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Vishlaghi N, Guo L, Griswold-Wheeler D, Sun Y, Booker C, Crossley JL, Bancroft AC, Juan C, Korlakunta S, Ramesh S, Pagani CA, Xu L, James AW, Tower RJ, Dellinger M, Levi B. Vegfc-expressing cells form heterotopic bone after musculoskeletal injury. Cell Rep 2024; 43:114049. [PMID: 38573853 DOI: 10.1016/j.celrep.2024.114049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/09/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024] Open
Abstract
Heterotopic ossification (HO) is a challenging condition that occurs after musculoskeletal injury and is characterized by the formation of bone in non-skeletal tissues. While the effect of HO on blood vessels is well established, little is known about its impact on lymphatic vessels. Here, we use a mouse model of traumatic HO to investigate the relationship between HO and lymphatic vessels. We show that injury triggers lymphangiogenesis at the injury site, which is associated with elevated vascular endothelial growth factor C (VEGF-C) levels. Through single-cell transcriptomic analyses, we identify mesenchymal progenitor cells and tenocytes as sources of Vegfc. We demonstrate by lineage tracing that Vegfc-expressing cells undergo osteochondral differentiation and contribute to the formation of HO. Last, we show that Vegfc haploinsufficiency results in a nearly 50% reduction in lymphangiogenesis and HO formation. These findings shed light on the complex mechanisms underlying HO formation and its impact on lymphatic vessels.
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Affiliation(s)
- Neda Vishlaghi
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Lei Guo
- Department of Population and Data Sciences, University of Texas Southwestern, Dallas, TX, USA
| | | | - Yuxiao Sun
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Cori Booker
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Janna L Crossley
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Alec C Bancroft
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Conan Juan
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Sneha Korlakunta
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Sowmya Ramesh
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Chase A Pagani
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Lin Xu
- Department of Population and Data Sciences, University of Texas Southwestern, Dallas, TX, USA
| | - Aaron W James
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Robert J Tower
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Michael Dellinger
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA.
| | - Benjamin Levi
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA.
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Kang H, Strong AL, Sun Y, Guo L, Juan C, Bancroft AC, Choi JH, Pagani CA, Fernandes AA, Woodard M, Lee J, Ramesh S, James AW, Hudson D, Dalby KN, Xu L, Tower RJ, Levi B. The HIF-1α/PLOD2 axis integrates extracellular matrix organization and cell metabolism leading to aberrant musculoskeletal repair. Bone Res 2024; 12:17. [PMID: 38472175 PMCID: PMC10933265 DOI: 10.1038/s41413-024-00320-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/04/2024] [Accepted: 02/01/2024] [Indexed: 03/14/2024] Open
Abstract
While hypoxic signaling has been shown to play a role in many cellular processes, its role in metabolism-linked extracellular matrix (ECM) organization and downstream processes of cell fate after musculoskeletal injury remains to be determined. Heterotopic ossification (HO) is a debilitating condition where abnormal bone formation occurs within extra-skeletal tissues. Hypoxia and hypoxia-inducible factor 1α (HIF-1α) activation have been shown to promote HO. However, the underlying molecular mechanisms by which the HIF-1α pathway in mesenchymal progenitor cells (MPCs) contributes to pathologic bone formation remain to be elucidated. Here, we used a proven mouse injury-induced HO model to investigate the role of HIF-1α on aberrant cell fate. Using single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics analyses of the HO site, we found that collagen ECM organization is the most highly up-regulated biological process in MPCs. Zeugopod mesenchymal cell-specific deletion of Hif1α (Hoxa11-CreERT2; Hif1afl/fl) significantly mitigated HO in vivo. ScRNA-seq analysis of these Hoxa11-CreERT2; Hif1afl/fl mice identified the PLOD2/LOX pathway for collagen cross-linking as downstream of the HIF-1α regulation of HO. Importantly, our scRNA-seq data and mechanistic studies further uncovered that glucose metabolism in MPCs is most highly impacted by HIF-1α deletion. From a translational aspect, a pan-LOX inhibitor significantly decreased HO. A newly screened compound revealed that the inhibition of PLOD2 activity in MPCs significantly decreased osteogenic differentiation and glycolytic metabolism. This suggests that the HIF-1α/PLOD2/LOX axis linked to metabolism regulates HO-forming MPC fate. These results suggest that the HIF-1α/PLOD2/LOX pathway represents a promising strategy to mitigate HO formation.
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Affiliation(s)
- Heeseog Kang
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Amy L Strong
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Yuxiao Sun
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Lei Guo
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Conan Juan
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Alec C Bancroft
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Ji Hae Choi
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Chase A Pagani
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Aysel A Fernandes
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Michael Woodard
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Juhoon Lee
- Division of Chemical Biology and Medicinal Chemistry, College of Pharmacy, University of Texas at Austin, Austin, TX, 78712, USA
| | - Sowmya Ramesh
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Aaron W James
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - David Hudson
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Kevin N Dalby
- Division of Chemical Biology and Medicinal Chemistry, College of Pharmacy, University of Texas at Austin, Austin, TX, 78712, USA
| | - Lin Xu
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Robert J Tower
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA
| | - Benjamin Levi
- Center for Organogenesis, Regeneration and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, 75390, USA.
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Bhat SG, Nagaraj M, Balentine C, Hogan T, Meier J, Prince H, Abdelfattah K, Zeh H, Levi B. Assessing a Structured Mental Fitness Program for Academic Acute Care Surgeons: A Pilot Study. J Surg Res 2024; 295:9-18. [PMID: 37956507 DOI: 10.1016/j.jss.2023.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/22/2023] [Accepted: 09/18/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION There is a well-established positive correlation between improved physician wellness and patient care outcomes. Mental fitness is a component of wellness that is understudied in academic medicine. We piloted a structured mental fitness Positive Intelligence (PQ) training program for academic surgeons, hypothesizing this would be associated with improvements in PQ scores, wellness, sleep, and trainee evaluations. METHODS This is a single-institution, prospective, mixed-methods pilot study. All active Burn/Trauma/Acute & Critical Care Surgical faculty and fellows in our division were offered the PQ program and the option to participate in this research study. The 6-wk program consists of daily exercises on a smartphone application, weekly readings, and small-group meetings with a trained mindfulness coach. Study outcomes included changes in pretraining versus post-training PQ scores, sleep hygiene, wellness, and teaching scores. A Net Promoter Score was calculated to measure user overall experience (range -100 to 100; positive scores being supportive). For secondary analysis, participants were stratified into high versus low user groups by "muscle" scores, which were calculated by program use over time. A postintervention focus group was also held to evaluate perceptions of wellness and experience with the PQ program. RESULTS Data were analyzed for 15 participants who provided consent. The participants were primarily White (73.3%), Assistant Professors (66.7%) with Surgical Critical Care fellowship training (86.7%), and a slight female predominance (53.3%). Comparison of scores pretraining versus post-training demonstrated statistically significant increases in PQ (59 versus 65, P = 0.004), but no significant differences for sleep (24.0 versus 29.0, P = 0.33) or well-being (89.0 versus 94.0, P = 0.10). Additionally, there was no significant difference in teaching evaluations for both residents (9.1 versus 9.3, P = 0.33) and medical students (8.3 versus 8.5, P = 0.77). High versus low user groups were defined by the median muscle score (166 [Interquartile range 95.5-298.5]). High users demonstrated a statistically higher proportion of ongoing usage (75% versus 14%, P < 0.05). The final Net Promoter Score score was 25, which demonstrates program support within this group. Focus group content analysis established eight major categories: current approaches to wellness, preknowledge, reasons for participation, expected gains, program strengths, suggestions for improvement, recommendations for approaches, and sustainability. CONCLUSIONS Our pilot study highlighted certain benefits of a structured mental fitness program for academic acute care surgeons. Our mixed-methods data demonstrate significant improvement in PQ scores, ongoing usage in high user participants, as well as interpersonal benefits such as improved connectedness and creation of a shared language within participants. Future work should evaluate this program on a higher-powered scale, with a focus on intentionality in wellness efforts, increased exposure to mental fitness, and recruitment of trainees and other health-care providers, as well as identifying the potential implications for patient outcomes.
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Affiliation(s)
- Sneha G Bhat
- Burns/Trauma/Acute & Critical Care Division, University Of Texas Southwestern Medical Center, Dallas, Texas.
| | - Madhuri Nagaraj
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Courtney Balentine
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Timothy Hogan
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jennie Meier
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hillary Prince
- Burns/Trauma/Acute & Critical Care Division, University Of Texas Southwestern Medical Center, Dallas, Texas
| | - Kareem Abdelfattah
- Burns/Trauma/Acute & Critical Care Division, University Of Texas Southwestern Medical Center, Dallas, Texas
| | - Herbert Zeh
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin Levi
- Burns/Trauma/Acute & Critical Care Division, University Of Texas Southwestern Medical Center, Dallas, Texas
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DeLuca JP, Selig DJ, Vir P, Vuong CV, Della-Volpe J, Rivera IM, Park C, Levi B, Pratt KP, Stewart IJ. Seraph 100 Microbind Affinity Blood Filter Does Not Clear Antibiotics: An Analysis of Antibiotic Concentration Data from PURIFY-OBS. Blood Purif 2024; 53:379-385. [PMID: 38219716 DOI: 10.1159/000531951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/29/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Novel hemoperfusion systems are emerging for the treatment of sepsis. These devices can directly remove pathogens, pathogen-associated molecular patterns, cytokines, and other inflammatory markers from circulation. However, significant safety concerns such as potential antibiotic clearance need to be addressed prior to these devices being used in large clinical studies. METHODS Prospective, observational study of 34 participants undergoing treatment with the Seraph 100® Microbind Affinity Blood Filter (Seraph 100) device at 6 participating sites in the USA. Patients were included for analysis if they had a record of receiving an antibiotic concurrent with Seraph 100 treatment. Patients were excluded if there was missing information for blood flow rate. Blood samples were drawn pre- and post-filter at 1 h and 4 h after treatment initiation. These average pre- and post-filter time-concentration observations were then used to estimate antibiotic clearance in L/h (CLSeraph) due to the Seraph 100 device. RESULTS Of the 34 participants in the study, 17 met inclusion and exclusion criteria for the antibiotic analysis. Data were obtained for 7 antibiotics (azithromycin, cefazolin, cefepime, ceftriaxone, linezolid, piperacillin, and vancomycin) and one beta-lactamase inhibitor. Mean CLSeraph for the antibiotics investigated ranged from -0.57 to 0.47 L/h. No antibiotic had a CLSeraph statistically significant from 0. DISCUSSION/CONCLUSION The Seraph 100 did not significantly clear any measured antibiotic in clinical samples. These data give further evidence to suggest that these therapies may be safely administered to critically ill patients and will not impact concentrations of administered antibiotics.
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Affiliation(s)
- Jesse P DeLuca
- Walter Reed Army Institute of Research, Bethesda, Maryland, USA
| | - Daniel J Selig
- Walter Reed Army Institute of Research, Bethesda, Maryland, USA
| | - Pooja Vir
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Chau V Vuong
- Walter Reed Army Institute of Research, Bethesda, Maryland, USA
| | | | - Ian M Rivera
- Department of Medicine, Eisenhower Army Medical Center, Augusta, Georgia, USA
| | - Caroline Park
- Department of Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Benjamin Levi
- Department of Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Kathleen P Pratt
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Ian J Stewart
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
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Cherief M, Xu J, Li Z, Tower RJ, Ramesh S, Qin Q, Gomez-Salazar M, Yea JH, Lee S, Negri S, Xu M, Price T, Kendal AR, Fan CM, Clemens TL, Levi B, James AW. TrkA-mediated sensory innervation of injured mouse tendon supports tendon sheath progenitor cell expansion and tendon repair. Sci Transl Med 2023; 15:eade4619. [PMID: 38117901 DOI: 10.1126/scitranslmed.ade4619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 11/29/2023] [Indexed: 12/22/2023]
Abstract
Peripheral neurons terminate at the surface of tendons partly to relay nociceptive pain signals; however, the role of peripheral nerves in tendon injury and repair remains unclear. Here, we show that after Achilles tendon injury in mice, there is new nerve growth near tendon cells that express nerve growth factor (NGF). Conditional deletion of the Ngf gene in either myeloid or mesenchymal mouse cells limited both innervation and tendon repair. Similarly, inhibition of the NGF receptor tropomyosin receptor kinase A (TrkA) abrogated tendon healing in mouse tendon injury. Sural nerve transection blocked the postinjury increase in tendon sensory innervation and the expansion of tendon sheath progenitor cells (TSPCs) expressing tubulin polymerization promoting protein family member 3. Single cell and spatial transcriptomics revealed that disruption of sensory innervation resulted in dysregulated inflammatory signaling and transforming growth factor-β (TGFβ) signaling in injured mouse tendon. Culture of mouse TSPCs with conditioned medium from dorsal root ganglia neuron further supported a role for neuronal mediators and TGFβ signaling in TSPC proliferation. Transcriptomic and histologic analyses of injured human tendon biopsy samples supported a role for innervation and TGFβ signaling in human tendon regeneration. Last, treating mice after tendon injury systemically with a small-molecule partial agonist of TrkA increased neurovascular response, TGFβ signaling, TSPC expansion, and tendon tissue repair. Although further studies should investigate the potential effects of denervation on mechanical loading of tendon, our results suggest that peripheral innervation is critical for the regenerative response after acute tendon injury.
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Affiliation(s)
- Masnsen Cherief
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jiajia Xu
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Zhao Li
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Robert J Tower
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Sowmya Ramesh
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Qizhi Qin
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21205, USA
| | | | - Ji-Hye Yea
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Seungyong Lee
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Stefano Negri
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Orthopaedics and Traumatology, University of Verona, Verona 37129, Italy
| | - Mingxin Xu
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Theodore Price
- Department of Neuroscience, Center for Advanced Pain Studies, University of Texas at Dallas, Dallas, TX 75080, USA
| | - Adrian R Kendal
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK
| | - Chen-Ming Fan
- Department of Embryology, Carnegie Institution for Science, Baltimore, MD 21208, USA
| | - Thomas L Clemens
- Department of Orthopaedics, University of Maryland, Baltimore, MD 21205, USA
- Baltimore Veterans Administration Medical Center, Baltimore, MD 21201, USA
| | - Benjamin Levi
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Aaron W James
- Department of Pathology, Johns Hopkins University, Baltimore, MD 21205, USA
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Nunez JH, Juan C, Sun Y, Hong J, Bancroft AC, Hwang C, Medrano JM, Huber AK, Tower RJ, Levi B. Neutrophil and NETosis Modulation in Traumatic Heterotopic Ossification. Ann Surg 2023; 278:e1289-e1298. [PMID: 37325925 PMCID: PMC10724380 DOI: 10.1097/sla.0000000000005940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To characterize the role of neutrophil extracellular traps (NETs) in heterotopic ossification (HO) formation and progression and to use mechanical and pharmacological methods to decrease NETosis and mitigate HO formation. BACKGROUND Traumatic HO is the aberrant osteochondral differentiation of mesenchymal progenitor cells after traumatic injury, burns, or surgery. While the innate immune response has been shown to be necessary for HO formation, the specific immune cell phenotype and function remain unknown. Neutrophils, one of the earliest immune cells to respond after HO-inducing injuries, can extrude DNA, forming highly inflammatory NETs. We hypothesized that neutrophils and NETs would be diagnostic biomarkers and therapeutic targets for the detection and mitigation of HO. METHODS C57BL6J mice underwent burn/tenotomy (a well-established mouse model of HO) or a non-HO-forming sham injury. These mice were either (1) ambulated ad libitum, (2) ambulated ad libitum with daily intraperitoneal hydroxychloroquine, ODN-2088 (both known to affect NETosis pathways), or control injections, or (3) had the injured hind limb immobilized. Single-cell analysis was performed to analyze neutrophils, NETosis, and downstream signaling after the HO-forming injury. Immunofluorescence microscopy was used to visualize NETosis at the HO site and neutrophils were identified using flow cytometry. Serum and cell lysates from HO sites were analyzed using enzyme-linked immunosorbent assay for myeloperoxidase-DNA and ELA2-DNA complexes to identify NETosis. Micro-computerized tomography was performed on all groups to analyze the HO volume. RESULTS Molecular and transcriptional analyses revealed the presence of NETs within the HO injury site, which peaked in the early phases after injury. These NETs were highly restricted to the HO site, with gene signatures derived from both in vitro NET induction and clinical neutrophil characterizations showing a high degree of NET "priming" at the site of injury, but not in neutrophils in the blood or bone marrow. Cell-cell communication analyses revealed that this localized NET formation coincided with high levels of toll-like receptor signaling specific to neutrophils at the injury site. Reducing the overall neutrophil abundance within the injury site, either pharmacologically through treatment with hydroxychloroquine, the toll-like receptor 9 inhibitor OPN-2088, or mechanical treatment with limb offloading, results in the mitigation of HO formation. CONCLUSIONS These data provide a further understanding of the ability of neutrophils to form NETs at the injury site, clarify the role of neutrophils in HO, and identify potential diagnostic and therapeutic targets for HO mitigation.
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Affiliation(s)
- Johanna H Nunez
- Department of Surgery, Center for Organogenesis and Trauma, University of Texas, Southwestern, Dallas, TX
| | - Conan Juan
- Department of Surgery, Center for Organogenesis and Trauma, University of Texas, Southwestern, Dallas, TX
| | - Yuxiao Sun
- Department of Surgery, Center for Organogenesis and Trauma, University of Texas, Southwestern, Dallas, TX
| | - Jonathan Hong
- Department of Surgery, Center for Organogenesis and Trauma, University of Texas, Southwestern, Dallas, TX
| | - Alec C Bancroft
- Department of Surgery, Center for Organogenesis and Trauma, University of Texas, Southwestern, Dallas, TX
| | - Charles Hwang
- Department of Plastic Surgery, Harvard University, Cambridge, MA
| | - Jessica Marie Medrano
- Department of Surgery, Center for Organogenesis and Trauma, University of Texas, Southwestern, Dallas, TX
| | - Amanda K Huber
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Robert J Tower
- Department of Surgery, Center for Organogenesis and Trauma, University of Texas, Southwestern, Dallas, TX
| | - Benjamin Levi
- Department of Surgery, Center for Organogenesis and Trauma, University of Texas, Southwestern, Dallas, TX
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Xiao X, Juan C, Drennon T, Uytingco CR, Vishlaghi N, Sokolowskei D, Xu L, Levi B, Sammarco MC, Tower RJ. Spatial transcriptomic interrogation of the murine bone marrow signaling landscape. Bone Res 2023; 11:59. [PMID: 37926705 PMCID: PMC10625929 DOI: 10.1038/s41413-023-00298-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023] Open
Abstract
Self-renewal and differentiation of skeletal stem and progenitor cells (SSPCs) are tightly regulated processes, with SSPC dysregulation leading to progressive bone disease. While the application of single-cell RNA sequencing (scRNAseq) to the bone field has led to major advancements in our understanding of SSPC heterogeneity, stem cells are tightly regulated by their neighboring cells which comprise the bone marrow niche. However, unbiased interrogation of these cells at the transcriptional level within their native niche environment has been challenging. Here, we combined spatial transcriptomics and scRNAseq using a predictive modeling pipeline derived from multiple deconvolution packages in adult mouse femurs to provide an endogenous, in vivo context of SSPCs within the niche. This combined approach localized SSPC subtypes to specific regions of the bone and identified cellular components and signaling networks utilized within the niche. Furthermore, the use of spatial transcriptomics allowed us to identify spatially restricted activation of metabolic and major morphogenetic signaling gradients derived from the vasculature and bone surfaces that establish microdomains within the marrow cavity. Overall, we demonstrate, for the first time, the feasibility of applying spatial transcriptomics to fully mineralized tissue and present a combined spatial and single-cell transcriptomic approach to define the cellular components of the stem cell niche, identify cell‒cell communication, and ultimately gain a comprehensive understanding of local and global SSPC regulatory networks within calcified tissue.
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Affiliation(s)
- Xue Xiao
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Conan Juan
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tingsheng Drennon
- Department of Cell Biology & Applications, 10x Genomics, Pleasanton, CA, USA
| | - Cedric R Uytingco
- Department of Cell Biology & Applications, 10x Genomics, Pleasanton, CA, USA
| | - Neda Vishlaghi
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dimitri Sokolowskei
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lin Xu
- Quantitative Biomedical Research Center, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin Levi
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mimi C Sammarco
- Department of Surgery, Tulane School of Medicine, New Orleans, LA, USA
| | - Robert J Tower
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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8
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Crossley JL, Ostashevskaya-Gohstand S, Comazzetto S, Hook JS, Guo L, Vishlaghi N, Juan C, Xu L, Horswill AR, Hoxhaj G, Moreland JG, Tower RJ, Levi B. Itaconate-producing neutrophils regulate local and systemic inflammation following trauma. JCI Insight 2023; 8:e169208. [PMID: 37707952 PMCID: PMC10619500 DOI: 10.1172/jci.insight.169208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
Modulation of the immune response to initiate and halt the inflammatory process occurs both at the site of injury as well as systemically. Due to the evolving role of cellular metabolism in regulating cell fate and function, tendon injuries that undergo normal and aberrant repair were evaluated by metabolic profiling to determine its impact on healing outcomes. Metabolomics revealed an increasing abundance of the immunomodulatory metabolite itaconate within the injury site. Subsequent single-cell RNA-Seq and molecular and metabolomic validation identified a highly mature neutrophil subtype, not macrophages, as the primary producers of itaconate following trauma. These mature itaconate-producing neutrophils were highly inflammatory, producing cytokines that promote local injury fibrosis before cycling back to the bone marrow. In the bone marrow, itaconate was shown to alter hematopoiesis, skewing progenitor cells down myeloid lineages, thereby regulating systemic inflammation. Therapeutically, exogenous itaconate was found to reduce injury-site inflammation, promoting tenogenic differentiation and impairing aberrant vascularization with disease-ameliorating effects. These results present an intriguing role for cycling neutrophils as a sensor of inflammation induced by injury - potentially regulating immune cell production in the bone marrow through delivery of endogenously produced itaconate - and demonstrate a therapeutic potential for exogenous itaconate following tendon injury.
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Affiliation(s)
| | | | | | | | - Lei Guo
- Quantitative Biomedical Research Center, Peter O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | | | - Lin Xu
- Department of Pediatrics, and
- Quantitative Biomedical Research Center, Peter O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Alexander R. Horswill
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Gerta Hoxhaj
- Children’s Research Institute and Department of Pediatrics
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9
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Lin YH, Zeng Q, Jia Y, Wang Z, Li L, Hsieh MH, Cheng Q, Pagani CA, Livingston N, Lee J, Zhang Y, Sharma T, Siegwart DJ, Yimlamai D, Levi B, Zhu H. In vivo screening identifies SPP2, a secreted factor that negatively regulates liver regeneration. Hepatology 2023; 78:1133-1148. [PMID: 37039560 PMCID: PMC10524179 DOI: 10.1097/hep.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/14/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND AND AIMS The liver is remarkably regenerative and can completely recover even when 80% of its mass is surgically removed. Identification of secreted factors that regulate liver growth would help us understand how organ size and regeneration are controlled but also provide candidate targets to promote regeneration or impair cancer growth. APPROACH AND RESULTS To enrich for secreted factors that regulate growth control, we induced massive liver overgrowth with either YAP or MYC . Differentially expressed secreted factors were identified in these livers using transcriptomic analysis. To rank candidates by functionality, we performed in vivo CRISPR screening using the Fah knockout model of tyrosinemia. We identified secreted phosphoprotein-2 (SPP2) as a secreted factor that negatively regulates regeneration. Spp2 -deficient mice showed increased survival after acetaminophen poisoning and reduced fibrosis after repeated carbon tetrachloride injections. We examined the impact of SPP2 on bone morphogenetic protein signaling in liver cells and found that SPP2 antagonized bone morphogenetic protein signaling in vitro and in vivo. We also identified cell-surface receptors that interact with SPP2 using a proximity biotinylation assay coupled with mass spectrometry. We showed that SPP2's interactions with integrin family members are in part responsible for some of the regeneration phenotypes. CONCLUSIONS Using an in vivo CRISPR screening system, we identified SPP2 as a secreted factor that negatively regulates liver regeneration. This study provides ways to identify, validate, and characterize secreted factors in vivo.
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Affiliation(s)
- Yu-Hsuan Lin
- Children’s Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Qiyu Zeng
- Children’s Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Yuemeng Jia
- Children’s Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Zixi Wang
- Children’s Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Lin Li
- Children’s Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Meng-Hsiung Hsieh
- Children’s Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Qiang Cheng
- Department of Biochemistry, Department of Biomedical Engineering, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Chase A. Pagani
- Department of Surgery, Center for Organogenesis and Trauma, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Nicholas Livingston
- Department of Surgery, Center for Organogenesis and Trauma, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jeon Lee
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Yu Zhang
- Children’s Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Tripti Sharma
- Children’s Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Daniel J. Siegwart
- Department of Biochemistry, Department of Biomedical Engineering, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Dean Yimlamai
- Section of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06519
| | - Benjamin Levi
- Department of Surgery, Center for Organogenesis and Trauma, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Hao Zhu
- Children’s Research Institute, Departments of Pediatrics and Internal Medicine, Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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10
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Lisiecki J, Buta M, Taylor S, Tait M, Farina N, Levin J, Schulz J, Sangji N, Friedstat J, Hemmila M, Wang S, Levi B, Goverman J. Efficacy of Mepliex ® Ag Versus Xeroform ® As A Split-Thickness Skin Graft Donor Site Dressing: Bad Habits Die Hard. Ann Burns Fire Disasters 2023; 36:243-250. [PMID: 38680433 PMCID: PMC11041881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/01/2022] [Indexed: 05/01/2024]
Abstract
Autografting with split-thickness skin grafts (STSG) remains an essential procedure in burn and reconstructive surgery. The process of harvesting STSG, however, leaves behind a donor site, an exposed area of partial-thickness dermis left to heal by secondary intention. There has yet to be a consensus amongst surgeons regarding optimal management of the donor site. The ideal donor site dressing is one that allows for expeditious healing while minimizing pain and infection. Despite numerous studies demonstrating the superiority of moist wound healing, many surgeons continue to treat STSG donor sites dry, with petroleum-based gauze. In this study, two burn centers performed a retrospective review of burn patients whose STSG donor sites were treated with either Xeroform® or Mepilex® Ag dressings. Infections were documented and in a subgroup analysis of patients, postoperative pain scores were noted and total opiate usage during hospitalization was calculated. Analysis revealed an overall infection rate of 1.2% in the Mepilex® Ag group and 11.4% in the Xeroform® group (p<0.0001). Patients with Xeroform® donor site dressings had increased odds of donor site infection (OR=10.8, p=0.002). In subgroup analysis, there were no significant differences in maximum pain scores between Mepilex® Ag and Xeroform® groups, nor were there differences in opiate usage. STSG donor sites dressed with silver foam dressings have a lower rate of donor site infection relative to those dressed with petroleum-based gauze. Moist donor site dressings such as foam dressings (including Mepilex® Ag) should be the standard of care in STSG donor site wound care.
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Affiliation(s)
- J.L. Lisiecki
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - M.R. Buta
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - S. Taylor
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - M. Tait
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - N. Farina
- Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USA
| | - J. Levin
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - J. Schulz
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - N. Sangji
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - J. Friedstat
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - M.R. Hemmila
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - S. Wang
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - B. Levi
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - J. Goverman
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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11
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Henn D, Zhao D, Sivaraj D, Trotsyuk A, Bonham CA, Fischer KS, Kehl T, Fehlmann T, Greco AH, Kussie HC, Moortgat Illouz SE, Padmanabhan J, Barrera JA, Kneser U, Lenhof HP, Januszyk M, Levi B, Keller A, Longaker MT, Chen K, Qi LS, Gurtner GC. Cas9-mediated knockout of Ndrg2 enhances the regenerative potential of dendritic cells for wound healing. Nat Commun 2023; 14:4729. [PMID: 37550295 PMCID: PMC10406832 DOI: 10.1038/s41467-023-40519-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/26/2023] [Indexed: 08/09/2023] Open
Abstract
Chronic wounds impose a significant healthcare burden to a broad patient population. Cell-based therapies, while having shown benefits for the treatment of chronic wounds, have not yet achieved widespread adoption into clinical practice. We developed a CRISPR/Cas9 approach to precisely edit murine dendritic cells to enhance their therapeutic potential for healing chronic wounds. Using single-cell RNA sequencing of tolerogenic dendritic cells, we identified N-myc downregulated gene 2 (Ndrg2), which marks a specific population of dendritic cell progenitors, as a promising target for CRISPR knockout. Ndrg2-knockout alters the transcriptomic profile of dendritic cells and preserves an immature cell state with a strong pro-angiogenic and regenerative capacity. We then incorporated our CRISPR-based cell engineering within a therapeutic hydrogel for in vivo cell delivery and developed an effective translational approach for dendritic cell-based immunotherapy that accelerated healing of full-thickness wounds in both non-diabetic and diabetic mouse models. These findings could open the door to future clinical trials using safe gene editing in dendritic cells for treating various types of chronic wounds.
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Affiliation(s)
- Dominic Henn
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Dehua Zhao
- Department of Bioengineering, Sarafan ChEM-H, Stanford University, Stanford, CA, USA
| | - Dharshan Sivaraj
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA
- Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Artem Trotsyuk
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA
- Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Clark Andrew Bonham
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA
| | - Katharina S Fischer
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA
- Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Tim Kehl
- Center for Bioinformatics, Saarland Informatics Campus, Saarland University, Saarbrücken, Germany
| | - Tobias Fehlmann
- Chair for Clinical Bioinformatics, Saarland University, Saarbruecken, Germany
| | - Autumn H Greco
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA
| | - Hudson C Kussie
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA
- Department of Burn, Trauma, Acute and Critical Care Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sylvia E Moortgat Illouz
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA
| | - Jagannath Padmanabhan
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA
| | - Janos A Barrera
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA
| | - Ulrich Kneser
- Department of Hand, Plastic, and Reconstructive Surgery, BG Trauma Center Ludwigshafen, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
| | - Hans-Peter Lenhof
- Center for Bioinformatics, Saarland Informatics Campus, Saarland University, Saarbrücken, Germany
| | - Michael Januszyk
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA
| | - Benjamin Levi
- Department of Burn, Trauma, Acute and Critical Care Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andreas Keller
- Center for Bioinformatics, Saarland Informatics Campus, Saarland University, Saarbrücken, Germany
| | - Michael T Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA
| | - Kellen Chen
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA
- Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Lei S Qi
- Department of Bioengineering, Sarafan ChEM-H, Stanford University, Stanford, CA, USA.
- Chan Zuckerberg Biohub - San Francisco, San Francisco, CA, USA.
| | - Geoffrey C Gurtner
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA.
- Department of Surgery, University of Arizona, Tucson, AZ, USA.
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12
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Loder S, Patel N, Morgani S, Sambon M, Leucht P, Levi B. Genetic models for lineage tracing in musculoskeletal development, injury, and healing. Bone 2023; 173:116777. [PMID: 37156345 PMCID: PMC10860167 DOI: 10.1016/j.bone.2023.116777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
Musculoskeletal development and later post-natal homeostasis are highly dynamic processes, marked by rapid structural and functional changes across very short periods of time. Adult anatomy and physiology are derived from pre-existing cellular and biochemical states. Consequently, these early developmental states guide and predict the future of the system as a whole. Tools have been developed to mark, trace, and follow specific cells and their progeny either from one developmental state to the next or between circumstances of health and disease. There are now many such technologies alongside a library of molecular markers which may be utilized in conjunction to allow for precise development of unique cell 'lineages'. In this review, we first describe the development of the musculoskeletal system beginning as an embryonic germ layer and at each of the key developmental stages that follow. We then discuss these structures in the context of adult tissues during homeostasis, injury, and repair. Special focus is given in each of these sections to the key genes involved which may serve as markers of lineage or later in post-natal tissues. We then finish with a technical assessment of lineage tracing and the techniques and technologies currently used to mark cells, tissues, and structures within the musculoskeletal system.
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Affiliation(s)
- Shawn Loder
- Department of Plastic Surgery, University of Pittsburgh, Scaife Hall, Suite 6B, 3550 Terrace Street, Pittsburgh, PA 15261, USA
| | - Nicole Patel
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | | | | | | | - Benjamin Levi
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
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13
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Yea JH, Gomez-Salazar M, Onggo S, Li Z, Thottappillil N, Cherief M, Negri S, Xing X, Qin Q, Tower RJ, Fan CM, Levi B, James AW. Tppp3 + synovial/tendon sheath progenitor cells contribute to heterotopic bone after trauma. Bone Res 2023; 11:39. [PMID: 37479686 PMCID: PMC10361999 DOI: 10.1038/s41413-023-00272-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/18/2023] [Accepted: 05/28/2023] [Indexed: 07/23/2023] Open
Abstract
Heterotopic ossification (HO) is a pathological process resulting in aberrant bone formation and often involves synovial lined tissues. During this process, mesenchymal progenitor cells undergo endochondral ossification. Nonetheless, the specific cell phenotypes and mechanisms driving this process are not well understood, in part due to the high degree of heterogeneity of the progenitor cells involved. Here, using a combination of lineage tracing and single-cell RNA sequencing (scRNA-seq), we investigated the extent to which synovial/tendon sheath progenitor cells contribute to heterotopic bone formation. For this purpose, Tppp3 (tubulin polymerization-promoting protein family member 3)-inducible reporter mice were used in combination with either Scx (Scleraxis) or Pdgfra (platelet derived growth factor receptor alpha) reporter mice. Both tendon injury- and arthroplasty-induced mouse experimental HO models were utilized. ScRNA-seq of tendon-associated traumatic HO suggested that Tppp3 is an early progenitor cell marker for either tendon or osteochondral cells. Upon HO induction, Tppp3 reporter+ cells expanded in number and partially contributed to cartilage and bone formation in either tendon- or joint-associated HO. In double reporter animals, both Pdgfra+Tppp3+ and Pdgfra+Tppp3- progenitor cells gave rise to HO-associated cartilage. Finally, analysis of human samples showed a substantial population of TPPP3-expressing cells overlapping with osteogenic markers in areas of heterotopic bone. Overall, these data demonstrate that synovial/tendon sheath progenitor cells undergo aberrant osteochondral differentiation and contribute to HO after trauma.
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Affiliation(s)
- Ji-Hye Yea
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Mario Gomez-Salazar
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Sharon Onggo
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Zhao Li
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21205, USA
| | | | - Masnsen Cherief
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Stefano Negri
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21205, USA
- Orthopaedic and Trauma Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology of the University of Verona, Verona, Italy
| | - Xin Xing
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Qizhi Qin
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Robert Joel Tower
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Chen-Ming Fan
- Carnegie Institution for Science, Baltimore, MD, USA
| | - Benjamin Levi
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Aaron W James
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21205, USA.
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14
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Rowe CJ, Walsh SA, Dragon AH, Rhodes AM, Pak OL, Ronzier E, Levi B, Potter BK, Spreadborough PJ, Davis TA. Tourniquet-induced ischemia creates increased risk of organ dysfunction and mortality following delayed limb amputation. Injury 2023:S0020-1383(23)00179-1. [PMID: 36906480 DOI: 10.1016/j.injury.2023.02.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/06/2023] [Accepted: 02/23/2023] [Indexed: 03/13/2023]
Abstract
Tourniquets are critical for the control of traumatic extremity hemorrhage. In this study, we sought to determine, in a rodent blast-related extremity amputation model, the impact of prolonged tourniquet application and delayed limb amputation on survival, systemic inflammation, and remote end organ injury. Adult male Sprague Dawley rats were subjected to blast overpressure (120±7 kPa) and orthopedic extremity injury consisting femur fracture, one-minute soft tissue crush injury (20 psi), ± 180 min of tourniquet-induced hindlimb ischemia followed by delayed (60 min of reperfusion) hindlimb amputation (dHLA). All animals in the non-tourniquet group survived whereas 7/21 (33%) of the animals in the tourniquet group died within the first 72 h with no deaths observed between 72 and 168 h post-injury. Tourniquet induced ischemia-reperfusion injury (tIRI) likewise resulted in a more robust systemic inflammation (cytokines and chemokines) and concomitant remote pulmonary, renal, and hepatic dysfunction (BUN, CR, ALT. AST, IRI/inflammation-mediated genes). These results indicate prolonged tourniquet application and dHLA increases risk of complications from tIRI, leading to greater risk of local and systemic complications including organ dysfunction or death. We thus need enhanced strategies to mitigate the systemic effects of tIRI, particularly in the military prolonged field care (PFC) setting. Furthermore, future work is needed to extend the window within which tourniquet deflation to assess limb viability remains feasible, as well as new, limb-specific or systemic point of care tests to better assess the risks of tourniquet deflation with limb preservation in order to optimize patient care and save both limb and life.
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Affiliation(s)
- Cassie J Rowe
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, United States
| | - Sarah A Walsh
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States
| | - Andrea H Dragon
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, United States
| | - Alisha M Rhodes
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, United States
| | - Olivia L Pak
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, United States
| | - Elsa Ronzier
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, United States
| | - Benjamin Levi
- Center for Organogenesis Research and Trauma, University of Texas Southwestern, Dallas, TX, United States
| | - Benjamin K Potter
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States
| | - Philip J Spreadborough
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Thomas A Davis
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States.
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15
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Nunez JH, Strong AL, Comish P, Hespe GE, Harvey J, Sorkin M, Levi B. A Review of Laser Therapies for the Treatment of Scarring and Vascular Anomalies. Adv Wound Care (New Rochelle) 2023; 12:68-84. [PMID: 35951024 DOI: 10.1089/wound.2021.0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Significance: Laser use has become part of the gold standard of treatment as an effective adjuvant in multimodal therapy for pathologic scarring caused by burns, trauma, acne, and surgery, as well as vascular anomalies. Understanding indications and applications for laser therapy is essential for physicians to improve patient outcomes. Recent Advances: Since the 1980s, the medical use of lasers has continuously evolved with improvements in technology. Novel lasers and fractionated technologies are currently being studied in the hopes to improve treatment efficacy, while reducing complications. Recent advancements include acne treatment with novel picosecond lasers, new hypertrophic scar therapies with simultaneous laser and intense pulsed light use, and novel systems such as lasers with intralesional optical fiber delivery devices. In addition, optimizing the timing of laser therapy and its use in multimodal treatments continue to advance the field of photothermolysis. Critical Issues: Selecting the correct laser for a given indication is the fundamental decision when choosing a laser balancing effective treatment with minimal complications. This article covers the principles of laser therapy, the preferred lasers used for the treatment of scarring and vascular anomalies, and discusses the current evidence behind these laser choices. Future Directions: To optimize laser therapy, larger randomized control trials and split scar studies are needed. Continued advancement through better randomized controlled studies will help to improve patient outcomes on a broader scale.
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Affiliation(s)
- Johanna H Nunez
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amy L Strong
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul Comish
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Geoffrey E Hespe
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jalen Harvey
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Sorkin
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Benjamin Levi
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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16
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Mohamed FF, Ge C, Hallett SA, Bancroft AC, Cowling RT, Ono N, Binrayes AA, Greenberg B, Levi B, Kaartinen VM, Franceschi RT. Control of craniofacial development by the collagen receptor, discoidin domain receptor 2. eLife 2023; 12:e77257. [PMID: 36656123 PMCID: PMC9977278 DOI: 10.7554/elife.77257] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/18/2023] [Indexed: 01/20/2023] Open
Abstract
Development of the craniofacial skeleton requires interactions between progenitor cells and the collagen-rich extracellular matrix (ECM). The mediators of these interactions are not well-defined. Mutations in the discoidin domain receptor 2 gene (DDR2), which encodes a non-integrin collagen receptor, are associated with human craniofacial abnormalities, such as midface hypoplasia and open fontanels. However, the exact role of this gene in craniofacial morphogenesis is not known. As will be shown, Ddr2-deficient mice exhibit defects in craniofacial bones including impaired calvarial growth and frontal suture formation, cranial base hypoplasia due to aberrant chondrogenesis and delayed ossification at growth plate synchondroses. These defects were associated with abnormal collagen fibril organization, chondrocyte proliferation and polarization. As established by localization and lineage-tracing studies, Ddr2 is expressed in progenitor cell-enriched craniofacial regions including sutures and synchondrosis resting zone cartilage, overlapping with GLI1 + cells, and contributing to chondrogenic and osteogenic lineages during skull growth. Tissue-specific knockouts further established the requirement for Ddr2 in GLI +skeletal progenitors and chondrocytes. These studies establish a cellular basis for regulation of craniofacial morphogenesis by this understudied collagen receptor and suggest that DDR2 is necessary for proper collagen organization, chondrocyte proliferation, and orientation.
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Affiliation(s)
- Fatma F Mohamed
- Department of Periodontics & Oral Medicine, University of Michigan School of DentistryAnn ArborUnited States
| | - Chunxi Ge
- Department of Periodontics & Oral Medicine, University of Michigan School of DentistryAnn ArborUnited States
| | - Shawn A Hallett
- Department of Periodontics & Oral Medicine, University of Michigan School of DentistryAnn ArborUnited States
| | - Alec C Bancroft
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas SouthwesternDallasUnited States
| | - Randy T Cowling
- Division of Cardiovascular Medicine, University of California, San DiegoSan DiegoUnited States
| | - Noriaki Ono
- Department of Diagnostic and Biomedical Sciences, University of Texas Health Science Center at Houston School of DentistryHoustonUnited States
| | - Abdul-Aziz Binrayes
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud UniversityRiyadhSaudi Arabia
| | - Barry Greenberg
- Division of Cardiovascular Medicine, University of California, San DiegoSan DiegoUnited States
| | - Benjamin Levi
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas SouthwesternDallasUnited States
| | - Vesa M Kaartinen
- Department of Biologic & Materials Science, University of Michigan School of DentistryAnn ArborUnited States
| | - Renny T Franceschi
- Department of Periodontics & Oral Medicine, University of Michigan School of DentistryAnn ArborUnited States
- Department of Biological Chemistry, School of Medicine, University of MichiganAnn ArborUnited States
- Department of Biomedical Engineering, University of MichiganAnn ArborUnited States
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17
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Pagani CA, Bancroft AC, Tower RJ, Livingston N, Sun Y, Hong JY, Kent RN, Strong AL, Nunez JH, Medrano JMR, Patel N, Nanes BA, Dean KM, Li Z, Ge C, Baker BM, James AW, Weiss SJ, Franceschi RT, Levi B. Discoidin domain receptor 2 regulates aberrant mesenchymal lineage cell fate and matrix organization. Sci Adv 2022; 8:eabq6152. [PMID: 36542719 PMCID: PMC9770942 DOI: 10.1126/sciadv.abq6152] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/05/2022] [Indexed: 06/17/2023]
Abstract
Extracellular matrix (ECM) interactions regulate both the cell transcriptome and proteome, thereby determining cell fate. Traumatic heterotopic ossification (HO) is a disorder characterized by aberrant mesenchymal lineage (MLin) cell differentiation, forming bone within soft tissues of the musculoskeletal system following traumatic injury. Recent work has shown that HO is influenced by ECM-MLin cell receptor signaling, but how ECM binding affects cellular outcomes remains unclear. Using time course transcriptomic and proteomic analyses, we identified discoidin domain receptor 2 (DDR2), a cell surface receptor for fibrillar collagen, as a key MLin cell regulator in HO formation. Inhibition of DDR2 signaling, through either constitutive or conditional Ddr2 deletion or pharmaceutical inhibition, reduced HO formation in mice. Mechanistically, DDR2 perturbation alters focal adhesion orientation and subsequent matrix organization, modulating Focal Adhesion Kinase (FAK) and Yes1 Associated Transcriptional Regulator and WW Domain Containing Transcription Regulator 1 (YAP/TAZ)-mediated MLin cell signaling. Hence, ECM-DDR2 interactions are critical in driving HO and could serve as a previously unknown therapeutic target for treating this disease process.
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Affiliation(s)
- Chase A. Pagani
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Alec C. Bancroft
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Robert J. Tower
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Nicholas Livingston
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Yuxiao Sun
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Jonathan Y. Hong
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Robert N. Kent
- Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Amy L. Strong
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Johanna H. Nunez
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Jessica Marie R. Medrano
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Nicole Patel
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin A. Nanes
- Department of Dermatology, University of Texas Southwestern, Dallas, TX, USA
- Lydia Hill Department of Bioinformatics, University of Texas Southwestern, Dallas, TX, USA
| | - Kevin M. Dean
- Lydia Hill Department of Bioinformatics, University of Texas Southwestern, Dallas, TX, USA
- Cecil H. and The Ida Green Center for Systems Biology, University of Texas Southwestern, Dallas, TX, USA
| | - Zhao Li
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Chunxi Ge
- School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Brendon M. Baker
- Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Aaron W. James
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen J. Weiss
- Life Sciences Institute, University of Michigan, Ann Arbor, MI, USA
| | | | - Benjamin Levi
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
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18
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Qin Q, Lee S, Patel N, Walden K, Gomez-Salazar M, Levi B, James AW. Neurovascular coupling in bone regeneration. Exp Mol Med 2022; 54:1844-1849. [PMID: 36446849 PMCID: PMC9722927 DOI: 10.1038/s12276-022-00899-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022] Open
Abstract
The mammalian skeletal system is densely innervated by both neural and vascular networks. Peripheral nerves in the skeleton include sensory and sympathetic nerves. The crosstalk between skeletal and neural tissues is critical for skeletal development and regeneration. The cellular processes of osteogenesis and angiogenesis are coupled in both physiological and pathophysiological contexts. The cellular and molecular regulation of osteogenesis and angiogenesis have yet to be fully defined. This review will provide a detailed characterization of the regulatory role of nerves and blood vessels during bone regeneration. Furthermore, given the importance of the spatial relationship between nerves and blood vessels in bone, we discuss neurovascular coupling during physiological and pathological bone formation. A better understanding of the interactions between nerves and blood vessels will inform future novel therapeutic neural and vascular targeting for clinical bone repair and regeneration.
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Affiliation(s)
- Qizhi Qin
- grid.21107.350000 0001 2171 9311Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
| | - Seungyong Lee
- grid.260024.20000 0004 0627 4571Department of Physiology, College of Graduate Studies, Midwestern University, Glendale, AZ 85308 USA ,grid.412977.e0000 0004 0532 7395Department of Physical Education, Incheon National University, Incheon, 22012 South Korea
| | - Nirali Patel
- grid.260024.20000 0004 0627 4571Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308 USA
| | - Kalah Walden
- grid.260024.20000 0004 0627 4571Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308 USA
| | - Mario Gomez-Salazar
- grid.21107.350000 0001 2171 9311Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
| | - Benjamin Levi
- grid.267313.20000 0000 9482 7121Departments of Surgery, UT Southwestern Medical Center, Dallas, TX 75390 USA
| | - Aaron W. James
- grid.21107.350000 0001 2171 9311Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205 USA
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19
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Audu CO, Melvin WJ, Joshi AD, Wolf SJ, Moon JY, Davis FM, Barrett EC, Mangum KD, Deng H, Xing X, Wasikowski R, Tsoi LC, Sharma SB, Bauer TM, Shadiow J, Corriere MA, Obi AT, Kunkel SL, Levi B, Moore BB, Gudjonsson JE, Smith AM, Gallagher KA. Macrophage-specific inhibition of the histone demethylase JMJD3 decreases STING and pathologic inflammation in diabetic wound repair. Cell Mol Immunol 2022; 19:1251-1262. [PMID: 36127466 PMCID: PMC9622909 DOI: 10.1038/s41423-022-00919-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/09/2022] [Indexed: 02/01/2023] Open
Abstract
Macrophage plasticity is critical for normal tissue repair following injury. In pathologic states such as diabetes, macrophage plasticity is impaired, and macrophages remain in a persistent proinflammatory state; however, the reasons for this are unknown. Here, using single-cell RNA sequencing of human diabetic wounds, we identified increased JMJD3 in diabetic wound macrophages, resulting in increased inflammatory gene expression. Mechanistically, we report that in wound healing, JMJD3 directs early macrophage-mediated inflammation via JAK1,3/STAT3 signaling. However, in the diabetic state, we found that IL-6, a cytokine increased in diabetic wound tissue at later time points post-injury, regulates JMJD3 expression in diabetic wound macrophages via the JAK1,3/STAT3 pathway and that this late increase in JMJD3 induces NFκB-mediated inflammatory gene transcription in wound macrophages via an H3K27me3 mechanism. Interestingly, RNA sequencing of wound macrophages isolated from mice with JMJD3-deficient myeloid cells (Jmjd3f/fLyz2Cre+) identified that the STING gene (Tmem173) is regulated by JMJD3 in wound macrophages. STING limits inflammatory cytokine production by wound macrophages during healing. However, in diabetic mice, its role changes to limit wound repair and enhance inflammation. This finding is important since STING is associated with chronic inflammation, and we found STING to be elevated in human and murine diabetic wound macrophages at late time points. Finally, we demonstrate that macrophage-specific, nanoparticle inhibition of JMJD3 in diabetic wounds significantly improves diabetic wound repair by decreasing inflammatory cytokines and STING. Taken together, this work highlights the central role of JMJD3 in tissue repair and identifies cell-specific targeting as a viable therapeutic strategy for nonhealing diabetic wounds.
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Affiliation(s)
- Christopher O Audu
- Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
- Department of Medicinal Chemistry, University of Michigan, Ann Arbor, MI, USA
| | - William J Melvin
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, Section of General Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Amrita D Joshi
- Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Sonya J Wolf
- Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Jadie Y Moon
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Frank M Davis
- Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Emily C Barrett
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
- Department of Surgery, Section of General Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kevin D Mangum
- Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Hongping Deng
- Department of Bioengineering, University of Illinois, Urbana-Champaign, Champaign, IL, USA
| | - Xianying Xing
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Rachel Wasikowski
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Lam C Tsoi
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Sriganesh B Sharma
- Department of Surgery, Section of General Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Tyler M Bauer
- Department of Surgery, Section of General Surgery, University of Michigan, Ann Arbor, MI, USA
| | - James Shadiow
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA
| | - Matthew A Corriere
- Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrea T Obi
- Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Steven L Kunkel
- Department of Surgery, Section of General Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin Levi
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bethany B Moore
- Department of Surgery, Section of General Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Andrew M Smith
- Department of Bioengineering, University of Illinois, Urbana-Champaign, Champaign, IL, USA
| | - Katherine A Gallagher
- Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA.
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, USA.
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20
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Cherief M, Negri S, Qin Q, Pagani CA, Lee S, Yang YP, Clemens TL, Levi B, James AW. TrkA+ Neurons Induce Pathologic Regeneration After Soft Tissue Trauma. Stem Cells Transl Med 2022; 11:1165-1176. [PMID: 36222619 PMCID: PMC9672853 DOI: 10.1093/stcltm/szac073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/03/2022] [Indexed: 11/13/2022] Open
Abstract
Heterotopic ossification (HO) is a dynamic, complex pathologic process that often occurs after severe polytrauma trauma, resulting in an abnormal mesenchymal stem cell differentiation leading to ectopic bone growth in soft-tissues including tendons, ligaments, and muscles. The abnormal bone structure and location induce pain and loss of mobility. Recently, we observed that NGF (Nerve growth factor)-responsive TrkA (Tropomyosin receptor kinase A)-expressing nerves invade sites of soft-tissue trauma, and this is a necessary feature for heterotopic bone formation at sites of injury. Here, we assayed the effects of the partial TrkA agonist Gambogic amide (GA) in peritendinous heterotopic bone after extremity trauma. Mice underwent HO induction using the burn/tenotomy model with or without systemic treatment with GA, followed by an examination of the injury site via radiographic imaging, histology, and immunohistochemistry. Single-cell RNA Sequencing confirmed an increase in neurotrophin signaling activity after HO-inducing extremity trauma. Next, TrkA agonism led to injury site hyper-innervation, more brisk expression of cartilage antigens within the injured tendon, and a shift from FGF to TGFβ signaling activity among injury site cells. Nine weeks after injury, this culminated in higher overall levels of heterotopic bone among GA-treated animals. In summary, these studies further link injury site hyper-innervation with increased vascular ingrowth and ultimately heterotopic bone after trauma. In the future, modulation of TrkA signaling may represent a potent means to prevent the trauma-induced heterotopic bone formation and improve tissue regeneration.
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Affiliation(s)
- Masnsen Cherief
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Stefano Negri
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA.,Department of Orthopaedics and Traumatology, University of Verona, Verona, Italy
| | - Qizhi Qin
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Chase A Pagani
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas, Southwestern, TX, USA
| | - Seungyong Lee
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Thomas L Clemens
- Department of Orthopaedics, Johns Hopkins University, Baltimore, MD, USA.,Baltimore Veterans Administration Medical Center, Baltimore, MD, USA
| | - Benjamin Levi
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas, Southwestern, TX, USA
| | - Aaron W James
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
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21
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Spreadborough PJ, Strong AL, Mares J, Levi B, Davis TA. Tourniquet use following blast-associated complex lower limb injury and traumatic amputation promotes end organ dysfunction and amplified heterotopic ossification formation. J Orthop Surg Res 2022; 17:422. [PMID: 36123728 PMCID: PMC9484189 DOI: 10.1186/s13018-022-03321-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Traumatic heterotopic ossification (tHO) is characterized by ectopic bone formation in extra-skeletal sites leading to impaired wound healing, entrapment of neurovascular structures, pain, and reduced range of motion. HO has become a signature pathology affecting wounded military personnel who have sustained blast-associated traumatic amputations during the recent conflicts in Iraq and Afghanistan and can compound recovery by causing difficulty with prosthesis limb wearing. Tourniquet use to control catastrophic limb hemorrhage prior to surgery has become almost ubiquitous during this time, with the recognition the prolonged use may risk an ischemia reperfusion injury and associated complications. While many factors influence the formation of tHO, the extended use of tourniquets to limit catastrophic hemorrhage during prolonged field care has not been explored. Methods Utilizing an established pre-clinical model of blast-associated complex lower limb injury and traumatic amputation, we evaluated the effects of tourniquet use on tHO formation. Adult male rats were subjected to blast overpressure exposure, femur fracture, and soft tissue crush injury. Pneumatic tourniquet (250–300 mmHg) applied proximal to the injured limb for 150-min was compared to a control group without tourniquet, before a trans-femoral amputation was performed. Outcome measures were volume to tHO formation at 12 weeks and changes in proteomic and genomic markers of early tHO formation between groups. Results At 12 weeks, volumetric analysis with microCT imaging revealed a 70% increase in total bone formation (p = 0.007) near the site of injury compared to rats with no tourniquet time in the setting of blast-injuries. Rats subjected to tourniquet usage had increased expression of danger-associated molecular patterns (DAMPs) and end organ damage as early as 6 h and as late as 7 days post injury. The expressions of pro-inflammatory cytokines and chemokines and osteochondrogenic genes using quantitative RT-PCR similarly revealed increased expression as early as 6 h post injury, and these genes along with hypoxia associated genes remained elevated for 7 days compared to no tourniquet use. Conclusion These findings suggest that tourniquet induced ischemia leads to significant increases in key transcription factors associated with early endochondral bone formation, systemic inflammatory and hypoxia, resulting in increased HO formation.
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Affiliation(s)
- Philip J Spreadborough
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.,Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Amy L Strong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - John Mares
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Benjamin Levi
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas A Davis
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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22
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Patel NK, Nunez JH, Sorkin M, Marini S, Pagani CA, Strong AL, Hwang CD, Li S, Padmanabhan KR, Kumar R, Bancroft AC, Greenstein JA, Nelson R, Rasheed HA, Livingston N, Vasquez K, Huber AK, Levi B. Macrophage TGFβ signaling is critical for wound healing with heterotopic ossification after trauma. JCI Insight 2022; 7:144925. [PMID: 36099022 DOI: 10.1172/jci.insight.144925] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
Transforming growth factor beta 1 (TGFβ1) plays a central role in normal and aberrant wound healing, but the precise mechanism in the local environment remains elusive. Here, using a mouse model of aberrant wound healing resulting in heterotopic ossification (HO) after traumatic injury, we find autocrine TGFβ1 signaling in macrophages, and not mesenchymal stem/progenitor cells (MPCs), is critical in HO formation. In-depth single cell transcriptomic and epigenomic analyses in combination with immunostaining of cells from the injury site demonstrate increased TGFβ1 signaling in early infiltrating macrophages, with open chromatin regions in TGFβ1 stimulated genes at binding sites specific for transcription factors of activated TGFβ1 (SMAD2/3). Genetic deletion of TGFβ1 receptor type 1, (Tgfbr1;Alk5) in macrophages, results in increased HO, with a trend toward decreased tendinous HO. To bypass the effect seen by altering the receptor we administered a systemic treatment with TGFβ1/3 ligand trap TGFβRII-Fc, which results in decreased HO formation and a delay macrophage infiltration to the injury site. Overall, our data support the role of the TGFβ1/ALK5 signaling pathway in HO.
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Affiliation(s)
- Nicole K Patel
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Medical School, Ann Arbor, United States of America
| | - Johanna H Nunez
- Department of Surgery, The UT Southwestern Medical Center, Dallas, United States of America
| | - Michael Sorkin
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Medical School, Ann Arbor, United States of America
| | - Simone Marini
- Department of Epidemiology and Emerging Pathogens Institute, University of Florida, Gainesville, United States of America
| | - Chase A Pagani
- Department of Surgery, The UT Southwestern Medical Center, Dallas, United States of America
| | - Amy L Strong
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Medical School, Ann Arbor, United States of America
| | - Charles D Hwang
- Division of Plastic and Reconstructive Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, United States of America
| | - Shuli Li
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Medical School, Ann Arbor, United States of America
| | - Karthik R Padmanabhan
- Epigenmics Core Facility, The University of Michigan Medical School, Ann Arbor, United States of America
| | - Ravi Kumar
- NA, Acceleron Pharma, Inc, Cambridge, United States of America
| | - Alec C Bancroft
- Department of Surgery, The UT Southwestern Medical Center, Dallas, United States of America
| | - Joseph A Greenstein
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Medical School, Ann Arbor, United States of America
| | - Reagan Nelson
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Medical School, Ann Arbor, United States of America
| | - Husain A Rasheed
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Medical School, Ann Arbor, United States of America
| | - Nicholas Livingston
- Department of Surgery, The UT Southwestern Medical Center, Dallas, United States of America
| | - Kaetlin Vasquez
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Medical School, Ann Arbor, United States of America
| | - Amanda K Huber
- Department of Radiation Oncology, The University of Michigan Medical School, Ann Arbor, United States of America
| | - Benjamin Levi
- Department of Surgery, The UT Southwestern Medical Center, Dallas, United States of America
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23
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Tower RJ, Bancroft AC, Chowdary AR, Barnes S, Edwards NJ, Pagani CA, Dawson LA, Levi B. Single-cell mapping of regenerative and fibrotic healing responses after musculoskeletal injury. Stem Cell Reports 2022; 17:2334-2348. [PMID: 36150381 PMCID: PMC9561541 DOI: 10.1016/j.stemcr.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022] Open
Abstract
After injury, a cascade of events repairs the damaged tissue, including expansion and differentiation of the progenitor pool and redeposition of matrix. To guide future wound regeneration strategies, we compared single-cell sequencing of regenerative (third phalangeal element [P3]) and fibrotic (second phalangeal element [P2]) digit tip amputation (DTA) models as well as traumatic heterotopic ossification (HO; aberrant). Analyses point to a common initial response to injury, including expansion of progenitors, redeposition of matrix, and activation of transforming growth factor β (TGF-β) and WNT pathways. Surprisingly, fibrotic P2 DTA showed greater transcriptional similarity to HO than to regenerative P3 DTA, suggesting that gene expression more strongly correlates with healing outcome than with injury type or cell origin. Differential analysis and immunostaining revealed altered activation of inflammatory pathways, such as the complement pathway, in the progenitor cells. These data suggests that common pathways are activated in response to damage but are fine tuned within each injury. Modulating these pathways may shift the balance toward regenerative outcomes. Regenerative and fibrotic injuries share common early response mechanisms Transcriptomes correlate with healing outcome more than injury type or cell source Matrix composition after injury-induced tissue repair is highly injury type dependent Inflammatory cascades are activated in immune and mesenchymal cells
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Affiliation(s)
- Robert J Tower
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | - Alec C Bancroft
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Ashish R Chowdary
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Spencer Barnes
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Bioinformatics Core, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Nicole J Edwards
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Chase A Pagani
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Lindsay A Dawson
- Department of Veterinary Physiology and Pharmacology, Texas A&M University, College Station, TX 77843, USA
| | - Benjamin Levi
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
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24
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Hwang CD, Pagani CA, Nunez JH, Cherief M, Qin Q, Gomez-Salazar M, Kadaikal B, Kang H, Chowdary AR, Patel N, James AW, Levi B. Contemporary perspectives on heterotopic ossification. JCI Insight 2022; 7:158996. [PMID: 35866484 PMCID: PMC9431693 DOI: 10.1172/jci.insight.158996] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Heterotopic ossification (HO) is the formation of ectopic bone that is primarily genetically driven (fibrodysplasia ossificans progressiva [FOP]) or acquired in the setting of trauma (tHO). HO has undergone intense investigation, especially over the last 50 years, as awareness has increased around improving clinical technologies and incidence, such as with ongoing wartime conflicts. Current treatments for tHO and FOP remain prophylactic and include NSAIDs and glucocorticoids, respectively, whereas other proposed therapeutic modalities exhibit prohibitive risk profiles. Contemporary studies have elucidated mechanisms behind tHO and FOP and have described new distinct niches independent of inflammation that regulate ectopic bone formation. These investigations have propagated a paradigm shift in the approach to treatment and management of a historically difficult surgical problem, with ongoing clinical trials and promising new targets.
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Affiliation(s)
- Charles D Hwang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts, USA
| | - Chase A Pagani
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Johanna H Nunez
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Masnsen Cherief
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Qizhi Qin
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Balram Kadaikal
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Heeseog Kang
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ashish R Chowdary
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicole Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Aaron W James
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Benjamin Levi
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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25
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Negri S, Wang Y, Li Z, Qin Q, Lee S, Cherief M, Xu J, Hsu GCY, Tower RJ, Presson B, Levin A, McCarthy E, Levi B, James AW. Acetabular Reaming Is a Reliable Model to Produce and Characterize Periarticular Heterotopic Ossification of the Hip. Stem Cells Transl Med 2022; 11:876-888. [PMID: 35758541 PMCID: PMC9397657 DOI: 10.1093/stcltm/szac042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/07/2022] [Indexed: 11/17/2022] Open
Abstract
Heterotopic ossification (HO) is a pathologic process characterized by the formation of bone tissue in extraskeletal locations. The hip is a common location of HO, especially as a complication of arthroplasty. Here, we devise a first-of-its-kind mouse model of post-surgical hip HO and validate expected cell sources of HO using several HO progenitor cell reporter lines. To induce HO, an anterolateral surgical approach to the hip was used, followed by disclocation and acetabular reaming. Animals were analyzed with high-resolution roentgenograms and micro-computed tomography, conventional histology, immunohistochemistry, and assessments of fluorescent reporter activity. All the treated animals' developed periarticular HO with an anatomical distribution similar to human patients after arthroplasty. Heterotopic bone was found in periosteal, inter/intramuscular, and intracapsular locations. Further, the use of either PDGFRα or scleraxis (Scx) reporter mice demonstrated that both cell types gave rise to periarticular HO in this model. In summary, acetabular reaming reproducibly induces periarticular HO in the mouse reproducing human disease, and with defined mesenchymal cellular contributors similar to other experimental HO models. This protocol may be used in the future for further detailing of the cellular and molecular mediators of post-surgical HO, as well as the screening of new therapies.
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Affiliation(s)
| | | | - Zhao Li
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Qizhi Qin
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Seungyong Lee
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Masnsen Cherief
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Jiajia Xu
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Robert Joel Tower
- Center for Organogenesis Research and Trauma, University of Texas Southwestern, Dallas, TX, USA
| | - Bradley Presson
- Orthopaedic and Trauma Surgery Unit, Department of Surgery, Dentistry, Paediatrics and Gynaecology of the University of Verona, Verona, Italy
| | - Adam Levin
- Department of Orthopaedics, Johns Hopkins University, Baltimore, MD, USA
| | - Edward McCarthy
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Benjamin Levi
- Center for Organogenesis Research and Trauma, University of Texas Southwestern, Dallas, TX, USA
| | - Aaron W James
- Corresponding author: Aaron W. James, 720 Rutland Avenue, Room 524A, Baltimore, MD 21205, USA. Tel: +1 410 502 4143; Fax: +1 410 955 9777;
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Levi B. In Memory of Richard L. Gamelli. J Burn Care Res 2022. [PMID: 35732273 DOI: 10.1093/jbcr/irac085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nunez JH, Park C, Clark A, Akarichi C, Arnoldo B, Mandell SP, Carlson DL, Huebinger RM, Chan RK, Goverman J, Mironov S, Levi B, Berenfeld O. 533 Human Case Characterizations of Skin Burn Using Novel Multi-Spectral Short Wave Infrared Imaging. Journal of Burn Care & Research 2022. [PMCID: PMC8946290 DOI: 10.1093/jbcr/irac012.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Determining the depth of skin burns in patients is critical for surgical decision making, but currently lacks accuracy in clinical practice. Short-wave infrared (SWIR) light penetrates tissue more than visual or near-infrared light and is very sensitive to water content. We have shown in animal models that imaging of skin burns in the SWIR range distinguishes between superficial and deep tissue necrosis. Here we present the first 2 cases of multi-spectral SWIR imaging of human burn injury as a first step toward a non-invasive, label-free, technique for burn depth determination. Methods Two subjects admitted for mixed depth, thermal, 6% and 7% total body surface area (TBSA), burns were studied. Prior to burn excision, a novel system, based on a specialized camera, imaged the burn areas and normal skin at 4 different SWIR bands. Standard photographs from imaged areas were collected and presented for 5 independent, blinded, surgeons’ assessments. In SWIR images, 3-5 regions of interest (ROIs) were selected in burned and adjacent normal skin and the reflected light intensity in each ROI was averaged. Results Visual and SWIR images were collected for 9 burn areas in the hands, arms, and shoulder of 2 patients (Panel A). Fifty ROIs from the burn areas were assessed by the surgeons and 30 (60%) ROIs were agreed as being superficial or superficial partial thickness (n=5), deep partial thickness (n=11), or full thickness (n=14) burns by a majority (60% or above consensus together with a possible disagreement only between deep partial and full thickness burn). In Panel B the cumulative SWIR reflectance intensity at the 4 SWIR bands for the 3 burn groups, determined by expert surgeon evaluation, and normal skin are compared. The reflectance from superficial and superficial partial thickness burns (yellow) were 102.7±1.2%, 102.3±0.7% and 103.4±1.4% of the normal skin reflectance for 1200, 1650 and 1940 nm, respectively. On the other hand, the reflectance from deep partial thickness burns (grey) were 96.7±0.1% and 94.7±0.1%, and for full thickness burn (red) were 96.1±1.4% and 93.7±1.6% of normal skin reflectance for 1650 and 1940 nm, respectively. Conclusions We present the first human SWIR study demonstrating a distinct reflectance intensity of SWIR wavelengths for different burn depths based on surgeon assessments. The results motivate further studies of SWIR imaging of burns in the hope to non-invasively and accurately identify operative versus non-operative burns.
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Affiliation(s)
- Johanna H Nunez
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Caroline Park
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Audra Clark
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Chiaka Akarichi
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Brett Arnoldo
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Samuel P Mandell
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Deborah L Carlson
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Ryan M Huebinger
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Rodney K Chan
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Jeremy Goverman
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Sergey Mironov
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Benjamin Levi
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
| | - Omer Berenfeld
- University of Texas, Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; University of Texas Southwestern, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern, Parkland Regional Burn Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas; UT Southwestern Medical Center, Dallas, Texas
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Gupta VS, Meier J, Nunez JH, Abdelfattah KR, Balentine C, Zeh HJ, Carlson D, Levi B. How We Did It: Implementing a Trainee-Focused Surgical Research Curriculum and Infrastructure. J Surg Educ 2022; 79:35-39. [PMID: 34353762 DOI: 10.1016/j.jsurg.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/31/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To describe the implementation of a department-wide research curriculum and infrastructure created to promote academic collaboration and productivity, particularly amongst trainees and junior investigators involved in basic, translational, clinical, quality, or education research. DESIGN Description of UT Southwestern Medical Center's (UTSW) surgical research resources and infrastructure and the development of a didactic curriculum focused on research methods, writing skills, and optimizing academic time and effort. SETTING The collaboration was initiated by UTSW Department of Surgery residents who were on dedicated research time (DRT) and grew to include trainees and faculty at all levels of the institution. Guest lecturers from institutions around the country were incorporated via virtual meeting platforms. PARTICIPANTS Medical students, residents, and clinical and research faculty from the Department of Surgery were invited to attend research meetings, didactics, and the guest-lecture series. Additionally, all groups were given access to shared resources and encouraged to share their own work. RESULTS A robust set of resources including data analysis tools, manuscript and grant writing templates, funding opportunities, and a comprehensive list of surgical conferences was created and made accessible to UTSW Surgery team members. Moreover, a curriculum of lectures covering a broad variety of topics for all types of research was created and has thus far reached an audience of over 40 UTSW Surgery trainees and staff. CONCLUSIONS A comprehensive set of lectures and resources targeted toward facilitating surgical research was designed and implemented at one of the largest surgical training programs in the country. This effort represents a low-cost, feasible, and accessible way to improve academic productivity and enhance the training of surgeon-scientists and can serve as a blueprint for other institutions around the country.
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Affiliation(s)
- Vikas S Gupta
- Department of Surgery, UT Southwestern Medical Center, Department of Surgery, Dallas, Texas.
| | - Jennie Meier
- Department of Surgery, UT Southwestern Medical Center, Department of Surgery, Dallas, Texas
| | - Johanna H Nunez
- Department of Surgery, UT Southwestern Medical Center, Department of Surgery, Dallas, Texas
| | - Kareem R Abdelfattah
- Department of Surgery, UT Southwestern Medical Center, Department of Surgery, Dallas, Texas
| | - Courtney Balentine
- Department of Surgery, UT Southwestern Medical Center, Department of Surgery, Dallas, Texas
| | - Herb J Zeh
- Department of Surgery, UT Southwestern Medical Center, Department of Surgery, Dallas, Texas
| | - Deborah Carlson
- Department of Surgery, UT Southwestern Medical Center, Department of Surgery, Dallas, Texas
| | - Benjamin Levi
- Department of Surgery, UT Southwestern Medical Center, Department of Surgery, Dallas, Texas
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29
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Dolgachev VA, Ciotti S, Liechty E, Levi B, Wang SC, Baker JR, Hemmila MR. Dermal Nanoemulsion Treatment Reduces Burn Wound Conversion and Improves Skin Healing in a Porcine Model of Thermal Burn Injury. J Burn Care Res 2021; 42:1232-1242. [PMID: 34145458 DOI: 10.1093/jbcr/irab118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Burn wound progression is an inflammation-driven process where an initial partial-thickness thermal burn wound can evolve over time to a full-thickness injury. We have developed an oil-in-water nanoemulsion formulation (NB-201) containing benzalkonium chloride for use in burn wounds that is antimicrobial and potentially inhibits burn wound progression. We used a porcine burn injury model to evaluate the effect of topical nanoemulsion treatment on burn wound conversion and healing. Anesthetized swine received thermal burn wounds using a 25-cm2 surface area copper bar heated to 80°C. Three different concentrations of NB-201 (10, 20, or 40% nanoemulsion), silver sulfadiazine cream, or saline were applied to burned skin immediately after injury and on days 1, 2, 4, 7, 10, 14, and 18 postinjury. Digital images and skin biopsies were taken at each dressing change. Skin biopsy samples were stained for histological evaluation and graded. Skin tissue samples were also assayed for mediators of inflammation. Dermal treatment with NB-201 diminished thermal burn wound conversion to a full-thickness injury as determined by both histological and visual evaluation. Comparison of epithelial restoration on day 21 showed that 77.8% of the nanoemulsion-treated wounds had an epidermal injury score of 0 compared to 16.7% of the silver sulfadiazine-treated burns (P = .01). Silver sulfadiazine cream- and saline-treated wounds (controls) converted to full-thickness burns by day 4. Histological evaluation revealed reduced inflammation and evidence of skin injury in NB-201-treated sites compared to control wounds. The nanoemulsion-treated wounds often healed with complete regrowth of epithelium and no loss of hair follicles (NB-201: 4.8 ± 2.1, saline: 0 ± 0, silver sulfadiazine: 0 ± 0 hair follicles per 4-mm biopsy section, P < .05). Production of inflammatory mediators and sequestration of neutrophils were also inhibited by NB-201. Topically applied NB-201 prevented the progression of a partial-thickness burn wound to full-thickness injury and was associated with a concurrent decrease in dermal inflammation.
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Affiliation(s)
| | - Susan Ciotti
- BlueWillow Biologics, Ann Arbor, Michigan, USA.,University of Michigan, College of Pharmacy, Ann Arbor, USA
| | - Emma Liechty
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Benjamin Levi
- Department of Surgery, University of Texas Southwestern Medical School, Dallas, USA
| | - Stewart C Wang
- Department of Surgery, University of Michigan Medical School, Ann Arbor, USA
| | - James R Baker
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, USA
| | - Mark R Hemmila
- Department of Surgery, University of Michigan Medical School, Ann Arbor, USA
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30
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Larouche JA, Mohiuddin M, Choi JJ, Ulintz PJ, Fraczek P, Sabin K, Pitchiaya S, Kurpiers SJ, Castor-Macias J, Liu W, Hastings RL, Brown LA, Markworth JF, De Silva K, Levi B, Merajver SD, Valdez G, Chakkalakal JV, Jang YC, Brooks SV, Aguilar CA. Murine muscle stem cell response to perturbations of the neuromuscular junction are attenuated with aging. eLife 2021; 10:e66749. [PMID: 34323217 PMCID: PMC8360658 DOI: 10.7554/elife.66749] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/28/2021] [Indexed: 01/29/2023] Open
Abstract
During aging and neuromuscular diseases, there is a progressive loss of skeletal muscle volume and function impacting mobility and quality of life. Muscle loss is often associated with denervation and a loss of resident muscle stem cells (satellite cells or MuSCs); however, the relationship between MuSCs and innervation has not been established. Herein, we administered severe neuromuscular trauma to a transgenic murine model that permits MuSC lineage tracing. We show that a subset of MuSCs specifically engraft in a position proximal to the neuromuscular junction (NMJ), the synapse between myofibers and motor neurons, in healthy young adult muscles. In aging and in a mouse model of neuromuscular degeneration (Cu/Zn superoxide dismutase knockout - Sod1-/-), this localized engraftment behavior was reduced. Genetic rescue of motor neurons in Sod1-/- mice reestablished integrity of the NMJ in a manner akin to young muscle and partially restored MuSC ability to engraft into positions proximal to the NMJ. Using single cell RNA-sequencing of MuSCs isolated from aged muscle, we demonstrate that a subset of MuSCs are molecularly distinguishable from MuSCs responding to myofiber injury and share similarity to synaptic myonuclei. Collectively, these data reveal unique features of MuSCs that respond to synaptic perturbations caused by aging and other stressors.
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Affiliation(s)
- Jacqueline A Larouche
- Department of Biomedical Engineering, University of MichiganAnn ArborUnited States
- Biointerfaces Institute, University of MichiganAnn ArborUnited States
| | - Mahir Mohiuddin
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of TechnologyAtlantaUnited States
- School of Biological Sciences, Georgia Institute of TechnologyAtlantaUnited States
- Wallace Coulter Departmentof Biomedical Engineering, Georgia Institute of TechnologyAtlantaUnited States
| | - Jeongmoon J Choi
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of TechnologyAtlantaUnited States
- School of Biological Sciences, Georgia Institute of TechnologyAtlantaUnited States
- Wallace Coulter Departmentof Biomedical Engineering, Georgia Institute of TechnologyAtlantaUnited States
| | - Peter J Ulintz
- Department of Biomedical Engineering, University of MichiganAnn ArborUnited States
- Biointerfaces Institute, University of MichiganAnn ArborUnited States
- Internal Medicine-Hematology/Oncology, University of MichiganAnn ArborUnited States
| | - Paula Fraczek
- Department of Biomedical Engineering, University of MichiganAnn ArborUnited States
- Biointerfaces Institute, University of MichiganAnn ArborUnited States
| | - Kaitlyn Sabin
- Department of Biomedical Engineering, University of MichiganAnn ArborUnited States
- Biointerfaces Institute, University of MichiganAnn ArborUnited States
| | | | - Sarah J Kurpiers
- Department of Biomedical Engineering, University of MichiganAnn ArborUnited States
- Biointerfaces Institute, University of MichiganAnn ArborUnited States
| | - Jesus Castor-Macias
- Department of Biomedical Engineering, University of MichiganAnn ArborUnited States
- Biointerfaces Institute, University of MichiganAnn ArborUnited States
| | - Wenxuan Liu
- Department of Pharmacology and Physiology, University of Rochester Medical CenterRochesterUnited States
- Department of Biomedical Engineering, University of Rochester Medical CenterRochesterUnited States
- Wilmot Cancer Institute, Stem Cell and Regenerative Medicine Institute, and The Rochester Aging Research Center, University of Rochester Medical CenterRochesterUnited States
| | - Robert Louis Hastings
- Departmentof Molecular Biology, Cell Biology and Biochemistry, Brown UniversityProvidenceUnited States
- Center for Translational Neuroscience, Robert J. and Nancy D. Carney Institute for Brain Science and Brown Institute for Translational Science, Brown UniversityProvidenceUnited States
| | - Lemuel A Brown
- Department of Molecular & Integrative Physiology, University of MichiganAnn ArborUnited States
| | - James F Markworth
- Department of Molecular & Integrative Physiology, University of MichiganAnn ArborUnited States
| | - Kanishka De Silva
- Department of Biomedical Engineering, University of MichiganAnn ArborUnited States
- Biointerfaces Institute, University of MichiganAnn ArborUnited States
| | - Benjamin Levi
- Department of Surgery, University of Texas SouthwesternDallasUnited States
- Childrens Research Institute and Center for Mineral MetabolismDallasUnited States
- Program in Cellular and Molecular Biology, University of MichiganAnn ArborUnited States
| | - Sofia D Merajver
- Department of Biomedical Engineering, University of MichiganAnn ArborUnited States
- Internal Medicine-Hematology/Oncology, University of MichiganAnn ArborUnited States
| | - Gregorio Valdez
- Departmentof Molecular Biology, Cell Biology and Biochemistry, Brown UniversityProvidenceUnited States
- Center for Translational Neuroscience, Robert J. and Nancy D. Carney Institute for Brain Science and Brown Institute for Translational Science, Brown UniversityProvidenceUnited States
| | - Joe V Chakkalakal
- Department of Pharmacology and Physiology, University of Rochester Medical CenterRochesterUnited States
- Department of Biomedical Engineering, University of Rochester Medical CenterRochesterUnited States
- Wilmot Cancer Institute, Stem Cell and Regenerative Medicine Institute, and The Rochester Aging Research Center, University of Rochester Medical CenterRochesterUnited States
| | - Young C Jang
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of TechnologyAtlantaUnited States
- School of Biological Sciences, Georgia Institute of TechnologyAtlantaUnited States
- Wallace Coulter Departmentof Biomedical Engineering, Georgia Institute of TechnologyAtlantaUnited States
| | - Susan V Brooks
- Department of Biomedical Engineering, University of MichiganAnn ArborUnited States
- Department of Molecular & Integrative Physiology, University of MichiganAnn ArborUnited States
| | - Carlos A Aguilar
- Department of Biomedical Engineering, University of MichiganAnn ArborUnited States
- Biointerfaces Institute, University of MichiganAnn ArborUnited States
- Childrens Research Institute and Center for Mineral MetabolismDallasUnited States
- Program in Cellular and Molecular Biology, University of MichiganAnn ArborUnited States
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van de Vyver M, Boodhoo K, Frazier T, Hamel K, Kopcewicz M, Levi B, Maartens M, Machcinska S, Nunez J, Pagani C, Rogers E, Walendzik K, Wisniewska J, Gawronska-Kozak B, Gimble JM. Histology Scoring System for Murine Cutaneous Wounds. Stem Cells Dev 2021; 30:1141-1152. [PMID: 34130483 DOI: 10.1089/scd.2021.0124] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Monitoring wound progression over time is a critical aspect for studies focused on in-depth molecular analysis or on evaluating the efficacy of potential novel therapies. Histopathological analysis of wound biopsies can provide significant insight into healing dynamics, yet there is no standardized and reproducible scoring system currently available. The purpose of this study was to develop and statistically validate a scoring system based on parameters in each phase of healing that can be easily and accurately assessed using either Hematoxylin & Eosin (H&E) or Masson's Trichrome (MT) staining. These parameters included re-epithelization, epithelial thickness index, keratinization, granulation tissue thickness, remodeling, and the scar elevation index. The initial phase of the study was to (1) optimize and clarify healing parameters to limit investigator bias and variability; (2) compare the consistency of parameters assessed using H&E versus MT staining. During the validation phase of this study, the accuracy and reproducibility of this scoring system was independently iterated upon and validated in four different types of murine skin wound models (Excisional; punch biopsy; pressure ulcers; burn wounds). A total of n = 54 histology sections were randomized, blinded, and assigned to two groups of independent investigators (n = 5 per group) for analysis. The sensitivity of each parameter (ranging between 80% and 95%) is reported with illustrations on the appropriate assessment method using ImageJ software. In the validated scoring system, the lowest score (score:0) is associated with an open/unhealed wound as is evident immediately and within the first day postinjury, whereas the highest score (score:12) is associated with a completely closed and healed wound without excessive scarring. This study defines and describes the minimum recommended criteria for assessing wound healing dynamics using the SPOT skin wound score. The acronym SPOT refers to the academic and scientific institutions that were involved in the development of the scoring system, namely, Stellenbosch University, Polish Academy of Sciences, Obatala Sciences, and the University of Texas Southwestern.
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Affiliation(s)
- Mari van de Vyver
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kiara Boodhoo
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Katie Hamel
- Obatala Sciences, Inc., New Orleans, Louisiana, USA
| | - Marta Kopcewicz
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Benjamin Levi
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michelle Maartens
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sylwia Machcinska
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Johanna Nunez
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chase Pagani
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Emma Rogers
- Obatala Sciences, Inc., New Orleans, Louisiana, USA
| | - Katarzyna Walendzik
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Joanna Wisniewska
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Barbara Gawronska-Kozak
- Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Jeffrey M Gimble
- Obatala Sciences, Inc., New Orleans, Louisiana, USA.,Department of Medicine, Structural and Cellular Biology, and Surgery, Center for Stem Cell Research and Regenerative Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
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32
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Lee S, Hwang C, Qin Q, Negri S, Pagani C, Stepien D, Sorkin M, Kubiak C, Huber A, Clemens T, Levi B, James A. The TrkA Antagonist AR786 Prevents Heterotopic Ossification. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.02408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Aaron James
- PathologyJohns Hopkins UniversityBaltimoreMD
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Edwards NJ, Hobson E, Dey D, Rhodes A, Overmann A, Hoyt B, Walsh SA, Pagani CA, Strong AL, Hespe GE, Padmanabhan KR, Huber A, Deng C, Davis TA, Levi B. High Frequency Spectral Ultrasound Imaging Detects Early Heterotopic Ossification in Rodents. Stem Cells Dev 2021; 30:473-484. [PMID: 33715398 PMCID: PMC8106252 DOI: 10.1089/scd.2021.0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/12/2021] [Indexed: 12/12/2022] Open
Abstract
Heterotopic ossification (HO) is a devastating condition in which ectopic bone forms inappropriately in soft tissues following traumatic injuries and orthopedic surgeries as a result of aberrant mesenchymal progenitor cell (MPC) differentiation. HO leads to chronic pain, decreased range of motion, and an overall decrease in quality of life. While several treatments have shown promise in animal models, all must be given during early stages of formation. Methods for early determination of whether and where endochondral ossification/soft tissue mineralization (HO anlagen) develop are lacking. At-risk patients are not identified sufficiently early in the process of MPC differentiation and soft tissue endochondral ossification for potential treatments to be effective. Hence, a critical need exists to develop technologies capable of detecting HO anlagen soon after trauma, when treatments are most effective. In this study, we investigate high frequency spectral ultrasound imaging (SUSI) as a noninvasive strategy to identify HO anlagen at early time points after injury. We show that by determining quantitative parameters based on tissue organization and structure, SUSI identifies HO anlagen as early as 1-week postinjury in a mouse model of burn/tenotomy and 3 days postinjury in a rat model of blast/amputation. We analyze single cell RNA sequencing profiles of the MPCs responsible for HO formation and show that the early tissue changes detected by SUSI match chondrogenic and osteogenic gene expression in this population. SUSI identifies sites of soft tissue endochondral ossification at early stages of HO formation so that effective intervention can be targeted when and where it is needed following trauma-induced injury. Furthermore, we characterize the chondrogenic to osteogenic transition that occurs in the MPCs during HO formation and correlate gene expression to SUSI detection of the HO anlagen.
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Affiliation(s)
- Nicole J. Edwards
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric Hobson
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Devaveena Dey
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Alisha Rhodes
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | - Archie Overmann
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Benjamin Hoyt
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sarah A. Walsh
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Chase A. Pagani
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amy L. Strong
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Geoffrey E. Hespe
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Amanda Huber
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Cheri Deng
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas A. Davis
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Benjamin Levi
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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34
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Pagani CA, Huber AK, Hwang C, Marini S, Padmanabhan K, Livingston N, Nunez J, Sun Y, Edwards N, Cheng YH, Visser N, Yu P, Patel N, Greenstein JA, Rasheed H, Nelson R, Kessel K, Vasquez K, Strong AL, Hespe GE, Song JY, Wellik DM, Levi B. Novel Lineage-Tracing System to Identify Site-Specific Ectopic Bone Precursor Cells. Stem Cell Reports 2021; 16:626-640. [PMID: 33606989 PMCID: PMC7940250 DOI: 10.1016/j.stemcr.2021.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 11/30/2022] Open
Abstract
Heterotopic ossification (HO) is a form of pathological cell-fate change of mesenchymal stem/precursor cells (MSCs) that occurs following traumatic injury, limiting range of motion in extremities and causing pain. MSCs have been shown to differentiate to form bone; however, their lineage and aberrant processes after trauma are not well understood. Utilizing a well-established mouse HO model and inducible lineage-tracing mouse (Hoxa11-CreERT2;ROSA26-LSL-TdTomato), we found that Hoxa11-lineage cells represent HO progenitors specifically in the zeugopod. Bioinformatic single-cell transcriptomic and epigenomic analyses showed Hoxa11-lineage cells are regionally restricted mesenchymal cells that, after injury, gain the potential to undergo differentiation toward chondrocytes, osteoblasts, and adipocytes. This study identifies Hoxa11-lineage cells as zeugopod-specific ectopic bone progenitors and elucidates the fate specification and multipotency that mesenchymal cells acquire after injury. Furthermore, this highlights homeobox patterning genes as useful tools to trace region-specific progenitors and enable location-specific gene deletion. Lineage tracing, single-cell RNA-seq and single cell ATAC enable cell specific analysis of in vivo cell fate Hoxa11 lineage marks distinct mesenchymal precursors in the zeugopod Hoxa11 lineage mesenchymal precursors undergo an aberrant cell fate change towards ectopic bone and cartilage
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Affiliation(s)
- Chase A Pagani
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, 6000 Harry Hines Boulevard, Dallas, TX 75235, USA
| | - Amanda K Huber
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Charles Hwang
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Simone Marini
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Nicholas Livingston
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, 6000 Harry Hines Boulevard, Dallas, TX 75235, USA
| | - Johanna Nunez
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, 6000 Harry Hines Boulevard, Dallas, TX 75235, USA
| | - Yuxiao Sun
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, 6000 Harry Hines Boulevard, Dallas, TX 75235, USA
| | - Nicole Edwards
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yu-Hao Cheng
- Institute for Cell Engineering, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Noelle Visser
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Pauline Yu
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nicole Patel
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Joseph A Greenstein
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Husain Rasheed
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Reagan Nelson
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Karen Kessel
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kaetlin Vasquez
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Amy L Strong
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Geoffrey E Hespe
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jane Y Song
- Department of Cell and Regenerative Biology, University of Wisconsin, Madison, WI 53705, USA
| | - Deneen M Wellik
- Department of Cell and Regenerative Biology, University of Wisconsin, Madison, WI 53705, USA
| | - Benjamin Levi
- Center for Organogenesis and Trauma, Department of Surgery, University of Texas Southwestern, 6000 Harry Hines Boulevard, Dallas, TX 75235, USA.
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35
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Strong AL, Spreadborough PJ, Dey D, Yang P, Li S, Lee A, Haskins RM, Grimm PD, Kumar R, Bradley MJ, Yu PB, Levi B, Davis TA. BMP Ligand Trap ALK3-Fc Attenuates Osteogenesis and Heterotopic Ossification in Blast-Related Lower Extremity Trauma. Stem Cells Dev 2021; 30:91-105. [PMID: 33256557 PMCID: PMC7826435 DOI: 10.1089/scd.2020.0162] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/25/2020] [Indexed: 01/05/2023] Open
Abstract
Traumatic heterotopic ossification (tHO) commonly develops in wounded service members who sustain high-energy and blast-related traumatic amputations. Currently, no safe and effective preventive measures have been identified for this patient population. Bone morphogenetic protein (BMP) signaling blockade has previously been shown to reduce ectopic bone formation in genetic models of HO. In this study, we demonstrate the efficacy of small-molecule inhibition with LDN193189 (ALK2/ALK3 inhibition), LDN212854 (ALK2-biased inhibition), and BMP ligand trap ALK3-Fc at inhibiting early and late osteogenic differentiation of tissue-resident mesenchymal progenitor cells (MPCs) harvested from mice subjected to burn/tenotomy, a well-characterized trauma-induced model of HO. Using an established rat tHO model of blast-related extremity trauma and methicillin-resistant Staphylococcus aureus infection, a significant decrease in ectopic bone volume was observed by micro-computed tomography imaging following treatment with LDN193189, LDN212854, and ALK3-Fc. The efficacy of LDN193189 and LDN212854 in this model was associated with weight loss (17%-19%) within the first two postoperative weeks, and in the case of LDN193189, delayed wound healing and metastatic infection was observed, while ALK3-Fc was well tolerated. At day 14 following injury, RNA-Seq and quantitative reverse transcriptase-polymerase chain reaction analysis revealed that ALK3-Fc enhanced the expression of skeletal muscle structural genes and myogenic transcriptional factors while inhibiting the expression of inflammatory genes. Tissue-resident MPCs harvested from rats treated with ALK3-Fc exhibited reduced osteogenic differentiation, proliferation, and self-renewal capacity and diminished expression of genes associated with endochondral ossification and SMAD-dependent signaling pathways. Together, these results confirm the contribution of BMP signaling in osteogenic differentiation and ectopic bone formation and that a selective ligand-trap approach such as ALK3-Fc may be an effective and tolerable prophylactic strategy for tHO.
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Affiliation(s)
- Amy L. Strong
- Division of Plastic Surgery, Department of Surgery, University of Michigan Health Systems, Ann Arbor, Michigan, USA
| | - Philip J. Spreadborough
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Devaveena Dey
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Peiran Yang
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shuli Li
- Division of Plastic Surgery, Department of Surgery, University of Michigan Health Systems, Ann Arbor, Michigan, USA
| | - Arthur Lee
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA
| | - Ryan M. Haskins
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland, USA
| | - Patrick D. Grimm
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Ravi Kumar
- Acceleron Pharma, Inc., Cambridge, Massachusetts, USA
| | - Matthew J. Bradley
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Paul B. Yu
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin Levi
- Division of Plastic Surgery, Department of Surgery, University of Michigan Health Systems, Ann Arbor, Michigan, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Thomas A. Davis
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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36
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Bredbeck BC, Maguire LH, Alam HB, Bednar F, Delano MJ, Dimick JB, Ignatoski KMW, Di Magliano MP, Levi B. Teamwork at the Bench: Strategies for Collaborative Surgical Science in a Pandemic. J Surg Res 2021; 261:39-42. [PMID: 33412507 DOI: 10.1016/j.jss.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/05/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022]
Abstract
The Center for Basic and Translational Science was formed to address the unique challenges faced by surgeon-scientists. Shortly after its inception, COVID-19 upended research workflows at our institution. We discuss how the collaborative Center for Basic and Translational Science framework was adapted to support laboratories during the pandemic by assisting with ramp-down, promoting mentorship and community building, and maintaining research productivity.
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Affiliation(s)
- Brooke C Bredbeck
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Basic and Translational Science (CBATS), Michigan Medicine, Ann Arbor, Michigan.
| | - Lillias H Maguire
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Basic and Translational Science (CBATS), Michigan Medicine, Ann Arbor, Michigan
| | - Hasan B Alam
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Basic and Translational Science (CBATS), Michigan Medicine, Ann Arbor, Michigan
| | - Filip Bednar
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Basic and Translational Science (CBATS), Michigan Medicine, Ann Arbor, Michigan
| | - Matthew J Delano
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Basic and Translational Science (CBATS), Michigan Medicine, Ann Arbor, Michigan
| | - Justin B Dimick
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Basic and Translational Science (CBATS), Michigan Medicine, Ann Arbor, Michigan
| | - Kathleen M W Ignatoski
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Basic and Translational Science (CBATS), Michigan Medicine, Ann Arbor, Michigan
| | - Marina Pasca Di Magliano
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Basic and Translational Science (CBATS), Michigan Medicine, Ann Arbor, Michigan
| | - Benjamin Levi
- Center for Basic and Translational Science (CBATS), Michigan Medicine, Ann Arbor, Michigan; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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37
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Edwards NJ, Hwang C, Marini S, Pagani CA, Spreadborough PJ, Rowe CJ, Yu P, Mei A, Visser N, Li S, Hespe GE, Huber AK, Strong AL, Shelef MA, Knight JS, Davis TA, Levi B. The role of neutrophil extracellular traps and TLR signaling in skeletal muscle ischemia reperfusion injury. FASEB J 2020; 34:15753-15770. [PMID: 33089917 DOI: 10.1096/fj.202000994rr] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022]
Abstract
Ischemia reperfusion (IR) injury results in devastating skeletal muscle fibrosis. Here, we recapitulate this injury with a mouse model of hindlimb IR injury which leads to skeletal muscle fibrosis. Injury resulted in extensive immune infiltration with robust neutrophil extracellular trap (NET) formation in the skeletal muscle, however, direct targeting of NETs via the peptidylarginine deiminase 4 (PAD4) mechanism was insufficient to reduce muscle fibrosis. Circulating levels of IL-10 and TNFα were significantly elevated post injury, indicating toll-like receptor (TLR) signaling may be involved in muscle injury. Administration of hydroxychloroquine (HCQ), a small molecule inhibitor of TLR7/8/9, following injury reduced NET formation, IL-10, and TNFα levels and ultimately mitigated muscle fibrosis and improved myofiber regeneration following IR injury. HCQ treatment decreased fibroadipogenic progenitor cell proliferation and partially inhibited ERK1/2 phosphorylation in the injured tissue, suggesting it may act through a combination of TLR7/8/9 and ERK signaling mechanisms. We demonstrate that treatment with FDA-approved HCQ leads to decreased muscle fibrosis and increased myofiber regeneration following IR injury, suggesting short-term HCQ treatment may be a viable treatment to prevent muscle fibrosis in ischemia reperfusion and traumatic extremity injury.
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Affiliation(s)
- Nicole J Edwards
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Charles Hwang
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Simone Marini
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Chase A Pagani
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Philip J Spreadborough
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cassie J Rowe
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Pauline Yu
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Annie Mei
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Noelle Visser
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Shuli Li
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Geoffrey E Hespe
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Amanda K Huber
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Amy L Strong
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Miriam A Shelef
- Division of Rheumatology, University of Wisconsin and William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Jason S Knight
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Thomas A Davis
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Benjamin Levi
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.,Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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38
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Thorpe CR, Ucer Ozgurel S, Simko LC, Goldstein R, Grant GG, Pagani C, Hwang C, Vasquez K, Sorkin M, Vaishampayan A, Goverman J, Sheridan RL, Friedstat J, Schulz JT, Schneider JC, Levi B, Ryan CM. Investigation into Possible Association of Oxandrolone and Heterotopic Ossification Following Burn Injury. J Burn Care Res 2020; 40:398-405. [PMID: 31053861 DOI: 10.1093/jbcr/irz063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Oxandrolone, a testosterone analog, is used to counteract the catabolic effects of burn injury. Recent animal studies suggest a possible hormonal association with heterotopic ossification (HO) development postburn. This work examines oxandrolone administration and HO development by exploring historical clinical data bridging the introduction of oxandrolone into clinical practice. Additionally, we examine associations between oxandrolone administration and HO in a standardized mouse model of burn/trauma-related HO. Acutely burned adults admitted between 2000 and 2014, survived through discharge, and had a HO risk factor of 7 or higher were selected for analysis from a single burn center. Oxandrolone administration, clinical and demographic data, and elbow HO were recorded and were analyzed with logistic regression. Associations of oxandrolone with HO were examined in a mouse model. Mice were administered oxandrolone or vehicle control following burn/tenotomy to examine any potential effect of oxandrolone on HO and were analyzed by Student's t test. Subjects who received oxandrolone had a higher incidence of elbow HO than those that did not receive oxandrolone. However, when controlling for oxandrolone administration, oxandrolone duration, postburn day oxandrolone initiation, HO risk score category, age, sex, race, burn size, and year of injury, there was no significant difference between rates of elbow HO between the two populations. In agreement with the review, in the mouse model, while there was a trend toward the oxandrolone group developing a greater volume of HO, this did not reach statistical significance.
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Affiliation(s)
- Catherine R Thorpe
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts
| | | | - Laura C Simko
- Shriners Hospitals for Children-Boston, Massachusetts.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
| | | | - Gabrielle G Grant
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts
| | | | | | | | | | | | - Jeremy Goverman
- Massachusetts General Hospital, Boston.,Harvard Medical School, Cambridge, Massachusetts
| | - Robert L Sheridan
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - Jonathan Friedstat
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - John T Schulz
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - Jeffrey C Schneider
- Massachusetts General Hospital, Boston.,Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
| | - Benjamin Levi
- Shriners Hospitals for Children-Boston, Massachusetts
| | - Colleen M Ryan
- Massachusetts General Hospital, Boston.,Shriners Hospitals for Children-Boston, Massachusetts.,Harvard Medical School, Cambridge, Massachusetts
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39
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Strong AL, Spreadborough PJ, Pagani CA, Haskins RM, Dey D, Grimm PD, Kaneko K, Marini S, Huber AK, Hwang C, Westover K, Mishina Y, Bradley MJ, Levi B, Davis TA. Small molecule inhibition of non-canonical (TAK1-mediated) BMP signaling results in reduced chondrogenic ossification and heterotopic ossification in a rat model of blast-associated combat-related lower limb trauma. Bone 2020; 139:115517. [PMID: 32622875 PMCID: PMC7945876 DOI: 10.1016/j.bone.2020.115517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
Abstract
Heterotopic ossification (HO) is defined as ectopic bone formation around joints and in soft tissues following trauma, particularly blast-related extremity injuries, thermal injuries, central nerve injuries, or orthopaedic surgeries, leading to increased pain and diminished quality of life. Current treatment options include pharmacotherapy with non-steroidal anti-inflammatory drugs, radiotherapy, and surgical excision, but these treatments have limited efficacy and have associated complication profiles. In contrast, small molecule inhibitors have been shown to have higher specificity and less systemic cytotoxicity. Previous studies have shown that bone morphogenetic protein (BMP) signaling and downstream non-canonical (SMAD-independent) BMP signaling mediated induction of TGF-β activated kinase-1 (TAK1) contributes to HO. In the current study, small molecule inhibition of TAK1, NG-25, was evaluated for its efficacy in limiting ectopic bone formation following a rat blast-associated lower limb trauma and a murine burn tenotomy injury model. A significant decrease in total HO volume in the rat blast injury model was observed by microCT imaging with no systemic complications following NG-25 therapy. Furthermore, tissue-resident mesenchymal progenitor cells (MPCs) harvested from rats treated with NG-25 demonstrated decreased proliferation, limited osteogenic differentiation capacity, and reduced gene expression of Tac1, Col10a1, Ibsp, Smad3, and Sox2 (P < 0.05). Single cell RNA-sequencing of murine cells harvested from the injury site in a burn tenotomy injury model showed increased expression of these genes in MPCs during stages of chondrogenic differentiation. Additional in vitro cell cultures of murine tissue-resident MPCs and osteochondrogenic progenitors (OCPs) treated with NG-25 demonstrated reduced chondrogenic differentiation by 10.2-fold (P < 0.001) and 133.3-fold (P < 0.001), respectively, as well as associated reduction in chondrogenic gene expression. Induction of HO in Tak1 knockout mice demonstrated a 7.1-fold (P < 0.001) and 2.7-fold reduction (P < 0.001) in chondrogenic differentiation of murine MPCs and OCPs, respectively, with reduced chondrogenic gene expression. Together, our in vivo models and in vitro cell culture studies demonstrate the importance of TAK1 signaling in chondrogenic differentiation and HO formation and suggest that small molecule inhibition of TAK1 is a promising therapy to limit the formation and progression of HO.
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Affiliation(s)
- Amy L Strong
- Division of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Philip J Spreadborough
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD, United States of America; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; Academic Department of Military Surgery and Trauma, Royal Centre for Defense Medicine, Birmingham, United Kingdom
| | - Chase A Pagani
- Division of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Ryan M Haskins
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD, United States of America
| | - Devaveena Dey
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD, United States of America; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Patrick D Grimm
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD, United States of America; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Keiko Kaneko
- Division of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Simone Marini
- Division of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Amanda K Huber
- Division of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Charles Hwang
- Division of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Kenneth Westover
- Departments of Biochemistry and Radiation Oncology, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, United States of America
| | - Yuji Mishina
- Department of Biologic and Materials Science and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States of America
| | - Matthew J Bradley
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD, United States of America; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
| | - Benjamin Levi
- Division of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America.
| | - Thomas A Davis
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD, United States of America; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America.
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40
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Huber AK, Patel N, Pagani CA, Marini S, Padmanabhan KR, Matera DL, Said M, Hwang C, Hsu GCY, Poli AA, Strong AL, Visser ND, Greenstein JA, Nelson R, Li S, Longaker MT, Tang Y, Weiss SJ, Baker BM, James AW, Levi B. Immobilization after injury alters extracellular matrix and stem cell fate. J Clin Invest 2020; 130:5444-5460. [PMID: 32673290 PMCID: PMC7524473 DOI: 10.1172/jci136142] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022] Open
Abstract
Cells sense the extracellular environment and mechanical stimuli and translate these signals into intracellular responses through mechanotransduction, which alters cell maintenance, proliferation, and differentiation. Here we use a mouse model of trauma-induced heterotopic ossification (HO) to examine how cell-extrinsic forces impact mesenchymal progenitor cell (MPC) fate. After injury, single-cell (sc) RNA sequencing of the injury site reveals an early increase in MPC genes associated with pathways of cell adhesion and ECM-receptor interactions, and MPC trajectories to cartilage and bone. Immunostaining uncovers active mechanotransduction after injury with increased focal adhesion kinase signaling and nuclear translocation of transcriptional coactivator TAZ, inhibition of which mitigates HO. Similarly, joint immobilization decreases mechanotransductive signaling, and completely inhibits HO. Joint immobilization decreases collagen alignment and increases adipogenesis. Further, scRNA sequencing of the HO site after injury with or without immobilization identifies gene signatures in mobile MPCs correlating with osteogenesis, and signatures from immobile MPCs with adipogenesis. scATAC-seq in these same MPCs confirm that in mobile MPCs, chromatin regions around osteogenic genes are open, whereas in immobile MPCs, regions around adipogenic genes are open. Together these data suggest that joint immobilization after injury results in decreased ECM alignment, altered MPC mechanotransduction, and changes in genomic architecture favoring adipogenesis over osteogenesis, resulting in decreased formation of HO.
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MESH Headings
- Acyltransferases
- Adipogenesis/genetics
- Animals
- Cell Differentiation
- Cell Lineage
- Disease Models, Animal
- Extracellular Matrix/metabolism
- Extremities/injuries
- Focal Adhesion Kinase 1/deficiency
- Focal Adhesion Kinase 1/genetics
- Focal Adhesion Kinase 1/metabolism
- Humans
- Male
- Mechanotransduction, Cellular/genetics
- Mechanotransduction, Cellular/physiology
- Mesenchymal Stem Cells/pathology
- Mesenchymal Stem Cells/physiology
- Mice
- Mice, Inbred C57BL
- Mice, Transgenic
- Ossification, Heterotopic/etiology
- Ossification, Heterotopic/pathology
- Ossification, Heterotopic/physiopathology
- Osteogenesis/genetics
- Restraint, Physical/adverse effects
- Restraint, Physical/physiology
- Signal Transduction/genetics
- Signal Transduction/physiology
- Transcription Factors/genetics
- Transcription Factors/metabolism
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Affiliation(s)
| | - Nicole Patel
- Section of Plastic Surgery, Department of Surgery
| | | | | | | | - Daniel L Matera
- Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Mohamed Said
- Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Andrea A Poli
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Amy L Strong
- Section of Plastic Surgery, Department of Surgery
| | | | | | | | - Shuli Li
- Section of Plastic Surgery, Department of Surgery
| | - Michael T Longaker
- Institute for Stem Cell Biology and Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Yi Tang
- Life Sciences Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephen J Weiss
- Life Sciences Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Brendon M Baker
- Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Aaron W James
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
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41
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Abstract
Bone development occurs through a series of synchronous events that result in the formation of the body scaffold. The repair potential of bone and its surrounding microenvironment - including inflammatory, endothelial and Schwann cells - persists throughout adulthood, enabling restoration of tissue to its homeostatic functional state. The isolation of a single skeletal stem cell population through cell surface markers and the development of single-cell technologies are enabling precise elucidation of cellular activity and fate during bone repair by providing key insights into the mechanisms that maintain and regenerate bone during homeostasis and repair. Increased understanding of bone development, as well as normal and aberrant bone repair, has important therapeutic implications for the treatment of bone disease and ageing-related degeneration.
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Affiliation(s)
- Ankit Salhotra
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Harsh N Shah
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Benjamin Levi
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
| | - Michael T Longaker
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA. .,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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42
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Hwang C, Pagani CA, Das N, Marini S, Huber AK, Xie L, Jimenez J, Brydges S, Lim WK, Nannuru KC, Murphy AJ, Economides AN, Hatsell SJ, Levi B. Activin A does not drive post-traumatic heterotopic ossification. Bone 2020; 138:115473. [PMID: 32553795 DOI: 10.1016/j.bone.2020.115473] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
Abstract
Heterotopic ossification (HO), the formation of ectopic bone in soft tissues, has been extensively studied in its two primary forms: post-traumatic HO (tHO) typically found in patients who have experienced musculoskeletal or neurogenic injury and in fibrodysplasia ossificans progressiva (FOP), where it is genetically driven. Given that in both diseases HO arises via endochondral ossification, the molecular mechanisms behind both diseases have been postulated to be manifestations of similar pathways including those activated by BMP/TGFβ superfamily ligands. A significant step towards understanding the molecular mechanism by which HO arises in FOP was the discovery that FOP causing ACVR1 variants trigger HO in response to activin A, a ligand that does not activate signaling from wild type ACVR1, and that is not inherently osteogenic in wild type settings. The physiological significance of this finding was demonstrated by showing that activin A neutralizing antibodies stop HO in two different genetically accurate mouse models of FOP. In order to explore the role of activin A in tHO, we performed single cell RNA sequencing and compared the expression of activin A as well as other BMP pathway genes in tHO and FOP HO. We show that activin A is expressed in response to injury in both settings, but by different types of cells. Given that wild type ACVR1 does not transduce signal when engaged by activin A, we hypothesized that inhibition of activin A will not block tHO. Nonetheless, as activin A was expressed in tHO lesions, we tested its inhibition and compared it with inhibition of BMPs. We show here that anti-activin A does not block tHO, whereas agents such as antibodies that neutralize ACVR1 or ALK3-Fc (which blocks osteogenic BMPs) are beneficial, though not completely curative. These results demonstrate that inhibition of activin A should not be considered as a therapeutic strategy for ameliorating tHO.
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Affiliation(s)
- Charles Hwang
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Chase A Pagani
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | | | - Simone Marini
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - Amanda K Huber
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America
| | - LiQin Xie
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | | | | | | | | | | | | | - Benjamin Levi
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States of America; Division of Plastic Surgery, Department of Surgery, University of Michigan Health System, 1500 E Medical Center Drive, SPC 5340, Ann Arbor, MI 48109-5340, United States of America.
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43
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Hsu GCY, Marini S, Negri S, Wang Y, Xu J, Pagani C, Hwang C, Stepien D, Meyers CA, Miller S, McCarthy E, Lyons KM, Levi B, James AW. Endogenous CCN family member WISP1 inhibits trauma-induced heterotopic ossification. JCI Insight 2020; 5:135432. [PMID: 32484792 DOI: 10.1172/jci.insight.135432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/21/2020] [Indexed: 12/26/2022] Open
Abstract
Heterotopic ossification (HO) is defined as abnormal differentiation of local stromal cells of mesenchymal origin, resulting in pathologic cartilage and bone matrix deposition. Cyr61, CTGF, Nov (CCN) family members are matricellular proteins that have diverse regulatory functions on cell proliferation and differentiation, including the regulation of chondrogenesis. However, little is known regarding CCN family member expression or function in HO. Here, a combination of bulk and single-cell RNA sequencing defined the dynamic temporospatial pattern of CCN family member induction within a mouse model of trauma-induced HO. Among CCN family proteins, Wisp1 (also known as Ccn4) was most upregulated during the evolution of HO, and Wisp1 expression corresponded with chondrogenic gene profile. Immunohistochemistry confirmed WISP1 expression across traumatic and genetic HO mouse models as well as in human HO samples. Transgenic Wisp1LacZ/LacZ knockin animals showed an increase in endochondral ossification in HO after trauma. Finally, the transcriptome of Wisp1-null tenocytes revealed enrichment in signaling pathways, such as the STAT3 and PCP signaling pathways, that may explain increased HO in the context of Wisp1 deficiency. In sum, CCN family members, and in particular Wisp1, are spatiotemporally associated with and negatively regulate trauma-induced HO formation.
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Affiliation(s)
| | - Simone Marini
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Stefano Negri
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yiyun Wang
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jiajia Xu
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chase Pagani
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Charles Hwang
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - David Stepien
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Carolyn A Meyers
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sarah Miller
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Edward McCarthy
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Karen M Lyons
- Orthopaedic Hospital Research Center, University of California, Los Angeles, Los Angeles, California, USA
| | - Benjamin Levi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Aaron W James
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA.,Orthopaedic Hospital Research Center, University of California, Los Angeles, Los Angeles, California, USA
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44
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Pignolo RJ, Cheung K, Kile S, Fitzpatrick MA, De Cunto C, Al Mukaddam M, Hsiao EC, Baujat G, Delai P, Eekhoff EMW, Di Rocco M, Grunwald Z, Haga N, Keen R, Levi B, Morhart R, Scott C, Sherman A, Zhang K, Kaplan FS. Self-reported baseline phenotypes from the International Fibrodysplasia Ossificans Progressiva (FOP) Association Global Registry. Bone 2020; 134:115274. [PMID: 32062004 DOI: 10.1016/j.bone.2020.115274] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 11/21/2022]
Abstract
A global, patient-reported registry has been established to characterize the course of disease and track clinical outcomes in patients with fibrodysplasia ossificans progressiva (FOP), an ultra-rare genetic condition of progressive heterotopic ossification (HO) that results in ankylosis of joints and renders most affected individuals immobile by the second decade of life. Here, we present baseline phenotypes on 299 patients (median age 21 years; range 0.1 to 78 years) from 54 countries based on aggregate data from the International FOP Association (IFOPA) Global Registry (the "FOP Registry"). The mean current age of the patients is 23.7 years (range, 0.1 to 78 years). Baseline characteristics are presented for FOP diagnosis, HO, flare-ups and precedent events, system-based prevalent symptomatology, encounters with medical and dental care providers, Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale scores, physical function, as well as the use of aids, assistive devices, and adaptations. Correlations of PROMIS Global Health scores with HO burden and physical function are calculated. Associations of joint mobility with PROMIS Global Health scores, physical function, and use of aids, assistive devices, and adaptations are summarized. Overall, the FOP Registry database contains a broad sample of the global FOP patient population, providing a useful tool for expanding knowledge of FOP, designing clinical trials and facilitating evidence-based decisions about the optimal monitoring and management of affected individuals.
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Affiliation(s)
- Robert J Pignolo
- Department of Medicine, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Kin Cheung
- BioSAS Consulting, Inc., Wellesley, MA, United States
| | - Sammi Kile
- International FOP Association, 1520 Clay St, Suite H2, North Kansas City, MO, United States.
| | - Mary Anne Fitzpatrick
- International FOP Association, 1520 Clay St, Suite H2, North Kansas City, MO, United States.
| | - Carmen De Cunto
- Pediatric Rheumatology Section, Department of Pediatrics, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Mona Al Mukaddam
- Departments of Medicine and Orthopaedic Surgery, The Center for Research in FOP and Related Disorders, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, United States.
| | - Edward C Hsiao
- Division of Endocrinology and Metabolism, The UCSF Metabolic Bone Clinic, The Institute of Human Genetics, the UCSF Program in Craniofacial Biology, Department of Medicine, University of California-San Francisco, San Francisco, CA, United States.
| | - Genevieve Baujat
- Departement de Genetique, Institut IMAGINE, Hôpital Necker-Enfants Malades, Paris, France.
| | - Patricia Delai
- Hospital Israelita Albert Einstein, Instituto de Ensino e Pesquisa, São Paulo, SP, Brazil.
| | - Elisabeth M W Eekhoff
- VU Medical Center Amsterdam, Department of Internal Medicine/Section Endocrinology, Amsterdam, the Netherlands.
| | - Maja Di Rocco
- Unit of Rare Diseases, Department of Pediatrics, Giannina Gaslini Institute, Genoa, Italy.
| | - Zvi Grunwald
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, United States.
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Richard Keen
- Centre for Metabolic Bone Disease, Royal National Orthopaedic Hospital, Stanmore, Middlesex, United Kingdom.
| | - Benjamin Levi
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States.
| | - Rolf Morhart
- Department of Pediatrics, Klinikum Garmisch-Partenkirchen GmbH, Garmisch-Partenkirchen, Germany.
| | - Christiaan Scott
- Department of Paediatric Rheumatology, Red Cross Children's Hospital, Cape Town, South Africa.
| | - Adam Sherman
- International FOP Association, 1520 Clay St, Suite H2, North Kansas City, MO, United States.
| | - Keqin Zhang
- Tongji Hospital, Shanghai Tongji University, Shanghai, PR China
| | - Fredrick S Kaplan
- Departments of Orthopaedic Surgery and Medicine, The Center for Research in FOP & Related Disorders, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, United States.
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45
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Stepien DM, Hwang C, Marini S, Pagani CA, Sorkin M, Visser ND, Huber AK, Edwards NJ, Loder SJ, Vasquez K, Aguilar CA, Kumar R, Mascharak S, Longaker MT, Li J, Levi B. Tuning Macrophage Phenotype to Mitigate Skeletal Muscle Fibrosis. J Immunol 2020; 204:2203-2215. [PMID: 32161098 PMCID: PMC8080967 DOI: 10.4049/jimmunol.1900814] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/20/2020] [Indexed: 12/16/2022]
Abstract
Myeloid cells are critical to the development of fibrosis following muscle injury; however, the mechanism of their role in fibrosis formation remains unclear. In this study, we demonstrate that myeloid cell-derived TGF-β1 signaling is increased in a profibrotic ischemia reperfusion and cardiotoxin muscle injury model. We found that myeloid-specific deletion of Tgfb1 abrogates the fibrotic response in this injury model and reduces fibro/adipogenic progenitor cell proliferation while simultaneously enhancing muscle regeneration, which is abrogated by adaptive transfer of normal macrophages. Similarly, a murine TGFBRII-Fc ligand trap administered after injury significantly reduced muscle fibrosis and improved muscle regeneration. This study ultimately demonstrates that infiltrating myeloid cell TGF-β1 is responsible for the development of traumatic muscle fibrosis, and its blockade offers a promising therapeutic target for preventing muscle fibrosis after ischemic injury.
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Affiliation(s)
- David M Stepien
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Charles Hwang
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Simone Marini
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109
| | - Chase A Pagani
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Michael Sorkin
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Noelle D Visser
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Amanda K Huber
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Nicole J Edwards
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Shawn J Loder
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Kaetlin Vasquez
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
| | - Carlos A Aguilar
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
- Biomedical Engineering Department, Biointerfaces Institute and Cellular and Molecular Biology Program, University of Michigan, Ann Arbor, MI 48109
| | - Ravi Kumar
- Acceleron Pharmaceuticals, Cambridge MA 02139
| | - Shamik Mascharak
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford University, Stanford, CA 94305; and
| | - Michael T Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford University, Stanford, CA 94305; and
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford School of Medicine, Stanford University, Stanford, CA 94305
| | - Jun Li
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109
| | - Benjamin Levi
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109;
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46
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Patel N, Huber AK, Pagani C, Marini S, Hwang C, Loder S, Visser N, Greenstein JA, Vasquez K, Li J, Mishina Y, Agarwal S, Levi B. Abstract 40. Plast Reconstr Surg Glob Open 2020. [PMCID: PMC7224740 DOI: 10.1097/01.gox.0000667224.07586.0a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Hwang C, Marini S, Huber AK, Lee S, Stepien DM, Kubiak CA, Meyers C, Sorkin M, Pagani CA, Rehse T, Visser ND, Garada MA, Rasheed H, Greenstein JA, Khatib ZN, Kotha P, Vasquez K, Lisiecki J, Cederna PS, Kemp SW, James AW, Levi B. Abstract 7. Plast Reconstr Surg Glob Open 2020. [PMCID: PMC7224784 DOI: 10.1097/01.gox.0000667092.81976.5b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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48
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Kaji DA, Tan Z, Johnson GL, Huang W, Vasquez K, Lehoczky JA, Levi B, Cheah KS, Huang AH. Cellular Plasticity in Musculoskeletal Development, Regeneration, and Disease. J Orthop Res 2020; 38:708-718. [PMID: 31721278 PMCID: PMC7213644 DOI: 10.1002/jor.24523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/04/2019] [Indexed: 02/04/2023]
Abstract
In this review, we highlight themes from a recent workshop focused on "Plasticity of Cell Fate in Musculoskeletal Tissues" held at the Orthopaedic Research Society's 2019 annual meeting. Experts in the field provided examples of mesenchymal cell plasticity during normal musculoskeletal development, regeneration, and disease. A thorough understanding of the biology underpinning mesenchymal cell plasticity may offer a roadmap for promoting regeneration while attenuating pathologic differentiation. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:708-718, 2020.
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Affiliation(s)
- Deepak A. Kaji
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, NYC, NY, USA
| | - Zhijia Tan
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong
| | - Gemma L. Johnson
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA,Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Wesley Huang
- Department of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kaetlin Vasquez
- Department of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jessica A. Lehoczky
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Benjamin Levi
- Department of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Alice H. Huang
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, NYC, NY, USA
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49
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Mironov S, Hwang CD, Nemzek J, Li J, Ranganathan K, Butts JT, Cholok DJ, Dolgachev VA, Wang SC, Hemmila M, Cederna PS, Morris MD, Berenfeld O, Levi B. Short-wave infrared light imaging measures tissue moisture and distinguishes superficial from deep burns. Wound Repair Regen 2020; 28:185-193. [PMID: 31675450 PMCID: PMC8513689 DOI: 10.1111/wrr.12779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/25/2019] [Accepted: 10/29/2019] [Indexed: 04/28/2024]
Abstract
Existing clinical approaches and tools to measure burn tissue destruction are limited resulting in misdiagnosis of injury depth in over 40% of cases. Thus, our objective in this study was to characterize the ability of short-wave infrared (SWIR) imaging to detect moisture levels as a surrogate for tissue viability with resolution to differentiate between burns of various depths. To accomplish our aim, we constructed an imaging system consisting of a broad-band Tungsten light source; 1,200-, 1,650-, 1,940-, and 2,250-nm wavelength filters; and a specialized SWIR camera. We initially used agar slabs to provide a baseline spectrum for SWIR light imaging and demonstrated the differential absorbance at the multiple wavelengths, with 1,940 nm being the highest absorbed wavelength. These spectral bands were then demonstrated to detect levels of moisture in inorganic and in vivo mice models. The multiwavelength SWIR imaging approach was used to diagnose depth of burns using an in vivo porcine burn model. Healthy and injured skin regions were imaged 72 hours after short (20 seconds) and long (60 seconds) burn application, and biopsies were extracted from those regions for histologic analysis. Burn depth analysis based on collagen coagulation histology confirmed the formation of superficial and deep burns. SWIR multispectral reflectance imaging showed enhanced intensity levels in long burned regions, which correlated with histology and distinguished between superficial and deep burns. This SWIR imaging method represents a novel, real-time method to objectively distinguishing superficial from deep burns.
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Affiliation(s)
- Sergey Mironov
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan
| | - Charles D Hwang
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jean Nemzek
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan
| | - John Li
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Jonathan T Butts
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - David J Cholok
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Stewart C Wang
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mark Hemmila
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Paul S Cederna
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Michael D Morris
- Department of Chemistry, University of Michigan, Ann Arbor, Michigan
| | - Omer Berenfeld
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, Michigan
| | - Benjamin Levi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
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50
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Abdulahad D, Ekpa N, Baker E, Foley KA, Fogel B, Phillips TA, Levi B. Being a Medical Scribe: Good Preparation for Becoming a Doctor. Med Sci Educ 2020; 30:569-572. [PMID: 34457703 PMCID: PMC8368643 DOI: 10.1007/s40670-020-00937-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | - Ndifreke Ekpa
- Penn State College of Medicine, Hershey, PA 17033 USA
| | - Emma Baker
- Penn State College of Medicine, Hershey, PA 17033 USA
| | - Kasey A. Foley
- Department of Communication Arts and Sciences, Pennsylvania State University, State College, PA USA
| | - Benjamin Fogel
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA USA
| | - Troy Allan Phillips
- Department of Learning and Performance Systems, Pennsylvania State University, University Park, PA USA
| | - Benjamin Levi
- Departments of Humanities and Pediatrics, Penn State College of Medicine, Hershey, PA USA
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