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Fang N, Wang Z, Jiang J, Yang A, Mao T, Wang Z, Chen Q. Nonsurgical therapy for lumbar spinal stenosis caused by ligamentum flavum hypertrophy: A review. Medicine (Baltimore) 2024; 103:e38782. [PMID: 38968524 PMCID: PMC11224896 DOI: 10.1097/md.0000000000038782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 06/11/2024] [Indexed: 07/07/2024] Open
Abstract
Lumbar spinal stenosis (LSS) can cause a range of cauda equina symptoms, including lower back and leg pain, numbness, and intermittent claudication. This disease affects approximately 103 million people worldwide, particularly the elderly, and can seriously compromise their health and well-being. Ligamentum flavum hypertrophy (LFH) is one of the main contributing factors to this disease. Surgical treatment is currently recommended for LSS caused by LFH. For patients who do not meet the criteria for surgery, symptom relief can be achieved by using oral nonsteroidal anti-inflammatory drugs (NSAIDs) and epidural steroid injections. Exercise therapy and needle knife can also help to reduce the effects of mechanical stress. However, the effectiveness of these methods varies, and targeting the delay in LF hypertrophy is challenging. Therefore, further research and development of new drugs is necessary to address this issue. Several new drugs, including cyclopamine and N-acetyl-l-cysteine, are currently undergoing testing and may serve as new treatments for LSS caused by LFH.
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Affiliation(s)
- Nan Fang
- College of Acupuncture & Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
- Department of Orthopedics & Traumatology, Hubei Provincial Hospital of TCM, Wuhan, China
| | - Zhigang Wang
- Department of Orthopedics & Traumatology, Hubei Provincial Hospital of TCM, Wuhan, China
- Department of Orthopedics & Traumatology, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
| | - Jiecheng Jiang
- College of Acupuncture & Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
- Department of Orthopedics & Traumatology, Hubei Provincial Hospital of TCM, Wuhan, China
| | - Aofei Yang
- Department of Orthopedics & Traumatology, Hubei Provincial Hospital of TCM, Wuhan, China
- Department of Orthopedics & Traumatology, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
| | - Tian Mao
- Department of Orthopedics & Traumatology, Hubei Provincial Hospital of TCM, Wuhan, China
- Department of Orthopedics & Traumatology, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China
| | - Zitong Wang
- College of Acupuncture & Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
- Department of Orthopedics & Traumatology, Hubei Provincial Hospital of TCM, Wuhan, China
| | - Qian Chen
- College of Acupuncture & Orthopedics, Hubei University of Chinese Medicine, Wuhan, China
- Department of Orthopedics & Traumatology, Hubei Provincial Hospital of TCM, Wuhan, China
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Puertas-Umbert L, Alonso J, Roselló-Díez E, Santamaría-Orleans A, Martínez-González J, Rodríguez C. Rolipram impacts on redox homeostasis and cellular signaling in an experimental model of abdominal aortic aneurysm. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2024; 36:108-117. [PMID: 38061958 DOI: 10.1016/j.arteri.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Cyclic nucleotide phosphodiesterases (PDEs) of the PDE4 subfamily are responsible for the hydrolysis and subcellular compartmentalization of cAMP, a second messenger that modulates vascular functionality. We had shown that PDE4B is induced in abdominal aortic aneurysms (AAA) and that PDE4 inhibition by rolipram limits experimental aneurysms. In this study we have delved into the mechanisms underlying the beneficial effect of rolipram on AAA. METHODS AAA were induced in ApoE-/- mice by angiotensin II (Ang II) infusion. Aneurysm formation was evaluated by ultrasonography. The expression of enzymes involved in rédox homeostasis was analyzed by real-time RT-PCR and the activation of signaling pathways by Western blot. RESULTS Induction of PDE4B in human AAA has been confirmed in a second cohort of patients. In Ang II-infused ApoE-/- mice, rolipram increased the percentage of animals free of aneurysms without affecting the percentage of aortic ruptures. Quantitative analyses determined that this drug significantly attenuated aortic collagen deposition. Additionally, rolipram reduced the increased Nox2 expression triggered by Ang II, exacerbated Sod1 induction, and normalized Sod3 expression. Likewise, PDE4 inhibition decreased the activation of both ERK1/2 and the canonical Wnt pathway, while AKT activity was not altered. CONCLUSIONS The inhibition of PDE4 activity modulates the expression of enzymes involved in rédox homeostasis and affects cell signaling pathways involved in the development of AAA.
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Affiliation(s)
- Lídia Puertas-Umbert
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, España; Institut de Recerca Hospital de la Santa Creu i Sant Pau (IRHSCSP), Barcelona, España; CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, España
| | - Judith Alonso
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, España; CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, España; Instituto de Investigaciones Biomédicas de Barcelona (IIBB-CSIC), Barcelona, España
| | - Elena Roselló-Díez
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, España; Departamento de Cirugía Cardíaca, Hospital de la Santa Creu i Sant Pau-Universitat Autònoma de Barcelona (HSCSP-UAB), Barcelona, España
| | - Alicia Santamaría-Orleans
- Laboratorios Ordesa S.L., Scientific Communication Department, Sant Boi del Llobregat, Barcelona, España
| | - José Martínez-González
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, España; CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, España; Instituto de Investigaciones Biomédicas de Barcelona (IIBB-CSIC), Barcelona, España
| | - Cristina Rodríguez
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, España; Institut de Recerca Hospital de la Santa Creu i Sant Pau (IRHSCSP), Barcelona, España; CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, España.
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Ma C, Qi X, Wei YF, Li Z, Zhang HL, Li H, Yu FL, Pu YN, Huang YC, Ren YX. Amelioration of ligamentum flavum hypertrophy using umbilical cord mesenchymal stromal cell-derived extracellular vesicles. Bioact Mater 2023; 19:139-154. [PMID: 35475028 PMCID: PMC9014323 DOI: 10.1016/j.bioactmat.2022.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/09/2022] Open
Abstract
Ligamentum flavum (LF) hypertrophy (LFH) has been recognised as one of the key contributors to lumbar spinal stenosis. Currently, no effective methods are available to ameliorate this hypertrophy. In this study, human umbilical cord mesenchymal stromal cell-derived extracellular vesicles (hUCMSC-EVs) were introduced for the first time as promising vehicles for drug delivery to treat LFH. The downregulation of miR-146a-5p and miR-221-3p expressions in human LF tissues negatively correlated with increased LF thickness. The hUCMSC-EVs enriched with these two miRNAs significantly suppressed LFH in vivo and notably ameliorated the progression of transforming growth factor β1(TGF-β1)-induced fibrosis in vitro after delivering these two miRNAs to mouse LF cells. The results further demonstrated that miR-146a-5p and miR-221-3p directly bonded to the 3′-UTR regions of SMAD4 mRNA, thereby inhibiting the TGF-β/SMAD4 signalling pathway. Therefore, this translational study determined the effectiveness of a hUCMSC-EVs-based approach for the treatment of LFH and revealed the critical target of miR-146a-5p and miR-221-3p. Our findings provide new insights into promising therapeutics using a hUCMSC-EVs-based delivery system for patients with lumbar spinal stenosis. The downregulation of miR-146a-5p and miR-221-3p expressions were negatively correlated with the development of LFH. MiR-146a-5p and miR-221-3p enriched in hUCMSC-EVs prevent the fibrosis of LF by targeting SMAD4. hUCMSC-EVs are effective as bioactive vehicles to ameliorate the progression of LFH. hUCMSC-EVs-based delivery system is a promising therapy for the patients with lumbar spinal stenosis.
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Li P, Fei CS, Chen YL, Chen ZS, Lai ZM, Tan RQ, Yu YP, Xiang X, Dong JL, Zhang JX, Wang L, Zhang ZM. Revealing the novel autophagy-related genes for ligamentum flavum hypertrophy in patients and mice model. Front Immunol 2022; 13:973799. [PMID: 36275675 PMCID: PMC9581255 DOI: 10.3389/fimmu.2022.973799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Fibrosis is a core pathological factor of ligamentum flavum hypertrophy (LFH) resulting in degenerative lumbar spinal stenosis. Autophagy plays a vital role in multi-organ fibrosis. However, autophagy has not been reported to be involved in the pathogenesis of LFH. Methods The LFH microarray data set GSE113212, derived from Gene Expression Omnibus, was analyzed to obtain differentially expressed genes (DEGs). Potential autophagy-related genes (ARGs) were obtained with the human autophagy regulator database. Functional analyses including Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment, Gene Set Enrichment Analysis (GSEA), and Gene Set Variation Analysis (GSVA) were conducted to elucidate the underlying biological pathways of autophagy regulating LFH. Protein-protein interaction (PPI) network analyses was used to obtain hub ARGs. Using transmission electron microscopy, quantitative RT-PCR, Western blotting, and immunohistochemistry, we identified six hub ARGs in clinical specimens and bipedal standing (BS) mouse model. Results A total of 70 potential differentially expressed ARGs were screened, including 50 up-regulated and 20 down-regulated genes. According to GO enrichment and KEGG analyses, differentially expressed ARGs were mainly enriched in autophagy-related enrichment terms and signaling pathways related to autophagy. GSEA and GSVA results revealed the potential mechanisms by demonstrating the signaling pathways and biological processes closely related to LFH. Based on PPI network analysis, 14 hub ARGs were identified. Using transmission electron microscopy, we observed the autophagy process in LF tissues for the first time. Quantitative RT-PCR, Western blotting, and immunohistochemistry results indicated that the mRNA and protein expression levels of FN1, TGFβ1, NGF, and HMOX1 significantly higher both in human and mouse with LFH, while the mRNA and protein expression levels of CAT and SIRT1 were significantly decreased. Conclusion Based on bioinformatics analysis and further experimental validation in clinical specimens and the BS mouse model, six potential ARGs including FN1, TGFβ1, NGF, HMOX1, CAT, and SIRT1 were found to participate in the fibrosis process of LFH through autophagy and play an essential role in its molecular mechanism. These potential genes may serve as specific therapeutic molecular targets in the treatment of LFH.
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Affiliation(s)
- Peng Li
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Cheng-shuo Fei
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yan-lin Chen
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ze-sen Chen
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhong-ming Lai
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rui-qian Tan
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yong-peng Yu
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xin Xiang
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jia-le Dong
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jun-xiong Zhang
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liang Wang
- Department of Orthopedics, The Third Affiliated Hospital, Southern Medical University, Academy of Orthopedics, Guangzhou, China
- *Correspondence: Liang Wang, ; Zhong-min Zhang,
| | - Zhong-min Zhang
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Liang Wang, ; Zhong-min Zhang,
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