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Estel K, Back DA, Scheuermann-Poley C, Willy C. Fulminant Heterotopic Ossification of the Lower Extremity After Gunshot Injury and Blunt Trauma: A Case Report. Mil Med 2024:usae109. [PMID: 38651560 DOI: 10.1093/milmed/usae109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/22/2023] [Accepted: 03/04/2024] [Indexed: 04/25/2024] Open
Abstract
Traumatic heterotopic ossification (HO) of the lower extremity is relatively rare but is of major importance in clinical practice. They are defined as posttraumatic abnormal formations of bone within soft tissue outside of the skeletal system. This article describes the clinical case of a 31-year-old male patient who suffered 2 traumatic events within 12 months-a gunshot wound in the lumbar spine/gluteal region followed by a severe traumatic brain injury with intracranial hemorrhage in a traffic accident as a pedestrian. Clinically, the patient was bedridden because of complete stiffening of the lumbar spine, both hip joints, and the left knee joint. After preoperative diagnosis, 3 surgical ablations of the HO were performed on both the hip joints and the left knee joint. In addition, physiotherapeutic exercise, postoperative nonsteroidal anti-inflammatory drug administration (25 mg of indomethazine for 6 weeks, 3 times a day), and perioperative radiation with 7 Gy for each operation were advised. After 4 years of follow-up, the patient showed significant improvement. In HO treatment, prophylactic local radiotherapy (pre- and postoperative radiation with a local single dose of 7 Gy) and postoperative administration of nonsteroidal anti-inflammatory drugs are often recommended. For therapeutic purposes, surgical resection is still indicated for pronounced cases.
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Affiliation(s)
- Katharina Estel
- Department for Traumatology and Orthopedics, Bundeswehr Hospital Berlin, 10115, Berlin, Germany
| | - David Alexander Back
- Department for Traumatology and Orthopedics, Bundeswehr Hospital Berlin, 10115, Berlin, Germany
| | | | - Christian Willy
- Department for Traumatology and Orthopedics, Bundeswehr Hospital Berlin, 10115, Berlin, Germany
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Cao G, Zhang S, Wang Y, Quan S, Yue C, Yao J, Alexander PG, Tan H. Pathogenesis of acquired heterotopic ossification: Risk factors, cellular mechanisms, and therapeutic implications. Bone 2023; 168:116655. [PMID: 36581258 DOI: 10.1016/j.bone.2022.116655] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/27/2022]
Abstract
Heterotopic ossification (HO), including hereditary and acquired HO, is the formation of extraskeletal bone in skeletal muscle and surrounding soft tissues. Acquired HO is often caused by range of motion, explosion injury, nerve injury or burns. Severe HO can lead to pain and limited joint activity, affecting functional rehabilitation and quality of life. Increasing evidence shows that inflammatory processes and mesenchymal stem cells (MSCs) can drive HO. However, explicit knowledge about the specific mechanisms that result in HO and related cell precursors is still limited. Moreover, there are no effective methods to prevent or reduce HO formation. In this review, we provide an update of known risk factors and relevant cellular origins for HO. In particular, we focus on the underlying mechanisms of MSCs in acquired HO, which follow the osteogenic program. We also discuss the latest therapeutic value and implications for acquired HO. Our review highlights the current gaps in knowledge regarding the pathogenesis of acquired HO and identifies potential targets for the prevention and treatment of HO.
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Affiliation(s)
- Guorui Cao
- Department of Knee Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan Province, People's Republic of China.
| | - Shaoyun Zhang
- Department of Orthopedics, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, People's Republic of China
| | - Yixuan Wang
- Hunan University of Chinese Medicine, Changsha, Hunan Province, People's Republic of China
| | - Songtao Quan
- Department of Knee Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan Province, People's Republic of China
| | - Chen Yue
- Department of Knee Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan Province, People's Republic of China
| | - Junna Yao
- Department of Knee Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan Province, People's Republic of China
| | - Peter G Alexander
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, United States of America.
| | - Honglue Tan
- Department of Knee Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan Province, People's Republic of China.
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Spreadborough PJ, Strong AL, Mares J, Levi B, Davis TA. Tourniquet use following blast-associated complex lower limb injury and traumatic amputation promotes end organ dysfunction and amplified heterotopic ossification formation. J Orthop Surg Res 2022; 17:422. [PMID: 36123728 PMCID: PMC9484189 DOI: 10.1186/s13018-022-03321-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Traumatic heterotopic ossification (tHO) is characterized by ectopic bone formation in extra-skeletal sites leading to impaired wound healing, entrapment of neurovascular structures, pain, and reduced range of motion. HO has become a signature pathology affecting wounded military personnel who have sustained blast-associated traumatic amputations during the recent conflicts in Iraq and Afghanistan and can compound recovery by causing difficulty with prosthesis limb wearing. Tourniquet use to control catastrophic limb hemorrhage prior to surgery has become almost ubiquitous during this time, with the recognition the prolonged use may risk an ischemia reperfusion injury and associated complications. While many factors influence the formation of tHO, the extended use of tourniquets to limit catastrophic hemorrhage during prolonged field care has not been explored. Methods Utilizing an established pre-clinical model of blast-associated complex lower limb injury and traumatic amputation, we evaluated the effects of tourniquet use on tHO formation. Adult male rats were subjected to blast overpressure exposure, femur fracture, and soft tissue crush injury. Pneumatic tourniquet (250–300 mmHg) applied proximal to the injured limb for 150-min was compared to a control group without tourniquet, before a trans-femoral amputation was performed. Outcome measures were volume to tHO formation at 12 weeks and changes in proteomic and genomic markers of early tHO formation between groups. Results At 12 weeks, volumetric analysis with microCT imaging revealed a 70% increase in total bone formation (p = 0.007) near the site of injury compared to rats with no tourniquet time in the setting of blast-injuries. Rats subjected to tourniquet usage had increased expression of danger-associated molecular patterns (DAMPs) and end organ damage as early as 6 h and as late as 7 days post injury. The expressions of pro-inflammatory cytokines and chemokines and osteochondrogenic genes using quantitative RT-PCR similarly revealed increased expression as early as 6 h post injury, and these genes along with hypoxia associated genes remained elevated for 7 days compared to no tourniquet use. Conclusion These findings suggest that tourniquet induced ischemia leads to significant increases in key transcription factors associated with early endochondral bone formation, systemic inflammatory and hypoxia, resulting in increased HO formation.
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Affiliation(s)
- Philip J Spreadborough
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.,Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Amy L Strong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - John Mares
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Benjamin Levi
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas A Davis
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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Ampadiotaki MM, Evangelopoulos DS, Pallis D, Vlachos C, Vlamis J, Evangelopoulos ME. New Strategies in Neurogenic Heterotopic Ossification. Cureus 2021; 13:e14709. [PMID: 34055549 PMCID: PMC8158068 DOI: 10.7759/cureus.14709] [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] [Indexed: 11/05/2022] Open
Abstract
The term neurogenic heterotopic ossification (NHO) is used to describe the pathological bone formation in soft tissues, due to spinal cord or brain injury. Commonly is presented with pain and stiffness of the affected joint. NHO affects the quality of life of these patients, delays their rehabilitation and therefore increases morbidity. The aim of this article is to emphasize pathophysiology mechanism and review new molecular treatments of heterotopic ossification (HO). It was demonstrated that potent treatment strategies are based on understanding the molecular mechanisms and aiming to inhibit the pathological process of the HO in various stages. New treatments are targeting several factors such as bone morphogenetic proteins (BMPs), retinoic acid receptors (RARs), hypoxic inhibitors (Hif1-inhibitors, rapamycin), free radical scavengers and immunological agents (imatinib). The endogenous pathways that lead to HO at molecular and cellular levels have been the aim of many studies in recent years. New treatment options for HO should be recommended due to the ineffectiveness of traditional older options, such as anti-inflammatory drugs and radiation, especially in the case of NHO.
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Affiliation(s)
| | - Dimitrios S Evangelopoulos
- 3rd Orthopaedic Department, KAT Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | | | - Christos Vlachos
- 3rd Orthopaedic Department, KAT Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - John Vlamis
- 3rd Orthopaedic Department, KAT Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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Li C, Huang Z, Anil KC, Lao C, Wu Q, Jiang H. Heterotopic ossification in the post cruciate ligament of the knee: a case report and literature review. BMC Musculoskelet Disord 2021; 22:304. [PMID: 33771141 PMCID: PMC7995791 DOI: 10.1186/s12891-021-04176-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background Heterotopic ossification (HO) is noted most frequently in periarticular muscles and has not yet been reported in the cruciate ligaments of the knee. We present a rare case of symptomatic ossification of the posterior cruciate ligament (PCL). Case presentation A 59-year-old woman had a 2-year history of knee pain that was getting worse during knee motion and had restricted knee motion for 1 year. X-rays could not show the lesion clearly. Multi-planar computed tomography demonstrated ossification within the PCL with mild osteoarthritic changes and excluded any other intra-articular pathology. The patient underwent arthroscopic debridement and then experienced immediate relief of pain and complete recovery of range of motion. Conclusion This is the first report of HO in the PCL as a possible cause of knee pain and restricted knee motion. On the basis of literature review, this case elaborates the difference between HO and calcification in the ligaments, the related factors inducing HO and the undefined pathogenesis, and favorable prognosis after adequate treatment.
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Affiliation(s)
- Cun Li
- Department of Sports Orthopaedics, The First People's Hospital of Nanning, Nanning, People's Republic of China
| | - Zonggui Huang
- Department of Sports Orthopaedics, The First People's Hospital of Nanning, Nanning, People's Republic of China
| | - K C Anil
- Department of Orthopaedics, The First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Chendeng Lao
- Department of Sports Orthopaedics, The First People's Hospital of Nanning, Nanning, People's Republic of China.
| | - Qianghua Wu
- Department of Sports Orthopaedics, The First People's Hospital of Nanning, Nanning, People's Republic of China
| | - Hongmian Jiang
- Department of Pathology, The First People's Hospital of Nanning, Nanning, People's Republic of China
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Cappato S, Gamberale R, Bocciardi R, Brunelli S. Genetic and Acquired Heterotopic Ossification: A Translational Tale of Mice and Men. Biomedicines 2020; 8:biomedicines8120611. [PMID: 33327623 PMCID: PMC7765130 DOI: 10.3390/biomedicines8120611] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/10/2020] [Accepted: 12/13/2020] [Indexed: 12/11/2022] Open
Abstract
Heterotopic ossification is defined as an aberrant formation of bone in extraskeletal soft tissue, for which both genetic and acquired conditions are known. This pathologic process may occur in many different sites such as the skin, subcutaneous tissue, skeletal muscle and fibrous tissue adjacent to joints, ligaments, walls of blood vessels, mesentery and other. The clinical spectrum of this disorder is wide: lesions may range from small foci of ossification to massive deposits of bone throughout the body, typical of the progressive genetically determined conditions such as fibrodysplasia ossificans progressiva, to mention one of the most severe and disabling forms. The ectopic bone formation may be regarded as a failed tissue repair process in response to a variety of triggers and evolving towards bone formation through a multistage differentiation program, with several steps common to different clinical presentations and distinctive features. In this review, we aim at providing a comprehensive view of the genetic and acquired heterotopic ossification disorders by detailing the clinical and molecular features underlying the different human conditions in comparison with the corresponding, currently available mouse models.
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Affiliation(s)
- Serena Cappato
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genova, 16132 Genova, Italy;
| | - Riccardo Gamberale
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Milano, Italy; (R.G.); (S.B.)
| | - Renata Bocciardi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genova, 16132 Genova, Italy;
- UOC Genetica Medica, IRCCS Giannina Gaslini, 16147 Genova, Italy
- Correspondence:
| | - Silvia Brunelli
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Milano, Italy; (R.G.); (S.B.)
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Shi L, Tee BC, Emam H, Prokes R, Larsen P, Sun Z. Enhancement of bone marrow aspirate concentrate with local self-healing corticotomies. Tissue Cell 2020; 66:101383. [PMID: 32933706 DOI: 10.1016/j.tice.2020.101383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/08/2023]
Abstract
Bone marrow aspirate concentrate (BMAC) is a potentially useful biological product for bone regeneration. This study investigated whether BMAC can be enriched by local minor corticotomies. Five 4-month-old domestic pigs were used with each pig undergoing two minor corticotomies at one randomly-selected tibia. Two weeks after the operation, bone marrow was aspirated from both tibiae and processed into BMAC samples. The amount of mesenchymal stem cells (MSCs) and the concentration of several regenerative growth factors contained in BMAC, as well as the proliferative and osteogenic differentiation capacity of MSCs, were compared between the corticotomy and the control sides. Another four weeks later, healing of the corticotomies was evaluated by radiographic and histological methods. The results demonstrated that BMAC from the corticotomy side contained significantly more MSCs than the control side. MSCs from the corticotomy side also proliferated significantly faster and tended to have stronger osteogenic differentiation than those from the control side. In contrast, the protein concentration of TGF-β, BMP-2 and PDGF contained in BMAC was only minimally changed by the corticotomies. The corticotomies in all pigs healed uneventfully, showing complete obliteration of the corticotomy gaps on CT images. Comparison between the two sides showed that the corticotomy side had thicker and denser cortical bone and more abundant osteogenic cell differentiation than the control side. These findings suggest that the quantity and proliferative/osteogenic differentiation capacity of MSCs contained in local BMAC can be enhanced by minor corticotomies, and spontaneous healing of the corticotomy can be completed within 6 weeks of the operation.
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Affiliation(s)
- Lei Shi
- Department of Pediatric Dentistry, Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200011, China; Division of Orthodontics, College of Dentistry, The Ohio State University, Rm 4088 Postle Hall, 305 W 12th Ave, 43210 Columbus, OH, USA
| | - Boon Ching Tee
- Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Hany Emam
- Division of Oral and Maxillofacial Surgery, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Rachael Prokes
- Division of Oral and Maxillofacial Surgery, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Peter Larsen
- Division of Oral and Maxillofacial Surgery, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Zongyang Sun
- Division of Orthodontics, College of Dentistry, The Ohio State University, Rm 4088 Postle Hall, 305 W 12th Ave, 43210 Columbus, OH, USA.
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Pan H, Fleming N, Hong CC, Mishina Y, Perrien DS. Methods for the reliable induction of heterotopic ossification in the conditional Alk2Q207D mouse. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2020; 20:149-159. [PMID: 32131380 PMCID: PMC7104591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Conditional Alk2Q207D-floxed (caALK2fl) mice have previously been used as a model of heterotopic ossification (HO). However, HO formation in this model can be highly variable, and it is unclear which methods reliably induce HO. Hence, these studies report validated methods for reproducibly inducing HO in caALK2fl mice. METHODS Varying doses of Adex-cre and cardiotoxin (CTX) were injected into the calf muscles of 9, 14, or 28-day-old caALK2fl/- or caALK2fl/fl mice. HO was measured by planar radiography or microCT at 14-28 days post-injury. RESULTS In 9-day-old caALK2fl/- or caALK2fl/fl mice, single injections of 109 PFU Adex-cre and 0.3 μg of CTX were sufficient to induce extensive HO within 14 days post-injury. In 28-day-old mice, the doses were increased to 5 x 109 PFU Adex-cre and 3.0 μg of CTX to achieve similar consistency, but at a slower rate versus younger mice. Using a crush injury, instead of CTX, also provided consistent induction of HO. Finally, the Type 1 BMPR inhibitor, DMH1, significantly reduced HO formation in 28-day-old caALK2fl/fl mice. CONCLUSIONS These data illustrate multiple methods for reliable induction of localized HO in the caALK2flmouse that can serve as a starting point for new laboratories utilizing this model.
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Affiliation(s)
- Haichun Pan
- University of Michigan School of Dentistry, Ann Arbor, MI
| | - Nicole Fleming
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN
| | - Charles C Hong
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN,Department of Pharmacology, and Vanderbilt University Medical Center, Nashville, TN,Division of Cardiology in the Department of Medicine, Vanderbilt University Medical Center, Nashville, TN,Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville TN
| | - Yuji Mishina
- University of Michigan School of Dentistry, Ann Arbor, MI
| | - Daniel S. Perrien
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN,Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville TN,Division of Clinical Pharmacology in the Department of Medicine and Vanderbilt University Medical Center, Nashville, TN,Center for Small Animal Imaging, Vanderbilt University Institute of Imaging Sciences, Vanderbilt University Medical Center, Nashville, TN,Corresponding author: Daniel S. Perrien, Ph.D., 101 Woodruff Circle, 1027 WMRB, Atlanta, GA 30322 E-mail: •
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Stanley A, Heo SJ, Mauck RL, Mourkioti F, Shore EM. Elevated BMP and Mechanical Signaling Through YAP1/RhoA Poises FOP Mesenchymal Progenitors for Osteogenesis. J Bone Miner Res 2019; 34:1894-1909. [PMID: 31107558 PMCID: PMC7209824 DOI: 10.1002/jbmr.3760] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/03/2019] [Accepted: 05/08/2019] [Indexed: 12/12/2022]
Abstract
Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disease characterized by the formation of extraskeletal bone, or heterotopic ossification (HO), in soft connective tissues such as skeletal muscle. All familial and sporadic cases with a classic clinical presentation of FOP carry a gain-of-function mutation (R206H; c.617 G > A) in ACVR1, a cell surface receptor that mediates bone morphogenetic protein (BMP) signaling. The BMP signaling pathway is recognized for its chondro/osteogenic-induction potential, and HO in FOP patients forms ectopic but qualitatively normal endochondral bone tissue through misdirected cell fate decisions by tissue-resident mesenchymal stem cells. In addition to biochemical ligand-receptor signaling, mechanical cues from the physical environment are transduced to activate intracellular signaling, a process known as mechanotransduction, and can influence cell fates. Utilizing an established mesenchymal stem cell model of mouse embryonic fibroblasts (MEFs) from the Acvr1R206H/+ mouse model that mimics the human disease, we demonstrated that activation of the mechanotransductive effectors Rho/ROCK and YAP1 are increased in Acvr1R206H/+ cells. We show that on softer substrates, a condition associated with low mechanical signaling, the morphology of Acvr1R206H/+ cells is similar to the morphology of control Acvr1+/+ cells on stiffer substrates, a condition that activates mechanotransduction. We further determined that Acvr1R206H/+ cells are poised for osteogenic differentiation, expressing increased levels of chondro/osteogenic markers compared with Acvr1+/+ cells. We also identified increased YAP1 nuclear localization in Acvr1R206H/+ cells, which can be rescued by either BMP inhibition or Rho antagonism. Our results establish RhoA and YAP1 signaling as modulators of mechanotransduction in FOP and suggest that aberrant mechanical signals, combined with and as a result of the increased BMP pathway signaling through mutant ACVR1, lead to misinterpretation of the cellular microenvironment and a heightened sensitivity to mechanical stimuli that promotes commitment of Acvr1R206H/+ progenitor cells to chondro/osteogenic lineages.
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Affiliation(s)
- Alexandra Stanley
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Su-jin Heo
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA
- Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA
- Center for Engineering Mechanobiology, University of Pennsylvania, Philadelphia, PA
| | - Robert L. Mauck
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA
- Translational Musculoskeletal Research Center, Philadelphia VA Medical Center, Philadelphia, PA
- Penn Institute for Regenerative Medicine, Musculoskeletal Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Engineering Mechanobiology, University of Pennsylvania, Philadelphia, PA
| | - Foteini Mourkioti
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Departments of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Penn Institute for Regenerative Medicine, Musculoskeletal Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Eileen M. Shore
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Penn Institute for Regenerative Medicine, Musculoskeletal Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Challenges and Controversies in Human Mesenchymal Stem Cell Therapy. Stem Cells Int 2019; 2019:9628536. [PMID: 31093291 PMCID: PMC6481040 DOI: 10.1155/2019/9628536] [Citation(s) in RCA: 294] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/12/2019] [Indexed: 12/13/2022] Open
Abstract
Stem cell therapy is being intensely investigated within the last years. Expectations are high regarding mesenchymal stem cell (MSC) treatment in translational medicine. However, many aspects concerning MSC therapy should be profoundly defined. Due to a variety of approaches that are investigated, potential effects of stem cell therapy are not transparent. On the other hand, most results of MSC administration in vivo have confirmed their safety and showed promising beneficial outcomes. However, the therapeutic effects of MSC-based treatment are still not spectacular and there is a potential risk related to MSC applications into specific cell niche that should be considered in long-term observations and follow-up outcomes. In this review, we intend to address some problems and critically discuss the complex nature of MSCs in the context of their effective and safe applications in regenerative medicine in different diseases including graft versus host disease (GvHD) and cardiac, neurological, and orthopedic disorders.
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11
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Nguyen TTN, Sory DR, Amin HD, Rankin SM, Proud WG. Platform development for primary blast injury studies. TRAUMA-ENGLAND 2019. [DOI: 10.1177/1460408618776035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Explosion-related injuries are currently the most commonly occurring wounds in modern conflicts. They are observed in both military and civilian theatres, with complex injury pathophysiologies. Primary blast injuries are the most frequently encountered critical injuries experienced by victims close to the explosion. They are caused by large and rapid pressure changes of the blast waves which produce a wide range of loading patterns resulting in varied injuries. Well-characterised experimental loading devices which can reproduce the real mechanical characteristics of blast loadings on biological specimens in in vivo, ex vivo, and in vitro models are essential in determining the injury mechanisms. This paper discusses the performance and application of platforms, including shock tubes, mechanical testing machines, drop-weight rigs, and split-Hopkinson pressure bar, with regards to the replication of primary blast.
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Affiliation(s)
| | - David R Sory
- Department of Physics, Imperial College London, London, UK
| | - Harsh D Amin
- Faculty of Medicine, Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, London, UK
| | - Sara M Rankin
- Faculty of Medicine, Inflammation, Repair and Development, National Heart & Lung Institute, Imperial College London, London, UK
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12
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Łęgosz P, Drela K, Pulik Ł, Sarzyńska S, Małdyk P. Challenges of heterotopic ossification-Molecular background and current treatment strategies. Clin Exp Pharmacol Physiol 2018; 45:1229-1235. [DOI: 10.1111/1440-1681.13025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 01/27/2023]
Affiliation(s)
- Paweł Łęgosz
- Department of Orthopaedics and Traumatology; 1st Faculty of Medicine; Medical University of Warsaw; Warsaw Poland
| | - Katarzyna Drela
- NeuroRepair Department; Mossakowski Medical Research Centre; Polish Academy of Sciences; Warsaw Poland
| | - Łukasz Pulik
- Department of Orthopaedics and Traumatology; 1st Faculty of Medicine; Medical University of Warsaw; Warsaw Poland
| | - Sylwia Sarzyńska
- Department of Orthopaedics and Traumatology; 1st Faculty of Medicine; Medical University of Warsaw; Warsaw Poland
| | - Paweł Małdyk
- Department of Orthopaedics and Traumatology; 1st Faculty of Medicine; Medical University of Warsaw; Warsaw Poland
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13
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Martin EC, Qureshi AT, Llamas CB, Boos EC, King AG, Krause PC, Lee OC, Dasa V, Freitas MA, Forsberg JA, Elster EA, Davis TA, Gimble JM. Trauma induced heterotopic ossification patient serum alters mitogen activated protein kinase signaling in adipose stem cells. J Cell Physiol 2018; 233:7035-7044. [PMID: 29377109 DOI: 10.1002/jcp.26504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/24/2018] [Indexed: 12/15/2022]
Abstract
Post-traumatic heterotopic ossification (HO) is the formation of ectopic bone in non-osseous structures following injury. The precise mechanism for bone development following trauma is unknown; however, early onset of HO may involve the production of pro-osteogenic serum factors. Here we evaluated serum from a cohort of civilian and military patients post trauma to determine early induction gene signatures in orthopaedic trauma induced HO. To test this, human adipose derived stromal/stem cells (hASCs) were stimulated with human serum from patients who developed HO following trauma and evaluated for a gene panel with qPCR. Pathway gene analysis ontology revealed that hASCs stimulated with serum from patients who developed HO had altered gene expression in the activator protein 1 (AP1) and AP1 transcriptional targets pathways. Notably, there was a significant repression in FOS gene expression in hASCs treated with serum from individuals with HO. Furthermore, the mitogen-activated protein kinase (MAPK) signaling pathway was activated in hASCs following serum exposure from individuals with HO. Serum from both military and civilian patients with trauma induced HO had elevated downstream genes associated with the MAPK pathways. Stimulation of hASCs with known regulators of osteogenesis (BMP2, IL6, Forskolin, and WNT3A) failed to recapitulate the gene signature observed in hASCs following serum stimulation, suggesting non-canonical mechanisms for gene regulation in trauma induced HO. These findings provide new insight for the development of HO and support ongoing work linking the systemic response to injury with wound specific outcomes.
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Affiliation(s)
- Elizabeth C Martin
- Department of Biological and Agricultural Engineering, Louisiana State University, Baton Rouge, Louisiana
| | - Ammar T Qureshi
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland
| | - Claire B Llamas
- Tulane University School of Medicine, Center for Stem Cell Research and Regenerative Medicine, New Orleans, Louisiana
| | - Elaine C Boos
- Department of Orthopaedics, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Andrew G King
- Department of Orthopaedics, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Peter C Krause
- Department of Orthopaedics, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Olivia C Lee
- Department of Orthopaedics, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Vinod Dasa
- Department of Orthopaedics, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Michael A Freitas
- Department of Cancer Biology and Genetics, Ohio State University, Columbus, Ohio
| | - Jonathan A Forsberg
- Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Eric A Elster
- Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Thomas A Davis
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland.,Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, Maryland
| | - J M Gimble
- Tulane University School of Medicine, Center for Stem Cell Research and Regenerative Medicine, New Orleans, Louisiana.,Departments of Medicine, Structural and Cellular Biology, & Surgery, Tulane University School of Medicine, New Orleans, Louisiana.,LaCell LLC, New Orleans, Louisiana
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14
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Bajwa NM, Kesavan C, Mohan S. Long-term Consequences of Traumatic Brain Injury in Bone Metabolism. Front Neurol 2018; 9:115. [PMID: 29556212 PMCID: PMC5845384 DOI: 10.3389/fneur.2018.00115] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/15/2018] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) leads to long-term cognitive, behavioral, affective deficits, and increase neurodegenerative diseases. It is only in recent years that there is growing awareness that TBI even in its milder form poses long-term health consequences to not only the brain but to other organ systems. Also, the concept that hormonal signals and neural circuits that originate in the hypothalamus play key roles in regulating skeletal system is gaining recognition based on recent mouse genetic studies. Accordingly, many TBI patients have also presented with hormonal dysfunction, increased skeletal fragility, and increased risk of skeletal diseases. Research from animal models suggests that TBI may exacerbate the activation and inactivation of molecular pathways leading to changes in both osteogenesis and bone destruction. TBI has also been found to induce the formation of heterotopic ossification and increased callus formation at sites of muscle or fracture injury through increased vascularization and activation of systemic factors. Recent studies also suggest that the disruption of endocrine factors and neuropeptides caused by TBI may induce adverse skeletal effects. This review will discuss the long-term consequences of TBI on the skeletal system and TBI-induced signaling pathways that contribute to the formation of ectopic bone, altered fracture healing, and reduced bone mass.
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Affiliation(s)
- Nikita M Bajwa
- Musculoskeletal Disease Center, VA Loma Linda Healthcare System, Loma Linda, CA, United States
| | - Chandrasekhar Kesavan
- Musculoskeletal Disease Center, VA Loma Linda Healthcare System, Loma Linda, CA, United States.,Department of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Subburaman Mohan
- Musculoskeletal Disease Center, VA Loma Linda Healthcare System, Loma Linda, CA, United States.,Department of Medicine, Loma Linda University, Loma Linda, CA, United States.,Department of Orthopedic Surgery, Loma Linda University, Loma Linda, CA, United States
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15
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Seavey JG, Wheatley BM, Pavey GJ, Tomasino AM, Hanson MA, Sanders EM, Dey D, Moss KL, Potter BK, Forsberg JA, Qureshi AT, Davis TA. Early local delivery of vancomycin suppresses ectopic bone formation in a rat model of trauma-induced heterotopic ossification. J Orthop Res 2017; 35:2397-2406. [PMID: 28390182 DOI: 10.1002/jor.23544] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/09/2017] [Indexed: 02/04/2023]
Abstract
Heterotopic ossification (HO) is a debilitating sequela of high-energy injuries. It frequently requires surgical excision once symptomatic and there is no practical prophylaxis for combat-injured patients. In this study, we examined the effect of local vancomycin powder on HO formation in a small animal model of blast-related, post-traumatic HO. Male Sprague-Dawley rats were subjected to a polytraumatic extremity injury and amputation with or without methicillin-resistant Staphylococcus aureus infection. Animals were randomized to receive a single local application of vancomycin (20 mg/kg) at the time of injury (POD-0, n = 34) or on postoperative day-3 (POD-3, n = 11). Quantitative volumetric measurement of ectopic bone was calculated at 12-weeks post-injury by micro-CT. Bone marrow and muscle tissues were also collected to determine the bacterial burden. Blood for serum cytokine analysis was collected at baseline and post-injury. Vancomycin treatment on POD-0 suppressed HO formation by 86% and prevented bone marrow and soft tissue infections. We concurrently observed a marked reduction histologically in nonviable tissue, chronic inflammatory cell infiltrates, bone infection, fibrous tissue, and areas of bone necrosis within this same cohort. Delayed treatment was significantly less efficacious. Neither treatment had a marked effect on the production of pro-inflammatory cytokines. Our study demonstrates that local vancomycin treatment at the time of injury significantly reduces HO formation in both the presence and absence of infection, with decreased efficacy if not given early. These findings further support the concept that the therapeutic window for prophylaxis is narrow, highlighting the need to develop early treatment strategies for clinical management. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2397-2406, 2017.
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Affiliation(s)
- Jonathan G Seavey
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland.,Orthopaedics, USU-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Benjamin M Wheatley
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland.,Orthopaedics, USU-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Gabriel J Pavey
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland.,Orthopaedics, USU-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Allison M Tomasino
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland
| | - Margaret A Hanson
- Department of Pathology, Naval Medical Research Center, Silver Spring, Maryland
| | - Erin M Sanders
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland
| | - Devaveena Dey
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland
| | - Kaitlyn L Moss
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland
| | - Benjamin K Potter
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland.,Orthopaedics, USU-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jonathan A Forsberg
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland.,Orthopaedics, USU-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Ammar T Qureshi
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland
| | - Thomas A Davis
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland.,Orthopaedics, USU-Walter Reed Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
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