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Langworthy M, Dasa V, Spitzer AI. Knee osteoarthritis: disease burden, available treatments, and emerging options. Ther Adv Musculoskelet Dis 2024; 16:1759720X241273009. [PMID: 39290780 PMCID: PMC11406648 DOI: 10.1177/1759720x241273009] [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: 11/09/2023] [Accepted: 07/10/2024] [Indexed: 09/19/2024] Open
Abstract
Osteoarthritis (OA) is a prevalent condition that affects nearly 528 million people worldwide, including 23% of the global population aged ⩾40, and is characterized by progressive damage to articular cartilage, which often leads to substantial pain, stiffness, and reduced mobility for affected patients. Pain related to OA is a barrier to maintaining physical activity and a leading cause of disability, accounting for 2.4% of all years lived with disability globally, reducing the ability to work in 66% of US patients with OA and increasing absenteeism in 21% of US patients with OA. The joint most commonly involved in OA is the knee, which is affected in about 60%-85% of all OA cases. The aging population and longer life expectancy, coupled with earlier and younger diagnoses, translate into a growing cohort of symptomatic patients in need of alternatives to surgery. Despite the large number of patients with knee OA (OAK) worldwide, the high degree of variability in patient presentation can lead to challenges in diagnosis and treatment. Multiple society guidelines recommend therapies for OAK, but departures from guidelines by healthcare professionals in clinical settings reflect a discordance between evidence-based treatment algorithms and routine clinical practice. Furthermore, disease-modifying pharmacotherapies are limited, and treatment for OAK often focuses solely on symptom relief, rather than underlying causes. In this narrative review, we summarize the patient journey, analyze current disease burden and nonsurgical therapy recommendations for OAK, and highlight emerging and promising therapies-such as cryoneurolysis, long-acting corticosteroids, and gene therapies-for this debilitating condition.
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Affiliation(s)
- Michael Langworthy
- Southcoast Health, 300 A Faunce Corner Road, Dartmouth, MA 02720-3703, USA
- Menko Labs, Mattapoisett, MA, USA
| | - Vinod Dasa
- Louisiana State University School of Medicine, New Orleans, LA, USA
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Hestehave S, Allen HN, Gomez K, Duran P, Calderon-Rivera A, Loya-López S, Rodríguez-Palma EJ, Khanna R. Small molecule targeting NaV1.7 via inhibition of CRMP2-Ubc9 interaction reduces pain-related outcomes in a rodent osteoarthritic model. Pain 2024:00006396-990000000-00667. [PMID: 39106443 DOI: 10.1097/j.pain.0000000000003357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/30/2024] [Indexed: 08/09/2024]
Abstract
ABSTRACT Osteoarthritis (OA) is a highly prevalent and disabling joint disease, characterized by pathological progressive joint deformation and clinical symptoms of pain. Disease-modifying treatments remain unavailable, and pain-mitigation is often suboptimal, but recent studies suggest beneficial effects by inhibition of the voltage-gated sodium channel NaV1.7. We previously identified compound 194 as an indirect inhibitor of NaV1.7 by preventing SUMOylation of the NaV1.7-trafficking protein, collapsin response mediator protein 2. Compound 194 reduces the functional activity of NaV1.7 channels and produces effective analgesia in a variety of acute and neuropathic pain models. However, its effectiveness has not yet been evaluated in models of OA. Here, we explore the effects of 194 on pain-related outcomes in the OA-like monoiodoacetate model using behavioral assessment, biochemistry, novel in vivo fiber photometry, and patch clamp electrophysiology. We found that the monoiodoacetate model induced (1) increased pain-like behaviors and calcium responses of glutamatergic neurons in the parabrachial nucleus after evoked cold and mechanical stimuli, (2) conditioned place aversion to mechanical stimulation, (3) functional weight bearing asymmetry, (4) increased sodium currents in dorsal root ganglia neurons, and (5) increased calcitonin gene-related peptide-release in the spinal cord. Crucially, administration of 194 improved all these pain-related outcomes. Collectively, these findings support indirect inhibition of NaV1.7 as an effective treatment of OA-related pain through the inhibition of collapsin response mediator protein 2-SUMOylation via compound 194.
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Affiliation(s)
- Sara Hestehave
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, United States
- Pain Research Center, New York University, New York, NY, United States. Dr. Hestehave is now with the Department of Experimental Medicine, University of Copenhagen, Copenhagen N, Denmark. Dr. Allen, Dr. Gomez, Dr. Calderon-Rivera, Dr. Loya-López, Dr. Rodríguez-Palma, and Dr. Khanna are now with the Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Heather N Allen
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, United States
- Pain Research Center, New York University, New York, NY, United States. Dr. Hestehave is now with the Department of Experimental Medicine, University of Copenhagen, Copenhagen N, Denmark. Dr. Allen, Dr. Gomez, Dr. Calderon-Rivera, Dr. Loya-López, Dr. Rodríguez-Palma, and Dr. Khanna are now with the Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Kimberly Gomez
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, United States
- Pain Research Center, New York University, New York, NY, United States. Dr. Hestehave is now with the Department of Experimental Medicine, University of Copenhagen, Copenhagen N, Denmark. Dr. Allen, Dr. Gomez, Dr. Calderon-Rivera, Dr. Loya-López, Dr. Rodríguez-Palma, and Dr. Khanna are now with the Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Paz Duran
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, United States
- Pain Research Center, New York University, New York, NY, United States. Dr. Hestehave is now with the Department of Experimental Medicine, University of Copenhagen, Copenhagen N, Denmark. Dr. Allen, Dr. Gomez, Dr. Calderon-Rivera, Dr. Loya-López, Dr. Rodríguez-Palma, and Dr. Khanna are now with the Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Aida Calderon-Rivera
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, United States
- Pain Research Center, New York University, New York, NY, United States. Dr. Hestehave is now with the Department of Experimental Medicine, University of Copenhagen, Copenhagen N, Denmark. Dr. Allen, Dr. Gomez, Dr. Calderon-Rivera, Dr. Loya-López, Dr. Rodríguez-Palma, and Dr. Khanna are now with the Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Santiago Loya-López
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, United States
- Pain Research Center, New York University, New York, NY, United States. Dr. Hestehave is now with the Department of Experimental Medicine, University of Copenhagen, Copenhagen N, Denmark. Dr. Allen, Dr. Gomez, Dr. Calderon-Rivera, Dr. Loya-López, Dr. Rodríguez-Palma, and Dr. Khanna are now with the Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Erick J Rodríguez-Palma
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, United States
- Pain Research Center, New York University, New York, NY, United States. Dr. Hestehave is now with the Department of Experimental Medicine, University of Copenhagen, Copenhagen N, Denmark. Dr. Allen, Dr. Gomez, Dr. Calderon-Rivera, Dr. Loya-López, Dr. Rodríguez-Palma, and Dr. Khanna are now with the Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Rajesh Khanna
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, United States
- Pain Research Center, New York University, New York, NY, United States. Dr. Hestehave is now with the Department of Experimental Medicine, University of Copenhagen, Copenhagen N, Denmark. Dr. Allen, Dr. Gomez, Dr. Calderon-Rivera, Dr. Loya-López, Dr. Rodríguez-Palma, and Dr. Khanna are now with the Department of Pharmacology & Therapeutics, University of Florida College of Medicine, Gainesville, FL, United States
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Cha M, Bak H, Lee BH, Jang JH. Alleviation of peripheral sensitization by quadriceps insertion of cog polydioxanone filaments in knee osteoarthritis rats. Biochem Biophys Res Commun 2024; 698:149549. [PMID: 38266311 DOI: 10.1016/j.bbrc.2024.149549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
A recently established therapeutic strategy, involving the insertion of biodegradable cog polydioxanone filaments into the quadriceps muscles using the Muscle Enhancement and Support Therapy (MEST) device, has demonstrated significant efficacy in alleviating knee osteoarthritis (OA) pain. This study investigated changes in peripheral sensitization as the potential mechanism underlying MEST-induced pain relief in monoiodoacetate (MIA) induced OA rats. The results revealed that MEST treatment potently reduces MIA-induced sensitization of L3/L4 dorsal root ganglion (DRG) neurons, the primary nociceptor pathway for the knee joint. This reduction in DRG sensitization, as elucidated by voltage-sensitive dye imaging, is accompanied by a diminished overexpression of TRPA1 and NaV1.7, key nociceptor receptors involved in mechanical pain perception. Importantly, these observed alterations strongly correlate with a decrease in mechanically-evoked pain behaviors, providing compelling neurophysiological evidence that MEST treatment alleviates OA pain by suppressing peripheral sensitization.
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Affiliation(s)
- Myeounghoon Cha
- Department of Physiology, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Heyji Bak
- Department of Physiology, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Bae Hwan Lee
- Department of Physiology, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea; Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
| | - Jun Ho Jang
- R&D Center, OV MEDI Co., Ltd., Gongdan-ro, Gunpo, Gyeonggi-do, 15847, Republic of Korea.
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