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Beverly M, Murray D. An in vitro model to explore subchondral perfusion and intraosseous pressure. J Exp Orthop 2019; 6:39. [PMID: 31471704 PMCID: PMC6717224 DOI: 10.1186/s40634-019-0207-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 08/22/2019] [Indexed: 12/04/2022] Open
Abstract
Background Little is known about subchondral perfusion physiology. We developed a 3Rs (Replace, Reduce, Refine) compliant in vitro calf foot model to explore perfusion and intraosseous pressure (IOP). Methods Calf feet were catheterised and perfused with serum. IOP was measured at three sites, the metacarpal diaphysis (MCD), metacarpal subchondral epiphysis (MCS) and proximal phalanx diaphysis (PPD) using intraosseous needles with pressure transducers and digital recorders. Fresh (< 4 h post mortem) and old feet (> 4 h post mortem) were perfused at different pressures, with and without a proximal tourniquet. Results There was a wide range in basal IOP with a mean IOP of 30.0 mmHg, SD 14.4, range 7.6 mmHg to 52.7 mmHg (n = 40 records) in 15 subjects. There was no significant difference between the three sites tested (p = 0.54, 0.12 and 0.051). At each individual site IOP correlated with perfusion pressure (r = 0.993). With a proximal venous tourniquet, IOP increased from 15.1 mmHg (SD 11.3 mmHg) to 44.9 mmHg (SD 24 mmHg), p < 0.0001, n = 9. Filling and emptying curves during perfusion and with using a tourniquet were similar, indicating that the model behaves in an elastic hydrodynamic manner. In fresh feet IOP peaked after about 1 min irrespective of perfusion pressure, possibly due to auto regulation. Older feet showed a continuously rising IOP and became oedematous. There was no significant difference in IOP between fresh and old feet perfused with serum at 150 cms pressure for 1 min. Conclusion Though basal intraosseous pressure varies, IOP behaves predictably. IOP measurements reflect the perfusion microclimate at the individual needle tip. This 3Rs compliant model will be used for further exploration of subchondral perfusion physiology with loading.
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Affiliation(s)
- Michael Beverly
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - David Murray
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Nawata K, Nakamura J, Ikeda K, Furuta S, Nakajima H, Ohtori S, Hagiwara S, Wako Y, Miura M, Kawarai Y, Sugano M, Yoshino K, Orita S, Inage K, Akazawa T. Transitional changes in the incidence of osteonecrosis in systemic lupus erythematosus patients: focus on immunosuppressant agents and glucocorticoids. Rheumatology (Oxford) 2018; 57:844-849. [PMID: 29462407 DOI: 10.1093/rheumatology/key009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Indexed: 11/13/2022] Open
Abstract
Objective The purpose of this study was to investigate transitional changes in the incidence of glucocorticoid-associated osteonecrosis in SLE patients, with a focus on immunosuppressive agent and glucocorticoid consumption. Methods We retrospectively registered 185 SLE patients with 740 joints, who were newly diagnosed and hospitalized for initial high-dose glucocorticoid therapy from 1986 to 2015. Immunosuppressive agent, glucocorticoid dose, age, sex, organ lesion at hospitalization, complement (C3, C4, CH50) and anti-DNA antibody before initial glucocorticoid therapy, the frequency of use of anticoagulant and antilipidemic drugs, and incidence of osteonecrosis were documented. Results Based on trends in immunosuppressive agent use, 116 patients treated from 1986 to 1999, before calcineurin inhibitors were introduced, comprised the past group, and 69 patients treated from 2000 to 2015 comprised the recent group. Patient characteristics (age, sex and organ lesion at hospitalization, complement, anti-DNA antibody, the frequency of use of anticoagulant and antilipidemic drugs) were similar between groups. Glucocorticoid doses were significantly lower in the recent group than in the past group (highest daily glucocorticoid dose, 45.7 vs 59.0 mg/day, respectively; dose per weight, 0.88 vs 1.16 mg/day/kg, respectively; and cumulative dose at 3 months, 3118 vs 3985 mg). The incidence of osteonecrosis was significantly lower in the recent group than in the past group (26.4 vs 41.0%, respectively), particularly in the knee (25.4 vs 46.6%, respectively). Conclusion The incidence of glucocorticoid-associated osteonecrosis in SLE patients decreased in association with a decrease in glucocorticoid administration after introduction of immunosuppressant agents.
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Affiliation(s)
- Kento Nawata
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Shunsuke Furuta
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Hiroshi Nakajima
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Yasushi Wako
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Michiaki Miura
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Yuya Kawarai
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Masahiko Sugano
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Kensuke Yoshino
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St Marianna University School of Medicine, Kanagawa, Japan
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Lampl M, Schoen M. How long bones grow children: Mechanistic paths to variation in human height growth. Am J Hum Biol 2017; 29. [DOI: 10.1002/ajhb.22983] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 02/01/2017] [Accepted: 02/05/2017] [Indexed: 12/25/2022] Open
Affiliation(s)
- Michelle Lampl
- Center for the Study of Human Health; Emory University; Atlanta Georgia 30324
- Department of Anthropology; Emory University; Atlanta Georgia 30324
| | - Meriah Schoen
- Center for the Study of Human Health; Emory University; Atlanta Georgia 30324
- Department of Nutrition; Georgia State University; Atlanta Georgia 30302
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Multifocal osteonecrosis related to corticosteroid: ten years later, risk of progression and observation of subsequent new osteonecroses. INTERNATIONAL ORTHOPAEDICS 2015; 40:669-72. [PMID: 26630885 DOI: 10.1007/s00264-015-3060-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE No study has reported the risk of other site osteonecroses after the diagnosis of multifocal osteonecrosis related to corticosteroids in patients who continue this corticosteroid treatment. An analysis of the time-course to other sites of osteonecrosis, as well as the effects of underlying corticosteroid risk factor on the evolution of asymptomatic lesions at the time of diagnosis, is presented. METHODS Two hundred patients were followed prospectively every year during a minimum ten years with a radiograph if a joint became symptomatic. In absence of evidence of osteonecrosis on radiographs of a symptomatic or non-symptomatic joint (hips, shoulders, knees, ankles), patients had an MRI performed at the most recent follow up. The average duration of follow-up after inclusion of the patient in the study was 15 years (range 10-20). RESULTS Of the 200 patients followed for an average of 15 years (minimum 10 years, maximum 20 years), 35 patients developed new osteonecrosis lesions during the period of study. Asymptomatic lesions became symptomatic and a high number of collapse was observed resulting in 258 arthroplasties (187 hips, 51 shoulders, 20 knees) at the most recent follow up. CONCLUSION The continuation of peak doses (>200 mg) of corticosteroids predicted (p = 0.04) occurrence of new lesions and the continuation of corticosteroids without peak dose was a risk for quicker progression to collapse.
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Co-transplantation of adipose and bone marrow derived stromal cells for treatment of osteonecrosis of femoral head. Tissue Eng Regen Med 2015. [DOI: 10.1007/s13770-015-0017-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Tetramethylpyrazine enhances vascularization and prevents osteonecrosis in steroid-treated rats. BIOMED RESEARCH INTERNATIONAL 2015; 2015:315850. [PMID: 25759816 PMCID: PMC4339822 DOI: 10.1155/2015/315850] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/20/2015] [Accepted: 01/20/2015] [Indexed: 11/18/2022]
Abstract
Steroid-induced osteonecrosis of the femoral head (steroid-induced ONFH) is an avascular necrosis disease of bone. Tetramethylpyrazine (TMP), with significant vascular protective properties, has been widely used for the treatments of ischemic neural disorders and cardiovascular diseases. However, its role in the treatment of steroid-induced ONFH has not been evaluated. In this study, our results showed that TMP significantly decreased the ratio of empty lacuna, adipose tissue area, and adipocyte perimeter in steroid-induced ONFH rats histopathologically. TMP also reduced the levels of serum lipid dramatically by haematological examination. According to the micro-CT quantification, TMP could improve the microstructure of the trabecular bone and increases bone mineral density in steroid-induced ONFH rats. Moreover, TMP significantly increased the vessel volume, vessel surface, percentage of vessel volume, and vessel thickness of the femoral heads by micro-CT. Interestingly, the downregulation of VEGF and FLK1 proteins in the sera and necrotic femoral heads could be reversed by TMP treatment, and this was true for their mRNA expressions in femoral heads. In conclusion, these findings suggest for the first time that TMP may prevent steroid-induced ONFH and also enhance femoral head vascularization by inhibiting the effect of steroid on VEGF/FLK1 signal pathway.
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Protective effects of total saponins of panax notoginseng on steroid-induced avascular necrosis of the femoral head in vivo and in vitro. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:165679. [PMID: 25694788 PMCID: PMC4324945 DOI: 10.1155/2015/165679] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 01/08/2023]
Abstract
This research was designed to investigate the protective effects of TSPN on steroid-induced avascular necrosis of the femoral head (ANFH) and the likely mechanisms of those effects. As an in vivo study, TSPN was shown to be protective against steroid-induced ANFH due to the upregulation of VEGF-A. Furthermore, TSPN attenuated the apoptosis of osteocytes and reduced the expression of Caspase-3 relative to the model group. As an in vitro study, TSPN exerted a concentration-dependent protective effect against apoptosis in MC3T3-E1 cells. Moreover, TSPN (at a dose of 100 μg/mL) significantly reversed the dexamethasone-induced augmentation of Caspase-3 expression and activity. Therefore, our study demonstrated that TSPN had a protective effect against steroid-induced ANFH that was related to the upregulation of VEGF-A and the inhibition of apoptosis and Caspase-3 activation.
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Zheng LZ, Liu Z, Lei M, Peng J, He YX, Xie XH, Man CW, Huang L, Wang XL, Fong DTP, Xiao DM, Wang DP, Chen Y, Feng JQ, Liu Y, Zhang G, Qin L. Steroid-associated hip joint collapse in bipedal emus. PLoS One 2013; 8:e76797. [PMID: 24204675 PMCID: PMC3804596 DOI: 10.1371/journal.pone.0076797] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 08/28/2013] [Indexed: 12/20/2022] Open
Abstract
In this study we established a bipedal animal model of steroid-associated hip joint collapse in emus for testing potential treatment protocols to be developed for prevention of steroid-associated joint collapse in preclinical settings. Five adult male emus were treated with a steroid-associated osteonecrosis (SAON) induction protocol using combination of pulsed lipopolysaccharide (LPS) and methylprednisolone (MPS). Additional three emus were used as normal control. Post-induction, emu gait was observed, magnetic resonance imaging (MRI) was performed, and blood was collected for routine examination, including testing blood coagulation and lipid metabolism. Emus were sacrificed at week 24 post-induction, bilateral femora were collected for micro-computed tomography (micro-CT) and histological analysis. Asymmetric limping gait and abnormal MRI signals were found in steroid-treated emus. SAON was found in all emus with a joint collapse incidence of 70%. The percentage of neutrophils (Neut %) and parameters on lipid metabolism significantly increased after induction. Micro-CT revealed structure deterioration of subchondral trabecular bone. Histomorphometry showed larger fat cell fraction and size, thinning of subchondral plate and cartilage layer, smaller osteoblast perimeter percentage and less blood vessels distributed at collapsed region in SAON group as compared with the normal controls. Scanning electron microscope (SEM) showed poor mineral matrix and more osteo-lacunae outline in the collapsed region in SAON group. The combination of pulsed LPS and MPS developed in the current study was safe and effective to induce SAON and deterioration of subchondral bone in bipedal emus with subsequent femoral head collapse, a typical clinical feature observed in patients under pulsed steroid treatment. In conclusion, bipedal emus could be used as an effective preclinical experimental model to evaluate potential treatment protocols to be developed for prevention of ON-induced hip joint collapse in patients.
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Affiliation(s)
- Li-Zhen Zheng
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zhong Liu
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ming Lei
- Department of Orthopaedics & Traumatology, Shenzhen Second People's Hospital, Shenzhen, China
- Department of Orthopeadics, Shenzhen Hospital of Beijing University, Shenzhen, China
| | - Jiang Peng
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Orthopedic Research Institute, General Hospital of Chinese People's Liberation Army, Beijing, China
| | - Yi-Xin He
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xin-Hui Xie
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics, Zhongda Hospital of Southeast University, Nanjing, China
| | - Chi-Wai Man
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Le Huang
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xin-Luan Wang
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Translational Medicine R&D Center, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Daniel Tik-Pui Fong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - De-Ming Xiao
- Department of Orthopaedics & Traumatology, Shenzhen Second People's Hospital, Shenzhen, China
- Department of Orthopeadics, Shenzhen Hospital of Beijing University, Shenzhen, China
| | - Da-Ping Wang
- Department of Orthopaedics & Traumatology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yang Chen
- Department of Orthopaedics & Traumatology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jian Q. Feng
- Baylor College of Dentistry, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Ying Liu
- Baylor College of Dentistry, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Ge Zhang
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China
- * E-mail: (LQ); (GZ)
| | - Ling Qin
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Translational Medicine R&D Center, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- * E-mail: (LQ); (GZ)
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Primary epiphyseal arteriopathy in a mouse model of steroid-induced osteonecrosis. THE AMERICAN JOURNAL OF PATHOLOGY 2013; 183:19-25. [PMID: 23673001 DOI: 10.1016/j.ajpath.2013.03.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/01/2013] [Accepted: 03/05/2013] [Indexed: 01/04/2023]
Abstract
Patients undergoing glucocorticoid therapy for a variety of disorders, including autoimmune diseases and hematological malignancies, are at risk of developing osteonecrosis. Despite extensive research in both patients and animal models, the underlying pathogenesis remains unclear. Proposed inciting mechanisms include intravascular thrombotic occlusion, marrow fat hypertrophy, osteocyte and/or endothelial cell apoptosis, hypercoagulability, and vasoconstriction of specific arteries and arterioles supplying bone. Our laboratory has developed a model of steroid-induced osteonecrosis in BALBcJ mice which reflects clinically relevant exposures to glucocorticoids in which treated mice develop osteonecrosis of the distal femoral epiphysis when administered 4 to 8 mg/L dexamethasone in drinking water for 6 weeks. We identified lesions in arterioles supplying this area, with the mildest occurring in knees without any evidence of osteonecrosis. However, arteriopathy was more common among mice that did versus did not develop osteonecrosis (P < 0.0001); in mice with osteonecrosis, the associated vessels showed transmural necrosis and thickening of the vessel wall progressing to the point of luminal obstruction. In the most severe cases of osteonecrosis, end-stage lesions consisted of fully occluded vessels with marrow and bone necrosis involving the entire epiphysis. We propose that a primary arteriopathy is the initiating event in the genesis of steroid-induced osteonecrosis and provides a basis for future investigation of this disease process.
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Wang L, Luo DK, Pan ZY. Expression of 11β-HSD in steroid-induced avascular necrosis of the femoral head. Mol Med Rep 2013; 7:1482-6. [PMID: 23546306 DOI: 10.3892/mmr.2013.1401] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 03/03/2013] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to investigate the association between glucocorticoid receptors and steroid‑induced avascular necrosis of the femoral head (SANFH). Healthy New Zealand rabbits were randomly divided into 3 groups (n=16/group); the normal (no treatment), control (horse serum injections) and treatment (horse serum and methylprednisolone injections) groups. Methylprednisolone and horse serum injections were used to establish a SANFH model in rabbits; magnetic resonance imaging (MRI) and histopathological analysis were used to evaluate the SANFH rabbit model. Total cholesterol and triglyceride contents in the blood of SANFH rabbits were determined. The protein expression levels of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) and type 2 (11β-HSD2) were determined using western blotting. The total cholesterol and triglyceride levels in the blood of methylprednisolone‑treated rabbits were significantly increased compared with the control and normal groups, which provides evidence in support of the metabolic disorder theory. Based on the results obtained from western blotting, the expression levels of 11β-HSD1 protein were increased, whereas the expression levels of 11β-HSD2 protein were decreased following injection. The results of the present study indicate that 11β-HSDs are important in the development of SANFH. Furthermore, 11β-HSDs may be important targets for preventing the development of ANFH in patients treated with steroids, which has a significant reference value for the use of steroids in clinical practice.
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Affiliation(s)
- Lin Wang
- Department of Orthopaedic Microsurgery and Hand Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, PR China
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Drescher W, Schlieper G, Floege J, Eitner F. Steroid-related osteonecrosis--an update. Nephrol Dial Transplant 2011; 26:2728-31. [PMID: 21602181 DOI: 10.1093/ndt/gfr212] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Han N, Yan Z, Guo CA, Shen F, Liu J, Shi Y, Zhang Z. Effects of p-glycoprotein on steroid-induced osteonecrosis of the femoral head. Calcif Tissue Int 2010; 87:246-53. [PMID: 20593167 DOI: 10.1007/s00223-010-9385-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 05/23/2010] [Indexed: 02/07/2023]
Abstract
P-glycoprotein (P-gp) activity may play an important role in steroid-induced osteonecrosis of the femoral head (ONF); however, the precise mechanism of its pathogenesis remains unknown. Therefore, we investigated the effects of increased P-gp activity on steroid-induced ONF using a rat model. Rats (n = 60) were treated with either a pharmacological stimulant of P-gp, rifampicin (group A); a suppressant, verapamil (group B); or normal saline (group C) administered in conjunction with methylprednisolone, an inducer of ONF. P-gp activity in bone marrow cells and expression in the femoral head significantly increased in group A (P < 0.05) but decreased in group B (P < 0.05). Likewise, the serum osteocalcin level, trabecular thickness and number, osteoclast and osteoblast numbers, and mean percentage of the epiphyseal ossification center were significantly increased in group A (P < 0.01) but decreased in group B (P < 0.01). In contrast, however, adipocytic variables, trabecular separation, and apoptotic cells decreased in group A (P < 0.01) but increased in group B (P < 0.01). The ONF incidence in group A (50%) and group B (100%) was significantly different from that in the control group C (80%, P < 0.05). Taken together, our findings suggested that enhanced P-gp activity was able to decrease the risk of steroid-induced ONF, possibly by inhibiting adipogenesis and apoptosis in the femoral head.
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Affiliation(s)
- Ning Han
- Zhongshan Hospital of Fudan University, 180 Fenglin Road, Shanghai, 200032, China
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Guo YJ, Jin DX, Zhang CQ, Chen SB, Sheng JG, Lee HS, Zhang KG, Zeng BF. Curative effect and safety of vascularized fibula grafting in renal transplant recipients with osteonecrosis of the femoral head: three case reports. Transplant Proc 2009; 41:3731-5. [PMID: 19917376 DOI: 10.1016/j.transproceed.2009.06.237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Revised: 06/15/2009] [Accepted: 06/24/2009] [Indexed: 10/20/2022]
Abstract
Osteonecrosis of the femoral head is a common and severe complication after renal transplantation. It is characterized by deterioration of hip joint function, which impairs quality of life. We present 3 renal transplant case reports of patients with osteonecrosis of the femoral head who underwent free vascularized fibular grafting at our hospital. Follow-up was from 1(1/2) to 2 years. All 3 patients exhibited good recovery with substantial improvement in joint function. Intraoperative and postoperative findings demonstrated the safety of this surgical procedure.
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Affiliation(s)
- Y J Guo
- Department of Orthopaedics Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Schneider T, Cremer D, Becker C, Hansen ES, Bünger C, Drescher W. Femoral head histology subsequent to ischemia, reperfusion and steroid treatment. Ann Anat 2009; 191:496-501. [DOI: 10.1016/j.aanat.2009.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 06/18/2009] [Accepted: 07/06/2009] [Indexed: 11/29/2022]
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Miyanishi K, Yamamoto T, Irisa T, Yamashita A, Motomura G, Jingushi S, Iwamoto Y. Effects of Tacrolimus (FK506) on the Development of Osteonecrosis in a Rabbit Model. Immunopharmacol Immunotoxicol 2008; 30:79-90. [DOI: 10.1080/08923970701812647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Effects of high-dose prednisolone on optic nerve head blood flow in patients with acute optic neuritis. Graefes Arch Clin Exp Ophthalmol 2008; 246:1423-7. [DOI: 10.1007/s00417-008-0870-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 05/02/2008] [Accepted: 05/11/2008] [Indexed: 10/21/2022] Open
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Okuma C, Kaketa T, Hikita A, Matsuda K, Nakamura M, Nagase Y, Oshima Y, Iwasawa M, Nakamura Y, Kurosawa H, Nakamura K, Tanaka S. Potential involvement of p53 in ischemia/reperfusion-induced osteonecrosis. J Bone Miner Metab 2008; 26:576-85. [PMID: 18979157 DOI: 10.1007/s00774-007-0849-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 12/20/2007] [Indexed: 11/29/2022]
Abstract
Idiopathic osteonecrosis of the femoral head (ION) is a devastating pathological condition of unknown etiology. In this study, we developed a simple murine model of osteonecrosis and investigated the underlying molecular mechanisms. In this model, the central portion of the tails of male C57BL/6 mice were tightly ligated to produce ischemic regions at sites distal to the ligatures. The occlusive ligatures were maintained for the indicated periods and then removed to induce reperfusion. The tails were histologically examined, and gene expression was analyzed by PCR array. The effect of p53 expression on osteocytes apoptosis was examined using preosteocytic MLO-A5 cells. In addition, the expression of p53 was analyzed in the femoral head samples obtained from hip osteoarthritis (OA) patients and ION patients. Caudal vertebrae distal to the ligatures (distal region) exhibited histological changes mimicking those observed in ION. Expression of p53 was increased in the distal region, and overexpression of p53 induced apoptosis in MLO-A5 cells. Treatment with a p53 inhibitor suppressed osteocyte apoptosis in the distal region. Strong p53 immunostaining was observed in osteocytes, vascular endothelial cells, and bone marrow cells in the femoral heads from ION patients but not from OA patients. Ischemia/reperfusion of the caudal vertebrae is a useful murine model of osteonecrosis, mimicking the histological changes found in ION. Using this model, we found the possible involvement of p53 in the osteocyte apoptosis observed in ION. Therapeutics targeting p53 might be a useful approach to ameliorating or even preventing osteonecrosis in ION patients.
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Affiliation(s)
- Chiaki Okuma
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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High incidence of avascular necrosis in adolescents with acute lymphoblastic leukaemia: a UKALL XII analysis. Leukemia 2007; 22:308-12. [PMID: 17989709 DOI: 10.1038/sj.leu.2405032] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Avascular necrosis (AVN) is a serious complication of acute lymphoblastic leukaemia (ALL) therapy. Little is known of the scope and magnitude of this problem among adults with ALL. We analysed the incidence and risk factors for AVN in 1053 patients on the UKALLXII/ECOG2993 study. AVN affected 99 joints in 42 patients at a median of 2.2 years post-diagnosis, giving a crude incidence rate of 4.0%. Statistically significant risk factors for the development of AVN were age and treatment with chemotherapy. Patients receiving prolonged chemotherapy without stem cell transplant were at significantly greater risk of developing AVN than stem cell transplant recipients (P<0.00005). The actuarial incidence of AVN was 29% at 10 years in patients <20 years old compared to 8% at 10 years in those >20 years old; P=0.0004; odds ratio 0.28 (95% CI=0.14-0.56).
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Murata M, Kumagai K, Miyata N, Osaki M, Shindo H. Osteonecrosis in stroke-prone spontaneously hypertensive rats: effect of glucocorticoid. J Orthop Sci 2007; 12:289-95. [PMID: 17530382 DOI: 10.1007/s00776-007-1129-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Accepted: 02/19/2007] [Indexed: 02/09/2023]
Abstract
BACKGROUND High-dose administration of a steroid hormone has been associated with a major risk of osteonecrosis. In this study we investigated the effects of a steroid hormone on the incidence of osteonecrosis of the femoral head in stroke-prone spontaneously hypertensive rats/Nagasaki (SHRSP/Ngsks). METHODS A total of 71 SHRSP/Ngsks were divided into two groups: a control group (C group, n = 40) and a steroid hormone group (S group, n = 31) given 5 mg (about 20 mg/kg) of methylprednisolone acetate during the 17th week of age. We compared the groups' laboratory data, histological appearance, incidence of osteonecrosis, and expression of oxidative stress on immunohistochemical analysis using the monoclonal antibodies anti-4HNE and anti-8OHdG. RESULTS The S group showed an increase in total cholesterol, with the amounts of high-density lipoprotein, low-density lipoprotein, and triglycerides all significantly higher than in the C group. Histological examination showed that the frequency of necrosis of the femoral head was significantly higher in the S group (95.2%) than in the C group (51.2%). Most of the histological features of the osteonecrosis demonstrated typical features of a similar sort in the two groups. However, the S group showed bone marrow spaces in the femoral head that were occupied by an increased number of adipocytes and that were swollen, partially degenerative, and necrotic. On immunohistochemical analysis, the stains of anti-4HNE and anti-8OHdG antibody were stronger in the S group than in the C group. CONCLUSIONS This study confirmed, to a remarkable degree, the suspicion that the administration of steroid hormone increases the number of adipocytes in marrow. Fat degeneration and necrosis, considered early signs of osteonecrosis, were also observed. It has been hypothesized that osteonecrosis is produced by the ischemic change accompanying compartment pressure load in marrow, where fat degeneration, necrosis, and endothelial cell injury might occur together with oxidative stress.
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Affiliation(s)
- Masakazu Murata
- Department of Orthopedic Surgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Drescher W, Weigert KP, Bünger MH, Ingerslev J, Bünger C, Hansen ES. Femoral head blood flow reduction and hypercoagulability under 24 h megadose steroid treatment in pigs. J Orthop Res 2004; 22:501-8. [PMID: 15099627 DOI: 10.1016/j.orthres.2003.10.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2003] [Accepted: 10/03/2003] [Indexed: 02/04/2023]
Abstract
The pathogenesis of corticosteroid-induced femoral head necrosis is assumed to be ischemia. The purpose of this study was to investigate the perfusion pattern of the femoral head and plasma coagulability during 24 h corticosteroid megadose treatment, as recommended by the National Acute Spinal Cord Injury Studies (NASCIS), in the awake big animal model. Blindedly, 9 animals underwent megadose methylprednisolone infusion (30 mg/kg intravenously as an initial bolus, followed by 5.4 mg/kg/h for further 23 h) while 9 animals served as placebo treated controls. Regional blood flow of the systematically subdivided femoral head, proximal femur, acetabulum, and soft tissue hip regions was investigated by the microsphere technique at steady state (phase 1), after the initial bolus infusion (phase 2), and after the completed treatment (phase 3). Plasma coagulability was examined in phases 1 and 3. Blood flow of the femoral head epiphysis and metaphyseal cancellous bone was unchanged after one hour of steroid infusion, but decreased after the completed treatment at 24 h in the experimental group. Femoral head blood flow reduction was global without a tendency to more pronounced blood flow decrease in any subregion. Plasma fibrinogen was significantly higher after 24 h of steroid infusion than in the placebo control group. 24 h high dose methylprednisolone treatment causes femoral head blood flow reduction and hypercoagulability of plasma in the normal awake immature pig. These findings may be pathogenetic factors in the early stage of steroid-induced osteonecrosis.
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Affiliation(s)
- Wolf Drescher
- Department of Orthopaedics, The Institute of Experimental Clinical Research, University Hospital, Michaelisstr. 1, D-24105 Kiel, Germany.
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Smink JJ, Buchholz IM, Hamers N, van Tilburg CM, Christis C, Sakkers RJB, de Meer K, van Buul-Offers SC, Koedam JA. Short-term glucocorticoid treatment of piglets causes changes in growth plate morphology and angiogenesis. Osteoarthritis Cartilage 2003; 11:864-71. [PMID: 14629962 DOI: 10.1016/s1063-4584(03)00187-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Glucocorticoid treatment of children often leads to growth retardation, and the precise target(s) in the growth plate responsible for this effect are unknown. Angiogenesis is an important part of the endochondral ossification process, and VEGF expressed in the growth plate is essential for proper angiogenesis to occur. Since glucocorticoid treatment down-regulates VEGF expression in cultured chondrocytes, we hypothesized that in vivo glucocorticoid treatment could result in VEGF down-regulation in the growth plate and disturbed angiogenesis, thus contributing to the growth retardation. DESIGN We treated 6-week-old prepubertal piglets (10 kg) for 5 days with prednisolone (50 mg/day). Tibial growth plate sections were studied for apoptosis and the expression of VEGF protein and mRNA and MMP-9 protein. Capillaries in the metaphysis were visualized by CD31 immunostaining. Growth plate morphology (width of various zones) was determined by interactive measurements on hematoxylin/eosin stained sections and apoptotic cells were detected by TUNEL assay. RESULTS In the prednisolone-treated animals, the total width of the growth plate decreased to 81% of controls (P<0.02), which was explained by a decrease of the width of the proliferative zone to 73% (P<0.05). The treatment had no effect on the orderly organization of the chondrocyte columns. In the growth plates of control animals, apoptosis was shown in 5.8% of the hypertrophic chondrocytes and was limited to the terminal hypertrophic chondrocytes. In prednisolone-treated animals, 40.5% of the hypertrophic chondrocytes was apoptotic (P<0.02), with apoptotic chondrocytes also appearing higher in the hypertrophic zone. We observed fewer capillaries and loss of their parallel organization in the metaphysis in the prednisolone-treated animals. The capillaries were shorter and chaotic in appearance. In contrast to controls, in prednisolone-treated animals VEGF mRNA and protein could not be detected in the hypertrophic zone of the growth plate. Trabecular bone length in the primary spongiosa was also diminished by the treatment. No changes were observed in the expression pattern of MMP-9, a matrix metalloproteinase, which is also important for angiogenesis and bone formation. CONCLUSIONS These results indicate that short-term glucocorticoid treatment of growing piglets severely disturbs the width of the growth plate, apoptosis of chondrocytes, VEGF expression by hypertrophic chondrocytes, the normal invasion of blood vessels from the metaphysis to the growth plate and bone formation at the chondro-osseous junction. These effects could alter the dynamics of endochondral ossification and thus contribute to glucocorticoid-induced growth retardation.
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Affiliation(s)
- J J Smink
- Department of Metabolic and Endocrine Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
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Anetzberger H, Thein E, Becker M, Walli AK, Messmer K. Validity of fluorescent microspheres method for bone blood flow measurement during intentional arterial hypotension. J Appl Physiol (1985) 2003; 95:1153-8. [PMID: 12730148 DOI: 10.1152/japplphysiol.00299.2003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In this study, we compared bone blood flow values obtained by simultaneously injected fluorescent (FM) and radiolabeled microspheres (RM) at stepwise reduced arterial blood pressure. Ten anesthetized female New Zealand White rabbits received simultaneous left ventricular injections of FM and RM at 90, 70, and 50 mmHg mean arterial blood pressure (MAP). After the experiments, both kidneys and long bones of all four limbs were removed and dissected in a standardized manner. Radioactivity (corrected for decay, background, and spillover) and fluorescence were determined, and blood flow values were calculated. Relative blood flow values estimated for each bone sample by RM and FM were significantly correlated (r = 0.98, slope = 0.99, and intercept = 0.04 for 90 mmHg; r = 0.98, slope = 0.94, and intercept = 0.09 for 70 mmHg; r = 0.98, slope = 0.96, and intercept = 0.07 for 50 mmHg). Blood flow values (ml x min-1 x 100 g-1) of right and left bone samples determined at the different arterial blood pressures were identical. During moderate hypotension (70 mmHg MAP), blood flow in all bone samples remained unchanged compared with 90 mmHg MAP, whereas a significant decrease of bone blood flow was observed at severe hypotension (50 mmHg MAP). Our results demonstrate that the FM technique is valid for measuring bone blood flow. Differences in bone blood flow during altered hemodynamic conditions can be detected reliably. In addition, changes in bone blood flow during hypotension indicate that vasomotor control mechanisms, as well as cardiac output, play a role in setting bone blood flow.
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Affiliation(s)
- H Anetzberger
- Department of Orthopaedics, Ludwig-Maximilians University, 81377 Munich, Germany.
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Drescher W, Li H, Jensen SD, Ingerslev J, Hansen ES, Hauge EM, Bünger C. The effect of long-term methylprednisolone treatment on the femoral head in growing pigs. J Orthop Res 2002; 20:662-8. [PMID: 12168652 DOI: 10.1016/s0736-0266(01)00183-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The effect of long term steroid treatment on coagulation, intraosseous pressure (IOP), femoral head (FH) blood flow, and histology in the normal organism was investigated in this study in growing pigs. From 24 growing female Danish Landrace pigs from 12 litters, 12 animals daily received 100 mg methylprednisolone orally for three months. Their 12 sister pigs served as controls without steroid treatment. Prothrombin time, activated partial thromboplastin time (aPTT), fibrinogen, and antithrombin III levels were recorded in jugular venous blood. Blood flow of the hip regions was measured by means of the radioactive microsphere technique. Metaphyseal and epiphyseal IOP of the left or right proximal femur were measured. Histomorphometry of the left or right FH epiphysis was performed. Major growth inhibition was found in the corticosteroid (CS) treated group. In CS pigs, aPTT was shortened to 50% compared to control pigs. Plasma fibrinogen was higher in the CS animals. Total FH blood flow was not different while regional blood flow in the cranial subregion of the FH epiphysis was higher in the CS group. Metaphyseal and epiphyseal IOP of the proximal femur were not different in the CS animals. Histomorphometrically, cancellous bone volume (23 +/- 1% vs. 34 +/- 2%; p < 0.001) and bone turnover (10 +/- 2% vs. 55 +/- 8%; p < 0.001) of the FH epiphysis was lowerin the CS than in the control group. The FH epiphysis of the CS animals invariably showed an irregular cartilage-bone interface with cartilaginous projections into the subchondral bone mainly in its cranial part. In normal growing pigs, long term high dose CS treatment has induced a hypercoagulable state of plasma via the intrinsic pathway of coagulation, cartilaginous projections into FH subchondral bone, FH osteopenia, and reduced bone turnover. Long-term steroid treatment did not produce FH necrosis or FH IOP alterations in the immature pig model.
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Affiliation(s)
- Wolf Drescher
- Department of Orthopaedics, Aarhus University Hospital, Denmark.
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Park JH, Park BH, Kim HK, Park TS, Baek HS. Hypoxia decreases Runx2/Cbfa1 expression in human osteoblast-like cells. Mol Cell Endocrinol 2002; 192:197-203. [PMID: 12088880 DOI: 10.1016/s0303-7207(02)00036-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To elucidate the molecular mechanism in relation to vascular supply and osteoporosis, we investigated the effect of hypoxia on Runx2 expression in MG63 cells. Also investigated was expression of type I collagen and osteocalcin, which are regulated by Runx2, alkaline phosphatase (ALPase) to see if they are affected by hypoxia. Quiescent cultures of MG63 cells were exposed to hypoxia (2% O(2)) and normoxia (18% O(2)) for 24, 48, 72 and 96 h. In cells exposed to hypoxia, reverse transcription-polymerase chain reaction (RT-PCR) analysis showed that mRNA expression of Runx2, type I collagen, osteocalcin, and ALPase were decreased in a time dependent manner to 96 h. Activity of ALPase was also reduced in the same manner. Western blotting showed a marked decrease in Runx2 protein at 96 h in cells under hypoxia compared to normoxia. These data indicate that Runx2 expression in osteoblasts is reduced by hypoxia, and may be a mechanism of osteoporosis by decreased vascular supply.
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Affiliation(s)
- J H Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine, #634-18, Keumam Dong, Dukjin Gu, Chonju, 561-712, Chonbuk, Republic of Korea
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Neidel J, Boehnke M, Küster RM. The efficacy and safety of intraarticular corticosteroid therapy for coxitis in juvenile rheumatoid arthritis. ARTHRITIS AND RHEUMATISM 2002; 46:1620-8. [PMID: 12115194 DOI: 10.1002/art.10313] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To study the efficacy and safety of intraarticular triamcinolone hexacetonide (IATH) for the treatment of coxitis in patients with juvenile rheumatoid arthritis (JRA). METHODS Fifty consecutive patients with JRA and coxitis were studied prospectively. Forty-eight children received IATH in 67 arthritic hips. The remaining 2 children exhibited 3 cases of femoral head necrosis (FHN) at the initial assessment and were only followed up; both were receiving long-term systemic steroids. After a minimum of 2 years, the study was concluded with a final evaluation that included magnetic resonance imaging. RESULTS In 39 of 67 hip joints (58%), remission of the coxitis for a period of 2 years was obtained through a single administration of IATH, while another 12 hip joints showed remission of coxitis after repeated TH injections (total remission rate 76%). We observed 2 patients with FHN following IATH. Both of these children were receiving long-term systemic steroids. During the period between onset of JRA and screening assessment for this study, the children exhibited 2.4 cases of FHN per 100 patient-years, while 1.5 cases of FHN per 100 patient-years were observed between IATH treatment and final followup. All 5 observed cases of FHN occurred among the 20 children who received long-term systemic steroids, while no necrosis occurred in the 30 children who did not receive systemic corticosteroids (P = 0.009 by Fisher's exact test). CONCLUSION IATH for juvenile rheumatoid coxitis was an effective treatment that did not increase the rate of FHN. Systemic steroids, however (or their covariable, severity of JRA), may increase the risk of FHN in JRA.
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Affiliation(s)
- Jasper Neidel
- Department of Orthopaedics, Charité University Hospital, Schumannstrasse 20/21, D-10177 Berlin, Germany.
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Abstract
Growth retardation is a complication often associated with corticosteroid therapy. Corticosteroids are frequently used in the treatment of children with chronic renal failure. To examine the effects of corticosteroids on the growth plate cartilage in renal failure, selected markers of chondrocyte function and phenotype were evaluated in the proximal tibia of subtotally nephrectomized rats treated with corticosteroid. Serum parathyroid hormone (PTH), urea nitrogen, and creatinine levels were higher in the nephrectomized animals. Weight gain was less in the corticosteroid-treated animals; however, linear growth and tibial length did not differ among the groups after 10 days of corticosteroid therapy. The total width of the growth plate and the width of the proliferative zone were much smaller in corticosteroid-treated nephrectomized (Nx-MP) animals. Type II collagen mRNA expression was lower in animals treated with corticosteroids, and proliferating-cell nuclear antigen staining, histone-4, and insulin-like growth factor-1 (IGF-1)-receptor mRNA expression were further decreased in the Nx-MP group. There was an increase in TUNEL-positive cells in the corticosteroid-treated rats with normal renal function (intact-MP), associated with an increase in Bax and a decrease in Bcl-2 protein expression. In the Nx-MP group, both Bax and Bcl-2 protein staining was much less frequent, and TUNEL-positive cells were lower in number compared with the intact-MP group. Vascular endothelial growth factor expression in the hypertrophic chondrocytes was lower in corticosteroid-treated animals. There was less gelatinase B/matrix metalloproteinase-9 expression in the Nx-MP group, which was not associated with a decrease in tartrate-resistant acid phosphatase (TRAP) staining in the chondro-osseous junction. Inhibition of chondrocyte proliferation, diminishing of apoptosis, and lower angiogenic activity may contribute to the alterations in growth plate architecture and the significant reduction in growth plate width in rats with renal failure receiving corticosteroid therapy.
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Affiliation(s)
- Cheryl P Sanchez
- Department of Pediatrics, University of Wisconsin Medical School, 1300 University Avenue, Madison, WI 53706, USA.
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Abstract
The use of corticosteroids, both systemically and locally, is commonplace for the management of numerous rheumatic and inflammatory conditions. The effects of corticosteroids are far-reaching and have both beneficial and potential detrimental effects on the musculoskeletal system. Understanding some of the mechanisms of action and the effects of these medications can allow the orthopaedic nurse to anticipate and prepare for possible untoward consequences.
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Affiliation(s)
- C L Crowther
- Chesapeake Orthopaedic and Sports Medicine Center, Glen Burnie, Maryland, USA
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