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Za P, Papalia GF, Gregori P, Vasta S, Papalia R. Osteonecrosis as a manifestation of Long-COVID Syndrome: a systematic review. Musculoskelet Surg 2024:10.1007/s12306-024-00854-w. [PMID: 39085687 DOI: 10.1007/s12306-024-00854-w] [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: 04/08/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
Purpose SARS-CoV-2 is an RNA virus responsible for COVID-19 pandemic. Some authors described the set of persistent symptoms COVID-related as "Long-COVID Syndrome." Several cases of post-COVID-19 osteonecrosis (ON) are described. Our primary aim was to study the hypothetical correlation between SARS-CoV-2 infection and ON; our secondary aim was to understand if ON can be considered part of Long-COVID. Materials and methods We performed a systematic review following the Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) guidelines. Because COVID-19 is a recently described disease, we included all levels of evidence studies. We excluded studies lacking specification regarding the use of corticosteroids (CCS) and studies not related to COVID-19. The variables extracted were age, sex, risk factors, affected joints, signs and symptoms, magnetic resonance imaging (MRI) and X-ray features, histology, treatment of COVID-19, dose and duration of treatment with CCS, treatment of ON, follow-up, and treatment outcome. Results A total of 13 studies were included, involving 95 patients and 159 joints. Time between the diagnosis of COVID-19 and the onset of symptoms related to ON was 16 weeks on average. Time between the onset of symptoms and the MRI was 6 weeks. An average of 926.4 mg of prednisolone equivalent per patient were administered. On average, CCS were administered for 20.6 days. Conclusions Patients with a history of COVID-19 infection developed osteonecrosis prematurely and with a lower dose of CCS than usually reported in the literature. Symptoms of osteonecrosis occur within the interval of the period described as Long-COVID. Surgeons should not underestimate the persistence of arthralgia when a history of SARS-CoV-2 infection and use of CCS is reported.
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Affiliation(s)
- P Za
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - G F Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - P Gregori
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - S Vasta
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - R Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
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Dong S, Ge J, Meng Q, Yuan T, Wang Y, Li Y, Lu Q, Song W, Li Z, Sun S. Crebanine mitigates glucocorticoid-induced osteonecrosis of the femoral head by restoring bone remodelling homeostasis via attenuating oxidative stress. J Cell Mol Med 2024; 28:e70044. [PMID: 39205463 PMCID: PMC11358393 DOI: 10.1111/jcmm.70044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 07/24/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
The onset of osteonecrosis of the femoral head (ONFH) is intimately associated with the extensive administration of glucocorticoids (GCs). Long-term stimulation of GCs can induce oxidative stress in both osteoclasts (OCs) and osteoblasts (OBs), resulting in the disturbance of bone remodelling. An alkaloid named crebanine (CN) demonstrates pharmacological properties including anti-inflammation and reactive oxygen species (ROS) modulation. Our objective is to assess the therapeutic potential of CN in treating ONFH and elucidate the associated underlying mechanisms. The network pharmacology analysis uncovered that CN played a role in regulating ROS metabolism. In vitro, CN demonstrated its ability to reduce the dexamethasone (DEX)-stimulated generation of OCs and suppress their resorptive function by downregulating the level of osteoclast marker genes. Concurrently, CN also mitigated DEX-induced damage to OBs, facilitating the restoration of osteoblast marker gene expression, cellular differentiation and function. These effects were achieved by CN augmenting the antioxidant system to reduce intracellular ROS levels. Furthermore, in vitro results were corroborated by micro-CT and histological data, which also showed that CN attenuated MPS-induced ONFH in mice. This study highlights the therapeutic potential of CN in counteracting GCs-induced ONFH.
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Affiliation(s)
- Shankun Dong
- Department of Joint SurgeryShandong Provincial Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Jianxun Ge
- Department of Joint SurgeryShandong Provincial Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Qi Meng
- Department of Joint SurgeryShandong Provincial Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Tao Yuan
- Department of Joint SurgeryShandong Provincial Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Yi Wang
- Department of Joint SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation CenterShandong First Medical University and Shandong Academy of Medical SciencesJinanShandongChina
| | - Yi Li
- Department of Joint SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation CenterShandong First Medical University and Shandong Academy of Medical SciencesJinanShandongChina
| | - Qizhen Lu
- Department of Joint SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation CenterShandong First Medical University and Shandong Academy of Medical SciencesJinanShandongChina
| | - Wenao Song
- Department of Clinical LaboratoryShandong Provincial Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
| | - Ziqing Li
- Department of Joint SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation CenterShandong First Medical University and Shandong Academy of Medical SciencesJinanShandongChina
| | - Shui Sun
- Department of Joint SurgeryShandong Provincial Hospital, Cheeloo College of Medicine, Shandong UniversityJinanShandongChina
- Department of Joint SurgeryShandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation CenterShandong First Medical University and Shandong Academy of Medical SciencesJinanShandongChina
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3
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Yang P, He W, Yang W, Jiang L, Lin T, Sun W, Zhang Q, Bai X, Guo D, Sun W. Panoramic heat map for spatial distribution of necrotic lesions. Bone Joint Res 2024; 13:294-305. [PMID: 38884556 PMCID: PMC11181948 DOI: 10.1302/2046-3758.136.bjr-2023-0181.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
Aims In this study, we aimed to visualize the spatial distribution characteristics of femoral head necrosis using a novel measurement method. Methods We retrospectively collected CT imaging data of 108 hips with non-traumatic osteonecrosis of the femoral head from 76 consecutive patients (mean age 34.3 years (SD 8.1), 56.58% male (n = 43)) in two clinical centres. The femoral head was divided into 288 standard units (based on the orientation of units within the femoral head, designated as N[Superior], S[Inferior], E[Anterior], and W[Posterior]) using a new measurement system called the longitude and latitude division system (LLDS). A computer-aided design (CAD) measurement tool was also developed to visualize the measurement of the spatial location of necrotic lesions in CT images. Two orthopaedic surgeons independently performed measurements, and the results were used to draw 2D and 3D heat maps of spatial distribution of necrotic lesions in the femoral head, and for statistical analysis. Results The results showed that the LLDS has high inter-rater reliability. As illustrated by the heat map, the distribution of Japanese Investigation Committee (JIC) classification type C necrotic lesions exhibited clustering characteristics, with the lesions being concentrated in the northern and eastern regions, forming a hot zone (90% probability) centred on the N4-N6E2, N3-N6E units of outer ring blocks. Statistical results showed that the distribution difference between type C2 and type C1 was most significant in the E1 and E2 units and, combined with the heat map, indicated that the spatial distribution differences at N3-N6E1 and N1-N3E2 units are crucial in understanding type C1 and C2 necrotic lesions. Conclusion The LLDS can be used to accurately measure the spatial location of necrotic lesions and display their distribution characteristics.
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Affiliation(s)
- Peng Yang
- Department of Orthopaedic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Orthopaedic Surgery, Shenzhen Second People's Hospital, Shenzhen, China
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Wei He
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Orthopaedic Surgery, Traumatology & Orthopedics Institute of Chinese Medicine of Guangdong, Guangzhou, China
| | - Weiming Yang
- Department of Orthopaedic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Luoyong Jiang
- Department of Orthopaedic Surgery, Shenzhen Second People's Hospital, Shenzhen, China
| | - Tianye Lin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weichao Sun
- Department of Orthopaedic Surgery, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qingwen Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Orthopaedic Surgery, Traumatology & Orthopedics Institute of Chinese Medicine of Guangdong, Guangzhou, China
| | - Xueling Bai
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Da Guo
- Department of Orthopaedic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Wei Sun
- Department of Orthopaedic Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Orthopaedic Surgery, Shenzhen Second People's Hospital, Shenzhen, China
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Wang C, Zhu Y, Pan D. Identifying the causal relationship between immune factors and osteonecrosis: a two-sample Mendelian randomization study. Sci Rep 2024; 14:9371. [PMID: 38654114 DOI: 10.1038/s41598-024-59810-0] [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: 12/15/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
A wealth of evidence intimates a profound connection between the immune system and osteonecrosis, albeit the specific immune factors underlying this connection remain largely veiled. A bidirectional Mendelian randomization (MR) study was conducted based on genome-wide association study summary data to identify causal links between 731 immune factors and osteonecrosis including drug-induced osteonecrosis. Preliminary MR analysis was accomplished utilizing the inverse-variance weighted method under a multiplicative random effects model, and heterogeneity and potential horizontal pleiotropy were evaluated through Cochrane's Q-test, MR-Egger intercept test, MR-PRESSO global test, and leave-one-out analysis. Upon false discovery rate correction, the gene-predicted level of one immune factor (CD62L - monocyte %monocyte) exhibited a significant positive correlation with osteonecrosis, while eight immune traits associated with monocytes, dendritic cells, and NK cells demonstrated significant causal effects with drug-induced osteonecrosis. Reverse MR revealed no significant correlations. This MR research provides genetic evidence for the causal associations between a broad spectrum of immune factors and osteonecrosis. Such a study aids in unraveling the intricate interaction patterns between the immune and skeletal systems, elucidating the pathogenesis of osteonecrosis, and identifying potential novel therapeutic approaches.
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Affiliation(s)
- Chao Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yong Zhu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Ding Pan
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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Zheng QY, Tao Y, Geng L, Ren P, Ni M, Zhang GQ. Non-traumatic osteonecrosis of the femoral head induced by steroid and alcohol exposure is associated with intestinal flora alterations and metabolomic profiles. J Orthop Surg Res 2024; 19:236. [PMID: 38609952 PMCID: PMC11015587 DOI: 10.1186/s13018-024-04713-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE Osteonecrosis of the femoral head (ONFH) is a severe disease that primarily affects the middle-aged population, imposing a significant economic and social burden. Recent research has linked the progression of non-traumatic osteonecrosis of the femoral head (NONFH) to the composition of the gut microbiota. Steroids and alcohol are considered major contributing factors. However, the relationship between NONFH caused by two etiologies and the microbiota remains unclear. In this study, we examined the gut microbiota and fecal metabolic phenotypes of two groups of patients, and analyzed potential differences in the pathogenic mechanisms from both the microbial and metabolic perspectives. METHODS Utilizing fecal samples from 68 NONFH patients (32 steroid-induced, 36 alcohol-induced), high-throughput 16 S rDNA sequencing and liquid chromatography with tandem mass spectrometry (LC-MS/MS) metabolomics analyses were conducted. Univariate and multivariate analyses were applied to the omics data, employing linear discriminant analysis effect size to identify potential biomarkers. Additionally, functional annotation of differential metabolites and associated pathways was performed using the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. Subsequently, Spearman correlation analysis was employed to assess the potential correlations between differential gut microbiota and metabolites. RESULTS High-throughput 16 S rDNA sequencing revealed significant gut microbial differences. At the genus level, the alcohol group had higher Lactobacillus and Roseburia, while the steroid group had more Megasphaera and Akkermansia. LC-MS/MS metabolomic analysis indicates significant differences in fecal metabolites between steroid- and alcohol-induced ONFH patients. Alcohol-induced ONFH (AONFH) showed elevated levels of L-Lysine and Oxoglutaric acid, while steroid-induced ONFH(SONFH) had increased Gluconic acid and Phosphoric acid. KEGG annotation revealed 10 pathways with metabolite differences between AONFH and SONFH patients. Correlation analysis revealed the association between differential gut flora and differential metabolites. CONCLUSIONS Our results suggest that hormones and alcohol can induce changes in the gut microbiota, leading to alterations in fecal metabolites. These changes, driven by different pathways, contribute to the progression of the disease. The study opens new research directions for understanding the pathogenic mechanisms of hormone- or alcohol-induced NONFH, suggesting that differentiated preventive and therapeutic approaches may be needed for NONFH caused by different triggers.
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Affiliation(s)
- Qing-Yuan Zheng
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Orthopedics, the First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China
- Department of Orthopedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ye Tao
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Orthopedics, the First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Lei Geng
- Department of Orthopedics, the First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Peng Ren
- Department of Orthopedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ming Ni
- Department of Orthopedics, the First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China
- Department of Orthopedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Guo-Qiang Zhang
- Department of Orthopedics, the First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China.
- Department of Orthopedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
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6
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Chen S, Kavanagh A, Zarick C. Steroid-Induced Avascular Necrosis in the Foot and Ankle-Pathophysiology, Surgical, and Nonsurgical Therapies: Case Study and Literature Review. Foot Ankle Spec 2024; 17:168-176. [PMID: 34142577 DOI: 10.1177/19386400211017375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Steroid-induced avascular necrosis (AVN) of the lower extremity is a destructive process of the bone found in patients who have been treated with these medications for a variety of medical conditions. There are several proposed etiologies for development of this condition, however much debate still remains for the exact pathophysiology. The main clinical characteristics include edema, arthralgias, and restricted joint range of motion. Diagnostic imaging is a key aspect in the analysis of this pathologic process. When steroid-induced AVN affects multiple bones, this atypical presentation is difficult to treat due to its diffuse nature, therefore surgical options are limited. In these cases, conservative therapy is targeted toward pain relief and preserving joint range of motion. This review aims to provide an overview on the presentation of steroid-induced AVN in the foot and ankle, outline the pathophysiology of the process, and describe a variety of both conservative and surgical treatment options. A case study is provided to showcase a patient presentation of diffuse steroid-induced AVN of the foot and ankle and their course of treatment.Levels of Evidence: Level V: Expert opinion.
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Affiliation(s)
- Shirley Chen
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Amber Kavanagh
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Caitlin Zarick
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
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Fang S, He T, You M, Zhu H, Chen P. Glucocorticoids promote steroid-induced osteonecrosis of the femoral head by down-regulating serum alpha-2-macroglobulin to induce oxidative stress and facilitate SIRT2-mediated BMP2 deacetylation. Free Radic Biol Med 2024; 213:208-221. [PMID: 38142952 DOI: 10.1016/j.freeradbiomed.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/07/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Abstract
Our study investigated the possible molecular mechanism of glucocorticoid in steroid-induced osteonecrosis of the femoral head (SINFH) through regulating serum alpha-2-macroglobulin and SIRT2-mediated BMP2 deacetylation. Essential genes involved in glucocorticoid-induced SINFH were screened by transcriptome sequencing and analyzed by bioinformatics, followed by identifying downstream regulatory targets. Rat bone marrow mesenchymal stem cells were isolated and treated with methylprednisolone (MP) for in vitro cell experiments. Besides, a glucocorticoid-induced rat ONFH was established using the treatment of MP and LPS. ChIP-PCR detected the enrichment of SIRT2 in the promoter region of BMP2, and the deacetylation modification of SIRT2 on BMP2 was determined. Bioinformatics analysis revealed that glucocorticoids may induce ONFH through the SIRT2/BMP2 axis. In vitro cell experiments showed that glucocorticoids up-regulated SIRT2 expression in BMSCs by inducing oxidative stress, thereby promoting cell apoptosis. The up-regulation of SIRT2 expression may be due to the decreased ability of α2 macroglobulin to inhibit oxidative stress, and the addition of NOX protein inhibitor DPI could significantly inhibit SIRT2 expression. SIRT2 could promote histone deacetylation of the BMP2 promoter and inhibit its expression. In vitro cell experiments further indicated that knocking down SIRT2 could protect BMSC from oxidative stress and cell apoptosis induced by glucocorticoids by promoting BMP2 expression. In addition, animal experiments conducted also demonstrated that the knockdown of SIRT2 could improve glucocorticoid-induced ONFH through up-regulating BMP2 expression. Glucocorticoids could induce oxidative stress by down-regulating serum α2M to promote SIRT2-mediated BMP2 deacetylation, leading to ONFH.
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Affiliation(s)
- Shanhong Fang
- Department of Sports Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, PR China; Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, PR China; Fujian Orthopaedics Research Institute, Fuzhou, 350000, PR China; Fujian Orthopedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, Fuzhou, 350000, PR China
| | - Tianmin He
- Department of Vascular Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, PR China
| | - Mengqiang You
- Department of Sports Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, PR China; Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, PR China
| | - Huixin Zhu
- Nursing Department, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, PR China; Nursing Department, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, PR China
| | - Peng Chen
- Department of Sports Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, PR China; Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, PR China; Fujian Orthopaedics Research Institute, Fuzhou, 350000, PR China; Fujian Orthopedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, Fuzhou, 350000, PR China.
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8
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Li W, Chai JL, Li Z, Guo CC, Wei R, Sun TF, Liang XZ. No evidence of genetic causality between diabetes and osteonecrosis: a bidirectional two-sample Mendelian randomization analysis. J Orthop Surg Res 2023; 18:970. [PMID: 38104164 PMCID: PMC10725608 DOI: 10.1186/s13018-023-04428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVE This study aimed to examine whether diabetes mellitus is causally associated with osteonecrosis. METHOD Using publicly accessible genome-wide association study statistics, a bidirectional two-sample Mendelian randomization analysis was carried out. In order to determine whether diabetes has a causal effect on osteonecrosis and whether osteonecrosis has a causal effect on diabetes, we extracted six date on diabetes in Europeans from IEU OpenGWAS and GWAS Catalogue and osteonecrosis in Europeans from FinnGen. We then evaluated the data using inverse variance weighting, MR-Egger regression, weighted median, weighted mode, and simple mode. The results' stability and dependability were then evaluated using sensitivity analysis and heterogeneity analysis. Finally, meta-analysis is used to further confirm if there is a relationship between diabetes and osteonecrosis. RESULTS When diabetes was used as an exposure factor, MR-Egger regression showed that directional fold product was unlikely to bias the results. Cochran's Q test showed only minor heterogeneity in a few data sets. Multidirectional tests Egger-intercept, MR-PRESSO and funnel plots for most data did not show multidirectional and asymmetry at the gene level. Most of the IVW results showed no causal relationship between diabetes mellitus and osteonecrosis. The results of meta-analysis of IVW methods further confirmed the absence of a causal relationship. Inverse MR analysis also showed no causal relationship between osteonecrosis and diabetes. CONCLUSION Results of bidirectional MR analysis show no evidence of causal relationship between diabetes and osteonecrosis.
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Affiliation(s)
- Wei Li
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China
| | - Jin-Lian Chai
- College of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China
| | - Zhe Li
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, 250000, Shandong, China
| | - Cong-Cong Guo
- Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, 250000, Shandong, China
| | - Ran Wei
- Science and Technology Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, Shandong, China
| | - Tie-Feng Sun
- Shandong Provincial Research Institute of Traditional Chinese Medicine, Jinan, 250014, Shandong, China
| | - Xue-Zhen Liang
- Orthopaedic Microsurgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, 250014, Shandong, China.
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, Shandong, China.
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Cai T, Chen S, Wu C, Lou C, Wang W, Lin C, Jiang H, Xu X. Erythropoietin suppresses osteoblast apoptosis and ameliorates steroid-induced necrosis of the femoral head in rats by inhibition of STAT1-caspase 3 signaling pathway. BMC Musculoskelet Disord 2023; 24:894. [PMID: 37978375 PMCID: PMC10655348 DOI: 10.1186/s12891-023-07028-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Steroid-induced avascular necrosis of the femoral head (SANFH) is characterized by osteoblast apoptosis, leading to a loss of bone structure and impaired hip joint function. It has been demonstrated that erythropoietin (EPO) performs a number of biological roles. OBJECTIVE We examined the effects of EPO on SANFH and its regulation of the STAT1-caspase 3 signaling pathway. METHOD In vitro, osteoblasts were treated with dexamethasone (Dex) or EPO. We identified the cytotoxicity of EPO by CCK-8, the protein expression of P-STAT1, cleaved-caspase9, cleaved-caspase3, Bcl-2, BAX, and cytochrome c by Western blotting, and evaluated the apoptosis of osteoblasts by flow cytometry. In vivo, we analyzed the protective effect of EPO against SANFH by hematoxylin and eosin (H&E), Immunohistochemical staining, and Micro-computed tomography (CT). RESULTS In vitro, EPO had no apparent toxic effect on osteoblasts. In Dex-stimulated cells, EPO therapy lowered the protein expression of BAX, cytochrome c, p-STAT1, cleaved-caspase9, and cleaved-caspase3 while increasing the expression of Bcl-2. EPO can alleviate the apoptosis induced by Dex. In vivo, EPO can lower the percentage of empty bone lacunae in SANFH rats. CONCLUSION The present study shows that EPO conferred beneficial effects in rats with SANFH by inhibiting STAT1-caspase 3 signaling, suggesting that EPO may be developed as a treatment for SANFH.
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Affiliation(s)
- Tingwen Cai
- Department of Orthopedics, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
- Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, Zhejiang Province, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Siyuan Chen
- Department of Orthopedics, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
- Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, Zhejiang Province, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Chenghu Wu
- School of Biomedical Engineering, School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Chao Lou
- Department of Orthopedics, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
- Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, Zhejiang Province, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Weidan Wang
- Department of Orthopedics, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
- Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, Zhejiang Province, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Chihao Lin
- Department of Orthopedics, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
- Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, Zhejiang Province, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Hongyi Jiang
- Department of Orthopedics, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
- Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou, Zhejiang Province, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xinxian Xu
- Department of Orthopedics, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
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10
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Jia W, Zhou Z, Zhan W. Musculoskeletal Biomaterials: Stimulated and Synergized with Low Intensity Pulsed Ultrasound. J Funct Biomater 2023; 14:504. [PMID: 37888169 PMCID: PMC10607075 DOI: 10.3390/jfb14100504] [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: 08/11/2023] [Revised: 09/10/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
Clinical biophysical stimulating strategies, which have significant effects on improving the function of organs or treating diseases by causing the salutary response of body, have shown many advantages, such as non-invasiveness, few side effects, and controllable treatment process. As a critical technique for stimulation, the low intensity pulsed ultrasound (LIPUS) has been explored in regulating osteogenesis, which has presented great promise in bone repair by delivering a combined effect with biomaterials. This review summarizes the musculoskeletal biomaterials that can be synergized with LIPUS for enhanced biomedical application, including bone regeneration, spinal fusion, osteonecrosis/osteolysis, cartilage repair, and nerve regeneration. Different types of biomaterials are categorized for summary and evaluation. In each subtype, the verified biological mechanisms are listed in a table or graphs to prove how LIPUS was effective in improving musculoskeletal tissue regeneration. Meanwhile, the acoustic excitation parameters of LIPUS that were promising to be effective for further musculoskeletal tissue engineering are discussed, as well as their limitations and some perspectives for future research. Overall, coupled with biomimetic scaffolds and platforms, LIPUS may be a powerful therapeutic approach to accelerate musculoskeletal tissue repair and even in other regenerative medicine applications.
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Affiliation(s)
- Wanru Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
| | - Zifei Zhou
- Department of Orthopedics, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
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11
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Zhao Y, Li S, Feng M, Zhang M, Liu Z, Yao Y, Zhang T, Jiang Y, Lin Y, Cai X. Effects of Puerarin-Loaded Tetrahedral Framework Nucleic Acids on Osteonecrosis of the Femoral Head. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2302326. [PMID: 37317020 DOI: 10.1002/smll.202302326] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/30/2023] [Indexed: 06/16/2023]
Abstract
Osteonecrosis of the femoral head (ONFH) is recognized as a common refractory orthopedic disease that causes severe pain and poor quality of life in patients. Puerarin (Pue), a natural isoflavone glycoside, can promote osteogenesis and inhibit apoptosis of bone mesenchymal stem cells (BMSCs), demonstrating its great potential in the treatment of osteonecrosis. However, its low aqueous solubility, fast degradation in vivo, and inadequate bioavailability, limit its clinical application and therapeutic efficacy. Tetrahedral framework nucleic acids (tFNAs) are promising novel DNA nanomaterials in drug delivery. In this study, tFNAs as Pue carriers is used and synthesized a tFNA/Pue complex (TPC) that exhibited better stability, biocompatibility, and tissue utilization than free Pue. A dexamethasone (DEX)-treated BMSC model in vitro and a methylprednisolone (MPS)-induced ONFH model in vivo is also established, to explore the regulatory effects of TPC on osteogenesis and apoptosis of BMSCs. This findings showed that TPC can restore osteogenesis dysfunction and attenuated BMSC apoptosis induced by high-dose glucocorticoids (GCs) through the hedgehog and Akt/Bcl-2 pathways, contributing to the prevention of GC-induced ONFH in rats. Thus, TPC is a promising drug for the treatment of ONFH and other osteogenesis-related diseases.
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Affiliation(s)
- Yuxuan Zhao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P. R. China
| | - Songhang Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P. R. China
| | - Maogeng Feng
- The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou, 646000, P. R. China
| | - Mei Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P. R. China
| | - Zhiqiang Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P. R. China
| | - Yangxue Yao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P. R. China
| | - Tianxu Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P. R. China
| | - Yueying Jiang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P. R. China
| | - Yunfeng Lin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P. R. China
- Sichuan Provincial Engineering Research Center of Oral Biomaterials, Chengdu, Sichuan, 610041, P. R. China
| | - Xiaoxiao Cai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, P. R. China
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12
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Li S, Kong Z, Ma B, Wang H, Han Y, Zhao H, Shi X, Lv P, Yue H, Grässel S, Yin L. Low miR-182-5p Expressing Extracellular Vesicles Derived From Human Bone Marrow Stromal Cells of Subjects With Steroid-Induced Osteonecrosis of the Femoral Head Aggravate Disease Progression. J Bone Miner Res 2023; 38:976-993. [PMID: 37155311 DOI: 10.1002/jbmr.4823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/10/2023]
Abstract
Steroid-induced osteonecrosis of the femoral head (SONFH) is a refractory, progressive disease. However, the underlying mechanisms that aggravate femoral head necrosis remain unclear. Extracellular vesicles (EVs) act as molecular carriers in intercellular communication. We hypothesize that EVs derived from human (h) bone marrow stromal cells (BMSC) resident in SONFH lesion areas promote the pathogenesis of SONFH. In the present study, we determined the modulatory effects of SONFH-hBMSCs-derived EVs on the pathogenesis of SONFH in vitro and in vivo. We found that the expression of hsa-miR-182-5p was downregulated in SONFH-hBMSCs and EVs isolated from those hBMSCs. After tail vein injection, EVs isolated from hBMSCs transfected with hsa-miR-182-5p inhibitor aggravated femoral head necrosis in the SONFH mouse model. We conclude that miR-182-5p regulates bone turnover in the SONFH mouse model via targeting MYD88 and subsequent upregulation of RUNX2 expression. We further assume that EVs derived from hBMSCs resident in SONFH lesion areas aggravate femoral head necrosis by downregulating miR-182-5p secreted from hBMSC located outside these lesions. We suggest that miR-182-5p could provide a novel target for future therapeutic approaches to treat or prevent SONFH. © 2023 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Shushan Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhiheng Kong
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Baodong Ma
- Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Haitao Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yu Han
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongbo Zhao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangyu Shi
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pengju Lv
- Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Han Yue
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Susanne Grässel
- Department of Orthopaedic Surgery, Experimental Orthopaedics, Centre for Medical Biotechnology (ZMB/Biopark 1), University of Regensburg, Regensburg, Germany
| | - Li Yin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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13
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Fan XL, Wang WT, Wang J, Xiao R. Current management of avascular necrosis of the metacarpal head: a comprehensive literature review. Int J Surg 2023; 109:1509-1517. [PMID: 37042565 PMCID: PMC10389567 DOI: 10.1097/js9.0000000000000377] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/24/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Avascular necrosis (AVN) of the metacarpal head is a rare disease that may lead to progressive destruction of the metacarpophalangeal joint and hand function. This study aimed to describe the epidemiology, possible risk factors, clinical presentation, diagnostic workup, and treatment of the rare condition of avascular necrosis of the metacarpal head. METHODS Articles were searched using the subject words "Dieterich disease","Mauclaire's disease", and "avascular necrosis of metacarpal head" in the PubMed and Scopus databases. Studies were retained for review after meeting the inclusion criteria. Those outcomes relevant to diagnose and assessing AVN of the metacarpal head and those related to curative management were extracted. RESULTS The literature search revealed 45 studies with 55 patients. Although the aetiology of osteonecrosis has not been clearly delineated, AVN of the metacarpal head most commonly arises from trauma but other risk factors may also be involved. Plain radiographs are often negative and therefore likely to be missed. Early-stage osteonecrosis of the metacarpal head was best assessed using MRI. Given the rarity of this condition, there is no clear consensus on the treatment. CONCLUSIONS Avascular necrosis of the metacarpal head should be considered in the differential diagnosis of painful metacarpophalangeal joints. An early understanding of this unusual disease will provide an optimal clinical outcome, restoring joint activity, and resolving pain. Nonoperative treatment cannot cure all patients. Surgical management is based on the patient and lesion characteristics.
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Affiliation(s)
- Xiao-Lei Fan
- Department of Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an
| | | | - Jian Wang
- Orthopedics, Karamay Central Hospital of Xinjiang, Karamay, China
| | - Rui Xiao
- Orthopedics, Karamay Central Hospital of Xinjiang, Karamay, China
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14
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Yang X, Shi L, Zhang T, Gao F, Sun W, Wang P, Wu X, Li Z. High-energy focused extracorporeal shock wave prevents the occurrence of glucocorticoid-induced osteonecrosis of the femoral head: A prospective randomized controlled trial. J Orthop Translat 2022; 36:145-151. [PMID: 36263382 PMCID: PMC9550842 DOI: 10.1016/j.jot.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022] Open
Abstract
Background Studies have shown that high-energy focused extracorporeal shock wave therapy (HF-ESWT) has a certain therapeutic effect on glucocorticoid-induced osteonecrosis of the femoral head (ONFH). This study aimed to observe the efficacy and safety of HF-ESWT as a precautionary measure to reduce the probability of glucocorticoid-induced ONFH. Methods A prospective randomized controlled trial was designed to evaluate whether HF-ESWT (Group A) can significantly prevent the incidence of glucocorticoid-induced ONFH relative to a control group without shockwave intervention (Group B). MRI was used to assess whether all participants experienced ONFH at 3, 6, and 12 months after the intervention. Continuous scoring was used to evaluate the intervention results: the 10-cm visual analog scale (VAS) was used to evaluate pain, and the hip Harris score (HHS) was used to evaluate the function of the hip joint. Any adverse events were recorded. Results 153 patients (89 females and 64 males) who had been allocated to group A (75 patients) or Group B (78 patients) were included in the final analysis. The patients were 45.0 ± 13.0 years old. There were significant differences between the two groups in MRI diagnosis of ONFH patients (2 cases in Group A, 9 cases in Group B; p = 0.034). Significant differences between groups were found in bilateral hip function measured using the HHS at 6 months (Left p = 0.026; Right p = 0.033) and 12 months (Left p = 0.018; Right p = 0.038). However, there was no difference in the functional results measured at 3 months and the VAS at any points. Conclusions This study confirms that HF-ESWT can be successfully used to reduce the probability of glucocorticoid-induced ONFH. Pain and hip dysfunction are common clinical manifestations when ONFH is unavoidable. Therefore, HF-ESWT can be recommended for the prevention and intervention of ONFH high-risk populations receiving high-dose glucocorticoid therapy. The Translational potential of this article The effective prevention of HF-ESWT on ONFH after high-dose glucocorticoid application demonstrated its transformation potential as a preventive method in the clinical prevention of glucocorticoid-induced ONFH.
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Affiliation(s)
- Xu Yang
- Department of Orthopedics, Peking University China-Japan Friendship Clinical Hospital, Beijing, 100029, China,Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Lijun Shi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Tao Zhang
- Department of Chinese Medicine, The First Clinical School of Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Fuqiang Gao
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Beijing, 100029, China,Corresponding author.
| | - Wei Sun
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Beijing, 100029, China,Corresponding author.
| | - Peixu Wang
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Xinjie Wu
- Department of Molecular Medicine and Surgery, Karolinska Institute, 171 76, Stockholm, Sweden
| | - Zirong Li
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Orthopaedic Department, China-Japan Friendship Hospital, Beijing, 100029, China
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15
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Zhao P, Zhao S, Zhang J, Lai M, Sun L, Yan F. Molecular Imaging of Steroid-Induced Osteonecrosis of the Femoral Head through iRGD-Targeted Microbubbles. Pharmaceutics 2022; 14:pharmaceutics14091898. [PMID: 36145646 PMCID: PMC9505504 DOI: 10.3390/pharmaceutics14091898] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/15/2022] [Accepted: 06/25/2022] [Indexed: 11/16/2022] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a disease that is commonly seen in the clinic, but its detection rate remains limited, especially at the early stage. We developed an ultrasound molecular imaging (UMI) approach for early diagnosis of ONFH by detecting the expression of integrin αvβ3 during the pathological changes in steroid-induced osteonecrosis of the femoral head (SIONFH) in rat models. The integrin αvβ3-targeted PLGA or lipid microbubbles modified with iRGD peptides were fabricated and characterized. Their adhesion efficiency to mouse brain microvascular endothelial cells in vitro was examined, and the better LIPOiRGD was used for further in vivo molecular imaging of SIONFH rats at 1, 3 and 5 weeks; revealing significantly higher UMI signals could be observed in the 3-week and 5-week SIONFH rats but not in the 1-week SIONFH rats in comparison with the non-targeted microbubbles (32.75 ± 0.95 vs. 0.17 ± 0.09 for 5 weeks, p < 0.05; 5.60 ± 1.31 dB vs. 0.94 ± 0.81 dB for 3 weeks, p < 0.01; 1.13 ± 0.13 dB vs. 0.73 ± 0.31 dB for 1 week, p > 0.05). These results were consistent with magnetic resonance imaging data and confirmed by immunofluorescence staining experiments. In conclusion, our study provides an alternative UMI approach to the early evaluation of ONFH.
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Affiliation(s)
- Ping Zhao
- Department of Ultrasound, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China
| | - Shuai Zhao
- Department of Ultrasound, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China
- Department of Ultrasound, Suzhou Hospital of Anhui Medical University (Suzhou Municipal Hospital of Anhui Province), Suzhou 234000, China
| | - Jiaqi Zhang
- Department of Ultrasound, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510407, China
| | - Manlin Lai
- Department of Ultrasound, The Second People’s Hospital of Shenzhen, The First Affiliated Hospital of Shenzhen University, Shenzhen 518061, China
| | - Litao Sun
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou 310014, China
- Correspondence: (L.S.); (F.Y.); Tel.: +86-755-8639-2284 (F.Y.); Fax: +86-755-9638-2299 (F.Y.)
| | - Fei Yan
- Center for Cell and Gene Circuit Design, CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
- Correspondence: (L.S.); (F.Y.); Tel.: +86-755-8639-2284 (F.Y.); Fax: +86-755-9638-2299 (F.Y.)
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16
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Yang F, Zhang X, Song T, Li X, Lv H, Li T, Zhao J, Liu Z, Zhang X, Hou Y, Xu X. Huogu injection alleviates SONFH by regulating adipogenic differentiation of BMSCs via targeting the miR-34c-5p/MDM4 pathway. Gene 2022; 838:146705. [PMID: 35772657 DOI: 10.1016/j.gene.2022.146705] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/23/2022] [Accepted: 06/24/2022] [Indexed: 11/23/2022]
Abstract
Although the precise pathogenesis of steroid-induced osteonecrosis of femoral head (SONFH) is not yet fully understood, evidence shows miRNAs-mediated posttranscription control directs the adipogenesis of bone marrow mesenchymal stem cells (BMSCs) and plays a pivotal role in the SONFH processes. Huogu injection formulated according to traditional Chinese medicine (TCM) theory has been used to treat SONFH by intra-articular injection. In this study, we asked whether the therapeutic effects of Huogu injection might depend on the inhibition of adipogenic differentiation of BMSCs, and if so, the pathway might be a therapeutic target to promote bone repair. Consequently, miR-34c-5p was upregulated in the dexamethasone (DEX)-treated BMSCs and might participate in the adipogenesis of BMSCs. TargetScan database and the luciferase reporter assay showed miR-34c-5p targeted on the MDM4 and negatively regulated its expression. Huogu injection in vitro inhibited the adipogenesis in the DEX-treated BMSCs by inhibiting the expression levels of PPARγ and C/EBPα, as well as reducing miR-34c-5p to prevent the degradation of MDM4. Moreover, miR-34c-5p mimic or MDM4 knockdown using shRNA neutralized the anti-adipogenesis of Huogu injection in BMSCs. In vivo, the results of X-ray imaging confirmed that Huogu injection alleviated the bone loss in rat SONFH. Consistent with results in vitro, Huogu injection reduced the lipid accumulation, removed the suppression of MDM4 by downregulating the expression of miR-34c-5p, and inhibited the expression of C/EBPα and PPARγ in bone tissues. When the lentivirus encoding miR-34c-5p was conducted by intra-articular injection, the overexpression of miR-34c-5p antagonized the therapeutic effects of Huogu injection. Our results underline the critical importance of the miR-34c-5p/MDM4 pathway in regulating the adipogenic outcome of BMSCs, suggesting the miR-34c-5p as a potentially effective therapeutic target in SONFH. These results further reinforce the potential of Huogu injection as an alternative approach in SONFH.
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Affiliation(s)
- Fubiao Yang
- Heilongjiang University of Traditional Chinese Medicine, Harbin 150000, Heilongjiang, China
| | - Xin Zhang
- Graduate School, Heilongjiang University of Traditional Chinese Medicine, Harbin 150000, Heilongjiang, China
| | - Tao Song
- College of Integrated Traditional Chinese and Western Medicine, Hebei University of Chinese Medicine, Shijiazhuang 050000, Hebei, China
| | - Xiaodong Li
- The Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin 150000, Heilongjiang, China
| | - Hang Lv
- The Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin 150000, Heilongjiang, China
| | - Tongtong Li
- College of Integrated Traditional Chinese and Western Medicine, Hebei University of Chinese Medicine, Shijiazhuang 050000, Hebei, China
| | - Jun Zhao
- Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai 510000, Guangdong, China
| | - Zhao Liu
- Graduate School, Heilongjiang University of Traditional Chinese Medicine, Harbin 150000, Heilongjiang, China
| | - Xiaofeng Zhang
- Heilongjiang University of Traditional Chinese Medicine, Harbin 150000, Heilongjiang, China
| | - Yunlong Hou
- College of Integrated Traditional Chinese and Western Medicine, Hebei University of Chinese Medicine, Shijiazhuang 050000, Hebei, China; National Key Laboratory of Collateral Disease Research and Innovative Chinese Medicine, Shijiazhuang 050000, Hebei, China.
| | - Xilin Xu
- The Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin 150000, Heilongjiang, China
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17
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Huang Z, Li T, Lin N, Cui Q, Chen W. Evaluation of Radiographic Outcomes after Core Decompression for Osteonecrosis of the Femoral Head: The Beijing University of Chinese Medicine X-ray Evaluation Method. J Bone Joint Surg Am 2022; 104:25-32. [PMID: 34319932 DOI: 10.2106/jbjs.20.00478] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Joint-preserving treatments for osteonecrosis of the femoral head (ONFH) are an area of significant interest in orthopaedics as they may restore function and provide durable benefit to patients who would otherwise require early total hip arthroplasty. Studies reporting the outcomes for these procedures generally rely on a combination of radiographic and clinical outcomes. However, there is not currently a standardized radiographic scoring system that allows for objective reporting of radiographic outcomes following these procedures. This article introduces a novel scoring system (Beijing University of Chinese Medicine X-ray evaluation, BUCMXE) based on Anteroposterior (AP) hip radiographs to allow for objective evaluation and comparison of postoperative outcomes following joint-preserving treatments for ONFH. METHODS The proposed scoring system utilizes AP radiographs of the hip and consists of a total score (0-10) derived from the sum of subscores in 3 domains: femoral head morphology, osteonecrotic lesion, and degree of osteoarthritis. Each radiographic parameter is scored from 0 (normal) to 3 or 4 (advanced disease). The scoring model was retrospectively applied to a cohort of patients who had undergone core decompression and cancellous bone grafting procedures by the principal investigator. RESULTS The BUCMXE provided a clear and reproducible means of quantifying and communicating radiographic changes over the course of follow-up in our study cohort. Statistical analysis demonstrated that the BUCMXE was sensitive to detect the radiographic changes associated with the index procedure. The median total score was reduced from 3 preoperatively to 2 at the initial (3-month) follow-up for this cohort. This change was attributable to the obvious improvement of osteonecrotic lesion in patients who had more advanced disease at the time of their procedure. CONCLUSION The BUCMXE system allowed for objective quantification of radiographic changes following joint-preserving hip surgery in our cohort. Statistical analysis of BUCMXE scores demonstrated that the scoring system was sensitive to detect subtle radiographic changes associated with disease progression in the follow-up period. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Zeqing Huang
- Department of Orthopaedics, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China.,Department of Orthopaedics, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Taixian Li
- Department of Orthopaedics, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Na Lin
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Quanjun Cui
- Department of Orthopaedic Surgery, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Weiheng Chen
- Department of Orthopaedics, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
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18
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Wang Y, Luan S, Yuan Z, Lin C, Fan S, Wang S, Ma C, Wu S. Therapeutic effect of platelet-rich plasma on glucocorticoid-induced rat bone marrow mesenchymal stem cells in vitro. BMC Musculoskelet Disord 2022; 23:151. [PMID: 35168574 PMCID: PMC8845312 DOI: 10.1186/s12891-022-05094-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Glucocorticoid-induced osteonecrosis of the femoral head (GIONFH) is a progressive and disabling disease caused by long-term or high-dose glucocorticoid use. Decreased osteogenesis and proliferation of bone marrow mesenchymal stem cells (BMSCs) are the main pathogenesis of GIONFH. Platelet-rich plasma (PRP) has been shown to play a promising role in bone regeneration. However, the effects of PRP on glucocorticoid-induced BMSCs inhibition remains elusive. The objective of this study was to explore whether PRP could improve the in vitro biological activities of BMSCs inhibited by high-dose glucocorticoid in vitro. METHODS In this study, a dexamethasone (Dex)-induced in vitro cell model was established. The effects of PRP on proliferation, migration, cell cycle and apoptosis of rat BMSCs induced with high-dose Dex compared to BMSCCTRL, using CCK-8 assay, transwell, flow cytometry and TUNEL assay, respectively. We further performed the alkaline phosphatase (ALP) and alizarin red (ALR) staining to explore the influence of PRP on osteogenic differentiation. Western Blot was used to detect the expression of Bcl-2, Caspase-3, RUNX2 apoptosis, and osteogenic-related proteins. RESULTS We observed increased apoptosis rate and Caspase-3 expression, and the decreased migration and osteogenic differentiation, and down-regulation of RUNX-2 and Bcl-2 expression in Dex-induced BMSCs. PRP could reverse these inhibitory effects of Dex, and enhance the BMSCs proliferation, migration, and osteogenic ability in vitro. CONCLUSION Our vitro study showed that PRP significantly protected BMSCs from Dex-induced apoptosis, and further promoted BMSCs proliferation, migration, and osteogenic differentiation. This study provides a scientific basis for the prevention and treatment of GIONFH with PRP. Meanwhile, it also lays the foundation for the application of PRP in other musculoskeletal diseases.
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Affiliation(s)
- Yanxue Wang
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510030, Guangdong, China
| | - Shuo Luan
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510030, Guangdong, China
| | - Ze Yuan
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510030, Guangdong, China
| | - Caina Lin
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510030, Guangdong, China
| | - Shengnuo Fan
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510030, Guangdong, China
| | - Shaoling Wang
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510030, Guangdong, China
| | - Chao Ma
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510030, Guangdong, China.
| | - Shaoling Wu
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510030, Guangdong, China.
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Curculigo orchioides polysaccharides extraction, characterization, and their protective effects against femoral head necrosis. ARAB J CHEM 2022. [DOI: 10.1016/j.arabjc.2021.103414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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The effect of Moringa oleifera polysaccharides on the regulation of glucocorticoid-induced femoral head necrosis: In vitro and in vivo. ARAB J CHEM 2022. [DOI: 10.1016/j.arabjc.2021.103410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Shi L, Yang X, Wang P, Ma X, Li D, Wu X, Gao F, Sun W. Quantitative Magnetic Resonance Imaging of Femoral Head Articular Cartilage Change in Patients with Hip Osteonecrosis Treated with Extracorporeal Shock Wave Therapy. Int J Clin Pract 2022; 2022:8609868. [PMID: 35814305 PMCID: PMC9208945 DOI: 10.1155/2022/8609868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/15/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Multiple reports have demonstrated the therapeutic potential of extracorporeal shock wave (ESWT) in osteonecrosis of the femoral head (ONFH). However, few studies reported the changes in hip articular cartilage after the intervention. This study aimed to investigate the effect of ESWT on femoral head cartilage using a novel technique, quantitative T2-mapping magnetic resonance imaging. METHODS A total of 143 eligible patients with unilateral early-stage ONFH were randomized into the ESWT group and control group. Seventy-three patients in the ESWT group received two sessions of ESWT with oral drug treatment, while seventy patients in the control group received oral drug treatment only. The visual analog pain scale (VAS) and Harris hip score (HHS) at 3-month, 6-month, and 12-month follow-up were used as the clinical evaluation index. The radiological evaluation index used the T2 mapping values, necrotic size, and China-Japan Friendship Hospital (CJFH) classification. RESULTS A total of 143 patients (62 females and 81 males) were finally included, and the characteristics before treatment were comparable between the two groups. At the last follow-up (12 months), the T2 values and ΔT2 changes in the ESWT group were all smaller than those in the control group (p=0.042; p=0.039), while the CJFH classification of ONFH and necrotic lesion size were not statistically significant. At 3 months and 6 months, the VAS in the ESWT group was lower than that in the control group (p=0.021; p=0.046) and the HHS in the ESWT group was higher (p=0.028; p=0.039). However, there were no significant differences in the VAS and HHS at 12 months between the ESWT and control groups. CONCLUSIONS The results of the current study indicated that, based on drug treatment, ESWT is an effective treatment method for nontraumatic ONFH, which could result in significant pain relief and function restoration. Furthermore, it could delay the injury of femoral head cartilage during the progression of ONFH.
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Affiliation(s)
- Lijun Shi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xu Yang
- Department of Orthopedics, Peking University China-Japan Friendship Clinical Hospital, Beijing 100029, China
| | - Peixu Wang
- Department of Orthopedic Surgery, Centre for Osteonecrosis and Joint-Preserving & Reconstruction, China-Japan Friendship Hospital, Beijing 100029, China
| | - Xiangwei Ma
- Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Dan Li
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan, China
| | - Xinjie Wu
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm 171 76, Sweden
| | - Fuqiang Gao
- Department of Orthopedic Surgery, Centre for Osteonecrosis and Joint-Preserving & Reconstruction, China-Japan Friendship Hospital, Beijing 100029, China
| | - Wei Sun
- Department of Orthopedic Surgery, Centre for Osteonecrosis and Joint-Preserving & Reconstruction, China-Japan Friendship Hospital, Beijing 100029, China
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22
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Chen Y, Miao Y, Liu K, Xue F, Zhu B, Zhang C, Li G. Evolutionary course of the femoral head osteonecrosis: Histopathological - radiologic characteristics and clinical staging systems. J Orthop Translat 2022; 32:28-40. [PMID: 35591937 PMCID: PMC9072800 DOI: 10.1016/j.jot.2021.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a recalcitrant ischemic disorder, which could be classified into two major categories: traumatic and nontraumatic. Regardless of different risk factors, it has been testified that ONFH results from primitive vascular problems, leading to temporary or permanent loss of blood supply to bone tissue. Histopathological and microarchitectural alterations ensues, which is a gradual evolutionary process involving bone marrow and osteocyte necrosis, progressive destruction of subchondral bone, unsuccessful reparative process, and eventual articular collapse and degenerative arthritis. Based on the imaging features of ONFH, different classification systems have been developed to evaluate the severity and prognosis of the disease, which is pivotal for implementation of treatment strategy, especially the joint-preserving surgery. However, patients classified with the same severity stage, especially in the peri-collapse stage, sometimes responded differently after similar joint-preserving surgery. The unusual phenomenon may be attributed to the limitation of the current imaging classification systems, which might underestimate the disease severity, especially when referring to the early stages. In this review, we briefly summarize the etiology and pathogenesis of ONFH. The imaging features and staging classification systems of ONFH are also described. More importantly, we focus on histopathological and microstructural alterations of the femoral head, and provide an overview of their essential contribution to ONFH progression. Given the observation of discordance between imaging characteristics and histopathological alterations, a substantial amount of research on the relationship between imaging and histopathological features is required to further modify and revise the current wide-accepted classification systems.
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Shang Y, Xu J, Zhang T, Dong Z, Li J, Bi W, Xie Z. Prediction of the Collapse of Necrotic Femoral Head by CT and X-Ray Examinations before Hip Replacement Based on Intelligent Medical Big Data. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:9971236. [PMID: 34976333 PMCID: PMC8716235 DOI: 10.1155/2021/9971236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022]
Abstract
It was to explore the effect of the CT and X-ray examinations before the hip replacement to predict the collapse of the necrotic femoral head under the classification of medical big data based on the decision tree algorithm of the difference grey wolf optimization (GWO) and provide a more effective examination basis for the treatment of patients with the osteonecrosis of the femoral head (ONFH). From January 2019 to January 2021, a total of 152,000 patients with ONFH and hip replacement in the tertiary hospitals were enrolled in this study. They were randomly divided into two groups, the study sample-X group (X-ray examination results) and based-CT group (CT examination results)-76,000 cases in each group. The actual measurement results of the femoral head form the gold standard to evaluate the effect of the two groups of detection methods. The measurement results of X-ray and CT before hip replacement are highly consistent with the detection results of the physical femoral head specimens, which can effectively predict the collapse of ONFH and carry out accurate staging. It is worthy of clinical promotion.
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Affiliation(s)
- Yongwei Shang
- The Second Department of Orthopedics, The People Hospital of Shijiazhuang, Shijiazhuang 050000, China
| | - Jianjie Xu
- The Second Department of Orthopedics, The People Hospital of Shijiazhuang, Shijiazhuang 050000, China
| | - Ting Zhang
- Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Zhihui Dong
- The Second Department of Orthopedics, The People Hospital of Shijiazhuang, Shijiazhuang 050000, China
| | - Jiebing Li
- The Second Department of Orthopedics, The People Hospital of Shijiazhuang, Shijiazhuang 050000, China
| | - Weidong Bi
- The Second Department of Orthopedics, The People Hospital of Shijiazhuang, Shijiazhuang 050000, China
| | - Zhe Xie
- The Second Department of Orthopedics, The People Hospital of Shijiazhuang, Shijiazhuang 050000, China
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Abstract
The etiology of avascular necrosis (AVN) of the proximal humerus can be classified as idiopathic or posttraumatic, the latter being mainly due to proximal humerus fractures. Evidence suggests that posttraumatic AVN may require surgical intervention more often than idiopathic AVN of the proximal humerus. This article provides a comprehensive review of the management of posttraumatic AVN of the proximal humerus. Early stage AVN (stages 1 to 3) is commonly treated with nonoperative intervention or core decompression of the humeral head, whereas later stage disease (stages 4 and 5) may require hemiarthroplasty or total shoulder arthroplasty to restore function. [Orthopedics. 2021;44(6):367-375.].
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Banerjee I, Robinson J, Sathian B. Corticosteroid induced avascular necrosis and COVID-19: The drug dilemma. Nepal J Epidemiol 2021; 11:1049-1052. [PMID: 34733566 PMCID: PMC8560140 DOI: 10.3126/nje.v11i3.39309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022] Open
Abstract
The severe and life-threatening nature of the COVID-19 infection, the ARDS (acute respiratory distress syndrome) as well as the cytokine storm induced by the infection, commands lifesaving high doses of steroid therapy. As in all pharmacological therapies adverse effects are present. One such adverse effect which is being reported is corticosteroid induced avascular necrosis of the femoral head/ osteonecrosis of the femoral head.
It must be noted that AVN principally affects the femoral head and most commonly the anterolateral aspect thereof as it is the crux of weight bearing. Corticosteroids induce fat mobilization and this thus innately enhances the likelihood of fat emboli developing from the liver to occlude minor blood vessels in the femur, this thereby compromises the microvascular environment. Superadded to this the steroid therapy disrupts calcium metabolism and homeostasis which induces hypertrophy in the intramedullary fat cells, Gaucher cells and inflammatory cells; whilst increasing the activity of osteoclasts, thus increasing bone resorption and decreasing calcium uptake and deposition; ultimately leading to an insufficiency in the trabecular and cortical bone. This insufficiency thus equates to an increased intraosseous pressure which impedes intramedullary circulation and results in avascular necrosis.
It is evident that avascular necrosis is directly caused by high dose steroid therapy, however the case reports have very clearly indicated that the rapid onset of AVN post recovery from the COVID-19 infection cannot be solely attributed to steroid therapy and that another benefactor induced by the COVID-19 infection is at play. It is thus vital for treating physicians to take cognisance of this adverse effect post recovery and therefore should ensure that prophylactic bisphosphonate therapy is initiated timeously and congruently.
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Affiliation(s)
| | - Jared Robinson
- Sir Seewoosagur Ramgoolam Medical College, Belle Rive, Mauritius
| | - Brijesh Sathian
- Geriatric and long term care Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
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26
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Li W, Huang Z, Tan B, Chen G, Li X, Xiong K, Zhu R, Li R, Li S, Ye H, Liang Z, Dong X, Zhou S, Chen S, Xi H, Cheng H, Xu R, Tu S, Chen Z, Qi L, Song J, Xiao R, Liu H, Nan Q, Yu H, Cui H, Shen Y, Wang C, Lin N, Zhang Y, Chen W. General recommendation for assessment and management on the risk of glucocorticoid-induced osteonecrosis in patients with COVID-19. J Orthop Translat 2021; 31:1-9. [PMID: 34692412 PMCID: PMC8526281 DOI: 10.1016/j.jot.2021.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/OBJECTIVE Coronavirus disease 2019 (COVID-19) is a disaster in human medical history and glucocorticoids remain the most promising therapy. Osteonecrosis is a disease caused by reduced intraosseous blood flow to bones in the joints, which will rapidly induce joint destruction. Approximately one-third patients with severe acute respiratory syndrome (SARS) who received high cumulative doses and long treatment durations of glucocorticoids occurred osteonecrosis. Considering the similarity of SARS and COVID-19 on their pathogen, clinical characteristics, and therapeutic strategies, it is particularly desirable to investigate whether osteonecrosis will become a common sequela among convalescent COVID-19 patients. METHODS This multi-strategy study was designed by integrating different research methods, such as meta-analysis, systematic review, and cross-sectional investigations to address above study objectives. At first, two meta-analyses were performed on the osteonecrosis incidence among SARS patients and the clinical data of glucocorticoid exposure among COVID-19 patients. Then, a systematic review of low-dosage glucocorticoid associated osteonecrosis and a cross-sectional investigation of glucocorticoid exposure of COVID-19 patients in Wuhan city of China were also conducted. Moreover, the pathogenesis, diagnosis, prevention, and treatment options for osteonecrosis patients with COVID-19 infection were further presented and discussed. RESULTS Our meta-analysis showed that 32% of SARS patients had developed osteonecrosis after receiving glucocorticoid treatment with high dose, and our system review supported that low level glucocorticoid exposure might also lead to the occurrence of osteonecrosis. Similarly, 40% of COVID-19 patients had undergone glucocorticoid treatment according to our meta-analysis. The cross-sectional investigation in Wuhan city of China found that the average of cumulative glucocorticoid exposure level was 504 mg calculated by the dosage of methylprednisolone. Notably, a confirmed osteonecrosis case was identified from 1406 patients with COVID-19 during our cross-sectional investigation, implying that preventive management of osteonecrosis should be better started with regular clinical follow-up observation. CONCLUSION Growing evidence of the glucocorticoid therapy for COVID-19 patients prompts us to establish risk-classification-based early screening and to introduce early prevention protocol of its associated osteonecrosis that will be of clinical significance in favor of improved prognosis of this disease. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE To establish risk-classification-based early screening and to introduce early prevention protocol of glucocorticoid-induced osteonecrosis will be of clinical significance in favor of improved prognosis of COVID-19.
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Affiliation(s)
- Wenlong Li
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Zeqing Huang
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, PR China
| | - Biao Tan
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, PR China
| | - Gang Chen
- Hubei College of Chinese Medicine, Jingzhou, 434020, PR China
- Hubei University of Chinese Medicine, Wuhan, 430065, PR China
| | - Xugui Li
- Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, 430079, PR China
| | - Kan Xiong
- Wuhan Jiangxia District Hospital of Traditional Chinese Medicine, Wuhan, 430200, PR China
| | - Ruizheng Zhu
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Ruihan Li
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Shuwen Li
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Hengli Ye
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
- Guizhou University of Traditional Chinese Medicine, Guiyang, 550025, PR China
| | - Zhi Liang
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Xiaojun Dong
- Wuhan Hospital of Traditional Chinese Medicine, Wuhan, 430014, PR China
| | - Shijing Zhou
- Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, 430079, PR China
| | - Song Chen
- Hubei University of Chinese Medicine, Wuhan, 430065, PR China
| | - Haixiang Xi
- Wuhan Hospital of Traditional Chinese Medicine, Wuhan, 430014, PR China
| | - Hao Cheng
- Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine, Wuhan, 430079, PR China
| | - Rongpeng Xu
- Hubei College of Chinese Medicine, Jingzhou, 434020, PR China
| | - Shenghao Tu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Zhe Chen
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Lihua Qi
- Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, 430061, PR China
| | - Jiandong Song
- Hubei Integrated Traditional Chinese and Western Medicine Hospital, Wuhan, 430015, PR China
| | - Ruoran Xiao
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Huilan Liu
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Qian Nan
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Huiyong Yu
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Hongsheng Cui
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Yanguang Shen
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Chengxiang Wang
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
| | - Na Lin
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Yanqiong Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, PR China
| | - Weiheng Chen
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, 100029, PR China
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Birla V, Vaish A, Vaishya R. Risk factors and pathogenesis of steroid-induced osteonecrosis of femoral head - A scoping review. J Clin Orthop Trauma 2021; 23:101643. [PMID: 34722150 PMCID: PMC8531658 DOI: 10.1016/j.jcot.2021.101643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 10/11/2021] [Indexed: 12/23/2022] Open
Abstract
Steroid induced osteonecrosis of the femoral head is commonly seen in clinical practice, but yet not fully understood. It is intriguing why only some cases develop and others escape from it. We did an extensive and up to date literature review on it, with the aim to identify its incidence, associated risk factor and pathogenesis. We found that the incidence ranged from 03 to 40%, and was more with associated risk factors. Several risk factors were identified, which included higher dose and prolonged duration of steroid consumption, and underlying disease for which the steroids were given. Pathogenesis of this disease is complex and not yet fully understood. Awareness about this condition and associated risk factors should help the clinicians in identifying the cases who are prone to develop osteonecrosis with the use of steroids.
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Integrated Analysis of miRNA-mRNA Regulatory Networks Associated with Osteonecrosis of the Femoral Head. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:8076598. [PMID: 34422080 PMCID: PMC8376457 DOI: 10.1155/2021/8076598] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/03/2021] [Indexed: 12/11/2022]
Abstract
Osteonecrosis of the femoral head (ONFH) accounts for as many as 18% of total hip arthroplasties. Knowledge of genetic changes and molecular abnormalities could help identify individuals considered to be at a higher risk of developing ONFH. In this study, we sought to identify differentially expressed miRNAs (DEmiRs) and genes (DEGs) associated with ONFH by integrated bioinformatics analyses as well as to construct the miRNA-mRNA regulatory network involving in the pathogenesis of ONFH. We performed differential expression analysis using a gene expression profile GSE123568 and a miRNA expression profile GSE89587 deposited in the Gene Expression Omnibus and identified 47 DEmiRs (24 upregulated miRNAs and 23 downregulated miRNAs) and 529 DEGs (218 upregulated genes and 311 downregulated genes). Gene Ontology enrichment analyses of DEGs suggested that DEGs were significantly enriched in neutrophil activation, cytosol, and ubiquitin-protein transferase activity. Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses of DEGs revealed that DEGs were significantly enriched in transcriptional misregulation in cancer. DEGs-based miRNA-mRNA regulatory networks were obtained by searching miRNA-mRNA prediction databases, TargetScan, miTarBase, miRMap, miRDB, and miRanda databases. Then, overlapped miRNAs were selected between these putative miRNAs and DEmiRs between ONFH and non-ONFH, and pairs of the DEmiR-DEG regulatory network were finally depicted. There were 12 nodes and 64 interactions for upDEmiR-downDEG regulatory networks and 6 nodes and 16 interactions for downDEmiR-upDEG regulatory networks. Using the STRING database, we established a protein-protein interaction network based on the overlapped DEGs between ONFH and non-ONFH. C5AR1, CDC27, CDC34, KAT2B, CPPED1, TFDP1, and MX2 were identified as the hub genes. The present study characterizes the miRNA profile, gene profile, and miRNA-mRNA regulatory network in ONFH, which may contribute to the interpretation of the pathogenesis of ONFH and the identification of novel biomarkers and therapeutic targets for ONFH.
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He P, Chen J, Yue C, Ma M, Hong Z, Liu Y. Effectiveness and safety of traditional Chinese medicine in the treatment of steroid-osteonecrosis of femoral head: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26811. [PMID: 34397740 PMCID: PMC8322482 DOI: 10.1097/md.0000000000026811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head (ONFH) is a common refractory disease in orthopedics. Overdose glucocorticoid application is a common trigger for ONFH. Traditional Chinese medicine (TCM), as a treatment for ONFH, has been shown to be effective in treating steroid-induced ONFH (SONFH). However, a systematic review and meta-analysis of them is lacking. We aim to systematically review the effectiveness and safety of TCM in the treatment of SONFH. METHODS We will search the following databases: PubMed, Embase, the Cochrane Library, MEDLINE, the Chinese Biomedical Literature Database, China Science and Technology Journal Database, China National Knowledge Infrastructure, and Wanfang Data (since the inception of the databases to the present). In addition, we will look for clinical trial registrations, prospective grey literature, relevant conference papers, and established study reference lists. We will use Review Manager 5.3 software for meta-analysis and heterogeneity assessment. We will evaluate the quality of the evidence using a hierarchy of recommendation assessment, development, and evaluation. RESULTS This study will systematically evaluate the efficacy and safety of TCM in the treatment of SONFH. CONCLUSION This systematic review to evaluate the effectiveness and safety of TCM in the treatment of SONFH will provide updated evidence for clinical application. INPLASY REGISTRATION NUMBER INPLASY202170015.
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Affiliation(s)
- Peilin He
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education (Fujian University of TCM), Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Junming Chen
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education (Fujian University of TCM), Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Chen Yue
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang
| | - Maoxiao Ma
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang
| | - Zhenqiang Hong
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation Ministry of Education (Fujian University of TCM), Fujian University of Traditional Chinese Medicine, Fuzhou
| | - Youwen Liu
- Department of Orthopedic Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang
- Quanzhou Orthopedic-Traumatological Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Quanzhou, China
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Shi S, Luo P, Sun L, Zhao Y, Yang X, Xie L, Yu T, Wang Z. Analysis of MR Signs to Distinguish Between ARCO Stages 2 and 3A in Osteonecrosis of the Femoral Head. J Magn Reson Imaging 2021; 55:610-617. [PMID: 34309130 DOI: 10.1002/jmri.27860] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND MRI is the most effective diagnostic tool of osteonecrosis of the femoral head (ONFH), especially for early diagnosis, but its detection of subchondral or cortical fractures is less accurate than CT. Therefore, it is difficult to accurately stage ONFH in the peri-collapse period by MRI. PURPOSE To improve the accuracy of MR for distinguishing between Association Research Circulation Osseous (ARCO) stages 2 and 3A in ONFH. STUDY TYPE Retrospective. SUBJECTS One hundred and fifty five cases of ARCO stage 2/3A of ONFH underwent MR examinations, M/F = 72/83. CT was used as reference standard for collapse, which was decided by an orthopedist and a radiologist in consultation. FIELD STRENGTH/SEQUENCE 3 T/axial and coronal T1 -weighted Turbo Spin Echo (T1 W TSE) sequence, axial T2 -weighted fat-saturated (T2 W FS) TSE sequence, and coronal proton density-weighted imaging (PDWI)-FS-Dixon fat/water image. ASSESSMENT Five potential MR signs (the maximum width of the necrotic-viable interface, bone marrow edema (BME), irregular articular surface of the femoral head, T2 heterogeneous high signal, and the absence of a necrotic-viable interface with the morphology of closed loop) were evaluated blindly by five radiologists independently and the total scores of different combinations of MR signs were calculated. STATISTICAL TESTS Mann-Whitney U test and Chi-square test were used to evaluate age, gender, and MR signs differences between the two groups. ROC curve was used to access the distinguishing value of MR signs. The consistency of the five radiologists was analyzed by intraclass correlation coefficient. RESULTS The area under the curve of the combined MR signs 2 for distinguishing between ARCO stages 2 and 3A was the greatest (0.967), sensitivity and specificity were 100.00% and 88.71% respectively, and greater than 1 was the threshold. DATA CONCLUSION Combined MR signs 2 has great values in distinguishing between ARCO stages 2 and 3A in ONFH, thus helping clinical therapy. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Shan Shi
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ping Luo
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Li Sun
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanping Zhao
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xuedong Yang
- Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Limin Xie
- Department of Orthopaedics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tong Yu
- Department of Orthopaedics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Chen D, Zhang G, Li Y, Zhang M, He Q, Yang J, Wen L, Zou X, Li Z, Wang H, Chen P. Up-regulation of urinary exosomal hsa-microRNA-200b-3p and hsa-microRNA-206 in patients of steroid-induced osteonecrosis of femoral head. Am J Transl Res 2021; 13:7574-7590. [PMID: 34377236 PMCID: PMC8340157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/25/2021] [Indexed: 06/13/2023]
Abstract
The aim of this study was to determine the value of microRNAs (miRNAs) in urinary exosomes in the diagnosis of steroid-induced osteonecrosis of femoral head (SONFH). RNA was extracted from urinary exosomes from 9 SONFH patients and 9 hip osteoarthritis (HOA) patients with age and gender matched and then miRNAs were analyzed by next generation sequencing. Intriguingly, 15 miRNAs including hsa-miR-200b-3p and hsa-miR-206 were significantly upregulated in exosomes from SONFH patients. Furthermore, qRT-PCR and area under curve (AUC) analysis of an independent cohort of 30 SONFH patients, 10 HOA patients and 10 healthy donors confirmed that hsa-miR-200b-3p and hsa-miR-206 were upregulated in SONFH samples which AUC values were 0.938 (95% CI: 0.828-1) and 0.926 (95% CI: 0.806-1) respectively. GO function, KEGG pathway, miRNAs-mRNAs network and protein-protein interaction (PPI) network were also constructed to analyze potentially pathological mechanisms. The enriched functions and pathways included Hippo, PI3K-Akt, TGF-β and Wnt signaling pathways. The top five hub genes (MAPK1, EP300, RHOA, PIK3CA, and CBL) were selected from PPI network, which consisted of 180 nodes and 518 edges. Collectively, our results showed that hsa-miR-200b-3p and hsa-miR-206 in urinary exosomes might serve as non-invasive biomarkers for SONFH.
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Affiliation(s)
- Delong Chen
- Department of Orthopaedic Surgery, Clifford Hospital, Jinan UniversityGuangzhou 510006, China
| | - Gangyu Zhang
- The First School of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhou 510405, China
| | - Ying Li
- Department of Orthopaedic Surgery, Third Affiliated Hospital, Guangzhou University of Chinese MedicineGuangzhou 510360, China
| | - Meng Zhang
- Department of Orthopedics, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan UniversityZhengzhou 450003, China
| | - Qi He
- The First School of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhou 510405, China
| | - Junzheng Yang
- The First School of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhou 510405, China
| | - Longfei Wen
- Department of Orthopaedic Surgery, Clifford Hospital, Jinan UniversityGuangzhou 510006, China
| | - Xuting Zou
- Orthopedics Department, Quanzhou Orthopedic-Traumatological Hospital, Fujian University of Chinese Medicine61, Citong Road, Fengze Area, Quanzhou 362000, China
| | - Ziqi Li
- Department of Joint Diseases, Third Affiliated Hospital, Guangzhou University of Chinese MedicineGuangzhou 510405, China
| | - Haibin Wang
- Department of Orthopaedic Surgery, First Affiliated Hospital, Guangzhou University of Chinese MedicineGuangzhou 510405, China
| | - Peng Chen
- Department of Orthopaedic Surgery, First Affiliated Hospital, Guangzhou University of Chinese MedicineGuangzhou 510405, China
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张 根, 刘 瑞, 党 晓, 刘 继, 焦 海. [Experimental study on improvement of osteonecrosis of femoral head with exosomes derived from miR-27a-overexpressing vascular endothelial cells]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:356-365. [PMID: 33719246 PMCID: PMC8171754 DOI: 10.7507/1002-1892.202011026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/21/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate whether exosomes derived from miR-27a-overexpressing human umbilical vein endothelial cells (HUVECs)-exo (miR-27a) can promote bone regeneration and improve glucocorticoids (GC) induced osteonecrosis of femoral head (ONFH) (GC-ONFH). METHODS The exo (miR-27a) were intended to be constructed and identified by transmission electron microscopy, nanoparticle tracking analysis, Western blot, and real-time fluorescent quantitative PCR (qRT-PCR). qRT-PCR was used to evaluate the effect of exo (miR-27a) in delivering miR-27a to osteoblasts (MC3T3-E1 cells). Alkaline phosphatase staining, alizarin red staining, and qRT-PCR were used to evaluate its effect on MC3T3-E1 cells osteogenesis. Dual-luciferase reporter (DLRTM) assay was used to verify whether miR-27a targeting Dickkopf WNT signaling pathway inhibitor 2 (DKK2) was a potential mechanism, and the mechanism was further verified by qRT-PCR, Western blot, and alizarin red staining in MC3T3-E1 cells. Finally, the protective effect of exo (miR-27a) on ONFH was verified by the GC-ONFH model in Sprague Dawley (SD) rats. RESULTS Transmission electron microscopy, nanoparticle tracking analysis, Western blot, and qRT-PCR detection showed that exo (miR-27a) was successfully constructed. exo (miR-27a) could effectively deliver miR-27a to MC3T3-E1 cells and enhance their osteogenic capacity. The detection of DLRTM showed that miR-27a promoted bone formation by directly targeting DDK2. Micro-CT and HE staining results of animal experiments showed that tail vein injection of exo (miR-27a) improved the osteonecrosis of SD rat GC-ONFH model. CONCLUSION exo (miR-27a) can promote bone regeneration and protect against GC-ONFH to some extent.
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Affiliation(s)
- 根生 张
- 西安交通大学医学部附属三二〇一医院骨科(陕西汉中 723000)Department of Orthopaedics, 3201 Hospital of Xi’an Jiaotong University Health Science Center, Hanzhong Shaanxi, 723000, P.R.China
| | - 瑞宇 刘
- 西安交通大学医学部附属三二〇一医院骨科(陕西汉中 723000)Department of Orthopaedics, 3201 Hospital of Xi’an Jiaotong University Health Science Center, Hanzhong Shaanxi, 723000, P.R.China
| | - 晓谦 党
- 西安交通大学医学部附属三二〇一医院骨科(陕西汉中 723000)Department of Orthopaedics, 3201 Hospital of Xi’an Jiaotong University Health Science Center, Hanzhong Shaanxi, 723000, P.R.China
| | - 继超 刘
- 西安交通大学医学部附属三二〇一医院骨科(陕西汉中 723000)Department of Orthopaedics, 3201 Hospital of Xi’an Jiaotong University Health Science Center, Hanzhong Shaanxi, 723000, P.R.China
| | - 海斌 焦
- 西安交通大学医学部附属三二〇一医院骨科(陕西汉中 723000)Department of Orthopaedics, 3201 Hospital of Xi’an Jiaotong University Health Science Center, Hanzhong Shaanxi, 723000, P.R.China
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Guo J, Ren R, Sun K, He J, Shao J. PERK signaling pathway in bone metabolism: Friend or foe? Cell Prolif 2021; 54:e13011. [PMID: 33615575 PMCID: PMC8016635 DOI: 10.1111/cpr.13011] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/18/2021] [Accepted: 02/05/2021] [Indexed: 12/12/2022] Open
Abstract
Osteoblasts and osteoclasts participate in the process of bone remodelling to meet the needs of normal growth and development or repair pathological damage. Endoplasmic reticulum stress (ER stress) can break the intracellular homeostasis of osteoclasts and osteoblasts, which is closely related to abnormal bone remodelling. The double‐stranded RNA‐dependent protein kinase (PKR)‐like ER kinase (PERK) is a key transmembrane protein that regulates ER stress, and growing evidence suggests that the PERK pathway plays a crucial role in regulating bone metabolism under both physiological and pathological conditions. Based on the current findings, we summarized the main mechanisms involved in bone metabolism downstream of the PERK pathway, among which elF2α, FOXO1, CaN, Nrf2 and DAG play a role in regulating the differentiation of osteoblasts and osteoclasts. Importantly, strategies by the regulation of PERK pathway exert beneficial effects in preclinical trials of several bone‐related diseases. Given the importance and novelty of PERK pathway, we provide an overview and discuss the roles of PERK pathway in regulating bone metabolism and its impact on bone‐related diseases. We hope that the development of research in this field will bring a bright future for the treatment of bone‐related diseases.
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Affiliation(s)
- Jiachao Guo
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ranyue Ren
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Sun
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinpeng He
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingfan Shao
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Gudmundsson P, Nakonezny PA, Lin J, Owhonda R, Richard H, Wells J. Functional improvement in hip pathology is related to improvement in anxiety, depression, and pain catastrophizing: an intricate link between physical and mental well-being. BMC Musculoskelet Disord 2021; 22:133. [PMID: 33535999 PMCID: PMC7860171 DOI: 10.1186/s12891-021-04001-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/20/2021] [Indexed: 12/13/2022] Open
Abstract
Background Pain catastrophizing, anxiety, and depression are risk factors for poor functional outcomes and worse post-treatment pain that can be treated alongside physical care given to orthopedic patients. While these factors have been shown to be common in patients with hip pathology, there is limited literature that follows these conditions throughout treatment. The purpose of this study was to track psychological factors in patients with various hip pathology to determine if they improved alongside functional measures following treatment. Methods Patients presenting to a specialist hip clinic were prospectively evaluated for outcomes of pain catastrophizing, anxiety, depression, and hip function. Pre- and post-treatment assessments were undertaken: Pain Catastrophizing Scale, the Hospital Anxiety Depression Scale, the Hip Outcome Survey, and Hip Disability and Osteoarthritis Outcome Score (HOOS). Patient characteristics were recorded. A correlation analysis, using the Spearman partial correlation coefficient (rs), was conducted to evaluate the relationship between change in psychological factors with change in functional outcomes. Results A total of 201 patients (78 male, 123 female) with a mean age of 53.75 ± 18.97 years were included, with diagnoses of hip dysplasia (n = 35), femoroacetabular impingement (n = 35), lateral trochanteric pain syndrome (n = 9), osteoarthrosis (n = 109), and avascular necrosis of the hip (n = 13). Statistical analysis revealed a significant negative relationship between change in function level (as measured by HOOS ADL) and change in pain catastrophizing (rs = − 0.373, p < 0.0001), depression (rs = − 0.363, p < 0.0001), and anxiety (rs = − 0.264, p = 0.0002). Pain catastrophizing, depression, and anxiety improved with function. Spearman correlation coefficients also revealed that pain catastrophizing, HADS anxiety, and HADS depression improved with improvement in other patient-reported functional outcomes. Conclusions Patients with hip pathology often exhibit pain catastrophizing, anxiety, and depression, but improvements in hip functionality are associated with decreased severity of these psychological comorbidities. Exploring this connection demonstrates the correlation between musculoskeletal impairment and psychosocial outcomes and mental health. Perioperative multidisciplinary assessment may be a beneficial part of comprehensive orthopaedic hip care. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04001-5.
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Affiliation(s)
- Paul Gudmundsson
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX, 75390, USA
| | - Paul A Nakonezny
- Department of Population and Data Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, USA
| | - Jason Lin
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX, 75390, USA
| | - Rebisi Owhonda
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX, 75390, USA
| | - Heather Richard
- Department of Psychology, TX Scottish Rite Hospital, Dallas, USA
| | - Joel Wells
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Rd, Dallas, TX, 75390, USA.
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Han X, Hong G, Guo Y, Wu H, Sun P, Wei Q, Chen Z, He W, Liu Z, Liang C. Novel MRI technique for the quantification of biochemical deterioration in steroid-induced osteonecrosis of femoral head: a prospective diagnostic trial. J Hip Preserv Surg 2021; 8:40-50. [PMID: 34567599 PMCID: PMC8460153 DOI: 10.1093/jhps/hnab032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/05/2021] [Indexed: 12/01/2022] Open
Abstract
To explore the novel magnetic resonance imaging techniques, IVIM-DWI and IDEAL-IQ in detecting bone marrow fat and microcirculation in steroid-induced osteonecrosis of the femoral head (SIONFH). In this prospective study, 49 patients (80 hips) with SIONFH taking glucocorticoids and 24 healthy volunteers (48 hips) were recruited and assessed by T1WI, T2WI/fs, IDEAL-IQ and IVIM-DWI. The affected hips, contralateral asymptomatic hips and normal hips, as well as normal, penumbra and necrotic areas in the affected hips, were classified and evaluated. Imaging results were compared with histologic bone sections obtained from SIONFH patients undergoing surgery. The fat fraction (FF) and perfusion fraction (f) differences between groups were analyzed using analysis of variance, the LSD t-test, Pearson correlation analysis and ROC curve analysis. Our results demonstrate that IDEAL-IQ (FF) and IVIM-DWI (f) enable the classification of SIONFH at different ARCO stages. The FF was positively associated with the progression of the disease (r = 0.72), in contrast to f (r = -0.17). The FF and f were significantly different among the necrotic, penumbra and normal areas, and they were negatively correlated with each other (r = -0.37). The diagnostic sensitivity and specificity of IDEAL-IQ were 96.9% and 86.7%, and those of IVIM-DWI were 72.34% and 58.33%, respectively. The FF in contralateral asymptomatic hips was significantly higher than in normal hips, but no difference was found for f. IDEAL-IQ, and not IVIM-DWI, was identified to successfully detect bone marrow fat, which is beneficial to the diagnosis of the severity of SIONFH.
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Affiliation(s)
- Xiaorui Han
- Division of Biomedical Engineering, School of Medicine, South China University of Technology, Guangzhou, Guangdong 510006, China
- Department of Radiology, Guangdong Provincial People’s Hospital/Guangdong Academy of Medical Science, Guangzhou, Guangdong 510080, China
| | - Guoju Hong
- Traumatology and Orthopedics Institute, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China
- Department of Orthopedic, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China
- Division of Orthopedic Surgery, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
| | - Yuan Guo
- Department of Radiology, Guangzhou First People’s Hospital/the Second Affiliated Hospital of South China University of Technology, Guangzhou, Guangdong, 510180, China
| | - Hongzhen Wu
- Department of Radiology, Guangzhou First People’s Hospital/the Second Affiliated Hospital of South China University of Technology, Guangzhou, Guangdong, 510180, China
| | - Ping Sun
- Department of Endocrinology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong 510080, China
| | - Qiushi Wei
- Traumatology and Orthopedics Institute, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China
- Department of Orthopedic, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China
| | - Zhenqiu Chen
- Traumatology and Orthopedics Institute, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China
- Department of Orthopedic, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China
| | - Wei He
- Traumatology and Orthopedics Institute, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China
- Department of Orthopedic, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China
| | - Zaiyi Liu
- Division of Biomedical Engineering, School of Medicine, South China University of Technology, Guangzhou, Guangdong 510006, China
- Department of Radiology, Guangdong Provincial People’s Hospital/Guangdong Academy of Medical Science, Guangzhou, Guangdong 510080, China
| | - Changhong Liang
- Division of Biomedical Engineering, School of Medicine, South China University of Technology, Guangzhou, Guangdong 510006, China
- Department of Radiology, Guangdong Provincial People’s Hospital/Guangdong Academy of Medical Science, Guangzhou, Guangdong 510080, China
- Correspondence to: C. Liang. E-mail:
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Sheng Z, Xiaoping H, Lu D, XiZhe W, Jie Z, Qing L, Yong C. Identification of key non-coding RNAs and transcription factors regulators and their potential drugs for steroid-induced femoral head necrosis. Genomics 2020; 113:490-496. [PMID: 33385494 DOI: 10.1016/j.ygeno.2020.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 09/20/2020] [Accepted: 12/22/2020] [Indexed: 12/09/2022]
Abstract
Steroid-induced necrosis of femoral head (SINFH) is a femoral head necrotic disease caused by prolonged use of hormones. The detailed pathogenesis has not been fully demonstrated. In this study, we employed the bioinformatics approach to probe the roles of SINFH inhibitors. Core dysfunction modules related to SINFH was obtained. Meanwhile, GO and KEGG analysis of genes in dysfunction modules are carried out. Furthermore, the pivot prediction analysis of dysfunction modules related to ncRNA and transcription factor (TF) has been performed. The functions of the enriched modules were focused on multiple perspectives, including circulation, gland development, bone development and reconstruction, calcium production, and fatty acid metabolism regulation. The ncRNAs and TFs analysis showed that miR-322-5p, miR-124-3p, miR-125a-3p, and Ctnnb1 were important members of SINFH dysfunction. Drug targets suggested that Zinc and adenosine monophosphate may have an impact on SINFH dysfunction. SINFH was closely related to bone development and reconstruction.
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Affiliation(s)
- Zhai Sheng
- The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China
| | - Han Xiaoping
- The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China
| | - Ding Lu
- The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China
| | - Wang XiZhe
- The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China
| | - Zhang Jie
- The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China
| | - Lv Qing
- The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China
| | - Cui Yong
- The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China.
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Wang X, Li J, Man D, Liu R, Zhao J. Early detection of steroid-induced femoral head necrosis using 99mTc-Cys-Annexin V-based apoptosis imaging in a rabbit model. Mol Med 2020; 26:120. [PMID: 33272196 PMCID: PMC7711260 DOI: 10.1186/s10020-020-00248-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/24/2020] [Indexed: 11/21/2022] Open
Abstract
Background At present, the early diagnosis of femoral head necrosis mainly relies on Magnetic resonance imaging (MRI), and most early patients are difficult to make an accurate diagnosis. Therefore, to investigate the early diagnostic value of 99mTc-Cys-Annexin V Single-photon emission computed tomography (SPECT) imaging were compared with MRI in rabbit models of steroid-induced femoral head necrosis. Methods The animal model of steroid-induced femoral head necrosis (SIFHN) was established in 5-month-old healthy New Zealand white rabbits by injecting horse serum into ear vein and methylprednisolone into gluteal muscle, the purpose of modeling is to simulate the actual clinical situation of SIFNH. 99mTc-Cys-Annexin V SPECT imaging and MRI were performed at 2nd week, 4th week, and 6th week after modeling. After that, histopathology was used to verify the success of modeling. Apoptosis was detected by transmission electron microscopy (TEM) and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay (TUNEL). Results At 2 weeks after the injection of hormone, 99mTc-Cys-Annexin V SPECT image showed abnormal radioactive uptake in the bilateral femoral head. And over time, the radioactivity concentration was more obvious, and the ratio of T/NT (target tissue/non-target tissues, which is the ratio of femoral head and the ipsilateral femoral shaft) was gradually increased. In the 99mTc-Cys-Annexin V SPECT imaging at each time point, T/NT ratio of the model group was significantly higher than that of the control group (P < 0.01); at 4 weeks after the injection of hormone, MRI showed an abnormal signal of osteonecrosis. At 2, 4, and 6 weeks after hormone injection, apoptosis was observed by TUNEL and TEM. Conclusions 99mTc-Cys-Annexin V SPECT imaging can diagnose steroid-induced femoral head necrosis earlier than MRI, and has potential application value for non-invasively detecting early and even ultra-early stage of femoral head necrosis.
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Affiliation(s)
- Xiaolong Wang
- Department of Hand and Foot Microsurgery, Second Affiliated Hospital of Inner Mongolia Medical University, No. 1 Yingfang Road, Hohhot, 010030, China
| | - Jianbo Li
- Department of Nuclear Medicine, Inner Mongolia Medical University Affiliated Hospital, No. 1 Tongdao North Street, Hohhot, 010050, China.,Key Laboratory of Molecular Imaging, Inner Mongolia Autonomous Region, No. 1 Tongdao North Street, Hohhot, 010050, China
| | - Da Man
- Department of Hand and Foot Microsurgery, Second Affiliated Hospital of Inner Mongolia Medical University, No. 1 Yingfang Road, Hohhot, 010030, China
| | - Rui Liu
- Department of Orthopaedics, Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdao North Street, Hohhot, 010050, China
| | - Jianmin Zhao
- Department of Orthopaedics, Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdao North Street, Hohhot, 010050, China.
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Ducros A. Oral steroids for episodic cluster headache. Lancet Neurol 2020; 20:19-20. [PMID: 33245859 DOI: 10.1016/s1474-4422(20)30402-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Anne Ducros
- Department of Neurology, Gui de Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier 34000, France.
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Li WL, Tan B, Jia ZX, Dong B, Huang ZQ, Zhu RZ, Zhao W, Gao HH, Wang RT, Chen WH. Exploring the Risk Factors for the Misdiagnosis of Osteonecrosis of Femoral Head: A Case-Control Study. Orthop Surg 2020; 12:1792-1798. [PMID: 33063422 PMCID: PMC7767694 DOI: 10.1111/os.12821] [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: 03/09/2020] [Revised: 09/11/2020] [Accepted: 09/12/2020] [Indexed: 12/14/2022] Open
Abstract
Objective The purpose of the present study was to evaluate the present situation and risk factors for the misdiagnosis of osteonecrosis of femoral head (ONFH), providing the basis for accurate diagnosis of ONFH. Methods For this retrospective study, 1471 patients with ONFH were selected from the China Osteonecrosis of Femoral Head Database (CONFHD). These patients had been recruited between July 2016 and December 2018. According to whether or not they were misdiagnosed, the patients were divided into two groups, with 1168 cases (22–84 years old) included in the diagnosis group and 303 cases (21–80 years old) in the misdiagnosis group. Misdiagnosis was measured using the following criteria: (i) the patient had the same symptoms and signs, and the second diagnosis was not consistent with the initial diagnosis within 6 months; and (ii) the patient was admitted to a hospital participating in CONFHD and the previous diagnosis was inconsistent with the diagnosis given by the expert group. Comparisons of age, visual analogue scale for pain, and body mass index between the two groups were performed using a t‐test. Gender, causes of ONFH, primary diseases requiring corticosteroids, methods of corticosteroid use, corticosteroid species, type of trauma, onset side of the disease, pain side, whether symptoms are hidden, and type of imaging examination at the initial visit were compared using the χ2‐test. Years of alcohol consumption, weekly alcohol consumption, and physician title at the initial visit were compared using a Mann–Whitney U‐test. Furthermore, the statistically significant factors were evaluated using multiple regression analysis to investigate the risk factors of misdiagnosis. Results A total of 303 patients (20.6%) were misdiagnosed: 118 cases were misdiagnosed as lumbar disc herniation, 86 cases as hip synovitis, 48 cases as hip osteoarthritis, 32 cases as rheumatoid arthritis, 11 cases as piriformis syndrome, 5 cases as sciatica, and 3 cases as soft‐tissue injury. Whether symptoms are hidden (P = 0.038, odds ratio [OR] = 1.546, 95% confidence interval [CI] = 1.025–2.332), physician title at the initial visit (P < 0.001, OR = 3.324, 95% CI = 1.850–5.972), X‐ray examination (P < 0.001, OR = 4.742, 95% CI = 3.159–7.118), corticosteroids (P < 0.001, OR = 0.295, 95% CI = 0.163–0.534), alcohol (P < 0.001, OR = 0.305, 95% CI = 0.171–0.546), and magnetic resonance imaging (MRI) examination (P = 0.042, OR = 0.649, 95% CI = 0.427–0.985) were each found to be associated with misdiagnosis. Conclusion Osteonecrosis of the femoral head is easily misdiagnosed as lumbar disc herniation, hip synovitis, hip osteoarthritis, and rheumatoid arthritis. Patient history of corticosteroid use or alcohol abuse and MRI examination at the initial diagnosis may be protective factors for misdiagnosis. Hidden symptoms, physician title at the initial visit (as attending doctor or resident doctor), and only X‐ray examination at the initial diagnosis may be risk factors for misdiagnosis.
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Affiliation(s)
- Wen-Long Li
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Biao Tan
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhao-Xu Jia
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Bo Dong
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Ze-Qing Huang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Rui-Zheng Zhu
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Wei Zhao
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Huan-Huan Gao
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Rong-Tian Wang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Wei-Heng Chen
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
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Wang XY, Gong LJ, Huang JM, Jiang C, Yan ZQ. Pinocembrin alleviates glucocorticoid-induced apoptosis by activating autophagy via suppressing the PI3K/Akt/mTOR pathway in osteocytes. Eur J Pharmacol 2020; 880:173212. [PMID: 32470335 DOI: 10.1016/j.ejphar.2020.173212] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 12/20/2022]
Abstract
Glucocorticoids are widely used in clinical practice, but are associated with potentially severe side effects like glucocorticoid-induced osteoporosis (GIOP) and glucocorticoid-associated osteonecrosis of the femoral head (GA-ONFH). Glucocorticoid-induced osteocyte apoptosis plays critical roles in the pathological processes of both GIOP and GA-ONFH. Pinocembrin is a natural flavonoid that may exert protective effects on osteocytes. The present study investigated the effects of pinocembrin on glucocorticoid-induced apoptosis of murine long bone osteocyte Y4 (MLO-Y4) cells and sought to elucidate the underlying molecular mechanism. We found that pinocembrin attenuated glucocorticoid-induced cell viability injury and apoptosis of MLO-Y4 cells. Moreover, pinocembrin increased Beclin-1 and LC3B-II level, but decreased p62 expression, suggesting that pinocembrin activates autophagy in glucocorticoid-treated MLO-Y4 cells. The protective effects of pinocembrin on glucocorticoid-induced apoptosis of MLO-Y4 cells were mimicked by a known stimulator of autophagy but prevented by a known inhibitor of autophagy. Pinocembrin also suppressed the PI3K/Akt/mTOR signaling pathway, which regulates cell autophagy, in glucocorticoid-treated MLO-Y4 cells. In conclusion, the results indicate that pinocembrin alleviates glucocorticoid-induced osteocyte apoptosis by activating autophagy via suppressing the PI3K/Akt/mTOR pathway. Pinocembrin may represent a potential natural agent for preventing and treating GIOP and GA-ONFH.
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Affiliation(s)
- Xin-Yuan Wang
- Department of Orthopaedics, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Lin-Jing Gong
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Jun-Ming Huang
- Department of Orthopaedics, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Chang Jiang
- Department of Orthopaedics, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Zuo-Qin Yan
- Department of Orthopaedics, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Jin Y, Zhu HX, Wei BF. Reduced serum and local LncRNA MALAT1 expressions are linked with disease severity in patients with non-traumatic osteonecrosis of the femoral head. Technol Health Care 2020; 29:479-488. [PMID: 32716338 DOI: 10.3233/thc-202244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study was performed to illustrate the potential relationship between reduced serum and local LncRNA MALAT1 expressions with disease severity in patients with non-traumatic osteonecrosis of the femoral head (ONFH). METHODS A total of 104 patients with non-traumatic ONFH and 100 healthy controls were consecutively recruited from our hospital. Serum and local LncRNA MALAT1 expressions were detected using real-time polymerase chain reaction (RT-PCR). Radiographic progression was defined by Ficat classification. Clinical severity was evaluated by Visual Analog Scale (VAS) and Harris Hip Score (HHS). Receiver operating characteristic (ROC) curve was carried out to determine the diagnostic value of MALAT1 in the radiographic progression. RESULTS Serum LncRNA MALAT1 expressions were significantly lower in non-traumatic ONFH patients than in healthy controls. In addition, local MALAT1 expressions in non-traumatic ONFH tissue were significantly lower in the affected area than in the non-affected area. Ficat grade 4 has significantly lower serum and local LncRNA MALAT1 expressions in comparison with grade 3, and Ficat grade 3 showed markedly decreased serum and local LncRNA MALAT1 expressions compared with grade 2. Serum and local LncRNA MALAT1 expressions were significantly and negatively associated with VAS and positively related to the HHS. Further ROC curve analysis indicated that serum MALAT1 may act as a decent indicator in the diagnosis of non-traumatic ONFH. CONCLUSIONS Decreased serum and local MALAT1 expressions may reflect disease severity in non-traumatic ONFH patients.
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Affiliation(s)
- Yan Jin
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Department of Rehabilitation, Linyi People's Hospital, Linyi, Shandong, China
| | - Hong-Xun Zhu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Department of Orthopedics, Linyi People's Hospital, Linyi, Shandong, China
| | - Biao-Fang Wei
- Department of Orthopedics, Linyi People's Hospital, Linyi, Shandong, China
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Tang C, Wang Y, Lv H, Guan Z, Gu J. Caution against corticosteroid-based COVID-19 treatment. Lancet 2020; 395:1759-1760. [PMID: 32464115 PMCID: PMC7247780 DOI: 10.1016/s0140-6736(20)30749-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/19/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Chong Tang
- Department of Orthopedics, Peking University Shougang Hospital, Beijing 100144, China
| | - Yichuan Wang
- Department of Orthopedics, Peking University Shougang Hospital, Beijing 100144, China
| | - Houshan Lv
- Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, China
| | - Zhenpeng Guan
- Department of Orthopedics, Peking University Shougang Hospital, Beijing 100144, China.
| | - Jin Gu
- Gastrointestinal Cancer Center, Peking University Cancer Hospital, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China; Department of Gastrointestinal Surgery, Peking University Shougang Hospital, Shijingshan District, Beijing, China
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Zhang M, Chen D, Zhang F, Zhang G, Wang Y, Zhang Q, He W, Wang H, Chen P. Serum exosomal hsa-miR-135b-5p serves as a potential diagnostic biomarker in steroid-induced osteonecrosis of femoral head. Am J Transl Res 2020; 12:2136-2154. [PMID: 32509207 PMCID: PMC7269975 DOI: pmid/32509207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/27/2020] [Indexed: 02/05/2023]
Abstract
Accumulating studies have demonstrated serum exosomal microRNAs (miRNAs) represent novel biomarkers for various diseases. In this study, we aimed to explore the feasibility of using serum exosomal miRNAs as novel serological biomarkers for steroid-induced osteonecrosis of femoral head (SONFH). We identified the characters of exosomes which were obtained from fresh serum of 5 systemic lupus erythematosus (SLE) patients without SONFH, 5 SLE patients with SONFH (SLE-SONFH) and 5 healthy ones. Comprehensive exosomal miRNA sequencing was performed to profile the differentially expressed miRNAs in the three groups. We then validated the expression levels of selected miRNAs by qRT-PCR. Furthermore, KEGG pathway, GO annotation, protein-protein interaction (PPI) network, module analysis and miRNAs-mRNAs interaction network were built to analyze the potential targets and mechanism. Sequencing data conveyed that hsa-miR-135b-5p, hsa-miR-150-5p, hsa-miR-509-3-5p, hsa-miR-514a-3p and hsa-miR-708-5p were significantly differentially expressed in the three groups. The results of qRT-PCR for the first time confirmed that the expression of hsa-miR-135b-5p was strikingly up-regulated in SLE-SONFH group which were consistent with miRNA sequencing results. In addition, bioinformatics analysis indicated that the enriched functions and pathways of the most differentially expressed miRNAs including Wnt, MAPK as well as Hippo signaling pathway. The top five hub genes (FGF2, PTEN, HACE1, VAMP2, and CBL) were part of module of the PPI network, which consisted of 713 nodes and 2191 edges. In conclusion, this study provides a novel and fundamental serum exosomal miRNAs profile of SONFH and hsa-miR-135b-5p may be identified as a unique diagnostic biomarker for SONFH.
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Affiliation(s)
- Meng Zhang
- The First School of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhou 510405, China
- Lingnan Medical Research Center, Guangzhou University of Chinese MedicineGuangzhou 510405, China
| | - Delong Chen
- Department of Orthopaedic Surgery, Clifford Hospital, Jinan UniversityGuangzhou 510006, China
| | - Fan Zhang
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical CollegeShantou 515041, China
| | - Gangyu Zhang
- The First School of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhou 510405, China
- Lingnan Medical Research Center, Guangzhou University of Chinese MedicineGuangzhou 510405, China
| | - Yueqi Wang
- Guangzhou Orthopaedic HospitalGuangzhou 510045, China
| | - Qingwen Zhang
- Hip Center, Guangzhou University of Chinese MedicineGuangzhou 510405, China
- Orthopedics Department, The First Affiliated Hospital, Guangzhou University of Chinese MedicineGuangzhou 510405, China
| | - Wei He
- Hip Center, Guangzhou University of Chinese MedicineGuangzhou 510405, China
- Orthopedics Department, The First Affiliated Hospital, Guangzhou University of Chinese MedicineGuangzhou 510405, China
| | - Haibin Wang
- Hip Center, Guangzhou University of Chinese MedicineGuangzhou 510405, China
- Orthopedics Department, The First Affiliated Hospital, Guangzhou University of Chinese MedicineGuangzhou 510405, China
| | - Peng Chen
- Hip Center, Guangzhou University of Chinese MedicineGuangzhou 510405, China
- Orthopedics Department, The First Affiliated Hospital, Guangzhou University of Chinese MedicineGuangzhou 510405, China
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Khalili M, Chegeni M, Javadi S, Farokhnia M, Sharifi H, Karamouzian M. Therapeutic interventions for COVID-19: a living overview of reviews. Ther Adv Respir Dis 2020; 14:1753466620976021. [PMID: 33326318 PMCID: PMC7747112 DOI: 10.1177/1753466620976021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/21/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, but safe and effective treatment options remain unavailable. Numerous systematic reviews of varying qualities have tried to summarize the evidence on the available therapeutic interventions for COVID-19. This overview of reviews aims to provide a succinct summary of the findings of systematic reviews on different pharmacological and non-pharmacological therapeutic interventions for COVID-19. METHODS We searched PubMed, Embase, Google Scholar, Cochrane Database of Systematic Reviews, and WHO database of publications on COVID-19 from 1 December 2019 through to 11 June 2020 for peer-reviewed systematic review studies that reported on potential pharmacological or non-pharmacological therapies for COVID-19. Quality assessment was completed using A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) measure. RESULTS Out of 816 non-duplicate studies, 45 were included in the overview. Antiviral and antibiotic agents, corticosteroids, and anti-malarial agents were the most common drug classes used to treat COVID-19; however, there was no direct or strong evidence to support their efficacy. Oxygen therapy and ventilatory support was the most common non-pharmacological supportive care. The quality of most of the included reviews was rated as low or critically low. CONCLUSION This overview of reviews demonstrates that although some therapeutic interventions may be beneficial to specific subgroups of COVID-19 patients, the available data are insufficient to strongly recommend any particular treatment option to be used at a population level. Future systematic reviews on COVID-19 treatments should adhere to the recommended systematic review methodologies and ensure that promptness and comprehensiveness are balanced.The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Malahat Khalili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Chegeni
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Javadi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehrdad Farokhnia
- Department of Internal Medicine, Faculty of Medicine, Afzalipour Hospital, Kerman University of Medical School, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
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Ma L, Feng X, Wang K, Song Y, Luo R, Yang C. Dexamethasone promotes mesenchymal stem cell apoptosis and inhibits osteogenesis by disrupting mitochondrial dynamics. FEBS Open Bio 2019; 10:211-220. [PMID: 31788976 PMCID: PMC6996403 DOI: 10.1002/2211-5463.12771] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/07/2019] [Accepted: 11/29/2019] [Indexed: 02/06/2023] Open
Abstract
Long‐term or heavy use of glucocorticoids can cause severe necrosis of the femoral head, but the underlying mechanisms are still unclear. Recent studies have found that mitochondrial dynamics play an important role in femoral head necrosis. Here, we investigated the effect of dexamethasone on the mitochondrial function of mesenchymal stem cells. We observed that high concentrations of dexamethasone (10−6 mol·L−1) decreased cell activity, promoted apoptosis, elevated levels of reactive oxygen species and disrupted mitochondrial dynamics. Furthermore, dexamethasone (10−6 mol·L−1) inhibited osteogenesis of stem cells and promoted adipogenesis. These findings may facilitate greater understanding of the adverse effects of dexamethasone on the femoral head.
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Affiliation(s)
- Liang Ma
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaobo Feng
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Song
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rongjin Luo
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cao Yang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Liu P, Zhang QD, Wang Y, Xia ZQ, Lu FF, Liu ZH, Wang WG, Guo WS. One-stage total hip arthroplasty and "light-bulb" procedure for bilateral non-traumatic osteonecrosis of femoral head in different stages. Chin Med J (Engl) 2019; 132:2883-2885. [PMID: 31856062 PMCID: PMC6940075 DOI: 10.1097/cm9.0000000000000545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Pei Liu
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Qi-Dong Zhang
- Department of Orthopedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yang Wang
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Zi-Qi Xia
- Beijing University of Chinese Medicine, Beijing 100029, China
| | - Fei-Fan Lu
- China-Japan Friendship School of Clinical Medicine, Peking University, Beijing 100029, China
| | - Zhao-Hui Liu
- Department of Orthopedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing 100029, China
| | - Wei-Guo Wang
- Department of Orthopedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing 100029, China
| | - Wan-Shou Guo
- Department of Orthopedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing 100029, China
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Lu J, Yang J, Zheng Y, Chen X, Fang S. Extracellular vesicles from endothelial progenitor cells prevent steroid-induced osteoporosis by suppressing the ferroptotic pathway in mouse osteoblasts based on bioinformatics evidence. Sci Rep 2019; 9:16130. [PMID: 31695092 PMCID: PMC6834614 DOI: 10.1038/s41598-019-52513-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/17/2019] [Indexed: 12/21/2022] Open
Abstract
Abnormal antioxidative capabilities were observed in the pathogenesis of steroid-induced osteoporosis (SIOP). Ferroptosis is a recently discovered type of cell death that is characterized by the overproduction of ROS in response to GPX4 and system Xc- downregulation, which is mediated by an Fe2+ fenton reaction. However, investigations focusing on the relationship between ferroptosis and steroid-induced bone disease remain limited. In the present study, high-dose dexamethasone was used to establish a mouse SIOP model, and extracellular vesicles extracted from bone marrow-derived endothelial progenitor cells (EPC-EVs) alleviated the pathological changes in SIOP via microtomography (micro-CT), with elevations in bone volume (BV), bone surface (BS), trabecular thickness (Tb.Th), and trabecular connectivity density (Conn-D) and decreases in trabecular separation (Tb.sp) and the structure model index (SMI). Histopathological analysis, such as haematoxylin and eosin (HE) and Masson staining, showed that EPC-EVs treatment increased the volume and density of the trabecular bone and bone marrow. RNA sequencing (RNA-seq) and bioinformatics analysis revealed subcellular biological alterations upon steroid and EPC-EVs treatment. Compared with the control, high-dose dexamethasone downregulated GPX4 and system XC-, and the Kyoto Encyclopedia of Genes and Genomes (KEGG)-based gene set enrichment analysis suggested that the ferroptotic pathway was activated. In contrast, combination treatment with EPC-EVs partly reversed the KEGG-mapped changes in the ferroptotic pathway at both the gene and mRNA expression levels. In addition, alterations in ferroptotic marker expression, such as SLC3A2, SLC7A11, and GPX4, were further confirmed by RNA-seq. EPC-EVs were able to reverse dexamethasone treatment-induced alterations in cysteine and several oxidative injury markers, such as malondialdehyde (MDA), glutathione (GSH), and glutathione disulphide (GSSG) (as detected by ELISA). In conclusion, EPC-EVs prevented mouse glucocorticoid-induced osteoporosis by suppressing the ferroptotic pathway in osteoblasts, which may provide a basis for novel therapies for SIOP in humans.
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Affiliation(s)
- Jinsen Lu
- Department of Orthopaedics, Anhui Provincial Hospital, Anhui Medical University, Lujiang Road No. 17, 230001, Hefei, China.
| | - Jiazhao Yang
- Department of Orthopaedics, Anhui Provincial Hospital, Anhui Medical University, Lujiang Road No. 17, 230001, Hefei, China
| | - Yongshun Zheng
- Department of Orthopaedics, Anhui Provincial Hospital, Anhui Medical University, Lujiang Road No. 17, 230001, Hefei, China
| | - Xiaoyu Chen
- Department of Histology and Embryology, Anhui Medical University, Meishan Road No. 81, 230032, Hefei, China
| | - Shiyuan Fang
- Department of Orthopaedics, Anhui Provincial Hospital, Anhui Medical University, Lujiang Road No. 17, 230001, Hefei, China.
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Zhao X, Wei Z, Li D, Yang Z, Tian M, Kang P. Glucocorticoid Enhanced the Expression of Ski in Osteonecrosis of Femoral Head: The Effect on Adipogenesis of Rabbit BMSCs. Calcif Tissue Int 2019; 105:506-517. [PMID: 31359074 DOI: 10.1007/s00223-019-00592-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/22/2019] [Indexed: 02/05/2023]
Abstract
Glucocorticoid (GC)-induced osteonecrosis has been considered as the most serious side effect in long-term or over-dose steroid therapy. The decreased bone mass and increased marrow fat tissue demonstrated that GC can destroy the normal differentiation of bone marrow mesenchymal stem cells (BMSCs), which accelerates adipogenesis but not osteogenesis. However, the underlying mechanisms are still unclear. Ski, an evolutionary conserved protein, is a multifunctional transcriptional regulator that involved in regulating signaling pathways associated with adipogenesis differentiation, but the concrete function remains unclear. In this work, we first established a methylprednisolone (MPS)-induced osteonecrosis of femoral head (ONFH) rabbit model, in which the expression of Ski, PPAR-γ, and FABP4 was up-regulated compared with control group, and then we induced the isolated BMSCs from rabbit with dexamethasone (Dex) in vitro and the results showed that the Ski expression was up-regulated by Dex in a dose- and time-dependent manner. Therefore, we demonstrated that the expression of Ski was up-regulated in glucocorticoid-related osteonecrosis disease in vivo and in vitro. Moreover, the adipogenesis differentiation capacity of BMSCs was enhanced after induced by Dex, which was identified by Oil Red O staining, and the up-regulated PPAR-γ and FABP4 expression. To further study the function of Ski in BMSC after induced by Dex, Ski specific small interfering RNA (Ski-siRNA) was used. Results showed that knockdown of Ski obviously decreased adipogenesis differentiation evident by Oil Red O staining, and the expression of PPAR-γ and FABP4 was down-regulated simultaneously. Collectively, our findings suggest that Ski increased significantly during glucocorticoid-induced adipogenic differentiation of BMSCs, and the expression level was consistent with adipogenic-related proteins including PPAR-γ and FABP4. Based on the above data, we believe that Ski might become a new molecule in the treatment of GC-induced ONFH and our study could provide a basis for further study on the detailed function of Ski in ONFH.
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Affiliation(s)
- Xin Zhao
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Zhun Wei
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Donghai Li
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Zhouyuan Yang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Meng Tian
- Neurosurgery Research Laboratory, West China Hospital, Sichuan Univerisity, Chengdu, Sichuan, 610041, People's Republic of China.
| | - Pengde Kang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Road, Chengdu, 610041, People's Republic of China.
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[Pathophysiology of aseptic femoral head necrosis: Pathogenesis and histopathological differential diagnosis]. DER ORTHOPADE 2019; 47:710-716. [PMID: 30062451 DOI: 10.1007/s00132-018-3608-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Aseptic osteonecrosis is characterized by a complete death of the tissue (necrosis), more specifically, an ischemic necrosis of the lamellar bone tissue. The denotation aseptic refers to causal pathogenesis; therefore, it is not a matter of an infectious, septic-induced bone necrosis as in the case of acute infectious osteomyelitis. Formal pathogenesis leads to either (1) a hypoperfusion of the lamellar bone in the sense of an ischemic necrosis or (2) to directly induced damage of osteocytes and osteoblasts, which causes aseptic osteonecrosis. CAUSE The causes of hypoperfusion/ischemia are manifold and entail vascular malformations, coagulopathies, haemoglobinopathies, thrombotic embolisms, myeloproliferative illnesses, air embolisms, decompression-caused illnesses, macro as well as micro traumata and, finally, vasculitis with necrosis, which complete the vascular-induced spectrum. Direct toxic damage to the osteocytes and osteoblasts is primarily caused by alcohol abuse, medical drug therapies (i. e. chemotherapeutic substances or cortisone) and disorders of the lipid embolism. Contemporary molecular and cellular models of pathogenesis assume a so-called dysbalance of the catabolic and anabolic osseous metabolism in osteocytes and osteoblasts. The RANKL-RANK system, the ROS system and PPAR-gamma signal transduction are involved in the molecular pathogenesis. DIFFERENTIAL DIAGNOSIS The most relevant histopathologic differential diagnosis entails the complete spectrum of focal osseous changes among which osteonecrosis can occur to a diverse extent: infectious osteomyelitis, chronic immunologic induced osteomyelitis, pseudoarthrosis, infected pseudoarthrosis, bone fractures and malignant metastatic intraosseous diseases and non-metastatic intraosseous malignant diseases.
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Abstract
In this report, we deliver a concise and up-to-date review of osteonecrosis, a pathologic, painful, and often disabling condition that is believed to result from the temporary or permanent disruption of blood supply to an affected area of bone. We will discuss the epidemiology (disease distribution), pathogenesis (mechanism of development), etiology (associated risk factors, causes, and disorders), clinical manifestations (reported symptoms and physical findings), diagnosis and classification, and treatment options for hip osteonecrosis.
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Affiliation(s)
| | - Nipun Sodhi
- Department of Orthopedic Surgery, Northwell Health Lenox Hill Hospital, New York, NY
| | - Michael A Mont
- Department of Orthopedic Surgery, Northwell Health Lenox Hill Hospital, New York, NY
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