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Panagi M, Mpekris F, Voutouri C, Hadjigeorgiou AG, Symeonidou C, Porfyriou E, Michael C, Stylianou A, Martin JD, Cabral H, Constantinidou A, Stylianopoulos T. Stabilizing Tumor-Resident Mast Cells Restores T-Cell Infiltration and Sensitizes Sarcomas to PD-L1 Inhibition. Clin Cancer Res 2024; 30:2582-2597. [PMID: 38578281 PMCID: PMC11145177 DOI: 10.1158/1078-0432.ccr-24-0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/10/2024] [Accepted: 04/03/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE To explore the cellular cross-talk of tumor-resident mast cells (MC) in controlling the activity of cancer-associated fibroblasts (CAF) to overcome tumor microenvironment (TME) abnormalities, enhancing the efficacy of immune-checkpoint inhibitors in sarcoma. EXPERIMENTAL DESIGN We used a coculture system followed by further validation in mouse models of fibrosarcoma and osteosarcoma with or without administration of the MC stabilizer and antihistamine ketotifen. To evaluate the contribution of ketotifen in sensitizing tumors to therapy, we performed combination studies with doxorubicin chemotherapy and anti-PD-L1 (B7-H1, clone 10F.9G2) treatment. We investigated the ability of ketotifen to modulate the TME in human sarcomas in the context of a repurposed phase II clinical trial. RESULTS Inhibition of MC activation with ketotifen successfully suppressed CAF proliferation and stiffness of the extracellular matrix accompanied by an increase in vessel perfusion in fibrosarcoma and osteosarcoma as indicated by ultrasound shear wave elastography imaging. The improved tissue oxygenation increased the efficacy of chemoimmunotherapy, supported by enhanced T-cell infiltration and acquisition of tumor antigen-specific memory. Importantly, the effect of ketotifen in reducing tumor stiffness was further validated in sarcoma patients, highlighting its translational potential. CONCLUSIONS Our study suggests the targeting of MCs with clinically administered drugs, such as antihistamines, as a promising approach to overcome resistance to immunotherapy in sarcomas.
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Affiliation(s)
- Myrofora Panagi
- Cancer Biophysics Laboratory, Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia, Cyprus
| | - Fotios Mpekris
- Cancer Biophysics Laboratory, Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia, Cyprus
| | - Chrysovalantis Voutouri
- Cancer Biophysics Laboratory, Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia, Cyprus
| | - Andreas G. Hadjigeorgiou
- Cancer Biophysics Laboratory, Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia, Cyprus
| | | | | | - Christina Michael
- Cancer Biophysics Laboratory, Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia, Cyprus
| | - Andreas Stylianou
- Cancer Biophysics Laboratory, Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia, Cyprus
- Basic and Translational Cancer Research Center, School of Sciences, European University of Cyprus, Nicosia, Cyprus
| | | | - Horacio Cabral
- Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Anastasia Constantinidou
- Bank of Cyprus Oncology Centre, Nicosia, Cyprus
- Cyprus Cancer Research Institute, Nicosia, Cyprus
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - Triantafyllos Stylianopoulos
- Cancer Biophysics Laboratory, Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia, Cyprus
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Leong E, Al-Bitar H, Marshall JS, Bezuhly M. Ketotifen directly modifies the fibrotic response of human skin fibroblasts. Sci Rep 2024; 14:7076. [PMID: 38528089 DOI: 10.1038/s41598-024-57776-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/21/2024] [Indexed: 03/27/2024] Open
Abstract
Fibrosis is a destructive, end-stage disease process. In the skin, it is associated with systemic sclerosis and scarring with considerable health burden. Ketotifen is a clinical antihistamine and mast cell stabilizer. Studies have demonstrated mast cell-dependent anti-fibrotic effects of ketotifen but direct effects on fibroblasts have not been determined. Human dermal fibroblasts were treated with pro-fibrotic transforming growth factor-β1 (TGFβ) followed by ketotifen or control treatments to determine direct effects on fibrotic fibroblasts. Ketotifen impaired TGFβ-induced α-smooth muscle actin gene and protein responses and decreased cytoskeletal- and contractility-associated gene responses associated with fibrosis. Ketotifen reduced Yes-associated protein phosphorylation, transcriptional coactivator with PDZ binding motif transcript and protein levels, and phosphorylation of protein kinase B. In a fibroblast-populated collagen gel contraction assay, ketotifen reduced the contractile activity of TGFβ-activated fibroblasts. In a murine model of bleomycin-induced skin fibrosis, collagen density and dermal thickness were significantly decreased in ketotifen-treated mice supporting in vitro findings. These results support a novel, direct anti-fibrotic activity of ketotifen, reducing pro-fibrotic phenotypic changes in fibroblasts and reducing collagen fibres in fibrotic mouse skin. Together, these findings suggest novel therapeutic potential and a novel mechanism of action for ketotifen in the context of fibrosis.
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Affiliation(s)
- Edwin Leong
- Department of Pathology, Dalhousie University, 5850 College Street, Room 7-C, PO BOX 15000, Halifax, NS, B3H 4R2, Canada
| | - Haya Al-Bitar
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Canada
| | - Jean S Marshall
- Department of Pathology, Dalhousie University, 5850 College Street, Room 7-C, PO BOX 15000, Halifax, NS, B3H 4R2, Canada.
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Canada.
- Beatrice Hunter Cancer Research Institute, Halifax, Canada.
| | - Michael Bezuhly
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Canada.
- Beatrice Hunter Cancer Research Institute, Halifax, Canada.
- Division of Plastic Surgery, Izaak Walton Killam Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada.
- Department of Surgery, Dalhousie University, Halifax, Canada.
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Takematsu E, Massidda M, Howe G, Goldman J, Felli P, Mei L, Callahan G, Sligar AD, Smalling R, Baker AB. Transmembrane stem factor nanodiscs enhanced revascularization in a hind limb ischemia model in diabetic, hyperlipidemic rabbits. Sci Rep 2024; 14:2352. [PMID: 38287067 PMCID: PMC10825164 DOI: 10.1038/s41598-024-52888-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/24/2024] [Indexed: 01/31/2024] Open
Abstract
Therapies to revascularize ischemic tissue have long been a goal for the treatment of vascular disease and other disorders. Therapies using stem cell factor (SCF), also known as a c-Kit ligand, had great promise for treating ischemia for myocardial infarct and stroke, however clinical development for SCF was stopped due to toxic side effects including mast cell activation in patients. We recently developed a novel therapy using a transmembrane form of SCF (tmSCF) delivered in lipid nanodiscs. In previous studies, we demonstrated tmSCF nanodiscs were able to induce revascularization of ischemia limbs in mice and did not activate mast cells. To advance this therapeutic towards clinical application, we tested this therapy in an advanced model of hindlimb ischemia in rabbits with hyperlipidemia and diabetes. This model has therapeutic resistance to angiogenic therapies and maintains long term deficits in recovery from ischemic injury. We treated rabbits with local treatment with tmSCF nanodiscs or control solution delivered locally from an alginate gel delivered into the ischemic limb of the rabbits. After eight weeks, we found significantly higher vascularity in the tmSCF nanodisc-treated group in comparison to alginate treated control as quantified through angiography. Histological analysis also showed a significantly higher number of small and large blood vessels in the ischemic muscles of the tmSCF nanodisc treated group. Importantly, we did not observe inflammation or mast cell activation in the rabbits. Overall, this study supports the therapeutic potential of tmSCF nanodiscs for treating peripheral ischemia.
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Affiliation(s)
- Eri Takematsu
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station, BME 5.202D, C0800, Austin, TX, 78712, USA
- School of Medicine, Surgery, Stanford University, Stanford, CA, USA
| | - Miles Massidda
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station, BME 5.202D, C0800, Austin, TX, 78712, USA
| | - Gretchen Howe
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA
| | - Julia Goldman
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA
- Center for Laboratory Animal Medicine and Care, UT Health Science Center at Houston, Houston, TX, USA
| | - Patricia Felli
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA
- Center for Laboratory Animal Medicine and Care, UT Health Science Center at Houston, Houston, TX, USA
| | - Lei Mei
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station, BME 5.202D, C0800, Austin, TX, 78712, USA
| | - Gregory Callahan
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station, BME 5.202D, C0800, Austin, TX, 78712, USA
| | - Andrew D Sligar
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station, BME 5.202D, C0800, Austin, TX, 78712, USA
| | - Richard Smalling
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA
- Memorial Hermann Heart and Vascular Institute, Houston, TX, USA
| | - Aaron B Baker
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station, BME 5.202D, C0800, Austin, TX, 78712, USA.
- Institute for Cellular and Molecular Biology, University of Texas at Austin, Austin, TX, USA.
- The Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX, USA.
- Institute for Biomaterials, Drug Delivery and Regenerative Medicine, University of Texas at Austin, Austin, TX, USA.
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Abstract
Fibrosis is a common and debilitating pathological process that affects many organ systems and contributes to connective tissue disorders in orthopaedics. Tendons heal after acute and chronic injury through a process of fibrovascular scar tissue formation, and soft tissue joint capsules can be affected after traumatic joint injury, leading to arthrofibrosis. Although the precise underlying mechanisms are still being elucidated, fibrosis is thought to be a consequence of dysregulated immune and cytokine signaling that leads to myofibroblast activation and proliferation and subsequent excessive collagen deposition. Current treatments for connective tissue fibrosis include physical therapy and surgery, but there are no therapies that directly target the underlying cellular and molecular mechanisms of fibrosis. Many pharmacological agents have been used to successfully target fibrosis in other tissues and organ systems and thus are a promising treatment option to fill this gap. However, limited evidence is available to guide the use of these agents in musculoskeletal connective tissues. This article provides an overview of pharmacological therapies that have potential to treat connective tissue fibrosis in patients with musculoskeletal conditions, along with the current supporting evidence and future uses of each therapy.
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Affiliation(s)
- Nathaniel P Disser
- Hospital for Special Surgery, New York, New York, USA
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jonathan S Yu
- Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medicine, New York, New York, USA
| | - Vincent J H Yao
- Hospital for Special Surgery, New York, New York, USA
- Sophie Davis Biomedical Education Program at CUNY School of Medicine, New York, New York, USA
| | - Scott A Rodeo
- Hospital for Special Surgery, New York, New York, USA
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Mast cell stabilization: new mechanism underlying the therapeutic effect of intense pulsed light on rosacea. Inflamm Res 2023; 72:75-88. [PMID: 36329130 DOI: 10.1007/s00011-022-01635-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/11/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Rosacea, a chronic inflammatory disorder of the facial skin, is effectively treated by intense pulsed light (IPL). OBJECTIVE To explore the potential molecular mechanism underlying the photobiomodulation effect of IPL for rosacea treatment. METHODS Skin samples from patients with rosacea were subjected to histological and immunohistological staining. Ten patients were followed up after IPL treatment using the VISIA® skin analysis system, and the severity was assessed. In vivo, skin changes in mice with rosacea-like inflammation induced by intradermal injection of 320 μM LL-37 with or without IPL treatment were evaluated using L*a*b colorimetry as well as histological and immunological staining. In vitro, LL-37-stimulated mast cells (MCs) with or without IPL treatment were evaluated for protein expression of matrix metalloproteinase (MMP)-9, kallikrein-related peptidase 5 (KLK5), and cathelicidin using western blotting and qRT-PCR. RESULTS Profound infiltration of inflammatory cells and evident MC degranulation were found in rosacea skin lesions. The expression of rosacea-related biomarkers and inflammatory cytokines was higher in lesional areas than in non-lesional areas, as demonstrated via immunochemical staining. In all patients, rosacea severity reduced after IPL therapy. In vivo, IPL alleviated inflammation in mice with rosacea-like inflammation, as demonstrated by the significantly decreased MMP-9, KLK5, and cathelicidin expression and reduced percentage of degranulating MCs. In vitro, IPL decreased MMP-9, KLK5, and cathelicidin expression in P815 cells, reducing the release of inflammatory cytokines and inhibiting rosacea-like inflammatory reactions. CONCLUSION The photobiomodulation effect of IPL for rosacea treatment may inhibit MC degranulation and alleviate inflammatory reactions.
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Limberg AK, Salib CG, Tibbo ME, Vargas-Hernandez JS, Bettencourt JW, Bayram B, Berry CE, Dudakovic A, Bolon B, van Wijnen AJ, Morrey ME, Sanchez-Sotelo J, Berry DJ, Carter JM, Abdel MP. Immune cell populations differ in patients undergoing revision total knee arthroplasty for arthrofibrosis. Sci Rep 2022; 12:22627. [PMID: 36587032 PMCID: PMC9805429 DOI: 10.1038/s41598-022-22175-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/11/2022] [Indexed: 01/01/2023] Open
Abstract
Arthrofibrosis following total knee arthroplasty (TKA) is a debilitating condition typically diagnosed based on clinical findings. To gain insight into the histopathologic immune cell microenvironment of arthrofibrosis, we assessed the extent of tissue fibrosis and quantified immune cell populations in specific tissue regions of the posterior capsule. We investigated specimens from three prospectively-collected, matched cohorts, grouped as patients receiving a primary TKA for osteoarthritis, revision TKA for arthrofibrosis, and revision TKA for non-arthrofibrotic, non-infectious reasons. Specimens were evaluated using hematoxylin and eosin staining, picrosirius red staining, immunofluorescence, and immunohistochemistry with Aperio®-based digital image analysis. Increased collagen deposition and increased number of α-SMA/ACTA2 expressing myofibroblasts were present in the arthrofibrosis group compared to the two non-arthrofibrotic groups. CD163 + macrophages were the most abundant immune cell type in any capsular sample with specific enrichment in the synovial tissue. CD163 + macrophages were significantly decreased in the fibrotic tissue region of arthrofibrosis patients compared to the patients with primary TKA, and significantly increased in adipose tissue region of arthrofibrotic specimens compared to non-arthrofibrotic specimens. Synovial CD117 + mast cells were significantly decreased in arthrofibrotic adipose tissue. Together, these findings inform diagnostic and targeted therapeutic strategies by providing insight into the underlying pathogenetic mechanisms of arthrofibrosis.
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Affiliation(s)
- Afton K. Limberg
- grid.66875.3a0000 0004 0459 167XDepartment of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905 USA
| | - Christopher G. Salib
- grid.66875.3a0000 0004 0459 167XDepartment of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905 USA
| | - Meagan E. Tibbo
- grid.66875.3a0000 0004 0459 167XDepartment of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905 USA
| | - Juan S. Vargas-Hernandez
- grid.66875.3a0000 0004 0459 167XDepartment of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905 USA
| | - Jacob W. Bettencourt
- grid.66875.3a0000 0004 0459 167XDepartment of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905 USA
| | - Banu Bayram
- grid.66875.3a0000 0004 0459 167XDepartment of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905 USA
| | - Charlotte E. Berry
- grid.66875.3a0000 0004 0459 167XDepartment of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905 USA
| | - Amel Dudakovic
- grid.66875.3a0000 0004 0459 167XDepartment of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905 USA
| | - Brad Bolon
- GEMpath Inc, 1927 Lincoln Street, Longmount, CO 80501 USA
| | - Andre J. van Wijnen
- grid.59062.380000 0004 1936 7689Department of Biochemistry, University of Vermont, 89 Beaumont Avenue, Burlington, VT 05405 USA
| | - Mark E. Morrey
- grid.66875.3a0000 0004 0459 167XDepartment of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905 USA
| | - Joaquin Sanchez-Sotelo
- grid.66875.3a0000 0004 0459 167XDepartment of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905 USA
| | - Daniel J. Berry
- grid.66875.3a0000 0004 0459 167XDepartment of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905 USA
| | - Jodi M. Carter
- grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905 USA
| | - Matthew P. Abdel
- grid.66875.3a0000 0004 0459 167XDepartment of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W, Rochester, MN 55905 USA
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Huang Z, Wang G, Yang B, Li P, Yang T, Wu Y, Yang X, Liu J, Li J. Mechanism of ketotifen fumarate inhibiting renal calcium oxalate stone formation in SD rats. Biomed Pharmacother 2022; 151:113147. [PMID: 35643070 DOI: 10.1016/j.biopha.2022.113147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/02/2022] [Accepted: 05/15/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To investigate the inhibitory effect of ketotifen fumarate (KFA), a mast cell membrane stabilizer, on renal calcium oxalate stone (CaOx) formation and its possible molecular mechanism. METHODS We used the Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) database for functional and pathway enrichment analyses of osteopontin (OPN), CD44 and fibronectin (FN). Blood biochemistry, reactive oxygen species ratio (ROS), mast cells, proteins (CD44, OPN and FN) and OPN receptor integrin family genes were detected by ELISA, flow cytometry, immunohistochemistry and RT-QPCR, respectively. RESULTS The crystal area of CaOx in the KFA and Control group was significantly smaller than that in the Model group. The number of activated mast cells, the expression levels of OPN and CD44 in the Control and KFA groups were significantly lower than those in the Model group, and the percentage of ROS in the KFA group was also significantly lower than that in the Model group. The mRNA expression levels of ITGB1, ITGA9, ITGAV and ITGA4 genes in the prominent OPN receptor integrin family increased significantly in the Model group. CONCLUSIONS Ketotifen can effectively inhibit the crystal formation of CaOx and reduce the inflammatory response of tissue in SD rats. The mechanism may be to reduce the infiltration and activation of mast cells in renal tissue and down-regulate the expression of OPN, CD44 and FN in renal tubules and renal interstitium. And affect the synthesis of integrins (ITGA9, ITGA4, ITGAV, ITGB1, ITGB3 and ITGB5) and ROS.
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Affiliation(s)
- Ziye Huang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374 Dian-Mian Avenue, Kunming, Yunnan 650101, PR China
| | - Guang Wang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374 Dian-Mian Avenue, Kunming, Yunnan 650101, PR China
| | - Bowei Yang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374 Dian-Mian Avenue, Kunming, Yunnan 650101, PR China
| | - Pei Li
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374 Dian-Mian Avenue, Kunming, Yunnan 650101, PR China
| | - Tongxin Yang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374 Dian-Mian Avenue, Kunming, Yunnan 650101, PR China
| | - Yuyun Wu
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374 Dian-Mian Avenue, Kunming, Yunnan 650101, PR China
| | - Xing Yang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374 Dian-Mian Avenue, Kunming, Yunnan 650101, PR China
| | - Jianhe Liu
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374 Dian-Mian Avenue, Kunming, Yunnan 650101, PR China.
| | - Jiongming Li
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374 Dian-Mian Avenue, Kunming, Yunnan 650101, PR China.
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An in vivo rabbit joint injury model to measure trauma-induced coagulopathy and the effect of timing of administration of ketotifen fumarate on posttraumatic joint contracture. OTA Int 2022; 5:e177. [PMID: 35282394 PMCID: PMC8900463 DOI: 10.1097/oi9.0000000000000177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
Objectives: Using a rabbit in vivo joint injury model, the primary objective of the study was to determine if a relationship exists between earlier time to initiation of ketotifen fumarate (KF) treatment and posttraumatic joint contracture (PTJC) reduction. The secondary objective was to determine if a coagulation response could be detected with serial thrombelastography (TEG) analysis following acute trauma in this model. Methods: PTJC of the knee were created in 25 skeletally mature, New Zealand White rabbits. Five groups of 5 animals were studied: a control group that received twice daily subcutaneous injections of normal saline and 4 treatment groups that received twice daily subcutaneous injections of KF (0.5 mg/kg) starting immediately, 1-, 2-, and 4-weeks post-injury. After 8 weeks of immobilization, flexion contractures were measured biomechanically. Serial TEG analysis was performed on the control group animals pre-injury and weekly post-injury. Results: The average joint contracture in the Control Group (43.1° ± 16.2°) was higher than all KF treatment groups; however, the differences were not statistically significant. The average joint contracture was lowest in the 2-week post-injury treatment group (29.4° ± 12.1°), although not statistically significant compared to the other treatment groups. Serial TEG analysis demonstrated significantly higher mean maximal amplitude (maximal amplitude = 68.9 ± 1.7 mm; P < .001), alpha-angle (81.9° ± 0.9°; P < .001), and coagulation index (4.5 ± 0.3; P < .001) 1-week post-injury, which normalized to pre-injury values by 5-weeks post-injury. Conclusions: The use of the mast cell stabilizer KF within 2 weeks of injury demonstrated a nonsignificant trend towards reducing joint contracture in a rabbit in vivo model of PTJC. TEG and the in vivo rabbit joint injury model may be valuable in future preclinical studies of venous thromboembolism prevention and furthering our understanding of the pathophysiology of posttraumatic hypercoagulability.
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Yousuf M, Ahmad M, Usman M, Naeem M, Ali Khan B, Khalid Khan M. Development and validation of HPLC method for simultaneous determination of Ketotifen Fumarate and Salbutamol Sulfate in bulk and tablets dosage forms. MAIN GROUP CHEMISTRY 2021. [DOI: 10.3233/mgc-210064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the study was to develop and validate a new, rapid, sensitive, simple, accurate and reproducible HPLC method for simultaneous determination of ketotifen fumarate and salbutamol sulfate. Simultaneous HPLC method was developed using RP-C18 stainless steel analytical column 4.6×150 mm C18.Acetonitrile and phosphate buffer pH 4 (30 : 70) were used as mobile phase and wavelength was adjusted to 276 nm for detection of drugs. Developed method was validated for its specificity, accuracy, precision, linearity and robustness. Method was also applied to quantify drugs in commercial tablets. Chromatogram obtained by newly developed method for simultaneous determination of two anti-asthmatic drugs, having well distinguished peaks for both drugs. Retention time of ketotifen fumarate and salbutamol sulfate were 2.69 minutes and 9.47 minutes respectively. Total run time for both anti-asthmatic drugs was 12 minutes. Limit of quantification for ketotifen fumarate and salbutamol sulfate was 1 ng/ml and 1.50 ng/ml respectively. Limit of detection of ketotifen fumarate and salbutamol sulfate was 3.03 and 4.54 respectively. A simple, easy, precise and new method was developed for simultaneous quantification of frequently used anti-asthmatic drugs. Developed method may prove effective and beneficial in determination of ketotifen fumarate and salbutamol sulfate in bulk and other pharmaceutical dosage forms.
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Affiliation(s)
- Muhammad Yousuf
- Institute of Pharmaceutical Sciences, Peoples University of Medical and Health Sciences for Women, Nawabshah, Sindh, Pakistan
| | - Mahmood Ahmad
- Director ORIC, University of Central Punjab, Lahore, Pakistan
| | - Muhammad Usman
- Faculty of Pharmacy University of Sargodha, Punjab, Pakistan
| | - Muhammad Naeem
- Department of Pharmacy, Shah Abdul Latif University Khairpur, Sindh, Pakistan
| | - Barkat Ali Khan
- Drug Designand Cosmetics Lab (DDCL), Gomal Centre of Pharmaceutical Sciences, Gomal University, D.I.Khan, Pakistan
| | - Muhammad Khalid Khan
- Drug Designand Cosmetics Lab (DDCL), Gomal Centre of Pharmaceutical Sciences, Gomal University, D.I.Khan, Pakistan
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Jang YJ, Hong EH, Park EJ, Kim KJ, Kim KH. Immunohistochemical Analysis of Differences of Toll-Like Receptor 2, Mast Cells, and Neurofilaments between Granulomatous Rosacea and Non-Granulomatous Rosacea. Indian J Dermatol 2021; 66:343-346. [PMID: 34759390 PMCID: PMC8530054 DOI: 10.4103/ijd.ijd_18_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Granulomatous rosacea is a distinct variant of rosacea because of its unique histopatholiogic findings. However, the pathogenesis of granulomatous rosacea has not yet been clearly demonstrated. Aims and Objectives: The aim of this study was to investigate the expression of toll-like receptor 2, mast cells, and neurofilaments in the granulomatous rosacea compared with the non-granulomatous rosacea. Materials and Methods: Biopsy specimens were obtained from 12 patients with erythematotelangiectatic rosacea, 11 patients with granulomatous rosacea, and 11 control patients. Biopsy tissue blocks were subjected to immunohistochemical staining using antibodies against toll-like receptor 2, mast cells, and neurofilaments. Results: In granulomatous rosacea, the expression of mast cells increased significantly, compared to the erythematotelangiectatic rosacea and the control group (P-value = 0.001 and 0.013, respectively). Additionally, the expression of toll-like receptor 2 in the granulomatous rosacea group was higher than that in the control group (P-value = 0.04). Conclusion: The results of this study suggest that the increased expression of mast cells may be a sign of chronic, later stage of granulomatous rosacea compared to the erythematotelangiectatic rosacea. The increased expression of toll-like receptor 2 suggests that cathelicidin-induced neuroimmune pathogenesis also contributes to the pathophysiology of granulomatous rosacea.
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Affiliation(s)
- Ye Ji Jang
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Hye Hong
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Joo Park
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Joong Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Ho Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
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Dan J, Izumi M, Habuchi H, Habuchi O, Takaya S, Kasai Y, Hayashi R, Aso K, Ushida T, Ikeuchi M. A novel mice model of acute flares in osteoarthritis elicited by intra-articular injection of cultured mast cells. J Exp Orthop 2021; 8:75. [PMID: 34495429 PMCID: PMC8426457 DOI: 10.1186/s40634-021-00391-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Mast cells are multifunctional in osteoarthritis (OA), and infiltration of activated mast cells likely contributes to disease severity and progression. However, the detailed mechanisms of action are unclear. The purpose of this study was to elucidate the role of mast cell infiltration in OA at histological level using a new mice model and to investigate pharmacological inhibitory effects of existing mast cell stabilizers in this model. METHODS Mice were injected intra-articularly with monosodium iodoacetate (MIA 0.5 mg) or PBS on day 0, and PBS, with or without mast cells (MC: 1 × 106 cells) on day 14. They were divided into four groups: OA flare (MIA + MC), OA (MIA + PBS), MC non-OA (PBS + MC), and PBS non-OA (PBS + PBS). In OA flare, the MC stabilizer drug (tranilast: 400 mg/kg/day) or PBS was administered intraperitoneally from days 15 to 21. RESULTS Histologically, modified Mankin score of the OA flare was significantly higher than that of OA (7.0 [1.8] vs. 3.3 [1.3], P < 0.05), and a larger number of mast cells was observed in OA flare than in OA (34.5 [6.3]/mm2 vs. 27.2 [2.3]/mm2, P < 0.05) on day 22. OA flare also showed acute exacerbation of pain and increased gene expression of pro-inflammatory cytokines and aggrecanase compared with OA. Administration of tranilast to OA flare-up provoked significant improvements in term of histological changes, pain, and gene expression at day 22. CONCLUSION Our novel model possibly mimics OA flare conditions, which may open a new strategy of disease-modifying treatment for OA, focused on controlling the multiple functions of mast cells.
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Affiliation(s)
- Junpei Dan
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, 185-1 Oko-cho, Nankoku, Kochi Pref, Japan
| | - Masashi Izumi
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, 185-1 Oko-cho, Nankoku, Kochi Pref, Japan.
| | - Hiroko Habuchi
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Osami Habuchi
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Shogo Takaya
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, 185-1 Oko-cho, Nankoku, Kochi Pref, Japan
| | - Yusuke Kasai
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, 185-1 Oko-cho, Nankoku, Kochi Pref, Japan
| | - Ryuzo Hayashi
- Center for Innovative and Translational Medicine, Kochi University, Nankoku, Japan
| | - Koji Aso
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, 185-1 Oko-cho, Nankoku, Kochi Pref, Japan
| | - Takahiro Ushida
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Masahiko Ikeuchi
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, 185-1 Oko-cho, Nankoku, Kochi Pref, Japan
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12
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Blessing WA, Williamson AK, Kirsch JR, Grinstaff MW. The Prognosis of Arthrofibroses: Prevalence, Clinical Shortcomings, and Future Prospects. Trends Pharmacol Sci 2021; 42:398-415. [PMID: 33795150 DOI: 10.1016/j.tips.2021.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 02/06/2023]
Abstract
Fibrosis is the dysregulated biosynthesis of connective tissue that results from persistent infection, high serum cholesterol, surgery, trauma, or prolonged joint immobilization. As a disease that impacts connective tissue, it is prevalent across the body and disrupts normal extracellular and tissue organization. Ultimately, fibrosis impairs the tissue structural, mechanical, or biochemical function. This review describes the clinical landscape of joint fibrosis, that is, arthrofibrosis, including the risk factors and causes, as well as current clinical treatments and their shortcomings. Because treating arthrofibrosis remains an unmet clinical challenge, we present several animal models used for exploration of the physiopathology of arthrofibrosis and summarize their use for testing novel treatments. We then discuss therapeutics for the prevention or treatment of arthrofibrosis that are in preclinical development and in ongoing clinical trials. We conclude with recent findings from molecular biological studies of arthrofibroses that shed insight on future areas of research for improved treatments.
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Affiliation(s)
- William A Blessing
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
| | - Amanda K Williamson
- Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, Boston, MA 02215, USA
| | - Jack R Kirsch
- Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, Boston, MA 02215, USA
| | - Mark W Grinstaff
- Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, Boston, MA 02215, USA.
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13
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Schneider PS, Johal H, Befus AD, Salo PT, Hart DA, Hildebrand KA. The Dose-Response Effect of the Mast Cell Stabilizer Ketotifen Fumarate on Posttraumatic Joint Contracture: An in Vivo Study in a Rabbit Model. JB JS Open Access 2021; 6:JBJSOA-D-20-00057. [PMID: 34386685 PMCID: PMC8352621 DOI: 10.2106/jbjs.oa.20.00057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Posttraumatic joint contracture is a debilitating complication following an acute fracture or intra-articular injury that can lead to loss of motion and an inability to complete activities of daily living. In prior studies using an established in vivo model, we found that ketotifen fumarate (KF), a mast cell stabilizer, was associated with a significant reduction in the severity of posttraumatic joint contracture. Our primary research question in the current study was to determine whether a dose-response relationship exists between KF and posttraumatic joint contracture reduction.
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Affiliation(s)
- Prism S Schneider
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | | | - A Dean Befus
- University of Alberta, Edmonton, Alberta, Canada
| | - Paul T Salo
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - David A Hart
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Kevin A Hildebrand
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
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14
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PrEvention of Posttraumatic contractuRes with Ketotifen 1 (PERK 1): A Randomized Clinical Trial. J Orthop Trauma 2020; 34:e442-e448. [PMID: 32639394 DOI: 10.1097/bot.0000000000001878] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the use of ketotifen fumarate (KF) to reduce posttraumatic contractures after elbow fractures and/or dislocations. DESIGN Randomized clinical trial. SETTING Three hospitals in Calgary, Canada, including one Level 1 trauma center. PARTICIPANTS Adults (n = 151) sustaining operative or nonoperatively managed isolated distal humerus or proximal radius ± ulna fractures or elbow dislocations within 7 days of injury. INTERVENTIONS KF 5 mg (n = 74) or lactose placebo (PL, n = 77) orally twice daily for 6 weeks. MAIN OUTCOMES Primary outcome elbow flexion-extension arc range of motion (ROM) at 12 weeks postrandomization. Safety measures including serious adverse events and radiographic fracture line disappearance from 2 to 52 weeks postrandomization. RESULTS The elbow ROM (mean, confidence interval) was not significantly different between KF (122 degrees, 118-127 degrees) and PL (124 degrees, 119-130 degrees) groups (P = 0.56). There was a significant difference in elbow ROM at 12 weeks postrandomization comparing operative (117 degrees, 112-122 degrees) versus nonoperative groups (128 degrees, 124-133 degrees) irrespective of intervention (P = 0.0011). There were 11 serious adverse events (KF = 6, PL = 5) that were those expected in an elbow fracture population potentially taking KF. There was no statistically significant difference in the rates of these events between the groups. The disappearance of fracture lines over the course of time was similar between groups. There was one nonunion in each group. CONCLUSIONS In a population of operative and nonoperatively managed elbow fractures and/or dislocations KF did not reduce posttraumatic contractures. The administration of KF in this population was not found to result in a significantly higher number of major adverse events when compared with placebo. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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15
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Limberg AK, Tibbo ME, Salib CG, McLaury AR, Turner TW, Berry CE, Jay AG, Carter JM, Bolon B, Berry DJ, Morrey ME, Sanchez-Sotelo J, van Wijnen AJ, Abdel MP. Reduction of arthrofibrosis utilizing a collagen membrane drug-eluting scaffold with celecoxib and subcutaneous injections with ketotifen. J Orthop Res 2020; 38:2474-2483. [PMID: 32134136 PMCID: PMC7483403 DOI: 10.1002/jor.24647] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/29/2020] [Indexed: 02/04/2023]
Abstract
The dense formation of abnormal scar tissue after total knee arthroplasty results in arthrofibrosis, an unfortunate sequela of inflammation. The purpose of this study was to use a validated rabbit model to assess the effects on surgically-induced knee joint contractures of two combined pharmacological interventions: celecoxib (CXB) loaded on an implanted collagen membrane, and subcutaneously (SQ) injected ketotifen. Thirty rabbits were randomly divided into five groups. The first group received no intervention after the index surgery. The remaining four groups underwent intra-articular implantation of collagen membranes loaded with or without CXB at the time of the index surgery; two of which were also treated with SQ ketotifen. Biomechanical joint contracture data were collected at 8, 10, 16, and 24 weeks. At the time of necropsy (24 weeks), posterior capsule tissue was collected for messenger RNA and histopathologic analyses. At 24 weeks, there was a statistically significant increase in passive extension among rabbits in all groups treated with CXB and/or ketotifen compared to those in the contracture control group. There was a statistically significant decrease in COL3A1, COL6A1, and ACTA2 gene expression in the treatment groups compared to the contracture control group (P < .001). Histopathologic data also demonstrated a trend towards decreased fibrous tissue density in the CXB membrane group compared to the vehicle membrane group. The present data suggest that intra-articular placement of a treated collagen membrane blunts the severity of contracture development in a rabbit model of arthrofibrosis, and that ketotifen and CXB may independently contribute to the prevention of arthrofibrosis. Statement of clinical significance: Current literature has demonstrated that arthrofibrosis may affect up to 5% of primary total knee arthroplasty patients. For that reason, novel pharmacologic prophylaxis and treatment modalities are critical to mitigating reoperations and revisions while improving the quality of life for patients with this debilitating condition.
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Affiliation(s)
| | - Meagan E. Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Alex R. McLaury
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Anthony G. Jay
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Jodi M. Carter
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Mark E. Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | | | - Andre J. van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN,Department of Biochemistry & Molecular Biology, Mayo Clinic, Rochester, MN
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16
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Liu CS, Ademola A, Zhang M, Garven A, Kopka M, Salo PT, Hart DA, Befus AD, Hildebrand KA. Human serum mast cell tryptase levels in elbow fractures or dislocations and its association with injury severity. J Orthop Res 2020; 38:2015-2019. [PMID: 32112583 DOI: 10.1002/jor.24642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/07/2020] [Accepted: 02/19/2020] [Indexed: 02/04/2023]
Abstract
Mast cells contain an abundance of tryptase, and preclinical models have shown elevated serum mast cell tryptase (SMCT) in the setting of posttraumatic joint contractures. Therefore, SMCT emerged as a potential biomarker to help recognize patients with more severe injuries and a higher likelihood of developing contractures. The objective of this study is to assess SMCT levels in participants with varying severity of elbow fractures and/or dislocations. A prospective cohort including 13 participants with more severe injuries that required an operation and 28 participants with less severe injuries managed nonoperatively were evaluated. A control group of eight individuals without elbow injuries was also evaluated. The SMCT levels were measured using an enzyme-linked immunosorbent assay kit specific for human mast cell tryptase. A one-way analysis of variance and Tukey's Honest Significance test was used to assess for statistical significance among and between the three groups. The average time from injury to the collection of the blood samples was 4 ± 2 days. Highly significant differences were identified between the operative, nonoperative, and control groups (P = .0005). In the operative group, SMCT levels were significantly higher than the nonoperative group (P = .0005) and the control group (P = .009), suggesting a correlation between SMCT levels and injury severity. There was no statistically significant difference in SMCT levels between the nonoperative and control groups. The SMCT levels were elevated in participants with acute elbow injuries requiring operative intervention, suggesting that SMCT levels were higher in injuries regarded as more severe.
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Affiliation(s)
- Crystal S Liu
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Ayoola Ademola
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mei Zhang
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexandra Garven
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Michaela Kopka
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,Banff Sport Medicine, Banff, Alberta, Canada
| | - Paul T Salo
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David A Hart
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Bone and Joint Health Strategic Clinic Network, Edmonton, Alberta, Canada
| | - A Dean Befus
- Department of Medicine, Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin A Hildebrand
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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17
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Tibbo ME, Limberg AK, Salib CG, Turner TW, McLaury AR, Jay AG, Bettencourt JW, Carter JM, Bolon B, Berry DJ, Morrey ME, Sanchez-Sotelo J, van Wijnen AJ, Abdel MP. Anti-fibrotic effects of the antihistamine ketotifen in a rabbit model of arthrofibrosis. Bone Joint Res 2020; 9:302-310. [PMID: 32728431 PMCID: PMC7376284 DOI: 10.1302/2046-3758.96.bjr-2019-0272.r2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Aims Arthrofibrosis is a relatively common complication after joint injuries and surgery, particularly in the knee. The present study used a previously described and validated rabbit model to assess the biomechanical, histopathological, and molecular effects of the mast cell stabilizer ketotifen on surgically induced knee joint contractures in female rabbits. Methods A group of 12 skeletally mature rabbits were randomly divided into two groups. One group received subcutaneous (SQ) saline, and a second group received SQ ketotifen injections. Biomechanical data were collected at eight, ten, 16, and 24 weeks. At the time of necropsy, posterior capsule tissue was collected for histopathological and gene expression analyses (messenger RNA (mRNA) and protein). Results At the 24-week timepoint, there was a statistically significant increase in passive extension among rabbits treated with ketotifen compared to those treated with saline (p = 0.03). However, no difference in capsular stiffness was detected. Histopathological data failed to demonstrate a decrease in the density of fibrous tissue or a decrease in α-smooth muscle actin (α-SMA) staining with ketotifen treatment. In contrast, tryptase and α-SMA protein expression in the ketotifen group were decreased when compared to saline controls (p = 0.007 and p = 0.01, respectively). Furthermore, there was a significant decrease in α-SMA (ACTA2) gene expression in the ketotifen group compared to the control group (p < 0.001). Conclusion Collectively, these data suggest that ketotifen mitigates the severity of contracture formation in a rabbit model of arthrofibrosis.
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Affiliation(s)
- Meagan E Tibbo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Afton K Limberg
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Travis W Turner
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alex R McLaury
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anthony G Jay
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jodi M Carter
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Andre J van Wijnen
- Department of Orthopedic Surgery and Department of Biochemistry & Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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18
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Wahl EP, Lampley AJ, Chen A, Adams SB, Nettles DL, Richard MJ. Inflammatory cytokines and matrix metalloproteinases in the synovial fluid after intra-articular elbow fracture. J Shoulder Elbow Surg 2020; 29:736-742. [PMID: 31784384 DOI: 10.1016/j.jse.2019.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/14/2019] [Accepted: 09/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Post-traumatic elbow contracture remains a common and challenging complication with often unsatisfactory outcomes. Although the etiology is unknown, elevated or abnormal post-fracture synovial fluid cytokine levels may result in the migration of fibroblasts to the capsule and contribute to capsular pathology. Thus, the purpose of this study was to characterize the cytokine composition in the synovial fluid fracture hematoma of patients with intra-articular elbow fractures. METHODS The elbow synovial fluid fracture hematoma of 11 patients with intra-articular elbow fractures was analyzed for CTXII (C-terminal telopeptides of type II collagen [a cartilage breakdown product]) as well as 15 cytokines and matrix metalloproteinases (MMPs) including interferon γ, interleukin (IL) 1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, tumor necrosis factor α, MMP-1, MMP-2, MMP-3, MMP-9, and MMP-10. The uninjured, contralateral elbow served as a matched control. Mean concentrations of each factor were compared between the fluid from fractured elbows and the fluid from control elbows. RESULTS The levels of 14 of 15 measured cytokines and MMPs-interferon γ, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, tumor necrosis factor α, MMP-1, MMP-3, MMP-9, and MMP-10-were significantly higher in the fractured elbows. In addition, post hoc power analysis revealed that 10 of 14 significant differences were detected with greater than 90% power. The mean concentration of CTXII was not significantly different between groups. CONCLUSIONS These results demonstrate a proinflammatory environment after fracture that may be the catalyst to the development of post-traumatic elbow joint contracture. The cytokines with elevated levels were similar, although not identical, to the cytokines with elevated levels in studies of other weight-bearing joints, indicating the elbow responds uniquely to trauma.
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Affiliation(s)
- Elizabeth P Wahl
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Alexander J Lampley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Angel Chen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Dana L Nettles
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Marc J Richard
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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19
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Wang MM, Feng YS, Xing Y, Dong F, Zhang F. Mechanisms involved in the arthrofibrosis formation and treatments following bone fracture. J Back Musculoskelet Rehabil 2020; 32:947-954. [PMID: 31403938 DOI: 10.3233/bmr-191499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Arthrofibrosis is a common complication for patients with bone fracture following external and internal fixation. In this review, we summarize the related factors and significant pathways for joint adhesion following fracture surgery. Moreover, the different types of treatments and related preventive measures are also discussed. Many factors related to the development and treatment of arthrofibrosis are discussed in this review in order to provide possible clues for the prospective targets to develop new medication or treatments for preventing or reducing the joint adhesion following orthopedic surgery.
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Affiliation(s)
- Man-Man Wang
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China
| | - Ya-Shuo Feng
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China
| | - Ying Xing
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China
| | - Fang Dong
- Department of Clinical Laboratory Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China
| | - Feng Zhang
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China.,Hebei Provincial Orthopedic Biomechanics key laboratory, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China
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20
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Ademola A, Hildebrand KA, Schneider PS, Mohtadi NGH, White NJ, Bosse MJ, Garven A, Walker REA, Sajobi TT. PrEvention of posttraumatic contractuRes with Ketotifen 2 (PERK 2) - protocol for a multicenter randomized clinical trial. BMC Musculoskelet Disord 2020; 21:123. [PMID: 32093652 PMCID: PMC7041204 DOI: 10.1186/s12891-020-3139-2] [Citation(s) in RCA: 4] [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: 10/16/2019] [Accepted: 02/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Injuries and resulting stiffness around joints, especially the elbow, have huge psychological effects by reducing quality of life through interference with normal daily activities such as feeding, dressing, grooming, and reaching for objects. Over the last several years and through numerous research results, the myofibroblast-mast cell-neuropeptide axis of fibrosis had been implicated in post-traumatic joint contractures. Pre-clinical models and a pilot randomized clinical trial (RCT) demonstrated the feasibility and safety of using Ketotifen Fumarate (KF), a mast cell stabilizer to prevent elbow joint contractures. This study aims to evaluate the efficacy of KF in reducing joint contracture severity in adult participants with operately treated elbow fractures and/or dislocations. Methods/design A Phase III randomized, controlled, double-blinded multicentre trial with 3 parallel groups (KF 2 mg or 5 mg or lactose placebo twice daily orally for 6 weeks). The study population consist of adults who are at least 18 years old and within 7 days of injury. The types of injuries are distal humerus (AO/OTA type 13) and/or proximal ulna and/or proximal radius fractures (AO/OTA type 2 U1 and/or 2R1) and/or elbow dislocations (open fractures with or without nerve injury may be included). A stratified randomization scheme by hospital site will be used to assign eligible participants to the groups in a 1:1:1 ratio. The primary outcome is change in elbow flexion-extension range of motion (ROM) arc from baseline to 12 weeks post-randomization. The secondary outcomes are changes in ROM from baseline to 6, 24 & 52 weeks, PROMs at 2, 6, 12, 24 & 52 weeks and impact of KF on safety including serious adverse events and fracture healing. Descriptive analysis for all outcomes will be reported and ANCOVA be used to evaluate the efficacy KF over lactose placebo with respect to the improvement in ROM. Discussion The results of this study will provide evidence for the use of KF in reducing post-traumatic joint contractures and improving quality of life after joint injuries. Trial registration This study was prospectively registered (July 10, 2018) with ClinicalTrials.gov reference: NCT03582176.
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Affiliation(s)
- Ayoola Ademola
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, Canada.
| | - Kevin A Hildebrand
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada.,Department of Surgery, University of Calgary, Calgary, Canada
| | - Prism S Schneider
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Surgery, University of Calgary, Calgary, Canada
| | - Nicholas G H Mohtadi
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada.,Department of Surgery, University of Calgary, Calgary, Canada
| | - Neil J White
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Michael J Bosse
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, USA
| | | | - Richard E A Walker
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada.,Department of Radiology, University of Calgary, Calgary, Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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21
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El Ayadi A, Jay JW, Prasai A. Current Approaches Targeting the Wound Healing Phases to Attenuate Fibrosis and Scarring. Int J Mol Sci 2020; 21:ijms21031105. [PMID: 32046094 PMCID: PMC7037118 DOI: 10.3390/ijms21031105] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/20/2020] [Accepted: 02/04/2020] [Indexed: 02/06/2023] Open
Abstract
Cutaneous fibrosis results from suboptimal wound healing following significant tissue injury such as severe burns, trauma, and major surgeries. Pathologic skin fibrosis results in scars that are disfiguring, limit normal movement, and prevent patient recovery and reintegration into society. While various therapeutic strategies have been used to accelerate wound healing and decrease the incidence of scarring, recent studies have targeted the molecular regulators of each phase of wound healing, including the inflammatory, proliferative, and remodeling phases. Here, we reviewed the most recent literature elucidating molecular pathways that can be targeted to reduce fibrosis with a particular focus on post-burn scarring. Current research targeting inflammatory mediators, the epithelial to mesenchymal transition, and regulators of myofibroblast differentiation shows promising results. However, a multimodal approach addressing all three phases of wound healing may provide the best therapeutic outcome.
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22
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Baranowski A, Schlemmer L, Förster K, Slotina E, Mickan T, Truffel S, Klein A, Mattyasovszky SG, Hofmann A, Ritz U, Rommens PM. Effects of losartan and atorvastatin on the development of early posttraumatic joint stiffness in a rat model. Drug Des Devel Ther 2019; 13:2603-2618. [PMID: 31440039 PMCID: PMC6679684 DOI: 10.2147/dddt.s204135] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/27/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND After a trauma, exuberant tissue healing with fibrosis of the joint capsule can lead to posttraumatic joint stiffness (PTJS). Losartan and atorvastatin have both shown their antifibrotic effects in different organ systems. OBJECTIVE The purpose of this study was the evaluation of the influence of losartan and atorvastatin on the early development of joint contracture. In addition to joint angles, the change in myofibroblast numbers and the distribution of bone sialoprotein (BSP) were assessed. STUDY DESIGN AND METHODS In this randomized and blinded experimental study with 24 rats, losartan and atorvastatin were compared to a placebo. After an initial joint injury, rat knees were immobilized with a Kirschner wire. Rats received either losartan, atorvastatin or a placebo orally daily. After 14 days, joint angle measurements and histological assessments were performed. RESULTS Losartan increased the length of the inferior joint capsule. Joint angle and other capsule length measurements did not reveal significant differences between both drugs and the placebo. At cellular level both losartan and atorvastatin reduced the total number of myofibroblasts (losartan: 191±77, atorvastatin: 98±58, placebo: 319±113 per counting field, p<0.01) and the percentage area of myofibroblasts (losartan: 2.8±1.8% [p<0.05], atorvastatin: 2.5±1.7% [p<0.01], vs control [6.4±4%], respectively). BSP was detectable in equivalent amounts in the joint capsules of all groups with only a trend toward a reduction of the BSP-stained area by atorvastatin. CONCLUSION Both atorvastatin and losartan reduced the number of myofibroblasts in the posterior knee joint capsule of rat knees 2 weeks after trauma and losartan increased the length of the inferior joint capsule. However, these changes at the cellular level did not translate an increase in range of motion of the rats´ knee joints during early contracture development.
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Affiliation(s)
- Andreas Baranowski
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Ludwig Schlemmer
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Katharina Förster
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Ekaterina Slotina
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Tim Mickan
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Sebastian Truffel
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Anja Klein
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Stefan G Mattyasovszky
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Alexander Hofmann
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
- Department of Traumatology and Orthopaedics 1, Westpfalz-Medical Centre Kaiserslautern, Kaiserslautern, Germany
| | - Ulrike Ritz
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Pol M Rommens
- Department of Orthopaedics and Traumatology, Biomatics Group, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
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Usher KM, Zhu S, Mavropalias G, Carrino JA, Zhao J, Xu J. Pathological mechanisms and therapeutic outlooks for arthrofibrosis. Bone Res 2019; 7:9. [PMID: 30937213 PMCID: PMC6433953 DOI: 10.1038/s41413-019-0047-x] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/17/2019] [Accepted: 02/26/2019] [Indexed: 02/07/2023] Open
Abstract
Arthrofibrosis is a fibrotic joint disorder that begins with an inflammatory reaction to insults such as injury, surgery and infection. Excessive extracellular matrix and adhesions contract pouches, bursae and tendons, cause pain and prevent a normal range of joint motion, with devastating consequences for patient quality of life. Arthrofibrosis affects people of all ages, with published rates varying. The risk factors and best management strategies are largely unknown due to a poor understanding of the pathology and lack of diagnostic biomarkers. However, current research into the pathogenesis of fibrosis in organs now informs the understanding of arthrofibrosis. The process begins when stress signals stimulate immune cells. The resulting cascade of cytokines and mediators drives fibroblasts to differentiate into myofibroblasts, which secrete fibrillar collagens and transforming growth factor-β (TGF-β). Positive feedback networks then dysregulate processes that normally terminate healing processes. We propose two subtypes of arthrofibrosis occur: active arthrofibrosis and residual arthrofibrosis. In the latter the fibrogenic processes have resolved but the joint remains stiff. The best therapeutic approach for each subtype may differ significantly. Treatment typically involves surgery, however, a pharmacological approach to correct dysregulated cell signalling could be more effective. Recent research shows that myofibroblasts are capable of reversing differentiation, and understanding the mechanisms of pathogenesis and resolution will be essential for the development of cell-based treatments. Therapies with significant promise are currently available, with more in development, including those that inhibit TGF-β signalling and epigenetic modifications. This review focuses on pathogenesis of sterile arthrofibrosis and therapeutic treatments.
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Affiliation(s)
- Kayley M. Usher
- School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia Australia
| | - Sipin Zhu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Georgios Mavropalias
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia Australia
| | | | - Jinmin Zhao
- Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi China
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi China
| | - Jiake Xu
- School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia Australia
- Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi China
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Abstract
Large joint arthrofibrosis and scarring, involving the shoulder, elbow, hip, and knee, can result in the loss of function and immobility. The pathway of joint contracture formation is still being elucidated and is due to aberrations in collagen synthesis and misorientation of collagen fibrils. Novel antibodies are being developed to prevent arthrofibrosis, and current treatment methods for arthrofibrosis include medical, physical, and surgical treatments. This article describes the biology of joint contracture formation, along with current and future pharmacologic, biologic, and medical interventions.
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Affiliation(s)
- Antonia F Chen
- a Department of Orthopaedic Surgery , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA
| | - Yong Seuk Lee
- b Department of Orthopedic Surgery , Seoul National University College of Medicine, Seoul National University Bundang Hospital , Seoul , Korea
| | - Adam J Seidl
- c Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedics , University of Colorado , Aurora , CO , USA
| | - Joseph A Abboud
- d Department of Orthopaedics , Rothman Institute at Thomas Jefferson University , Philadelphia , PA , USA
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Song C, Xu X, Wu Y, Ji B, Zhou X, Qin L. Study of the mechanism underlying hsa-miR338-3p downregulation to promote fibrosis of the synovial tissue in osteoarthritis patients. Mol Biol Rep 2018; 46:627-637. [PMID: 30484106 DOI: 10.1007/s11033-018-4518-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/22/2018] [Indexed: 12/27/2022]
Abstract
Osteoarthritis (OA) is a degenerative joint disease characterized by the degradation of joint cartilage, the formation of osteophyma at joint margins, and synovial changes. Whereas lesions of the joint cartilage were the key point of the research and treatment of osteoarthritis before, a recent study showed that the synovium plays a crucial role in the pathological progress of OA. The inflammatory environment in the joints of OA patients always results in the overactivation of fibroblast-like synoviocytes (FLSs), which produce a multitude of inflammatory factors and media, not only leading to the degradation and injury of the cartilage tissue and promoting the development of osteoarthritis but also resulting in synovial fibrosis and joint stiffness. Therefore, the synovium has attracted increasing attention in the research of OA, and the study of the mechanism of activation of FLSs and the fibrosis of joint synovium may shed new light on OA treatment. By using high-throughput screening, we have identified that hsa-miR338-3p is significantly downregulated in the synovial tissue and joint effusion from OA patients. A functional study showed that overexpression of hsa-miR338-3p in the FLSs inhibited the TGF-β1-induced overactivation of the TGF-β/Smad fibrosis regulation pathway by suppressing TRAP-1 expression and thus reducing the TGF-β1-induced activation of the FLSs and the expression of vimentin and collagen I, two fibrosis markers. Meanwhile, a mechanism study also showed that the upregulation of hsa-miR338-3p reduced Smad2/3 phosphorylation by suppressing TRAP-1 and thus inhibited the TGF-β/Smad pathway and TIMP1, a downstream protein. The present study, for the first time, illustrates the role of hsa-miR338-3p in synovial fibrosis in OA patients and the related mechanism, which is of importance to the treatment of OA and its complications by targeting the FLSs and synovial tissue. Hsa-miR338-3p not only has the potential to be a target for the gene therapy of OA but also has the potential to be a new marker for the diagnosis of clinical progression in OA patients.
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Affiliation(s)
- Changzhi Song
- Department of Orthopaedics, Yancheng City No. 1 People's Hospital, Yancheng, 224006, China
| | - Xiaozu Xu
- Department of Orthopaedics, Yancheng City No. 1 People's Hospital, Yancheng, 224006, China.
| | - Ya Wu
- Department of Orthopaedics, Yancheng City No. 1 People's Hospital, Yancheng, 224006, China
| | - Biao Ji
- Department of Orthopaedics, Yancheng City No. 1 People's Hospital, Yancheng, 224006, China
| | - Xiaoye Zhou
- Department of Gynecology and Obstetrics, Yancheng City No. 1 People's Hospital, Yancheng, 224006, China
| | - Ling Qin
- Department of Orthopaedics, Yancheng City No. 1 People's Hospital, Yancheng, 224006, China
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Effect of Keller Funnel on the Rate of Capsular Contracture in Periareolar Breast Augmentation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1834. [PMID: 30276059 PMCID: PMC6157951 DOI: 10.1097/gox.0000000000001834] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/20/2018] [Indexed: 11/26/2022]
Abstract
Background Capsular contracture is 1 of the most common complications after breast implant surgery and is a major indication for reoperation. Capsular contracture is believed to be a multifactorial process that is affected by implant texture, incision type, and ultimately pocket contamination. This contamination causes a biofilm that leads to capsular contracture. The intraoperative use of a Keller funnel is a mechanical way to decrease the implant's contact with the skin and ducts, reducing bacterial contamination that can cause these biofilms. For this reason, periareolar breast augmentation has been less popular among surgeons. The purpose of this study was to examine if there was a significant difference between the rates of capsular contracture in patients having periareolar breast augmentations with the use of a Keller funnel for insertion and those having periareolar breast augmentations without Funnel use. Methods This level 3 retrospective study followed 2 groups of patients, the first having periareolar breast augmentations without the use of a funnel for insertion (group A; patients n = 15; implants n = 30) and the second having periareolar breast augmentations with the use of a funnel for insertion (group B; patients n = 151; implants n = 300). Results The rate of capsular contracture in group A was found to be 10% compared with a rate of capsular contracture of 1.3% for patients in group B, an 87% reduction (P = 0.0019). Conclusions According to the results found in this study, the rate of capsular contracture in patients having periareolar breast augmentations after insertion with a Keller funnel was statistically significantly lower than the rate in patients having implants inserted without the assistance of a funnel, making the device useful in reducing the occurrence of postoperative capsular contracture.
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27
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Dunham CL, Castile RM, Havlioglu N, Chamberlain AM, Galatz LM, Lake SP. Persistent motion loss after free joint mobilization in a rat model of post-traumatic elbow contracture. J Shoulder Elbow Surg 2017; 26:611-618. [PMID: 28081997 PMCID: PMC5502529 DOI: 10.1016/j.jse.2016.09.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/19/2016] [Accepted: 09/29/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Post-traumatic joint contracture (PTJC) in the elbow is a challenging clinical problem due to the anatomical and biomechanical complexity of the elbow joint. METHODS We previously established an animal model to study elbow PTJC, wherein surgically induced soft tissue damage, followed by 6 weeks of unilateral immobilization in Long-Evans rats, led to stiffened and contracted joints that exhibited features similar to the human condition. In this study, after 6 weeks of immobilization, we remobilized the animal (ie, external bandage removed and free cage activity) for an additional 6 weeks, after which the limbs were evaluated mechanically and histologically. The objective of this study was to evaluate whether this decreased joint motion would persist after 6 weeks of free mobilization (FM). RESULTS After FM, flexion-extension demonstrated decreased total range of motion (ROM) and neutral zone length, and increased ROM midpoint for injured limbs compared with control and contralateral limbs. Specifically, after FM total ROM demonstrated a significant decrease of approximately 22% and 26% compared with control and contralateral limbs for injury I (anterior capsulotomy) and injury II (anterior capsulotomy with lateral collateral ligament transection), respectively. Histologic evaluation showed increased adhesion, fibrosis, and thickness of the capsule tissue in the injured limbs after FM compared with control and contralateral limbs, which is consistent with patterns previously reported in human tissue. CONCLUSION Even with FM, injured limbs in this model demonstrate persistent joint motion loss and histologic results similar to the human condition. Future work will use this animal model to investigate the mechanisms responsible for PTJC and responses to therapeutic intervention.
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Affiliation(s)
- Chelsey L. Dunham
- Department of Biomedical Engineering, Washington University, St. Louis, MO
| | - Ryan M. Castile
- Department of Mechanical Engineering & Materials Science, Washington University, St. Louis, MO
| | - Necat Havlioglu
- Department of Pathology, John Cochran VA Medical Center, St. Louis, MO
| | | | - Leesa M. Galatz
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY
| | - Spencer P. Lake
- Department of Biomedical Engineering, Washington University, St. Louis, MO,Department of Mechanical Engineering & Materials Science, Washington University, St. Louis, MO,Department of Orthopaedic Surgery, Washington University, St. Louis, MO,Corresponding Author: Spencer P. Lake, Ph.D., 1 Brookings Drive, Campus Box 1185, St. Louis, MO 63130,
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28
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Abstract
OBJECTIVES Mast cells have been identified as key mediators of posttraumatic joint contracture, and stabilizing medications (ketotifen) have been shown to decrease contracture severity. Serum mast cell tryptase (SMCT) levels are used clinically to monitor mast cell-mediated conditions. The goals of this study were to determine if SMCT levels are elevated in the setting of joint contracture, if they can be decreased in association with ketotifen therapy, and if they correlate with contracture severity. METHODS This study used a previously developed rabbit model in which 39 animals were divided into 4 groups: operatively created joint contracture (ORC, n = 13), operatively created contracture treated with ketotifen at 2 doses (KF0.5, n = 9; KF1.0, n = 9), and healthy rabbits (NC, n = 8). Range of motion measures were performed at 8 weeks after the surgery. Serum samples were collected on postoperative days 1, 3, 5, 7, 21, 35, and 49. SMCT levels were measured using a rabbit-specific enzyme-linked immunosorbent assay. RESULTS Levels of SMCT were highest in the operatively created joint contracture group and were significantly greater compared with both ketotifen groups (P < 0.001). Levels were highest at postoperative day 1 with a trend to decrease over time. A positive correlation between SMCT levels and contracture severity was observed in all operative groups (P < 0.05). CONCLUSIONS Levels of SMCT are elevated in the setting of joint contracture, decreased in association with ketotifen therapy, and positively correlated with contracture severity. This is the first study to establish a relationship between SMCT and joint injury. Measurement of SMCT may be valuable in identifying those at risk of posttraumatic joint contracture.
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29
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Walker JA, Ewald TJ, Lewallen E, Van Wijnen A, Hanssen AD, Morrey BF, Morrey ME, Abdel MP, Sanchez-Sotelo J. Intra-articular implantation of collagen scaffold carriers is safe in both native and arthrofibrotic rabbit knee joints. Bone Joint Res 2017; 6:162-171. [PMID: 28347978 PMCID: PMC5376662 DOI: 10.1302/2046-3758.63.bjr-2016-0193] [Citation(s) in RCA: 7] [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: 07/27/2016] [Accepted: 10/20/2016] [Indexed: 12/14/2022] Open
Abstract
Objectives Sustained intra-articular delivery of pharmacological agents is an attractive modality but requires use of a safe carrier that would not induce cartilage damage or fibrosis. Collagen scaffolds are widely available and could be used intra-articularly, but no investigation has looked at the safety of collagen scaffolds within synovial joints. The aim of this study was to determine the safety of collagen scaffold implantation in a validated in vivo animal model of knee arthrofibrosis. Materials and Methods A total of 96 rabbits were randomly and equally assigned to four different groups: arthrotomy alone; arthrotomy and collagen scaffold placement; contracture surgery; and contracture surgery and collagen scaffold placement. Animals were killed in equal numbers at 72 hours, two weeks, eight weeks, and 24 weeks. Joint contracture was measured, and cartilage and synovial samples underwent histological analysis. Results Animals that underwent arthrotomy had equivalent joint contractures regardless of scaffold implantation (-13.9° versus -10.9°, equivalence limit 15°). Animals that underwent surgery to induce contracture did not demonstrate equivalent joint contractures with (41.8°) or without (53.9°) collagen scaffold implantation. Chondral damage occurred in similar rates with (11 of 48) and without (nine of 48) scaffold implantation. No significant difference in synovitis was noted between groups. Absorption of the collagen scaffold occurred within eight weeks in all animals Conclusion Our data suggest that intra-articular implantation of a collagen sponge does not induce synovitis or cartilage damage. Implantation in a native joint does not seem to induce contracture. Implantation of the collagen sponge in a rabbit knee model of contracture may decrease the severity of the contracture. Cite this article: J. A. Walker, T. J. Ewald, E. Lewallen, A. Van Wijnen, A. D. Hanssen, B. F. Morrey, M. E. Morrey, M. P. Abdel, J. Sanchez-Sotelo. Intra-articular implantation of collagen scaffold carriers is safe in both native and arthrofibrotic rabbit knee joints. Bone Joint Res 2016;6:162–171. DOI: 10.1302/2046-3758.63.BJR-2016-0193.
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Affiliation(s)
- J A Walker
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - T J Ewald
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - E Lewallen
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - A Van Wijnen
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - A D Hanssen
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - B F Morrey
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - M E Morrey
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - M P Abdel
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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30
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Lake SP, Castile RM, Borinsky S, Dunham CL, Havlioglu N, Galatz LM. Development and use of an animal model to study post-traumatic stiffness and contracture of the elbow. J Orthop Res 2016; 34:354-64. [PMID: 26177969 DOI: 10.1002/jor.22981] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 07/08/2015] [Indexed: 02/04/2023]
Abstract
Post-traumatic joint stiffness (PTJS) of the elbow is a debilitating condition that poses unique treatment challenges. While previous research has implicated capsular tissue in PTJS, much regarding the development and progression of this condition remains unknown. The objective of this study was to develop an animal model of post-traumatic elbow contracture and evaluate its potential for studying the etiology of PTJS. The Long-Evans rat was identified as the most appropriate species/breed for development due to anatomical and functional similarities to the human elbow joint. Two surgical protocols of varying severity were utilized to replicate soft tissue damage seen in elbow subluxation/dislocation injuries, including anterior capsulotomy and lateral collateral ligament transection, followed by 6 weeks of unilateral joint immobilization. Following sacrifice, flexion-extension mechanical joint testing demonstrated decreased range-of-motion and increased stiffness for injured-immobilized limbs compared to control and sham animals, where functional impact correlated with severity of injury. Histological evaluation showed increased cellularity, adhesion, and thickness of capsule tissue in injured limbs, consistent with clinical evidence. To our knowledge, this is the first animal model capable of examining challenges unique to the anatomically and biomechanically complex elbow joint. Future studies will use this animal model to investigate mechanisms responsible for PTJS.
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Affiliation(s)
- Spencer P Lake
- Department of Mechanical Engineering & Materials Science, Washington University, 1 Brookings Hall, Campus Box 1185, St. Louis, 63130, Missouri.,Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri.,Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Ryan M Castile
- Department of Mechanical Engineering & Materials Science, Washington University, 1 Brookings Hall, Campus Box 1185, St. Louis, 63130, Missouri
| | - Stephanie Borinsky
- Department of Mechanical Engineering & Materials Science, Washington University, 1 Brookings Hall, Campus Box 1185, St. Louis, 63130, Missouri.,Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Chelsey L Dunham
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Necat Havlioglu
- Department of Pathology, John Cochran VA Medical Center, St Louis, Missouri
| | - Leesa M Galatz
- Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
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Frieri M, Kumar K, Boutin A. Role of mast cells in trauma and neuroinflammation in allergy immunology. Ann Allergy Asthma Immunol 2015; 115:172-7. [PMID: 26356588 DOI: 10.1016/j.anai.2015.06.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/05/2015] [Accepted: 06/24/2015] [Indexed: 01/02/2023]
Affiliation(s)
- Marianne Frieri
- Division of Allergy Immunology, Department of Medicine, Nassau University Medical Center, East Meadow, New York.
| | - Krishan Kumar
- Division of Adult Emergency Medicine, Department of Emergency Medicine, Nassau University Medical Center, East Meadow, New York
| | - Anthony Boutin
- Division of Adult Emergency Medicine, Department of Emergency Medicine, Nassau University Medical Center, East Meadow, New York
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Sun Y, Li F, Fan C. Effect of pERK2 on extracellular matrix turnover of the fibrotic joint capsule in a post-traumatic joint contracture model. Exp Ther Med 2015; 11:547-552. [PMID: 26893645 DOI: 10.3892/etm.2015.2948] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 11/05/2015] [Indexed: 12/19/2022] Open
Abstract
Lentivirus (LV)-mediated extracellular signal-regulated kinase (ERK)2 small interfering RNA (siRNA) has previously been demonstrated to reduce post-traumatic joint contractures: In the present study, the effect of ERK2 siRNA on extracellular matrix turnover within fibrotic joint capsules in post-traumatic joint contractures was examined. Rats were randomly assigned to one of three groups as follows: The non-operated control (CON), operated contracture (ORC) and contracture-treatment (CNT) groups. Representative post-traumatic joint contracture was created through 8 weeks of immobilization following intra-articular injury. In the CNT group, LV-mediated ERK2 siRNA was injected into the model knee at days 3 and 7 after surgery. The posterior joint capsule was examined by western blotting, histology and immunohistochemistry to evaluate alterations in ERK2, phosphorylated (p)ERK2, total collagen, collagen I, collagen III, matrix metalloproteinase (MMP)-1, MMP-13 and tissue inhibitor of metalloproteinase (TIMP)-13. In the ORC group, pERK2 was elevated and total collagen, collagen I, MMP-1 and MMP-13 were significantly increased (P<0.01 vs. CON group); however, these were significantly decreased in the CNT group, and pERK2 was downregulated (P<0.01 vs. ORC group). Collagen III and TIMP-13 were markedly decreased in the ORC group (P<0.01 vs. CON group), but elevated in the CNT group (P<0.01 vs. ORC group). The present res4ults demonstrate unique pathological changes of the fibrotic joint capsule that are responsible for joint contracture following traumatic injury, and reveal that extracellular matrix turnover can be affected by pERK2.
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Affiliation(s)
- Yangbai Sun
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Fengfeng Li
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Cunyi Fan
- Department of Orthopedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
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Curbing Inflammation in Multiple Sclerosis and Endometriosis: Should Mast Cells Be Targeted? Int J Inflam 2015; 2015:452095. [PMID: 26550518 PMCID: PMC4624887 DOI: 10.1155/2015/452095] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 09/28/2015] [Indexed: 12/16/2022] Open
Abstract
Inflammatory diseases and conditions can arise due to responses to a variety of external and internal stimuli. They can occur acutely in response to some stimuli and then become chronic leading to tissue damage and loss of function. While a number of cell types can be involved, mast cells are often present and can be involved in the acute and chronic processes. Recent studies in porcine and rabbit models have supported the concept of a central role for mast cells in a “nerve-mast cell-myofibroblast axis” in some inflammatory processes leading to fibrogenic outcomes. The current review is focused on the potential of extending aspects of this paradigm into treatments for multiple sclerosis and endometriosis, diseases not usually thought of as having common features, but both are reported to have activation of mast cells involved in their respective disease processes. Based on the discussion, it is proposed that targeting mast cells in these diseases, particularly the early phases, may be a fruitful avenue to control the recurring inflammatory exacerbations of the conditions.
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Monument MJ, Hart DA, Salo PT, Befus AD, Hildebrand KA. Neuroinflammatory Mechanisms of Connective Tissue Fibrosis: Targeting Neurogenic and Mast Cell Contributions. Adv Wound Care (New Rochelle) 2015; 4:137-151. [PMID: 25785237 DOI: 10.1089/wound.2013.0509] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 11/26/2013] [Indexed: 12/26/2022] Open
Abstract
Significance: The pathogenesis of fibrogenic wound and connective tissue healing is complex and incompletely understood. Common observations across a vast array of human and animal models of fibroproliferative conditions suggest neuroinflammatory mechanisms are important upstream fibrogenic events. Recent Advances: As detailed in this review, mast cell hyperplasia is a common observation in fibrotic tissue. Recent investigations in human and preclinical models of hypertrophic wound healing and post-traumatic joint fibrosis provides evidence that fibrogenesis is governed by a maladaptive neuropeptide-mast cell-myofibroblast signaling pathway. Critical Issues: The blockade and manipulation of these factors is providing promising evidence that if timed correctly, the fibrogenic process can be appropriately regulated. Clinically, abnormal fibrogenic healing responses are not ubiquitous to all patients and the identification of those at-risk remains an area of priority. Future Directions: Ultimately, an integrated appreciation of the common pathobiology shared by many fibrogenic connective tissue conditions may provide a scientific framework to facilitate the development of novel antifibrotic prevention and treatment strategies.
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Affiliation(s)
- Michael J. Monument
- Division of Orthopaedic Surgery, McCaig Institute for Bone & Joint Health, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David A. Hart
- Division of Orthopaedic Surgery, McCaig Institute for Bone & Joint Health, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul T. Salo
- Division of Orthopaedic Surgery, McCaig Institute for Bone & Joint Health, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A. Dean Befus
- Pulmonary Research Group, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin A. Hildebrand
- Division of Orthopaedic Surgery, McCaig Institute for Bone & Joint Health, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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Hildebrand KA, Zhang M, Befus AD, Salo PT, Hart DA. A myofibroblast-mast cell-neuropeptide axis of fibrosis in post-traumatic joint contractures: an in vitro analysis of mechanistic components. J Orthop Res 2014; 32:1290-6. [PMID: 24985721 DOI: 10.1002/jor.22676] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 06/06/2014] [Indexed: 02/04/2023]
Abstract
Previous studies have implicated a myofibroblast-mast cell-neuropeptide axis of fibrosis in pathologic joint capsules from post-traumatic contractures. The hypothesis to be tested is that joint capsule cells (JC) from human elbows with post-traumatic contractures and their interactions with mast cells (MC) and neuropeptides in the microenvironment underlie the pathogenesis of contractures. The hypothesis was tested using an in vitro collagen gel contraction model. The JC were isolated from human elbow capsules and mixed with neutralized PureCol collagen I. The gels were treated in various ways, including addition of MC (HMC-1), the neuropeptide substance P (SP), an NK1 receptor (SP receptor) antagonist RP67580 and the mast cell stabilizer ketotifen fumarate (KF). The collagen gels were released from the wells and gel size (contraction) was measured optically at multiple time points. The JC contracted collagen gels in a dose-dependent manner. This was enhanced in the presence of MC and increased further with SP. Increasing concentrations of the SP receptor antagonist, RP67580 or the mast cell stabilizer, KF decreased the magnitude of contraction. These observations identify putative mechanistic components of a myofibroblast-mast cell-neuropeptide axis of fibrosis in the joint capsules in post-traumatic contractures and potential prophylactic or therapeutic interventions.
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Affiliation(s)
- Kevin A Hildebrand
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada, T2N 4Z6
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Doornberg JN, Bosse T, Cohen MS, Jupiter JB, Ring D, Kloen P. Temporary presence of myofibroblasts in human elbow capsule after trauma. J Bone Joint Surg Am 2014; 96:e36. [PMID: 24599208 DOI: 10.2106/jbjs.m.00388] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Elbow stiffness is a common complication after elbow trauma. The elbow capsule is often thickened, fibrotic, and contracted at the time of surgical release. The limited studies available suggest that the capsule is contracted because of fibroblast-to-myofibroblast differentiation. We hypothesize that myofibroblasts are absent in normal elbow capsules and in acute trauma and that they are subsequently elevated in patients with posttraumatic elbow contracture. METHODS We obtained twenty-one human elbow joint capsules within fourteen days after an elbow fracture and/or dislocation and thirty-four elbow joint capsules in thirty-four patients who had undergone operative release of posttraumatic contractures more than five months after injury. Myofibroblasts in the joint capsules were quantified with use of immunohistochemistry. Alpha-smooth muscle actin was used as a marker for myofibroblasts. Samples were characterized and were scored by an independent pathologist blinded for clinical data. RESULTS Eleven capsules were associated with the acute phase after trauma (hours to less than seven days), and staining for alpha-smooth muscle actin was negative in all but one capsule. Ten capsules were associated with a later posttraumatic phase with myofibroblasts staining positive for alpha-smooth muscle actin in all but two capsules. Thirty-two long-standing contractures showed a histological pattern consistent with chronic stages of fibrosis, characterized by increased fibroblast-like cell proliferation and higher cellular density of fibroblast-like cells with highly unstructured collagen. Two joint capsules showed an earlier phase of fibrosis. Only two of the long-standing contractures had staining of alpha-smooth muscle actin in fibroblast-like cells; the lack of staining in the other contractures suggested an absence of myofibroblasts. CONCLUSIONS This study presents negative results on the hypothesis that myofibroblast numbers are elevated in long-standing (more than five months) human posttraumatic elbow capsules. The absence of myofibroblasts in long-standing elbow contracture capsules is in contrast to most other studies on human tissue in the literature to date.
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Affiliation(s)
- Job N Doornberg
- Department of Orthopaedic Surgery, Academic Medical Center & University of Amsterdam, Secretariaat G4-Noord, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands
| | - Tjalling Bosse
- Leids Universitair Medisch Centrum, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Mark S Cohen
- Section of Hand and Elbow Surgery, Rush University Medical Center, 1611 West Harrison Street, Chicago, IL 60612
| | - Jesse B Jupiter
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Peter Kloen
- Department of Orthopaedic Surgery, Academic Medical Center & University of Amsterdam, Secretariaat G4-Noord, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands
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Dehail P, Simon O, Godard A, Faucher N, Coulomb Y, Schnitzler A, Denormandie P, Jeandel C. Acquired deforming hypertonia and contractures in elderly subjects: Definition and prevalence in geriatric institutions (ADH survey). Ann Phys Rehabil Med 2014; 57:11-23. [DOI: 10.1016/j.rehab.2013.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 11/12/2013] [Accepted: 11/14/2013] [Indexed: 11/24/2022]
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Reddy V, Bhagwath SS, Reddy M. Mast cell count in oral reactive lesions: A histochemical study. Dent Res J (Isfahan) 2014; 11:187-92. [PMID: 24932188 PMCID: PMC4052643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this study was to quantify the number of mast cells in focal reactive hyperplastic lesions of the oral cavity and to compare these two number of mast cells in normal gingival tissues and to correlate their presence with the state of connective tissue changes in reactive lesions and probably suggest a role for mast cells in these lesions. MATERIALS AND METHODS Patient records were retrieved during a 10 year period from 2001 to 2010. Data of all reactive hyperplasias namely focal fibrous hyperplasia, pyogenic granuloma (PG), peripheral ossifying fibroma (POF) and peripheral giant cell granuloma (PGCG) were reviewed and 10 cases seen in the gingiva were selected for each category and stained with 1% toluidine blue for mast cells. Statistical analysis was applied to see the significant differences between the groups and with the normal gingival tissue. One-way ANOVA-F and unpaired t-test was applied and significant differences were seen between the groups at 5% level of significance. RESULTS In this study, mast cell count was maximum in POF and fibrous hyperplasia (FH) followed by cases of PG and PGCG. CONCLUSION The number of mast cells was more numerous in POF and FH suggesting that mast cell activation is a characteristic feature of chronic inflammation, a condition that may lead to fibrosis as a result of increased collagen synthesis by fibroblasts.
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Affiliation(s)
- Vandana Reddy
- Department of Oral Pathology and Microbiology, Subharti Dental College, Meerut, Uttar Pradesh, India,Address for correspondence: Dr. Vandana Reddy, Department of Oral Pathology & Microbiology, Subharti Dental College, Meerut, Uttar Pradesh, India. E-mail:
| | - Sundeep S. Bhagwath
- Department of Oral Pathology and Microbiology, Subharti Dental College, Meerut, Uttar Pradesh, India
| | - Munish Reddy
- Department of Orthodontics, Subharti Dental College, Meerut, Uttar Pradesh, India
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Everding NG, Maschke SD, Hoyen HA, Evans PJ. Prevention and treatment of elbow stiffness: a 5-year update. J Hand Surg Am 2013; 38:2496-507; quiz 2507. [PMID: 24210721 DOI: 10.1016/j.jhsa.2013.06.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 05/31/2013] [Accepted: 06/01/2013] [Indexed: 02/02/2023]
Abstract
Elbow stiffness is a challenging and common problem faced by upper extremity surgeons. Although functional improvements can be made with both nonsurgical and surgical management strategies, physicians must remain vigilant with efforts to prevent stiffness before it starts. Recent advancements in the biology and pathology of elbow contracture have led to improved understanding of this difficult problem, and they may lead to future breakthroughs in the prevention and treatment of elbow stiffness. This article serves as an update to our previous review of elbow stiffness, focusing on recent advancements in the past 5 years, as well as updating our current algorithm for treatment.
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Affiliation(s)
- Nathan G Everding
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic; Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH
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Hildebrand KA. Posttraumatic elbow joint contractures: defining pathologic capsular mechanisms and potential future treatment paradigms. J Hand Surg Am 2013; 38:2227-33. [PMID: 24075128 DOI: 10.1016/j.jhsa.2013.07.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 02/02/2023]
Abstract
The Andrew J. Weiland Medal is presented by the American Society for Surgery of the Hand to a midcareer researcher who is dedicated to advancing patient care in the field of hand surgery. This essay, awarded the Weiland Medal in 2012, focuses on posttraumatic elbow joint contractures. Joint contractures are well known to hand surgeons because they limit function of our patients. There is a thorough understanding of the pathoanatomy underlying joint contractures. However, the mechanisms leading to the pathoanatomy are either unknown or partially understood, depending on the etiology of the particular clinical condition. This review describes our research over the past 14 years on posttraumatic elbow joint contractures. It defines pathologic cellular, matrix, and growth factor changes in the joint capsule, elaborates on the development of an animal model of posttraumatic joint contractures, presents an evaluation of a potential prevention strategy based on our research, and outlines future plans to bring this work to the clinical realm for the benefit of patients.
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Affiliation(s)
- Kevin A Hildebrand
- Department of Surgery, University of Calgary and Alberta Health Services-Calgary Zone, Calgary, Alberta, Canada..
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Monument MJ, Hart DA, Salo PT, Befus AD, Hildebrand KA. Posttraumatic elbow contractures: targeting neuroinflammatory fibrogenic mechanisms. J Orthop Sci 2013; 18:869-77. [PMID: 24005582 DOI: 10.1007/s00776-013-0447-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/14/2013] [Indexed: 10/26/2022]
Abstract
Posttraumatic elbow stiffness remains a common and challenging clinical problem. In the setting of a congruent articular surface, the joint capsule is regarded as the major motion-limiting anatomic structure. The affected joint capsule is characterized by irreversible biomechanical and biochemical fibrogenic changes strikingly similar to those observed in many other fibroproliferative human conditions. Studies in humans and preclinical animal models are providing emergent evidence that neuroinflammatory mechanisms are critical upstream events in the pathogenesis of posttraumatic connective tissue fibrogenesis. Maladaptive recruitment and activation of mast cell infiltrates coupled with the aberrant expression of growth factors such as transforming growth factor-beta, nerve growth factor, and neuropeptides such as substance P are common observations in posttraumatic joint contractures and many other fibroproliferative disorders. Blockade of these factors is providing promising evidence that if treatment is timed correctly, the fibrogenic process can be interrupted or impeded. This review serves to highlight opportunities derived from these recent discoveries across many aberrant fibrogenic disorders as we strive to develop novel, targeted antifibrotic prevention and treatment strategies for posttraumatic elbow stiffness.
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Affiliation(s)
- Michael J Monument
- Department of Orthopaedic Surgery, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Rm #4260, Salt Lake City, UT, 84112, USA,
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Lentivirus-mediated ERK2 siRNA reduces joint capsule fibrosis in a rat model of post-traumatic joint contracture. Int J Mol Sci 2013; 14:20833-44. [PMID: 24141184 PMCID: PMC3821646 DOI: 10.3390/ijms141020833] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/25/2013] [Accepted: 09/30/2013] [Indexed: 01/21/2023] Open
Abstract
Extracellular signal-regulated kinase (ERK)-2 is presumed to play an important role in the development of post-traumatic joint contractures. Using a rat injury model, we investigated whether treatment with ERK2 small interfering RNA (siRNA) could reduce the extent of joint capsule fibrosis after an induced injury. Rats were separated into three groups (n = 32 each): non-operated control group, operated contracture group and contracture-treatment group. Stable post-traumatic joint contracture was created through surgical intra-articular joint injury followed by eight weeks of immobilization. In the contracture-treatment group, the rats were treated with lentivirus (LV)-mediated ERK2 siRNA at days 3 and 7 post-surgery. The posterior joint capsule was assessed by western blotting, immunohistochemistry and biochemical analysis for changes in ERK2, phosphorylated (p)-ERK2, myofibroblast, total collagen and relative collagen Type III expression level. Biomechanical testing was used to assess the development of flexion contractures. Statistical analysis was performed using an analysis of variance. In the operated contracture group, rats that developed flexion contractures also showed elevated phosphorylated p-ERK2 expression. In the contracture-treatment group, ERK2 siRNA significantly reduced p-ERK2 expression levels, as well as the severity of flexion contracture development (p < 0.01). Myofibroblast numbers and measurements of total collagen content were also significantly reduced following ERK2 siRNA (p < 0.01). Relative collagen type III expression as a proportion of total of Types I and III collagen, however, was significantly increased in response to ERK2 siRNA (p < 0.01). Our findings demonstrate a role for ERK2 in the induction of joint capsule fibrosis after injury. Furthermore, we show that development of flexion contractures and the resultant increase of joint capsule fibrosis can be reduced by LV-mediated ERK2 siRNA treatment.
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Multiple testing in orthopedic literature: a common problem? BMC Res Notes 2013; 6:374. [PMID: 24053281 PMCID: PMC3856470 DOI: 10.1186/1756-0500-6-374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/17/2013] [Indexed: 11/19/2022] Open
Abstract
Background Performing multiple tests in primary research is a frequent subject of discussion. This discussion originates from the fact that when multiple tests are performed, it becomes more likely to reject one of the null hypotheses, conditional on that these hypotheses are true and thus commit a type one error. Several correction methods for multiple testing are available. The primary aim of this study was to assess the quantity of articles published in two highly esteemed orthopedic journals in which multiple testing was performed. The secondary aims were to determine in which percentage of these studies a correction was performed and to assess the risk of committing a type one error if no correction was applied. Methods The 2010 annals of two orthopedic journals (A and B) were systematically hand searched by two independent investigators. All articles on original research in which statistics were applied were considered. Eligible publications were reviewed for the use of multiple testing with respect to predetermined criteria. Results A total of 763 titles were screened and 127 articles were identified and included in the analysis. A median of 15 statistical inference results were reported per publication in both journal A and B. Correction for multiple testing was performed in 15% of the articles published in journal A and in 6% from journal B. The estimated median risk of obtaining at least one significant result for uncorrected studies was calculated to be 54% for both journals. Conclusion This study shows that the risk of false significant findings is considerable and that correcting for multiple testing is only performed in a small percentage of all articles published in the orthopedic literature reviewed.
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Hart DA. Treatments for fibrosis development and progression: Lessons learned from preclinical models and potential impact on human conditions such as scleroderma, pulmonary fibrosis, hypertrophic scarring and tendinopathies. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jbise.2013.68a2001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Early posttraumatic elbow contractures may be treated with a combination of manipulation with the patient under anesthesia followed by bracing.Extrinsic contractures of the elbow may be treated with open or arthroscopic release, whereas intrinsic and combined contractures may require tissue release as well as partial or total arthroplasty.
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Neurovascular and neuroimmune aspects in the pathophysiology of rosacea. J Investig Dermatol Symp Proc 2012; 15:53-62. [PMID: 22076328 DOI: 10.1038/jidsymp.2011.6] [Citation(s) in RCA: 182] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Rosacea is a common skin disease with a high impact on quality of life. Characterized by erythema, edema, burning pain, immune infiltration, and facial skin fibrosis, rosacea has all the characteristics of neurogenic inflammation, a condition induced by sensory nerves via antidromically released neuromediators. To investigate the hypothesis of a central role of neural interactions in the pathophysiology, we analyzed molecular and morphological characteristics in the different subtypes of rosacea by immunohistochemistry, double immunofluorescence, morphometry, real-time PCR, and gene array analysis, and compared the findings with those for lupus erythematosus or healthy skin. Our results showed significantly dilated blood and lymphatic vessels. Signs of angiogenesis were only evident in phymatous rosacea. The number of mast cells and fibroblasts was increased in rosacea, already in subtypes in which fibrosis is not clinically apparent, indicating early activation. Sensory nerves were closely associated with blood vessels and mast cells, and were increased in erythematous rosacea. Gene array studies and qRT-PCR confirmed upregulation of genes involved in vasoregulation and neurogenic inflammation. Thus, dysregulation of mediators and receptors implicated in neurovascular and neuroimmune communication may be crucial at early stages of rosacea. Drugs that function on neurovascular and/or neuroimmune communication may be beneficial for the treatment of rosacea.
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Monument MJ, Hart DA, Befus AD, Salo PT, Zhang M, Hildebrand KA. The mast cell stabilizer ketotifen reduces joint capsule fibrosis in a rabbit model of post-traumatic joint contractures. Inflamm Res 2011; 61:285-92. [PMID: 22173279 DOI: 10.1007/s00011-011-0409-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 11/22/2011] [Accepted: 11/28/2011] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVES Using a rabbit model of post-traumatic joint contractures, we investigated whether treatment with a mast cell stabilizer after joint injury would lessen the molecular manifestations of joint capsule fibrosis. METHODS Surgical joint injury was used to create stable post-traumatic contractures of the knee in skeletally mature New Zealand white rabbits. Four groups of animals were studied: a non-operated control group (n = 8), an operated contracture group (n = 13) and two operated groups treated with the mast cell stabilizer, ketotifen, at doses of 0.5 mg/kg (n = 9) and 1.0 mg/kg (n = 9) twice daily. Joint capsule fibrosis was assessed by quantifying the mRNA and protein levels of α-SMA, tryptase, TGF-β1, collagen I and collagen III. Significance was tested using an ANOVA analysis of variance. RESULTS The protein and mRNA levels of α-SMA, TGF-β1, tryptase and collagen I and III were significantly elevated in the operated contracture group compared to control (p < 0.01). In both ketotifen-treated groups, protein and mRNA levels of α-SMA, TGF-β1 and collagen I were significantly reduced compared to the operated contracture group (p < 0.01). CONCLUSIONS These data suggest an inflammatory pathway mediated by mast cell activation is involved in joint capsule fibrosis after traumatic injury.
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Affiliation(s)
- Michael J Monument
- Division of Orthopaedic Surgery, Faculty of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
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Cai C, Cao Z, Loughran PA, Kim S, Darwiche S, Korff S, Billiar TR. Mast cells play a critical role in the systemic inflammatory response and end-organ injury resulting from trauma. J Am Coll Surg 2011; 213:604-15. [PMID: 21920785 DOI: 10.1016/j.jamcollsurg.2011.08.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 08/16/2011] [Accepted: 08/16/2011] [Indexed: 01/10/2023]
Abstract
BACKGROUND Much of the morbidity after trauma results from excessive activation of the innate immune system. This is manifested as a systemic inflammatory response and associated end-organ damage. Although mast cells are known to be important in many immune responses, their role in the systemic response to severe trauma is unknown. STUDY DESIGN C57BL/6J-KitW-sh/BsmJ (mast cell deficient) and wild type mice were subjected to 1.5 hours of hemorrhagic shock plus bilateral femur fracture and soft tissue injury (HS/T), followed by resuscitation at 4.5 hours. Blood withdrawal volumes, mean arterial pressures, circulating cytokine, chemokine, high mobility group box-1 (HMGB-1), double strain DNA (dsDNA), transaminase levels, and histology in liver and lung were compared between groups. RESULTS Mast cell deficient mice exhibited greater hemodynamic stability than wild type mice. At baseline, the mast cell deficient mice exhibited no difference in any of the organ injury or inflammatory markers measured. As expected, wild type mice subjected to HS/T exhibited end-organ damage manifested by marked increases in circulating alanine transaminase, aspartate aminotransferase, and dsDNA levels, as well as histologic evidence of tissue necrosis. In clear contrast, mast cell deficient mice exhibited almost no tissue damage. Similarly, the magnitude of increased circulating cytokine and chemokine induced by HS/T was much less in the mast cell deficient mice than in the wild type group. CONCLUSIONS Mast cell deficiency resulted in a damped systemic inflammatory response, greatly attenuated multiple organ injury, and more stable hemodynamics in HS/T. So mast cells appear to be a critical component of the initial host response to severe injury.
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Affiliation(s)
- Changchun Cai
- Department of Hepatobiliary Surgery, Qingdao University Medical School Hospital, Qingdao, China
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Sharma A, Abraham T, Sampaio A, Cowan M, Underhill M, Scott A. Sodium cromolyn reduces expression of CTGF, ADAMTS1, and TIMP3 and modulates post-injury patellar tendon morphology. J Orthop Res 2011; 29:678-83. [PMID: 21437947 PMCID: PMC3951484 DOI: 10.1002/jor.21291] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 10/04/2010] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to determine whether administration of a mast cell inhibitor (sodium cromolyn, SC) would influence tendon repair and extracellular matrix gene expression following acute injury. CD1 mouse patellar tendons were unilaterally injured and mast cell prevalence was determined. The effect of SC injection on tendon hypercellularity, cross-sectional area, collagen organization, and expression of extracellular matrix-related genes was examined. Mast cell prevalence was markedly increased in injured patellar tendons (p = 0.009), especially at 8 weeks post-injury (p = 0.025). SC injection increased collagen organization compared to uninjected animals at 4 weeks and attenuated the development of tendon hypercellularity and tendon thickening post-injury. Expression of CTGF, ADAMTS1, and TIMP3 in injured tendon was reduced in the SC group. SC injections moderated the structural alterations of healing tendon in association with downregulation of several genes associated with tendon fibrosis. This work corroborates previous findings pointing to a role of mast cells in tendon repair.
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Affiliation(s)
- Aishwariya Sharma
- Department of Cellular and Physiological Sciences, University of British Columbia
| | - Thomas Abraham
- James Hogg Centre for Cardiovascular Research, St Paul’s Hospital
| | - Arthur Sampaio
- Department of Cellular and Physiological Sciences, University of British Columbia
| | - Matthew Cowan
- Biomedical Research Centre, University of British Columbia
| | - Michael Underhill
- Department of Cellular and Physiological Sciences, University of British Columbia
| | - Alex Scott
- Department of Physical Therapy, University of British Columbia,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute,Correspondence or reprint requests should be addressed to A Scott, Department of Physical Therapy, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3,
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