Pulsed shortwave electromagnetic field therapy increases quality of life in canines with symptoms of osteoarthritics

BACKGROUND

Joint stiffness, lameness and reduced activity levels are common inflammatory responses observed in canines and have significant impact on quality of life (QOL). The symptoms are often ascribed to osteoarthritis (OA), for which the standard treatment is systemic anti-inflammatories, but pharmacologic intervention can have significant short-term and long-term side effects.

OBJECTIVES

Test the efficacy of a Food and Drug Administration (FDA)-cleared pulsed shortwave therapy (PSWT) device as a means to modulate vagus nerve activity and initiate a systemic anti-inflammatory response to determine its ability to improve functionality and the QOL of canines with inflammatory symptoms commonly associated with OA.

METHODS

A randomized, double-blinded, placebo-controlled 14-day study of 60 dogs with a presumptive prior diagnosis of OA in at least one limb joint. Two outcomes assessing changes in the dog's QOL and functionality were measured: subjectively determined changes in eight behaviours associated with discomfort and objectively determined changes in passive range of motion (PROM). The device was secured near the cervico-thoracic region of the dog's spine. PROM measures were taken at baseline and at the end of study. Behavioural measures were taken daily.

RESULTS

Forty-nine animals completed the study. No negative side effects were reported. Average subjective discomfort scores for the treatment group (N = 26) were reduced from 3.74 to 2.10 (44%), compared to no improvement in the placebo group (N = 23) over the study period (p = 0.0001). Average PROM scores increased by 5.51 (4.59-6.23) degrees relative to the placebo group (p < 0.01). Ninety-six per cent of the treatment group showed either increased PROM or improved behavioural changes or both, compared to 4% for the placebo group (p < 0.01). Most changes occurred within the first 8 days of treatment.

CONCLUSIONS

PSWT applied at the level of the cervico-thoracic spine to target the vagus nerve may have the potential to improve QOL in dogs manifesting behaviours commonly associated with OA.

Reversal of cognitive impairment in a hypotensive elderly population using a passive exercise intervention

Background

Cognitive decline in the elderly is strongly associated with cerebral hypoperfusion, a condition that can be reversed with exercise. Adhering to a traditional exercise regimen, however, is challenging for this population.

Objective

In a pilot clinical study, we evaluated the ability of a “passive” exercise regimen (noninvasive calf muscle pump stimulation) to normalize blood pressure in a chronically hypotensive elderly population and enhance cognitive function.

Participants and methods

Ten elderly (82.5±7.5 years) men and women volunteers, residing in a senior living facility in upstate New York, were divided into control (N=5) and intervention (N=5) groups based on initial diastolic blood pressure (DBP); participants with initial DBP <65 mmHg became intervention participants, and those with initial DBP >65 mmHg enrolled in the control group. Body mass, blood pressure, and executive function (using incongruent Stroop and Trailmaking B test) were evaluated weekly for 4 months.

Results

At initiation of the study, time to complete the executive function tests in the hypotensive group was almost twice that of the control group. Daily calf muscle pump stimulation (passive exercise) for 1 hour/day, or less, was found to be sufficient to normalize DBP and significantly improve performance on the executive function tests.

Postural Hypotension and Cognitive Function in Older Adults

Background: Cognitive decline in the elderly is associated with chronic cerebral hypoperfusion. While many forms of exercise can slow or reverse cognitive decline, compliance in unsupervised exercise programs is poor. Objective: We address whether passive exercise, that is, muscle stimulation, is capable of reversing postural hypotension in an older adult population sufficiently to significantly improve cognitive function as measured by executive function tests. Subjects and Methods: In this study, 50- to 80-year-old women underwent cognitive testing, long-duration cardiac hemodynamic recordings during quiet sitting, and 60 min of soleus muscle stimulation with continued hemodynamic recording. Results: Two thirds of our subjects were hypotensive (diastolic blood pressure [DBP] < 70 mmHg) after 30 min of quiet sitting. Cognitive performance was significantly better in individuals with higher DBPs (0.79 s per 1-mmHg increase in DBP). Soleus muscle stimulation resulted in an average increase in DBP of 6.1 mmHg, which could translate into a 30% or greater improvement in cognitive performance. Conclusions: Incongruent Stroop testing provides high statistical power for distinguishing differential cognitive responses to resting DBP levels. These results set the stage to investigate whether regular use of calf muscle pump stimulation could effectively reverse age-related cognitive impairment.

Association of Calf Muscle Pump Stimulation With Sleep Quality in Adults

Prevention of lower extremity fluid pooling (LEFP) is associated with improved sleep quality. Physical activity and compression stockings are non-invasive methods used to manage LEFP, but both are associated with low adherence. Calf muscle pump (CMP) stimulation is an alternative and more convenient approach. Convenience sampling was used to recruit 11 participants between ages 45 and 65 with poor sleep quality. A within-person single-group pre-test-post-test design was used to evaluate changes in sleep quality, daytime sleepiness, and functional outcomes sensitive to impaired sleep as measured by the Pittsburgh Sleep Quality Index (PSQI), Functional Outcomes of Sleep Questionnaire, and Epworth Sleepiness Scale after 4 weeks of CMP stimulation. Statistical analysis included effect size (ES) calculations. After daily use of CMP stimulation, participants demonstrated improvement in overall sleep quality (ES = -.97) and a large reduction in daily disturbance from poor sleep (ES = -1.25). Moderate improvements were observed in daytime sleepiness (ES = -.53) and functional outcomes sensitive to sleepiness (ES = .49). Although causality could not be determined with this study design, these results support further research to determine whether CMP stimulation can improve sleep quality. © 2016 Wiley Periodicals, Inc.

Calf muscle pump stimulation as a means to reduce symptoms of fibromyalgia syndrome

Fibromyalgia (FM) is a debilitating chronic condition that often affects women in midlife with widespread pain that interrupts attempts to exercise. The purpose of this pilot study was to test the efficacy of calf muscle pump (CMP) stimulation as an adjuvant therapy for FM by (1) assessing the correlation of the level of symptoms, as measured by the revised Fibromyalgia Impact Questionnaire (FIQR), and blood pressure (BP), (2) measuring change in mean FIQR scores for subjects who use a CMP-stimulation device for 12 weeks, and (3) measuring the correlation of total device usage and the level of symptoms as measured by the FIQR. The 29 male and female participants (mean age = 47.3 years) were screened using the Widespread Pain Index (WPI), Symptom Severity (SS) score, and the FIQR. Participants were contacted weekly, and progress was assessed using the WPI, SS score, and the FIQR as well as general questions regarding responses to CMP stimulation. The attrition rate was high, which is not uncommon in studies of patients with FM. We found that diastolic BP was significantly inversely correlated with baseline FIQR scores during quiet sitting. Further, 12 weeks of CMP stimulation was associated with significant improvement in average FIQR scores at a rate of approximately -1.5 points per week (R (2) = .9; p ≤ .0001). Total device usage was strongly and inversely correlated with baseline FIQR scores (R (2) = .43; p = .02). These findings suggest that CMP stimulation may provide an additional treatment option for individuals with FM who are challenged to perform traditional forms of exercise.

Influence of Seated Rocking on Blood Pressure in the Elderly: A Pilot Clinical Study

Patients with Alzheimer’s disease (AD) who rock for 1—2 hr per day in a rocking chair demonstrate significant improvements in depression, anxiety, and balance and a decrease in pain medication usage; however, the underlying basis for their responses remains unclear. Rocking with plantar flexion uses the calf muscles, enhancing lower limb fluid return to the heart, which should increase blood pressure (BP) and may, then, also increase cerebral perfusion. Accordingly, we tested the efficacy of rocking activity for increasing BP in healthy, older persons. In a pilot laboratory study of 24 healthy, White men and women aged 55—87 years, we observed that 30 min of steady rocking led to an average 12 mmHg increase in systolic blood pressure (SBP, p < .001) and a 3.6 mmHg average increase in diastolic blood pressure (DBP, p < .001). To determine the effect of using this intervention in a nonclinical setting, we tested a similar group of 7 participants at a senior center. In this setting, we observed an average increase in SBP of 27 mmHg (p < .001) and in DBP of 2.5 mmHg (p < .001) after 30 min of rocking. In a subgroup (n = 8) of hypotensive individuals (SBP < 110 mmHg after sitting quietly for 30 min) extracted from both settings, rocking raised the average SBP from <100 mmHg to approximately 120 mmHg. These results are consistent with the hypothesis that rocking can increase BP and, therefore, may enhance cerebral perfusion. This observation may play a fundamental role in designing nursing interventions focused on improvement of symptoms associated with AD.

Vibromyographic quantification of voluntary isometric contractile force in the brachioradialis

This study investigated the ability of vibromyography (VMG) to accurately represent voluntary forearm muscle contractile force during attempted-isometric contraction of the brachioradialis. VMG signals were collected from the brachioradialis of healthy adult men (mean age, 26.6+/-9.8 years, N=24) during attempted-isometric contraction over a force range of 4.45 N to maximum sustained load. The VMG signals were decomposed using wavelet packet analysis techniques, and the corresponding wavelet packets were utilized in a multiple regression model for parameter reduction and identification of signal components which best correlated to muscle force. It was observed that just two wavelet components were sufficient to accurately predict muscle force (R2=0.984, P<0.0001). The signal force relationship observed is monotonic, though quadratic in form. More importantly, the wavelet data was able to predict absolute force output of the brachioradialis without normalization or prior knowledge of a subject's maximum voluntary force. These data show that VMG recordings are capable of providing a monotonic relationship between VMG signal and muscle force. Moreover, in contrast to EMG technology which can only provide relative force levels, VMG appears to be capable of reporting absolute force levels, an observation which is expected to lead to numerous applications in medicine and rehabilitation.

Reversal of lower limb venous and lymphatic pooling by passive non-invasive calf muscle pump stimulation

Our preliminary data indicate that exogenous plantar micromechanical stimulation at 45 Hz applied at the plantar surface can prevent tachycardia and blood pressure depression associated with immobility, consistent with improvement in venous and lymphatic fluid return delivered by increased calf muscle activity. In this study, instantaneous beat-to-beat systolic blood pressure of thirty four healthy adult women participants (n=34; age range: 35-78 years) were assessed non-invasively using servo-controlled infra-red finger arterial plethysmography, for 30 minutes in the supine position, followed by 30 minutes in the seated position without plantar stimulation, and lastly for 30 minutes in the seated position with the application of a 45 Hz plantar stimulus (50 microm, p-p). Thirty minutes of supine rest resulted in an average increase of 15 mmHg in systolic pressure. During the 30 minutes of upright sitting regimen, two distinct sub-populations were observed. One group (n=18; "hypotensives") experienced a depression of approximately 15 mmHg in systolic pressure, while the other group (n=16; "normotensives and hypertensives") experienced an elevation in the systolic pressure by approximately 8 mmHg. The subsequent 30 minute application of plantar stimulus reversed the pressure drop in hypotensives and elevated the systolic pressure by approximately 20 mmHg in all the subjects. Plantar-based exogenous micromechanical vibration may be an effective approach for reversal of blood pressure depression associated with the physical stress of immobility over a long term, consistent with enhanced venous and lymphatic fluid return delivered via improved calf muscle contractility.

Calibration of the continuous glucose monitoring system for transient glucose monitoring

BACKGROUND

Oral glucose tolerance testing (OGTT) remains the gold standard for diagnosis of diabetes and is used commonly in the research laboratory. The Medtronic MiniMed (North-ridge, CA) Continuous Glucose Monitoring System (CGMS Gold), developed for long-term monitoring of glycemic levels, could provide a convenient means for tracking OGTT results during research protocols; however, the sensor demonstrates glucose and time dependencies that preclude direct application of the company-provided conversion algorithm in the first 12-24 h after sensor insertion. Here, we propose an alternative conversion algorithm that permits utilization of the CGMS monitor for glucose monitoring during this time.

METHODS

Healthy female participants underwent CGMS monitoring during OGTT or fasting sessions in combination with finger-stick blood glucose measurements. Logarithmic transformations and multiple regression analysis were used to quantify the time and glucose dependence of the sensors.

RESULTS

Sensor performance, as characterized by sensitivity (ratio of sensor current to capillary blood glucose levels), was shown to vary logarithmically with glucose levels as well as time after sensor insertion. A conversion algorithm developed on the basis of these observations was tested on 17 subjects during OGTT. A mean absolute relative difference between capillary blood glucose and CGMS values of 11.6 +/- 6.5% for the new algorithm was seen, compared to 20.6 +/- 5.9% with the Medtronic Solutions version 3.0c algorithm.

CONCLUSIONS

Incorporation of the glucose and time dependence in CGMS sensor data yields an improved mean absolute difference between actual and estimated blood glucose values compared to the Medtronic-supplied algorithm in the immediate time period following sensor insertion.

Cardiovascular systemic regulation by plantar surface stimulation

The decreased blood pressure and flow rates associated with orthostasis have been implicated in the etiology of numerous clinical conditions, including deep vein thrombosis, chronic fatigue syndrome, and more recently osteoporosis. Here, we investigate the potential of low-magnitude vibration, applied at the plantar surface, to inhibit the cardiovascular responses of adult women to the orthostatic stress associated with quiet sitting.

METHODS

Thirty healthy women, aged 22-82 years, were exposed to a plantar-based vibration immediately after taking a seated position. Seven stimulus frequencies (0, 15, 22, 44, 60, 90, and 120 Hz, all at 0.2g) were tested on each subject, and cardiovascular responses were followed for 20 minutes. Each subject experienced only a single test frequency on any day. Pre- and poststimulus blood pressures and continuous electrocardiogram results were obtained, from which mean arterial pressure (MAP) and heart rate variability (HRV) were calculated.

RESULTS

In the per-protocol study population (n = 25), 20 minutes of quiet sitting was associated with an average depression of 8.95 mm Hg in systolic pressure and of 1.9 mm Hg in diastolic blood pressure, corresponding to an average decrease in MAP of 5.15 mm Hg. These orthostasis-based changes in blood pressure were significantly reduced by exposure to plantar vibration, in a frequency-dependent manner, with essentially complete suppression of the drop in MAP achieved with plantar stimulation at 44 Hz (P < or = . 01). In the orthostatically hypotensive subpopulation (n = 15), both the 9.3-mm Hg depression in MAP and the decline in HRV were eliminated by exposure to plantar vibrations in the 40- to 60-Hz range (P = .01 and P = .03, respectively). These results are consistent with the hypothesis that the plantar vibration may be stimulating type IIA muscle fiber activity in the leg, which is critical for effective skeletal muscle pumping in the absence of locomotion.

CONCLUSIONS

Our findings lead us to suggest that noninvasive, low-level, plantar-based vibration in the regime of 30-60 Hz can significantly inhibit the effects of the orthostatic stress of quiet sitting on the cardiovascular system.

Effect of Plantar Micromechanical Stimulation on Cardiovascular Responses to Immobility

OBJECTIVE

We investigated the cardiovascular responses of adult women to the influence of extended quiet sitting and the extent to which these responses may be reversed by micromechanical stimulation of the plantar surface.

DESIGN

The cardiovascular responses of 20 healthy adult women (mean age, 55.9 +/- 4.45 yrs) were observed during quiet sitting with and without exposure to a plantar-based micromechanical stimulation. Beat-to-beat heart rate via electrocardiogram was acquired along with preexposure and postexposure blood pressures, from which heart rate variability and mean arterial pressure were determined. Seven stimulus frequencies (0, 15, 22, 44, 60, 90, and 120 Hz, all at 0.2 x g, peak to peak) were tested on each subject.

RESULTS

Over one-half of the women tested (11/20) exhibited a significant resting tachycardia (mean, 8.3 +/- 0.5 beats/min) with a corresponding decline in their systolic blood pressure (9.45 +/- 1.8 mm Hg) after 20 mins of quiet sitting. Plantar stimulation at 44 Hz (25 mum, peak to peak) was able to completely reverse the effect of immobility in this group, resulting in a heart rate decline of 2.5 beats/min (P < 0.0001) and a decrease of only 1 mm Hg in systolic pressure (P = 0.006).

CONCLUSION

We interpret these results to suggest that the immobility of quiet sitting has a profound effect on the cardiovascular systems in a large fraction of otherwise healthy women, perhaps due to inadequate muscle tone leading to venous insufficiency. Simple external stimulation of the plantar surface seems to be capable of preventing these cardiovascular stress-based responses.

Calf muscle pump stimulation as an adjunct to orthopaedic surgery

Management of patients following extensive orthopaedic surgery, and in particular, joint replacement surgery, represents a continuing challenge. The associated bed rest burdens a broad range of physiologic functions, exacerbating vascular, venous, and lymphatic conditions, as well as cardiovascular conditions and glucose regulation in the hyperglycemic or diabetic patient. Most of these problems arise from a lack of mobility/exercise during recuperation. In a recent series of clinical studies, non-invasive micromechanical stimulation (MMS) of the plantar surface has been demonstrated to significantly enhance skeletal muscle pump activity in the lower limbs of patients, which results in improved blood and lymphatic flow in the lower body. These studies demonstrate efficacy in both the supine and upright positions, suggesting the potential of MMS technology to significantly improve post-surgical patient care. Moreover, evidence is increasing that sustained skeletal muscle pump activity helps to maintain normal fluid flow in bone tissue, such that MMS may provide a non-drug treatment for maintaining bone mass during bed rest, or possibly increasing bone mass following extended bed rest.

Relation of postural vasovagal syncope to splanchnic hypervolemia in adolescents

BACKGROUND

The mechanisms of simple faint remain elusive. We propose that postural fainting is related to excessive thoracic hypovolemia and splanchnic hypervolemia during orthostasis compared with healthy subjects.

METHODS AND RESULTS

We studied 34 patients 12 to 22 years old referred for multiple episodes of postural faint and 11 healthy subjects. Subjects were studied in the supine position and during upright tilt to 70 degrees for 30 minutes and subgrouped into S+, historical fainters who fainted during testing (n=24); S-, historical fainters who did not faint during testing (n=10); and control subjects. Supine venous occlusion plethysmography showed no differences between blood flows of the forearm and calf in S+, S-, or control. Cardiac index, total peripheral resistance, and blood volume were not different. Using impedance plethysmography, we assessed blood redistribution during upright tilt. This demonstrated decreased thoracic blood volume and increased splanchnic, pelvic, and leg blood volumes for all subjects. However, thoracic blood volume was decreased in S+ compared with control volume, correlating well with the maximum upright heart rate. Splanchnic volume was decreased in the S+ and S- groups, correlating with the change in thoracic blood volume. Pelvic and leg volume changes were similar for all groups and uncorrelated to thoracic blood volume.

CONCLUSIONS

Enhanced postural thoracic hypovolemia and splanchnic hypervolemia are associated with postural simple faint.

Plantar vibration improves leg fluid flow in perimenopausal women

Recent studies have indicated that plantar-based vibration may be an effective approach for the prevention and treatment of osteoporosis. We addressed the hypothesis of whether the plantar vibration operated by way of the skeletal muscle pump, resulting in enhanced blood and fluid flow to the lower body. We combined plantar stimulation with upright tilt table testing in 18 women aged 46-63 yr. We used strain-gauge plethysmography to measure calf blood flow, venous capacitance, and the microvascular filtration relation, as well as impedance plethysmography to examine changes in leg, splanchnic, and thoracic blood flow while supine at a 35 degrees upright tilt. A vibrating platform was placed on the footboard of a tilt table, and measurements were made at 0, 15, and 45 Hz with an amplitude of 0.2 g point to point, presented in random order. Impedance-measured supine blood flows were significantly (P = 0.05) increased in the calf (30%), pelvic (26%), and thoracic regions (20%) by plantar vibration at 45 Hz. Moreover, the 25-35% decreases in calf and pelvic blood flows associated with upright tilt were reversed by plantar vibration, and the decrease in thoracic blood flow was significantly attenuated. Strain-gauge measurements showed an attenuation of upright calf blood flow. In addition, the microvascular filtration relation was shifted with vibration, producing a pronounced increase in the threshold for edema, P(i), due to enhanced lymphatic flow. Supine values for P(i) increased from 24 +/- 2 mmHg at 0 Hz to 27 +/- 3 mmHg at 15 Hz, and finally to 31 +/- 2 mmHg at 45 Hz (P < 0.01). Upright values for P(i) increased from 25 +/- 3 mmHg at 0 Hz, to 28 +/- 4 mmHg at 15 Hz, and finally to 35 +/- 4 mmHg at 45 Hz. The results suggest that plantar vibration serves to significantly enhance peripheral and systemic blood flow, peripheral lymphatic flow, and venous drainage, which may account for the apparent ability of such stimuli to influence bone mass.

Effect of power-frequency magnetic fields on genome-scale gene expression in Saccharomyces cerevisiae

To estimate the effect of 50 Hz magnetic-field exposure on genome-wide gene expression, the yeast Saccharomyces cerevisiae was used as a model for eukaryotes. 2D PAGE (about 1,000 spots) for protein and cDNA microarray (about 5,900 genes) analysis for mRNA were performed. The cells were exposed to 50 Hz vertical magnetic fields at 10, 150 or 300 mT r.m.s. for 24 h. As positive controls, the cells were exposed to aerobic conditions, heat (40 degrees C) or minimal medium. The 2D PAGE and microarray analyses for the positive controls showed high-confidence differential expression of many genes including those for known or unknown proteins and mRNAs. For magnetic-field exposure, no high-confidence changes in expression were observed for proteins or genes that were related to heat-shock response, DNA repair, respiration, protein synthesis and the cell cycle. Principal component analysis showed no statistically significant difference in principal components, with only insignificant differences between the magnetic-field intensities studied. In contrast, the principal components for the positive controls were significantly different. The results indicate that a 50 Hz magnetic field below 300 mT did not act as a general stress factor like heat shock or DNA damage, as had been reported previously by others. This study failed to find a plausible differential gene expression that would point to a possible mechanism of an effect of magnetic fields. The findings provide no evidence that the magnetic-field exposure alters the fundamental mechanism of translation and transcription in eukaryotic cells.

On the relationship between streaming potential and strain in an in vivo bone preparation

Transcortical streaming potentials were measured at each of two cortical-surface sites with respect to a reference electrode in the medullary canal, in the left ulnae of six live, adult (2 yr-old), male 18.2 +/- 1.4 kg domestic turkeys, under general anesthesia, for each of two loading conditions. We observed that the relationship among streaming potential magnitude, surface strain, and strain gradient is not as simple as anticipated. Under predominantly axial and bending load conditions, significantly different strain and strain gradients were generated at the two recording sites. However, no significant differences were detectable in transcortical streaming potentials for one of the loading conditions, and only a slight difference was detected in the other. Conversely, correlations of streaming potential magnitude to strain at both sites show robust relationships (r2 = 0.45, P - 0.02), albeit with different slopes for the two sites. These findings may have implications for the contribution of streaming potentials, or at least, fluid flow to the stimulation of bone cells.

Differential phosphorylation of paxillin in response to surface-bound serum proteins during early osteoblast adhesion

An early signaling event during the adhesion and spreading of cells is integrin-mediated tyrosine phosphorylation of the cytoskeletal adaptor protein paxillin and the non-receptor tyrosine kinase pp125(FAK) at focal contacts. To determine the influence of surface-charge and -adsorbed adhesion proteins on this signaling pathway, paxillin phosphorylation was examined during attachment of MC3T3-E1 osteoblast-like cell onto charged and uncharged polystyrene, and on adsorbed layers of serum proteins, fibronectin (Fn), vitronectin (Vn), a mixture of Fn and Vn, and albumin. Paxillin phosphorylation was induced 2.4-fold (P < 0.05) on charged vs uncharged polystyrene only in the presence of serum proteins. Activation of paxillin via Fn or Vn alone, or in combination, resulted in significantly lower phosphorylation signals compared to whole serum (41 +/- 6.9%, P < 0.05, 45 +/- 5.9%, P < 0.05, and 76 +/- 9.8%, P < 0.075, respectively). Confocal laser microscopy confirmed increased co-localization of phosphotyrosine and paxillin at protruding lamellopodia of spreading osteoblasts on charged vs uncharged serum-pretreated polystyrene. Taken together, these data suggest that subtle differences in surface characteristics mediate effects on adhering cells via adsorbed serum proteins involving the cytoskeletal adaptor protein paxillin.

Integrin-mediated mechanotransduction in vascular smooth muscle cells: frequency and force response characteristics

Blood vessels are continuously exposed to mechanical forces that lead to adaptive remodeling and atherosclerosis. Although there have been many studies characterizing the responses of vascular cells to mechanical stimuli, the precise mechanical characteristics of the forces applied to cells to elicit these responses are not clear. We designed a magnetic exposure system capable of producing a defined normal force on ferromagnetic beads that are specifically bound to cultured cells coated with extracellular matrix proteins or integrin-specific antibodies. Rat aortic smooth muscle cells were incubated with engineered fibronectin-coated ferromagnetic beads and then exposed to a magnetic field. With activation of extracellular signal-regulated mitogen-activated protein kinase 1/2 (ERK 1/2(MAPK)) used as a prototypical marker for cell responsiveness to mechanical forces, Western blot analysis demonstrated an increase in phosphorylated ERK 1/2(MAPK) expression reaching a maximal response of a 3.5-fold increase at a total force of approximately 2.5 pN per cell. The peak response occurred after 5 minutes of exposure and slowly decreased to baseline after 30 minutes. A cyclic, rather than static, force was required for this activation, and the frequency-response curve increased approximately 2-fold between 0.5 and 2.0 HZ: Vitronectin- and beta(3) antibody-coated beads showed a response nearly identical to those coated with engineered fibronectin, whereas forces applied to beads coated with alpha(2) and beta(1) antibodies did not significantly activate ERK 1/2(MAPK). Mechanical activation of the ERK 1/2(MAPK) system in rat aortic smooth muscle cells occurs through specific integrin receptors and requires a cyclic force with a magnitude estimated to be in the piconewton range.

"And afterwards your body to be given for public dissection": a history of the murderers dissected in Glasgow and the west of Scotland

Between 1752 and 1832, the bodies of hanged murderers were dissected or gibbeted. During this period, 38 murderers were executed in the West of Scotland. The bodies of at least 23 were dissected in Glasgow. The stories of these murders are recounted. Insight is also given into the attitudes of the public and the anatomists to dissection of executed murderers.

Osteoblastic networks with deficient coupling: differential effects of magnetic and electric field exposure

A gap junction-deficient cell line was utilized to test whether intercellular coupling plays a significant role in modulating the influence of biophysical stimuli such as extracellular electrical currents. ROS 17/2.8 cells, an osteosarcoma cell line, along with a control transfected cell line and a connexin 43-gap junction-deficient cell line, were exposed to a time-changing magnetic flux (30 Hz, 1.8 milliTesla) sufficient to induce an electric field in the cultures on the order of 2 mV/m. Field exposure inhibited cell growth independent of gap junctional coupling, while alkaline phosphatase activity was found to be dependent on gap junctional coupling. These findings can be interpreted to suggest that magnetic and electric field exposures have differential effects on cell cultures, with magnetic field exposure inhibiting cell growth through a mechanism independent of gap junctional coupling, while the alteration in enzyme activity appears to be stimulated by the induced electric field in a gap junction-dependent manner.

Suppression of a differentiation response in MC-3T3-E1 osteoblast-like cells by sustained, low-level, 30 Hz magnetic-field exposure

Extremely low-frequency (ELF) magnetic fields have been reported to be capable of influencing both tissue remodeling and cell phenotypic expression in culture. However, whether the cells or tissues respond directly to the magnetic flux or to the electric field induced by the time-changing magnetic flux remains a controversial topic. To address this question, we developed an osteoblast cell assay based on the activity of alkaline phosphatase, an enzyme whose activity is up-regulated during the differentiation of bone cells. MC-3T3-E1 cells plated at a confluent density were allowed to proceed through the differentiation process for 3 days, after which they were exposed to a 30 Hz, 1.8-mT r.m.s. magnetic field inducing a spatially varying electric field with a maximum intensity of 0.9 mV/m r.m.s. In situ assays of alkaline phosphatase activity at 4, 8, 16 and 64 h demonstrated a progressive inhibition of enzyme activity, the pattern of which maps to the intensity of the induced electric field (R(2) = 0.5, P<0.001). We interpret these results to indicate that cells are capable of responding to ELF induced electric fields at intensities below 1 mV/m, and that the principal effect on cells is an inhibition of differentiation.

Quantifying the strain history of bone: spatial uniformity and self-similarity of low-magnitude strains

We hypothesize that when a broad spectrum of bone strain is considered, strain history is similar for different bones in different species. Using a data collection protocol with a fine resolution, mid-diaphyseal strains were measured in vivo for both weightbearing and non-weightbearing bones in three species: dog, sheep, and turkey, with strain information collected continuously while the animals performed their natural daily activities. The daily strain history was quantified by both counting cyclic strain events (to quantify the distribution of strains of different magnitudes) and by estimating the average spectral characteristics of the strain (to quantify the frequency content of the strain signals). Counting of the daily (12-24 h) strain events show that large strains (> 1000 microstrain) occur relatively few times a day, while very small strains (< 10 microstrain) occur thousands of times a day. The lower magnitude strains (< approximately 200 microstrain) are found to be more uniform around the bone cross-section than the higher magnitude, peak strains. Strain dynamics are found to be well described by a power-law relationship and exhibit self-similar characteristics. These data lead to the suggestion that the organization of bone tissue is driven by the continual barrage of activity spanning a wide but consistent range of frequency and amplitude, and until the mechanism of bone's mechanosensory system is fully understood, all portions of bone's strain history should be considered to possibly play a role in bone adaptation.

Morphologic responses of osteoblast-like cells in monolayer culture to ELF electromagnetic fields

Osteoblast-like cells (MC 3T3-E1) were exposed for 24 h, immediately after plating, to a 60 Hz, 0.7 mT rms magnetic flux density, sufficient to induce an electric field of 0.5 mV/m rms, in order to investigate the influence of ELF field exposure on cell morphology. Using phase contrast images of the live cells, computerized image-analysis permitted rapid and objective quantification of cell length, width, area, perimeter, circularity and angular orientation. While the field-exposed cells were consistently smaller than sham treated cells, the morphologic alterations were not significantly different in the exposed cell population when cell orientation was not considered. When analyzed with respect to cell orientation, cells oriented parallel to the induced electric field (orthogonal to the applied magnetic field) demonstrated a significant decrease in cell length and an increase in roundness. These results confirm and extend previous studies on the morphologic adaptation of cells to low level ELF electromagnetic fields. The results suggest that the observed responses most likely depend on the induced electric field, with a field intensity threshold well below 1 mV/m. Further, these results provide important clues to the specific mechanism by which such low level fields may be capable of influencing cell behavior, and help to explain some of the difficulties in obtaining robust responses in in vitro EMF experiments.

Does bone perfusion/reperfusion initiate bone remodeling and the stress fracture syndrome?

Stress fractures have been proposed to arise from repetitive activity of training inducing an accumulation of microfractures in locations of peak strain. However, stress fractures most often occur long before accumulation of material damage could occur; they occur in cortical locations of low, not high, strain; and intracortical osteopenia precedes any evidence of micro-cracks. We propose that this lesion arises from a focal remodeling response to site-specific changes in bone perfusion during redundant axial loading of appendicular bones. Intramedullary pressures significantly exceeding peak arterial pressure are generated by strenuous exercise and, if the exercise is maintained, the bone tissue can suffer from ischemia caused by reduced blood flow into the medullary canal and hence to the inner two-thirds of the cortex. Site specificity is caused by the lack, in certain regions of the cortex, of compensating matrix-consolidation-driven fluid flow which brings nutrients from the periosteal surface to portions of the cortex. Upon cessation of the exercise, re-flow of fresh blood into the vasculature leads to reperfusion injury, causing an extended no-flow or reduced flow to that portion of the bone most strongly denied perfusion during the exercise. This leads to a cell-stress-initiated remodeling which ultimately weakens the bone, predisposing it to fracture.

Changes in postural muscle dynamics as a function of age

Histologic studies have demonstrated both a decrease in size and loss in number of type II muscle fibers with increasing age. Although these age-related histologic changes are believed to result in decreased strength and functional capacity, age-related changes in muscle force dynamics have not been clearly elucidated. Using vibromyographic (VMG) techniques, we recorded muscle activity of the soleus in 40 healthy adult volunteers spanning the age range of 20-82 years to test whether changes in postural muscle dynamics, in the frequency range of 0.1-50 Hz, were also associated with age. Although muscle dynamics below 15 Hz do not change with aging, the 30-50 Hz frequency components of the VMG were found to change significantly with advancing age (r = -.619, p = .0001). This was observed in both sexes independently. The observed age-related changes in muscle force dynamics demonstrate distinct physiologic alterations in muscle fiber activity. Further research will be required to fully elucidate the relationship between age-related changes in muscle fiber activity and other age-related conditions such as postural instability and osteoporosis.

Mechanically induced calcium waves in articular chondrocytes are inhibited by gadolinium and amiloride

Chondrocytes in articular cartilage utilize mechanical signals from their environment to regulate their metabolic activity. However, the sequence of events involved in the transduction of mechanical signals to a biochemical signal is not fully understood. It has been proposed that an increase in the concentration of intracellular calcium ion ([Ca2+]i) is one of the earliest events in the process of cellular mechanical signal transduction. With use of fluorescent confocal microscopy, [Ca2+]i was monitored in isolated articular chondrocytes subjected to controlled deformation with the edge of a glass micropipette. Mechanical stimulation resulted in an immediate and transient increase in [Ca2+]i. The initiation of Ca2+ waves was abolished by removing Ca2+ from the extracellular media and was significantly inhibited by the presence of gadolinium ion (10 microM) or amiloride (1 mM), which have previously been reported to block mechanosensitive ion channels. Inhibitors of intracellular Ca2+ release (dantrolene and 8-diethylaminooctyl 3,4,5-trimethoxybenzoate hydrochloride) or cytoskeletal disrupting agents (cytochalasin D and colchicine) had no significant effect on the characteristics of the Ca2+ waves. These findings suggest that a possible mechanism of Ca2+ mobilization in this case is a self-reinforcing influx of Ca2+ from the extracellular media, initiated by a Ca2+-permeable mechanosensitive ion channel. Our results indicate that a transient increase in intracellular Ca2+ concentration may be one of the earliest events involved in the response of chondrocytes to mechanical stress and support the hypothesis that deformation-induced Ca2+ waves are initiated through mechanosensitive ion channels.

Effects of electromagnetic fields in experimental fracture repair

The clinical benefits of electromagnetic fields have been claimed for 20 centuries, yet it still is not clear how they work or in what circumstances they should be used. There is a large body of evidence that steady direct current and time varying electric fields are generated in living bone by metabolic activity and mechanical deformation, respectively. Externally supplied direct currents have been used to treat nonunions, appearing to trigger mitosis and recruitment of osteogenic cells, possibly via electrochemical reactions at the electrode-tissue interface. Time varying electromagnetic fields also have been used to heal nonunions and to stabilize hip implants, fuse spines, and treat osteonecrosis and osteoarthritis. Recent research into the mechanism(s) of action of these time varying fields has concentrated on small, extremely low frequency sinusoidal electric fields. The osteogenic capacity of these fields does not appear to involve changes in the transmembrane electric potential, but instead requires coupling to the cell interior via transmembrane receptors or by mechanical coupling to the membrane itself.

Skeletal cell stresses and bone adaptation

There is no tissue in which mechanical stresses have been studied in more detail than the skeletal system, this focus arising primarily because bone plays a clear structural role in the body. However, the hypothesis that the skeleton represents an optimally designed structure has contributed remarkably little to our understanding of the development and adaptive capabilities of bone tissue. Recent investigations on the consequences of mechanical, hydrostatic, and electrical stresses on the cells of bone tissue have served to redirect the discussion of bone modeling and remodeling processes. These studies have refocused attention on the importance of chronic low-level dynamic stresses in mediating the physiologic response of bone tissue. Important recent observations suggest that an approach premised on the self-organizational properties of bone tissue may lead to significant improvements in our understanding and control of bone morphologic development, adaptation, and healing.

Cloning of a novel cDNA expressed during the early stages of fracture healing

Using differential mRNA display (DD-PCR), a novel cDNA, FxC1 (Fracture Callus 1) was isolated from the early stages of a healing fractured femur. Utilizing 5' RACE PCR, a 598-bp full-length cDNA was obtained for FxC1 that contains an open reading frame (ORF) of 243 bp, encoding for an 80 amino acid protein. Within this ORF, a leucine zipper motif was present. In vitro transcription/translation of the full-length cDNA generated the expected 9-kDa protein. Northern analysis reveals that this gene is expressed in calluses harvested from post-fracture day 5, 7 and 10, as well as in several other tissues and bone-derived cell lines. During the differentiation of MC3T3 cells along the osteoblast lineage, FxC1 expression increases 3- to 4-fold during the production and deposition of matrix proteins, suggesting a possible role for this protein in cell differentiation.

Nonlinear dependence of loading intensity and cycle number in the maintenance of bone mass and morphology

The daily stress stimulus theory of bone adaptation was formulated to describe the loading conditions necessary to maintain bone mass. This theory identifies stress/strain magnitude and loading cycle number as sufficient to define an appropriate maintenance loading signal. Here, we extend the range over which loading cycle number has been evaluated to determine whether the daily stress stimulus theory can be applied to conditions of very high numbers of loading cycles at very low strain magnitudes. The ability of a relatively high-frequency (30-Hz) and moderate-duration (60-minute) loading regimen to maintain bone mass in a turkey ulna model of disuse osteopenia was evaluated by correlating the applied strain distributions to site-specific remodeling activity. Changes in morphology were investigated following 8 weeks of disuse compared with disuse plus daily exposure to 108,000 applied loading cycles sufficient to induce peak strains of approximately 100 microstrain. A strong correlation was observed between the preservation of bone mass and longitudinal normal strain (R = 0.91) (p < 0.01). The results confirm the strong antiresorptive influence of mechanical loading and identify a threshold near 70 microstrain for a daily loading cycle regimen of approximately 100,000 strain cycles. These results are not consistent with the daily stress stimulus theory and suggest that the frequency or strain rate associated with the loading stimulus must also play a critical role in the mechanism by which bone responds to mechanical strain.

Patterns of strain in the macaque ulna during functional activity

In vivo bone strain experiments were performed on the ulnae of three female rhesus macaques to test how the bone deforms during locomotion. The null hypothesis was that, in an animal moving its limbs predominantly in sagittal planes, the ulna experiences anteroposterior bending. Three rosette strain gauges were attached around the circumference of the bone slightly distal to midshaft. They permit a complete characterization of the ulna's loading environment. Strains were recorded during walking and galloping activities. Principal strains and strain directions relative to the long axis of the bone were calculated for each gauge site. In all three animals, the lateral cortex experienced higher tensile than compressive principal strains during the stance phase of walking. Compressive strains predominated at the medial cortex of two animals (the gauge on this cortex of the third animal did not function). The posterior cortex was subject to lower strains; the nature of the strain was highly dependent on precise gauge position. The greater principal strains were aligned closely with the long axis of the bone in two animals, whereas they deviated up to 45 degrees from the long axis in the third animal. A gait change from walk to gallop was recorded for one animal. It was not accompanied by an incremental change in strain magnitudes. Strains are at the low end of the range of strain magnitudes recorded for walking gaits of nonprimate mammals. The measured distribution of strains in the rhesus monkey ulna indicates that mediolateral bending, rather than anteroposterior bending, is the predominant loading regime, with the neutral axis of bending running from anterior and slightly medial to posterior and slightly lateral. A variable degree of torsion was superimposed over this bending regime. Ulnar mediolateral bending is apparently caused by a ground reaction force vector that passes medial to the forearm. The macaque ulna is not reinforced in the plane of bending. The lack of buttressing in the loaded plane and the somewhat counterintuitive bending direction recommend caution with regard to conventional interpretations of long bone cross-sectional geometry.

Whole-body vibration in the skeleton: development of a resonance-based testing device

Whole-body vibration (WBV) has been demonstrated to have a strong influence on physiological systems, ranging from severely destructive to potentially beneficial. Unfortunately, the study of WBV in a controlled manner is commonly constrained by space and budgetary factors, particularly where vibration in the low frequency range is considered. In the work presented here, a small, low-cost device for performing WBV of the human skeleton is developed to assist in studies of vertical acceleration in a clinical setting. The device design consists of a spring-supported plate driven by an 18 N peak-force electromagnetic actuator, and the associated driving and monitoring electronics. Animal and human lumped-mass models have been coupled with a model of the loading device to seek a resonance response in the vicinity of 30 Hz. This approach minimizes the loading requirements of such a device, and thus a major component of the cost, yet can provide peak accelerations of 0.15 g at a frequency of 30 Hz in a small, lightweight package capable of use in a clinical or laboratory setting.

Strain gradients correlate with sites of periosteal bone formation

We examined the hypothesis that peak magnitude strain gradients are spatially correlated with sites of bone formation. Ten adult male turkeys underwent functional isolation of the right radius and a subsequent 4-week exogenous loading regimen. Full field solutions of the engendered strains were obtained for each animal using animal-specific, orthotropic finite element models. Circumferential, radial, and longitudinal gradients of normal strain were calculated from these solutions. Site-specific bone formation within 24 equal angle pie sectors was determined by automated image analysis of microradiographs taken from the mid-diaphysis of the experimental radii. The loading regimen increased mean cortical area (+/-SE) by 32.3 +/- 10.5% (p = 0.01). Across animals, some periosteal bone formation was observed in every sector. The amount of periosteal new bone area contained within each sector was not uniform. Circumferential strain gradients (r2 = 0.36) were most strongly correlated with the observed periosteal bone formation. SED (a scalar measure of stress/strain magnitude with minimal relation to fluid flow) was poorly correlated with periosteal bone formation (r2 = 0.01). The combination of circumferential, radial, and longitudinal strain gradients accounted for over 60% of the periosteal new bone area (r2 = 0.63). These data indicate that strain gradients, which are readily determined given a knowledge of the bone's strain environment and geometry, may be used to predict specific locations of new bone formation stimulated by mechanical loading.

Correlation of bony ingrowth to the distribution of stress and strain parameters surrounding a porous-coated implant

The ability of shear strains to inhibit bony ingrowth was investigated by use of a transcortical porous-coated cylindrical plug implant in a functionally isolated turkey ulna model in which the mechanical loading environment could be accurately controlled and rigorously defined. The distribution of ingrowth at the bone-implant interface was quantified following 8 weeks of in vivo loading consisting of 100 seconds per day of a 20 Hz sinusoidal stimulus sufficient to cause a local peak strain of approximately 100 microstrain in the cortex at the bone-implant interface in four turkeys. A nonuniform but repeatable pattern of bony ingrowth, from 33 +/- 6 to 72 +/- 6% (mean +/- SE), was observed. The mechanical environment in the vicinity of the bone-implant interface was calculated using a three-dimensional elastic orthotropic finite element model. The general stress-strain state of the bone as predicted by the finite element model was validated in two additional turkeys using four three-element rosette strain gauges, while high resolution moiré interferometry was used to determine the mechanical state of the region immediately adjacent to the implant itself. Shear strains and stresses were evaluated at the interface and correlated to the pattern of bony ingrowth circumscribing the implant interface. Linear regressions between ingrowth and both shear strain and shear stress were negative, with the values of R = -0.75 and R = -0.78 (p < 0.001), respectively, indicating significant inhibition of ingrowth where shear components were maximal. These results suggest that the minimization of shear stress and strain components is a major determinant in achieving successful ingrowth of bone into a prosthesis.

Gap junctional intercellular communication contributes to hormonal responsiveness in osteoblastic networks

To evaluate whether intercellular coupling via connexin43 gap junction channels modulates hormonal responsiveness of cells in contact, we have created osteoblastic cell lines deficient in connexin43. Osteoblastic ROS 17/2.8 cells were transfected with a plasmid containing an antisense cDNA construct to rat connexin43. Control transfection did not alter cell-to-cell coupling nor connexin43 mRNA or protein expression relative to nontransfected ROS 17/2.8 cells. In contrast, stable transfection with an antisense connexin43 cDNA resulted in two clones, RCx4 and RCx16, which displayed significant decreases in connexin43 mRNA and protein expression and were dramatically deficient in cell-to-cell coupling. Phenotypically, all transfectants retained osteoblastic characteristics. However, cells rendered connexin43-deficient through antisense transfection displayed a dramatic attenuation in the cAMP response to parathyroid hormone. Alterations in hormonal responses were not due to changes in parathyroid hormone receptor number or binding kinetics nor to alterations in adenylyl cyclase activity. These results indicate that gap junctions may be required for mediating hormonal signals. Furthermore, these experiments support a regulatory role for connexin43-mediated intercellular communication in the modulation of hormonal responses within elaborately networked bone cells.

Formation of osteoclast-like cells is suppressed by low frequency, low intensity electric fields

With use of a solenoid to generate uniform time-varying electric fields, the effect of extremely low frequency electric fields on osteoclast-like cell formation stimulated by 1,25(OH)2D3 was studied in primary murine marrow culture. Recruitment of osteoclast-like cells was assessed by counting multinuclear, tartrate-resistant acid phosphatase positive cells on day 8 of culture. A solenoid was used to impose uniform time-varying electric fields on cells; sham exposures were performed with an identical solenoid with a null net electric field. During the experiments, both solenoids heated interiorly to approximately 1.5 degrees C above ambient incubator temperature. As a result of the heating, cultures in the sham solenoid formed more osteoclast-like cells than those on the incubator shelf (132 +/- 12%). For this reason, cells exposed to the sham solenoid were used for comparison with cultures exposed to the active coil. Marrow cells were plated at 1.4 x 10(6)/cm2 in square chamber dishes and exposed to 60 Hz electric fields at 9.6 muV/cm from days 1 to 8. Field exposure inhibited osteoclast-like cell recruitment by 17 +/- 3% as compared with sham exposure (p < 0.0001). Several variables, including initial cell plating density, addition of prostaglandin E2 to enhance osteoclast-like cell recruitment, and field parameters, were also assessed. In this secondary series, extremely low frequency fields inhibited osteoclast-like cell formation by 24 +/- 4% (p < 0.0001), with their inhibitory effect consistent throughout all variations in protocol. These experiments demonstrate that extremely low intensity, low frequency sinusoidal electric fields suppress the formation of osteoclast-like cells in marrow culture. The in vitro results support in vivo findings that demonstrate that electric fields inhibit the onset of osteopenia and the progression of osteonecrosis; this suggests that extremely low frequency fields may inhibit osteoclast recruitment in vivo.

Mechanically induced periosteal bone formation is paralleled by the upregulation of collagen type one mRNA in osteocytes as measured by in situ reverse transcript-polymerase chain reaction

Reverse transcript polymerase chain reaction (RT-PCR) was developed for use in situ to measure mechanically mediated changes in gene expression activity in osteocytes within dense cortical bone. Using the functionally isolated turkey ulna model of bone adaptation, the left ulna of 6 old adult (36-40 months) male turkeys were subject to 4 weeks of a mechanical regimen consisting either of (1) 3000 microstrain at 1 Hz for 5 minutes/day or (2) 500 microstrain at 30 Hz for 10 minutes/day. The right ulna of each bird remained intact and served as control. Only a small percentage of osteocytes in the intact control bones and the 3000 microstrain ulnae showed any evidence of mRNA for collagen (each 1.2% +/- 0.3%). However, mRNA for collagen type I was strongly evident in 92.4% (+/-2%) of the osteocytes within the ulnae subject to the high frequency, low magnitude load. Sense primer control sections from both experimental and intact animals were used to verify that only osteocytes of the loaded bone had elevated the level of collagen mRNA. This high frequency, low magnitude mechanical stimulus was also sufficient to stimulate substantial new bone formation (14% +/- 5% over intact controls), whereas the low frequency, high magnitude stimulus failed to elicit any bone formation (-3% +/- 7%). These experiments show that specific mechanical regimens can activate the osteocyte's expression of a message responsible for the synthesis of proteins remote from the site where the formation of bone is ultimately to occur, even under systemic distress such as aging. Further, these data suggest that osteocytes perceive the strain environment and that they play a role in orchestrating the modeling/remodeling response. By developing a technique as flexible and powerful as RT-PCR for use in dense cortical bone, determining the relative contribution of specific proteins to the transduction of regulatory signals to formative or resorptive responses is facilitated.

Chondrocytes isolated from mature articular cartilage retain the capacity to form functional gap junctions

The distribution, expression, and functionality of gap junctions was examined in bovine chondrocytes (BCs) isolated from mature articular cartilage. BC cells displayed immunoreactivity for connexin 43 (Cx43), a specific gap junction protein. Cx43 protein expression was confirmed by Western blot analysis, and Cx43 mRNA was detected by nuclease protection assay. Additionally, BCs were shown to be functionally coupled, as revealed by dye transfer studies, and octanol, a gap junction uncoupler, greatly attenuated coupling. Furthermore, confocal microscopy of fluo-3 loaded BC cells revealed that deformation-induced cytosolic Ca2+ ion (Ca2+) signals propagated from cell-to-cell via gap junctions. To our knowledge, this is the first evidence suggesting that chondrocytes isolated from adult articular cartilage express functional gap junctions.

Cell-to-cell communication in osteoblastic networks: cell line-dependent hormonal regulation of gap junction function

We have characterized the distribution, expression, and hormonal regulation of gap junctions in primary cultures of rat osteoblast-like cells (ROBs), and three osteosarcoma cell lines, ROS 17/2.8, UMR-106, and SAOS-2, and a continuous osteoblastic cell line, MC3T3-E1. All cell lines we examined were functionally coupled. ROS 17/2.8 were the more strongly coupled, while ROB and MC3T3-E1 were moderately coupled and UMR-106 and SAOS-2 were weakly coupled. Exposure to parathyroid hormone (PTH) for 1 h increased functional coupling in ROB cells in a concentration-dependent manner. Furthermore, PTH(3-34), an analog of PTH with binds to the PTH receptor and thus attenuates PTH-stimulated cAMP accumulation, also attenuated PTH-stimulated functional coupling in ROB. This suggests that PTH increases functional coupling partly through a cAMP-dependent mechanism. A 1 h exposure to PTH did not affect coupling in ROS 17/2.8, UMR-106, MC3T3-E1, or SAOS-2. To examine whether connexin43 (Cx43), a specific gap junction protein, is present in functionally coupled osteoblastic cells, we characterized Cx43 distribution and expression. Indirect immunofluorescence with antibodies to Cx43 revealed that ROS 17/2.8, ROB, and to a lesser extent MC3T3-E1 and UMR-106, expressed Cx43 immunoreactivity. SAOS-2 showed little if any Cx43 immunoreactivity. Cx43 mRNA and Cx43 protein were detected by Northern blot analysis and immunoblot analysis, respectively, in all cell lines examined, including SAOS-2. Our findings suggest that acute exposure to PTH regulates gap junction coupling, in a cell-line dependent manner, in osteoblastic cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Morphologic stages in lamellar bone formation stimulated by a potent mechanical stimulus

The temporal stages of lamellar bone formation were studied using an animal model subject to up to 16 weeks of a controlled, externally applied load. The left ulnae of 15 adult male turkeys were functionally isolated via transverse metaphyseal osteotomies, while transcutaneous Steinmann pins permitted in vivo loading of the preparation via a servo-hydraulic actuator. For 5 days per week, the ulnae were exposed to 100 cycles per day of an applied load sufficient to cause a peak strain normal to the bone's longitudinal axis of 2000 microstrain (mu E). The contralateral limb was left surgically undisturbed and served as a baseline control. Following a loading period of 4, 8 or 16 weeks, ulnae were harvested and prepared for quantitative bone histomorphometry. Compared with each animal's contralateral ulna, the area of the experimental ulnae increased by 12.5% (+/- 5.6%) at 16 weeks. Periosteal mineral apposition rates in the loaded ulnae were significantly increased compared with control values, with a maximum rate of 6.0 +/- 3.4 microns/day at 5 weeks, slowing to 2.0 +/- 0.3 microns/day by 15 weeks. At 16 weeks, new bone was composed of primary and secondary osteons as well as circumferential lamellae, with osteocyte density and organization indistinguishable from that of the original cortex. Remnants of the initial woven bone response seen at 4 weeks remained clearly visible at both 8 and 16 weeks as diffusely labeled interstitial elements within the newly formed lamellar construct.(ABSTRACT TRUNCATED AT 250 WORDS)

Promotion of bony ingrowth by frequency-specific, low-amplitude mechanical strain

The ability of extremely low-amplitude mechanical strains to promote bony ingrowth was evaluated in an in vivo animal model, the functionally isolated turkey ulna. A cylindrical, porous-coated titanium implant was placed across the dorsal and ventral cortices of the left ulna diaphysis of 12 animals. Back scatter electron microscopy was used to quantify the relative bony ingrowth after eight weeks of: (1) disuse alone, (2) disuse plus 100 seconds per day of a 1-Hz, 150-microstrain (mu epsilon) mechanical stimulus, or (3) disuse plus 100 seconds per day of a 20-Hz stimulus of similar strain magnitude. Disuse alone caused a mean 8.3% (+/- 5.5%) less of bone away from the implant, with the area between implant and bone actively filling with a fibrous membrane. A daily 100-second regimen of low-magnitude, 1-Hz mechanical stimulation caused 28% (+/- 6.2%) of the implant area available for ingrowth to be filled with bone. At 20 Hz, the amount of bony ingrowth increased to 69% (+/- 3.0%). These data demonstrate that brief exposure to extremely low-amplitude mechanical strains can enhance the biologic fixation of cementless implants. Moreover, the degree of ingrowth is dependent on the frequency of the applied strain.

Optimization of electric field parameters for the control of bone remodeling: exploitation of an indigenous mechanism for the prevention of osteopenia

The discovery of piezoelectric potentials in loaded bone was instrumental in developing a plausible mechanism by which functional activity could intrinsically influence the tissue's cellular environment and thus affect skeletal mass and morphology. Using an in vivo model of osteopenia, we have demonstrated that the bone resorption that normally parallels disuse can be prevented or even reversed by the exogenous induction of electric fields. Importantly, the manner of the response (i.e., formation, turnover, resorption) is exceedingly sensitive to subtle changes in electric field parameters. Fields below 10 microV/cm, when induced at frequencies between 50 and 150 Hz for 1 h/day, were sufficient to maintain bone mass even in the absence of function. Reducing the frequency to 15 Hz made the field extremely osteogenic. Indeed, this frequency-specific sinusoidal field initiated more new bone formation than a more complex pulsed electromagnetic field (PEMF), though inducing only 0.1% of the electrical energy of the PEMF. The frequencies and field intensities most effective in the exogenous stimulation of bone formation are similar to those produced by normal functional activity. This lends strong support to the hypothesis that endogenous electric fields serve as a critical regulatory factor in both bone modeling and remodeling processes. Delineation of the field parameters most effective in retaining or promoting bone mass will accelerate the development of electricity as a unique and site-specific prophylaxis for osteopenia. Because fields of these frequencies and intensities are indigenous to bone tissue, it further suggests that such exogenous treatment can promote bone quantity and quality with minimal risk or consequence.