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Kim K. Rethinking about Metformin: Promising Potentials. Korean J Fam Med 2024; 45:258-267. [PMID: 39182908 PMCID: PMC11427230 DOI: 10.4082/kjfm.24.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 08/19/2024] [Indexed: 08/27/2024] Open
Abstract
Metformin is widely used drugs in the treatment of type 2 diabetes mellitus. However, the mechanisms of action are complex and are still not fully understood yet. Metformin has a dose-dependent blood sugar-lowering effect. The most common adverse reactions of metformin are gastrointestinal symptoms, and women tend to be more experienced than men. A positive correlation between the administration of duration and the daily dose of metformin and the risk of vitamin B12 deficiency is confirmed. Novel glucose-lowering mechanism through the activation of AMP-activated protein kinase and alteration of gut microbiota composition is identified. In addition, metformin has immunomodulatory properties in various mechanisms, including anti-inflammatory actions, and so forth. Metformin improves insulin sensitivity, which may reduce the risk of tumor growth in certain cancers. The antiviral effects of metformin may occur through several mechanisms, including blocking angiotensin converting enzyme 2 receptor, and so forth. These potential mechanisms of metformin are promising in various clinical settings, such as inflammatory diseases, autoimmune diseases, cancer, and coronavirus disease 2019.
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Affiliation(s)
- Kyunam Kim
- Department of Family Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
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Binvignat M, Sellam J, Berenbaum F, Felson DT. The role of obesity and adipose tissue dysfunction in osteoarthritis pain. Nat Rev Rheumatol 2024; 20:565-584. [PMID: 39112603 DOI: 10.1038/s41584-024-01143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2024] [Indexed: 08/29/2024]
Abstract
Obesity has a pivotal and multifaceted role in pain associated with osteoarthritis (OA), extending beyond the mechanistic influence of BMI. It exerts its effects both directly and indirectly through various modifiable risk factors associated with OA-related pain. Adipose tissue dysfunction is highly involved in OA-related pain through local and systemic inflammation, immune dysfunction, and the production of pro-inflammatory cytokines and adipokines. Adipose tissue dysfunction is intricately connected with metabolic syndrome, which independently exerts specific effects on OA-related pain, distinct from its association with BMI. The interplay among obesity, adipose tissue dysfunction and metabolic syndrome influences OA-related pain through diverse pain mechanisms, including nociceptive pain, peripheral sensitization and central sensitization. These complex interactions contribute to the heightened pain experience observed in individuals with OA and obesity. In addition, pain management strategies are less efficient in individuals with obesity. Importantly, therapeutic interventions targeting obesity and metabolic syndrome hold promise in managing OA-related pain. A deeper understanding of the intricate relationship between obesity, metabolic syndrome and OA-related pain is crucial and could have important implications for improving pain management and developing innovative therapeutic options in OA.
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Affiliation(s)
- Marie Binvignat
- Department of Rheumatology, Sorbonne University, AP-HP Saint-Antoine hospital, Paris, France
- Sorbonne University, INSERM UMRS_938, Centre de Recherche Saint-Antoine (CRSA), Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France
- Sorbonne University, INSERM UMRS_959, I3 Lab Immunology Immunopathology Immunotherapy, Paris, France
| | - Jérémie Sellam
- Department of Rheumatology, Sorbonne University, AP-HP Saint-Antoine hospital, Paris, France.
- Sorbonne University, INSERM UMRS_938, Centre de Recherche Saint-Antoine (CRSA), Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France.
| | - Francis Berenbaum
- Department of Rheumatology, Sorbonne University, AP-HP Saint-Antoine hospital, Paris, France
- Sorbonne University, INSERM UMRS_938, Centre de Recherche Saint-Antoine (CRSA), Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France
| | - David T Felson
- Boston University School of Medicine, Department of Medicine, Section of Rheumatology, Boston, MA, USA
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Aiad AAE, El-Haggar SM, El-Barbary AM, El-Afify DR. Metformin as adjuvant therapy in obese knee osteoarthritis patients. Inflammopharmacology 2024; 32:2349-2359. [PMID: 38869746 PMCID: PMC11300470 DOI: 10.1007/s10787-024-01495-y] [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: 05/08/2024] [Accepted: 05/15/2024] [Indexed: 06/14/2024]
Abstract
AIMS This study aimed at investigating the efficacy of metformin as adjuvant therapy for obese knee osteoarthritis (OA) patients, considering its anti-inflammatory and cartilage-protective effects. PATIENTS AND METHODS In this randomized, double-blind, placebo-controlled study, 50 obese knee OA patients were assigned randomly to two groups, the metformin group (n = 25) which was treated with metformin 500 mg orally BID plus celecoxib 200 mg orally once daily, and the placebo group (n = 25) which was treated with placebo tablets BID plus celecoxib 200 mg orally once daily for 12 weeks. Cartilage Oligomeric Matrix Protein (COMP), C-terminal cross-linked telopeptide of type I collagen (CTX-1), and Interleukin 1-beta (IL-1β) serum levels were measured, while Western Ontario and McMaster Universities Arthritis Index (WOMAC) score assessed knee pain, stiffness, and physical function at baseline and after 12 weeks. RESULTS Following a 12-week treatment, the metformin group exhibited significantly reduced levels of COMP, CTX-1, and IL-1β in the serum compared to the placebo group (p = 0.0081, p = 0.0106, and p = 0.0223, respectively). Furthermore, metformin group produced significant improvements in WOMAC total scale (p < 0.0001), specifically in knee pain, stiffness, and physical function compared to placebo group (p < 0.0001, p < 0.0001, and p < 0.0001, respectively). CONCLUSION Metformin as an adjuvant therapy in obese knee OA patients may have beneficial effects on cartilage degradation and inflammation, as evidenced by the significant decreases in serum COMP, CTX-1, and IL-1β levels. Additionally, metformin may improve clinical outcomes, as shown by the significant improvements in WOMAC scores. CLINICALTRIALS GOV ID NCT05638893/Registered December 6, 2022 - Retrospectively.
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Affiliation(s)
- Amany Abd Elaal Aiad
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tanta University, Tanta, 31527, Egypt.
| | | | - Amal Mohamed El-Barbary
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Tanta University, Tanta, 31527, Egypt
| | - Dalia Refat El-Afify
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tanta University, Tanta, 31527, Egypt
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Courties A. Osteoarthritis and diabetes: Is there a true link? Joint Bone Spine 2024; 91:105684. [PMID: 38181900 DOI: 10.1016/j.jbspin.2023.105684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Alice Courties
- Inserm UMRS_938, Department of Rheumatology, Centre de Recherche Saint-Antoine, Saint-Antoine Hospital, Sorbonne Université, Assistance publique-Hôpitaux de Paris (AP-HP), 75012 Paris, France.
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Aw E, Lin SL, Zhang Y, Herrmann U, Yalcin E, Langston K, Castrillion C, Ma M, Moffitt JR, Carroll MC. [WITHDRAWN] Spatial enrichment of the type 1 interferon signature in the brain of a neuropsychiatric lupus murine model. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.21.537814. [PMID: 37131759 PMCID: PMC10153248 DOI: 10.1101/2023.04.21.537814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
bioRxiv has withdrawn this manuscript because it was posted without the consent of all authors. If you have any questions, please contact the corresponding author.
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Gezer HH, Ostor A. What is new in pharmacological treatment for osteoarthritis? Best Pract Res Clin Rheumatol 2023; 37:101841. [PMID: 37302928 DOI: 10.1016/j.berh.2023.101841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 06/13/2023]
Abstract
Osteoarthritis (OA) is a degenerative joint disease in which structural changes of hyaline articular cartilage, subchondral bone, ligaments, capsule, synovium, muscles, and periarticular changes are involved. The knee is the most commonly affected joint, followed by the hand, hip, spine, and feet. Different pathological mechanisms are at play in each of these various involvement sites. Although systemic inflammation is more prominent in hand OA, knee and hip OA have been associated with excessive joint load and injury. As OA has varied phenotypes and the primarily affected tissues differ, treatment options must be tailored accordingly. In recent years, ongoing efforts have been made to develop disease-modifying options that halt or slow disease progression. Many are still in clinical trials, and as insights into the pathogenesis of OA evolve, novel therapeutic strategies will be developed. In this chapter, we provide an overview of the novel and emerging strategies in the management of OA.
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Affiliation(s)
- Halise Hande Gezer
- Marmara University School of Medicine, PMR Department Rheumatology Division, Istanbul, Turkiye
| | - Andrew Ostor
- Cabrini Medical Centre, Monash University, Melbourne & ANU, Canberra, Australia.
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Li S, Cao P, Chen T, Ding C. Latest insights in disease-modifying osteoarthritis drugs development. Ther Adv Musculoskelet Dis 2023; 15:1759720X231169839. [PMID: 37197024 PMCID: PMC10184265 DOI: 10.1177/1759720x231169839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 03/29/2023] [Indexed: 05/19/2023] Open
Abstract
Osteoarthritis (OA) is a prevalent and severely debilitating disease with an unmet medical need. In order to alleviate OA symptoms or prevent structural progression of OA, new drugs, particularly disease-modifying osteoarthritis drugs (DMOADs), are required. Several drugs have been reported to attenuate cartilage loss or reduce subchondral bone lesions in OA and thus potentially be DMOADs. Most biologics (including interleukin-1 (IL-1) and tumor necrosis factor (TNF) inhibitors), sprifermin, and bisphosphonates failed to yield satisfactory results when treating OA. OA clinical heterogeneity is one of the primary reasons for the failure of these clinical trials, which can require different therapeutic approaches based on different phenotypes. This review describes the latest insights into the development of DMOADs. We summarize in this review the efficacy and safety profiles of various DMOADs targeting cartilage, synovitis, and subchondral bone endotypes in phase 2 and 3 clinical trials. To conclude, we summarize the reasons for clinical trial failures in OA and suggest possible solutions.
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Affiliation(s)
- Shengfa Li
- Clinical Research Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Peihua Cao
- Clinical Research Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Tianyu Chen
- Clinical Research Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Changhai Ding
- Clinical Research Center, Zhujiang Hospital, Southern Medical University, 261 Industry Road, Guangzhou 510515, China
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Clinical Research Center, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
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Smith SL, Alexander S, Nair N, Viatte S, Eyre S, Hyrich KL, Morgan AW, Wilson AG, Isaacs JD, Plant D, Barton A. Pre-treatment calprotectin (MRP8/14) provides no added value to testing CRP alone in terms of predicting response to TNF inhibitors in rheumatoid arthritis in a post hoc analysis. Ann Rheum Dis 2023; 82:611-620. [PMID: 36810200 PMCID: PMC10176427 DOI: 10.1136/ard-2022-222519] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 01/12/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES The inflammatory protein calprotectin (MRP8/14) has been identified as a promising biomarker of treatment response in rheumatoid arthritis (RA). Our aim was to test MRP8/14 as a biomarker of response to tumour necrosis factor (TNF)-inhibitors in the largest RA cohort to date and to compare with C-reactive protein (CRP). METHODS Serum MRP8/14 was measured in 470 patients with RA about to commence treatment with adalimumab (n=196) or etanercept (n=274). Additionally, MRP8/14 was measured in the 3-month sera of 179 adalimumab-treated patients. Response was determined using European League against Rheumatism (EULAR) response criteria calculated using the traditional 4-component (4C) DAS28-CRP and alternate validated versions using 3-component (3C) and 2-component (2C), clinical disease activity index (CDAI) improvement criteria and change in individual outcome measures. Logistic/linear regression models were fitted for response outcome. RESULTS In the 3C and 2C models, patients with RA were 1.92 (CI: 1.04 to 3.54) and 2.03 (CI: 1.09 to 3.78) times more likely to be classified as EULAR responders if they had high (75th quartile) pre-treatment levels of MRP8/14 compared with low (25th quartile). No significant associations were observed for the 4C model. When only using CRP as a predictor, in the 3C and 2C analyses, patients above the 75th quartile were 3.79 (CI: 1.81 to 7.93) and 3.58 (CI: 1.74 to 7.35) times more likely to be EULAR responders and addition of MRP8/14 did not significantly improve model fit (p values=0.62 and 0.80, respectively). No significant associations were observed in the 4C analysis. Exclusion of CRP from the outcome measure (CDAI) did not result in any significant associations with MRP8/14 (OR 1.00 (CI: 0.99 to 1.01), suggesting that the associations were due to the correlation with CRP and that there is no additional utility of MRP8/14 beyond use of CRP in patients with RA starting TNFi therapy. CONCLUSION Beyond correlation with CRP, we found no evidence to suggest that MRP8/14 explains additional variability in response to TNFi in patients with RA over and above CRP alone.
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Affiliation(s)
- Samantha Louise Smith
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Sheree Alexander
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Nisha Nair
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Sebastien Viatte
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Stephen Eyre
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Kimme L Hyrich
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Ann W Morgan
- School of Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Anthony G Wilson
- UCD School of Medicine and Medical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - John D Isaacs
- Musculoskeletal Research Group, Translational and Clinical Research Institute, Newcastle University and NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Darren Plant
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Anne Barton
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Yan S, Dong W, Li Z, Wei J, Han T, Wang J, Lin F. Metformin regulates chondrocyte senescence and proliferation through microRNA-34a/SIRT1 pathway in osteoarthritis. J Orthop Surg Res 2023; 18:198. [PMID: 36915137 PMCID: PMC10012483 DOI: 10.1186/s13018-023-03571-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/31/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) is the most common degenerative disease in joints among elderly patients. Senescence is deeply involved in the pathogenesis of osteoarthritis. Metformin is widely used as the first-line drug for Type 2 diabetes mellitus (T2DM), and has great potential for the treatment of other aging-related disorders, including OA. However, the role of metformin in OA is not fully elucidated. Therefore, our aim here was to investigate the effects of metformin on human chondrocytes. METHODS After metformin treatment, expression level of microRNA-34a and SIRT1 in chondrocyte were detected with quantitative real-time PCR and immunofluorescence staining. Then, microRNA-34a mimic and small interfering RNA (siRNA) against SIRT1 (siRNA-SIRT1) were transfected into chondrocyte. Senescence-associated β-galactosidase (SA-β-gal) staining was performed to assess chondrocyte senescence. Chondrocyte viability was illustrated with MTT and colony formation assays. Western blot was conducted to detect the expression of P16, IL-6, matrix metalloproteinase-13 (MMP-13), Collagen type II (COL2A1) and Aggrecan (ACAN). RESULTS We found that metformin treatment (1 mM) inhibited microRNA-34a while promoted SIRT1 expression in OA chondrocytes. Both miR-34a mimics and siRNA against SIRT1 inhibited SIRT1 expression in chondrocytes. SA-β-gal staining assay confirmed that metformin reduced SA-β-gal-positive rate of chondrocytes, while transfection with miR-34a mimics or siRNA-SIRT1 reversed it. MTT assay and colony formation assay showed that metformin accelerated chondrocyte proliferation, while miR-34a mimics or siRNA-SIRT1 weakened this effect. Furthermore, results from western blot demonstrated that metformin suppressed expression of senescence-associated protein P16, proinflammatory cytokine IL-6 and catabolic gene MMP-13 while elevated expression of anabolic proteins such as Collagen type II and Aggrecan, which could be attenuated by transfection with miR-34a mimics. CONCLUSION Overall, our data suggest that metformin regulates chondrocyte senescence and proliferation through microRNA-34a/SIRT1 pathway, indicating it could be a novel strategy for OA treatment.
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Affiliation(s)
- Shiju Yan
- Department of Orthopedics, Hainan Hospital of Chinese PLA General Hospital, 80 Jianglin Road, Sanya, Hainan, People's Republic of China
| | - Wenjing Dong
- Department of Gerontology, Hainan Hospital of Chinese PLA General Hospital, Sanya, People's Republic of China
| | - Zhirui Li
- Department of Orthopedics, Hainan Hospital of Chinese PLA General Hospital, 80 Jianglin Road, Sanya, Hainan, People's Republic of China
| | - Junqiang Wei
- Department of Orthopedics, Hainan Hospital of Chinese PLA General Hospital, 80 Jianglin Road, Sanya, Hainan, People's Republic of China
| | - Tao Han
- Department of Orthopedics, Hainan Hospital of Chinese PLA General Hospital, 80 Jianglin Road, Sanya, Hainan, People's Republic of China
| | - Junliang Wang
- Department of Orthopedics, Hainan Hospital of Chinese PLA General Hospital, 80 Jianglin Road, Sanya, Hainan, People's Republic of China
| | - Feng Lin
- Department of Orthopedics, Hainan Hospital of Chinese PLA General Hospital, 80 Jianglin Road, Sanya, Hainan, People's Republic of China.
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Baker MC, Sheth K, Liu Y, Lu D, Lu R, Robinson WH. Development of Osteoarthritis in Adults With Type 2 Diabetes Treated With Metformin vs a Sulfonylurea. JAMA Netw Open 2023; 6:e233646. [PMID: 36939700 PMCID: PMC10028483 DOI: 10.1001/jamanetworkopen.2023.3646] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
IMPORTANCE Metformin may have a protective association against developing osteoarthritis (OA), but robust epidemiological data are lacking. OBJECTIVE To determine the risk of OA and joint replacement in individuals with type 2 diabetes treated with metformin compared with a sulfonylurea. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used claims data from the Optum deidentified Clinformatics Data Mart Database between December 2003 and December 2019. Participants included individuals aged 40 years or older with at least 1 year of continuous enrollment and type 2 diabetes. Individuals with type 1 diabetes or a prior diagnosis of OA, inflammatory arthritis, or joint replacement were excluded. Time-conditional propensity score matching was conducted using age, sex, race, Charlson comorbidity score, and treatment duration to create a prevalent new-user cohort. Data were analyzed from April to December 2021. EXPOSURES Treatment with metformin or a sulfonylurea. MAIN OUTCOMES AND MEASURES The outcomes of interest were incident OA and joint replacement. Cox proportional hazard models were used to calculate adjusted hazard ratios (aHRs) of incident OA and joint replacement. In a sensitivity analysis, individuals only ever treated with metformin were compared with individuals only ever treated with a sulfonylurea, allowing for longer-term follow up of the outcome (even after stopping the medication of interest). RESULTS After time-conditional propensity score matching, the metformin and control groups each included 20 937 individuals (mean [SD] age 62.0 [11.5] years; 24 379 [58.2%] males). In the adjusted analysis, the risk of developing OA was reduced by 24% for individuals treated with metformin compared with a sulfonylurea (aHR, 0.76; 95% CI, 0.68-0.85; P < .001), but there was no significant difference for risk of joint replacement (aHR, 0.80; 95% CI, 0.50-1.27; P = .34). In the sensitivity analysis, the risk of developing OA remained lower in individuals treated with metformin compared with a sulfonylurea (aHR, 0.77; 95% CI, 0.65-0.90; P < .001) and the risk of joint replacement remained not statistically significant (aHR, 1.04; 95% CI, 0.60-1.82; P = .89). CONCLUSIONS AND RELEVANCE In this cohort study of individuals with diabetes, metformin treatment was associated with a significant reduction in the risk of developing OA compared with sulfonylurea treatment. These results further support preclinical and observational data that suggest metformin may have a protective association against the development of OA; future interventional studies with metformin for the treatment or prevention of OA should be considered.
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Affiliation(s)
- Matthew C Baker
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California
| | - Khushboo Sheth
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California
- Chinook Therapeutics, Seattle, Washington
- The VA Palo Alto Health Care System, Palo Alto, California
| | - Yuhan Liu
- The Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, California
| | - Di Lu
- The Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, California
| | - Rong Lu
- The Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Stanford, California
| | - William H Robinson
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, California
- The VA Palo Alto Health Care System, Palo Alto, California
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The modifier effect of physical activity, body mass index, and age on the association of metformin and chronic back pain: A cross-sectional analysis of 21,899 participants from the UK Biobank. PLoS One 2023; 18:e0282205. [PMID: 36854023 PMCID: PMC9974111 DOI: 10.1371/journal.pone.0282205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 02/10/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND There is growing evidence of the anti-inflammatory effect of the anti-diabetic drug metformin and its use to reduce pain. However, we currently lack studies investigating whether metformin is associated with a reduction in chronic back pain prevalence when considering physical activity levels, body mass index (BMI), and age. OBJECTIVE To investigate whether use of metformin is associated with lower levels of reporting of chronic back pain in a large cohort with type 2 diabetes when stratified for physical activity, BMI, and age. METHODS This is a cross-sectional study of 21,889 participants with type 2 diabetes who were drawn from the UK Biobank database. We investigated whether people using metformin reported a higher prevalence of chronic low back pain than those who did not. Type 2 diabetes, chronic back pain, and metformin were self-reported. Participants were stratified according to their physical activity level (low, moderate and high), BMI (normal, overweight, and obese), and age (40 to <50; 50 to < 60; and ≥60 years). Logistic regression models were built for each physical activity level, BMI and age category to investigate the prevalence of chronic back pain amongst those using and not using metformin. RESULTS Participants who were using metformin and who had low levels of physical activity [OR 0.87, 95%CI 0.78 to 0.96] or who were obese [OR 0.90, 95%CI 0.86 to 0.98] or older [OR 0.85, 95%CI 0.78 to 0.93] had lower odds of reporting chronic back pain than their counterparts. CONCLUSION The anti-diabetic drug metformin might reduce prevalence of chronic low back pain in people who are older, overweight, or less active. These findings should be confirmed in studies using a longitudinal design.
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Lambova SN. Pleiotropic Effects of Metformin in Osteoarthritis. Life (Basel) 2023; 13:life13020437. [PMID: 36836794 PMCID: PMC9960992 DOI: 10.3390/life13020437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/15/2023] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
The involvement of the knee joint is the most common localization of the pathological process in osteoarthritis (OA), which is associated with obesity in over 50% of the patients and is mediated by mechanical, inflammatory, and metabolic mechanisms. Obesity and the associated conditions (hyperglycemia, dyslipidemia, and hypertension) have been found to be risk factors for the development of knee OA, which has led to the emerging concept of the existence of a distinct phenotype, i.e., metabolic knee OA. Combined assessment of markers derived from dysfunctional adipose tissue, markers of bone and cartilage metabolism, as well as high-sensitivity inflammatory markers and imaging, might reveal prognostic signs for metabolic knee OA. Interestingly, it has been suggested that drugs used for the treatment of other components of the metabolic syndrome may also affect the clinical course and retard the progression of metabolic-associated knee OA. In this regard, significant amounts of new data are accumulating about the role of metformin-a drug, commonly used in clinical practice with suggested multiple pleiotropic effects. The aim of the current review is to analyze the current views about the potential pleiotropic effects of metformin in OA. Upon the analysis of the different effects of metformin, major mechanisms that might be involved in OA are the influence of inflammation, oxidative stress, autophagy, adipokine levels, and microbiome modulation. There is an increasing amount of evidence from in vitro studies, animal models, and clinical trials that metformin can slow OA progression by modulating inflammatory and metabolic factors that are summarized in the current up-to-date review. Considering the contemporary concept about the existence of metabolic type knee OA, in which the accompanying obesity and systemic low-grade inflammation are suggested to influence disease course, metformin could be considered as a useful and safe component of the personalized therapeutic approach in knee OA patients with accompanying type II diabetes or obesity.
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Affiliation(s)
- Sevdalina Nikolova Lambova
- Department of Propaedeutics of Internal Diseases “Prof Dr Anton Mitov”, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria;
- Department in Rheumatology, MHAT “Sveti Mina”, 4002 Plovdiv, Bulgaria
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Yao Q, Wu X, Tao C, Gong W, Chen M, Qu M, Zhong Y, He T, Chen S, Xiao G. Osteoarthritis: pathogenic signaling pathways and therapeutic targets. Signal Transduct Target Ther 2023; 8:56. [PMID: 36737426 PMCID: PMC9898571 DOI: 10.1038/s41392-023-01330-w] [Citation(s) in RCA: 266] [Impact Index Per Article: 266.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Osteoarthritis (OA) is a chronic degenerative joint disorder that leads to disability and affects more than 500 million population worldwide. OA was believed to be caused by the wearing and tearing of articular cartilage, but it is now more commonly referred to as a chronic whole-joint disorder that is initiated with biochemical and cellular alterations in the synovial joint tissues, which leads to the histological and structural changes of the joint and ends up with the whole tissue dysfunction. Currently, there is no cure for OA, partly due to a lack of comprehensive understanding of the pathological mechanism of the initiation and progression of the disease. Therefore, a better understanding of pathological signaling pathways and key molecules involved in OA pathogenesis is crucial for therapeutic target design and drug development. In this review, we first summarize the epidemiology of OA, including its prevalence, incidence and burdens, and OA risk factors. We then focus on the roles and regulation of the pathological signaling pathways, such as Wnt/β-catenin, NF-κB, focal adhesion, HIFs, TGFβ/ΒΜP and FGF signaling pathways, and key regulators AMPK, mTOR, and RUNX2 in the onset and development of OA. In addition, the roles of factors associated with OA, including MMPs, ADAMTS/ADAMs, and PRG4, are discussed in detail. Finally, we provide updates on the current clinical therapies and clinical trials of biological treatments and drugs for OA. Research advances in basic knowledge of articular cartilage biology and OA pathogenesis will have a significant impact and translational value in developing OA therapeutic strategies.
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Affiliation(s)
- Qing Yao
- Department of Biochemistry, School of Medicine, Shenzhen Key Laboratory of Cell Microenvironment, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Southern University of Science and Technology, Shenzhen, 518055, China.
| | - Xiaohao Wu
- Department of Biochemistry, School of Medicine, Shenzhen Key Laboratory of Cell Microenvironment, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Chu Tao
- Department of Biochemistry, School of Medicine, Shenzhen Key Laboratory of Cell Microenvironment, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Weiyuan Gong
- Department of Biochemistry, School of Medicine, Shenzhen Key Laboratory of Cell Microenvironment, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Mingjue Chen
- Department of Biochemistry, School of Medicine, Shenzhen Key Laboratory of Cell Microenvironment, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Minghao Qu
- Department of Biochemistry, School of Medicine, Shenzhen Key Laboratory of Cell Microenvironment, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Yiming Zhong
- Department of Biochemistry, School of Medicine, Shenzhen Key Laboratory of Cell Microenvironment, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Tailin He
- Department of Biochemistry, School of Medicine, Shenzhen Key Laboratory of Cell Microenvironment, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Sheng Chen
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Guozhi Xiao
- Department of Biochemistry, School of Medicine, Shenzhen Key Laboratory of Cell Microenvironment, Guangdong Provincial Key Laboratory of Cell Microenvironment and Disease Research, Southern University of Science and Technology, Shenzhen, 518055, China.
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Knee Osteoarthritis-How Close Are We to Disease-Modifying Treatment: Emphasis on Metabolic Type Knee Osteoarthritis. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010140. [PMID: 36676089 PMCID: PMC9866724 DOI: 10.3390/life13010140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023]
Abstract
Osteoarthritis (OA) is a whole-joint disease that affects cartilage, bone, and synovium as well as ligaments, menisci, and muscles [...].
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Liu X, Guo Q, Wang L, Gu Y, Meng S, Gu Y, Yu B. Metformin attenuates high-fat diet induced metabolic syndrome related osteoarthritis through inhibition of prostaglandins. Front Cell Dev Biol 2023; 11:1184524. [PMID: 37200628 PMCID: PMC10185907 DOI: 10.3389/fcell.2023.1184524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/17/2023] [Indexed: 05/20/2023] Open
Abstract
High-fat diet induces bone marrow inflammation and osteoarthritis phenotype in knee joint, but the underlying mechanisms is unknown. Here, we report that high-fat diet induces aberrant bone formation and cartilage degeneration in knee joint. Mechanistically, a high-fat diet increases the number of macrophages and the secretion of prostaglandins in subchondral bone, promoting bone formation. Metformin treatment is able to decrease the number of macrophages and also the level of prostaglandins induced by high-fat diet in subchondral bone. Importantly, metformin rescues aberrant bone formation and cartilage lesions by decreasing the number of osteoprogenitors and type-H vessels, which also results in relief of osteoarthritis pain response. Thus, we demonstrate prostaglandins secreted by macrophages may be a key reason for high-fat diet induced aberrant bone formation and metformin is a promising therapy for high-fat diet induced osteoarthritis.
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Affiliation(s)
- Xiaonan Liu
- Division of Orthopaedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiaoyue Guo
- Department of Endocrinology, Endocrinology Research Center, Xiangya Hospital of Central South University, Changsha, China
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, United States
| | - Lei Wang
- Division of Orthopaedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yiru Gu
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, United States
| | - Senxiong Meng
- Division of Orthopaedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuan Gu
- Division of Orthopaedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yu
- Division of Orthopaedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Bin Yu,
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Zhu Z, Huang JY, Ruan G, Cao P, Chen S, Zhang Y, Han W, Chen T, Cai X, Liu J, Tang Y, Yu N, Wang Q, Hunter DJ, Wei JCC, Ding C. Metformin use and associated risk of total joint replacement in patients with type 2 diabetes: a population-based matched cohort study. CMAJ 2022; 194:E1672-E1684. [PMID: 36535678 PMCID: PMC9829054 DOI: 10.1503/cmaj.220952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is uncertain whether metformin use is associated with reduced risk of joint replacement in patients with type 2 diabetes mellitus. We aimed to establish whether metformin use was associated with a reduced risk of total knee replacement (TKR) or total hip replacement (THR) among these patients. METHODS We selected patients with type 2 diabetes mellitus that was diagnosed between 2000 and 2012 from the Taiwan National Health Insurance Research Database. We used prescription time-distribution matching and propensity-score matching to balance potential confounders between metformin users and nonusers. We assessed the risks of TKR or THR using Cox proportional hazards regression. RESULTS We included 20 347 participants who were not treated with metformin and 20 347 who were treated with metformin, for a total of 40 694 participants (mean age 63 yr, standard deviation 11 yr; 49.8% were women) after prescription time-distribution matching. Compared with participants who did not use metformin, those who used metformin had lower risks of TKR or THR (adjusted hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.60-0.81 for TKR or THR; adjusted HR 0.71, 95% CI 0.61-0.84 for TKR; adjusted HR 0.61, 95% CI 0.41-0.92 for THR) after adjustment for covariates. Propensity-score matching analyses (10 163 participants not treated with metformin v. 10 163 treated with metformin) and sensitivity analyses using inverse probability of treatment weighting and competing risk regression showed similar results. INTERPRETATION Metformin use in patients with type 2 diabetes mellitus was associated with a significantly reduced risk of total joint replacement. Randomized controlled clinical trials in patients with osteoarthritis are warranted to determine whether metformin is effective in decreasing the need for joint replacement.
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Affiliation(s)
- Zhaohua Zhu
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Jing-Yang Huang
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Guangfeng Ruan
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Peihua Cao
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Shibo Chen
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Yan Zhang
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Weiyu Han
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Tianyu Chen
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Xiaoyan Cai
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Jia Liu
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Yujin Tang
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Na Yu
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Qian Wang
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - David J Hunter
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - James Cheng-Chung Wei
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Changhai Ding
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
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Agmatine Administration Effects on Equine Gastric Ulceration and Lameness. J Clin Med 2022; 11:jcm11247283. [PMID: 36555900 PMCID: PMC9780949 DOI: 10.3390/jcm11247283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Osteoarthritis (OA) accounts for up to 60% of equine lameness. Agmatine, a decarboxylated arginine, may be a viable option for OA management, based on reports of its analgesic properties. Six adult thoroughbred horses, with lameness attributable to thoracic limb OA, received either daily oral phenylbutazone (6.6 mg/kg), agmatine sulfate (25 mg/kg) or a control for 30 days, with 21-day washout periods between treatments. Subjective lameness, thoracic limb ground reaction forces (GRF), plasma agmatine and agmatine metabolite levels were evaluated using an established rubric, a force platform, and mass spectrometry, respectively, before, during and after each treatment period. Gastric ulceration and plasma chemistries were evaluated before and after treatments. Braking GRFs were greater after 14 and 29 days of agmatine compared to phenylbutazone administration. After 14 days of phenylbutazone administration, vertical GRFs were greater than for agmatine or the control. Glandular mucosal ulcer scores were lower after agmatine than phenylbutazone administration. Agmatine plasma levels peaked between 30 and 60 min and were largely undetectable by 24 h after oral administration. In contrast, plasma citric acid levels increased throughout agmatine administration, representing a shift in the metabolomic profile. Agmatine may be a viable option to improve thoracic limb GRFs while reducing the risk of glandular gastric ulceration in horses with OA.
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Alsaleh G, Richter FC, Simon AK. Age-related mechanisms in the context of rheumatic disease. Nat Rev Rheumatol 2022; 18:694-710. [PMID: 36329172 DOI: 10.1038/s41584-022-00863-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Ageing is characterized by a progressive loss of cellular function that leads to a decline in tissue homeostasis, increased vulnerability and adverse health outcomes. Important advances in ageing research have now identified a set of nine candidate hallmarks that are generally considered to contribute to the ageing process and that together determine the ageing phenotype, which is the clinical manifestation of age-related dysfunction in chronic diseases. Although most rheumatic diseases are not yet considered to be age related, available evidence increasingly emphasizes the prevalence of ageing hallmarks in these chronic diseases. On the basis of the current evidence relating to the molecular and cellular ageing pathways involved in rheumatic diseases, we propose that these diseases share a number of features that are observed in ageing, and that they can therefore be considered to be diseases of premature or accelerated ageing. Although more data are needed to clarify whether accelerated ageing drives the development of rheumatic diseases or whether it results from the chronic inflammatory environment, central components of age-related pathways are currently being targeted in clinical trials and may provide a new avenue of therapeutic intervention for patients with rheumatic diseases.
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Affiliation(s)
- Ghada Alsaleh
- The Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK.
- Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK.
| | - Felix C Richter
- The Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK
| | - Anna K Simon
- The Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK
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19
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Zhang Y, Li D, Zhu Z, Chen S, Lu M, Cao P, Chen T, Li S, Xue S, Zhang Y, Zhu J, Ruan G, Ding C. Evaluating the impact of metformin targets on the risk of osteoarthritis: a mendelian randomization study. Osteoarthritis Cartilage 2022; 30:1506-1514. [PMID: 35803489 DOI: 10.1016/j.joca.2022.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/14/2022] [Accepted: 06/23/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To provide some causal evidence concerning the effects of metformin on osteoarthritis (OA) using two metformin targets, namely AMP-activated protein kinase (AMPK) and growth differentiation factor 15 (GDF-15) as metformin proxies. METHODS This is a 2-sample Mendelian randomization design. We constructed 44 AMPK-related variants genetically predicted in HbA1c (%) as instruments for AMPK and five variants strongly predicted GDF-15 as instruments for GDF-15. Summary-level data for three OA phenotypes, including OA at any site, knee OA, and hip OA were obtained from the largest genome-wide meta-analysis across the UK Biobank and arcOGEN with 455,211 Europeans. Main analyses were conducted using the inverse-variance weighted method. Weighted median and MR-Egger were conducted as sensitivity analyses to assess the robustness of our results. RESULTS Genetically predicted AMPK were negatively associated with OA at any site (OR: 0.60; 95% CI: 0.43-0.83) and hip OA (OR: 0.42; 95% CI: 0.22-0.80), but with not knee OA (OR: 0.85; 95% CI: 0.49-1.50). Higher levels of genetically predicted GDF-15 reduced the risk of hip OA (OR: 0.95; 95% CI: 0.90-0.99), but not OA at any site (OR: 1.00; 95% CI: 0.98-1.02) and knee OA (OR: 1.02; 95% CI: 0.98-1.07). CONCLUSION This study indicates that AMPK and GDF-15 can be potential therapeutic targets for OA, especially for hip OA, and metformin would be repurposed for OA therapy which needs to be verified in randomized controlled trials.
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Affiliation(s)
- Y Zhang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - D Li
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Department of Spine Surgery, Center for Orthopedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Z Zhu
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - S Chen
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - M Lu
- Department of Immunology, School of Basic Medical Sciences, Anhui Medical University, Hefei, Anhui, China
| | - P Cao
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - T Chen
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - S Li
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - S Xue
- Department of Rheumatology and Immunology, Arthritis Research Institute, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Y Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - J Zhu
- Department of Orthopedics, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - G Ruan
- Clinical Research Centre, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
| | - C Ding
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
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20
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Lim YZ, Wang Y, Estee M, Abidi J, Udaya Kumar M, Hussain SM, Wluka AE, Little CB, Cicuttini FM. Metformin as a potential disease-modifying drug in osteoarthritis: a systematic review of pre-clinical and human studies. Osteoarthritis Cartilage 2022; 30:1434-1442. [PMID: 35597372 DOI: 10.1016/j.joca.2022.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 04/30/2022] [Accepted: 05/11/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis causes significant pain and disability with no approved disease-modifying drugs. We systematically reviewed the evidence from both pre-clinical and human studies for the potential disease-modifying effect of metformin in osteoarthritis. METHODS Ovid Medline, Embase and CINAHL were searched between inception and June 2021 using MeSH terms and key words to identify studies examining the association between metformin use and outcome measures related to osteoarthritis. Two reviewers performed the risk of bias assessment and 3 reviewers extracted data independently. Qualitative evidence synthesis was performed. This systematic review is registered on PROSPERO (CRD42021261052 and CRD42021261060). RESULTS Fifteen (10 pre-clinical and 5 human) studies were included. Most studies (10 pre-clinical and 3 human) assessed the effect of metformin using knee osteoarthritis models. In pre-clinical studies, metformin was assessed for the effect on structural outcomes (n = 10); immunomodulation (n = 5); pain (n = 4); and molecular pathways of its effect in osteoarthritis (n = 7). For human studies, metformin was evaluated for the effect on structural progression (n = 3); pain (n = 1); and immunomodulation (n = 1). Overall, pre-clinical studies consistently showed metformin having a chondroprotective, immunomodulatory and analgesic effect in osteoarthritis, predominantly mediated by adenosine monophosphate-activated protein kinase activation. Evidence from human studies, although limited, was consistent with findings in pre-clinical studies. CONCLUSION We found consistent evidence across pre-clinical and human studies to support a favourable effect of metformin on chondroprotection, immunomodulation and pain reduction in knee osteoarthritis. Further high-quality clinical trials are needed to confirm these findings as metformin could be a novel therapeutic drug for the treatment of osteoarthritis.
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Affiliation(s)
- Y Z Lim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
| | - Y Wang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
| | - M Estee
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
| | - J Abidi
- Alfred Hospital, Melbourne, VIC, 3004, Australia.
| | | | - S M Hussain
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
| | - A E Wluka
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
| | - C B Little
- Raymond Purves Bone and Joint Research Laboratories, Kolling Institute, The University of Sydney Faculty of Medicine and Health, St Leonards, NSW, Australia.
| | - F M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
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21
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Sit RWS. Metformin as a potential disease-modifying agent in osteoarthritis: the present and the future. Osteoarthritis Cartilage 2022; 30:1418-1419. [PMID: 36030060 DOI: 10.1016/j.joca.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 02/02/2023]
Affiliation(s)
- R W S Sit
- The JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
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22
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Wei J, Wei Y, Huang M, Wang P, Jia S. Is metformin a possible treatment for diabetic neuropathy? J Diabetes 2022; 14:658-669. [PMID: 36117320 PMCID: PMC9574743 DOI: 10.1111/1753-0407.13310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/29/2022] [Accepted: 08/16/2022] [Indexed: 12/04/2022] Open
Abstract
Metformin is a hypoglycemic drug widely used in the treatment of type 2 diabetes. It has been proven to have analgesic and neuroprotective effects. Metformin can reverse pain in rodents, such as diabetic neuropathic pain, neuropathic pain caused by chemotherapy drugs, inflammatory pain and pain caused by surgical incision. In clinical use, however, metformin is associated with reduced plasma vitamin B12 levels, which can further neuropathy. In rodent diabetes models, metformin plays a neuroprotective and analgesic role by activating adenosine monophosphate-activated protein kinase, clearing methylgloxal, reducing insulin resistance, and neuroinflammation. This paper also summarized the neurological adverse reactions of metformin in diabetic patients. In addition, whether metformin has sexual dimorphism needs further study.
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Affiliation(s)
- Juechun Wei
- The Second Medical CollegeBinzhou Medical UniversityYantaiChina
| | - Yanling Wei
- Qingdao Dongheng Zhiyuan Automobile Service Co. LTDQingdaoChina
| | - Meiyan Huang
- The Second Medical CollegeBinzhou Medical UniversityYantaiChina
| | - Peng Wang
- The Second Medical CollegeBinzhou Medical UniversityYantaiChina
| | - Shushan Jia
- Yantai Affiliated Hospital of Binzhou Medical UniversityYantaiChina
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23
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He M, Lu B, Opoku M, Zhang L, Xie W, Jin H, Chen S, Li Y, Deng Z. Metformin Prevents or Delays the Development and Progression of Osteoarthritis: New Insight and Mechanism of Action. Cells 2022; 11:3012. [PMID: 36230974 PMCID: PMC9563728 DOI: 10.3390/cells11193012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022] Open
Abstract
For over 60 years, metformin has been widely prescribed by physicians to treat type 2 diabetes. Along with more in-depth research on metformin and its molecular mechanism in recent decades, metformin has also been proposed as an effective drug to prevent or delay musculoskeletal disorders, including osteoarthritis (OA). The occurrence and development of OA are deemed to be associated with the impaired mitochondrial functions of articular chondrocytes. Metformin can activate the pathways and expressions of both AMPK and SIRT1 so as to protect the mitochondrial function of chondrocytes, thereby promoting osteoblast production. Moreover, the clinical significance of the metformin combination therapy in preventing OA has also been demonstrated. This review aimed to comprehensively summarize the current research progress on metformin as a proposed drug for OA prevention or treatment.
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Affiliation(s)
- Miao He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Bangbao Lu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Michael Opoku
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Liang Zhang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Wenqing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Hongfu Jin
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Siyu Chen
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, China
| | - Yusheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Zhenhan Deng
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, China
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24
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Song Y, Wu Z, Zhao P. The effects of metformin in the treatment of osteoarthritis: Current perspectives. Front Pharmacol 2022; 13:952560. [PMID: 36081941 PMCID: PMC9445495 DOI: 10.3389/fphar.2022.952560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Osteoarthritis is a chronic and irreversible disease of the locomotor system which is closely associated with advancing age. Pain and limited mobility frequently affect the quality of life in middle-aged and older adults. With a global population of more than 350 million, osteoarthritis is becoming a health threat alongside cancer and cardiovascular disease. It is challenging to find effective treatments to promote cartilage repair and slow down disease progression. Metformin is the first-line drug for patients with type 2 diabetes, and current perspectives suggest that it cannot only lower glucose but also has anti-inflammatory and anti-aging properties. Experimental studies applying metformin for the treatment of osteoarthritis have received much attention in recent years. In our review, we first presented the history of metformin and the current status of osteoarthritis, followed by a brief review of the mechanism that metformin acts, involving AMPK-dependent and non-dependent pathways. Moreover, we concluded that metformin may be beneficial in the treatment of osteoarthritis by inhibiting inflammation, modulating autophagy, antagonizing oxidative stress, and reducing pain levels. Finally, we analyzed the relevant evidence from animal and human studies. The potential of metformin for the treatment of osteoarthritis deserves to be further explored.
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25
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Association between Metformin Use and Risk of Total Knee Arthroplasty and Degree of Knee Pain in Knee Osteoarthritis Patients with Diabetes and/or Obesity: A Retrospective Study. J Clin Med 2022; 11:jcm11164796. [PMID: 36013035 PMCID: PMC9409735 DOI: 10.3390/jcm11164796] [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: 06/19/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives: We aimed to examine whether metformin (MET) use is associated with a reduced risk of total knee arthroplasty (TKA) and low severity of knee pain in patients with knee osteoarthritis (OA) and diabetes and/or obesity. Methods: Participants diagnosed with knee OA and diabetes and/or obesity from June 2000 to July 2019 were selected from the information system of a local hospital. Regular MET users were defined as those with recorded prescriptions of MET or self-reported regular MET use for at least 6 months. TKA information was extracted from patients’ surgical records. Knee pain was assessed using the numeric rating scale. Log-binomial regression, linear regression, and propensity score weighting (PSW) were performed for statistical analyses. Results: A total of 862 participants were included in the analyses. After excluding missing data, there were 346 MET non-users and 362 MET users. MET use was significantly associated with a reduced risk of TKA (prevalence ratio: 0.26, 95% CI: 0.15 to 0.45, p < 0.001), after adjustment for age, gender, body mass index, various analgesics, and insurance status. MET use was significantly associated with a reduced degree of knee pain after being adjusted for the above covariates (β: −0.48, 95% CI: −0.91 to −0.05, p = 0.029). There was a significantly accumulative effect of MET use on the reduced risk of TKA. Conclusion: MET can be a potential therapeutic option for OA. Further clinical trials are needed to determine if MET can reduce the risk of TKA and the severity of knee pain in metabolic-associated OA patients.
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26
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Metformin use and the risk of total knee replacement among diabetic patients: a propensity-score-matched retrospective cohort study. Sci Rep 2022; 12:11571. [PMID: 35798867 PMCID: PMC9262887 DOI: 10.1038/s41598-022-15871-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/30/2022] [Indexed: 12/30/2022] Open
Abstract
Metformin has been shown to modulate meta-inflammation, an important pathogenesis in knee osteoarthritis (OA). The study aimed to test the association between regular metformin use with total knee replacement (TKR) in patients with diabetes. This is a retrospective study with electronic records retrieved in Hong Kong public primary care. Patients with diabetes aged ≥ 45 who visited during 2007 to 2010, were followed up for a four-year period from 2011 to 2014 to determine the incidence of TKR. Propensity score matching based on age, sex, co-medications and chronic conditions was conducted to adjust for confounding. Cox regression was implemented to examine the association between metformin use and TKR. In total, 196,930 patients were eligible and 93,330 regular metformin users (defined as ≥ 4 prescriptions over the previous year) and non-users were matched. Among 46,665 regular users, 184 TKRs were conducted, 17.1% fewer than that among non-users. Cox regression showed that regular metformin users had a 19%-lower hazard of TKR [hazard ratio (HR) = 0.81, 95% confidence interval: 0.67 to 0.98, P = 0.033], with a dose–response relationship. Findings suggest a potential protective effect of metformin on knee OA progression and later TKR incidence among diabetic patients.
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27
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Yan J, Feng G, Ma L, Chen Z, Jin Q. Metformin alleviates osteoarthritis in mice by inhibiting chondrocyte ferroptosis and improving subchondral osteosclerosis and angiogenesis. J Orthop Surg Res 2022; 17:333. [PMID: 35765024 PMCID: PMC9238069 DOI: 10.1186/s13018-022-03225-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/22/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) is the most common musculoskeletal disease, and it has a complex pathology and unknown pathogenesis. Chondrocyte ferroptosis is closely associated with the development of OA. As a common drug administered for the treatment of type 2 diabetes, metformin (Met) is known to inhibit the development of ferroptosis. However, its therapeutic effect in OA remains unknown. The present study aimed to explore the effects of Met on cartilage and subchondral bone in a mouse OA model and to explore the potential underlying mechanisms. METHODS A mouse OA model was induced using destabilization of the medial meniscus (DMM) surgery, chondrocyte ferroptosis was induced using an intra-articular injection of Erastin, and Met (200 mg/kg/day) was intragastrically administered for 8 weeks after surgery. H&E and Safranin O‑fast green staining were used to evaluate cartilage degeneration, and μ‑computed tomography was used to evaluate changes in subchondral bone microarchitecture. Moreover, immunohistochemical staining was performed to detect mechanistic metalloproteinases 13, type II collagen, glutathione peroxidase 4, acyl-CoA synthetase long-chain family member 4, solute carrier family 7 member 11 and p53. Runt-associated transcription factor 2 and CD31 were detected using immunofluorescent staining. RESULTS Met protected articular cartilage and reversed the abnormal expression of ferroptosis-related proteins in the chondrocytes of DMM mice. Moreover, intra-articular injection of Erastin induced ferroptosis in mouse chondrocytes, and Met eliminated the ferroptosis effects induced by Erastin and protected articular cartilage. In addition, the results of the present study demonstrated that Met alleviated the microstructural changes of subchondral osteosclerosis and reduced heterotypic angiogenesis in DMM mice. CONCLUSION Met alleviates the pathological changes of OA by inhibiting ferroptosis in OA chondrocytes, alleviating subchondral sclerosis and reducing abnormal angiogenesis in subchondral bone in advanced OA.
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Affiliation(s)
- Jiangbo Yan
- Ningxia Medical University, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.,Orthopedics Ward 3, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Gangning Feng
- Ningxia Medical University, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Long Ma
- Orthopedics Ward 3, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zhirong Chen
- Ningxia Medical University, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China. .,Orthopedics Ward 3, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
| | - Qunhua Jin
- Ningxia Medical University, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China. .,Orthopedics Ward 3, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
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28
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Ruan G, Yuan S, Lou A, Mo Y, Qu Y, Guo D, Guan S, Zhang Y, Lan X, Luo J, Mei Y, Zhang H, Wu W, Dai L, Yu Q, Cai X, Ding C. Can metformin relieve tibiofemoral cartilage volume loss and knee symptoms in overweight knee osteoarthritis patients? Study protocol for a randomized, double-blind, and placebo-controlled trial. BMC Musculoskelet Disord 2022; 23:486. [PMID: 35598008 PMCID: PMC9124394 DOI: 10.1186/s12891-022-05434-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 05/13/2022] [Indexed: 01/07/2023] Open
Abstract
Background Osteoarthritis (OA) is the most common joint disease, and is most frequently seen in the knees. However, there is no effective therapy to relieve the progression of knee OA. Metformin is a safe, well-tolerated oral medication that is extensively used as first-line therapy for type 2 diabetes. Previous observational studies and basic researches suggested that metformin may have protective effects on knee OA, which needs to be verified by clinical trials. This study, therefore, aims to examine the effects of metformin versus placebo on knee cartilage volume loss and knee symptoms in overweight knee OA patients by a randomized controlled trial over 24 months. Methods This protocol describes a multicenter, randomized, double-blind, and placebo-controlled clinical trial aiming to recruit 262 overweight knee OA patients. Participants will be randomly allocated to the two arms of the study, receiving metformin hydrochloride sustained-release tablets or identical inert placebo for 24 months (start from 0.5 g/day for the first 2 weeks, and increase to 1 g/day for the second 2 weeks, and further increase to 2 g/day for the remaining period if tolerated). Primary outcomes will be changes in tibiofemoral cartilage volume and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score over 24 months. Secondary outcomes will be changes in visual analogue scale (VAS) knee pain, tibiofemoral cartilage defects, effusion-synovitis volume, and tibiofemoral bone marrow lesions maximum size over 24 months. The primary analyses will be intention-to-treat analyses of primary and secondary outcomes. Per-protocol analyses will be performed as the secondary analyses. Discussion If metformin is proved to slow knee cartilage volume loss and to relieve knee symptoms among overweight knee OA patients, it will have the potential to become a disease modifying drug for knee OA. Metformin is a convenient intervention with low cost, and its potential effects on slowing down the structural progression and relieving the symptoms of knee OA would effectively reduce the disease burden worldwide. Trial registration ClinicalTrials. gov NCT05034029. Registered on 30 Sept 2021.
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Affiliation(s)
- Guangfeng Ruan
- Clinical Research Centre, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.,Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Shiwen Yuan
- Department of Rheumatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Aiju Lou
- Department of Rheumatology and Immunology, Liwan Central Hospital of Guangzhou, Guangzhou, Guangdong, China
| | - Yingqian Mo
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yuan Qu
- Rheumatology and Clinical Immunology Department, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Dongmei Guo
- Department of Rheumatology, Foshan First People's Hospital, Foshan, Guangdong, China
| | - Shangqi Guan
- Department of Rheumatology, Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yan Zhang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoyong Lan
- Department of Rehabilitation Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jun Luo
- Department of Rehabilitation Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yifang Mei
- Department of Rheumatology, Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Hongwei Zhang
- Department of Rheumatology, Foshan First People's Hospital, Foshan, Guangdong, China
| | - Weirong Wu
- Department of Rheumatology and Immunology, Liwan Central Hospital of Guangzhou, Guangzhou, Guangdong, China
| | - Lie Dai
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Qinghong Yu
- Rheumatology and Clinical Immunology Department, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoyan Cai
- Department of Rheumatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
| | - Changhai Ding
- Clinical Research Centre, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China. .,Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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29
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Oo WM, Hunter DJ. Repurposed and investigational disease-modifying drugs in osteoarthritis (DMOADs). Ther Adv Musculoskelet Dis 2022; 14:1759720X221090297. [PMID: 35619876 PMCID: PMC9128067 DOI: 10.1177/1759720x221090297] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/10/2022] [Indexed: 12/12/2022] Open
Abstract
In spite of a major public health burden with increasing prevalence, current osteoarthritis (OA) management is largely palliative with an unmet need for effective treatment. Both industry and academic researchers have invested a vast amount of time and financial expense to discover the first diseasing-modifying osteoarthritis drugs (DMOADs), with no regulatory success so far. In this narrative review, we discuss repurposed drugs as well as investigational agents which have progressed into phase II and III clinical trials based on three principal endotypes: bone-driven, synovitis-driven and cartilage-driven. Then, we will briefly describe the recent failures and lessons learned, promising findings from predefined post hoc analyses and insights gained, novel methodologies to enhance future success and steps underway to overcome regulatory hurdles.
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Affiliation(s)
- Win Min Oo
- Rheumatology Department, Royal North Shore Hospital, and Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Physical Medicine and Rehabilitation, Mandalay General Hospital, University of Medicine, Mandalay, Mandalay, Myanmar
| | - David J. Hunter
- Rheumatology Department, Royal North Shore Hospital, and Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
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Waltereit-Kracke V, Wehmeyer C, Beckmann D, Werbenko E, Reinhardt J, Geers F, Dienstbier M, Fennen M, Intemann J, Paruzel P, Korb-Pap A, Pap T, Dankbar B. Deletion of activin A in mesenchymal but not myeloid cells ameliorates disease severity in experimental arthritis. Ann Rheum Dis 2022; 81:1106-1118. [PMID: 35418478 PMCID: PMC9279851 DOI: 10.1136/annrheumdis-2021-221409] [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: 08/25/2021] [Accepted: 04/06/2022] [Indexed: 12/03/2022]
Abstract
Objective The aim of this study was to assess the extent and the mechanism by which activin A contributes to progressive joint destruction in experimental arthritis and which activin A-expressing cell type is important for disease progression. Methods Levels of activin A in synovial tissues were evaluated by immunohistochemistry, cell-specific expression and secretion by PCR and ELISA, respectively. Osteoclast (OC) formation was assessed by tartrat-resistant acid phosphatase (TRAP) staining and activity by resorption assay. Quantitative assessment of joint inflammation and bone destruction was performed by histological and micro-CT analysis. Immunoblotting was applied for evaluation of signalling pathways. Results In this study, we demonstrate that fibroblast-like synoviocytes (FLS) are the main producers of activin A in arthritic joints. Most significantly, we show for the first time that deficiency of activin A in arthritic FLS (ActβAd/d ColVI-Cre) but not in myeloid cells (ActβAd/d LysM-Cre) reduces OC development in vitro, indicating that activin A promotes osteoclastogenesis in a paracrine manner. Mechanistically, activin A enhanced OC formation and activity by promoting the interaction of activated Smad2 with NFATc1, the key transcription factor of osteoclastogenesis. Consistently, ActβAd/d LysM-Cre hTNFtg mice did not show reduced disease severity, whereas deficiency of activin A in ColVI-Cre-expressing cells such as FLS highly diminished joint destruction reflected by less inflammation and less bone destruction. Conclusions The results highly suggest that FLS-derived activin A plays a crucial paracrine role in inflammatory joint destruction and may be a promising target for treating inflammatory disorders associated with OC formation and bone destruction like rheumatoid arthritis.
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Affiliation(s)
- Vanessa Waltereit-Kracke
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
| | - Corinna Wehmeyer
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
| | - Denise Beckmann
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
| | - Eugenie Werbenko
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
| | - Julia Reinhardt
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
| | - Fabienne Geers
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
| | - Mike Dienstbier
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
| | - Michelle Fennen
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
| | - Johanna Intemann
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
| | - Peter Paruzel
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
| | - Adelheid Korb-Pap
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
| | - Thomas Pap
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
| | - Berno Dankbar
- Institute of Musculoskeletal Medicine, University Hospital Muenster, Muenster, Nordrhein-Westfalen, Germany
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Song Y, Wu Z, Zhao P. The Function of Metformin in Aging-Related Musculoskeletal Disorders. Front Pharmacol 2022; 13:865524. [PMID: 35392559 PMCID: PMC8982084 DOI: 10.3389/fphar.2022.865524] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/21/2022] [Indexed: 12/22/2022] Open
Abstract
Metformin is a widely accepted first-line hypoglycemic agent in current clinical practice, and it has been applied to the clinic for more than 60 years. Recently, researchers have identified that metformin not only has an efficient capacity to lower glucose but also exerts anti-aging effects by regulating intracellular signaling molecules. With the accelerating aging process and mankind’s desire for a long and healthy life, studies on aging have witnessed an unprecedented boom. Osteoporosis, sarcopenia, degenerative osteoarthropathy, and frailty are age-related diseases of the musculoskeletal system. The decline in motor function is a problem that many elderly people have to face, and in serious cases, they may even fail to self-care, and their quality of life will be seriously reduced. Therefore, exploring potential treatments to effectively prevent or delay the progression of aging-related diseases is essential to promote healthy aging. In this review, we first briefly describe the origin of metformin and the aging of the movement system, and next review the evidence associated with its ability to extend lifespan. Furthermore, we discuss the mechanisms related to the modulation of aging in the musculoskeletal system by metformin, mainly its contribution to bone homeostasis, muscle aging, and joint degeneration. Finally, we analyze the protective benefits of metformin in aging-related diseases of the musculoskeletal system.
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Affiliation(s)
- Yanhong Song
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ziyi Wu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ping Zhao
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
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Burkard T, Vallejo-Yagüe E, Hügle T, Finckh A, Burden AM. Interruptions of biological and targeted synthetic disease-modifying antirheumatic drugs in rheumatoid arthritis: a descriptive cohort study assessing trends in patient characteristics in Switzerland. BMJ Open 2022; 12:e056352. [PMID: 35292498 PMCID: PMC8928292 DOI: 10.1136/bmjopen-2021-056352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To identify differing patient characteristics at the time of stop and restart of biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in rheumatoid arthritis (RA), stratified by stop reason. DESIGN Explorative descriptive cohort study. SETTING Swiss Clinical Quality Management in Rheumatic Diseases (1999-2018). PARTICIPANTS Patients with RA who stopped their first b/tsDMARD. OUTCOME MEASURES We assessed patient characteristics at b/tsDMARD stop and restart, stratified by stop reason (non-response, adverse event, remission, other). RESULTS Among 2526 eligible patients, most patients (38%) stopped their b/tsDMARD due to non-response. At treatment stop, most characteristics did not differ by stop reason, yet some differed significantly (p<0.0001, those stopping due to remission had lowest median Health Assessment Questionnaire measurements (0.1) and were least likely to use leflunomide combination therapy (3.9%) and to have fibromyalgia (6.7%)). The majority of patients restarted b/tsDMARDs without changes in patient characteristics at restart. However, among the 48% of patients who restarted a b/tsDMARD after having previously stopped due to remission or other reasons, disease activity measurements were significantly worse compared with treatment stop date (mean disease activity score-erythrocyte sedimentation rate score of 2.0 at b/tsDMARD restart vs 3.5 at treatment stop (p<0.0001)). Furthermore, we observed non-significant trends in several patient characteristics (eg, higher proportion of women (75% at b/tsDMARD restart vs 70% at treatment stop, p=0.38), patients with seropositivity (anti-citrullinated protein antibody positive 67% vs 58%, p=0.25), with family history of rheumatic diseases (24% vs 20%, p=0.15), osteoarthritis/arthroplasty (25% vs 20%, p=0.34) and the metabolic syndrome (11% vs 6%, p=0.15). CONCLUSION Differences among patient characteristics across b/tsDMARD cessation strata were few. However, differences between stop and restart may have identified an RA phenotype that is challenging to treat. Further research on identifying the patient characteristics predictive of successful drug holidays and the optimal time to initiate and stop a drug holiday is warranted.
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Affiliation(s)
- Theresa Burkard
- Intstitute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Enriqueta Vallejo-Yagüe
- Intstitute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Thomas Hügle
- Department of Rheumatology, Lusanne University Hospital, University of Lusanne, Lausanne, Switzerland
| | - Axel Finckh
- Division of Rheumatology, HUG, Geneva, Switzerland
| | - Andrea Michelle Burden
- Intstitute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
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Allen KD, Thoma LM, Golightly YM. Epidemiology of osteoarthritis. Osteoarthritis Cartilage 2022; 30:184-195. [PMID: 34534661 PMCID: PMC10735233 DOI: 10.1016/j.joca.2021.04.020] [Citation(s) in RCA: 227] [Impact Index Per Article: 113.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 04/01/2021] [Accepted: 04/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarize the current state of the evidence regarding osteoarthritis (OA) prevalence, incidence and risk factors at the person-level and joint-level. DESIGN This was a narrative review that took a comprehensive approach regarding inclusion of potential risk factors. The review complements prior reviews of OA epidemiology, with a focus on new research and emerging topics since 2017, as well as seminal studies. RESULTS Studies continue to illustrate the high prevalence of OA worldwide, with a greater burden among older individuals, women, some racial and ethnic groups, and individuals with lower socioeconomic status. Modifiable risk factors for OA with the strongest evidence are obesity and joint injury. Topics of high interest or emerging evidence for a potential association with OA risk or progression include specific vitamins and diets, high blood pressure, genetic factors, metformin use, bone mineral density, abnormal joint shape and malalignment, and lower muscle strength/quality. Studies also continue to highlight the heterogenous nature of OA, with strong interest in understanding and defining OA phenotypes. CONCLUSIONS OA is an increasingly prevalent condition with worldwide impacts on many health outcomes. The strong evidence for obesity and joint injury as OA risk factors calls for heightened efforts to mitigate these risks at clinical and public health levels. There is also a need for continued research regarding how potential person- and joint-level risk factors may interact to influence the development and progression of OA.
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Affiliation(s)
- K D Allen
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Center for Health Services Research in Primary Care, Department of Veterans Affairs Medical Center, Durham, NC, USA.
| | - L M Thoma
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Y M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Schadler P, Lohberger B, Stündl N, Stradner MH, Glänzer D, Sadoghi P, Leithner A, Steinecker-Frohnwieser B. The Effect of Body Mass Index and Metformin on Matrix Gene Expression in Arthritic Primary Human Chondrocytes. Cartilage 2021; 13:1004S-1018S. [PMID: 33025801 PMCID: PMC8804722 DOI: 10.1177/1947603520962558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Obesity is a known risk factor for knee osteoarthritis (OA). Diabetes has been associated with progression of OA and metformin is the first-line treatment in type 2 diabetes. The effect of the body mass index (BMI) and metformin on the expression of certain matrix genes in human chondrocytes is unclear. The purpose of this study was to investigate the effect of BMI and metformin on the expression of matrix genes in primary human chondrocytes. DESIGN Adult female patients undergoing knee arthroplasty for end-stage OA were enrolled. Primary chondrocytes were cultivated and stimulated with metformin. Matrix gene expression was analyzed using polymerase chain reaction. Clinical data were used in multivariable regression models to assess the influence of BMI and metformin stimulation on gene expression. RESULTS A total of 14 patients were analyzed. BMI was a predictor of increased expression in ADAMTS5 (β = -0.11, P = 0.03). Metformin slightly reduced expression in ADAMTS5 (β = 0.34, P = 0.04), HIF-1a (β = 0.39, P = 0.04), IL4 (β = 0.30, P = 0.02), MMP1 (β = 0.47, P < 0.01), and SOX9 (β = 0.37, P = 0.03). The hip-knee-ankle angle and proton pump inhibitors (PPIs) intake were associated with reduced SOX9 expression (β = 0.23, P < 0.01; β = 2.39, P < 0.01). Higher C-reactive protein (CRP) levels were associated with increased MMP1 expression (β = -0.16, P = 0.02). CONCLUSION We found that BMI exerts a destructive effect via induction of ADAMTS5. Metformin reduced the expression of catabolic genes ADAMTS5 and MMP1 and might play a role in disease prevention. Limb malalignment and PPI intake was associated with a reduced expression of SOX9, and higher CRP levels correlated with increased MMP1 expression, indicating a destructive process.
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Affiliation(s)
- Paul Schadler
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria,Paul Schadler, Department of Orthopaedics
and Trauma, Medical University of Graz, Auenbruggerplatz 5-7, Graz, 8036,
Austria.
| | - Birgit Lohberger
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria
| | - Nicole Stündl
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria,Department for Rehabilitation, Ludwig
Boltzmann Institute for Arthritis and Rehabilitation, Gröbming, Austria
| | - Martin Helmut Stradner
- Department for Rehabilitation, Ludwig
Boltzmann Institute for Arthritis and Rehabilitation, Gröbming, Austria
| | - Dietmar Glänzer
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria,Department for Rehabilitation, Ludwig
Boltzmann Institute for Arthritis and Rehabilitation, Gröbming, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria
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Hagelskjær V, Nielsen KT, von Bulow C, Oestergaard LG, Graff M, Wæhrens EE. Evaluating a complex intervention addressing ability to perform activities of daily living among persons with chronic conditions: study protocol for a randomised controlled trial (ABLE). BMJ Open 2021; 11:e051722. [PMID: 34836902 PMCID: PMC8628341 DOI: 10.1136/bmjopen-2021-051722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The need to develop and evaluate interventions, addressing problems performing activities of daily living (ADL) among persons with chronic conditions, is evident. Guided by the British Medical Research Council's guidance on how to develop and evaluate complex interventions, the occupational therapy programme (A Better everyday LifE (ABLE)) was developed and feasibility tested. The aim of this protocol is to report the planned design and methods for evaluating effectiveness, process and cost-effectiveness of the programme. METHODS AND ANALYSIS The evaluation is designed as a randomised controlled trial with blinded assessors and investigators. Eighty participants with chronic conditions and ADL problems are randomly allocated to ABLE or usual occupational therapy. Data for effectiveness and cost-effectiveness evaluations are collected at baseline (week 0), post intervention (week 10) and follow-up (week 26). Coprimary outcomes are self-reported ADL ability (ADL-Interview (ADL-I) performance) and observed ADL motor ability (Assessment of Motor and Process Skills (AMPS)). Secondary outcomes are perceived satisfaction with ADL ability (ADL-I satisfaction); and observed ADL process ability (AMPS). Explorative outcomes are occupational balance (Occupational Balance Questionnaire); perceived change (Client-Weighted Problems Questionnaire) and general health (first question of the MOS 36-item Short Form Survey Instrument). The process evaluation is based on quantitative data from registration forms and qualitative interview data, collected during and after the intervention period. A realist evaluation approach is applied. A programme theory expresses how context (C) and mechanisms (M) in the programme may lead to certain outcomes (O), in so-called CMO configurations. Outcomes in the cost-effectiveness evaluation are quality-adjusted life years (EuroQool 5-dimension) and changes in ADL ability (AMPS, ADL-I). Costs are estimated from microcosting and national registers. ETHICS AND DISSEMINATION Danish Data Protection Service Agency approval: Journal-nr.: P-2020-203. The Ethical Committee confirmed no approval needed: Journal-nr.: 19 045 758. Dissemination for study participants, in peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER NCT04295837.
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Affiliation(s)
- Vita Hagelskjær
- Copenhagen University, Bispebjerg and Frederiksberg Hospital, The Parker Institute, Copenhagen, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
- Department of Occupational Therapy, VIA University College, Holstebro, Denmark
| | - Kristina Tomra Nielsen
- Copenhagen University, Bispebjerg and Frederiksberg Hospital, The Parker Institute, Copenhagen, Denmark
- Department of Occupational Therapy, University College of Northern Denmark (UCN), Aalborg, Denmark
| | - Cecilie von Bulow
- Copenhagen University, Bispebjerg and Frederiksberg Hospital, The Parker Institute, Copenhagen, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Lisa Gregersen Oestergaard
- Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
- DEFACTUM, Department of Public Health and Rehabilitation, Central Denmark Region, Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Maud Graff
- Department of Rehabilitation & Scientific Institute for Quality of Care Research, Radboud University Medical Center, Nijmegen, Netherlands
| | - Eva Ejlersen Wæhrens
- Copenhagen University, Bispebjerg and Frederiksberg Hospital, The Parker Institute, Copenhagen, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
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Siddiq MAB, Clegg D, Jansen TL, Rasker JJ. Emerging and New Treatment Options for Knee Osteoarthritis. Curr Rheumatol Rev 2021; 18:20-32. [PMID: 34784876 DOI: 10.2174/1573397117666211116111738] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/15/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022]
Abstract
Osteoarthritis (OA) is the most prevalent type of arthritis worldwide, resulting in pain and often chronic disability and a significant burden on healthcare systems globally. Non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, intra-articular corticosteroid injections are of little value in the long term, and opioids may have ominous consequences. Radiotherapy of knee OA has no added value. Physical therapy, exercises, weight loss, and lifestyle modifications may give pain relief, improve physical functioning and quality of life. However, no single treatment has regenerating potential for damaged articular cartilage. Due to a better understanding of osteoarthritis, innovative new treatment options have been developed. In this narrative review, we focus on emerging OA knee treatments, relieving symptoms, and regenerating damaged articular cartilage that includes intra-articular human serum albumin, conventional disease-modifying anti-rheumatic drugs (DMARDs), lipid-lowering agents (statin), nerve growth factors antagonists, bone morphogenetic protein, fibroblast growth factors, Platelet-Rich Plasma (PRP), Mesenchymal Stem Cells (MSC), exosomes, interleukin-1 blockers, gene-based therapy, and bisphosphonate.
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Affiliation(s)
- Md Abu Bakar Siddiq
- Department of Physical Medicine and Rheumatology, Brahmanbaria Medical College, Brahmanbaria. Bangladesh
| | - Danny Clegg
- School of Health and Social Care, London South Bank University, London. United Kingdom
| | - Tim L Jansen
- Department of Rheumatology, Viecuri MC, Venlo. Netherlands
| | - Johannes J Rasker
- Faculty of Behavioral, Management and Social sciences, Department Psychology, Health and Technology, University of Twente, Enschede . Netherlands
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Minton DM, Elliehausen CJ, Javors MA, Santangelo KS, Konopka AR. Rapamycin-induced hyperglycemia is associated with exacerbated age-related osteoarthritis. Arthritis Res Ther 2021; 23:253. [PMID: 34620223 PMCID: PMC8495984 DOI: 10.1186/s13075-021-02637-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study was to determine if mechanistic target of rapamycin (mTOR) inhibition with or without AMP-activated protein kinase (AMPK) activation can protect against primary, age-related OA. DESIGN Dunkin-Hartley guinea pigs develop mild primary OA pathology by 5 months of age that progresses to moderate OA by 8 months of age. At 5 months, guinea pigs served as young control (n = 3) or were fed either a control diet (n = 8), a diet enriched with the mTOR-inhibitor rapamycin (Rap, 14 ppm, n = 8), or Rap with the AMPK-activator metformin (Rap+Met, 1000 ppm, n = 8) for 12 weeks. Knee joints were evaluated by OARSI scoring, micro-computed tomography, and immunohistochemistry. Glenohumeral articular cartilage was collected for western blotting. RESULTS Rap- and Rap+Met-treated guinea pigs displayed lower body weight than control. Rap and Rap+Met inhibited articular cartilage mTORC1 but not mTORC2 signaling. Rap+Met, but not Rap alone, stimulated AMPK. Despite lower body weight and articular cartilage mTORC1 inhibition, Rap- and Rap+Met-treated guinea pigs had greater OA severity in the medial tibial plateau due to articular cartilage structural damage and/or proteoglycan loss. Rap and Rap+Met increased plasma glucose compared to control. Plasma glucose concentration was positively correlated with proteoglycan loss, suggesting hyperglycemic stress after Rap treatment was related to worsened OA. CONCLUSIONS This is the first study to show that Rap induced increase in plasma glucose was associated with greater OA severity. Further, articular cartilage mTORC1 inhibition and bodyweight reduction by dietary Rap and Rap+Met did not appear to protect against primary OA during the prevailing hyperglycemia.
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Affiliation(s)
- Dennis M Minton
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Kinesiology, University of Illinois at Urbana-Champaign, Champaign, Illinois , USA
| | - Christian J Elliehausen
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Kinesiology, University of Illinois at Urbana-Champaign, Champaign, Illinois , USA
| | - Martin A Javors
- Departments of Psychiatry and Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Kelly S Santangelo
- Department of Microbiology, Immunology, Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Adam R Konopka
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA.
- Department of Kinesiology, University of Illinois at Urbana-Champaign, Champaign, Illinois , USA.
- Geriatric Research, Education, and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA.
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Interleukin-26 Has Synergistic Catabolic Effects with Palmitate in Human Articular Chondrocytes via the TLR4-ERK1/2-c-Jun Signaling Pathway. Cells 2021; 10:cells10092500. [PMID: 34572149 PMCID: PMC8471695 DOI: 10.3390/cells10092500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 12/24/2022] Open
Abstract
The inflammatory cytokine interleukin-26 (IL-26) is highly expressed in the serum and synovial fluid of patients with inflammatory arthritis. The effect of IL-26 on human articular chondrocytes (HACs) remains unclear. Obesity is associated with disability of patients with rheumatoid arthritis and disease activity in those with ankylosing spondylitis. The saturated free fatty acid palmitate with IL-1β can synergistically induce catabolic effects in HACs. The aim of this study was to evaluate the effects of IL-26 and palmitate in HACs. In this study, palmitate markedly synergizes the IL-26-induced proinflammatory effects and matrix protease, including COX-2, IL-6, and MMP-1, in HACs via the toll-like receptor 4 (TLR4)-ERK1/2-c-Jun signal transduction pathway. The synergistic catabolic effects of palmitate and IL-26 were attenuated by inhibitors of TLR4 (TAK242), ERK1/2 (U0126), or c-Jun (SP600125) in HACs and cartilage matrix. In addition, metformin, a potential inhibitor of TLR4, also decreased expression of COX-2 and IL-6 induced by co-incubation with IL-26 and palmitate. IL-26 and palmitate synergistically induced expression of inflammatory and catabolic mediators, resulting in articular cartilage matrix breakdown. The present study also revealed a possible mechanism and therapeutic targets against articular cartilage degradation by increased saturated fatty acids in patients with inflammatory arthritis.
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Disease-Modifying Potential of Metformin and Alendronate in an Experimental Mouse Model of Osteoarthritis. Biomedicines 2021; 9:biomedicines9081017. [PMID: 34440221 PMCID: PMC8391621 DOI: 10.3390/biomedicines9081017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/01/2021] [Accepted: 08/13/2021] [Indexed: 01/05/2023] Open
Abstract
Osteoarthritis (OA) is the most common degenerative joint disease causing progressive damages of the cartilage and subchondral bone, synovial inflammation, and severe pain. Despite the complex pathomorphological changes that occur in OA, the approach to different forms of OA is standardized. The global results from pharmacological treatment are not satisfactory. Hence, this study aimed to explore the effects of metformin, alendronate, and their combination on OA development and progression in mice with collagenase-induced osteoarthritis (CIOA). Female ICR (CD-2) mice were randomized to five groups: control group, CIOA untreated, CIOA + metformin, CIOA + alendronate, and CIOA + metformin + alendronate. OA was induced by the intra-articular (i.a.) injection of collagenase. OA phenotype was analyzed by flow cytometry (bone marrow cell differentiation), ELISA (serum levels of the adipokines leptin and resistin), and histology (pathological changes of the knee joint). Treatment with metformin, alendronate, or their combination inhibited the expression of RANK and RANKL on osteoblasts and osteoclasts obtained by ex vivo cultivation of bone marrow cells in mineralization or osteoclastogenic media. In addition, metformin treatment was effective for the attenuation of fibroblast differentiation, but not of mesenchymal stem cells (MSCs), while alendronate had an opposite effect. The combination of metformin and alendronate had a suppressive effect on both MSCs and fibroblasts differentiation. Treatment with metformin, alendronate, and their combination decreased serum concentrations of leptin and resistin in the chronic phase of arthritis. The histopathological examination showed that compared with the untreated CIOA group (OA score 9), the groups treated with metformin (OA score 4) or alendronate (OA score 6) had lower scores for cartilage changes. Metformin combined with alendronate significantly decreased the degree of cartilage degeneration (OA score 2), suggesting that this combination might be a useful approach for the treatment of OA patients.
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Griffiths H, Smith T, Mack C, Leadbetter J, Butcher B, Acar M, Ciciriello S. Persistence to Biologic Therapy among Patients with Spondyloarthritis: An Observational Study using the OPAL Dataset. J Rheumatol 2021; 49:150-156. [PMID: 34334362 DOI: 10.3899/jrheum.201551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe the treatment response and persistence to biologic DMARD (bDMARD) therapy in patients with ankylosing spondylitis (AS) in a real-world Australian cohort. METHODS This was a retrospective, non-interventional cohort study that extracted data for patients with AS from the Optimising Patient outcomes in Australian rheumatology (OPAL) dataset for the period Aug-2006 to Sep-2019. Patients were classified as either bDMARD initiators if they commenced a bDMARD during the sampling window, or bDMARD naïve if they did not. Results were summarised descriptively. Treatment persistence was calculated using Kaplan-Meier methods. Differences in treatment persistence were explored using log-rank tests. RESULTS 5048 patients with AS were identified. 2597 patients initiated bDMARDs and 2451 remained bDMARD naïve throughout the study window. Treatment with first, second and third line bDMARDs significantly reduced disease activity. Median persistence on first line bDMARDs was 96 months (95% CI 85 to 109), declining to 19 months (95% CI 16 to 22) in second line, and 14 months (95% CI 11 to 18) in third line therapy. Median persistence was longest for the golimumab treated group in all lines of therapy and shortest for the etanercept group. Differences in persistence rates according to the time-period that bDMARDs were prescribed (pre-and post-2012) were also seen for etanercept and adalimumab. CONCLUSION In this cohort all bDMARDs effectively reduced disease activity. Patients remained on their first bDMARD longer than subsequent agents. Median persistence was longest for the golimumab treated group in all lines of therapy and shortest for the etanercept group.
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Affiliation(s)
- Hedley Griffiths
- OPAL Rheumatology Ltd, Sydney, NSW, Australia; Barwon Rheumatology Service, Geelong, VIC, Australia; Coast Joint Care, Maroochydore, QLD, Australia; WriteSource Medical, Lane Cove, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Janssen-Cilag, Macquarie Park, NSW, Australia; Royal Melbourne Hospital, Parkville, VIC, Australia. Funding: This study received financial assistance from Janssen-Cilag Pty Ltd, Australia. The study was conducted independently by OPAL with review and input on the study start up documents (protocol and statistical analysis plan) as well as review and input into final manuscript by Janssen staff member M. Acar. Conflicts of interest: A.M. is an employee of Janssen-Cilag Pty Ltd. Australia Data statement: The OPAL dataset collects information from individual clinicians' servers during routine clinical consultations. Clinicians contributing data to OPAL use purpose-built worksheets in Audit4 software (Software4Specialists, Australia), and this software serves as the patient's medical record. Data de-identified for patient, clinic, and clinician were exported from each of the OPAL member's local server, and aggregated across all sites. Each clinician retains their patient records. Patient and Public Involvement: The research activities of OPAL Rheumatology Ltd are based on a patient opt-out arrangement. This report is based on data captured for routine clinical care and does not require additional informed consent to be obtained from patients. We thank patients for providing their clinical data for research purposes. Address correspondence to Hedley Griffiths, Barwon Rheumatology Service, 156 Bellerine Street, Geelong 3220 VIC, Australia.
| | - Tegan Smith
- OPAL Rheumatology Ltd, Sydney, NSW, Australia; Barwon Rheumatology Service, Geelong, VIC, Australia; Coast Joint Care, Maroochydore, QLD, Australia; WriteSource Medical, Lane Cove, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Janssen-Cilag, Macquarie Park, NSW, Australia; Royal Melbourne Hospital, Parkville, VIC, Australia. Funding: This study received financial assistance from Janssen-Cilag Pty Ltd, Australia. The study was conducted independently by OPAL with review and input on the study start up documents (protocol and statistical analysis plan) as well as review and input into final manuscript by Janssen staff member M. Acar. Conflicts of interest: A.M. is an employee of Janssen-Cilag Pty Ltd. Australia Data statement: The OPAL dataset collects information from individual clinicians' servers during routine clinical consultations. Clinicians contributing data to OPAL use purpose-built worksheets in Audit4 software (Software4Specialists, Australia), and this software serves as the patient's medical record. Data de-identified for patient, clinic, and clinician were exported from each of the OPAL member's local server, and aggregated across all sites. Each clinician retains their patient records. Patient and Public Involvement: The research activities of OPAL Rheumatology Ltd are based on a patient opt-out arrangement. This report is based on data captured for routine clinical care and does not require additional informed consent to be obtained from patients. We thank patients for providing their clinical data for research purposes. Address correspondence to Hedley Griffiths, Barwon Rheumatology Service, 156 Bellerine Street, Geelong 3220 VIC, Australia.
| | - Christopher Mack
- OPAL Rheumatology Ltd, Sydney, NSW, Australia; Barwon Rheumatology Service, Geelong, VIC, Australia; Coast Joint Care, Maroochydore, QLD, Australia; WriteSource Medical, Lane Cove, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Janssen-Cilag, Macquarie Park, NSW, Australia; Royal Melbourne Hospital, Parkville, VIC, Australia. Funding: This study received financial assistance from Janssen-Cilag Pty Ltd, Australia. The study was conducted independently by OPAL with review and input on the study start up documents (protocol and statistical analysis plan) as well as review and input into final manuscript by Janssen staff member M. Acar. Conflicts of interest: A.M. is an employee of Janssen-Cilag Pty Ltd. Australia Data statement: The OPAL dataset collects information from individual clinicians' servers during routine clinical consultations. Clinicians contributing data to OPAL use purpose-built worksheets in Audit4 software (Software4Specialists, Australia), and this software serves as the patient's medical record. Data de-identified for patient, clinic, and clinician were exported from each of the OPAL member's local server, and aggregated across all sites. Each clinician retains their patient records. Patient and Public Involvement: The research activities of OPAL Rheumatology Ltd are based on a patient opt-out arrangement. This report is based on data captured for routine clinical care and does not require additional informed consent to be obtained from patients. We thank patients for providing their clinical data for research purposes. Address correspondence to Hedley Griffiths, Barwon Rheumatology Service, 156 Bellerine Street, Geelong 3220 VIC, Australia.
| | - Jo Leadbetter
- OPAL Rheumatology Ltd, Sydney, NSW, Australia; Barwon Rheumatology Service, Geelong, VIC, Australia; Coast Joint Care, Maroochydore, QLD, Australia; WriteSource Medical, Lane Cove, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Janssen-Cilag, Macquarie Park, NSW, Australia; Royal Melbourne Hospital, Parkville, VIC, Australia. Funding: This study received financial assistance from Janssen-Cilag Pty Ltd, Australia. The study was conducted independently by OPAL with review and input on the study start up documents (protocol and statistical analysis plan) as well as review and input into final manuscript by Janssen staff member M. Acar. Conflicts of interest: A.M. is an employee of Janssen-Cilag Pty Ltd. Australia Data statement: The OPAL dataset collects information from individual clinicians' servers during routine clinical consultations. Clinicians contributing data to OPAL use purpose-built worksheets in Audit4 software (Software4Specialists, Australia), and this software serves as the patient's medical record. Data de-identified for patient, clinic, and clinician were exported from each of the OPAL member's local server, and aggregated across all sites. Each clinician retains their patient records. Patient and Public Involvement: The research activities of OPAL Rheumatology Ltd are based on a patient opt-out arrangement. This report is based on data captured for routine clinical care and does not require additional informed consent to be obtained from patients. We thank patients for providing their clinical data for research purposes. Address correspondence to Hedley Griffiths, Barwon Rheumatology Service, 156 Bellerine Street, Geelong 3220 VIC, Australia.
| | - Belinda Butcher
- OPAL Rheumatology Ltd, Sydney, NSW, Australia; Barwon Rheumatology Service, Geelong, VIC, Australia; Coast Joint Care, Maroochydore, QLD, Australia; WriteSource Medical, Lane Cove, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Janssen-Cilag, Macquarie Park, NSW, Australia; Royal Melbourne Hospital, Parkville, VIC, Australia. Funding: This study received financial assistance from Janssen-Cilag Pty Ltd, Australia. The study was conducted independently by OPAL with review and input on the study start up documents (protocol and statistical analysis plan) as well as review and input into final manuscript by Janssen staff member M. Acar. Conflicts of interest: A.M. is an employee of Janssen-Cilag Pty Ltd. Australia Data statement: The OPAL dataset collects information from individual clinicians' servers during routine clinical consultations. Clinicians contributing data to OPAL use purpose-built worksheets in Audit4 software (Software4Specialists, Australia), and this software serves as the patient's medical record. Data de-identified for patient, clinic, and clinician were exported from each of the OPAL member's local server, and aggregated across all sites. Each clinician retains their patient records. Patient and Public Involvement: The research activities of OPAL Rheumatology Ltd are based on a patient opt-out arrangement. This report is based on data captured for routine clinical care and does not require additional informed consent to be obtained from patients. We thank patients for providing their clinical data for research purposes. Address correspondence to Hedley Griffiths, Barwon Rheumatology Service, 156 Bellerine Street, Geelong 3220 VIC, Australia.
| | - Mustafa Acar
- OPAL Rheumatology Ltd, Sydney, NSW, Australia; Barwon Rheumatology Service, Geelong, VIC, Australia; Coast Joint Care, Maroochydore, QLD, Australia; WriteSource Medical, Lane Cove, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Janssen-Cilag, Macquarie Park, NSW, Australia; Royal Melbourne Hospital, Parkville, VIC, Australia. Funding: This study received financial assistance from Janssen-Cilag Pty Ltd, Australia. The study was conducted independently by OPAL with review and input on the study start up documents (protocol and statistical analysis plan) as well as review and input into final manuscript by Janssen staff member M. Acar. Conflicts of interest: A.M. is an employee of Janssen-Cilag Pty Ltd. Australia Data statement: The OPAL dataset collects information from individual clinicians' servers during routine clinical consultations. Clinicians contributing data to OPAL use purpose-built worksheets in Audit4 software (Software4Specialists, Australia), and this software serves as the patient's medical record. Data de-identified for patient, clinic, and clinician were exported from each of the OPAL member's local server, and aggregated across all sites. Each clinician retains their patient records. Patient and Public Involvement: The research activities of OPAL Rheumatology Ltd are based on a patient opt-out arrangement. This report is based on data captured for routine clinical care and does not require additional informed consent to be obtained from patients. We thank patients for providing their clinical data for research purposes. Address correspondence to Hedley Griffiths, Barwon Rheumatology Service, 156 Bellerine Street, Geelong 3220 VIC, Australia.
| | - Sabina Ciciriello
- OPAL Rheumatology Ltd, Sydney, NSW, Australia; Barwon Rheumatology Service, Geelong, VIC, Australia; Coast Joint Care, Maroochydore, QLD, Australia; WriteSource Medical, Lane Cove, NSW, Australia; University of New South Wales, Kensington, NSW, Australia; Janssen-Cilag, Macquarie Park, NSW, Australia; Royal Melbourne Hospital, Parkville, VIC, Australia. Funding: This study received financial assistance from Janssen-Cilag Pty Ltd, Australia. The study was conducted independently by OPAL with review and input on the study start up documents (protocol and statistical analysis plan) as well as review and input into final manuscript by Janssen staff member M. Acar. Conflicts of interest: A.M. is an employee of Janssen-Cilag Pty Ltd. Australia Data statement: The OPAL dataset collects information from individual clinicians' servers during routine clinical consultations. Clinicians contributing data to OPAL use purpose-built worksheets in Audit4 software (Software4Specialists, Australia), and this software serves as the patient's medical record. Data de-identified for patient, clinic, and clinician were exported from each of the OPAL member's local server, and aggregated across all sites. Each clinician retains their patient records. Patient and Public Involvement: The research activities of OPAL Rheumatology Ltd are based on a patient opt-out arrangement. This report is based on data captured for routine clinical care and does not require additional informed consent to be obtained from patients. We thank patients for providing their clinical data for research purposes. Address correspondence to Hedley Griffiths, Barwon Rheumatology Service, 156 Bellerine Street, Geelong 3220 VIC, Australia.
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Kim J, Kim YS, Park SH. Metformin as a Treatment Strategy for Sjögren's Syndrome. Int J Mol Sci 2021; 22:7231. [PMID: 34281285 PMCID: PMC8269365 DOI: 10.3390/ijms22137231] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 12/26/2022] Open
Abstract
Sjögren's syndrome (SS), a chronic inflammatory disease involving the salivary and lacrimal glands, presents symptoms of sicca as well as systemic manifestations such as fatigue and musculoskeletal pain. Only a few treatments have been successful in management of SS; thus treatment of the disease is challenging. Metformin is the first-line agent for type 2 diabetes and has anti-inflammatory potential. Its immunomodulatory capacity is exerted via activation of 5' adenosine monophosphate-activated protein kinase (AMPK). Metformin inhibits mitochondrial respiratory chain complex I which leads to change in adenosine mono-phosphate (AMP) to adenosine tri-phosphate (ATP) ratio. This results in AMPK activation and causes inhibition of mammalian target of rapamycin (mTOR). mTOR plays an important role in T cell differentiation and mTOR deficient T cells differentiate into regulatory T cells. In this manner, metformin enhances immunoregulatory response in an individual. mTOR is responsible for B cell proliferation and germinal center (GC) differentiation. Thus, reduction of B cell differentiation into antibody-producing plasma cells occurs via downregulation of mTOR. Due to the lack of suggested treatment for SS, metformin has been considered as a treatment strategy and is expected to ameliorate salivary gland function.
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Affiliation(s)
- Joa Kim
- Division of Rheumatology, Department of Internal Medicine, Chosun University Hospital, Gwangju 61453, Korea; (J.K.); (Y.-S.K.)
| | - Yun-Sung Kim
- Division of Rheumatology, Department of Internal Medicine, Chosun University Hospital, Gwangju 61453, Korea; (J.K.); (Y.-S.K.)
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
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Cai X, Yuan S, Zeng Y, Wang C, Yu N, Ding C. New Trends in Pharmacological Treatments for Osteoarthritis. Front Pharmacol 2021; 12:645842. [PMID: 33935742 PMCID: PMC8085504 DOI: 10.3389/fphar.2021.645842] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) is the leading cause of function loss and disability among the elderly, with significant burden on the individual and society. It is a severe disease for its high disability rates, morbidity, costs, and increased mortality. Multifactorial etiologies contribute to the occurrence and development of OA. The heterogeneous condition poses a challenge for the development of effective treatment for OA; however, emerging treatments are promising to bring benefits for OA management in the future. This narrative review will discuss recent developments of agents for the treatment of OA, including potential disease-modifying osteoarthritis drugs (DMOADs) and novel therapeutics for pain relief. This review will focus more on drugs that have been in clinical trials, as well as attractive drugs with potential applications in preclinical research. In the past few years, it has been realized that a complex interaction of multifactorial mechanisms is involved in the pathophysiology of OA. The authors believe there is no miracle therapeutic strategy fitting for all patients. OA phenotyping would be helpful for therapy selection. A variety of potential therapeutics targeting inflammation mechanisms, cellular senescence, cartilage metabolism, subchondral bone remodeling, and the peripheral nociceptive pathways are expected to reshape the landscape of OA treatment over the next few years. Precise randomized controlled trials (RCTs) are expected to identify the safety and efficacy of novel therapies targeting specific mechanisms in OA patients with specific phenotypes.
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Affiliation(s)
- Xiaoyan Cai
- Department of Rheumatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Shiwen Yuan
- Department of Rheumatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yanting Zeng
- Department of Rheumatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Cuicui Wang
- Department of Rheumatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Na Yu
- Department of Rheumatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Changhai Ding
- Department of Rheumatology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.,Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Therapeutic Applications of Type 2 Diabetes Mellitus Drug Metformin in Patients with Osteoarthritis. Pharmaceuticals (Basel) 2021; 14:ph14020152. [PMID: 33668426 PMCID: PMC7918864 DOI: 10.3390/ph14020152] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/14/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) and osteoarthritis (OA) are common chronic diseases that frequently co-exist. The link between OA and T2DM is attributed to common risk factors, including age and obesity. Several reports suggest that hyperglycemia and accumulated advanced glycosylation end-products might regulate cartilage homeostasis and contribute to the development and progression of OA. Metformin is used widely as the first-line treatment for T2DM. The drug acts by regulating glucose levels and improving insulin sensitivity. The anti-diabetic effects of metformin are mediated mainly via activation of adenosine monophosphate (AMP)-activated protein kinase (AMPK), which is an energy sensing enzyme activated directly by an increase in the AMP/ATP ratio under conditions of metabolic stress. Dysregulation of AMPK is strongly associated with development of T2DM and metabolic syndrome. In this review, we discuss common risk factors, the association between OA and T2DM, and the role of AMPK. We also address the adaptive use of metformin, a known AMPK activator, as a new drug for treatment of patients with OA and T2DM.
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Osteoarthritis year in review 2020: imaging. Osteoarthritis Cartilage 2021; 29:170-179. [PMID: 33418028 DOI: 10.1016/j.joca.2020.12.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/23/2020] [Accepted: 12/17/2020] [Indexed: 02/02/2023]
Abstract
This narrative "Year in Review" highlights a selection of articles published between January 2019 and April 2020, to be presented at the OARSI World Congress 2020 within the field of osteoarthritis (OA) imaging. Articles were obtained from a PubMed search covering the above period, utilizing a variety of relevant search terms. We then selected original and review studies on OA-related imaging in humans, particularly those with direct clinical relevance, with a focus on the knee. Topics selected encompassed clinically relevant models of early OA, particularly imaging applications on cruciate ligament rupture, as these are of direct clinical interest and provide potential opportunity to evaluate preventive therapy. Further, imaging applications on structural modification of articular tissues in patients with established OA, by non-pharmacological, pharmacological and surgical interventions are summarized. Finally, novel deep learning approaches to imaging are reviewed, as these facilitate implementation and scaling of quantitative imaging application in clinical trials and clinical practice. Methodological or observational studies outside these key focus areas were not included. Studies focused on biology, biomechanics, biomarkers, genetics and epigenetics, and clinical studies that did not contain an imaging component are covered in other articles within the OARSI "Year in Review" series. In conclusion, exciting progress has been made in clinically validating human models of early OA, and the field of automated articular tissue segmentation. Most importantly though, it has been shown that structure modification of articular cartilage is possible, and future research should focus on the translation of these structural findings to clinical benefit.
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van den Bosch MHJ. Osteoarthritis year in review 2020: biology. Osteoarthritis Cartilage 2021; 29:143-150. [PMID: 33242602 DOI: 10.1016/j.joca.2020.10.006] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/08/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023]
Abstract
This year in review about osteoarthritis biology highlights a selection of articles published between the 2019 and 2020 Osteoarthritis Research Society International (OARSI) World Congress meetings, within the field of osteoarthritis biology. Highlights were selected from PubMed searches covering osteoarthritis (OA) cartilage, subchondral bone, synovium and aging. Subsequently, a personal selection was based on new and emerging themes together with common research topics that were studied by multiple groups. Themes discussed include novel insights into the inflammatory changes during OA, with a number of noteworthy publications concerning the role of macrophages in healthy and osteoarthritic joints. Next, the application of mesenchymal stem cells as OA-dampening therapy is discussed, including possible ways to improve their efficacy by pre-treatment. Other significant themes including treatment of OA with metformin, enhancing autophagy to alleviate OA and the involvement of the gastro-intestinal microbiome in development of OA symptoms and structural damage are discussed. An effort was made to connect the seemingly distant topics from which the overarching conclusion can be drawn that over the last year promising breakthroughs have been achieved in further understanding the biology of OA development and that new therapeutic possibilities have been explored.
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Affiliation(s)
- M H J van den Bosch
- Experimental Rheumatology, Radboud university medical center Nijmegen, the Netherlands..
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Perry TA, Wang X, Nevitt M, Abdelshaheed C, Arden N, Hunter DJ. Association between current medication use and progression of radiographic knee osteoarthritis: data from the Osteoarthritis Initiative. Rheumatology (Oxford) 2021; 60:4624-4632. [PMID: 33502488 PMCID: PMC8487312 DOI: 10.1093/rheumatology/keab059] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/14/2020] [Indexed: 02/02/2023] Open
Abstract
Objective Use of specific medications may accelerate the progression of radiographic knee OA (RKOA). Our aim was to examine the effect of medication use on the progression of RKOA. Methods We used longitudinal data from the Osteoarthritis Initiative (OAI), an observational study of risk factors for knee OA. At baseline, we selected participants with RKOA (Kellgren–Lawrence grade ≥2) and excluded those with a history of knee-related injury/surgery and other musculoskeletal disorders. Current medication use (use/non-use in the previous 30 days) and radiographic medial minimum joint space width (mJSW) data were available at baseline and annually up to 96 months follow-up. We used random effects, panel regression to assess the association between current medication use (non-users as reference group) and change in mJSW. Results Of 2054 eligible participants, 2003 participants with baseline mJSW data were included [55.7% female, mean age 63.3 (s.d. 8.98) years]. Of seven medication classes, at baseline NSAIDs were the most frequently used analgesia (14.7%), anti-histamine (10.4%) use was frequent and the following comorbidity medications were used most frequently: statins (27.4%), anti-hypertensives (up to 15.0%), anti-depressant/anxiolytics/psychotropics (14.0%), osteoporosis-related medication (10.9%) and diabetes-related medication (6.9%). Compared with current non-users, current use of NSAIDs was associated with a loss of mJSW (b = −0.042, 95% CI −0.08, −0.0004). No other associations were observed. Conclusions In current users of NSAIDs, mJSW loss was increased compared with current non-users in participants with RKOA. Clinical trials are required to assess the potential disease-modifying effects of these medications.
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Affiliation(s)
- Thomas A Perry
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, United Kingdom.,Institute of Bone and Joint Research, Rheumatology Department, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Xia Wang
- Institute of Bone and Joint Research, Rheumatology Department, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Michael Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Christina Abdelshaheed
- Faculty of Medicine and Health, School of Public Health, University of Sydney, New South Wales, Australia.,Institute for Musculoskeletal Health, University of Sydney, Sydney, Australia
| | - Nigel Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, United Kingdom.,MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | - David J Hunter
- Institute of Bone and Joint Research, Rheumatology Department, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
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Cai D, Wang J, Chen S, Jiang L, Chen J, Wu J, Qin J. Coniferaldehyde prevents articular cartilage destruction in a murine model via Nrf2/HO‑1 pathway. Mol Med Rep 2021; 23:224. [PMID: 33495836 PMCID: PMC7851827 DOI: 10.3892/mmr.2021.11863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/17/2020] [Indexed: 12/19/2022] Open
Abstract
Osteoarthritis (OA) is the most prevalent joint disorder characterized by progressive cartilage damage, resulting in gradual disability among the elderly. We previously provided in vivo evidence that nuclear factor erythroid 2‑related factor 2 (Nrf2) deficiency is associated with the development of OA. It has been reported that coniferaldehyde (CFA) acts as a potential Nrf2 activator. The aim of the present study was to investigate the protective effects of CFA against osteoarthritis. A murine model of surgical‑induced OA was used in the present study and CFA was administered by peritoneal injection every day, and the knee joints were assessed by histological analysis. The results demonstrated that CFA activated the Nrf2 signaling pathway in primary chondrocytes and articular cartilage from the knee joints. Cartilage damage in mice subjected to the destabilization of the medial meniscus was evidently alleviated by CFA treatment. CFA also robustly suppressed apoptosis induced by H2O2 in murine chondrocytes and reduced the expression of matrix metalloproteinase (MMP)1, MMP3, interleukin (IL)‑1 and IL‑6 in vivo. On the whole, the findings suggested that CFA exerts a therapeutic effect against OA, and the activation of the Nrf2/heme oxygenase‑1 pathway may play a crucial role in CFA‑mediated cartilage protection.
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Affiliation(s)
- Dawei Cai
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 211100, P.R. China
| | - Jieling Wang
- Department of Critical Medicine, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230011, P.R. China
| | - Sichun Chen
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 211100, P.R. China
| | - Longhai Jiang
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 211100, P.R. China
| | - Jinwei Chen
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 211100, P.R. China
| | - Ji Wu
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 211100, P.R. China
| | - Jian Qin
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 211100, P.R. China
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Yousuf MS, Shiers SI, Sahn JJ, Price TJ. Pharmacological Manipulation of Translation as a Therapeutic Target for Chronic Pain. Pharmacol Rev 2021; 73:59-88. [PMID: 33203717 PMCID: PMC7736833 DOI: 10.1124/pharmrev.120.000030] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Dysfunction in regulation of mRNA translation is an increasingly recognized characteristic of many diseases and disorders, including cancer, diabetes, autoimmunity, neurodegeneration, and chronic pain. Approximately 50 million adults in the United States experience chronic pain. This economic burden is greater than annual costs associated with heart disease, cancer, and diabetes combined. Treatment options for chronic pain are inadequately efficacious and riddled with adverse side effects. There is thus an urgent unmet need for novel approaches to treating chronic pain. Sensitization of neurons along the nociceptive pathway causes chronic pain states driving symptoms that include spontaneous pain and mechanical and thermal hypersensitivity. More than a decade of preclinical research demonstrates that translational mechanisms regulate the changes in gene expression that are required for ongoing sensitization of nociceptive sensory neurons. This review will describe how key translation regulation signaling pathways, including the integrated stress response, mammalian target of rapamycin, AMP-activated protein kinase (AMPK), and mitogen-activated protein kinase-interacting kinases, impact the translation of different subsets of mRNAs. We then place these mechanisms of translation regulation in the context of chronic pain states, evaluate currently available therapies, and examine the potential for developing novel drugs. Considering the large body of evidence now published in this area, we propose that pharmacologically manipulating specific aspects of the translational machinery may reverse key neuronal phenotypic changes causing different chronic pain conditions. Therapeutics targeting these pathways could eventually be first-line drugs used to treat chronic pain disorders. SIGNIFICANCE STATEMENT: Translational mechanisms regulating protein synthesis underlie phenotypic changes in the sensory nervous system that drive chronic pain states. This review highlights regulatory mechanisms that control translation initiation and how to exploit them in treating persistent pain conditions. We explore the role of mammalian/mechanistic target of rapamycin and mitogen-activated protein kinase-interacting kinase inhibitors and AMPK activators in alleviating pain hypersensitivity. Modulation of eukaryotic initiation factor 2α phosphorylation is also discussed as a potential therapy. Targeting specific translation regulation mechanisms may reverse changes in neuronal hyperexcitability associated with painful conditions.
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Affiliation(s)
- Muhammad Saad Yousuf
- Center for Advanced Pain Studies, School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas (M.S.Y., S.I.S., T.J.P.) and 4E Therapeutics Inc, Austin, Texas (J.J.S.)
| | - Stephanie I Shiers
- Center for Advanced Pain Studies, School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas (M.S.Y., S.I.S., T.J.P.) and 4E Therapeutics Inc, Austin, Texas (J.J.S.)
| | - James J Sahn
- Center for Advanced Pain Studies, School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas (M.S.Y., S.I.S., T.J.P.) and 4E Therapeutics Inc, Austin, Texas (J.J.S.)
| | - Theodore J Price
- Center for Advanced Pain Studies, School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas (M.S.Y., S.I.S., T.J.P.) and 4E Therapeutics Inc, Austin, Texas (J.J.S.)
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Salvatore T, Pafundi PC, Galiero R, Gjeloshi K, Masini F, Acierno C, Di Martino A, Albanese G, Alfano M, Rinaldi L, Sasso FC. Metformin: A Potential Therapeutic Tool for Rheumatologists. Pharmaceuticals (Basel) 2020; 13:ph13090234. [PMID: 32899806 PMCID: PMC7560003 DOI: 10.3390/ph13090234] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
Abstract
Metformin is an oral antihyperglycemic drug widely used to treat type 2 diabetes, acting via indirect activation of 5′ Adenosine Monophosphate-activated Protein Kinase (AMPK). Actually, evidence has accumulated of an intriguing anti-inflammatory activity, mainly mediated by AMPK through a variety of mechanisms such as the inhibition of cytokine-stimulated Nuclear Factor-κB (NF-κB) and the downregulation of the Janus Kinase/Signal Transducer and Activator of Transcription (JAK/STAT) signaling pathways. Moreover, AMPK plays an important role in the modulation of T lymphocytes and other pivotal cells of the innate immune system. The current understanding of these AMPK effects provides a strong rationale for metformin repurposing in the management of autoimmune and inflammatory conditions. Several studies demonstrated metformin’s beneficial effects on both animal and human rheumatologic diseases, especially on rheumatoid arthritis. Unfortunately, even though data are large and remarkable, they almost exclusively come from experimental investigations with only a few from clinical trials. The lack of support from prospective placebo-controlled trials does not allow metformin to enter the therapeutic repertoire of rheumatologists. However, a large proportion of rheumatologic patients can currently benefit from metformin, such as those with concomitant obesity and type 2 diabetes, two conditions strongly associated with rheumatoid arthritis, osteoarthritis, and gout, as well as those with diabetes secondary to steroid therapy.
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Affiliation(s)
- Teresa Salvatore
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via de Crecchio, 7, I-80138 Naples, Italy;
| | - Pia Clara Pafundi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia, 2, I-80138 Naples, Italy; (P.C.P.); (R.G.); (K.G.); (F.M.); (C.A.); (A.D.M.); (G.A.); (M.A.); (L.R.)
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia, 2, I-80138 Naples, Italy; (P.C.P.); (R.G.); (K.G.); (F.M.); (C.A.); (A.D.M.); (G.A.); (M.A.); (L.R.)
| | - Klodian Gjeloshi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia, 2, I-80138 Naples, Italy; (P.C.P.); (R.G.); (K.G.); (F.M.); (C.A.); (A.D.M.); (G.A.); (M.A.); (L.R.)
| | - Francesco Masini
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia, 2, I-80138 Naples, Italy; (P.C.P.); (R.G.); (K.G.); (F.M.); (C.A.); (A.D.M.); (G.A.); (M.A.); (L.R.)
| | - Carlo Acierno
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia, 2, I-80138 Naples, Italy; (P.C.P.); (R.G.); (K.G.); (F.M.); (C.A.); (A.D.M.); (G.A.); (M.A.); (L.R.)
| | - Anna Di Martino
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia, 2, I-80138 Naples, Italy; (P.C.P.); (R.G.); (K.G.); (F.M.); (C.A.); (A.D.M.); (G.A.); (M.A.); (L.R.)
| | - Gaetana Albanese
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia, 2, I-80138 Naples, Italy; (P.C.P.); (R.G.); (K.G.); (F.M.); (C.A.); (A.D.M.); (G.A.); (M.A.); (L.R.)
| | - Maria Alfano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia, 2, I-80138 Naples, Italy; (P.C.P.); (R.G.); (K.G.); (F.M.); (C.A.); (A.D.M.); (G.A.); (M.A.); (L.R.)
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia, 2, I-80138 Naples, Italy; (P.C.P.); (R.G.); (K.G.); (F.M.); (C.A.); (A.D.M.); (G.A.); (M.A.); (L.R.)
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia, 2, I-80138 Naples, Italy; (P.C.P.); (R.G.); (K.G.); (F.M.); (C.A.); (A.D.M.); (G.A.); (M.A.); (L.R.)
- Correspondence: ; Tel.: +39-081-566-5010
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Gratal P, Lamuedra A, Medina JP, Bermejo-Álvarez I, Largo R, Herrero-Beaumont G, Mediero A. Purinergic System Signaling in Metainflammation-Associated Osteoarthritis. Front Med (Lausanne) 2020; 7:506. [PMID: 32984382 PMCID: PMC7485330 DOI: 10.3389/fmed.2020.00506] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/22/2020] [Indexed: 12/18/2022] Open
Abstract
Inflammation triggered by metabolic imbalance, also called metainflammation, is low-grade inflammation caused by the components involved in metabolic syndrome (MetS), including central obesity and impaired glucose tolerance. This phenomenon is mainly due to excess nutrients and energy, and it contributes to the pathogenesis of osteoarthritis (OA). OA is characterized by the progressive degeneration of articular cartilage, which suffers erosion and progressively becomes thinner. Purinergic signaling is involved in several physiological and pathological processes, such as cell proliferation in development and tissue regeneration, neurotransmission and inflammation. Adenosine and ATP receptors, and other members of the signaling pathway, such as AMP-activated protein kinase (AMPK), are involved in obesity, type 2 diabetes (T2D) and OA progression. In this review, we focus on purinergic regulation in osteoarthritic cartilage and how different components of MetS, such as obesity and T2D, modulate the purinergic system in OA. In that regard, we describe the critical role in this disease of receptors, such as adenosine A2A receptor (A2AR) and ATP P2X7 receptor. Finally, we also assess how nucleotides regulate the inflammasome in OA.
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Affiliation(s)
- Paula Gratal
- Bone and Joint Research Unit, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
| | - Ana Lamuedra
- Bone and Joint Research Unit, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
| | - Juan Pablo Medina
- Bone and Joint Research Unit, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
| | | | - Raquel Largo
- Bone and Joint Research Unit, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
| | | | - Aránzazu Mediero
- Bone and Joint Research Unit, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
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