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Kaliya-Perumal AK, Celik C, Carney TJ, Harris MP, Ingham PW. Genetic regulation of injury-induced heterotopic ossification in adult zebrafish. Dis Model Mech 2024; 17:dmm050724. [PMID: 38736327 DOI: 10.1242/dmm.050724] [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: 01/31/2024] [Accepted: 04/05/2024] [Indexed: 05/14/2024] Open
Abstract
Heterotopic ossification is the inappropriate formation of bone in soft tissues of the body. It can manifest spontaneously in rare genetic conditions or as a response to injury, known as acquired heterotopic ossification. There are several experimental models for studying acquired heterotopic ossification from different sources of damage. However, their tenuous mechanistic relevance to the human condition, invasive and laborious nature and/or lack of amenability to chemical and genetic screens, limit their utility. To address these limitations, we developed a simple zebrafish injury model that manifests heterotopic ossification with high penetrance in response to clinically emulating injuries, as observed in human myositis ossificans traumatica. Using this model, we defined the transcriptional response to trauma, identifying differentially regulated genes. Mutant analyses revealed that an increase in the activity of the potassium channel Kcnk5b potentiates injury response, whereas loss of function of the interleukin 11 receptor paralogue (Il11ra) resulted in a drastically reduced ossification response. Based on these findings, we postulate that enhanced ionic signalling, specifically through Kcnk5b, regulates the intensity of the skeletogenic injury response, which, in part, requires immune response regulated by Il11ra.
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Affiliation(s)
- Arun-Kumar Kaliya-Perumal
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive 636921, Singapore
| | - Cenk Celik
- Department of Genetics, Evolution and Environment, Genetics Institute, University College London, London WC1E 6BT, UK
| | - Tom J Carney
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive 636921, Singapore
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Proteos 138673, Singapore
| | - Matthew P Harris
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
- Department of Orthopedic Research, Boston Children's Hospital, Boston, MA 02115, USA
| | - Philip W Ingham
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive 636921, Singapore
- Department of Life Sciences, University of Bath, Bath BA2 7AY, UK
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2
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Epperson RT, Isaacson BM, Rothberg DL, Olsen RE, Kawaguchi B, Rasmussen RM, Dickerson M, Pasquina PF, Shero J, Williams DL. Determining Which Combinatorial Combat-Relevant Factors Contribute to Heterotopic Ossification Formation in an Ovine Model. Bioengineering (Basel) 2024; 11:350. [PMID: 38671772 PMCID: PMC11048030 DOI: 10.3390/bioengineering11040350] [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: 02/27/2024] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Traumatic heterotopic ossification (HO) is frequently observed in Service Members following combat-related trauma. Estimates suggest that ~65% of wounded warriors who suffer limb loss or major extremity trauma will experience some type of HO formation. The development of HO delays rehabilitation and can prevent the use of a prosthetic. To date there are limited data to suggest a standard mechanism for preventing HO. This may be due to inadequate animal models not producing a similar bone structure as human HO. We recently showed that traumatic HO growth is possible in an ovine model. Within that study, we demonstrated that 65% of sheep developed a human-relevant hybrid traumatic HO bone structure after being exposed to a combination of seven combat-relevant factors. Although HO formed, we did not determine which traumatic factor contributed most. Therefore, in this study, we performed individual and various combinations of surgical/traumatic factors to determine their individual contribution to HO growth. Outcomes showed that the presence of mature biofilm stimulated a large region of bone growth, while bone trauma resulted in a localized bone response as indicated by jagged bone at the linea aspera. However, it was not until the combinatory factors were included that an HO structure similar to that of humans formed more readily in 60% of the sheep. In conclusion, data suggested that traumatic HO growth can develop following various traumatic factors, but a combination of known instigators yields higher frequency size and consistency of ectopic bone.
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Affiliation(s)
- Richard T. Epperson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; (B.M.I.); (D.L.R.); (R.E.O.); (B.K.); (R.M.R.); (D.L.W.)
- Bone & Biofilm Research Laboratory, University of Utah, Salt Lake City, UT 84112, USA
| | - Brad M. Isaacson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; (B.M.I.); (D.L.R.); (R.E.O.); (B.K.); (R.M.R.); (D.L.W.)
- The Center for Rehabilitation Sciences Research, Uniformed Services University, Bethesda, MD 20814, USA; (P.F.P.); (J.S.)
- The Geneva Foundation, Tacoma, WA 98402, USA
| | - David L. Rothberg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; (B.M.I.); (D.L.R.); (R.E.O.); (B.K.); (R.M.R.); (D.L.W.)
| | - Raymond E. Olsen
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; (B.M.I.); (D.L.R.); (R.E.O.); (B.K.); (R.M.R.); (D.L.W.)
| | - Brooke Kawaguchi
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; (B.M.I.); (D.L.R.); (R.E.O.); (B.K.); (R.M.R.); (D.L.W.)
- Bone & Biofilm Research Laboratory, University of Utah, Salt Lake City, UT 84112, USA
| | - Ryan M. Rasmussen
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; (B.M.I.); (D.L.R.); (R.E.O.); (B.K.); (R.M.R.); (D.L.W.)
- Bone & Biofilm Research Laboratory, University of Utah, Salt Lake City, UT 84112, USA
| | - Mary Dickerson
- Office of Comparative Medicine, University of Utah, Salt Lake City, UT 84112, USA;
| | - Paul F. Pasquina
- The Center for Rehabilitation Sciences Research, Uniformed Services University, Bethesda, MD 20814, USA; (P.F.P.); (J.S.)
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20910, USA
| | - John Shero
- The Center for Rehabilitation Sciences Research, Uniformed Services University, Bethesda, MD 20814, USA; (P.F.P.); (J.S.)
- Extremity Trauma Center of Excellence, Joint Base San Antonio Fort Sam Houston, San Antonio, TX 78240, USA
| | - Dustin L. Williams
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; (B.M.I.); (D.L.R.); (R.E.O.); (B.K.); (R.M.R.); (D.L.W.)
- Bone & Biofilm Research Laboratory, University of Utah, Salt Lake City, UT 84112, USA
- The Center for Rehabilitation Sciences Research, Uniformed Services University, Bethesda, MD 20814, USA; (P.F.P.); (J.S.)
- Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
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Negri S, Wang Y, Li Z, Qin Q, Lee S, Cherief M, Xu J, Hsu GCY, Tower RJ, Presson B, Levin A, McCarthy E, Levi B, James AW. Acetabular Reaming Is a Reliable Model to Produce and Characterize Periarticular Heterotopic Ossification of the Hip. Stem Cells Transl Med 2022; 11:876-888. [PMID: 35758541 PMCID: PMC9397657 DOI: 10.1093/stcltm/szac042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/07/2022] [Indexed: 11/17/2022] Open
Abstract
Heterotopic ossification (HO) is a pathologic process characterized by the formation of bone tissue in extraskeletal locations. The hip is a common location of HO, especially as a complication of arthroplasty. Here, we devise a first-of-its-kind mouse model of post-surgical hip HO and validate expected cell sources of HO using several HO progenitor cell reporter lines. To induce HO, an anterolateral surgical approach to the hip was used, followed by disclocation and acetabular reaming. Animals were analyzed with high-resolution roentgenograms and micro-computed tomography, conventional histology, immunohistochemistry, and assessments of fluorescent reporter activity. All the treated animals' developed periarticular HO with an anatomical distribution similar to human patients after arthroplasty. Heterotopic bone was found in periosteal, inter/intramuscular, and intracapsular locations. Further, the use of either PDGFRα or scleraxis (Scx) reporter mice demonstrated that both cell types gave rise to periarticular HO in this model. In summary, acetabular reaming reproducibly induces periarticular HO in the mouse reproducing human disease, and with defined mesenchymal cellular contributors similar to other experimental HO models. This protocol may be used in the future for further detailing of the cellular and molecular mediators of post-surgical HO, as well as the screening of new therapies.
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Affiliation(s)
| | | | - Zhao Li
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Qizhi Qin
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Seungyong Lee
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Masnsen Cherief
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Jiajia Xu
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Robert Joel Tower
- Center for Organogenesis Research and Trauma, University of Texas Southwestern, Dallas, TX, USA
| | - Bradley Presson
- Orthopaedic and Trauma Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology of the University of Verona, Verona, Italy
| | - Adam Levin
- Department of Orthopaedics, Johns Hopkins University, Baltimore, MD, USA
| | - Edward McCarthy
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Benjamin Levi
- Center for Organogenesis Research and Trauma, University of Texas Southwestern, Dallas, TX, USA
| | - Aaron W James
- Corresponding author: Aaron W. James, 720 Rutland Avenue, Room 524A, Baltimore, MD 21205, USA. Tel: +1 410 502 4143; Fax: +1 410 955 9777;
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Epperson RT, Isaacson BM, Rothberg DL, Olsen RE, Kawaguchi B, Maxwell JM, Dickerson M, Pasquina PF, Shero J, Williams DL. Developing a combat-relevant translatable large animal model of heterotopic ossification. Bone Rep 2021; 15:101127. [PMID: 34584904 PMCID: PMC8452791 DOI: 10.1016/j.bonr.2021.101127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/25/2021] [Accepted: 09/04/2021] [Indexed: 11/05/2022] Open
Abstract
Heterotopic ossification (HO) refers to ectopic bone formation, typically in residual limbs following trauma and injury. A review of injuries from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) indicated that approximately 70% of war wounds involved the musculoskeletal system, largely in part from the use of improvised explosive devices (IED) and rocket-propelled grenades (RPG). HO is reported to occur in approximately 63%–65% of wounded warriors from OIF and OEF. Symptomatic HO may delay rehabilitation regimens since it often requires modifications to prosthetic limb componentry and socket size. There is limited evidence indicating a mechanism for preventing HO. This may be due to inadequate models, which do not produce HO bone structure that is morphologically similar to HO samples obtained from wounded warfighters injured in theatre. We hypothesized that using a high-power blast of air (shockwave) and simulated battlefield trauma (i.e. bone damage, tourniquet, bacteria, negative pressure wound therapy) in a large animal model, HO would form and have similar morphology to ectopic bone observed in clinical samples. Initial radiographic and micro-computed tomography (CT) data demonstrated ectopic bone growth in sheep 24 weeks post-procedure. Advanced histological and backscatter electron (BSE) analyses showed that 5 out of 8 (63%) sheep produced HO with similar morphology to clinical samples. We conclude that not all ectopic bone observed by radiograph or micro-CT in animal models is HO. Advanced histological and BSE analyses may improve confirmation of HO presence and morphology, which we demonstrated can be produced in a large animal model.
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Affiliation(s)
- Richard T Epperson
- University of Utah, Bone & Biofilm Research Laboratory, Salt Lake City, UT, United States of America.,University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States of America
| | - Brad M Isaacson
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States of America.,The Geneva Foundation, Tacoma, WA, United States of America.,The Center for Rehabilitation Sciences Research, Uniformed Services University, Bethesda, MD, United States of America
| | - David L Rothberg
- University of Utah, Bone & Biofilm Research Laboratory, Salt Lake City, UT, United States of America.,University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States of America
| | - Raymond E Olsen
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States of America
| | - Brooke Kawaguchi
- University of Utah, Bone & Biofilm Research Laboratory, Salt Lake City, UT, United States of America.,University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States of America
| | - John M Maxwell
- University of Utah, Bone & Biofilm Research Laboratory, Salt Lake City, UT, United States of America.,University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States of America
| | - Mary Dickerson
- University of Utah, Office of Comparative Medicine, Salt Lake City, UT, United States of America
| | - Paul F Pasquina
- The Center for Rehabilitation Sciences Research, Uniformed Services University, Bethesda, MD, United States of America.,Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, United States of America
| | - John Shero
- The Center for Rehabilitation Sciences Research, Uniformed Services University, Bethesda, MD, United States of America.,Extremity Trauma Center of Excellence, Joint Base San Antonio Fort Sam Houston, San Antonio, TX, United States of America
| | - Dustin L Williams
- University of Utah, Bone & Biofilm Research Laboratory, Salt Lake City, UT, United States of America.,University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States of America.,The Center for Rehabilitation Sciences Research, Uniformed Services University, Bethesda, MD, United States of America.,University of Utah, Department of Pathology, Salt Lake City, UT, United States of America.,University of Utah, Department of Bioengineering, Salt Lake City, UT, United States of America
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5
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Kazezian Z, Bull AMJ. A review of the biomarkers and in vivo models for the diagnosis and treatment of heterotopic ossification following blast and trauma-induced injuries. Bone 2021; 143:115765. [PMID: 33285256 DOI: 10.1016/j.bone.2020.115765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/29/2020] [Accepted: 11/18/2020] [Indexed: 12/29/2022]
Abstract
Heterotopic ossification (HO) is the process of de novo bone formation in non-osseous tissues. HO can occur following trauma and burns and over 60% of military personnel with blast-associated amputations develop HO. This rate is far higher than in other trauma-induced HO development. This suggests that the blast effect itself is a major contributing factor, but the pathway triggering HO following blast injury specifically is not yet fully identified. Also, because of the difficulty of studying the disease using clinical data, the only sources remain the relevant in vivo models. The aim of this paper is first to review the key biomarkers and signalling pathways identified in trauma and blast induced HO in order to summarize the molecular mechanisms underlying HO development, and second to review the blast injury in vivo models developed. The literature derived from trauma-induced HO suggests that inflammatory cytokines play a key role directing different progenitor cells to transform into an osteogenic class contributing to the development of the disease. This highlights the importance of identifying the downstream biomarkers under specific signalling pathways which might trigger similar stimuli in blast to those of trauma induced formation of ectopic bone in the tissues surrounding the site of the injury. The lack of information in the literature regarding the exact biomarkers leading to blast associated HO is hampering the design of specific therapeutics. The majority of existing blast injury in vivo models do not fully replicate the combat scenario in terms of blast, fracture and amputation; these three usually happen in one insult. Hence, this paper highlights the need to replicate the full effect of the blast in preclinical models to better understand the mechanism of blast induced HO development and to enable the design of a specific therapeutic to supress the formation of ectopic bone.
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Affiliation(s)
- Zepur Kazezian
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom.
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom
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