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Chen Y, Wu J, Wong C, Gao W, Qi X, Zhou H. Disturbed glycolipid metabolism activates CXCL13-CXCR5 axis in senescent TSCs to promote heterotopic ossification. Cell Mol Life Sci 2024; 81:265. [PMID: 38880863 DOI: 10.1007/s00018-024-05302-3] [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: 11/16/2023] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/18/2024]
Abstract
Heterotopic ossification (HO) occurs as a common complication after injury, while its risk factor and mechanism remain unclear, which restricts the development of pharmacological treatment. Clinical research suggests that diabetes mellitus (DM) patients are prone to developing HO in the tendon, but solid evidence and mechanical research are still needed. Here, we combined the clinical samples and the DM mice model to identify that disordered glycolipid metabolism aggravates the senescence of tendon-derived stem cells (TSCs) and promotes osteogenic differentiation. Then, combining the RNA-seq results of the aging tendon, we detected the abnormally activated autocrine CXCL13-CXCR5 axis in TSCs cultured in a high fat, high glucose (HFHG) environment and also in the aged tendon. Genetic inhibition of CXCL13 successfully alleviated HO formation in DM mice, providing a potential therapeutic target for suppressing HO formation in DM patients after trauma or surgery.
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Affiliation(s)
- Yuyu Chen
- Department of Plastic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jinna Wu
- Department of Breast Surgery, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, China
| | - Chipiu Wong
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, 510120, China
| | - Wenjie Gao
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, 510120, China.
| | - Xiangdong Qi
- Department of Plastic Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Hang Zhou
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, 510120, China.
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2
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Cong Q, Yang Y. Hedgehog Signaling Controls Chondrogenesis and Ectopic Bone Formation via the Yap-Ihh Axis. Biomolecules 2024; 14:347. [PMID: 38540766 PMCID: PMC10968511 DOI: 10.3390/biom14030347] [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: 02/01/2024] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 07/16/2024] Open
Abstract
Fibrodysplasia ossificans progressiva (FOP) is a rare congenital disorder characterized by abnormal bone formation due to ACVR1 gene mutations. The identification of the molecular mechanisms underlying the ectopic bone formation and expansion in FOP is critical for the effective treatment or prevention of HO. Here we find that Hh signaling activation is required for the aberrant ectopic bone formation in FOP. We show that the expression of Indian hedgehog (Ihh), a Hh ligand, as well as downstream Hh signaling, was increased in ectopic bone lesions in Acvr1R206H; ScxCre mice. Pharmacological treatment with an Ihh-neutralizing monoclonal antibody dramatically reduced chondrogenesis and ectopic bone formation. Moreover, we find that the activation of Yap in the FOP mouse model and the genetic deletion of Yap halted ectopic bone formation and decreased Ihh expression. Our mechanistic studies showed that Yap and Smad1 directly bind to the Ihh promoter and coordinate to induce chondrogenesis by promoting Ihh expression. Therefore, the Yap activation in FOP lesions promoted ectopic bone formation and expansion in both cell-autonomous and non-cell-autonomous manners. These results uncovered the crucial role of the Yap-Ihh axis in FOP pathogenesis, suggesting the inhibition of Ihh or Yap as a potential therapeutic strategy to prevent and reduce HO.
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Affiliation(s)
- Qian Cong
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, Boston, MA 02115, USA;
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3
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Ertogrul R, Sahin K, Celik H, Kapicioglu M, Ersen A, Bilsel K. Is coracoclavicular ossification a complication or a good prognostic factor after surgical treatment of acromioclavicular joint injury? JSES Int 2022; 6:769-774. [PMID: 36081692 PMCID: PMC9445996 DOI: 10.1016/j.jseint.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The purpose of this study was to investigate whether heterotopic ossification (HO) in the coracoclavicular (CC) space after surgical treatment of acromioclavicular joint (ACJ) injury is a complication or a sign of good prognosis. Methods Fifty-nine consecutive patients who underwent CC reconstruction with or without augmentation of the ACJ for acute ACJ injuries were analyzed. Postoperative American Shoulder and Elbow Surgeons (ASES) score, Constant score (CS), subjective shoulder value (SSV), and visual analog scale (VAS) results were evaluated. For radiological evaluation, HO was evaluated, and CC distances were measured. Results Fifty-one patients (11 women and 40 men; mean age, 36 years [range, 17-68 years]) were evaluated after a mean follow-up of 3 years (range, 2-8 years). The mean ASES score at the follow-up was 82.73 (range, 51.6-100), mean CS was 85 (range, 50-100), mean SSV was 80 (range, 40-100), and mean VAS was 1.9 (range, 0-5). It was observed that the clinical outcomes (ASES, CS, SSV, VAS) of patients who developed ossification in the CC space were better than those who did not although it was not statistically significant. No statistically significant differences were found in the clinical outcomes (ASES, CS, SSV, VAS) between patients who underwent CC reconstruction without augmentation of the ACJ and those who were combined (P > .05). Conclusion HO in the CC space is a common finding following AC joint fixation injury. We suggest that HO is not a complication and might possibly have positive effects on clinical outcomes.
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Affiliation(s)
- Rodi Ertogrul
- Sisli Hamidiye Etfal Training and Research Hospital, Orthopaedics Department, Istanbul, Turkey
| | - Koray Sahin
- Mus State Hospital, Department of Orthopaedics and Traumatology, Muş, Turkey
| | - Haluk Celik
- Hisar Intercontinental Private Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Bezmialem Vakif University, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Ali Ersen
- Istanbul University, Istanbul Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Kerem Bilsel
- Bezmialem Vakif University, Department of Orthopaedics and Traumatology, Istanbul, Turkey
- Corresponding author: Kerem Bilsel, MD, Bezmialem Vakif Universitesi Tip Fakultesi Hastanesi, vatan street, Fatih, istanbul 34093, Turkey.
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4
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Xu Y, Huang M, He W, He C, Chen K, Hou J, Huang M, Jiao Y, Liu R, Zou N, Liu L, Li C. Heterotopic Ossification: Clinical Features, Basic Researches, and Mechanical Stimulations. Front Cell Dev Biol 2022; 10:770931. [PMID: 35145964 PMCID: PMC8824234 DOI: 10.3389/fcell.2022.770931] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 01/03/2022] [Indexed: 12/13/2022] Open
Abstract
Heterotopic ossification (HO) is defined as the occurrence of extraskeletal bone in soft tissue. Although this pathological osteogenesis process involves the participation of osteoblasts and osteoclasts during the formation of bone structures, it differs from normal physiological osteogenesis in many features. In this article, the primary characteristics of heterotopic ossification are reviewed from both clinical and basic research perspectives, with a special highlight on the influence of mechanics on heterotopic ossification, which serves an important role in the prophylaxis and treatment of HO.
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Affiliation(s)
- Yili Xu
- Department of Endocrinology, Endocrinology Research Center, The Xiangya Hospital of Central South University, Changsha, China
| | - Mei Huang
- Department of Endocrinology, Endocrinology Research Center, The Xiangya Hospital of Central South University, Changsha, China
| | - Wenzhen He
- Department of Endocrinology, Endocrinology Research Center, The Xiangya Hospital of Central South University, Changsha, China
| | - Chen He
- Department of Endocrinology, Endocrinology Research Center, The Xiangya Hospital of Central South University, Changsha, China
| | - Kaixuan Chen
- Department of Endocrinology, Endocrinology Research Center, The Xiangya Hospital of Central South University, Changsha, China
| | - Jing Hou
- Department of Endocrinology, Endocrinology Research Center, The Xiangya Hospital of Central South University, Changsha, China
| | - Min Huang
- Department of Endocrinology, Endocrinology Research Center, The Xiangya Hospital of Central South University, Changsha, China
| | - Yurui Jiao
- Department of Endocrinology, Endocrinology Research Center, The Xiangya Hospital of Central South University, Changsha, China
| | - Ran Liu
- Department of Endocrinology, Endocrinology Research Center, The Xiangya Hospital of Central South University, Changsha, China
| | - Nanyu Zou
- Department of Endocrinology, Endocrinology Research Center, The Xiangya Hospital of Central South University, Changsha, China
| | - Ling Liu
- Department of Endocrinology, Endocrinology Research Center, The Xiangya Hospital of Central South University, Changsha, China
| | - Changjun Li
- Department of Endocrinology, Endocrinology Research Center, The Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
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5
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Macrophages in heterotopic ossification: from mechanisms to therapy. NPJ Regen Med 2021; 6:70. [PMID: 34702860 PMCID: PMC8548514 DOI: 10.1038/s41536-021-00178-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 09/30/2021] [Indexed: 01/04/2023] Open
Abstract
Heterotopic ossification (HO) is the formation of extraskeletal bone in non-osseous tissues. It is caused by an injury that stimulates abnormal tissue healing and regeneration, and inflammation is involved in this process. It is worth noting that macrophages are crucial mediators of inflammation. In this regard, abundant macrophages are recruited to the HO site and contribute to HO progression. Macrophages can acquire different functional phenotypes and promote mesenchymal stem cell (MSC) osteogenic differentiation, chondrogenic differentiation, and angiogenesis by expressing cytokines and other factors such as the transforming growth factor-β1 (TGF-β1), bone morphogenetic protein (BMP), activin A (Act A), oncostatin M (OSM), substance P (SP), neurotrophin-3 (NT-3), and vascular endothelial growth factor (VEGF). In addition, macrophages significantly contribute to the hypoxic microenvironment, which primarily drives HO progression. Thus, these have led to an interest in the role of macrophages in HO by exploring whether HO is a "butterfly effect" event. Heterogeneous macrophages are regarded as the "butterflies" that drive a sequence of events and ultimately promote HO. In this review, we discuss how the recruitment of macrophages contributes to HO progression. In particular, we review the molecular mechanisms through which macrophages participate in MSC osteogenic differentiation, angiogenesis, and the hypoxic microenvironment. Understanding the diverse role of macrophages may unveil potential targets for the prevention and treatment of HO.
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6
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Cong Q, Liu Y, Zhou T, Zhou Y, Xu R, Cheng C, Chung HS, Yan M, Zhou H, Liao Z, Gao B, Bocobo GA, Covington TA, Song HJ, Su P, Yu PB, Yang Y. A self-amplifying loop of YAP and SHH drives formation and expansion of heterotopic ossification. Sci Transl Med 2021; 13:13/599/eabb2233. [PMID: 34162750 PMCID: PMC8638088 DOI: 10.1126/scitranslmed.abb2233] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 12/03/2020] [Accepted: 05/30/2021] [Indexed: 12/15/2022]
Abstract
Heterotopic ossification (HO) occurs as a common complication after injury or in genetic disorders. The mechanisms underlying HO remain incompletely understood, and there are no approved prophylactic or secondary treatments available. Here, we identify a self-amplifying, self-propagating loop of Yes-associated protein (YAP)-Sonic hedgehog (SHH) as a core molecular mechanism underlying diverse forms of HO. In mouse models of progressive osseous heteroplasia (POH), a disease caused by null mutations in GNAS, we found that Gnas-/- mesenchymal cells secreted SHH, which induced osteoblast differentiation of the surrounding wild-type cells. We further showed that loss of Gnas led to activation of YAP transcription activity, which directly drove Shh expression. Secreted SHH further induced YAP activation, Shh expression, and osteoblast differentiation in surrounding wild-type cells. This self-propagating positive feedback loop was both necessary and sufficient for HO expansion and could act independently of Gnas in fibrodysplasia ossificans progressiva (FOP), another genetic HO, and nonhereditary HO mouse models. Genetic or pharmacological inhibition of YAP or SHH abolished HO in POH and FOP and acquired HO mouse models without affecting normal bone homeostasis, providing a previously unrecognized therapeutic rationale to prevent, reduce, and shrink HO.
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Affiliation(s)
- Qian Cong
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA
| | - Yuchen Liu
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA
| | - Taifeng Zhou
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA
| | - Yaxing Zhou
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA
| | - Ruoshi Xu
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA
| | - Caiqi Cheng
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA
| | - Hye Soo Chung
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA
| | - Meijun Yan
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Hang Zhou
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Zhiheng Liao
- Department of Orthopaedic Surgery, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Bo Gao
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA
| | - Geoffrey A Bocobo
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Taylor A Covington
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Hyeon Ju Song
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Peiqiang Su
- Department of Orthopaedic Surgery, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Paul B Yu
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Yingzi Yang
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA.
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7
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Wang T, Chen P, Chen L, Zhou Y, Wang A, Zheng Q, Mitchell CA, Leys T, Tuan RS, Zheng MH. Reduction of mechanical loading in tendons induces heterotopic ossification and activation of the β-catenin signaling pathway. J Orthop Translat 2021; 29:42-50. [PMID: 34094857 PMCID: PMC8142054 DOI: 10.1016/j.jot.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/15/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background Tendons are the force transferring tissue that enable joint movement. Excessive mechanical loading is commonly considered as a primary factor causing tendinopathy, however, an increasing body of evidence supports the hypothesis that overloading creates microdamage of collagen fibers resulting in a localized decreased loading on the cell population within the damaged site. Heterotopic ossification is a complication of late stage tendinopathy, which can significantly affect the mechanical properties and homeostasis of the tendon. Here, we the examine the effect of mechanical underloading on tendon ossification and investigate its underlying molecular mechanism. Method Rabbit Achilles tendons were dissected and cultured in an underloading environment (3% cyclic tensile stain,0.25 Hz, 8 h/day) for either 10, 15 or 20 days. Using isolated tendon-derived stem cells (TDSCs) 3D constructs were generated, cultured and subjected to an underloading environment for 6 days. Histological assessments were performed to evaluate the structure of the 3D constructs; qPCR and immunohistochemistry were employed to study TDSC differentiation and the β-catenin signal pathway was investigated by Western blotting. Mechanical testing was used to determine ability of the tendon to withstand force generation. Result Tendons cultured for extended times in an environment of underloading showed progressive heterotopic ossification and a reduction in biomechanical strength. qPCR revealed that 3D TDSCs constructs cultured in an underloading environment exhibited increased expression of several osteogenic genes: these include RUNX2, ALP and osteocalcin in comparison to tenogenic differentiation markers (scleraxis and tenomodulin). Immunohistochemical analysis further confirmed high osteocalcin production in 3D TDSCs constructs subject to underloading. Western blotting of TDSC constructs revealed that β-catenin accumulation and translocation were associated with an increase in phosphorylation at Ser552 and decrease phosphorylation at Ser33. Conclusion These findings unveil a potential mechanism for heterotopic ossification in tendinopathy due to the underloading of TDSCs at the damage sites, and also that β-catenin could be a potential target for treating heterotopic ossification in tendons. The Translational potential Tendon heterotopic ossification detrimentally affect quality of life especially for those who has atheletic career. This study reveals the possible mechanism of heterotpic ossification in tendon related to mechanical loading. This study provided the possible to develop a mechanical stimulation protocol for preventive and therapeutic purpose for tendon heterotopic ossification.
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Affiliation(s)
- Tao Wang
- Centre for Orthopaedic Translational Research, School of Biomedical Sciences, University of Western Australia, Nedlands, Australia.,Division of Orthopaedic Surgery, Department of Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Peilin Chen
- Centre for Orthopaedic Translational Research, School of Biomedical Sciences, University of Western Australia, Nedlands, Australia
| | - Lianzhi Chen
- Centre for Orthopaedic Translational Research, School of Biomedical Sciences, University of Western Australia, Nedlands, Australia
| | - Yinghong Zhou
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia
| | - Allan Wang
- Centre for Orthopaedic Translational Research, School of Biomedical Sciences, University of Western Australia, Nedlands, Australia.,Sir Charles Gairdner Hospital, Perth, Australia
| | - Qiujian Zheng
- Division of Orthopaedic Surgery, Department of Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Christopher A Mitchell
- Centre for Orthopaedic Translational Research, School of Biomedical Sciences, University of Western Australia, Nedlands, Australia
| | - Toby Leys
- Sir Charles Gairdner Hospital, Perth, Australia
| | - Rocky S Tuan
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Ming H Zheng
- Division of Orthopaedic Surgery, Department of Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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8
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Feng H, Xing W, Han Y, Sun J, Kong M, Gao B, Yang Y, Yin Z, Chen X, Zhao Y, Bi Q, Zou W. Tendon-derived cathepsin K-expressing progenitor cells activate Hedgehog signaling to drive heterotopic ossification. J Clin Invest 2021; 130:6354-6365. [PMID: 32853181 DOI: 10.1172/jci132518] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/20/2020] [Indexed: 12/31/2022] Open
Abstract
Heterotopic ossification (HO) is pathological bone formation characterized by ossification within muscle, tendons, or other soft tissues. However, the cells of origin and mechanisms involved in the pathogenesis of HO remain elusive. Here we show that deletion of suppressor of fused (Sufu) in cathepsin K-Cre-expressing (Ctsk-Cre-expressing) cells resulted in spontaneous and progressive ligament, tendon, and periarticular ossification. Lineage tracing studies and cell functional analysis demonstrated that Ctsk-Cre could label a subpopulation of tendon-derived progenitor cells (TDPCs) marked by the tendon marker Scleraxis (Scx). Ctsk+Scx+ TDPCs are enriched for tendon stem cell markers and show the highest self-renewal capacity and differentiation potential. Sufu deficiency caused enhanced chondrogenic and osteogenic differentiation of Ctsk-Cre-expressing tendon-derived cells via upregulation of Hedgehog (Hh) signaling. Furthermore, pharmacological intervention in Hh signaling using JQ1 suppressed the development of HO. Thus, our results show that Ctsk-Cre labels a subpopulation of TDPCs contributing to HO and that their cell-fate changes are driven by activation of Hh signaling.
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Affiliation(s)
- Heng Feng
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, CAS Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Wenhui Xing
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, CAS Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Yujiao Han
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, CAS Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Jun Sun
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, CAS Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Mingxiang Kong
- Department of Orthopedics and Joint Surgery, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Bo Gao
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, CAS Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China.,Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yang Yang
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, CAS Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Zi Yin
- Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiao Chen
- Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yun Zhao
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, CAS Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Qing Bi
- Department of Orthopedics and Joint Surgery, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Weiguo Zou
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, CAS Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China.,Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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9
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Ohba S. Hedgehog Signaling in Skeletal Development: Roles of Indian Hedgehog and the Mode of Its Action. Int J Mol Sci 2020; 21:E6665. [PMID: 32933018 PMCID: PMC7555016 DOI: 10.3390/ijms21186665] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/16/2022] Open
Abstract
Hedgehog (Hh) signaling is highly conserved among species and plays indispensable roles in various developmental processes. There are three Hh members in mammals; one of them, Indian hedgehog (Ihh), is expressed in prehypertrophic and hypertrophic chondrocytes during endochondral ossification. Based on mouse genetic studies, three major functions of Ihh have been proposed: (1) Regulation of chondrocyte differentiation via a negative feedback loop formed together with parathyroid hormone-related protein (PTHrP), (2) promotion of chondrocyte proliferation, and (3) specification of bone-forming osteoblasts. Gli transcription factors mediate the major aspect of Hh signaling in this context. Gli3 has dominant roles in the growth plate chondrocytes, whereas Gli1, Gli2, and Gli3 collectively mediate biological functions of Hh signaling in osteoblast specification. Recent studies have also highlighted postnatal roles of the signaling in maintenance and repair of skeletal tissues.
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Affiliation(s)
- Shinsuke Ohba
- Department of Cell Biology, Institute of Biomedical Sciences, Nagasaki University, Nagasaki 852-8588, Japan
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10
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Ibarra BA, Atit R. What Do Animal Models Teach Us About Congenital Craniofacial Defects? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1236:137-155. [PMID: 32304072 PMCID: PMC7394376 DOI: 10.1007/978-981-15-2389-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The formation of the head and face is a complex process which involves many different signaling cues regulating the migration, differentiation, and proliferation of the neural crest. This highly complex process is very error-prone, resulting in craniofacial defects in nearly 10,000 births in the United States annually. Due to the highly conserved mechanisms of craniofacial development, animal models are widely used to understand the pathogenesis of various human diseases and assist in the diagnosis and generation of preventative therapies and treatments. Here, we provide a brief background of craniofacial development and discuss several rare diseases affecting craniofacial bone development. We focus on rare congenital diseases of the cranial bone, facial jaw bones, and two classes of diseases, ciliopathies and RASopathies. Studying the animal models of these rare diseases sheds light not only on the etiology and pathology of each disease, but also provides meaningful insights towards the mechanisms which regulate normal development of the head and face.
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Affiliation(s)
- Beatriz A Ibarra
- Department of Biology, Case Western Reserve University, Cleveland, OH, USA
| | - Radhika Atit
- Department of Biology, Case Western Reserve University, Cleveland, OH, USA.
- Department of Genetics, Case Western Reserve University, Cleveland, OH, USA.
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA.
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11
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Recent Insights into Long Bone Development: Central Role of Hedgehog Signaling Pathway in Regulating Growth Plate. Int J Mol Sci 2019; 20:ijms20235840. [PMID: 31757091 PMCID: PMC6928971 DOI: 10.3390/ijms20235840] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 12/30/2022] Open
Abstract
The longitudinal growth of long bone, regulated by an epiphyseal cartilaginous component known as the “growth plate”, is generated by epiphyseal chondrocytes. The growth plate provides a continuous supply of chondrocytes for endochondral ossification, a sequential bone replacement of cartilaginous tissue, and any failure in this process causes a wide range of skeletal disorders. Therefore, the cellular and molecular characteristics of the growth plate are of interest to many researchers. Hedgehog (Hh), well known as a mitogen and morphogen during development, is one of the best known regulatory signals in the developmental regulation of the growth plate. Numerous animal studies have revealed that signaling through the Hh pathway plays multiple roles in regulating the proliferation, differentiation, and maintenance of growth plate chondrocytes throughout the skeletal growth period. Furthermore, over the past few years, a growing body of evidence has emerged demonstrating that a limited number of growth plate chondrocytes transdifferentiate directly into the full osteogenic and multiple mesenchymal lineages during postnatal bone development and reside in the bone marrow until late adulthood. Current studies with the genetic fate mapping approach have shown that the commitment of growth plate chondrocytes into the skeletal lineage occurs under the influence of epiphyseal chondrocyte-derived Hh signals during endochondral bone formation. Here, we discuss the valuable observations on the role of the Hh signaling pathway in the growth plate based on mouse genetic studies, with some emphasis on recent advances.
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Jobmann S, Buckup J, Colcuc C, Roessler PP, Zimmermann E, Schüttler KF, Hoffmann R, Welsch F, Stein T. Anatomic ligament consolidation of the superior acromioclavicular ligament and the coracoclavicular ligament complex after acute arthroscopically assisted double coracoclavicular bundle stabilization. Knee Surg Sports Traumatol Arthrosc 2019; 27:3168-3179. [PMID: 28924949 DOI: 10.1007/s00167-017-4717-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 09/13/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE The consolidation of the acromioclavicular (AC) and coracoclavicular (CC) ligament complex after arthroscopically assisted stabilization of acute acromioclavicular joint (ACJ) separation is still under consideration. METHODS Fifty-five consecutive patients after arthroscopically assisted double-CC-bundle stabilization within 14 days after acute high-grade ACJ separation were studied prospectively. All patients were clinically analysed preoperatively (FU0) and post-operatively (FU1 = 6 months; FU2 = 12 months). The structural MRI assessments were performed at FU0 (injured ACJ) and at FU2 bilateral (radiologic control group) and assessed separately the ligament thickness and length at defined regions for the conoid, trapezoid and the superior AC ligament. RESULTS Thirty-seven patients were assessed after 6.5 months and after 16.0 months. The 16-month MRI analysis revealed for all patients continuous ligament healing for the CC-complex and the superior AC ligament with in the average hypertrophic consolidation compared to the control side. Separate conoid and trapezoid strands (double-strand configuration) were detected in 27 of 37 (73%) patients, and a single-strand configuration was detected in 10 of 37 (27%) patients; both configurations showed similar CCD data. The ligament healing was not influenced by the point of surgery, age at surgery and heterotopic ossification. The clinical outcome was increased (FU0-FU2): Rowe, 47.7-97.0 pts.; TAFT, 3.9-10.6 pts.; NAS pain, 8.9-1.4 pts. (all P < 0.05). CONCLUSION The arthroscopically assisted double-CC-bundle stabilization within 14 days after acute high-grade ACJ separation showed 16 months after surgery sufficient consolidations of the AC and double-CC ligament complex in 73%. LEVEL OF EVIDENCE III, Case series.
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Affiliation(s)
- S Jobmann
- Department of Sporttraumatology - Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - J Buckup
- Department of Sporttraumatology - Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - C Colcuc
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - P P Roessler
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Marburg, Germany
| | - E Zimmermann
- Department of Sports medicine, University of Bielefeld, Bielefeld, Germany
| | - K F Schüttler
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Marburg, Germany
| | - R Hoffmann
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - F Welsch
- Department of Sporttraumatology - Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - T Stein
- Department of Sporttraumatology - Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany. .,Department of Sports medicine, University of Bielefeld, Bielefeld, Germany.
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Abstract
BACKGROUND Heterotopic ossification (HO) is a known complication of hip arthroscopy. We investigated incidence of HO after hip arthroscopy and determined whether revision for HO improved outcome. METHODS A retrospective study was conducted on 242 patients (140 men and 102 women, mean age: 36.2 ± 9.5 years) who underwent hip arthroscopy for femoroacetabular impingement (FAI) between January 2016 and January 2018. The average follow-up period was 22.88 ± 11.74 months (range: 11-34 months). Thirteen (5.37%) cases of HO (six men and seven women, five left hips and eight right hips; mean age: 37.5 ± 4.7 years) were observed. Among them, four cases with HO with obvious pain symptoms and persistent non-remission underwent revision surgery to remove HO. Monthly follow-up was conducted. Visual analog scale (VAS), modified Harris Hip Score (mHHS), and non-Arthritis Hip Score (NAHS) were evaluated and compared between HO and non-HO patients. Independent sample t test, Mann-Whitney U test and the Chi-square test were used for inter-group comparisons. HO degree was evaluated using Brooker classification. Symptoms and function were evaluated before and after revision. RESULTS A total of 242 patients were involved in this study. Thirteen cases (5.4%) had imaging evidence of HO. Nine (9/13) were classified as Brooker stage I, three (3/13) Brooker stage II, and one (1/13) Brooker stage III. HO was detected by ultrasonography as early as 3 weeks after operation. After primary surgery, the mHHS of the HO group and non-HO group increased by 13.00 (8.50, 25.50) and 24.00 (14.00, 34.50) points (Z = -1.80, P = 0.08), NAHS increased by 18.00 (9.50, 31.50) and 26.00 (13.50, 36.00) points (Z = -1.34, P = 0.18), and VAS decreased by 3.00 (2.00, 4.00) and 4.00 (3.00, 4.50) points (Z = -1.55, P = 0.12). Average follow-up time after revision was 9.00 ± 2.94 months; mHHS increased by 34.75 points (t = -55.23, P < 0.01) and NAHS by 28.75 points (t = -6.03, P < 0.01), and VAS decreased by 4 points (t = 9.80, P < 0.01). HO and non-HO patients were similar for demographic and surgical data, and clinical and functional scores. CONCLUSION HO incidence after arthroscopic treatment of FAI is similar to that found in previous studies. Most HO have no effect on clinical symptoms. Patients who undergo revision HO resection show improvement in pain and joint function.
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In Vitro and In Vivo Osteogenesis of Human Orbicularis Oculi Muscle-Derived Stem Cells. Tissue Eng Regen Med 2019; 15:445-452. [PMID: 30603568 DOI: 10.1007/s13770-018-0122-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/22/2018] [Accepted: 04/25/2018] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND Cell-based therapies for treating bone defects require a source of stem cells with osteogenic potential. There is evidence from pathologic ossification within muscles that human skeletal muscles contain osteogenic progenitor cells. However, muscle samples are usually acquired through a traumatic biopsy procedure which causes pain and morbidity to the donor. Herein, we identified a new alternative source of skeletal muscle stem cells (SMSCs) without conferring morbidity to donors. METHODS Adherent cells isolated from human orbicularis oculi muscle (OOM) fragments, which are currently discarded during ophthalmic cosmetic surgeries, were obtained using a two-step plating method. The cell growth kinetics, immunophenotype and capabilities of in vitro multilineage differentiation were evaluated respectively. Moreover, the osteogenically-induced cells were transduced with GFP gene, loaded onto the porous β-tricalcium phosphate (β-TCP) bioceramics, and transplanted into the subcutaneous site of athymic mice. Ectopic bone formation was assessed and the cell fate in vivo was detected. RESULTS OOM-derived cells were fibroblastic in shape, clonogenic in growth, and displayed phenotypic and behavioral characteristics similar to SMSCs. In particular, these cells could be induced into osteoblasts in vitro evidenced by the extracellular matrix calcification and enhanced alkaline phosphatase (ALP) activity and osteocalcin (OCN) production. New bone formation was found in the cell-loaded bioceramics 6 weeks after implantation. By using the GFP-labeling technique, these muscle cells were detected to participate in the process of ectopic osteogenesis in vivo. CONCLUSION Our data suggest that human OOM tissue is a valuable and noninvasive resource for osteoprogenitor cells to be used in bone repair and regeneration.
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Abstract
Skeletal development is exquisitely controlled both spatially and temporally by cell signaling networks. Gαs is the stimulatory α-subunit in a heterotrimeric G protein complex transducing the signaling of G-protein-coupled receptors (GPCRs), responsible for controlling both skeletal development and homeostasis. Gαs, encoded by the GNAS gene in humans, plays critical roles in skeletal development and homeostasis by regulating commitment, differentiation and maturation of skeletal cells. Gαs-mediated signaling interacts with the Wnt and Hedgehog signaling pathways, both crucial regulators of skeletal development, remodeling and injury repair. Genetic mutations that disrupt Gαs functions cause human disorders with severe skeletal defects, such as fibrous dysplasia of bone and heterotopic bone formation. This chapter focuses on the crucial roles of Gαs signaling during skeletal development and homeostasis, and the pathological mechanisms underlying skeletal diseases caused by GNAS mutations.
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Affiliation(s)
- Qian Cong
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, United States
| | - Ruoshi Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yingzi Yang
- Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA, United States.
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Xu R, Khan SK, Zhou T, Gao B, Zhou Y, Zhou X, Yang Y. Gα s signaling controls intramembranous ossification during cranial bone development by regulating both Hedgehog and Wnt/β-catenin signaling. Bone Res 2018; 6:33. [PMID: 30479847 PMCID: PMC6242855 DOI: 10.1038/s41413-018-0034-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/11/2018] [Accepted: 09/27/2018] [Indexed: 02/05/2023] Open
Abstract
How osteoblast cells are induced is a central question for understanding skeletal formation. Abnormal osteoblast differentiation leads to a broad range of devastating craniofacial diseases. Here we have investigated intramembranous ossification during cranial bone development in mouse models of skeletal genetic diseases that exhibit craniofacial bone defects. The GNAS gene encodes Gαs that transduces GPCR signaling. GNAS activation or loss-of-function mutations in humans cause fibrous dysplasia (FD) or progressive osseous heteroplasia (POH) that shows craniofacial hyperostosis or craniosynostosis, respectively. We find here that, while Hh ligand-dependent Hh signaling is essential for endochondral ossification, it is dispensable for intramembranous ossification, where Gαs regulates Hh signaling in a ligand-independent manner. We further show that Gαs controls intramembranous ossification by regulating both Hh and Wnt/β-catenin signaling. In addition, Gαs activation in the developing cranial bone leads to reduced ossification but increased cartilage presence due to reduced cartilage dissolution, not cell fate switch. Small molecule inhibitors of Hh and Wnt signaling can effectively ameliorate cranial bone phenotypes in mice caused by loss or gain of Gnas function mutations, respectively. Our work shows that studies of genetic diseases provide invaluable insights in both pathological bone defects and normal bone development, understanding both leads to better diagnosis and therapeutic treatment of bone diseases.
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Affiliation(s)
- Ruoshi Xu
- 1Department of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA USA.,2State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Sanjoy Kumar Khan
- 1Department of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA USA
| | - Taifeng Zhou
- 1Department of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA USA.,3Department of Orthopaedic Surgery, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bo Gao
- 1Department of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA USA.,4Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yaxing Zhou
- 1Department of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA USA
| | - Xuedong Zhou
- 2State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Cariology and Endodontology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yingzi Yang
- 1Department of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA USA
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Pacifici M. Acquired and congenital forms of heterotopic ossification: new pathogenic insights and therapeutic opportunities. Curr Opin Pharmacol 2018; 40:51-58. [PMID: 29614433 PMCID: PMC6015534 DOI: 10.1016/j.coph.2018.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/20/2018] [Indexed: 12/27/2022]
Abstract
Heterotopic ossification (HO) involves the formation and accumulation of extraskeletal bone tissue at the expense of local tissues including muscles and connective tissues. There are common forms of HO that are triggered by extensive trauma, burns and other bodily insults, and there are also rare congenital severe forms of HO that occur in children with Fibrodysplasia Ossificans Progressiva or Progressive Osseous Heteroplasia. Given that HO is often preceded by inflammation, current treatments usually involve anti-inflammatory drugs alone or in combination with local irradiation, but are not very effective. Recent studies have provided novel insights into the pathogenesis of acquired and genetic forms of HO and have used the information to conceive and test new and more specific therapies in animal models. In this review, I provide salient examples of these exciting and promising advances that are undoubtedly paving the way toward resolution of this debilitating and at times fatal disease.
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MESH Headings
- Animals
- Anti-Inflammatory Agents/therapeutic use
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Bone Diseases, Metabolic/diagnosis
- Bone Diseases, Metabolic/genetics
- Bone Diseases, Metabolic/physiopathology
- Bone Diseases, Metabolic/therapy
- Bone and Bones/drug effects
- Bone and Bones/pathology
- Bone and Bones/physiopathology
- Bone and Bones/radiation effects
- Drug Discovery/methods
- Genetic Predisposition to Disease
- Humans
- Molecular Targeted Therapy
- Myositis Ossificans/diagnosis
- Myositis Ossificans/genetics
- Myositis Ossificans/physiopathology
- Myositis Ossificans/therapy
- Ossification, Heterotopic/diagnosis
- Ossification, Heterotopic/genetics
- Ossification, Heterotopic/physiopathology
- Ossification, Heterotopic/therapy
- Osteogenesis/drug effects
- Osteogenesis/genetics
- Osteogenesis/radiation effects
- Phenotype
- Skin Diseases, Genetic/diagnosis
- Skin Diseases, Genetic/genetics
- Skin Diseases, Genetic/physiopathology
- Skin Diseases, Genetic/therapy
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Affiliation(s)
- Maurizio Pacifici
- Translational Research Program in Pediatric Orthopaedics, Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
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Xu R, Hu J, Zhou X, Yang Y. Heterotopic ossification: Mechanistic insights and clinical challenges. Bone 2018; 109:134-142. [PMID: 28855144 DOI: 10.1016/j.bone.2017.08.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/26/2017] [Indexed: 02/05/2023]
Abstract
Bone formation is exquisitely controlled both spatially and temporally. Heterotopic ossification (HO) is pathological bone formation in soft tissues that often leads to deleterious outcomes. Inherited genetic forms of HO can be life-threatening and can happen as early as in infancy. However, there is currently no effective treatment for HO as the underlying cellular and molecular mechanisms have not been completely elucidated. Trauma-induced non-genetic forms of HO often occur as a common complication after surgeries or accidents, and the location of HO occurrence largely determines the symptom and outcome. While it has been difficult to determine the complicated factors causing HO, recent advancement in identifying cellular and molecular mechanism causing the genetic forms of HO may provide important insights in all HO. Here in this review, we summarize recent studies on HO to provide a current status of both clinical options of HO treatments and mechanical understanding of HO.
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Affiliation(s)
- Ruoshi Xu
- Department of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Ave. Boston, MA 02215, USA; State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodonics West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Rd., Chengdu, 610041, China
| | - Jiajie Hu
- Department of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Ave. Boston, MA 02215, USA
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodonics West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Rd., Chengdu, 610041, China.
| | - Yingzi Yang
- Department of Developmental Biology, Harvard School of Dental Medicine, 188 Longwood Ave. Boston, MA 02215, USA.
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19
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Wang X, Li F, Xie L, Crane J, Zhen G, Mishina Y, Deng R, Gao B, Chen H, Liu S, Yang P, Gao M, Tu M, Wang Y, Wan M, Fan C, Cao X. Inhibition of overactive TGF-β attenuates progression of heterotopic ossification in mice. Nat Commun 2018; 9:551. [PMID: 29416028 PMCID: PMC5803194 DOI: 10.1038/s41467-018-02988-5] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 01/11/2018] [Indexed: 12/24/2022] Open
Abstract
Acquired heterotopic ossification (HO) is a painful and debilitating disease characterized by extraskeletal bone formation after injury. The exact pathogenesis of HO remains unknown. Here we show that TGF-β initiates and promotes HO in mice. We find that calcified cartilage and newly formed bone resorb osteoclasts after onset of HO, which leads to high levels of active TGF-β that recruit mesenchymal stromal/progenitor cells (MSPCs) in the HO microenvironment. Transgenic expression of active TGF-β in tendon induces spontaneous HO, whereas systemic injection of a TGF-β neutralizing antibody attenuates ectopic bone formation in traumatic and BMP-induced mouse HO models, and in a fibrodysplasia ossificans progressive mouse model. Moreover, inducible knockout of the TGF-β type II receptor in MSPCs inhibits HO progression in HO mouse models. Our study points toward elevated levels of active TGF-β as inducers and promoters of ectopic bone formation, and suggest that TGF-β might be a therapeutic target in HO.
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MESH Headings
- Achilles Tendon/drug effects
- Achilles Tendon/injuries
- Adult
- Animals
- Antibodies, Neutralizing/pharmacology
- Becaplermin/metabolism
- Bone Remodeling
- Brain Injuries, Traumatic
- Cartilage
- Case-Control Studies
- Disease Models, Animal
- Elbow Joint/surgery
- Female
- Fracture Fixation, Internal
- Fractures, Bone
- Humans
- Male
- Mesenchymal Stem Cells/metabolism
- Mice
- Mice, Knockout
- Mice, Transgenic
- Middle Aged
- Muscle, Skeletal/pathology
- Myositis Ossificans/metabolism
- Ossification, Heterotopic/metabolism
- Osteoclasts
- Osteogenesis/drug effects
- Receptor, Transforming Growth Factor-beta Type II/genetics
- Spinal Cord Injuries
- Tendon Injuries
- Tendons
- Transforming Growth Factor beta/antagonists & inhibitors
- Transforming Growth Factor beta/metabolism
- Transforming Growth Factor beta1/metabolism
- Young Adult
- Elbow Injuries
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Affiliation(s)
- Xiao Wang
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Fengfeng Li
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, 200030, Shanghai, China
| | - Liang Xie
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Janet Crane
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Gehua Zhen
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Yuji Mishina
- School of Dentistry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Ruoxian Deng
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Bo Gao
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Hao Chen
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Shen Liu
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, 200030, Shanghai, China
| | - Ping Yang
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Manman Gao
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Manli Tu
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Yiguo Wang
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Mei Wan
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Cunyi Fan
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, 200030, Shanghai, China
| | - Xu Cao
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA.
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Zhang SD, Xie ZL, Zhang KQ, Nh-Tseung K, Zhao JJ. Progressive osseous heteroplasia in a Chinese infant and a novel mutation in the GNAS gene. J Eur Acad Dermatol Venereol 2017; 32:e209-e211. [PMID: 29224258 DOI: 10.1111/jdv.14743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S-D Zhang
- Department of Dermatology, Affiliated Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, Fujian, 355200, China
| | - Z-L Xie
- Department of Endocrinology, Tongji Hospital of Tongji University, Shanghai, 200065, China
| | - K-Q Zhang
- Department of Endocrinology, Tongji Hospital of Tongji University, Shanghai, 200065, China
| | - K Nh-Tseung
- Department of Dermatology, Tongji Hospital of Tongji University, Shanghai, 200065, China
| | - J-J Zhao
- Department of Dermatology, Tongji Hospital of Tongji University, Shanghai, 200065, China
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Tafaj O, Jüppner H. Pseudohypoparathyroidism: one gene, several syndromes. J Endocrinol Invest 2017; 40:347-356. [PMID: 27995443 DOI: 10.1007/s40618-016-0588-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/25/2016] [Indexed: 01/04/2023]
Abstract
Pseudohypoparathyroidism (PHP) and pseudopseudohypoparathyroidism (PPHP) are caused by mutations and/or epigenetic changes at the complex GNAS locus on chromosome 20q13.3 that undergoes parent-specific methylation changes at several sites. GNAS encodes the alpha-subunit of the stimulatory G protein (Gsα) and several splice variants thereof. Heterozygous inactivating mutations involving the maternal GNAS exons 1-13 cause PHP type Ia (PHP1A). Because of much reduced paternal Gsα expression in certain tissues, such as the proximal renal tubules, thyroid, and pituitary, there is little or no Gsα protein in the presence of maternal GNAS mutations, thus leading to PTH-resistant hypocalcemia and hyperphosphatemia. When located on the paternal allele, the same or similar GNAS mutations are the cause of PPHP. Besides biochemical abnormalities, patients affected by PHP1A show developmental abnormalities, referred to as Albrights hereditary osteodystrophy (AHO). Some, but not all of these AHO features are encountered also in patients affected by PPHP, who typically show no laboratory abnormalities. Autosomal dominant PHP type Ib (AD-PHP1B) is caused by heterozygous maternal deletions within GNAS or STX16, which are associated with loss-of-methylation (LOM) at exon A/B alone or at all maternally methylated GNAS exons. LOM at exon A/B and the resulting biallelic expression of A/B transcripts reduces Gsα expression, thus leading to hormonal resistance. Epigenetic changes at all differentially methylated GNAS regions are also observed in sporadic PHP1B, the most frequent disease variant, which remains unresolved at the molecular level, except for rare cases with paternal uniparental isodisomy or heterodisomy of chromosome 20q (patUPD20q).
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Affiliation(s)
- O Tafaj
- Endocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Thier 10, 50 Blossom Street, Boston, MA, 02114, USA
| | - H Jüppner
- Endocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Thier 10, 50 Blossom Street, Boston, MA, 02114, USA.
- Pediatric Nephrology Unit, Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Severe heterotopic ossifications after Rockwood type II acromioclavicular joint injury: a case report. Arch Orthop Trauma Surg 2016; 136:381-8. [PMID: 26728275 DOI: 10.1007/s00402-015-2383-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Heterotopic ossification (HO) is a benign condition of abnormal bone formation in soft tissue. It is frequently asymptomatic, though it manifests as decreased range of motion in the affected joints that may occur in the shoulder after a substantial traumatic injury and can complicate the functional outcome of the affected upper extremity. However, severe HO is an extremely rare event following acromioclavicular joint (ACJ) injury. MATERIALS AND METHODS We are presenting a case of a 29-year-old male patient who had a trauma with resultant Rockwood type II injury. He subsequently complained of left shoulder pain with decreased range of motion 3 years later. HO was diagnosed after X-rays and the severity was assessed with a computerized tomography scan and magnetic resonance imaging. The patient was treated with a combination of pre-operative radiotherapy, surgical excision, mobilization under anesthesia, non-steroidal anti-inflammatory drug (NSAID) therapy and physiotherapy. RESULTS At 6-month follow-up, excellent clinical and radiological outcomes were achieved with a Constant score of 92 points, DASH score of 24%, and ASES score 100%, with a full range of motion of the left shoulder. Furthermore, there was no more radiological evidence of HO on plain radiographs. CONCLUSION Severe heterotopic ossification after a Rockwood type II ACJ injury in this case was successfully treated with combination of pre-operative radiotherapy, surgical excision and manipulation under anesthesia as well as NSAID therapy and physiotherapy.
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Wang L, Carroll DO, Liu X, Roth T, Kim H, Halloran B, Nissenson RA. Effects of blockade of endogenous Gi signaling in Tie2-expressing cells on bone formation in a mouse model of heterotopic ossification. J Orthop Res 2015; 33:1212-7. [PMID: 25773760 DOI: 10.1002/jor.22876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 02/13/2015] [Indexed: 02/04/2023]
Abstract
Available evidence indicates that some Tie2-expressing (Tie2(+) ) cells serve as multipotent progenitors that have robust BMP-dependent osteogenic activity and mediate heterotopic ossification (HO). Since signaling through the G protein Gi is required for cell motility, we hypothesized that blockade of endogenous Gi signaling in Tie2(+) cell populations would prevent HO formation. Blockade of Gi signaling in Tie2(+) cells was accomplished in transgenic mice with expression of pertussis toxin (PTX) under the control of the Tie2 promoter (Tie2(+) /PTX(+) ). Bone formation within HOs was evaluated 2 weeks after BMP injection. Expression of PTX in Tie2(+) cells significantly reduced the bone volume (BV) of HOs in male and female mice. Orthotopic bones were assessed at the distal femur and expression of PTX significantly increased trabecular bone fractional volume and bone formation rate in females only. In adult Tie2(+) /GFP(+) mice, GFP(+) cells appeared both inside and at the surfaces of bone tissue within HOs and in orthotopic bones. In summary, blockade of Gi signaling in Tie2(+) cells reduced the accrual of HOs and stimulated osteogenesis in orthotopic bones. Targeting of Gi protein coupled receptors in Tie2(+) cells may be a novel therapeutic strategy in states of abnormal bone formation such as osteoporosis and HO.
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Affiliation(s)
- Liping Wang
- Endocrine Research Unit, VA Medical Center, San Francisco, 94121, California.,Department of Medicine and Physiology, University of California, San Francisco, 94143, California
| | - Dylan O' Carroll
- Endocrine Research Unit, VA Medical Center, San Francisco, 94121, California
| | - Xuhui Liu
- Department of Orthopedic Surgery, University of California, San Francisco, 94143, California
| | - Theresa Roth
- Endocrine Research Unit, VA Medical Center, San Francisco, 94121, California
| | - Hubert Kim
- Department of Orthopedic Surgery, University of California, San Francisco, 94143, California
| | - Bernard Halloran
- Endocrine Research Unit, VA Medical Center, San Francisco, 94121, California
| | - Robert A Nissenson
- Endocrine Research Unit, VA Medical Center, San Francisco, 94121, California.,Department of Medicine and Physiology, University of California, San Francisco, 94143, California
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Abstract
The Hedgehog (Hh) signalling pathway plays many important roles in development, homeostasis and tumorigenesis. The critical function of Hh signalling in bone formation has been identified in the past two decades. Here, we review the evolutionarily conserved Hh signalling mechanisms with an emphasis on the functions of the Hh signalling pathway in bone development, homeostasis and diseases. In the early stages of embryonic limb development, Sonic Hedgehog (Shh) acts as a major morphogen in patterning the limb buds. Indian Hedgehog (Ihh) has an essential function in endochondral ossification and induces osteoblast differentiation in the perichondrium. Hh signalling is also involved intramembrane ossification. Interactions between Hh and Wnt signalling regulate cartilage development, endochondral bone formation and synovial joint formation. Hh also plays an important role in bone homeostasis, and reducing Hh signalling protects against age-related bone loss. Disruption of Hh signalling regulation leads to multiple bone diseases, such as progressive osseous heteroplasia. Therefore, understanding the signalling mechanisms and functions of Hh signalling in bone development, homeostasis and diseases will provide important insights into bone disease prevention, diagnoses and therapeutics.
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Feng W, Lv S, Cui J, Han X, Du J, Sun J, Wang K, Wang Z, Lu X, Guo J, Oda K, Amizuka N, Xu X, Li M. Histochemical examination of adipose derived stem cells combined with β-TCP for bone defects restoration under systemic administration of 1α,25(OH)2D3. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 54:133-41. [PMID: 26046276 DOI: 10.1016/j.msec.2015.05.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 04/07/2015] [Accepted: 05/08/2015] [Indexed: 01/06/2023]
Abstract
The purpose of this study was to evaluate the effects of osteogenic differentiated adipose-derived stem cell (ADSC) loaded beta-tricalcium phosphate (β-TCP) in the restoration of bone defects under intraperitoneal administration of 1α,25-dihydroxyvitamin D3(1α,25(OH)2D3). ADSCs were isolated from the fat tissue of 8 week old Wister rats and co-cultured with β-TCP for 21 days under osteogenic induction. Then the ADSC-β-TCP complexes were implanted into bone defects in the femora of rats. 1α,25(OH)2D3 (VD) or normal saline (NS) was administrated intraperitoneally every other day after the surgery. Femora were harvested at day 7, day 14 and day 28 post-surgery. There were 4 groups for all specimens: β-TCP-NS group; β-TCP-ADSC-NS group; β-TCP-VD group and β-TCP-ADSC-VD group. Alkaline phosphatase (ALP) was up-regulated obviously in ADSC groups compared with non-ADSC groups at day 7, day 14 and day 28, although high expression of runt-related transcription factor 2 (RUNX2) was only seen at day 7. Furthermore, the number of TRAP-positive osteoclasts and the expression of cathepsin K (CK) were significantly decreased in VD groups compared with non-VD groups at day 7 and day 14. As a most significant finding, the β-TCP-ADSC-VD group showed the highest BV/TV ratio compared with the other three groups at day 28. Taken together, ADSC-loaded β-TCP under the administration of 1α,25(OH)2D3 made a promising therapy for bone defects restoration.
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Affiliation(s)
- Wei Feng
- Department of Bone Metabolism, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Biomedicine, Jinan, China
| | - Shengyu Lv
- Department of Bone Metabolism, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Biomedicine, Jinan, China
| | - Jian Cui
- Department of Bone Metabolism, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Biomedicine, Jinan, China
| | - Xiuchun Han
- Department of Bone Metabolism, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Biomedicine, Jinan, China
| | - Juan Du
- Department of Bone Metabolism, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Biomedicine, Jinan, China
| | - Jing Sun
- Department of Bone Metabolism, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Biomedicine, Jinan, China
| | - Kefeng Wang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Zhenming Wang
- Key Lab of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, China
| | - Xiong Lu
- Key Lab of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, China
| | - Jie Guo
- Department of Bone Metabolism, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Biomedicine, Jinan, China
| | - Kimimitsu Oda
- Division of Biochemistry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Norio Amizuka
- Department of Developmental Biology of Hard Tissue, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Xin Xu
- Department of Bone Metabolism, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Biomedicine, Jinan, China
| | - Minqi Li
- Department of Bone Metabolism, School of Stomatology, Shandong University, Shandong Provincial Key Laboratory of Oral Biomedicine, Jinan, China.
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Rigueur D, Brugger S, Anbarchian T, Kim JK, Lee Y, Lyons KM. The type I BMP receptor ACVR1/ALK2 is required for chondrogenesis during development. J Bone Miner Res 2015; 30:733-41. [PMID: 25413979 PMCID: PMC4376569 DOI: 10.1002/jbmr.2385] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 09/07/2014] [Accepted: 10/07/2014] [Indexed: 11/12/2022]
Abstract
Bone morphogenetic proteins (BMPs) are crucial regulators of chondrogenesis. BMPs transduce their signals through three type I receptors: BMPR1A, BMPR1B, and ACVR1/ALK2. Fibrodysplasia ossificans progressiva (FOP), a rare disorder characterized by progressive ossification of connective tissue, is caused by an activating mutation in Acvr1 (the gene that encodes ACVR1/ALK2). However, there are few developmental defects associated with FOP. Thus, the role of ACVR1 in chondrogenesis during development is unknown. Here we report the phenotype of mice lacking ACVR1 in cartilage. Acvr1(CKO) mice are viable but exhibit defects in the development of cranial and axial structures. Mutants exhibit a shortened cranial base, and cervical vertebrae are hypoplastic. Acvr1(CKO) adult mice develop progressive kyphosis. These morphological defects were associated with decreased levels of Smad1/5 and p38 activation, and with reduced rates of chondrocyte proliferation in vertebral cartilage. We also tested whether ACVR1 exerts coordinated functions with BMPR1A and BMPR1B through analysis of double mutants. Acvr1/Bmpr1a and Acvr1/Bmpr1b mutant mice exhibited generalized perinatal lethal chondrodysplasia that was much more severe than in any of the corresponding mutant strains. These findings demonstrate that ACVR1 is required for chondrocyte proliferation and differentiation, particularly in craniofacial and axial elements, but exerts coordinated functions with both BMPR1A and BMPR1B throughout the developing endochondral skeleton.
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Affiliation(s)
- Diana Rigueur
- Department of Molecular, Cell and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, USA
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Harris M, Cilwa K, Elster EA, Potter BK, Forsberg JA, Crane NJ. Pilot study for detection of early changes in tissue associated with heterotopic ossification: moving toward clinical use of Raman spectroscopy. Connect Tissue Res 2015; 56:144-52. [PMID: 25738521 DOI: 10.3109/03008207.2015.1013190] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Over 60% of combat-wounded patients develop heterotopic ossification (HO). Nearly 33% of them require surgical excision for symptomatic lesions, a procedure that is both fraught with complications and can delay or regress functional rehabilitation. Relative medical contraindications limit widespread use of conventional means of primary prophylaxis, such as nonspecific nonsteroidal anti-inflammatory medications and radiotherapy. Better methods for risk stratification are needed to both mitigate the risk of current means of primary prophylaxis as well as to evaluate novel preventive strategies currently in development. We asked whether Raman spectral changes, measured ex vivo, could be associated with histologic evidence of the earliest signs of HO formation and substance P (SP) expression in tissue biopsies from the wounds of combat casualties. In this pilot study, we compared normal muscle tissue, injured muscle tissue, very early HO lesions (< 16 d post-injury), early HO lesions (> 16 d post-injury) and mature HO lesions. The Raman spectra of these tissues demonstrate clear differences in the Amide I and III spectral regions of HO lesions compared to normal tissue, denoted by changes in the Amide I band center (p < 0.01) and the 1340/1270 cm(-1) (p < 0.05) band area and band height ratios. SP expression in the HO lesions appears to peak between 16 and 30 d post-injury, as determined by SP immunohistochemistry of corresponding tissue sections, potentially indicating optimal timing for administration of therapeutics. Raman spectroscopy may therefore prove a useful, non-invasive and early diagnostic modality to detect HO formation before it becomes evident either clinically or radiographically.
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Affiliation(s)
- Mitchell Harris
- Department of Surgery, Uniformed Services University of Health Science , Bethesda, MD , USA
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Amar E, Warschawski Y, Sampson TG, Atoun E, Steinberg EL, Rath E. Capsular closure does not affect development of heterotopic ossification after hip arthroscopy. Arthroscopy 2015; 31:225-30. [PMID: 25442652 DOI: 10.1016/j.arthro.2014.08.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 08/12/2014] [Accepted: 08/26/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the role of capsular closure after hip arthroscopy in reduction of the incidence of heterotopic ossification (HO). METHODS One hundred (50 study group, 50 control group) consecutive hip arthroscopy procedures with radiographic follow-up of more than 9 weeks were included in the study. The study group consisted of 50 patients in whom capsular closure with 2 No. 1 polydioxanone (PDS) sutures was performed, and a control group consisted of 50 patients in whom the capsule remained open after capsulotomy. HO was assessed by radiographs using the Brooker classification. Statistical analysis of the data was carried out with the χ-square or Fisher exact test and Student t test, when appropriate, at a significance level of .05. RESULTS Thirty-six (36%) patients had radiographic evidence of postoperative HO (14 patients in the capsular closure group). No significant difference was found regarding sex, side of operation, age, or HO rate between the study and the control groups (P = .778, P = .123, P = .744, and P = .144, respectively). Furthermore, no significant difference was found in the rate of HO with potential clinical significance (Brooker classification > I) between the control and study groups (P = .764). CONCLUSIONS Capsular closure did not seem to alter the rate of HO when compared with a control group of patients in whom the capsulotomy was not repaired. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Eyal Amar
- Department of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel.
| | - Yaniv Warschawski
- Department of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Thomas G Sampson
- Department of Hip Arthroscopy, Post Street Orthopaedics and Sports Medicine, San Francisco, California, U.S.A
| | - Ehud Atoun
- Barzilai Medical Center Campus, Faculty of Health Sciences, Ben-Gurion University, Ashkelon, Israel
| | - Ely L Steinberg
- Department of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Department of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
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Adipose-Derived Stem Cells for Therapeutic Applications. Regen Med 2015. [DOI: 10.1007/978-1-4471-6542-2_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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30
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Human Adipose-Derived Stem Cells (ASC): Their Efficacy in Clinical Applications. Regen Med 2015. [DOI: 10.1007/978-1-4471-6542-2_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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31
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Sivan U, Jayakumar K, Krishnan LK. Constitution of fibrin-based niche for in vitro differentiation of adipose-derived mesenchymal stem cells to keratinocytes. Biores Open Access 2014; 3:339-47. [PMID: 25469318 PMCID: PMC4245880 DOI: 10.1089/biores.2014.0036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Epithelialization of chronic cutaneous wound is troublesome and may require use of skin/cell substitutes. Adipose-derived mesenchymal stem cells (ADMSCs) have immense potential as autologous cell source for treating wounds; they can cross the germ layer boundary of differentiation and regenerate skin. When multipotent adult stem cells are considered for skin regeneration, lineage committed keratinocytes may be beneficial to prevent undesirable post-transplantation outcome. This study hypothesized that ADMSCs may be directed to epidermal lineage in vitro on a specifically designed biomimetic and biodegradable niche. Cells were seeded on the test niche constituted with fibrin, fibronectin, gelatin, hyaluronic acid, laminin V, platelet growth factor, and epidermal growth factor in the presence of cell-specific differentiation medium (DM). The ADMSCs grown on bare tissue culture polystyrene surface in DM is designated DM-control and those grown in basal medium (BM) is the BM-control. Lineage commitment was monitored with keratinocyte-specific markers such as cytokeratin 14, cytokeratin 5, cytokeratin 19, and integrin α6 at the transcriptional/translational level. The in vitro designed biomimetic fibrin composite matrix may have potential application as cell transplantation vehicle.
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Affiliation(s)
- Unnikrishnan Sivan
- Thrombosis Research Unit, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology , Trivandrum, Kerala, India
| | - K Jayakumar
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology , Trivandrum, Kerala, India
| | - Lissy K Krishnan
- Thrombosis Research Unit, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology , Trivandrum, Kerala, India
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Whelan DB, Dold AP, Trajkovski T, Chahal J. Risk factors for the development of heterotopic ossification after knee dislocation. Clin Orthop Relat Res 2014; 472:2698-704. [PMID: 25002209 PMCID: PMC4117869 DOI: 10.1007/s11999-014-3730-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Results of treatment for acute knee dislocations and multiligament knee injuries may be influenced by a multitude of patient- and injury-related factors, including neurologic function, vascular status, ipsilateral fractures, and joint stability. The development of heterotopic ossification (HO) may nullify any benefits of reconstruction, because it can cause stiffness and discomfort. Identifying factors associated with HO after knee dislocation may help identify patients who might benefit from prophylaxis. QUESTIONS/PURPOSES The purposes of this study were (1) to identify specific risk factors for the development of HO in patients with knee dislocation; and (2) to elucidate the relationship between the presence of absence of HO and postoperative range of motion. METHODS Between 2005 and 2010, we performed 101 multiligament reconstructions for patients with knee dislocations, of which 91 (90%) in 91 patients were available for followup at a minimum of 6 months (mean, 18 months; range, 6-44 months), and were reviewed here. AP and lateral radiographs were reviewed for all patients and HO was classified according to the Mills and Tejwani classification system. This knee dislocation cohort was separated into two groups based on the presence or absence of HO for comparison. Using a significance level of p < 0.05 for factors in the univariate analyses, we identified potential variables for a multivariate logistic regression model to identify risk factors predicting development of HO in patients with multiligament knee injuries; multivariate analysis then was performed to mitigate the influence of potentially confounding variables. Thirty patients (34%) developed HO after multiligament knee injury in our series. RESULTS Posterior cruciate ligament reconstruction was the only independent predictor of HO that we identified (odds ratio, 6.3; 95% confidence interval, 1.2-34.6). Patients who developed HO were more likely to develop stiff knees and undergo surgery (50%; 15 of 30 patients) versus those without HO (12%; seven of 58 patients) to attempt to restore functional range of motion (p < 0.001). CONCLUSIONS HO is a common complication after knee dislocation and can diminish range of motion and cause patients to undergo further surgery. Posterior cruciate ligament reconstruction is an independent risk factor for the development of HO. Strategies to identify risk factors for, and safe prevention of, HO after multiple ligament injury and surgery should be investigated going forward. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel B Whelan
- Department of Surgery, University of Toronto, c/o St Michael's Orthopaedic Associates, 55 Queen Street E, Suite 800, Toronto, ON, M5C 1R6, Canada,
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Sivan U, Jayakumar K, Krishnan LK. Matrix-directed differentiation of human adipose-derived mesenchymal stem cells to dermal-like fibroblasts that produce extracellular matrix. J Tissue Eng Regen Med 2014; 10:E546-E558. [DOI: 10.1002/term.1865] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 11/02/2013] [Accepted: 12/16/2013] [Indexed: 12/22/2022]
Affiliation(s)
- Unnikrishnan Sivan
- Thrombosis Research Unit, Biomedical Technology Wing; Sree Chitra Tirunal Institute for Medical Sciences and Technology; Thiruvananthapuram Kerala India
| | - K. Jayakumar
- Department of Cardiovascular and Thoracic Surgery; Sree Chitra Tirunal Institute for Medical Sciences and Technology; Thiruvananthapuram Kerala India
| | - Lissy K. Krishnan
- Thrombosis Research Unit, Biomedical Technology Wing; Sree Chitra Tirunal Institute for Medical Sciences and Technology; Thiruvananthapuram Kerala India
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Activation of Hedgehog signaling by loss of GNAS causes heterotopic ossification. Nat Med 2013; 19:1505-12. [PMID: 24076664 PMCID: PMC3917515 DOI: 10.1038/nm.3314] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 07/19/2013] [Indexed: 12/17/2022]
Abstract
Bone formation is exquisitely controlled in space and time. Heterotopic ossification (HO), the pathologic formation of extra-skeletal bone, occurs as a common complication of trauma or in genetic disorders and can be disabling and lethal. However, the underlying molecular mechanisms are largely unknown. Here we demonstrate that Gαs restricts bone formation to the skeleton by inhibiting Hedgehog (Hh) signaling in mesenchymal progenitor cells. In progressive osseous heteroplasia (POH), a human disease caused by null mutations in GNAS that encodes Gαs, HH signaling is upregulated in ectopic osteoblasts and progenitor cells. Ectopic Hh signaling is sufficient to induce HO, while Hh signaling inhibition blocks HO in animal models. As our previous work has shown that GNAS gain of function mutations upregulate WNT/β-Catenin signaling in fibrous dysplasia (FD), our findings identify Gαs as a critical regulator of osteoblast differentiation by maintaining a balance between two key signaling pathways: Wnt/β-catenin and Hh. HH signaling inhibitors developed for cancer therapy may be repurposed to treat HO and other diseases caused by GNAS inactivation.
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Davis TA, Lazdun Y, Potter BK, Forsberg JA. Ectopic bone formation in severely combat-injured orthopedic patients -- a hematopoietic niche. Bone 2013; 56:119-26. [PMID: 23727270 DOI: 10.1016/j.bone.2013.05.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/24/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022]
Abstract
Combat-related heterotopic ossification (HO) has emerged as a common and problematic complication of modern wartime extremity injuries, contributing to substantial patient morbidity and loss of function. We have previously reported that HO-forming patients exhibit a more pronounced systemic and local inflammatory response very early in the wound healing process. Moreover, traumatized muscle-derived mesenchymal progenitor cells from these patients have a skewed differentiation potential toward bone. Here, we demonstrate that HO lesions excised from this patient population contain highly vascularized, mature, cancellous bone containing adipogenic marrow. Histologic analysis showed immature hematopoietic cells located within distinct foci in perivascular regions. The adipogenic marrow often contained low numbers of functional erythroid (BFU-E), myeloid (CFU-GM, CFU-M) and multilineage (CFU-GEMM) colony-forming hematopoietic progenitor cells (HPCs). Conversely, tissue from control muscle and non-HO traumatic wound granulation tissue showed no evidence of hematopoietic progenitor cell activity. In summary, our findings suggest that ectopic bone can provide an appropriate hematopoietic microenvironment for supporting the proliferation and differentiation of HPCs. This reactive and vibrant cell population may help maintain normal hematopoietic function, particularly in those with major extremity amputations who have sustained both massive blood loss, prompting systemic marrow stimulation, as well as loss of available native active marrow space. These findings begin to characterize the functional biology of ectopic bone and elucidate the interactions between HPC and non-hematopoietic cell types within the ectopic intramedullary hematopoietic microenvironmental niche identified.
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Affiliation(s)
- Thomas A Davis
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD, USA.
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Heterotopic bone formation about the hip undergoes endochondral ossification: a rabbit model. Clin Orthop Relat Res 2013; 471:1584-92. [PMID: 23361932 PMCID: PMC3613540 DOI: 10.1007/s11999-013-2801-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 01/11/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Heterotopic ossification (HO) occurs most commonly after trauma and surgery about the hip and may compromise subsequent function. Currently available animal models describing the cellular progression of HO are based on exogenous osteogenic induction agents and may not reflect the processes following trauma. QUESTIONS/PURPOSES We therefore sought to characterize the histologic progression of heterotopic bone formation in an animal model that recapitulates the human condition without the addition of exogenous osteogenic material. METHODS We used a rabbit model that included intramedullary instrumentation of the upper femur and ischemic crush injury of the gluteal muscle. Bilateral surgical induction procedures were performed on 30 animals with the intention of inciting the process of HO; no supplemental osteogenic stimulants were used. Three animals were sacrificed at each of 10 predetermined times between 1 day and 26 weeks postoperatively and the progression of tissue maturation was graded histologically using a five-item scale. RESULTS Heterotopic bone reliably formed de novo and consistently followed a pathway of endochondral ossification. Chondroid elements were found in juxtaposition with immature woven bone in all sections that contained mature osseous elements. CONCLUSIONS These results establish that HO occurs in an animal model mimicking the human condition following surgical trauma about the hip; it is predictable in its histologic progression and follows a pathway of endochondral bone formation. CLINICAL RELEVANCE By showing a consistent pathway of endochondral ossification leading to ectopic bone formation, this study provides a basis for understanding the mechanisms by which HO might be mitigated by interventions.
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Rath E, Sherman H, Sampson TG, Ben Tov T, Maman E, Amar E. The incidence of heterotopic ossification in hip arthroscopy. Arthroscopy 2013; 29:427-33. [PMID: 23351728 DOI: 10.1016/j.arthro.2012.10.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 10/12/2012] [Accepted: 10/15/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to assess the incidence of heterotopic ossification (HO) after hip arthroscopy. METHODS Between July 2010 and July 2011, 83 patients underwent hip arthroscopy for various etiologies. We prospectively reviewed 50 consecutive hip arthroscopy procedures (31 male and 19 female patients; mean age, 36.7 years) with a mean follow-up of 29.56 weeks (range, 9 to 62 weeks) to assess the incidence of HO and its effect on function and clinical outcome. Preoperative and postoperative evaluation included general assessment by visual analog scoring, modified Harris Hip Score, Hip Outcome Score, and preoperative and postoperative radiographs. Heterotopic bone formation was assessed on radiographs at a minimum of 9 weeks from surgery with the Brooker classification. RESULTS Of the patients, 22 (44%) had radiographic evidence of postoperative HO (15 male patients): 13 (26%) had Brooker stage 1, 5 (10%) had Brooker stage 2, and 4 (8%) had Brooker stage 3. HO appeared as early as 9 weeks after surgery. No significant difference was found in demographic data, surgery-related data, or clinical and functional scores between patients with HO and patients without HO. No factor was found to significantly affect the incidence of HO after logistic regression. No distinct clinical manifestation was associated with the presence of HO. CONCLUSIONS This study shows that the incidence of HO after hip arthroscopy may be underestimated. We could not find a contributing factor to the formation of HO. Although in most cases the presence of HO will have minimal or no clinical and functional significance, it should be sought at a minimum of 9 weeks postoperatively. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Ehud Rath
- Department of Orthopedics, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kang SH, Park IJ, Jeong C. Suprascapular neuropathy caused by heterotopic ossification after clavicle shaft fracture: a case report. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2011; 22 Suppl 1:63-6. [PMID: 26662750 DOI: 10.1007/s00590-011-0913-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 11/14/2011] [Indexed: 11/30/2022]
Abstract
Suprascapular neuropathy is a rare peripheral neuropathy that can be easily overlooked in the differential diagnosis of shoulder pain and dysfunction. The suprascapular nerve may be injured as a result of repetitive overuse, constriction due to anatomic variants, compression due to space occupying lesions, retraction due to a massive rotator cuff tear and iatrogenic or traumatic lesions. Trauma-related suprascapular neuropathies are often caused by glenohumeral joint dislocations, scapular fractures, proximal humeral fractures, penetrating injuries and displaced clavicle fractures. Although many causes of suprascapular neuropathy have been described, there have been few reports of suprascapular neuropathy caused by heterotophic ossification after trauma around shoulder. Heterotophic ossification is the formation of bone in non-skeletal tissue, usually between the muscle and joint capsule. It usually occurs following trauma, surgery, burns, fractures, dislocation or soft tissue trauma. The spectrum of heterotophic ossification ranges from incidental radiographic findings to severe functional limitations. The range of motion can be decreased, resulting in soft tissue contractures. It can also cause peripheral neuropathy by impinging adjacent nerves. Management of heterotopic ossification is aimed at limiting its progression and maximizing function of the affected joint. Nonsurgical treatment is appropriate for early heterotopic ossification; however, surgical excision should be considered in cases of joint ankylosis or significant complications. We report a very unusual case of suprascapular neuropathy that resulted from heterotophic ossification after clavicle shaft fracture. This case was treated by open excision of the heterotophic ossification and external neurolysis of the suprascapular nerve. Although the incidence is very low, the heterotophic ossification should be considered as a possible cause of suprascapular neuropathy.
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Affiliation(s)
- Soo-Hwan Kang
- Department of Orthopaedic Surgery, St. Paul's Hospital, The Catholic University of Korea, 620-56 Jeonnong-dong, Dongdaemun-gu, Seoul, 130-709, Korea.
| | - Il-Jung Park
- Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, 2 Sosa-dong, Wonmi-gu, Bucheon, 420-717, Korea.
| | - Changhoon Jeong
- Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, 2 Sosa-dong, Wonmi-gu, Bucheon, 420-717, Korea.
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Lindenhovius ALC, Jupiter JB. The posttraumatic stiff elbow: a review of the literature. J Hand Surg Am 2007; 32:1605-23. [PMID: 18070653 DOI: 10.1016/j.jhsa.2007.09.015] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 09/12/2007] [Indexed: 02/02/2023]
Abstract
Loss of motion is a common complication of elbow trauma. Restoration of joint motion in the posttraumatic stiff elbow can be a difficult, time-consuming, and costly challenge. In this review of the literature, the biologic response to trauma and the possible etiologic events that may lead to fibrosis of the capsules and heterotopic ossification will be discussed, as well as nonsurgical and surgical management of stiffness and expected outcomes of treatment.
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Liu K, Tripp S, Layfield LJ. Heterotopic ossification: Review of histologic findings and tissue distribution in a 10-year experience. Pathol Res Pract 2007; 203:633-40. [PMID: 17728073 DOI: 10.1016/j.prp.2007.05.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 02/09/2007] [Accepted: 05/24/2007] [Indexed: 10/22/2022]
Abstract
Heterotopic ossification (HO) within tissues involved by a pathologic process is a well-recognized phenomenon. It is most frequently observed in atherosclerotic plaques, in soft tissue around joints, and in the central nervous system. Less frequently, carcinomas and some benign neoplasms will undergo heterotopic ossification. We performed a retrospective review of our experience with HO over a 10-year period to determine the frequency and tissue site distribution of heterotopic ossification. A computerized review of surgical pathology records of approximately 126,000 reports revealed 85 cases in which heterotopic ossification, ectopic bone or metaplastic bone was specifically mentioned in the surgical pathology diagnosis. Twenty-two cases were neoplasms of non-osseous tissues, and 63 cases were non-neoplastic lesions. Immunohistochemical staining for bone morphogenic proteins (BMP) 1, 4, and 6 was performed. Fourteen cases showed staining for BMP-1, 22 cases showed staining for BMP-4, and five cases showed weak staining for BMP-6. HO is a relatively infrequent finding and is more commonly seen in degenerative and reparative conditions than in neoplasms.
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Affiliation(s)
- Katharine Liu
- Department of Pathology, University Hospital, Augusta, GA, USA
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Abstract
The emerging field of regenerative medicine will require a reliable source of stem cells in addition to biomaterial scaffolds and cytokine growth factors. Adipose tissue represents an abundant and accessible source of adult stem cells with the ability to differentiate along multiple lineage pathways. The isolation, characterization, and preclinical and clinical application of adipose-derived stem cells (ASCs) are reviewed in this article.
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Affiliation(s)
- Jeffrey M Gimble
- Stem Cell Biology Laboratory and Clinical Nutrition Research Unit, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA 70808, USA.
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Hicok KC, Du Laney TV, Zhou YS, Halvorsen YDC, Hitt DC, Cooper LF, Gimble JM. Human adipose-derived adult stem cells produce osteoid in vivo. ACTA ACUST UNITED AC 2005; 10:371-80. [PMID: 15165454 DOI: 10.1089/107632704323061735] [Citation(s) in RCA: 250] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Adult subcutaneous fat tissue is an abundant source of multipotent cells. Previous studies from our laboratory have shown that, in vitro, adipose-derived adult stem (ADAS) cells express bone marker proteins including alkaline phosphatase, type I collagen, osteopontin, and osteocalcin and produce a mineralized matrix as shown by alizarin red staining. In the current study, the ADAS cell ability to form osteoid in vivo was determined. ADAS cells were isolated from liposuction waste of three individual donors and expanded in vitro before implantation. Equal numbers of cells (3 x 10(6)) were loaded onto either hydroxyapatite/tricalcium phosphate (HA-TCP) cubes or the collagen/HA-TCP composite matrix, Collagraft, and then implanted subcutaneously into SCID mice. After 6 weeks, implants were removed, fixed, and demineralized and sectioned for hematoxylin and eosin staining. Osteoid formation was observed in 80% of HA-TCP implants loaded with ADAS cells. Only 20% of Collagraft implants were positive for the presence of osteoid matrix. Whereas 100% of HA-TCP implants loaded with hFOB 1.19 cells formed osteoid, Collagraft loaded with hFOB 1.19 cells displayed a high degree of adipose tissue within the matrix. Immunostaining of serial sections for human nuclear antigen demonstrated that the osteoid contained human cells. Osteoid formation was not observed in control HA-TCP or Collagraft matrices implanted without cells. In summary, the data demonstrate the ability of ADAS cells to form osteoid matrix in vivo. Because of their abundance and accessibility, ADAS cells may prove to be a novel cell therapeutic for bone repair and regeneration.
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Strem BM, Hicok KC, Zhu M, Wulur I, Alfonso Z, Schreiber RE, Fraser JK, Hedrick MH. Multipotential differentiation of adipose tissue-derived stem cells. Keio J Med 2005; 54:132-41. [PMID: 16237275 DOI: 10.2302/kjm.54.132] [Citation(s) in RCA: 629] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Tissue engineering offers considerable promise in the repair or replacement of diseased and/or damaged tissues. The cellular component of this regenerative approach will play a key role in bringing these tissue engineered constructs from the laboratory bench to the clinical bedside. However, the ideal source of cells still remains unclear and may differ depending upon the application. Current research for many applications is focused on the use of adult stem cells. The properties of adult stem cells that make them well-suited for regenerative medicine are (1) ease of harvest for autologous transplantation, (2) high proliferation rates for ex vivo expansion and (3) multilineage differentiation capacity. This review will highlight the use of adipose tissue as a reservoir of adult stem cells and draw conclusions based upon comparisons with bone marrow stromal cells.
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44
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Abstract
Heterotopic ossification, the formation of bone in soft tissue, requires inductive signaling pathways, inducible osteoprogenitor cells, and a heterotopic environment conducive to osteogenesis. Little is known about the molecular pathogenesis of this condition. Research into two rare heritable and developmental forms, fibrodysplasia ossificans progressiva and progressive osseous heteroplasia, has provided clinical, pathologic, and genetic insights. In fibrodysplasia ossificans progressiva, overexpression of bone morphogenetic protein 4 and underexpression of multiple antagonists of this protein highlight the potential role of a potent morphogenetic gradient. Research on fibrodysplasia ossificans progressiva also has led to the identification of the genetic cause of progressive osseous heteroplasia: inactivating mutations in the alpha subunit of the gene coding for the stimulatory G protein of adenylyl cyclase. Better understanding of the complex developmental and molecular pathology of these disorders may lead to more effective strategies to prevent and treat other, more common forms of heterotopic ossification.
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Affiliation(s)
- Frederick S Kaplan
- Departments of Orthopaedic Surgery and Medicine, The University of Pennsylvania School of Medicine, Silverstein 2, 3400 Spruce Street, Philadelphia, PA 19104-5283, USA
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45
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Stannard JP, Wilson TC, Sheils TM, McGwin G, Volgas DA, Alonso JE. Heterotopic ossification associated with knee dislocation. Arthroscopy 2002; 18:835-9. [PMID: 12368779 DOI: 10.1053/jars.2002.32842] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the prevalence of heterotopic ossification following knee dislocation. TYPE OF STUDY Prospective clinical evaluation and a retrospective chart review. METHODS This study evaluated 57 knees in 55 patients who sustained high-energy blunt trauma with resultant knee dislocations. Radiographs were reviewed by 2 of the authors (J.P.S., T.C.W.), and the incidence of heterotopic ossification (HO) was documented. Additionally, patients were classified regarding the degree of HO on a scale from 0 to 4. One is punctate calcification, 2 is HO involving less than 50% of the joint space; 3 is HO involving more than 50%; and 4 is ankylosis of the joint. RESULTS Thirteen patients with 15 knee dislocations developed HO. The incidence of HO was 26%. Seven knees demonstrated severe HO (grade 3 or 4) which represented an incidence of 12% of all knee dislocations. Injury severity score for both groups was 18, documenting that the patients in this study represent multiple trauma patients. There was no significant difference in the incidence of HO based on mechanism of injury with the current number enrolled in the study. However, 60% (3 of 5) of patients involved in a motor vehicle versus pedestrian accident developed HO. There was a significant increase in the incidence of arthrofibrosis in patients with severe HO (P <.05). Patients with significant HO had a mean flexion of 97 degrees, compared with flexion of 117 degrees in patients with no or mild HO. This difference was borderline significant (P =.058). There was no difference between the groups in mean extension. There was a significant increase in knee HO in patients with HO at another anatomic site (P =.01). CONCLUSIONS HO is a common problem following knee dislocation. Of the 7 knees with severe HO, 5 developed HO medially, 4 developed HO posteriorly, 3 developed HO laterally, and only 1 had involvement anteriorly. A similar distribution was present in the patients with mild HO, with posterior and medial ossification being the most common. Five of the 7 severe HO cases involved at least 3 of the 4 sides (anterior, posterior, medial, or lateral) of the knee. Patients were evaluated for the presence of head injury and any relationship to the development of HO around the knee. There was no increased incidence of HO around the knee in our 10 patients with severe head injuries when compared with those with no head injury. There was also no increased incidence of HO in knee dislocations associated with periarticular fractures.
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Affiliation(s)
- James P Stannard
- Department of Surgery, Division of Orthopaedic Surgery, The University of Alabama at Birmingham, Birmingham, Alabama 35294-3295, USA.
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Halvorsen YD, Franklin D, Bond AL, Hitt DC, Auchter C, Boskey AL, Paschalis EP, Wilkison WO, Gimble JM. Extracellular matrix mineralization and osteoblast gene expression by human adipose tissue-derived stromal cells. TISSUE ENGINEERING 2001; 7:729-41. [PMID: 11749730 DOI: 10.1089/107632701753337681] [Citation(s) in RCA: 359] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Human adipose tissue represents an abundant reservoir of stromal cells with potential utility for tissue engineering. The current study demonstrates the ability of human adipose tissue-derived stromal cells to display some of the hallmarks of osteoblast differentiation in vitro. Following treatment with ascorbate, beta-glycerophosphate, dexamethasone, and 1,25 dihydroxy vitamin D(3), adipose tissue-derived stromal cells mineralize their extracellular matrix based on detection of calcium phosphate deposits using Alizarin Red and von Kossa histochemical stains. Fourier transform infrared analysis demonstrates the apatitic nature of these crystals. Mineralization is accompanied by increased expression or activity of the osteoblast-associated proteins osteocalcin and alkaline phosphatase. These and other osteoblast-associated gene markers are detected based on polymerase chain reaction. In contrast, the adipocyte gene markers--leptin, lipoprotein lipase, and peroxisome proliferator activated receptor gamma2--are reduced under mineralization conditions, consistent with the reciprocal relationship postulated to exist between adipocytes and osteoblasts. The current work supports the presence of a multipotent stromal cell population within human extramedullary adipose tissue. These findings have potential implications for human bone tissue bioengineering.
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Affiliation(s)
- Y D Halvorsen
- Artecel Sciences, Inc., Durham, North Carolina 27713, USA
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Lorio MP, Duplechain M. Limitation of flexor tendon excursion by heterotopic ossification after isolated flexor tendon laceration. J Orthop Trauma 2001; 15:583-7. [PMID: 11733679 DOI: 10.1097/00005131-200111000-00012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A patient, one year after flexor digitorum superficialis/profundus repair in the left index finger, was diagnosed with heterotopic ossification involving the palmar surface of the proximal phalanx creating a secondary proximal interphalangeal joint contracture. A Compass PIP Hinge facilitated the treatment. Flexor tendon excursion improved, and active range of motion increased from 60 to 90 degrees before surgery to 30 to 105 degrees 20 months after surgery. Ectopic bone involvement of the hand is rare. This article reports a successful treatment for a unique complication of flexor injury and repair.
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Affiliation(s)
- M P Lorio
- Division of Appalachian Orthopaedic Associates, Highlands Spine Institute, 240 Medical Park Blvd., Suite 1500, Bristol, TN 37620, U.S.A
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Gronthos S, Franklin DM, Leddy HA, Robey PG, Storms RW, Gimble JM. Surface protein characterization of human adipose tissue-derived stromal cells. J Cell Physiol 2001; 189:54-63. [PMID: 11573204 DOI: 10.1002/jcp.1138] [Citation(s) in RCA: 977] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Human bone marrow stromal cells are a multipotent population of cells capable of differentiating into a number of mesodermal lineages as well as supporting hematopoeisis. Their distinct protein and gene expression phenotype is well characterized in the literature. Human adipose tissue presents an alternative source of multipotent stromal cells. In this study, we have defined the phenotype of the human adipose tissue-derived stromal cells in both the differentiated and undifferentiated states. Flow cytometry and immunohistochemistry show that human adipose tissue-derived stromal cells have a protein expression phenotype that is similar to that of human bone marrow stromal cells. Expressed proteins include CD9, CD10, CD13, CD29, CD34, CD44, CD 49(d), CD 49(e), CD54, CD55, CD59, CD105, CD106, CD146, and CD166. Expression of some of these proteins was further confirmed by PCR and immunoblot detection. Unlike human bone marrow-derived stromal cells, we did not detect the STRO-1 antigen on human adipose tissue-derived stromal cells. Cells cultured under adipogenic conditions uniquely expressed C/EBPalpha and PPARdelta, two transcriptional regulators of adipogenesis. Cells cultured under osteogenic conditions were more likely to be in the proliferative phases of the cell cycle based on flow cytometric analysis of PCNA and Ki67. The similarities between the phenotypes of human adipose tissue-derived and human bone marrow-derived stromal cells could have broad implications for human tissue engineering.
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Affiliation(s)
- S Gronthos
- Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, Bethesda, Maryland, USA
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Abstract
The spectrum of heterotopic calcification or ossification is expanding because of the reports of several kindreds with calcium pyrophosphate deposition disease, apatite deposition disease, and others with less common syndromes associated with extracellular matrix calcification, such as fibrodysplasia ossificans progressiva and related syndromes. Genomic DNA studies in both humans and mice provide a shortcut to understanding the genetic basis of promotion and prevention of ECM calcification. Mutation in the COL2A1 gene has been identified in one family with spondyloepiphyseal dysplasia and calcium pyrophosphate and apatite crystalline deposits. In another kindred with precocious osteoarthritis without spondyloepiphyseal dysplasia, the phenotype was linked to markers of chromosome 8. In four other kindreds, the phenotypes were linked to an area of chromosome 5p. Two genes located in this region, which are expressed in articular cartilage, are being investigated as possible calcium pyrophosphate deposition disease genes. The results of linkage studies in three kindreds with articular/periarticular ADD with the COL2A1 gene were noninformative. Two different mouse mutations, the ank/ank and the ttw/ttw mice, are associated with intra-articular and ligament apatite deposits caused by a decrease in extracellular pyrophosphate concentrations, mimicking human arthritis caused by apatite deposition disease. Mutations in the matrix GLA protein, both in mice and in humans, are also associated with vascular and articular calcification. These mouse mutations provide cutting-edge information in the investigation of the mechanisms of apatite deposition in humans.
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Affiliation(s)
- I Maldonado
- Department of Medicine, Hospital Universitario Ruiz y Paez, Universidad de Oriente, Ciudad Bolivar, Venezuela
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Abstract
Progressive osseous heteroplasia (POH) is a recently described genetic disorder of mesenchymal differentiation characterized by dermal ossification during infancy and progressive heterotopic ossification of cutaneous, subcutaneous, and deep connective tissues during childhood. The disorder can be distinguished from fibrodysplasia ossificans progressiva (FOP) by the presence of cutaneous ossification, the absence of congenital malformations of the skeleton, the absence of inflammatory tumorlike swellings, the asymmetric mosaic distribution of lesions, the absence of predictable regional patterns of heterotopic ossification, and the predominance of intramembranous rather than endochondral ossification. POH can be distinguished from Albright hereditary osteodystrophy (AHO) by the progression of heterotopic ossification from skin and subcutaneous tissue into skeletal muscle, the presence of normal endocrine function, and the absence of a distinctive habitus associated with AHO. Although the genetic basis of POH is unknown, inactivating mutations of the GNAS1 gene are associated with AHO. The report in this issue of the JBMR of 2 patients with combined features of POH and AHO--one with classic AHO, severe POH-like features, and reduced levels of Gsalpha protein and one with mild AHO, severe POH-like features, reduced levels of Gsalpha protein, and a mutation in GNAS1--suggests that classic POH also could be caused by GNAS1 mutations. This possibility is further supported by the identification of a patient with atypical but severe platelike osteoma cutis (POC) and a mutation in GNAS1, indicating that inactivating mutations in GNAS1 may lead to severe progressive heterotopic ossification of skeletal muscle and deep connective tissue independently of AHO characteristics. These observations suggest that POH may lie at one end of a clinical spectrum of ossification disorders mediated by abnormalities in GNAS1 expression and impaired activation of adenylyl cyclase. Analysis of patients with classic POH (with no AHO features) is necessary to determine whether the molecular basis of POH is caused by inactivating mutations in the GNAS1 gene.
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Affiliation(s)
- F S Kaplan
- Department of Orthopaedic Surgery, The University of Pennsylvania School of Medicine, Philadelphia, USA
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