risk factors. RESULTS The levels of sCOMP were elevated in patients with severe late OA and knee pain and correlated weakly with OA severity. A weakly correlation of sHA levels and OA severity OA was observed. We demonstrated that only sPIICP levels were markedly decreased in patients with late knee OA suggesting the alterations of cartilage metabolism in this arthritic disease. Moreover, we found that sPIICP has the strongest correlation with obesity and the severity of OA, as well as with the knee pain at rest and during walking regardless of the severity of the disease. ROC analysis showed that the area under the ROC curve (AUC) was 0.980 (95% CI: 0.945-0.995; p < 0.0001), suggesting high diagnostic accuracy of sPIICP. Interestingly, gender and age had also an effect on the levels of sPIICP. CONCLUSION This study revealed the potential of serum PIICP to be used as a biomarker to monitor the progression of knee OA, however, further studies are warranted to elucidate its clinical implication.
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Affiliation(s)
- Christos Papaneophytou
- Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, 2417, Nicosia, Cyprus
| | - Ana Alabajos-Cea
- Physical Medicine & Rehabilitation Department, Hospital La Fe, 46026, Valencia, Spain.,Health Research Institute La Fe, 46026, Valencia, Spain
| | | | - Carme Calvis
- Drug Development Area, Health & Biomedicine Department, LEITAT Technological Centre, Parc Científic de Barcelona, 08028, Barcelona, Spain
| | - Marta Costa
- Drug Development Area, Health & Biomedicine Department, LEITAT Technological Centre, Parc Científic de Barcelona, 08028, Barcelona, Spain
| | | | - Alexander Kroushovski
- Apollonion Hospital, 2054, Nicosia, Cyprus.,Medical School, University of Nicosia, 2408, Nicosia, Cyprus
| | | | | | | | | | - Ramon Messeguer
- Drug Development Area, Health & Biomedicine Department, LEITAT Technological Centre, Parc Científic de Barcelona, 08028, Barcelona, Spain
| | - Christoforos Giannaki
- Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, 2417, Nicosia, Cyprus.
| | - Kyriacos Felekkis
- Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, 2417, Nicosia, Cyprus.
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11
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Lampen N, Su H, Chan DD, Yan P. T 2 Mapping Refined Finite Element Modeling to Predict Knee Osteoarthritis Progression. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4592-4595. [PMID: 34892238 DOI: 10.1109/embc46164.2021.9629780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper presents a novel method for informing cartilage material properties in finite element models from T2 relaxometry. In the developed pipeline, T2 relaxation values are mapped to elements in subject-specific finite element models of the cartilage and menisci. The Young's modulus for each element within the cartilage is directly calculated from its corresponding T2 relaxation voxel value. Our model was tested on a single subject (Subject ID 9932809, Kellgren-Lawrence grade 2) from the Osteoarthritis Initiative dataset at baseline imaging. For comparison, an identical finite element model was built with homogeneous material properties. Kinematics of the stance phase of a standard gait cycle were used as model constraints. Simulation results were compared qualitatively to the MRI Osteoarthritis Knee Score (MOAKS) from the same baseline timepoint. Our T2-refined material model showed higher maximum shear strain in regions with moderate cartilage loss as compared to the homogeneous material model, and the homogeneous model showed higher maximum principal stress and maximum shear strain in regions with no cartilage loss. These results show that a homogeneous material model likely underestimates tissue strains in regions with cartilage damage while overestimating strains in regions with healthy cartilage. This preliminary study demonstrates that T2-refined material properties are more appropriate than assumptions of homogeneity in predictive models of cartilage damage.Clinical relevance- The proposed pipeline demonstrates a computationally efficient way to improve the subject-specificity of finite element models used for evaluation of osteoarthritis.
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12
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Common Biochemical and Magnetic Resonance Imaging Biomarkers of Early Knee Osteoarthritis and of Exercise/Training in Athletes: A Narrative Review. Diagnostics (Basel) 2021; 11:diagnostics11081488. [PMID: 34441422 PMCID: PMC8391340 DOI: 10.3390/diagnostics11081488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 12/24/2022] Open
Abstract
Knee osteoarthritis (OA) is the most common joint disease of the world population. Although considered a disease of old age, OA also affects young individuals and, more specifically among them, those practicing knee-joint-loading sports. Predicting OA at an early stage is crucial but remains a challenge. Biomarkers that can predict early OA development will help in the design of specific therapeutic strategies for individuals and, for athletes, to avoid adverse outcomes due to exercising/training regimens. This review summarizes and compares the current knowledge of fluid and magnetic resonance imaging (MRI) biomarkers common to early knee OA and exercise/training in athletes. A variety of fluid biochemical markers have been proposed to detect knee OA at an early stage; however, few have shown similar behavior between the two studied groups. Moreover, in endurance athletes, they are often contingent on the sport involved. MRI has also demonstrated its ability for early detection of joint structural alterations in both groups. It is currently suggested that for optimal forecasting of early knee structural alterations, both fluid and MRI biomarkers should be analyzed as a panel and/or combined, rather than individually.
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13
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Relationship between abnormalities detected by magnetic resonance imaging and knee symptoms in early knee osteoarthritis. Sci Rep 2021; 11:15179. [PMID: 34312418 PMCID: PMC8313522 DOI: 10.1038/s41598-021-94382-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/06/2021] [Indexed: 12/30/2022] Open
Abstract
We investigated the prevalence of magnetic resonance imaging (MRI) findings and their relationship with knee symptoms in women without radiographic evidence of knee osteoarthritis (KOA). This cross-sectional cohort study included 359 Japanese women without radiographic evidence of KOA (Kellgren‒Lawrence grade < 2). All participants underwent T2-weighted fat-suppressed MRI of their knees. Structural abnormalities (cartilage damage, bone marrow lesions [BMLs], subchondral cysts, bone attrition, osteophytes, meniscal lesions, and synovitis) were scored according to the whole-organ MRI score method. Knee symptoms were evaluated using the Knee Injury and Osteoarthritis Outcome Score. Participants were divided into early and non-KOA groups based on early KOA classification criteria. Logistic regression analysis was performed to evaluate the relationship between MRI abnormalities and knee symptoms. Cartilage damage was the most common abnormality (43.5%). The prevalences of cartilage damage, BMLs, subchondral cysts, bone attrition, meniscal lesions, and synovitis were higher in patients with early KOA than in those without. Synovitis (odds ratio [OR] 2.254, P = 0.002) and meniscal lesions (OR 1.479, P = 0.031) were positively associated with the presence of early KOA. Synovitis was most strongly associated with knee pain and might be a therapeutic target in patients with early KOA.
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14
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Schön C, Reule C, Knaub K, Micka A, Wilhelm M, Alt W, Menzel D. Evaluation and Validation of a Joint Stress Test to Induce Activity-Related Knee Joint Discomfort - a Prospective Case-Control Study. SPORTS MEDICINE-OPEN 2021; 7:24. [PMID: 33825065 PMCID: PMC8024428 DOI: 10.1186/s40798-021-00317-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/17/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The assessment of improvement or maintenance of joint health in healthy subjects is a great challenge. The aim of the study was the evaluation of a joint stress test to assess joint discomfort in subjects with activity-related knee joint discomfort (ArJD). RESULTS Forty-five subjects were recruited to perform the single-leg-step-down (SLSD) test (15 subjects per group). Subjects with ArJD of the knee (age 22-62 years) were compared to healthy subjects (age 24-59 years) with no knee joint discomfort during daily life sporting activity and to subjects with mild-to-moderate osteoarthritis of the knee joint (OA, Kellgren score 2-3, age 42-64 years). The subjects performed the SLSD test with two different protocols: (I) standardization for knee joint discomfort; (II) standardization for load on the knee joint. In addition, range of motion (ROM), reach test, acute pain at rest and after a single-leg squat and knee injury, and osteoarthritis outcome score (KOOS) were assessed. In OA and ArJD subjects, knee joint discomfort could be reproducibly induced in a short time interval of less than 10 min (200 steps). In healthy subjects, no pain was recorded. A clear differentiation between study groups was observed with the SLSD test (maximal step number) as well as KOOS questionnaire, ROM, and reach test. In addition, a moderate to good intra-class correlation was shown for the investigated outcomes. CONCLUSIONS These results suggest the SLSD test is a reliable tool for the assessment of knee joint health function in ArJD and OA subjects to study the improvements in their activities. Further, this model can be used as a stress model in intervention studies to study the impact of stress on knee joint health function.
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Affiliation(s)
- Christiane Schön
- BioTeSys GmbH, Schelztorstraße 54-56, 73728, Esslingen, Baden-Württemberg, Germany
| | - Claudia Reule
- BioTeSys GmbH, Schelztorstraße 54-56, 73728, Esslingen, Baden-Württemberg, Germany
| | - Katharina Knaub
- BioTeSys GmbH, Schelztorstraße 54-56, 73728, Esslingen, Baden-Württemberg, Germany.
| | - Antje Micka
- BioTeSys GmbH, Schelztorstraße 54-56, 73728, Esslingen, Baden-Württemberg, Germany
| | - Manfred Wilhelm
- Department of Mathematics, Natural and Economic Sciences, Ulm University of Applied Sciences, Albert-Einstein-Allee 55, 89081, Ulm, Baden-Württemberg, Germany
| | - Wilfried Alt
- Institute of Sports Science and Kinesiology, University of Stuttgart, Allmandring 28, 70569, Stuttgart, Baden-Württemberg, Germany
| | - Daniel Menzel
- BioTeSys GmbH, Schelztorstraße 54-56, 73728, Esslingen, Baden-Württemberg, Germany
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15
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Reduced serum levels of anti-Mullerian hormone is a putative biomarker of early knee osteoarthritis in middle-aged females at menopausal transition. Sci Rep 2021; 11:4931. [PMID: 33654174 PMCID: PMC7925604 DOI: 10.1038/s41598-021-84584-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/18/2021] [Indexed: 01/17/2023] Open
Abstract
A recent epidemiological study revealed that the highest prevalence of early knee osteoarthritis (OA) was observed in females aged ≥ 50 years. The major causal factor of early knee OA was sex. Despite the relevance of estrogen in evaluating chondral and bone metabolism in OA, it is not easily clinically monitored because irregular menstrual cycles induce unstable female hormone patterns during menopausal transitions. Anti-Mullerian hormone (AMH) has been found to be a new stable biomarker to predict menopause. This study aimed to investigate the association between menopausal transition and early knee OA by using serum biomarkers, with special focus on AMH. A total of 518 female volunteers who participated in the Iwaki cohort study were enrolled and divided into pre-menopause and post-menopause groups. Weight-bearing anterior–posterior knee radiographs were classified by Kellgren–Lawrence (KL) grade, and grade ≥ 2 was defined as radiographic knee OA. In participants with KL grades 0 and 1, early knee OA was defined by Luyten’s criteria. AMH, luteinizing hormone, follicle-stimulating hormone, estradiol (pg/ml), prolactin, and testosterone were measured on the female hormones. Bone mineral density at a distal radius was measured. The predictive power of female hormones for early knee OA was estimated by ROC analysis (comparison of area under curve, AUC) and regression analysis. Fifty-two participants (10.0%) were diagnosed with early knee OA and 204 (39.4%) with radiographic knee OA. In 393 (75.9%) females, menopause began. From the ROC analysis in pre-menopausal females, cutoff value of AMH for detecting early knee OA was 0.08 ng/ml (area under curve (AUC), 0.712; 95% CI, 0.527–0.897; p value, 0.025; odds ratio, 8.28). AUCs of other female hormones did not reach the level of AMH (range, 0.513 of prolactine to 0.636 of estradiol). Logistic regression analysis focusing on AMH reduction at menopausal transition showed that the related AMH below 0.08 ng/ml was significantly related to the presence of early knee OA (p = 0.035; odds ratio, 5.55). Reduced serum levels of AMH in middle-aged females were correlated with the presence of early knee OA, which might be a useful serum biomarker.
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16
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Saruga T, Sasaki E, Inoue R, Chiba D, Ota S, Iwasaki H, Uesato R, Nakaji S, Ishibashi Y. Usefulness of serum hyaluronic acid levels as a predictor of incidence of hand osteoarthritis analyzed by longitudinal analysis from the Iwaki cohort. Sci Rep 2021; 11:4074. [PMID: 33603120 PMCID: PMC7892545 DOI: 10.1038/s41598-021-83693-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 02/01/2021] [Indexed: 11/17/2022] Open
Abstract
The factors predicting hand osteoarthritis (HOA) in patients remain unknown. We aimed to investigate the usefulness of serum hyaluronic acid (sHA) levels in predicting HOA progression from a 6-year longitudinal epidemiological study. A total of 417 participants in the Iwaki cohort were followed-up over 6 years. Hand and knee radiographs taken at baseline and follow-up were scored according to Kellgren–Lawrence grades and Kallman score. Participants were classified into the HOA group and the non-HOA group. sHA levels at baseline were determined by ELISA. Correlations between sHA levels, the number of involved joints, and Kallman score were estimated. Factors related to the incidence or progression of HOA over 6 years were analyzed. The prevalence of HOA was 19.9% at baseline, and 3.6 ± 2.1 joints were involved. sHA levels in the HOA group at baseline were significantly higher than in the non-HOA group (p < 0.001) and correlated with the number of involved joints (r = 0.399, p < 0.001) and Kallman score (r = 0.540, p < 0.001). The incidence rate was 14.5%, and the progression rate was 46.1% over 6 years. Higher sHA levels at baseline were the risk factor of HOA incidence. Thus, sHA levels predicted the incidence of HOA over 6 years.
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Affiliation(s)
- Tatsuro Saruga
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Eiji Sasaki
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Ryo Inoue
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daisuke Chiba
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Seiya Ota
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hiroki Iwasaki
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Ryoko Uesato
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Shigeyuki Nakaji
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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Bernotiene E, Bagdonas E, Kirdaite G, Bernotas P, Kalvaityte U, Uzieliene I, Thudium CS, Hannula H, Lorite GS, Dvir-Ginzberg M, Guermazi A, Mobasheri A. Emerging Technologies and Platforms for the Immunodetection of Multiple Biochemical Markers in Osteoarthritis Research and Therapy. Front Med (Lausanne) 2020; 7:572977. [PMID: 33195320 PMCID: PMC7609858 DOI: 10.3389/fmed.2020.572977] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/31/2020] [Indexed: 12/12/2022] Open
Abstract
Biomarkers, especially biochemical markers, are important in osteoarthritis (OA) research, clinical trials, and drug development and have potential for more extensive use in therapeutic monitoring. However, they have not yet had any significant impact on disease diagnosis and follow-up in a clinical context. Nevertheless, the development of immunoassays for the detection and measurement of biochemical markers in OA research and therapy is an active area of research and development. The evaluation of biochemical markers representing low-grade inflammation or extracellular matrix turnover may permit OA prognosis and expedite the development of personalized treatment tailored to fit particular disease severities. However, currently detection methods have failed to overcome specific hurdles such as low biochemical marker concentrations, patient-specific variation, and limited utility of single biochemical markers for definitive characterization of disease status. These challenges require new and innovative approaches for development of detection and quantification systems that incorporate clinically relevant biochemical marker panels. Emerging platforms and technologies that are already on the way to implementation in routine diagnostics and monitoring of other diseases could potentially serve as good technological and strategic examples for better assessment of OA. State-of-the-art technologies such as advanced multiplex assays, enhanced immunoassays, and biosensors ensure simultaneous screening of a range of biochemical marker targets, the expansion of detection limits, low costs, and rapid analysis. This paper explores the implementation of such technologies in OA research and therapy. Application of novel immunoassay-based technologies may shed light on poorly understood mechanisms in disease pathogenesis and lead to the development of clinically relevant biochemical marker panels. More sensitive and specific biochemical marker immunodetection will complement imaging biomarkers and ensure evidence-based comparisons of intervention efficacy. We discuss the challenges hindering the development, testing, and implementation of new OA biochemical marker assays utilizing emerging multiplexing technologies and biosensors.
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Affiliation(s)
- Eiva Bernotiene
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Edvardas Bagdonas
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Gailute Kirdaite
- Department of Experimental, Preventive and Clinical Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Paulius Bernotas
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Ursule Kalvaityte
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Ilona Uzieliene
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | - Heidi Hannula
- Microelectronics Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Gabriela S. Lorite
- Microelectronics Research Unit, Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Mona Dvir-Ginzberg
- Laboratory of Cartilage Biology, Institute of Dental Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ali Guermazi
- Department of Radiology, Veterans Affairs Boston Healthcare System, Boston University School of Medicine, Boston, MA, United States
| | - Ali Mobasheri
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Departments of Orthopedics, Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Queen's Medical Centre, Nottingham, United Kingdom
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18
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Ahedi H, Aitken D, Blizzard L, Cicuttini F, Jones G. Quantification of hip effusion-synovitis and its cross-sectional and longitudinal associations with hip pain, MRI findings and early radiographic hip OA. BMC Musculoskelet Disord 2020; 21:533. [PMID: 32778082 PMCID: PMC7419183 DOI: 10.1186/s12891-020-03532-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 07/23/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Hip effusion-synovitis may be relevant to osteoarthritis (OA) but is of uncertain etiology. The aim of this study was to describe the cross-sectional and longitudinal associations of hip effusion-synovitis with clinical and structural risk factors of OA in older adults. METHODS One hundred ninety-six subjects from the Tasmanian Older Adult Cohort (TASOAC) study with a right hip STIR (Short T1 Inversion Recovery) Magnetic Resonance Imaging (MRI) on two occasions were included. Hip effusion-synovitis CSA (cm2) was assessed quantitatively. Hip pain was determined by WOMAC (Western Ontario and McMaster Universities Osteoarthritis) while hip bone marrow lesions (BMLs), cartilage defects (femoral and/or acetabular) and high cartilage signal were assessed on MRI. Joint space narrowing (0-3) and osteophytes (0-3) were measured on x-ray using Altman's atlas. RESULTS Of 196 subjects, 32% (n = 63) had no or a small hip effusion-synovitis while 68% (n = 133) subjects had a moderate or large hip effusion-synovitis. Both groups were similar but those with moderate or large hip effusion-synovitis were older, had higher BMI and more hip pain. Cross-sectionally, hip effusion-synovitis at multiple sites was associated with presence of hip pain [Prevalence ratio (PR):1.42 95%CI:1.05,1.93], but not with severity of hip pain. Furthermore, hip effusion-synovitis size associated with femoral defect (βeta:0.32 95%CI:0.08,0.56). Longitudinally, and incident hip cartilage defect (PR: 2.23 95%CI:1.00, 4.97) were associated with an increase in hip effusion-synovitis CSA. Furthermore, independent of presence of effusion-synovitis, hip BMLs predicted incident (PR: 1.62 95%CI: 1.13, 2.34) and worsening of hip cartilage defects (PR: 1.50 95%CI: 1.20, 1.86). While hip cartilage defect predicted incident (PR: 1.11 95%CI: 1.03, 1.20) and worsening hip BMLs (PR: 1.16 95%CI: 1.04, 1.30). CONCLUSIONS Hip effusion-synovitis at multiple sites (presumably reflecting extent) may be associated with hip pain. Hip BMLs and hip cartilage defects are co-dependent and predict worsening hip effusion-synovitis, indicating causal pathways between defects, BMLs and effusion-synovitis.
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Affiliation(s)
- Harbeer Ahedi
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
- Institute of Musculoskeletal Health, Sydney, NSW, Australia.
- Sydney School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Torgomyan A, Saroyan M. Molecular Mechanisms of Chondro- and Osteogenesis Disturbance in Osteoarthritis and Ways of Their Correction. CYTOL GENET+ 2020. [DOI: 10.3103/s0095452720040118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Ishibashi K, Sasaki E, Ota S, Chiba D, Yamamoto Y, Tsuda E, Yoshikuni S, Ihara K, Ishibashi Y. Detection of synovitis in early knee osteoarthritis by MRI and serum biomarkers in Japanese general population. Sci Rep 2020; 10:12310. [PMID: 32704147 PMCID: PMC7378056 DOI: 10.1038/s41598-020-69328-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/08/2020] [Indexed: 01/16/2023] Open
Abstract
To investigate synovitis' influence on early knee osteoarthritis (EKOA) by serum biomarkers and magnetic resonance imaging (MRI) findings in Japanese women. We enrolled 255 women aged 30-70 without radiographic abnormalities (Kellgren-Lawrence grade ≥ 2). Knee injury, OA outcome scores (KOOS), clinical examinations, and standing radiograph were used for classification criteria of EKOA. Participants were classified into normal knee group and EKOA group. All participants underwent MRIs of their right knee. The amount of effusion-synovitis volume was quantified. We compared serum matrix metalloproteinases-3 levels (MMP-3), high-sensitivity C-reactive protein, interleukin-6, and adiponectin between the groups. The relationship between synovitis and EOKA was investigated using multiple linear regression. Fifty-four participants (21%) were classified as EKOA. Serum MMP-3 concentration and effusion-synovitis volume were higher in patients with EKOA (p = 0.025 and p = 0.001, respectively). Effusion-synovitis volume negatively correlated with all KOOS subscales and positively correlated with serum MMP-3 concentration. Serum MMP-3 concentration was associated with effusion-synovitis volume β = 0.60, p < 0.001). There was mildly active but definitive synovitis in EKOA. This was an observational study so that no conclusions can be drawn regarding cause-effect for synovitis and symptoms. Future studies should conduct follow-up of participants with synovitis to assess the progression of knee OA.
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Affiliation(s)
- Kyota Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Seiya Ota
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Eiichi Tsuda
- Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Sugimura Yoshikuni
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazushige Ihara
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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21
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Lyu JL, Wang TM, Chen YH, Chang ST, Wu MS, Lin YH, Lin YH, Kuan CM. Oral intake of Streptococcus thermophil us improves knee osteoarthritis degeneration: A randomized, double-blind, placebo-controlled clinical study. Heliyon 2020; 6:e03757. [PMID: 32368640 PMCID: PMC7184258 DOI: 10.1016/j.heliyon.2020.e03757] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/05/2020] [Accepted: 03/31/2020] [Indexed: 01/15/2023] Open
Abstract
This preliminary clinical study demonstrates the possibility of a new species of probiotic for improvement of the degeneration of knee osteoarthritis (KOA). TCI633 (Streptococcus thermophil us) is a newly founded bacterium from human breast milk, and it is able to produce hyaluronate (HA) in gastrointestinal (GI) tract. A recent study has proved that TCI633 can substantially alleviate synovial tissue inflammation and cartilage damage in the animal models, but so far it has never been applied in clinical intervention. In this study, we recruited 80 subjects and conducted 12 weeks clinical trial to validate the efficacy of TCI633 for improvement of the progression of KOA. TCI633 could improve serum collagen type II C-telopeptide (sCTX-II) and serum C-reactive protein (sCRP) by 41.58% and 39.58%, respectively, after the study. The improvement rates for sCTX-II and sCRP in TCI633 group were 54% and 57%, respectively, at 12 weeks. Compared to the results of placebo, the indistinct improvement progresses of sCTX-II and sCRP might be caused by the uneventful distribution of K/L populations between the TCI633 and placebo groups, a short term of study period, and few recruited subjects. Moreover, the results of Western Ontario and McMaster Universities (WOMAC) questionnaires show that TCI633 might retard the progression and development of KOA after the trial. In brief, this preliminary research may provide an alternative approach to the improvement of KOA by probiotics although more detailed investigations should be conducted for solid conclusions.
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Affiliation(s)
- Jia-Ling Lyu
- Research & Design Center, TCI CO., Ltd., Taipei, 114, Taiwan
- Department of Cosmeceutics, China Medical University, Taichung, 404, Taiwan
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, 100, Taiwan
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Yen-Hao Chen
- Research & Design Center, TCI Gene Inc., Taipei, 114, Taiwan
| | - Shu-Ting Chang
- Research & Design Center, TCI CO., Ltd., Taipei, 114, Taiwan
| | - Ming-Shiang Wu
- Departments of Internal Medicine, School of Medicine, National Taiwan University, Taipei, 100, Taiwan
- Departments of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Yung-Hao Lin
- Global Business Center, TCI CO., Ltd., Taipei, 114, Taiwan
| | - Yung-Hsiang Lin
- Research & Design Center, TCI CO., Ltd., Taipei, 114, Taiwan
| | - Chen-Meng Kuan
- Research & Design Center, TCI CO., Ltd., Taipei, 114, Taiwan
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22
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Early knee osteoarthritis prevalence is highest among middle-aged adult females with obesity based on new set of diagnostic criteria from a large sample cohort study in the Japanese general population. Knee Surg Sports Traumatol Arthrosc 2020; 28:984-994. [PMID: 31292689 DOI: 10.1007/s00167-019-05614-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 07/01/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE A few new criteria for early detection and prevention of early knee osteoarthritis (EKOA) have been proposed. However, its prevalence, risk factors, relationship with function and prognosis have not been clarified. The purpose of this study was to investigate the prevalence of EKOA and its risk factors in the Japanese general population. METHODS A total of 1104 volunteers (443 males, 661 females) who participated in the Iwaki cohort study in Japan were enrolled in this cross-sectional study. Their bilateral weight-bearing anterior-posterior knee radiographs were classified by Kellgren-Lawrence (KL) grade. EKOA (KL grade 0/1) was defined according to the following criteria: knee injury and osteoarthritis outcome score < 85%, joint line tenderness, and crepitus and its prevalence among age-sex groups was calculated. Logistic regression analyses were performed to determine the risk factors for EKOA. RESULTS Eight hundred and twenty-two participants had KL grade 0/1, and the EKOA prevalence was 9.5% in males and 15.0% in females (p = 0.011). The prevalence of EKOA increased with age. The highest prevalence was noted in females aged 50-59 years. Logistic regression analysis showed that the risk factors for EKOA were age (p < 0.001, odds ratio (OR) 1.1), female sex (p = 0.002, OR 2.5), high body mass index (p < 0.001, OR 1.2), and history of knee injury (p < 0.001, OR 21.7). CONCLUSIONS The highest EKOA prevalence was observed in middle adult females (50-59 years old). The risk factors for EKOA were female sex, ageing, obesity and knee injury history, which were extremely similar to those of definitive knee osteoarthritis. LEVEL OF EVIDENCE Level I in diagnostic studies-investigating a diagnostic test.
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23
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García-Alvarado FJ, González-Martínez MDR, Jaramillo-Rodríguez Y, Delgado-Aguirre HA. Increased Urinary Concentration of C-Terminal Telopeptide of Type II Collagen and Pain by Radiographic Grade in Women with Knee Osteoarthritis in Northeastern Mexico: A Cross-Sectional Study. Biores Open Access 2020; 9:7-12. [PMID: 32064175 PMCID: PMC7019197 DOI: 10.1089/biores.2019.0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Osteoarthritis (OA) of the knee causes disability, pain, and progressive destruction of cartilage in adult women. The objective of the study was to evaluate the concentrations of the urinary biomarker C-terminal telopeptide of type II collagen (CTX-II) and pain by radiographic grade in women with knee OA in northeastern Mexico: Cross-sectional study of 155 women with knee OA. Concentrations of biochemical parameters were evaluated and urine samples were collected to measure biomarker levels (uCTX-II) ng/mmol by competitive enzyme-linked immunoabsorbent assay (ELISA) technique and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale was used for pain classification; median age of 49 years and 29.1 kg/m2 of body mass index (BMI). uCTX-II biomarker levels were grade 2 (210.7 ng/mmol), grade 3 (314.8 ng/mmol), and grade 4 (478.8 ng/mmol) relative to Kellgren and Lawrence, uCTX-II levels were compared with WOMAC scale and presented significant statistical difference (p = 0.0001). An association of the biomarker CTX-II and an increase in BMI was found in female patients with knee OA (odds ratio = 1.01; 95% confidence interval 1.001–1.005; p = 0.047).This study demonstrates an increase in the levels of the biomarker uCTX-II, the degree of pain, and radiographic grade in women with knee OA in northeastern Mexico.
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Affiliation(s)
| | | | - Yolanda Jaramillo-Rodríguez
- Unidad Médica de Alta Especialidad No. 71, División de Investigación en Salud, Departamento de Patología General, Instituto Mexicano del Seguro Social, Torreón, México
| | - Héctor Alberto Delgado-Aguirre
- Unidad Médica de Alta Especialidad No. 71, División de Investigación en Salud, Departamento de Trasplantes, Instituto Mexicano del Seguro Social, Torreón, México
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24
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Hudita A, Galateanu B, Dinescu S, Costache M, Dinischiotu A, Negrei C, Stan M, Tsatsakis A, Nikitovic D, Lupuliasa D, Balanescu A. In Vitro Effects of Cetylated Fatty Acids Mixture from Celadrin on Chondrogenesis and Inflammation with Impact on Osteoarthritis. Cartilage 2020; 11:88-97. [PMID: 29808705 PMCID: PMC6921950 DOI: 10.1177/1947603518775798] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Cetylated fatty acids are a group of naturally occurring fats of plant and/or animal origin. Cetyl myristoleate, in particular, was initially involved in osteoarthritis related research as its therapeutic administration prevented experimentally induced arthritis in Swiss Albino mice. In this context, the aim of our study was to investigate the possible mechanisms of Celadrin cetylated fatty acids action at the cellular level inflammation related pain relief and chondrogenesis. DESIGN For this, we tested the effects of the cetylated fatty acids mixture from Celadrin on an in vitro scaffold-free 3-dimensional mesenchymal stem cells culture model of chondrogenesis. Furthermore, we treated stimulated mouse macrophage cells with the cetylated fatty acids mixture to investigate the expression profile of secreted inflammatory cytokines. RESULTS The cetylated fatty acids mixture from Celadrin significantly decreased the production of IL-6, MCP-1, and TNF, key regulators of the inflammatory process, in stimulated RAW264.7 mouse macrophage cells. The treatment with cetylated fatty acids mixture initiated and propagated the process of chondrogenesis as demonstrated by the increased expression and deposition of chondrogenic markers by the differentiating mesenchymal cells. CONCLUSION The cetylated fatty acids mixture from Celadrin reduces inflammation in vitro by significantly decreasing the expression of IL-6, MCP-1, and TNF in stimulated RAW264.7 mouse macrophage cells. These compounds facilitate the chondrogenic differentiation process of human adipose-derived stem cells by stimulating the expression of chondrogenic markers under chondrogenic induction conditions.
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Affiliation(s)
- Ariana Hudita
- Department of Biochemistry and Molecular
Biology, University of Bucharest, Bucharest, Romania
| | - Bianca Galateanu
- Department of Biochemistry and Molecular
Biology, University of Bucharest, Bucharest, Romania
| | - Sorina Dinescu
- Department of Biochemistry and Molecular
Biology, University of Bucharest, Bucharest, Romania
| | - Marieta Costache
- Department of Biochemistry and Molecular
Biology, University of Bucharest, Bucharest, Romania
| | - Anca Dinischiotu
- Department of Biochemistry and Molecular
Biology, University of Bucharest, Bucharest, Romania
| | - Carolina Negrei
- Departament of Toxicology, Faculty of
Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Bucharest,
Romania,Carolina Negrei, Department of Toxicology,
Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6
Traian Vuia Street, Bucharest, 020956, Romania.
| | - Miriana Stan
- Departament of Toxicology, Faculty of
Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Bucharest,
Romania
| | - Aristidis Tsatsakis
- Laboratory of Toxicology, School of
Medicine, University of Crete, Heraklion, Greece
| | - Dragana Nikitovic
- Laboratory of
Anatomy-Histology-Embryology, School of Medicine, University of Crete, Heraklion,
Greece
| | - Dumitru Lupuliasa
- Department of Pharmaceutical Technology,
Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Bucharest,
Romania
| | - Andra Balanescu
- ”Sfanta Maria” Clinical Hospital, “Carol
Davila” University, Medicine and Pharmacy Faculty, Internal and Rheumatology
Department, Bucharest, Romania
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25
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Rudnik-Jansen I, Schrijver K, Woike N, Tellegen A, Versteeg S, Emans P, Mihov G, Thies J, Eijkelkamp N, Tryfonidou M, Creemers L. Intra-articular injection of triamcinolone acetonide releasing biomaterial microspheres inhibits pain and inflammation in an acute arthritis model. Drug Deliv 2019; 26:226-236. [PMID: 30843733 PMCID: PMC6407600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 10/07/2023] Open
Abstract
Inflammation of the synovium and joint capsule is a main driver of pain in an osteoarthritic (OA) joint. Triamcinolone acetonide (TAA) is a classical corticosteroid that reduces synovitis and alleviates pain, albeit transiently. Biomaterial-based local TAA release may prolong the suppression of pain without the need for multiple injections. Polylactic-co-glycolic acid (PLGA) formulations of TAA prolong OA pain relief to a limited extent. A novel polyesteramide (PEA) microsphere platform allows for extended release in the OA joint for over 3 months. To evaluate their effect on pain and inflammation, TAA-loaded microspheres were intra-articularly delivered to the knee joint in a rat model of acute arthritis induced by intra-articular injection of streptococcal cell wall peptidoglycan-polysaccharide (PGPS) and subsequent flare-ups by intravenous PGPS injections. PEA-loaded microspheres were benchmarked with TAA-loaded PLGA microspheres and bolus TAA injection. TAA treatments were injected intra-articularly before the first induced flare-up. TAA-loaded PEA and PLGA microspheres reduced joint swelling and signs of pain-like behavior over the entire study period, as assessed by weight bearing and referred mechanical hypersensitivity, whereas bolus suspension was effective for a shorter time period. TAA-loaded PEA microspheres reduced lameness to a greater extent than TAA-loaded PLGA microspheres. In conclusion, a single intra-articular injection of TAA-loaded PEA microspheres reduced joint swelling and induced longer pain relief compared to bolus injection. Hence relief of inflammation and pain by PEA-based delivery of TAA may prove to be effective and durable.
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Affiliation(s)
- Imke Rudnik-Jansen
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Karin Schrijver
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nina Woike
- DSM Biomedical B.V, Geleen, The Netherlands
| | - Anna Tellegen
- Department of Clinical Sciences of Companion Animals, Utrecht University, Utrecht, the Netherlands
| | - Sabine Versteeg
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Pieter Emans
- Department of Orthopedics, Maastricht University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Jens Thies
- DSM Biomedical B.V, Geleen, The Netherlands
| | - Niels Eijkelkamp
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marianna Tryfonidou
- Department of Clinical Sciences of Companion Animals, Utrecht University, Utrecht, the Netherlands
| | - Laura Creemers
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
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26
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Jorge PB, Sprey JWC, Runco GM, Lima MVD, Severino NR, Santili C. Difference in Articular Degeneration Depending on the Type of Sport. Rev Bras Ortop 2019; 54:509-515. [PMID: 31736520 PMCID: PMC6855921 DOI: 10.1016/j.rboe.2018.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/21/2018] [Indexed: 11/29/2022] Open
Abstract
Objective
To determine whether type-II collagen degradation is determined by the type of sport. Carboxy-terminal telepoptide of type-II collagen (CTX-II), a serum biomarker of collagen degradation, was measured in athletes who play different sports, and was compared with matched controls.
Methods
The sample size consisted of 70 female participants aged between 18 and 25 years, 15 of whom were members of a soccer team, 10 of a
futsal
(a variant of association football played on a hard court) team, 10 of a handball team, 18 of a volleyball team, and 7 of a swimming team. A total of 9 age- and sex-matched individuals with sedentary lifestyles were included in the control group. 3-mL blood samples were collected from each participant, and they were analyzed using an enzyme-linked immunosorbent assay (ELISA).
Results
A comparison of the CTX-II concentrations of the players of different sports with those of the control group resulted in the following
p
-values: volleyball (
p
= 0.21); soccer (
p
= 0.91); handball (
p
= 0.13);
futsal
(
p
= 0.02); and swimming (
p
= 0.0015). Therefore, in the investigated population,
futsal
represented the highest risk for type-II collagen degradation and, consequently, for articular cartilage degradation, whereas swimming was a protective factor for the articular cartilage. No statistically significant difference was found in the body mass index among the groups.
Conclusion
Futsal
players are exposed to greater articular degradation, while swimmers exhibited less cartilage degradation compared with the control group in the study population, suggesting that strengthening the periarticular muscles and aerobic exercise in low-load environments has a positive effect on the articular cartilage.
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Affiliation(s)
- Pedro Baches Jorge
- Grupo de Trauma do Esporte, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade de Misericórdia da Santa Casa de São Paulo, São Paulo, SP, Brasil
- Endereço para correspondência Pedro Baches Jorge, MD Clínica SO.U - Matriz, Rua Barata Ribeiro398, 3° andar, Bela Vista, São Paulo, 01308-000, SPBrasil
| | - Jan Willem Cerf Sprey
- Grupo de Trauma do Esporte, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade de Misericórdia da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Guilherme Morgado Runco
- Grupo de Trauma do Esporte, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade de Misericórdia da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Marcos Vaz de Lima
- Grupo de Trauma do Esporte, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade de Misericórdia da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Nilson Roberto Severino
- Grupo de Trauma do Esporte, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade de Misericórdia da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Claudio Santili
- Grupo de Trauma do Esporte, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade de Misericórdia da Santa Casa de São Paulo, São Paulo, SP, Brasil
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27
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Bihlet AR, Byrjalsen I, Bay-Jensen AC, Andersen JR, Christiansen C, Riis BJ, Karsdal MA. Associations between biomarkers of bone and cartilage turnover, gender, pain categories and radiographic severity in knee osteoarthritis. Arthritis Res Ther 2019; 21:203. [PMID: 31481084 PMCID: PMC6724319 DOI: 10.1186/s13075-019-1987-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/23/2019] [Indexed: 01/15/2023] Open
Abstract
Background Excessive cartilage degradation is a known characteristic of osteoarthritis (OA). Biochemical markers, such as uCTX-II, have been shown to be associated with disease severity, yet the tissue origin of CTX-II has been disputed. This analysis investigates the association between OA knee joints at different radiographic stages and pain categories with levels of uCTX-II and biomarkers of bone resorption and formation. Methods Baseline data of two randomised clinical trials (NCT00486434 and NCT00704847) in patients with radiographic OA and presence of pain were analysed post hoc. A subgroup with available urine samples and evaluable radiographs for both knees (N = 1241) was analysed. Urine CTX-I, urine CTX-II and serum osteocalcin were analysed for associations with combined Kellgren-Lawrence (KL) scores, gender and pain for both knees to assess the contribution of joints at different stages. Results Pain, BMI, age, gender and KL grade were all significantly associated with uCTX-II. The association between pain and CTX-II appeared to be driven by weight-bearing pain. The level of uCTX-II incrementally increased with higher radiographic severity of each knee. Levels of bone markers CTX-I and osteocalcin were both significantly associated with BMI and gender, but neither were associated with radiographic severity. Biomarker levels between male or female groups of identical KL scores were found to be higher in females compared to males in some but not all KL score groups. Conclusions These results indicate that levels of uCTX-II are independently associated with radiographic severity of OA and pain intensity. CTX-II was associated with weight-bearing pain, but not non-weight-bearing pain, independent of co-variates. Bilateral OA knee joints appear to contribute to uCTX-II levels in an incremental manner according to radiographic severity of single joints. The data suggest that biomarker differences between genders should be taken into account when evaluating these markers in the context of structural features of OA.
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Affiliation(s)
| | - Inger Byrjalsen
- Nordic Bioscience Clinical Development, Herlev Hovedgade 82, DK2730, Herlev, Denmark
| | | | - Jeppe Ragnar Andersen
- Nordic Bioscience Clinical Development, Herlev Hovedgade 82, DK2730, Herlev, Denmark
| | | | - Bente Juel Riis
- Nordic Bioscience A/S, Herlev Hovedgade 207, DK2730, Herlev, Denmark
| | - Morten A Karsdal
- Nordic Bioscience Biomarkers and Research, Herlev Hovedgade 207, DK2730, Herlev, Denmark
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28
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Nees TA, Rosshirt N, Reiner T, Schiltenwolf M, Moradi B. [Inflammation and osteoarthritis-related pain]. Schmerz 2019; 33:4-12. [PMID: 30560495 DOI: 10.1007/s00482-018-0346-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Osteoarthritis (OA) is one of the major causes of chronic pain. Although OA has long been considered a non-inflammatory "wear and tear" disease leading to loss of articular cartilage, recent findings provide convincing evidence that inflammatory mechanisms play a pivotal role in the pathophysiology of OA. In OA mononuclear cells (e. g. T‑cells and macrophages) infiltrate the synovial membrane and the levels of pro-inflammatory cytokines in peripheral blood and synovial fluid samples are elevated. Increased release of inflammatory mediators including interleukin (IL) IL-1β, IL-6, IL-8, IL-15 und tumor necrosis factor alpha (TNF‑α) induces the expression of proteolytic enzymes such as matrix metalloproteinases resulting in cartilage breakdown. Molecular and cellular interactions between the immune and nervous system are also involved in the development of OA-related pain. Inflammatory mediators including IL-6 und TNF‑α lead to peripheral sensitization of joint nociceptors and growth factors (e. g. NGF) trigger the expression of TRPV1 channels in primary afferents. Moreover, neuropeptides reduce the threshold of nociceptors of OA joints. The current review highlights the role of inflammatory mechanisms in OA-induced joint pain considering clinical signs of inflammation and major inflammatory pathways.
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Affiliation(s)
- T A Nees
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - N Rosshirt
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - T Reiner
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - M Schiltenwolf
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - B Moradi
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
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29
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Rudnik-Jansen I, Schrijver K, Woike N, Tellegen A, Versteeg S, Emans P, Mihov G, Thies J, Eijkelkamp N, Tryfonidou M, Creemers L. Intra-articular injection of triamcinolone acetonide releasing biomaterial microspheres inhibits pain and inflammation in an acute arthritis model. Drug Deliv 2019. [PMID: 30843733 PMCID: PMC6407600 DOI: 10.1080/10717544.2019.1568625] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Inflammation of the synovium and joint capsule is a main driver of pain in an osteoarthritic (OA) joint. Triamcinolone acetonide (TAA) is a classical corticosteroid that reduces synovitis and alleviates pain, albeit transiently. Biomaterial-based local TAA release may prolong the suppression of pain without the need for multiple injections. Polylactic-co-glycolic acid (PLGA) formulations of TAA prolong OA pain relief to a limited extent. A novel polyesteramide (PEA) microsphere platform allows for extended release in the OA joint for over 3 months. To evaluate their effect on pain and inflammation, TAA-loaded microspheres were intra-articularly delivered to the knee joint in a rat model of acute arthritis induced by intra-articular injection of streptococcal cell wall peptidoglycan-polysaccharide (PGPS) and subsequent flare-ups by intravenous PGPS injections. PEA-loaded microspheres were benchmarked with TAA-loaded PLGA microspheres and bolus TAA injection. TAA treatments were injected intra-articularly before the first induced flare-up. TAA-loaded PEA and PLGA microspheres reduced joint swelling and signs of pain-like behavior over the entire study period, as assessed by weight bearing and referred mechanical hypersensitivity, whereas bolus suspension was effective for a shorter time period. TAA-loaded PEA microspheres reduced lameness to a greater extent than TAA-loaded PLGA microspheres. In conclusion, a single intra-articular injection of TAA-loaded PEA microspheres reduced joint swelling and induced longer pain relief compared to bolus injection. Hence relief of inflammation and pain by PEA-based delivery of TAA may prove to be effective and durable.
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Affiliation(s)
- Imke Rudnik-Jansen
- a Department of Orthopedics , University Medical Center Utrecht , Utrecht , the Netherlands
| | - Karin Schrijver
- a Department of Orthopedics , University Medical Center Utrecht , Utrecht , the Netherlands
| | - Nina Woike
- b DSM Biomedical B.V , Geleen , The Netherlands
| | - Anna Tellegen
- c Department of Clinical Sciences of Companion Animals , Utrecht University , Utrecht , the Netherlands
| | - Sabine Versteeg
- d Laboratory of Translational Immunology , University Medical Center Utrecht, Utrecht University , Utrecht , the Netherlands
| | - Pieter Emans
- e Department of Orthopedics , Maastricht University Medical Center Utrecht , Utrecht , the Netherlands
| | | | - Jens Thies
- b DSM Biomedical B.V , Geleen , The Netherlands
| | - Niels Eijkelkamp
- d Laboratory of Translational Immunology , University Medical Center Utrecht, Utrecht University , Utrecht , the Netherlands
| | - Marianna Tryfonidou
- c Department of Clinical Sciences of Companion Animals , Utrecht University , Utrecht , the Netherlands
| | - Laura Creemers
- a Department of Orthopedics , University Medical Center Utrecht , Utrecht , the Netherlands
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Hore Z, Denk F. Neuroimmune interactions in chronic pain - An interdisciplinary perspective. Brain Behav Immun 2019; 79:56-62. [PMID: 31029795 DOI: 10.1016/j.bbi.2019.04.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/16/2019] [Accepted: 04/24/2019] [Indexed: 02/07/2023] Open
Abstract
It is widely accepted that communication between the nervous and immune systems is involved in the development of chronic pain. At each level of the nervous system, immune cells have been reported to accompany and frequently mediate dysfunction of nociceptive circuitry; however the exact mechanisms are not fully understood. One way to speed up progress in this area is to increase interdisciplinary cross-talk. This review sets out to summarize what pain research has already learnt, or indeed might still learn, from examining peripheral and central nociceptive mechanisms using tools and perspectives from other fields like immunology, inflammation biology or the study of stress.
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Affiliation(s)
- Zoe Hore
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE1 1UL, UK
| | - Franziska Denk
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE1 1UL, UK.
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Sadatsuki R, Ishijima M, Kaneko H, Liu L, Futami I, Hada S, Kinoshita M, Kubota M, Aoki T, Takazawa Y, Ikeda H, Okada Y, Kaneko K. Bone marrow lesion is associated with disability for activities of daily living in patients with early stage knee osteoarthritis. J Bone Miner Metab 2019; 37:529-536. [PMID: 30187274 DOI: 10.1007/s00774-018-0950-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 08/13/2018] [Indexed: 01/19/2023]
Abstract
Osteoarthritis of the knee (knee OA) induces pain, loss of mobility and diminished activities of daily living (ADL). Although an understanding of the pathophysiology of early stage knee OA has been developed, the structural changes associated with disability for ADL in early stage knee OA are still unclear. The aim of the present study was to examine magnetic resonance imaging (MRI)-detected changes associated with disability for ADL in patients with early stage knee OA. One hundred and thirty-two patients with early stage medial knee OA (Kellgren-Lawrence grade ≤ 2) who first visited the outpatient clinic at our university hospital were included. They were also examined by 3.0-Tesla knee MRI. The OA-associated structural changes were scored using the Whole-Organ Magnetic Resonance Imaging Score (WORMS), and clinical manifestations were evaluated by the Japanese Knee Osteoarthritis Measure (JKOM). Median quartile regression was used for the analysis. Cartilage lesion, subchondral bone attrition and osteophytes were observed in all patients. Bone marrow lesions (BMLs) and synovitis were observed in 60% and 55% of the patients, respectively. Subchondral cysts and ligament changes were observed in 6% and 17% of the patients, respectively. Pain severity of the patients was associated with medial cartilage lesions (coefficient 2.50, 95% confidence interval 0.61-4.40, p < 0.01). Disability for ADL of the patients was associated with BMLs in the medial side of the knee joint (0.82, 0.21-1.02, p = 0.04). BMLs in the medial side of the knee joint were associated with disability for ADL of patients with early stage medial knee OA.
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Affiliation(s)
- Ryo Sadatsuki
- Department of Medicine for Orthtopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
- Orthopaedic Surgery, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthtopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
- Sportoloy Center, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Haruka Kaneko
- Department of Medicine for Orthtopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Lizu Liu
- Department of Medicine for Orthtopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
- Sportoloy Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ippei Futami
- Department of Medicine for Orthtopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shinnosuke Hada
- Department of Medicine for Orthtopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mayuko Kinoshita
- Department of Medicine for Orthtopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mitsuaki Kubota
- Department of Medicine for Orthtopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takako Aoki
- Sportoloy Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuji Takazawa
- Department of Medicine for Orthtopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroshi Ikeda
- Department of Medicine for Orthtopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yasunori Okada
- Department of Pathophysiology for Locomotive and Neoplastic Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Medicine for Orthtopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
- Sportoloy Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Pathophysiology for Locomotive and Neoplastic Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Bolgla LA, Gordon R, Sloan G, Pretlow LG, Lyon M, Fulzele S. COMPARISON OF PATELLA ALIGNMENT AND CARTILAGE BIOMARKERS IN YOUNG ADULT FEMALES WITH AND WITHOUT PATELLOFEMORAL PAIN: A PILOT STUDY. Int J Sports Phys Ther 2019; 14:46-54. [PMID: 30746291 PMCID: PMC6350658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Evidence suggests that individuals with patellofemoral pain (PFP) may develop patellofemoral joint osteoarthritis (PFJOA). Limited data exist regarding an absolute association between PFP and PFJOA. Understanding this relationship will support the need for early interventions to manage PFP. HYPOTHESIS/PURPOSE This study was conducted to determine if females with PFP have a patella position and cartilage biomarkers similar to individuals with PFJOA. It was hypothesized that females with PFP and excessive patella lateralization would have higher cartilage biomarker levels than controls. It also was hypothesized that a significant association would exist between pain and cartilage biomarker levels in subjects with excessive patella lateralization. STUDY DESIGN Single-occasion, cross-sectional, observational. METHODS Pain was assessed using a 10-cm visual analog scale (VAS) for activity pain over the previous week. Patella offset position (RAB angle) was measured using diagnostic ultrasound. Urine was collected and cartilage biomarkers quantified by analyzing C-telopeptide fragments of type II collagen (uCTX-II). Independent t-tests were used to determine between-group differences for RAB angle and uCTX-II. Bivariate correlations were used to determine associations between VAS and uCTX-II for females with PFP. RESULTS Subjects (age range 20 to 30 years) had similar RAB angles (p = 0.21) and uCTX-II (p = 0.91). A significant association only existed between VAS scores and uCTX-II for females with PFP who had a RAB angle > 13 ° (r = 0.86; p = 0.003). Comparison of uCTX-II in the 25-to-30-year-old females with PFP and excessive patella lateralization in the current study to published normative data showed that this cohort had elevated biomarkers. CONCLUSION These findings support that a certain cohort of individuals with PFP have features similar to individuals with confirmed PFJOA (patella lateralization and elevated biomarkers). Additional studies are needed to determine if interventions can reverse not only pain but biomarker levels. LEVEL OF EVIDENCE 2b (diagnosis).
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Affiliation(s)
- Lori A Bolgla
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Richard Gordon
- Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gloria Sloan
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Lester G. Pretlow
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Matthew Lyon
- Department of Emergency Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Sadanand Fulzele
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Wang W, Wang L, Deng Q, Cai Y, Wu X, Sun L. The levels of urine CTX-II, C2C, and PYD in children patients with Kashin-Beck disease in Qinghai Province of China. J Orthop Surg Res 2019; 14:17. [PMID: 30635000 PMCID: PMC6330459 DOI: 10.1186/s13018-018-1057-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/28/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Kashin-Beck disease (KBD) is an endemic and chronic osteoarthropathy. At present, the diagnosis of KBD mainly depends on the X-ray examination and which could not reflect early damage of cartilage sensitively. So, the aim of this study was to find effective and sensitive biomarkers for early diagnosis of pediatric KBD. METHODS A total of 122 children aged 7-15 years old from 3 villages of Qinghai Province were eligible for the study. Thirty-one, 41, and 50 children were assigned in case, internal, and external control groups, respectively. The levels of CTX-II, C2C, and PYD in urine were measured by using ELISA and compared statistically. In addition, the receiver operating characteristic curve (ROC) analysis was used to assess the performance of diagnostic biomarkers. RESULTS There were significant differences in levels of CTX-II, C2C, and PYD in urine of subjects among three groups. The levels of CTX-II and PYD in the case group were significantly higher than those in external and internal control groups. On the contrary, the level of C2C in the case group was lower than that in the external control group. Compared to the external control group, the area under the curve (AUC) of CTX-II, C2C, and PYD were 0.857, 0.837, and 0.79, and the AUC of CTX-II significantly higher than that of PYD. Compared to the internal control group, the AUC of CTX-II, C2C, and PYD were 0.911, 0.875, and 0.839, and there were no significant differences in the AUC among three indicators. CONCLUSION Both CTX-II and PYD in urine could be used as biomarkers for early diagnosis of pediatric KBD, and the prediction accuracy of CTX-II was relatively superior.
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Affiliation(s)
- Wanying Wang
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China.,Key Laboratory of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health (23618504), Harbin, 150081, China
| | - Lihua Wang
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China.,Key Laboratory of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health (23618504), Harbin, 150081, China
| | - Qing Deng
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China.,Key Laboratory of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health (23618504), Harbin, 150081, China
| | - Yun Cai
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China.,Key Laboratory of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health (23618504), Harbin, 150081, China
| | - Xianhao Wu
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China.,Key Laboratory of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health (23618504), Harbin, 150081, China
| | - Liyan Sun
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, 157 Baojian Road, Harbin, 150081, China. .,Key Laboratory of Etiology and Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health (23618504), Harbin, 150081, China.
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Thudium CS, Löfvall H, Karsdal MA, Bay-Jensen AC, Bihlet AR. Protein biomarkers associated with pain mechanisms in osteoarthritis. J Proteomics 2019; 190:55-66. [DOI: 10.1016/j.jprot.2018.04.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/16/2018] [Accepted: 04/20/2018] [Indexed: 12/19/2022]
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Select Biomarkers on the Day of Anterior Cruciate Ligament Reconstruction Predict Poor Patient-Reported Outcomes at 2-Year Follow-Up: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9387809. [PMID: 30105266 PMCID: PMC6076965 DOI: 10.1155/2018/9387809] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/05/2018] [Accepted: 07/04/2018] [Indexed: 12/11/2022]
Abstract
Background The majority of patients develop posttraumatic osteoarthritis within 15 years of anterior cruciate ligament (ACL) injury. Inflammatory and chondrodegenerative biomarkers have been associated with both pain and the progression of osteoarthritis; however, it remains unclear if preoperative biomarkers differ for patients with inferior postoperative outcomes. Hypothesis/Purpose The purpose of this pilot study was to compare biomarkers collected on the day of ACL reconstruction between patients with “good” or “poor” 2-year postoperative outcomes. We hypothesized that inflammatory cytokines and chondrodegenerative biomarker concentrations would be significantly greater in patients with poorer outcomes. Study Design Prospective cohort design. Methods 22 patients (9 females, 13 males; age = 19.5 ± 4.1 years; BMI = 24.1 ± 3.6 kg/m2) previously enrolled in a randomized trial evaluating early anti-inflammatory treatment after ACL injury. Biomarkers of chondrodegeneration and inflammation were assessed from synovial fluid (sf) samples collected on the day of ACL reconstruction. Participants completed Knee Injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) questionnaires two years following surgery. Patients were then categorized based on whether their KOOS Quality of Life (QOL) score surpassed the Patient Acceptable Symptom State (PASS) threshold of 62.5 points or the IKDC PASS threshold of 75.9 points. Results Patients that failed to reach the QOL PASS threshold after surgery (n = 6, 27%) had significantly greater sf interleukin-1 alpha (IL-1α; p = 0.004), IL-1 receptor antagonist (IL-1ra; p = 0.03), and matrix metalloproteinase-9 (MMP-9; p = 0.01) concentrations on the day of surgery. Patients that failed to reach the IKDC PASS threshold (n = 9, 41%) had significantly greater sf IL-1α (p = 0.02). Conclusion These pilot data suggest that initial biochemical changes after injury may be an indicator of poor outcomes that are not mitigated by surgical stabilization alone. Biological adjuvant treatment in addition to ACL reconstruction may be beneficial; however, these data should be used for hypothesis generation and more definitive randomized clinical trials are necessary.
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Qadri M, Almadani S, Jay GD, Elsaid KA. Role of CD44 in Regulating TLR2 Activation of Human Macrophages and Downstream Expression of Proinflammatory Cytokines. THE JOURNAL OF IMMUNOLOGY 2017; 200:758-767. [PMID: 29196459 DOI: 10.4049/jimmunol.1700713] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/05/2017] [Indexed: 12/11/2022]
Abstract
Osteoarthritis (OA) is a low-grade chronic inflammatory joint disease. Innate immunity contributes to OA progression, mediated by TLR2 and TLR4. We evaluated the role of cluster determinant 44 (CD44), a transmembrane glycoprotein, in regulating TLR2-linked macrophage activation and resultant proinflammatory responses. TLR2 stimulation was performed on differentiated THP-1 macrophages in the presence or absence of a CD44-specific Ab or hyaluronan (HA). NF-κB nuclear translocation, IL-1 β and TNF-α gene expression, and protein concentrations were determined. Anti-CD44 Ab and HA treatments reduced NF-κB translocation, IL-1β and TNF-α expression, and production (p < 0.001). Inhibition of proinflammatory response in macrophages by HA was mediated by CD44. Protein phosphatase 2A mediated the reduction in NF-κB translocation by HA. CD44 knockdown reduced NF-κB nuclear translocation and downstream IL-1β and TNF-α protein production following TLR2 receptor stimulation (p < 0.001). CD44+/+ murine bone marrow-derived macrophages produced higher TNF-α compared with CD44-/- macrophages following TLR2 stimulation (p < 0.01). HA dose-dependently inhibited TLR2-induced TNF-α production by murine bone marrow-derived macrophages (p < 0.001). OA synovial fluids (SF) stimulated TLR2 and TLR4 receptors and induced NF-κB translocation in THP-1 macrophages. Anti-CD44 Ab treatment significantly reduced macrophage activation by OA SF (p < 0.01). CD44 regulated TLR2 responses in human macrophages, whereby a reduction in CD44 levels or engagement of CD44 by its ligand (HA) or a CD44-specific Ab reduced NF-κB translocation and downstream proinflammatory cytokine production. A CD44-specific Ab reduced macrophage activation by OA SF, and CD44 is a potentially novel target in OA treatment.
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Affiliation(s)
- Marwa Qadri
- Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy, Chapman University, Irvine, CA 92618
| | - Sara Almadani
- Department of Pharmaceutical Sciences, Massachusetts College of Pharmacy and Health Sciences, Boston, MA 02115; and
| | - Gregory D Jay
- Department of Emergency Medicine, Rhode Island Hospital, Providence, RI 02903
| | - Khaled A Elsaid
- Department of Biomedical and Pharmaceutical Sciences, School of Pharmacy, Chapman University, Irvine, CA 92618;
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Sensitization and Serological Biomarkers in Knee Osteoarthritis Patients With Different Degrees of Synovitis. Clin J Pain 2017; 32:841-8. [PMID: 26633689 DOI: 10.1097/ajp.0000000000000334] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Synovitis is a frequent condition in knee osteoarthritis (KOA) and has been associated with pain. This study investigated the links between the pressure hyperalgesia, the clinical pain, the degree of the synovitis, inflammatory biomarkers, and tissue-specific biomarkers in KOA patients. MATERIALS AND METHODS Fifty-eight KOA patients and 33 pain-free controls participated in this study. The patients were magnetic resonance imaging scanned, and the Boston-Leeds OA Knee Score (BLOKS, 0 to 3) was used to assess the degree of synovitis. The maximal knee pain intensity over the last 24 hours was scored on a visual analog scale (VAS). The pressure pain thresholds (PPTs) were assessed over the KOA-affected knee. Serological biomarkers were measured in fasting serum: high-sensitive C-reactive protein, matrix metalloproteinase-mediated degradation of CRP, and matrix metalloproteinase-mediated collagen type I, II, and III degradation (C1M [connective tissue], C2M [cartilage], C3M [synovial membrane]). RESULTS Compared with controls, the KOA patients showed increased levels of C1M (P<0.02), C2M (P<0.001), and high-sensitive C-reactive protein (P<0.02), decreased level of C3M (P<0.03), and reduced PPTs (P<0.03). Patients with no (BLOKS 0) and moderate to severe (BLOKS 2&3) synovitis had significantly lower PPTs compared with mild synovitis (BLOKS 1). Significantly negative correlations were found between VAS and PPTs. No correlations were found between BLOKS and the VAS, PPT, or biomarkers. DISCUSSION Patients without and with moderate to severe synovitis demonstrated local pressure hyperalgesia and increased degrees of: (1) systemic inflammation, (2) connective tissue degradation, (3) cartilage degradation, and (4) decreased synovial membrane degradation as compared with controls.
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Eitner A, Hofmann GO, Schaible HG. Mechanisms of Osteoarthritic Pain. Studies in Humans and Experimental Models. Front Mol Neurosci 2017; 10:349. [PMID: 29163027 PMCID: PMC5675866 DOI: 10.3389/fnmol.2017.00349] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/13/2017] [Indexed: 12/12/2022] Open
Abstract
Pain due to osteoarthritis (OA) is one of the most frequent causes of chronic pain. However, the mechanisms of OA pain are poorly understood. This review addresses the mechanisms which are thought to be involved in OA pain, derived from studies on pain mechanisms in humans and in experimental models of OA. Three areas will be considered, namely local processes in the joint associated with OA pain, neuronal mechanisms involved in OA pain, and general factors which influence OA pain. Except the cartilage all structures of the joints are innervated by nociceptors. Although the hallmark of OA is the degradation of the cartilage, OA joints show multiple structural alterations of cartilage, bone and synovial tissue. In particular synovitis and bone marrow lesions have been proposed to determine OA pain whereas the contribution of the other pathologies to pain generation has been studied less. Concerning the peripheral neuronal mechanisms of OA pain, peripheral nociceptive sensitization was shown, and neuropathic mechanisms may be involved at some stages. Structural changes of joint innervation such as local loss and/or sprouting of nerve fibers were shown. In addition, central sensitization, reduction of descending inhibition, descending excitation and cortical atrophies were observed in OA. The combination of different neuronal mechanisms may define the particular pain phenotype in an OA patient. Among mediators involved in OA pain, nerve growth factor (NGF) is in the focus because antibodies against NGF significantly reduce OA pain. Several studies show that neutralization of interleukin-1β and TNF may reduce OA pain. Many patients with OA exhibit comorbidities such as obesity, low grade systemic inflammation and diabetes mellitus. These comorbidities can significantly influence the course of OA, and pain research just began to study the significance of such factors in pain generation. In addition, psychologic and socioeconomic factors may aggravate OA pain, and in some cases genetic factors influencing OA pain were found. Considering the local factors in the joint, the neuronal processes and the comorbidities, a better definition of OA pain phenotypes may become possible. Studies are under way in order to improve OA and OA pain monitoring.
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Affiliation(s)
- Annett Eitner
- Department of Physiology, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Gunther O Hofmann
- Department of Traumatology and Orthopedic Surgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany.,Trauma Center Bergmannstrost Halle, Halle, Germany
| | - Hans-Georg Schaible
- Department of Physiology, University Hospital Jena, Friedrich Schiller University, Jena, Germany
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Prakash J, Gabdulina G, Trofimov S, Livshits G. Quantitative genetics of circulating Hyaluronic Acid (HA) and its correlation with hand osteoarthritis and obesity-related phenotypes in a community-based sample. Ann Hum Biol 2017; 44:522-530. [PMID: 28535729 DOI: 10.1080/03014460.2017.1334822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND One of the potential molecular biomarkers of osteoarthritis (OA) is hyaluronic acid (HA). HA levels may be related to the severity and progression of OA. However, little is known about the contribution of major risk factors for osteoarthritis, e.g. obesity-related phenotypes and genetics to HA variation. AIM To clarify the quantitative effect of these factors on HA. SUBJECTS AND METHODS An ethnically homogeneous sample of 911 apparently healthy European-derived individuals, assessed for radiographic hand osteoarthritis (RHOA), HA, leptin, adiponectin, and several anthropometrical measures of obesity-related phenotypes was studied. Model-based quantitative genetic analysis was used to reveal genetic and shared environmental factors affecting the variation of the study's phenotypes. RESULTS The HA levels significantly correlated with the age, RHOA, adiponectin, obesity-related phenotypes, and the waist-to-hip ratio. The putative genetic effects contributed significantly to the variation of HA (66.2 ± 9.3%) and they were also significant factors in the variations of all the other studied phenotypes, with the heritability estimate ranging between 0.122 ± 4.4% (WHR) and 45.7 ± 2.2% (joint space narrowing). CONCLUSIONS This is the first study to report heritability estimates of HA variation and its correlation with obesity-related phenotypes, ADP and RHOA. However, the nature of genetic effects on HA and its correlation with other study phenotypes require further clarification.
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Affiliation(s)
- Jai Prakash
- a Human Population Biology Research Unit, Department of Anatomy and Anthropology , Tel Aviv University , Tel Aviv , Israel
| | - Gulzhan Gabdulina
- b Department of Internal Medicine , Asfendiyarov Kazakh National Medical University , Almigty , Kazakhstan
| | - Svetlana Trofimov
- a Human Population Biology Research Unit, Department of Anatomy and Anthropology , Tel Aviv University , Tel Aviv , Israel
| | - Gregory Livshits
- a Human Population Biology Research Unit, Department of Anatomy and Anthropology , Tel Aviv University , Tel Aviv , Israel.,c Lilian and Marcel Pollak Chair of Biological Anthropology, Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Is there a relationship between serum ox-LDL, oxidative stress, and PON1 in knee osteoarthritis? Clin Rheumatol 2017. [DOI: 10.1007/s10067-017-3732-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Pain prediction by serum biomarkers of bone turnover in people with knee osteoarthritis: an observational study of TRAcP5b and cathepsin K in OA. Osteoarthritis Cartilage 2017; 25:858-865. [PMID: 28087412 DOI: 10.1016/j.joca.2017.01.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/16/2016] [Accepted: 01/04/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate serum biomarkers, tartrate resistant acid phosphatase 5b (TRAcP5b) and cathepsin K (cath-K), indicative of osteoclastic bone resorption, and their relationship to pain and pain change in knee osteoarthritis (OA). METHODS Sera and clinical data were collected from 129 people (97 with 3-year follow-up) with knee OA from the Prediction of Osteoarthritis Progression (POP) cohort. Knee OA-related outcomes in POP included: WOMAC pain, National Health and Nutrition Examination Survey (NHANES) I (pain, aching and stiffness), subchondral sclerosis, and radiographically determined tibiofemoral and patellofemoral OA. Two putative osteoclast biomarkers were measured in sera: TRAcP5b and cath-K. Medial tibia plateaux were donated at knee arthroplasty for symptomatic OA (n = 84) or from 16 post mortem (PM) controls from the Arthritis Research UK (ARUK) Pain Centre joint tissue repository. Osteoclasts were stained for tartrate resistant acid phosphatase (TRAcP) within the subchondral bone of the medial tibia plateaux. RESULTS Serum TRAcP5b activity, but not cath-K-immunoreactivity, was associated with density of TRAcP-positive osteoclasts in the subchondral bone of medial tibia plateaux. TRAcP-positive osteoclasts were more abundant in people with symptomatic OA compared to controls. Serum TRAcP5b activity was associated with baseline pain and pain change. CONCLUSIONS Our observations support a role for subchondral osteoclast activity in the generation of OA pain. Serum TRAcP5b might be a clinically relevant biomarker of disease activity in OA.
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Alquraini A, Jamal M, Zhang L, Schmidt T, Jay GD, Elsaid KA. The autocrine role of proteoglycan-4 (PRG4) in modulating osteoarthritic synoviocyte proliferation and expression of matrix degrading enzymes. Arthritis Res Ther 2017; 19:89. [PMID: 28482921 PMCID: PMC5423025 DOI: 10.1186/s13075-017-1301-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 04/28/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Lubricin/proteoglycan 4 (PRG4) is a mucinous glycoprotein secreted by synovial fibroblasts and superficial zone chondrocytes. Recently, we showed that recombinant human PRG4 (rhPRG4) is a putative ligand for CD44 receptor. rhPRG4-CD44 interaction inhibits cytokine-induced rheumatoid arthritis synoviocyte proliferation. The objective of this study is to decipher the autocrine function of PRG4 in regulating osteoarthritic synoviocyte proliferation and expression of catabolic and pro-inflammatory mediators under basal and interleukin-1 beta (IL-1β)-stimulated conditions. METHODS Cytosolic and nuclear levels of nuclear factor kappa B (NFκB) p50 and p65 subunits in Prg4 +/+ and Prg4 -/- synoviocytes were studied using western blot. Nuclear translocation of p50 and p65 proteins in osteoarthritis (OA) fibroblast-like synoviocytes (FLS) in response to IL-1β stimulation in the absence or presence of rhPRG4 was studied using DNA binding assays. OA synoviocyte (5000 cells per well) proliferation following IL-1β (20 ng/ml) treatment in the absence or presence of rhPRG4 (50-200 μg/ml) over 48 hours was determined using a colorimetric assay. Gene expression of matrix metalloproteinases (MMPs), tissue inhibitor of metallproteinases-1 (TIMP-1), TIMP-2, IL-1β, IL-6, IL-8, TNF-α, cycloxygenae-2 (COX2) and PRG4 in unstimulated and IL-1β (1 ng/ml)-stimulated OA synoviocytes, in the presence or absence of rhPRG4 (100 and 200 μg/ml), was studied following incubation for 24 hours. RESULTS Prg4 -/- synoviocytes contained higher nuclear p50 and p65 levels compared to Prg4 +/+ synoviocytes (p < 0.05). rhPRG4 (100 μg/ml) reduced p50 and p65 nuclear levels in Prg4 +/+ and Prg4 -/- synoviocytes (p < 0.001). Similarly, rhPRG4 (200 μg/ml) inhibited NFκB translocation and cell proliferation in OA synoviocytes in a CD44-dependent manner (p < 0.001) via inhibition of IκBα phosphorylation. IL-1β reduced PRG4 expression in OA synoviocytes and rhPRG4 (100 μg/ml) treatment reversed this effect (p < 0.001). rhPRG4 (200 μg/ml) reduced basal gene expression of MMP-1, MMP-3, MMP-13, IL-6, IL-8, and PRG4 in OA synoviocytes, while increasing TIMP-2 and cycloxygenase-2 (COX2) expression (p < 0.001). rhPRG4 (200 μg/ml) reduced IL-1β induction of MMP-1, MMP-3, MMP-9, MMP-13, IL-6, IL-8, and COX2 expression in a CD44-dependent manner (p < 0.001). CONCLUSION PRG4 plays an important anti-inflammatory role in regulating OA synoviocyte proliferation and reduces basal and IL-1β-stimulated expression of catabolic mediators. Exogenous rhPRG4 autoregulates native PRG4 expression in OA synoviocytes.
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Affiliation(s)
- Ali Alquraini
- Department of Pharmaceutical Sciences, MCPHS University, Boston, MA, USA.,School of Pharmacy, Albaha University, Albaha, Saudi Arabia
| | - Maha Jamal
- Department of Pharmaceutical Sciences, MCPHS University, Boston, MA, USA
| | - Ling Zhang
- Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Tannin Schmidt
- Faculty of Kinesiology and Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Gregory D Jay
- Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA.,Department of Biomedical Engineering, Brown University, Providence, RI, USA
| | - Khaled A Elsaid
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Rinker Health Sciences Campus, 9401 Jeronimo Road, Irvine, CA, 92618, USA.
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Li H, Zeng C, Wei J, Yang T, Gao SG, Luo W, Li YS, Xiong YL, Xiao WF, Lei GH. Associations of dietary and serum magnesium with serum high-sensitivity C-reactive protein in early radiographic knee osteoarthritis patients. Mod Rheumatol 2016; 27:669-674. [PMID: 27588353 DOI: 10.1080/14397595.2016.1230296] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Hui Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China,
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China,
| | - Jie Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China, and
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, China
| | - Tuo Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China,
| | - Shu-Guang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China,
| | - Wei Luo
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China,
| | - Yu-Sheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China,
| | - Yi-Lin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China,
| | - Wen-Feng Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China,
| | - Guang-Hua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China,
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Robinson WH, Lepus CM, Wang Q, Raghu H, Mao R, Lindstrom TM, Sokolove J. Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nat Rev Rheumatol 2016; 12:580-92. [PMID: 27539668 DOI: 10.1038/nrrheum.2016.136] [Citation(s) in RCA: 824] [Impact Index Per Article: 103.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Osteoarthritis (OA) has long been viewed as a degenerative disease of cartilage, but accumulating evidence indicates that inflammation has a critical role in its pathogenesis. Furthermore, we now appreciate that OA pathogenesis involves not only breakdown of cartilage, but also remodelling of the underlying bone, formation of ectopic bone, hypertrophy of the joint capsule, and inflammation of the synovial lining. That is, OA is a disorder of the joint as a whole, with inflammation driving many pathologic changes. The inflammation in OA is distinct from that in rheumatoid arthritis and other autoimmune diseases: it is chronic, comparatively low-grade, and mediated primarily by the innate immune system. Current treatments for OA only control the symptoms, and none has been FDA-approved for the prevention or slowing of disease progression. However, increasing insight into the inflammatory underpinnings of OA holds promise for the development of new, disease-modifying therapies. Indeed, several anti-inflammatory therapies have shown promise in animal models of OA. Further work is needed to identify effective inhibitors of the low-grade inflammation in OA, and to determine whether therapies that target this inflammation can prevent or slow the development and progression of the disease.
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Affiliation(s)
- William H Robinson
- Geriatric Research Education and Clinical Centers, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, California 94304, USA.,Division of Immunology and Rheumatology, Stanford University School of Medicine, Center for Clinical Sciences Research (CCSR) 4135, 269 Campus Drive, Stanford, California 94305, USA
| | - Christin M Lepus
- Geriatric Research Education and Clinical Centers, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, California 94304, USA.,Division of Immunology and Rheumatology, Stanford University School of Medicine, Center for Clinical Sciences Research (CCSR) 4135, 269 Campus Drive, Stanford, California 94305, USA
| | - Qian Wang
- Geriatric Research Education and Clinical Centers, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, California 94304, USA.,Division of Immunology and Rheumatology, Stanford University School of Medicine, Center for Clinical Sciences Research (CCSR) 4135, 269 Campus Drive, Stanford, California 94305, USA
| | - Harini Raghu
- Geriatric Research Education and Clinical Centers, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, California 94304, USA.,Division of Immunology and Rheumatology, Stanford University School of Medicine, Center for Clinical Sciences Research (CCSR) 4135, 269 Campus Drive, Stanford, California 94305, USA
| | - Rong Mao
- Geriatric Research Education and Clinical Centers, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, California 94304, USA.,Division of Immunology and Rheumatology, Stanford University School of Medicine, Center for Clinical Sciences Research (CCSR) 4135, 269 Campus Drive, Stanford, California 94305, USA
| | - Tamsin M Lindstrom
- Geriatric Research Education and Clinical Centers, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, California 94304, USA.,Division of Immunology and Rheumatology, Stanford University School of Medicine, Center for Clinical Sciences Research (CCSR) 4135, 269 Campus Drive, Stanford, California 94305, USA
| | - Jeremy Sokolove
- Geriatric Research Education and Clinical Centers, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, California 94304, USA.,Division of Immunology and Rheumatology, Stanford University School of Medicine, Center for Clinical Sciences Research (CCSR) 4135, 269 Campus Drive, Stanford, California 94305, USA
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Chiba D, Tsuda E, Maeda S, Sasaki E, Takahashi I, Nakaji S, Ishibashi Y. Evaluation of a quantitative measurement of suprapatellar effusion by ultrasonography and its association with symptoms of radiographic knee osteoarthritis: a cross-sectional observational study. Arthritis Res Ther 2016; 18:181. [PMID: 27487832 PMCID: PMC4973041 DOI: 10.1186/s13075-016-1078-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/15/2016] [Indexed: 12/20/2022] Open
Abstract
Background Quantitative measurement of knee joint effusion by ultrasonography has not been well established; however, a categorical measurement (e.g., a ≥4-mm-deep suprapatellar pouch) is recommended. Therefore, the current study aimed to elucidate the association between symptoms of knee osteoarthritis (OA) and the quantitative measurement of suprapatellar effusion by ultrasonography. Methods One hundred twenty-seven volunteers participated (31 men and 96 women; mean age: 68.3 ± 9.8 years; body mass index: 23.2 ± 3.0 kg/m2). The Kellgren-Lawrence grades (KLGs) of both knees were assessed; all subjects had definitive osteoarthritic change (KLG ≥2) in both knee joints. Joint effusion was evaluated using an ultrasound probe, which was placed longitudinally on the suprapatellar pouch, and we determined the area (mm2) of the echo-free space. Then we summed the effusion area of both knees. All subjects answered the knee injury and osteoarthritis outcome scale (KOOS) questionnaire. Multiple linear regression analysis was conducted to elucidate the association between the summed value of the knee effusion area and the KOOS subscales, which were adjusted by age, sex, body mass index, and KLG. Results Of 254 knees, 180 were KLG 2, 57 were KLG 3, and 17 were KLG 4. The multiple regression models showed that the quantitative knee effusion area significantly correlated with the following KOOS subscales: pain (B = −0.057; β = −0.253; P = 0.002), symptom (B = −0.053; β = −0.251; P = 0.002), sport and recreation (B = −0.069; β = −0.205; P = 0.007), and quality of life (B = −0.083; β = −0.276; P = 0.001). Conclusion In this cross-sectional study, the quantitative measurement of suprapatellar effusion by ultrasonography was associated with symptoms of radiographic knee OA.
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Affiliation(s)
- Daisuke Chiba
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. .,Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Eiichi Tsuda
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shugo Maeda
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ippei Takahashi
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shigeyuki Nakaji
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Liu L, Ishijima M, Kaneko H, Sadatsuki R, Hada S, Kinoshita M, Aoki T, Futami I, Yusup A, Arita H, Shiozawa J, Takazawa Y, Ikeda H, Kaneko K. The MRI-detected osteophyte score is a predictor for undergoing joint replacement in patients with end-stage knee osteoarthritis. Mod Rheumatol 2016; 27:332-338. [PMID: 27425372 DOI: 10.1080/14397595.2016.1206509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this prospective cohort study was to examine whether MRI-detected osteoarthritis (OA)-structural changes at baseline could predict knee OA patients who would undergo total knee arthroplasty (TKA). METHODS In total, 128 end-stage medial-type knee OA patients were enrolled and followed up for 6 months. MRI using the whole-organ MRI scoring (WORMS) method, radiographic findings, visual analog scale (VAS) for pain and a patient-oriented outcome measure, and the Japanese Knee Osteoarthritis Measure (JKOM) were recorded at baseline. The area under the curve (AUC) was estimated to determine the discriminative value of the prediction models. RESULTS While 74 patients (57.8%) did not undergo TKA, the remaining 54 patients (42.2%) underwent TKA during this period. The AUCs of the receiver operating characteristic (ROC) curve for the activities of daily living (ADL) score evaluated by the JKOM ADL score [0.70 (95% CI: 0.60-0.79)] and osteophyte score [0.72 (0.64-0.81)] were 0.70 or greater. The JKOM ADL score (17/40) and the osteophyte score (30/98) showed relative risks (RR) of 2.61 (1.32-5.15) and 3.01 (1.39-6.52) for undergoing TKA, respectively. CONCLUSION The osteophyte score detected by MRI, in addition to ADL score, was found to be an important factor in determining whether the patient should undergo TKA.
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Affiliation(s)
- Lizu Liu
- a Department of Medicine for Orthopaedics and Motor Organ , Juntendo University Graduate School of Medicine , Tokyo , Japan.,b Sportology Center, Juntendo University Graduate School of Medicine , Tokyo , Japan , and
| | - Muneaki Ishijima
- a Department of Medicine for Orthopaedics and Motor Organ , Juntendo University Graduate School of Medicine , Tokyo , Japan.,b Sportology Center, Juntendo University Graduate School of Medicine , Tokyo , Japan , and
| | - Haruka Kaneko
- a Department of Medicine for Orthopaedics and Motor Organ , Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Ryo Sadatsuki
- a Department of Medicine for Orthopaedics and Motor Organ , Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Shinnosuke Hada
- a Department of Medicine for Orthopaedics and Motor Organ , Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Mayuko Kinoshita
- a Department of Medicine for Orthopaedics and Motor Organ , Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Takako Aoki
- b Sportology Center, Juntendo University Graduate School of Medicine , Tokyo , Japan , and
| | - Ippei Futami
- a Department of Medicine for Orthopaedics and Motor Organ , Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Anwarjan Yusup
- a Department of Medicine for Orthopaedics and Motor Organ , Juntendo University Graduate School of Medicine , Tokyo , Japan.,c Research Institute for Diseases of Old Age, Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Hitoshi Arita
- a Department of Medicine for Orthopaedics and Motor Organ , Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Jun Shiozawa
- a Department of Medicine for Orthopaedics and Motor Organ , Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Yuji Takazawa
- a Department of Medicine for Orthopaedics and Motor Organ , Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Hiroshi Ikeda
- a Department of Medicine for Orthopaedics and Motor Organ , Juntendo University Graduate School of Medicine , Tokyo , Japan
| | - Kazuo Kaneko
- a Department of Medicine for Orthopaedics and Motor Organ , Juntendo University Graduate School of Medicine , Tokyo , Japan.,b Sportology Center, Juntendo University Graduate School of Medicine , Tokyo , Japan , and
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Wei Y, Bai L. Recent advances in the understanding of molecular mechanisms of cartilage degeneration, synovitis and subchondral bone changes in osteoarthritis. Connect Tissue Res 2016; 57:245-61. [PMID: 27285430 DOI: 10.1080/03008207.2016.1177036] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Osteoarthritis (OA), the most common form of degenerative joint disease, is linked to high morbidity. It is predicted to be the single greatest cause of disability in the general population by 2030. The development of disease-modifying therapy for OA currently face great obstacle mainly because the onset and development of the disease involve complex molecular mechanisms. In this review, we will comprehensively summarize biological and pathological mechanisms of three key aspects: degeneration of articular cartilage, synovial immunopathogenesis, and changes in subchondral bone. For each tissue, we will focus on the molecular receptors, cytokines, peptidases, related cell, and signal pathways. Agents that specifically block mechanisms involved in synovial inflammation, degeneration of articular cartilage, and subchondral bone remodeling can potentially be exploited to produce targeted therapy for OA. Such new comprehensive agents will benefit affected patients and bring exciting new hope for the treatment of OA.
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Affiliation(s)
- Yingliang Wei
- a Department of Orthopedic Surgery, Sheng-Jing Hospital , China Medical University , ShenYang , China
| | - Lunhao Bai
- a Department of Orthopedic Surgery, Sheng-Jing Hospital , China Medical University , ShenYang , China
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48
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Osteoarthritis as a Cause of Locomotive Syndrome: Its Influence on Functional Mobility and Activities of Daily Living. Clin Rev Bone Miner Metab 2016. [DOI: 10.1007/s12018-016-9212-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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49
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Vilar JM, Rubio M, Spinella G, Cuervo B, Sopena J, Cugat R, Garcia-Balletbó M, Dominguez JM, Granados M, Tvarijonaviciute A, Ceron JJ, Carrillo JM. Serum Collagen Type II Cleavage Epitope and Serum Hyaluronic Acid as Biomarkers for Treatment Monitoring of Dogs with Hip Osteoarthritis. PLoS One 2016; 11:e0149472. [PMID: 26886592 PMCID: PMC4757546 DOI: 10.1371/journal.pone.0149472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/31/2016] [Indexed: 01/10/2023] Open
Abstract
The aim of this study was to evaluate the use of serum type II collagen cleavage epitope and serum hyaluronic acid as biomarkers for treatment monitoring in osteoarthritic dogs. For this purpose, a treatment model based on mesenchymal stem cells derived from adipose tissue combined with plasma rich in growth factors was used. This clinical study included 10 dogs with hip osteoarthritis. Both analytes were measured in serum at baseline, just before applying the treatment, and 1, 3, and 6 months after treatment. These results were compared with those obtained from force plate analysis using the same animals during the same study period. Levels of type II collagen cleavage epitope decreased and those of hyaluronic acid increased with clinical improvement objectively verified via force plate analysis, suggesting these two biomarkers could be effective as indicators of clinical development of joint disease in dogs.
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Affiliation(s)
- José M. Vilar
- Departamento de Patología Animal, Universidad de las Palmas de Gran Canaria, Arucas, Las Palmas, Spain
- * E-mail:
| | - Mónica Rubio
- Departamento Medicina y Cirugía Animal, Cátedra García Cugat, Universidad CEU Cardenal Herrera, Valencia, Spain
| | - Giuseppe Spinella
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell’Emilia, Bologna, Italy
| | - Belén Cuervo
- Departamento Medicina y Cirugía Animal, Cátedra García Cugat, Universidad CEU Cardenal Herrera, Valencia, Spain
| | - Joaquín Sopena
- Departamento Medicina y Cirugía Animal, Cátedra García Cugat, Universidad CEU Cardenal Herrera, Valencia, Spain
| | - Ramón Cugat
- Artroscopia GC, Hospital Quirón, Barcelona, Spain
| | | | - Juan M. Dominguez
- Departamento de Medicina y Cirugía Animal, Universidad de Córdoba, Córdoba, Spain
| | - Maria Granados
- Departamento de Medicina y Cirugía Animal, Universidad de Córdoba, Córdoba, Spain
| | | | - José J. Ceron
- Departamento de Medicina y cirugía animal, Universidad de Murcia, Murcia, Spain
| | - José M. Carrillo
- Departamento Medicina y Cirugía Animal, Cátedra García Cugat, Universidad CEU Cardenal Herrera, Valencia, Spain
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50
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Rodriguez-Merchan EC. Synovium and cartilage biomarkers in hemophilic arthropathy. Expert Rev Hematol 2016; 9:409-14. [DOI: 10.1586/17474086.2016.1141674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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