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Aguilera K, Bladh O, Marking U, Norin NG, Rihani A, Ujvari D, Ning FC, Klingström J, Havervall S, Åberg M, Blom K, Alm JJ, Thålin C. Prevalence of SARS-CoV-2 infections among Swedish healthcare workers on duty in December 2023. Lancet Reg Health Eur 2024; 38:100872. [PMID: 38476745 PMCID: PMC10928269 DOI: 10.1016/j.lanepe.2024.100872] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Katherina Aguilera
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Oscar Bladh
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Ulrika Marking
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
- Public Health Agency of Sweden, Sweden
| | - Nina Greilert Norin
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Ali Rihani
- Department of Microbiology, Tumor and Cell Biology, and National Pandemic Center, Karolinska Institutet, Solna, Sweden
| | - Dorina Ujvari
- Department of Microbiology, Tumor and Cell Biology, and National Pandemic Center, Karolinska Institutet, Solna, Sweden
| | - Frank Chenfei Ning
- Department of Microbiology, Tumor and Cell Biology, and National Pandemic Center, Karolinska Institutet, Solna, Sweden
| | - Jonas Klingström
- Public Health Agency of Sweden, Sweden
- Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
| | - Sebastian Havervall
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Mikael Åberg
- Department of Medical Sciences, Clinical Chemistry and SciLifeLab, Uppsala University, Uppsala, Sweden
| | - Kim Blom
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
- Public Health Agency of Sweden, Sweden
| | - Jessica J. Alm
- Department of Microbiology, Tumor and Cell Biology, and National Pandemic Center, Karolinska Institutet, Solna, Sweden
| | - Charlotte Thålin
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
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2
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Wang S, Nikamo P, Laasonen L, Gudbjornsson B, Ejstrup L, Iversen L, Lindqvist U, Alm JJ, Eisfeldt J, Zheng X, Catrina SB, Taylan F, Vaz R, Ståhle M, Tapia-Paez I. Rare coding variants in NOX4 link high ROS levels to psoriatic arthritis mutilans. EMBO Mol Med 2024; 16:596-615. [PMID: 38379095 PMCID: PMC10940640 DOI: 10.1038/s44321-024-00035-z] [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: 06/14/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/22/2024] Open
Abstract
Psoriatic arthritis mutilans (PAM) is the rarest and most severe form of psoriatic arthritis, characterized by erosions of the small joints and osteolysis leading to joint disruption. Despite its severity, the underlying mechanisms are unknown, and no susceptibility genes have hitherto been identified. We aimed to investigate the genetic basis of PAM by performing massive parallel sequencing in sixty-one patients from the PAM Nordic cohort. We found rare variants in the NADPH oxidase 4 (NOX4) in four patients. In silico predictions show that the identified variants are potentially damaging. NOXs are the only enzymes producing reactive oxygen species (ROS). NOX4 is specifically involved in the differentiation of osteoclasts, the cells implicated in bone resorption. Functional follow-up studies using cell culture, zebrafish models, and measurement of ROS in patients uncovered that these NOX4 variants increase ROS levels both in vitro and in vivo. We propose NOX4 as the first candidate susceptibility gene for PAM. Our study links high levels of ROS caused by NOX4 variants to the development of PAM, offering a potential therapeutic target.
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Affiliation(s)
- Sailan Wang
- Division of Dermatology and Venereology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Nikamo
- Division of Dermatology and Venereology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Leena Laasonen
- Helsinki Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Leif Ejstrup
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Ulla Lindqvist
- Department of Medical Sciences, Rheumatology, Uppsala University, Uppsala, Sweden
| | - Jessica J Alm
- Department of Microbiology, Tumor and Cell Biology & National Pandemic Center, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Eisfeldt
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Xiaowei Zheng
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Sergiu-Bogdan Catrina
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Diabetes, Academic Specialist Center, Stockholm, Sweden
| | - Fulya Taylan
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Raquel Vaz
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Mona Ståhle
- Division of Dermatology and Venereology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Dermatology and Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Isabel Tapia-Paez
- Division of Dermatology and Venereology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
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Bladh O, Greilert-Norin N, Havervall S, Marking U, Aguilera K, Alm JJ, Blom K, Åberg M, Klingström J, Thålin C. Mucosal and Serum Antibodies 3 Weeks after Symptomatic BA.2.86 Infection. N Engl J Med 2023; 389:1626-1628. [PMID: 37888924 PMCID: PMC10755831 DOI: 10.1056/nejmc2310347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
| | | | | | | | | | | | - Kim Blom
- Public Health Agency of Sweden, Solna, Sweden
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4
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Blom K, Bladh O, Havervall S, Marking U, Greilert Norin N, Alm JJ, Klingström J, Thålin C. Point prevalence of SARS-CoV-2 infection among healthcare workers in March and June 2023 in Sweden. Lancet Reg Health Eur 2023; 33:100725. [PMID: 37680234 PMCID: PMC10480508 DOI: 10.1016/j.lanepe.2023.100725] [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] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Kim Blom
- Public Health Agency of Sweden, Solna, Sweden
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Oscar Bladh
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Ulrika Marking
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Jessica J. Alm
- Department of Microbiology, Tumor and Cell Biology (MTC) and National Pandemic Center, Karolinska Institutet, Solna, Sweden
| | - Jonas Klingström
- Public Health Agency of Sweden, Solna, Sweden
- Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
| | - Charlotte Thålin
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
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Marking U, Bladh O, Havervall S, Greilert-Norin N, Gordon M, Alm JJ, Blom K, Åberg M, Klingström J, Thålin C. Mucosal IgA protects against BQ.1 and BQ.1.1 infection. Lancet Infect Dis 2023:S1473-3099(23)00421-8. [PMID: 37453441 DOI: 10.1016/s1473-3099(23)00421-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Ulrika Marking
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm 18288, Sweden; Public Health Agency of Sweden, Solna, Sweden
| | - Oscar Bladh
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm 18288, Sweden
| | - Sebastian Havervall
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm 18288, Sweden
| | - Nina Greilert-Norin
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm 18288, Sweden
| | - Max Gordon
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm 18288, Sweden
| | - Jessica J Alm
- Department of Microbiology, Tumor and Cell Biology, and National Pandemic Center, Karolinska Institutet, Solna, Sweden
| | - Kim Blom
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm 18288, Sweden; Public Health Agency of Sweden, Solna, Sweden
| | - Mikael Åberg
- Department of Medical Sciences, Clinical Chemistry and SciLifeLab Affinity Proteomics, Uppsala University, Uppsala, Sweden
| | - Jonas Klingström
- Public Health Agency of Sweden, Solna, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Charlotte Thålin
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm 18288, Sweden.
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6
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Marking U, Havervall S, Norin NG, Bladh O, Christ W, Gordon M, Ng H, Blom K, Phillipson M, Mangsbo S, Alm JJ, Smed-Sörensen A, Nilsson P, Hober S, Åberg M, Klingström J, Thålin C. Correlates of protection and viral load trajectories in omicron breakthrough infections in triple vaccinated healthcare workers. Nat Commun 2023; 14:1577. [PMID: 36949041 PMCID: PMC10031702 DOI: 10.1038/s41467-023-36984-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 02/27/2023] [Indexed: 03/24/2023] Open
Abstract
Vaccination offers protection against severe COVID-19 caused by SARS-CoV-2 omicron but is less effective against infection. Characteristics such as serum antibody titer correlation to protection, viral abundance and clearance of omicron infection in vaccinated individuals are scarce. We present a 4-week twice-weekly SARS-CoV-2 qPCR screening in 368 triple vaccinated healthcare workers. Spike-specific IgG levels, neutralization titers and mucosal spike-specific IgA-levels were determined at study start and qPCR-positive participants were sampled repeatedly for two weeks. 81 (cumulative incidence 22%) BA.1, BA.1.1 and BA.2 infections were detected. High serum antibody titers are shown to be protective against infection (p < 0.01), linked to reduced viral load (p < 0.01) and time to viral clearance (p < 0.05). Pre-omicron SARS-CoV-2 infection is independently associated to increased protection against omicron, largely mediated by mucosal spike specific IgA responses (nested models lr test p = 0.02 and 0.008). Only 10% of infected participants remain asymptomatic through the course of their infection. We demonstrate that high levels of vaccine-induced spike-specific WT antibodies are linked to increased protection against infection and to reduced viral load if infected, and suggest that the additional protection offered by pre-omicron SARS-CoV-2 infection largely is mediated by mucosal spike-specific IgA.
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Affiliation(s)
- Ulrika Marking
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Sebastian Havervall
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Nina Greilert Norin
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Oscar Bladh
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Wanda Christ
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Max Gordon
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Henry Ng
- Department of Medical Cell Biology and SciLifeLab, Uppsala University, Uppsala, Sweden
| | - Kim Blom
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Mia Phillipson
- Department of Medical Cell Biology and SciLifeLab, Uppsala University, Uppsala, Sweden
| | - Sara Mangsbo
- Department of Pharmacy and SciLifeLab, Uppsala University, Uppsala, Sweden
| | - Jessica J Alm
- Department of Microbiology, Tumor and Cell Biology & National Pandemic Center, Karolinska Institutet, Solna, Sweden
| | - Anna Smed-Sörensen
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Nilsson
- Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Sophia Hober
- Department of Protein Science, KTH Royal Institute of Technology, SciLifeLab, Stockholm, Sweden
| | - Mikael Åberg
- Department of Medical Sciences, Clinical Chemistry and SciLifeLab, Uppsala University, Uppsala, Sweden
| | - Jonas Klingström
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Charlotte Thålin
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden.
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Hober A, Tran-Minh KH, Foley D, McDonald T, Vissers JPC, Pattison R, Ferries S, Hermansson S, Betner I, Uhlén M, Razavi M, Yip R, Pope ME, Pearson TW, Andersson LN, Bartlett A, Calton L, Alm JJ, Engstrand L, Edfors F. Rapid and sensitive detection of SARS-CoV-2 infection using quantitative peptide enrichment LC-MS analysis. eLife 2021; 10:e70843. [PMID: 34747696 PMCID: PMC8626084 DOI: 10.7554/elife.70843] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/04/2021] [Indexed: 12/11/2022] Open
Abstract
Reliable, robust, large-scale molecular testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is essential for monitoring the ongoing coronavirus disease 2019 (COVID-19) pandemic. We have developed a scalable analytical approach to detect viral proteins based on peptide immuno-affinity enrichment combined with liquid chromatography-mass spectrometry (LC-MS). This is a multiplexed strategy, based on targeted proteomics analysis and read-out by LC-MS, capable of precisely quantifying and confirming the presence of SARS-CoV-2 in phosphate-buffered saline (PBS) swab media from combined throat/nasopharynx/saliva samples. The results reveal that the levels of SARS-CoV-2 measured by LC-MS correlate well with their correspondingreal-time polymerase chain reaction (RT-PCR) read-out (r = 0.79). The analytical workflow shows similar turnaround times as regular RT-PCR instrumentation with a quantitative read-out of viral proteins corresponding to cycle thresholds (Ct) equivalents ranging from 21 to 34. Using RT-PCR as a reference, we demonstrate that the LC-MS-based method has 100% negative percent agreement (estimated specificity) and 95% positive percent agreement (estimated sensitivity) when analyzing clinical samples collected from asymptomatic individuals with a Ct within the limit of detection of the mass spectrometer (Ct ≤ 30). These results suggest that a scalable analytical method based on LC-MS has a place in future pandemic preparedness centers to complement current virus detection technologies.
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Affiliation(s)
| | - Khue Hua Tran-Minh
- Science for Life LaboratorySolnaSweden
- The Royal Institute of Technology, Division of Systems Biology, Department of Protein Science, School of Chemistry, Biotechnology and HealthStockholmSweden
| | | | | | | | | | | | | | | | - Mathias Uhlén
- Science for Life LaboratorySolnaSweden
- The Royal Institute of Technology, Division of Systems Biology, Department of Protein Science, School of Chemistry, Biotechnology and HealthStockholmSweden
| | | | - Richard Yip
- SISCAPA Assay Technologies, IncVictoriaCanada
| | | | | | | | | | | | - Jessica J Alm
- Karolinska Institutet, Department of Microbiology, Tumor and Cell Biology & National Pandemic Center, Karolinska InstitutetSolnaSweden
| | - Lars Engstrand
- Microbiology, Tumour and Cell Biology, Karolinska InstitutetStockholmSweden
| | - Fredrik Edfors
- Science for Life LaboratorySolnaSweden
- The Royal Institute of Technology, Division of Systems Biology, Department of Protein Science, School of Chemistry, Biotechnology and HealthStockholmSweden
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8
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Costantini A, Alm JJ, Tonelli F, Valta H, Huber C, Tran AN, Daponte V, Kirova N, Kwon YU, Bae JY, Chung WY, Tan S, Sznajer Y, Nishimura G, Näreoja T, Warren AJ, Cormier-Daire V, Kim OH, Forlino A, Cho TJ, Mäkitie O. Novel RPL13 Variants and Variable Clinical Expressivity in a Human Ribosomopathy With Spondyloepimetaphyseal Dysplasia. J Bone Miner Res 2021; 36:283-297. [PMID: 32916022 PMCID: PMC7988564 DOI: 10.1002/jbmr.4177] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/31/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
Spondyloepimetaphyseal dysplasias (SEMDs) are a heterogeneous group of disorders with variable growth failure and skeletal impairments affecting the spine and long bone epiphyses and metaphyses. Here we report on four unrelated families with SEMD in which we identified two monoallelic missense variants and one monoallelic splice site variant in RPL13, encoding the ribosomal protein eL13. In two out of four families, we observed autosomal dominant inheritance with incomplete penetrance and variable clinical expressivity; the phenotypes of the mutation-positive subjects ranged from normal height with or without hip dysplasia to severe SEMD with severe short stature and marked skeletal dysplasia. In vitro studies on patient-derived dermal fibroblasts harboring RPL13 missense mutations demonstrated normal eL13 expression, with proper subcellular localization but reduced colocalization with eL28 (p < 0.001). Cellular functional defects in fibroblasts from mutation-positive subjects indicated a significant increase in the ratio of 60S subunits to 80S ribosomes (p = 0.007) and attenuated global translation (p = 0.017). In line with the human phenotype, our rpl13 mutant zebrafish model, generated by CRISPR-Cas9 editing, showed cartilage deformities at embryonic and juvenile stages. These findings extend the genetic spectrum of RPL13 mutations causing this novel human ribosomopathy with variable skeletal features. Our study underscores for the first time incomplete penetrance and broad phenotypic variability in SEMD-RPL13 type and confirms impaired ribosomal function. Furthermore, the newly generated rpl13 mutant zebrafish model corroborates the role of eL13 in skeletogenesis. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR)..
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Affiliation(s)
- Alice Costantini
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jessica J Alm
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Francesca Tonelli
- Department of Molecular Medicine, Biochemistry Unit, University of Pavia, Pavia, Italy
| | - Helena Valta
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Céline Huber
- Department of Clinical Genetics, INSERM UMR 1163, Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Necker Enfans Malades Hospital (AP-HP), Paris, France
| | - Anh N Tran
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Valentina Daponte
- Department of Molecular Medicine, Biochemistry Unit, University of Pavia, Pavia, Italy
| | - Nadi Kirova
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Yong-Uk Kwon
- Department of Orthopaedic Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jung Yun Bae
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Woo Yeong Chung
- Department of Pediatrics, Busan Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| | - Shengjiang Tan
- Cambridge Institute for Medical Research, Keith Peters Building, Cambridge, UK.,Department of Haematology, University of Cambridge, Cambridge, UK.,Wellcome Trust-Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Yves Sznajer
- Centre de Génétique Humaine - CGH, Cliniques Universitaires St. Luc, UCL, Bruxelles, Belgium
| | - Gen Nishimura
- Center for Intractable Diseases, Saitama Medical University Hospital, Saitama, Japan
| | - Tuomas Näreoja
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Alan J Warren
- Cambridge Institute for Medical Research, Keith Peters Building, Cambridge, UK.,Department of Haematology, University of Cambridge, Cambridge, UK.,Wellcome Trust-Medical Research Council Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - Valérie Cormier-Daire
- Department of Clinical Genetics, INSERM UMR 1163, Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Necker Enfans Malades Hospital (AP-HP), Paris, France
| | - Ok-Hwa Kim
- Department of Radiology, I-Bone Hospital, Cheonan, Republic of Korea
| | - Antonella Forlino
- Department of Molecular Medicine, Biochemistry Unit, University of Pavia, Pavia, Italy
| | - Tae-Joon Cho
- Division of Pediatric Orthopaedics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Outi Mäkitie
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden.,Folkhälsan Institute of Genetics, and Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
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9
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Costantini A, Alm JJ, Tonelli F, Valta H, Huber C, Tran AN, Daponte V, Kirova N, Kwon YU, Bae JY, Chung WY, Tan S, Sznajer Y, Nishimura G, Näreoja T, Warren AJ, Cormier-Daire V, Kim OH, Forlino A, Cho TJ, Mäkitie O. Novel RPL13 variants and evidence for incomplete penetrance in a human ribosomopathy with spondyloepimetaphyseal dysplasia. Bone Rep 2020. [DOI: 10.1016/j.bonr.2020.100647] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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10
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Mäkitie RE, Kämpe A, Costantini A, Alm JJ, Magnusson P, Mäkitie O. Biomarkers in WNT1 and PLS3 Osteoporosis: Altered Concentrations of DKK1 and FGF23. J Bone Miner Res 2020; 35:901-912. [PMID: 31968132 DOI: 10.1002/jbmr.3959] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 06/24/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 12/12/2022]
Abstract
Recent advancements in genetic research have uncovered new forms of monogenic osteoporosis, expanding our understanding of the molecular pathways regulating bone health. Despite active research, knowledge on the pathomechanisms, disease-specific biomarkers, and optimal treatment in these disorders is still limited. Mutations in WNT1, encoding a WNT/β-catenin pathway ligand WNT1, and PLS3, encoding X chromosomally inherited plastin 3 (PLS3), both result in early-onset osteoporosis with prevalent fractures and disrupted bone metabolism. However, despite marked skeletal pathology, conventional bone markers are usually normal in both diseases. Our study aimed to identify novel bone markers in PLS3 and WNT1 osteoporosis that could offer diagnostic potential and shed light on the mechanisms behind these skeletal pathologies. We measured several parameters of bone metabolism, including serum dickkopf-1 (DKK1), sclerostin, and intact and C-terminal fibroblast growth factor 23 (FGF23) concentrations in 17 WNT1 and 14 PLS3 mutation-positive subjects. Findings were compared with 34 healthy mutation-negative subjects from the same families. Results confirmed normal concentrations of conventional metabolic bone markers in both groups. DKK1 concentrations were significantly elevated in PLS3 mutation-positive subjects compared with WNT1 mutation-positive subjects (p < .001) or the mutation-negative subjects (p = .002). Similar differences were not seen in WNT1 subjects. Sclerostin concentrations did not differ between any groups. Both intact and C-terminal FGF23 were significantly elevated in WNT1 mutation-positive subjects (p = .039 and p = .027, respectively) and normal in PLS3 subjects. Our results indicate a link between PLS3 and DKK1 and WNT1 and FGF23 in bone metabolism. The normal sclerostin and DKK1 levels in patients with impaired WNT signaling suggest another parallel regulatory mechanism. These findings provide novel information on the molecular networks in bone. Extended studies are needed to investigate whether these biomarkers offer diagnostic value or potential as treatment targets in osteoporosis. © 2020 American Society for Bone and Mineral Research.
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Affiliation(s)
- Riikka E Mäkitie
- Faculty of Medicine, Folkhälsan Institute of Genetics and Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.,Molecular Endocrinology Laboratory, Department of Medicine, Hammersmith Campus, Imperial College London, London, UK
| | - Anders Kämpe
- Department of Molecular Medicine and Surgery, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | - Alice Costantini
- Department of Molecular Medicine and Surgery, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jessica J Alm
- Department of Molecular Medicine and Surgery, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Per Magnusson
- Department of Clinical Chemistry, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Outi Mäkitie
- Faculty of Medicine, Folkhälsan Institute of Genetics and Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.,Department of Molecular Medicine and Surgery, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden.,Children's Hospital and Pediatric Research Center, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
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11
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Costantini A, Valta H, Baratang NV, Yap P, Bertola DR, Yamamoto GL, Kim CA, Chen J, Wierenga KJ, Fanning EA, Escobar L, McWalter K, McLaughlin H, Willaert R, Begtrup A, Alm JJ, Reinhardt DP, Mäkitie O, Campeau PM. Novel fibronectin mutations and expansion of the phenotype in spondylometaphyseal dysplasia with "corner fractures". Bone 2019; 121:163-171. [PMID: 30599297 DOI: 10.1016/j.bone.2018.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 07/09/2018] [Revised: 12/02/2018] [Accepted: 12/29/2018] [Indexed: 01/15/2023]
Abstract
Heterozygous pathogenic variants in the FN1 gene, encoding fibronectin (FN), have recently been shown to be associated with a skeletal disorder in some individuals affected by spondylometaphyseal dysplasia with "corner fractures" (SMD-CF). The most striking feature characterizing SMD-CF is irregularly shaped metaphyses giving the appearance of "corner fractures". An array of secondary features, including developmental coxa vara, ovoid vertebral bodies and severe scoliosis, may also be present. FN is an important extracellular matrix component for bone and cartilage development. Here we report five patients affected by this subtype of SMD-CF caused by five novel FN1 missense mutations: p.Cys123Tyr, p.Cys169Tyr, p.Cys213Tyr, p.Cys231Trp and p.Cys258Tyr. All individuals shared a substitution of a cysteine residue, disrupting disulfide bonds in the FN type-I assembly domains located in the N-terminal assembly region. The abnormal metaphyseal ossification and "corner fracture" appearances were the most remarkable clinical feature in these patients. In addition, generalized skeletal fragility with low-trauma bilateral femoral fractures was identified in one patient. Interestingly, the distal femoral changes in this patient healed with skeletal maturation. Our report expands the phenotypic and genetic spectrum of the FN1-related SMD-CF and emphasizes the importance of FN in bone formation and possibly also in the maintenance of bone strength.
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Affiliation(s)
- Alice Costantini
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm 171 76, Sweden
| | - Helena Valta
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki 00290, Finland
| | - Nissan Vida Baratang
- CHU Sainte Justine Research Centre, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Patrick Yap
- Genetic Health Service New Zealand (Northern Hub), Auckland 1023, New Zealand
| | - Débora R Bertola
- Centro de Pesquisa sobre o Genoma Humano e Células-Tronco do Instituto de Biociências- Universidade de São Paulo, São Paulo, SP 05508-090, Brazil; Clinical Genetics Unit, Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP 05403-000, Brazil
| | - Guilherme L Yamamoto
- Centro de Pesquisa sobre o Genoma Humano e Células-Tronco do Instituto de Biociências- Universidade de São Paulo, São Paulo, SP 05508-090, Brazil; Clinical Genetics Unit, Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP 05403-000, Brazil
| | - Chong A Kim
- Clinical Genetics Unit, Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP 05403-000, Brazil
| | - Jiani Chen
- University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | | | - Elizabeth A Fanning
- University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; Division of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Luis Escobar
- Payton Manning Children's Hospital at St. Vincent Health, Indianapolis, IN 46260, USA
| | | | | | | | - Amber Begtrup
- GeneDx, 207 Perry Parkway, Gaithersburg, MD 20877, USA
| | - Jessica J Alm
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm 171 76, Sweden
| | - Dieter P Reinhardt
- Department of Anatomy and Cell Biology, and Faculty of Dentistry, McGill University, Montreal, QC H3A 0C7, Canada
| | - Outi Mäkitie
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm 171 76, Sweden; Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki 00290, Finland; Department of Clinical Genetics, Karolinska University Hospital, Stockholm 171 76, Sweden; Folkhälsan Institute of Genetics, University of Helsinki, Helsinki 00290, Finland.
| | - Philippe M Campeau
- CHU Sainte Justine Research Centre and Department of Pediatrics, University of Montreal, Montreal, QC H3T 1C5, Canada.
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12
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Finnilä S, Moritz N, Strandberg N, Alm JJ, Aro HT. Radiostereometric analysis of the initial stability of internally fixed femoral neck fractures under differential loading. J Orthop Res 2019; 37:239-247. [PMID: 30273993 PMCID: PMC6587786 DOI: 10.1002/jor.24150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 02/05/2018] [Accepted: 09/24/2018] [Indexed: 02/04/2023]
Abstract
We examined the feasibility of radiostereometric analysis (RSA) in the assessment of the initial stability of internally fixed femoral neck fractures. The study included 16 patients (mean age 73 years). During surgery, multiple RSA-beads were inserted on both sides of the fracture. Radiographs for RSA were taken in the supine position within the first 3 days and 6, 12, 24, and 52 weeks after surgery. To detect any inducible motion at the fracture-site, radiographs for RSA were taken with the patient resting or applying a load through the fracture. Fracture loading was achieved by the patient pressing the ipsilateral foot as much as tolerated on a force plate while providing a counterforce through both hands. Micromotion exceeding the precision values of RSA (≥0.3 mm for the translation vector and/or ≥1.2 degrees for the rotation vector) was considered significant. Permanent three-dimensional fracture-site displacement was also recorded. Voluntary loading induced fracture-site micromotion, which exhibited a dichotomous distribution. In patients with uncomplicated fracture union, inducible micromotion was detectable only at baseline-if at all. Conversely, fractures that developed a nonunion were characterized by the continuation of inducible micromotion beyond baseline. Permanent fracture-site displacement was, on average, nearly an order of magnitude greater than the inducible micromotion. Fracture unions were characterized by the cessation of permanent fracture-site displacement by 12 weeks. Nonunions presented as outliers in permanent fracture-site displacement. Large-scale studies are warranted to evaluate whether the detection of inducible micromotion beyond baseline could serve as an indicator of insufficient fixation stability. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society.
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Affiliation(s)
- Sami Finnilä
- Orthopedic Research Unit, Department of Orthopedic Surgery and TraumatologyTurku University Hospital and University of TurkuTurkuFinland
| | - Niko Moritz
- Orthopedic Research Unit, Department of Orthopedic Surgery and TraumatologyTurku University Hospital and University of TurkuTurkuFinland
| | - Niko Strandberg
- Orthopedic Research Unit, Department of Orthopedic Surgery and TraumatologyTurku University Hospital and University of TurkuTurkuFinland
| | - Jessica J. Alm
- Orthopedic Research Unit, Department of Orthopedic Surgery and TraumatologyTurku University Hospital and University of TurkuTurkuFinland
| | - Hannu T. Aro
- Orthopedic Research Unit, Department of Orthopedic Surgery and TraumatologyTurku University Hospital and University of TurkuTurkuFinland
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13
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Abstract
Osteoporosis, characterized by deteriorated bone microarchitecture and low bone mineral density, is a chronic skeletal disease with high worldwide prevalence. Osteoporosis related to aging is the most common form and causes significant morbidity and mortality. Rare, monogenic forms of osteoporosis have their onset usually in childhood or young adulthood and have specific phenotypic features and clinical course depending on the underlying cause. The most common form is osteogenesis imperfecta linked to mutations in COL1A1 and COL1A2, the two genes encoding type I collagen. However, in the past years, remarkable advancements in bone research have expanded our understanding of the intricacies behind bone metabolism and identified novel molecular mechanisms contributing to skeletal health and disease. Especially high-throughput sequencing techniques have made family-based studies an efficient way to identify single genes causative of rare monogenic forms of osteoporosis and these have yielded several novel genes that encode proteins partaking in type I collagen modification or regulating bone cell function directly. New forms of monogenic osteoporosis, such as autosomal dominant osteoporosis caused by WNT1 mutations or X-linked osteoporosis due to PLS3 mutations, have revealed previously unidentified bone-regulating proteins and clarified specific roles of bone cells, expanded our understanding of possible inheritance mechanisms and paces of disease progression, and highlighted the potential of monogenic bone diseases to extend beyond the skeletal tissue. The novel gene discoveries have introduced new challenges to the classification and diagnosis of monogenic osteoporosis, but also provided promising new molecular targets for development of pharmacotherapies. In this article we give an overview of the recent discoveries in the area of monogenic forms of osteoporosis, describing the key cellular mechanisms leading to skeletal fragility, the major recent research findings and the essential challenges and avenues in future diagnostics and treatments.
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Affiliation(s)
- Riikka E. Mäkitie
- Folkhälsan Institute of Genetics and University of Helsinki, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Alice Costantini
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Kämpe
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jessica J. Alm
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Outi Mäkitie
- Folkhälsan Institute of Genetics and University of Helsinki, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Children's Hospital, Pediatric Research Center, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
- Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
- *Correspondence: Outi Mäkitie
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14
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Abstract
Background and purpose - We previously reported a transient, bone mineral density (BMD)-dependent early migration of anatomically designed hydroxyapatite-coated femoral stems with ceramic-ceramic bearing surfaces (ABG-II) in aging osteoarthritic women undergoing cementless total hip arthroplasty. To evaluate the clinical significance of the finding, we performed a follow-up study for repeated radiostereometric analysis (RSA) 9 years after surgery. Patients and methods - Of the 53 female patients examined at 2 years post-surgery in the original study, 32 were able to undergo repeated RSA of femoral stem migration at a median of 9 years (7.8-9.3) after surgery. Standard hip radiographs were obtained, and the subjects completed the Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index outcome questionnaires. Results - Paired comparisons revealed no statistically significant migration of the femoral stems between 2 and 9 years post-surgery. 1 patient exhibited minor but progressive RSA stem migration. All radiographs exhibited uniform stem osseointegration. No stem was revised for mechanical loosening. The clinical outcome scores were similar between 2 and 9 years post-surgery. Interpretation - Despite the BMD-related early migration observed during the first 3 postoperative months, the anatomically designed femoral stems in aging women are osseointegrated, as evaluated by RSA and radiographs, and exhibit good clinical function at 9 years.
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Affiliation(s)
- Erik Aro
- Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku;
| | - Jessica J Alm
- Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku;
| | - Niko Moritz
- Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku;
| | - Kimmo Mattila
- Department of Diagnostic Imaging, Turku University Hospital, Turku, Finland
| | - Hannu T Aro
- Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku; ,Correspondence:
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15
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Iacobaeus E, Sugars RV, Törnqvist Andrén A, Alm JJ, Qian H, Frantzen J, Newcombe J, Alkass K, Druid H, Bottai M, Röyttä M, Le Blanc K. Dynamic Changes in Brain Mesenchymal Perivascular Cells Associate with Multiple Sclerosis Disease Duration, Active Inflammation, and Demyelination. Stem Cells Transl Med 2017; 6:1840-1851. [PMID: 28941240 PMCID: PMC6430046 DOI: 10.1002/sctm.17-0028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 02/02/2017] [Accepted: 07/05/2017] [Indexed: 12/22/2022] Open
Abstract
Vascular changes, including blood brain barrier destabilization, are common pathological features in multiple sclerosis (MS) lesions. Blood vessels within adult organs are reported to harbor mesenchymal stromal cells (MSCs) with phenotypical and functional characteristics similar to pericytes. We performed an immunohistochemical study of MSCs/pericytes in brain tissue from MS and healthy persons. Post‐mortem brain tissue from patients with early progressive MS (EPMS), late stage progressive MS (LPMS), and healthy persons were analyzed for the MSC and pericyte markers CD146, platelet‐derived growth factor receptor beta (PDGFRβ), CD73, CD271, alpha‐smooth muscle actin, and Ki67. The MS samples included active, chronic active, chronic inactive lesions, and normal‐appearing white matter. MSC and pericyte marker localization were detected in association with blood vessels, including subendothelial CD146+PDGFRβ+Ki67+ cells and CD73+CD271+PDGFRβ+Ki67– cells within the adventitia and perivascular areas. Both immunostained cell subpopulations were termed mesenchymal perivascular cells (MPCs). Quantitative analyses of immunostainings showed active lesions containing increased regions of CD146+PDGFRβ+Ki67+ and CD73+CD271+PDGFRβ+Ki67– MPC subpopulations compared to inactive lesions. Chronic lesions presented with decreased levels of CD146+PDGFRβ+Ki67+ MPC cells compared to control tissue. Furthermore, LPMS lesions displayed increased numbers of blood vessels harboring greatly enlarged CD73+CD271+ adventitial and perivascular areas compared to control and EPMS tissue. In conclusion, we demonstrate the presence of MPC subgroups in control human brain vasculature, and their phenotypic changes in MS brain, which correlated with inflammation, demyelination and MS disease duration. Our findings demonstrate that brain‐derived MPCs respond to pathologic mechanisms involved in MS disease progression and suggest that vessel‐targeted therapeutics may benefit patients with progressive MS. Stem Cells Translational Medicine2017;6:1840–1851
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Affiliation(s)
- Ellen Iacobaeus
- Division of Clinical Immunology, Department of Laboratory Medicine, Finland.,Department of Clinical Neuroscience, Finland
| | - Rachael V Sugars
- Division of Oral Facial Diagnostics and Surgery, Department of Dental Medicine, Finland
| | | | - Jessica J Alm
- Division of Clinical Immunology, Department of Laboratory Medicine, Finland.,Department of Pathology, University of Turku and Turku University Hospital, Finland
| | - Hong Qian
- Center for Hematology and Regenerative Medicine, Department of Medicine, Stockholm, Sweden
| | - Janek Frantzen
- Division of Clinical Neuroscience, Department of Neurosurgery, University of Turku and Turku University Hospital, Finland
| | - Jia Newcombe
- NeuroResource, UCL Institute of Neurology, University College London, London, England, United Kingdom
| | - Kanar Alkass
- KI Donatum, Department of Forensic Medicine, Stockholm, Sweden
| | - Henrik Druid
- KI Donatum, Department of Forensic Medicine, Stockholm, Sweden
| | - Matteo Bottai
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Matias Röyttä
- Department of Pathology, University of Turku and Turku University Hospital, Finland
| | - Katarina Le Blanc
- Division of Clinical Immunology, Department of Laboratory Medicine, Finland.,Hematology Centre, Karolinska University Hospital, Stockholm, Sweden
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16
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Nazari-Farsani S, Finnilä S, Moritz N, Mattila K, Alm JJ, Aro HT. Is Model-based Radiostereometric Analysis Suitable for Clinical Trials of a Cementless Tapered Wedge Femoral Stem? Clin Orthop Relat Res 2016; 474:2246-53. [PMID: 27334320 PMCID: PMC5014820 DOI: 10.1007/s11999-016-4930-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/06/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND In clinical trials of THA, model-based radiostereometric analysis (RSA) techniques may be less precise than conventional marker-based RSA for measurement of femoral stem rotation. We verified the accuracy and clinical precision of RSA based on computer-aided design models of a cementless tapered wedge femoral stem. QUESTIONS We asked: (1) Is the accuracy of model-based RSA comparable to that of marker-based RSA? (2) What is the clinical precision of model-based RSA? METHODS Model-based RSA was performed using combined three-dimensional computer-aided design models of the stem and head provided by the implant manufacturer. The accuracy of model-based RSA was compared with that of marker-based RSA in a phantom model using micromanipulators for controlled translation in three axes (x, y, z) and rotation around the y axis. The clinical precision of model-based RSA was evaluated by double examinations of patients who had arthroplasties (n = 24) in an ongoing trial. The clinical precision was defined as being at an acceptable level if the number of patients needed for a randomized trial would not differ from a trial done with conventional marker-based RSA (15-25 patients per group). RESULTS The accuracy of model-based RSA was 0.03 mm for subsidence (translation along the y axis) (95% CI for the difference between RSA measurements and actual displacement measured with micrometers, -0.03-0.00) and 0.39° for rotation around the y axis (95% CI, -0.41 to -0.06). The accuracy of marker-based RSA was 0.06 mm for subsidence (95% CI, -0.04-0.01; p = 0.728 compared with model-based RSA) and 0.18° for the y axis rotation (95% CI, -0.23 to -0.07; p = 0.358). The clinical precision of model-based RSA was 0.14 mm for subsidence (95% CI for the difference between double examinations, -0.02-0.04) and 0.79° for the y axis rotation (95% CI, -0.16-0.18). CONCLUSIONS The accuracy of model-based RSA for measurement of the y axis rotation was not quite as high as that of marker-based RSA, but its clinical precision is at an acceptable level. CLINICAL RELEVANCE Model-based RSA may be suitable for clinical trials of cementless tapered wedge femoral stem designs.
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Affiliation(s)
- Sanaz Nazari-Farsani
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku and Turku University Hospital, T-hospital, PL 52, 20521, Turku, Finland
| | - Sami Finnilä
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku and Turku University Hospital, T-hospital, PL 52, 20521, Turku, Finland
| | - Niko Moritz
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku and Turku University Hospital, T-hospital, PL 52, 20521, Turku, Finland
| | - Kimmo Mattila
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Jessica J Alm
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku and Turku University Hospital, T-hospital, PL 52, 20521, Turku, Finland
| | - Hannu T Aro
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku and Turku University Hospital, T-hospital, PL 52, 20521, Turku, Finland.
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17
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Abstract
Background and purpose - Bisphosphonates are widely used in the treatment of bone loss, but they might also have positive effects on osteoblastic cells and bone formation. We evaluated the effect of in vivo zoledronic acid (ZA) treatment and possible concomitant effects of ZA and fracture on the ex vivo osteogenic capacity of rat mesenchymal stromal cells (MSCs). Methods - A closed femoral fracture model was used in adult female rats and ZA was administered as a single bolus or as weekly doses up to 8 weeks. Bone marrow MSCs were isolated and cultured for in vitro analyses. Fracture healing was evaluated by radiography, micro-computed tomography (μCT), and histology. Results - Both bolus and weekly ZA increased fracture-site bone mineral content and volume. MSCs from weekly ZA-treated animals showed increased ex vivo proliferative capacity, while no substantial effect on osteoblastic differentiation was observed. Fracture itself did not have any substantial effect on cell proliferation or differentiation at 8 weeks. Serum biochemical markers showed higher levels of bone formation in animals with fracture than in intact animals, while no difference in bone resorption was observed. Interestingly, ex vivo osteoblastic differentiation of MSCs was found to correlate with in vivo serum bone markers. Interpretation - Our data show that in vivo zoledronic acid treatment can influence ex vivo proliferation of MSCs, indicating that bisphosphonates can have sustainable effects on cells of the osteoblastic lineage. Further research is needed to investigate the mechanisms.
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Affiliation(s)
- Terhi J Heino
- Department of Cell Biology and Anatomy, Institute of Biomedicine, University of Turku;
| | - Jessica J Alm
- Orthopaedic Research Unit, University of Turku, Turku;
| | - Heikki J Halkosaari
- Department of Cell Biology and Anatomy, Institute of Biomedicine, University of Turku;
| | - Ville-Valtteri Välimäki
- Orthopaedic Research Unit, University of Turku, Turku; ,Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Correspondence:
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18
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Davies LC, Alm JJ, Heldring N, Moll G, Gavin C, Batsis I, Qian H, Sigvardsson M, Nilsson B, Kyllonen LE, Salmela KT, Carlsson PO, Korsgren O, Le Blanc K. Type 1 Diabetes Mellitus Donor Mesenchymal Stromal Cells Exhibit Comparable Potency to Healthy Controls In Vitro. Stem Cells Transl Med 2016; 5:1485-1495. [PMID: 27412884 DOI: 10.5966/sctm.2015-0272] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 04/01/2016] [Indexed: 12/13/2022] Open
Abstract
: Bone marrow mesenchymal stromal cells (BM-MSCs) have been characterized and used in many clinical studies based on their immunomodulatory and regenerative properties. We have recently reported the benefit of autologous MSC systemic therapy in the treatment of type 1 diabetes mellitus (T1D). Compared with allogeneic cells, use of autologous products reduces the risk of eliciting undesired complications in the recipient, including rejection, immunization, and transmission of viruses and prions; however, comparable potency of autologous cells is required for this treatment approach to remain feasible. To date, no analysis has been reported that phenotypically and functionally characterizes MSCs derived from newly diagnosed and late-stage T1D donors in vitro with respect to their suitability for systemic immunotherapy. In this study, we used gene array in combination with functional in vitro assays to address these questions. MSCs from T1D donors and healthy controls were expanded from BM aspirates. BM mononuclear cell counts and growth kinetics were comparable between the groups, with equivalent colony-forming unit-fibroblast capacity. Gene microarrays demonstrated differential gene expression between healthy and late-stage T1D donors in relation to cytokine secretion, immunomodulatory activity, and wound healing potential. Despite transcriptional differences, T1D MSCs did not demonstrate a significant difference from healthy controls in immunosuppressive activity, migratory capacity, or hemocompatibility. We conclude that despite differential gene expression, expanded MSCs from T1D donors are phenotypically and functionally similar to healthy control MSCs with regard to their immunomodulatory and migratory potential, indicating their suitability for use in autologous systemic therapy. SIGNIFICANCE The potential for mesenchymal stromal cells (MSCs) as a cell-based therapy in the treatment of immunologic disorders has been well established. Recent studies reported the clinical potential for autologous MSCs as a systemic therapy in the treatment of type I diabetes mellitus (T1D). The current study compared the genotypic and phenotypic profiles of bone marrow-derived MSCs from T1D and healthy donors as autologous (compared with allogeneic) therapy provides distinct advantages, such as reduced risk of immune reaction and transmission of infectious agents. The findings of the current study demonstrate that despite moderate differences in T1D MSCs at the gene level, these cells can be expanded in culture to an extent corresponding to that of MSCs derived from healthy donors. No functional difference in terms of immunosuppressive activity, blood compatibility, or migratory capacity was evident between the groups. The study findings also show that autologous MSC therapy holds promise as a T1D treatment and should be evaluated further in clinical trials.
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Affiliation(s)
- Lindsay C Davies
- Center for Hematology and Regenerative Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Divisions of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Jessica J Alm
- Center for Hematology and Regenerative Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Divisions of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Nina Heldring
- Center for Hematology and Regenerative Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Divisions of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Guido Moll
- Center for Hematology and Regenerative Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Divisions of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Caroline Gavin
- Center for Hematology and Regenerative Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Divisions of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ioannis Batsis
- Center for Hematology and Regenerative Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Hong Qian
- Center for Hematology and Regenerative Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Sigvardsson
- Institution for Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Bo Nilsson
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Lauri E Kyllonen
- Division of Transplantation, Helsinki University Hospital, Helsinki, Finland
| | - Kaija T Salmela
- Division of Transplantation, Helsinki University Hospital, Helsinki, Finland
| | - Per-Ola Carlsson
- Department of Medical Cell Biology, Uppsala University, Sweden
- Department of Medical Sciences, Uppsala University, Sweden
| | - Olle Korsgren
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Katarina Le Blanc
- Center for Hematology and Regenerative Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Divisions of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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19
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Finnilä S, Moritz N, SvedströM E, Alm JJ, Aro HT. Increased migration of uncemented acetabular cups in female total hip arthroplasty patients with low systemic bone mineral density. A 2-year RSA and 8-year radiographic follow-up study of 34 patients. Acta Orthop 2016; 87:48-54. [PMID: 26569616 PMCID: PMC4940591 DOI: 10.3109/17453674.2015.1115312] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Low bone mineral density (BMD) may jeopardize the initial component stability and delay osseointegration of uncemented acetabular cups in total hip arthroplasty (THA). We measured the migration of uncemented cups in women with low or normal BMD. PATIENTS AND METHODS We used radiostereometric analysis (RSA) to measure the migration of hydroxyapatite-coated titanium alloy cups with alumina-on-alumina bearings in THA of 34 female patients with a median age of 64 (41-78) years. 10 patients had normal BMD and 24 patients had low systemic BMD (T-score ≤ -1) based on dual-energy X-ray absorptiometry (DXA). Cup migration was followed with RSA for 2 years. Radiographic follow-up was done at a median of 8 (2-10) years. RESULTS Patients with normal BMD did not show a statistically significant cup migration after the settling period of 3 months, while patients with low BMD had a continuous proximal migration between 3 and 12 months (p = 0.03). These differences in cup migration persisted at 24 months. Based on the perceived risk of cup revision, 14 of the 24 cases were "at risk" (proximal translation of 0.2 to 1.0 mm) in the low-BMD group and 2 of the 10 cases were "at risk" in the normal-BMD group (odds ratio (OR) = 8.0, 95% CI: 1.3-48). The radiographic follow-up showed no radiolucent lines or osteolysis. 2 cups have been revised for fractures of the ceramic bearings, but none for loosening. INTERPRETATION Low BMD contributed to cup migration beyond the settling period of 3 months, but the migrating cups appeared to osseointegrate eventually.
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Affiliation(s)
- Sami Finnilä
- Orthopaedic Research Unit, Turku University Hospital and University of Turku
| | - Niko Moritz
- Orthopaedic Research Unit, Turku University Hospital and University of Turku
| | - Erkki SvedströM
- Department of Diagnostic Radiology, Turku University Hospital, Turku, Finland.
| | - Jessica J Alm
- Orthopaedic Research Unit, Turku University Hospital and University of Turku
| | - Hannu T Aro
- Orthopaedic Research Unit, Turku University Hospital and University of Turku,Correspondence:
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Alm JJ, Moritz N, Aro HT. In vitro osteogenic capacity of bone marrow MSCs from postmenopausal women reflect the osseointegration of their cementless hip stems. Bone Rep 2016; 5:124-135. [PMID: 28326353 PMCID: PMC4926811 DOI: 10.1016/j.bonr.2016.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/12/2015] [Revised: 04/25/2016] [Accepted: 05/20/2016] [Indexed: 11/06/2022] Open
Abstract
Age-related dysfunction of mesenchymal stromal cells (MSCs) is suggested as a main cause of altered bone repair with aging. We recently showed that in postmenopausal women undergoing cementless total hip arthroplasty (THA) aging, low bone mineral density (BMD) and age-related geometric changes of the proximal femur are risk factors for increased early migration and delayed osseointegration of the femoral stems. Extending these analyses, we have here explored how the in vitro osteogenic capacity of bone marrow MSCs from these patients reflects implant osseointegration, representing the patient's in vivo bone healing capacity. A total of 19 postmenopausal women with primary hip osteoarthritis (mean age 65 years, range 50–78) and well-defined bone quality underwent successful preoperative in vitro analysis of osteogenic capacity of iliac crest bone marrow MSCs as well as two-year radiostereometric (RSA) follow-up of femoral stem migration after cementless THA. In patients with MSCs of low osteogenic capacity, the magnitude of cumulative stem subsidence after the settling period of three months was greater (p = 0.028) and the time point for translational osseointegration was significantly delayed (p = 0.030) compared to patients with MSCs of high osteogenic capacity. This study suggests that patients with MSCs of low in vitro osteogenic capacity may display increased stem subsidence after the settling period of 3 months and thereby delayed osseointegration. Our study presents a novel approach for studying the biological progress of hip implant osseointegration and to verify the impact of decreased MSCs function, especially in patients with age-related dysfunction of MSCs and bone healing capacity. Age-related dysfunction of MSCs is a main cause of altered bone repair with aging. MSCs play a critical role in osseointegration of cementless hip replacement. We explored if hip implant osseointegration in postmenopausal women is mirrored by in vitro osteogenic ability of their MSCs. Low osteogenic differentiation of MSCs correlated with increased implant migration.
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Affiliation(s)
- Jessica J Alm
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku/Turku University Hospital, Turku, Finland
| | - Niko Moritz
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku/Turku University Hospital, Turku, Finland
| | - Hannu T Aro
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku/Turku University Hospital, Turku, Finland
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Moll G, Alm JJ, Davies LC, von Bahr L, Heldring N, Stenbeck-Funke L, Hamad OA, Hinsch R, Ignatowicz L, Locke M, Lönnies H, Lambris JD, Teramura Y, Nilsson-Ekdahl K, Nilsson B, Le Blanc K. Do cryopreserved mesenchymal stromal cells display impaired immunomodulatory and therapeutic properties? Stem Cells 2015; 32:2430-42. [PMID: 24805247 DOI: 10.1002/stem.1729] [Citation(s) in RCA: 236] [Impact Index Per Article: 26.2] [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: 12/18/2013] [Revised: 04/01/2014] [Accepted: 04/09/2014] [Indexed: 12/17/2022]
Abstract
We have recently reported that therapeutic mesenchymal stromal cells (MSCs) have low engraftment and trigger the instant blood mediated inflammatory reaction (IBMIR) after systemic delivery to patients, resulting in compromised cell function. In order to optimize the product, we compared the immunomodulatory, blood regulatory, and therapeutic properties of freeze-thawed and freshly harvested cells. We found that freeze-thawed MSCs, as opposed to cells harvested from continuous cultures, have impaired immunomodulatory and blood regulatory properties. Freeze-thawed MSCs demonstrated reduced responsiveness to proinflammatory stimuli, an impaired production of anti-inflammatory mediators, increased triggering of the IBMIR, and a strong activation of the complement cascade compared to fresh cells. This resulted in twice the efficiency in lysis of thawed MSCs after 1 hour of serum exposure. We found a 50% and 80% reduction in viable cells with freshly detached as opposed to thawed in vitro cells, indicating a small benefit for fresh cells. In evaluation of clinical response, we report a trend that fresh cells, and cells of low passage, demonstrate improved clinical outcome. Patients treated with freshly harvested cells in low passage had a 100% response rate, twice the response rate of 50% observed in a comparable group of patients treated with freeze-thawed cells at higher passage. We conclude that cryobanked MSCs have reduced immunomodulatory and blood regulatory properties directly after thawing, resulting in faster complement-mediated elimination after blood exposure. These changes seem to be paired by differences in therapeutic efficacy in treatment of immune ailments after hematopoietic stem cell transplantation.
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Affiliation(s)
- Guido Moll
- Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Hematology and Regenerative Medicine Centre at Karolinska University Hospital Huddinge, Stockholm, Sweden
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Joensuu K, Uusitalo L, Alm JJ, Aro HT, Hentunen TA, Heino TJ. Enhanced osteoblastic differentiation and bone formation in co-culture of human bone marrow mesenchymal stromal cells and peripheral blood mononuclear cells with exogenous VEGF. Orthop Traumatol Surg Res 2015; 101:381-6. [PMID: 25813558 DOI: 10.1016/j.otsr.2015.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 10/23/2014] [Revised: 01/19/2015] [Accepted: 01/27/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite recent advances in bone tissue engineering, efficient bone formation and vascularization remains a challenge for clinical applications. HYPOTHESIS The aim of this study was to investigate if the osteoblastic differentiation of human mesenchymal stromal cells (MSCs) can be enhanced by co-culturing them with peripheral blood (PB) mononuclear cells (MNCs), with and without vascular endothelial growth factor (VEGF), a coupling factor of bone formation and angiogenesis. MATERIALS AND METHODS Human bone marrow (BM) derived MSCs were co-cultured with PB-MNCs in osteogenic medium with or without VEGF. Osteoblastic differentiation and mineral deposition were studied by staining for alkaline phosphatase (ALP), and von Kossa, respectively, and measurements for ALP activity and calcium concentration (Ca). Cell proliferation was assayed with Alamar blue. The mechanism(s) were further studied by Transwell(®) cell culture experiments. RESULTS Both ALP and mineralization (von Kossa and Ca) were significantly higher in the MSC-MNC co-cultures compared to plain MSC cultures. VEGF alone had no effect on osteoblastic differentiation of MSCs, but further enhanced differentiation in co-culture settings. The mechanism was shown to require cell-cell contact between MSCs and MNCs and the factors contributing to further differentiation appear to be soluble. No differences were observed in cell proliferation. CONCLUSION Our study demonstrates that the in vitro ALP activity and mineralization of human BM-MSCs is more efficient in the presence of PB-MNCs, and exogenously added VEGF further enhances the stimulatory effect. This indicates that PB-MNCs could be a potential cell source in development of co-culture systems for novel tissue engineering applications for enhanced bone healing.
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Affiliation(s)
- K Joensuu
- Department of Cell Biology and Anatomy, Kiinamyllynkatu 10 C3, 20520 Turku, Finland.
| | - L Uusitalo
- Department of Cell Biology and Anatomy, Kiinamyllynkatu 10 C3, 20520 Turku, Finland
| | - J J Alm
- Orthopedic Research Unit, Department of Orthopedic Surgery and Traumatology, University of Turku, Turku, Finland
| | - H T Aro
- Orthopedic Research Unit, Department of Orthopedic Surgery and Traumatology, University of Turku, Turku, Finland
| | - T A Hentunen
- Department of Cell Biology and Anatomy, Kiinamyllynkatu 10 C3, 20520 Turku, Finland
| | - T J Heino
- Department of Cell Biology and Anatomy, Kiinamyllynkatu 10 C3, 20520 Turku, Finland; Orthopedic Research Unit, Department of Orthopedic Surgery and Traumatology, University of Turku, Turku, Finland
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Moll G, Hult A, von Bahr L, Alm JJ, Heldring N, Hamad OA, Stenbeck-Funke L, Larsson S, Teramura Y, Roelofs H, Nilsson B, Fibbe WE, Olsson ML, Le Blanc K. Do ABO blood group antigens hamper the therapeutic efficacy of mesenchymal stromal cells? PLoS One 2014; 9:e85040. [PMID: 24454787 PMCID: PMC3890285 DOI: 10.1371/journal.pone.0085040] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/19/2013] [Indexed: 12/14/2022] Open
Abstract
Investigation into predictors for treatment outcome is essential to improve the clinical efficacy of therapeutic multipotent mesenchymal stromal cells (MSCs). We therefore studied the possible harmful impact of immunogenic ABO blood groups antigens – genetically governed antigenic determinants – at all given steps of MSC-therapy, from cell isolation and preparation for clinical use, to final recipient outcome. We found that clinical MSCs do not inherently express or upregulate ABO blood group antigens after inflammatory challenge or in vitro differentiation. Although antigen adsorption from standard culture supplements was minimal, MSCs adsorbed small quantities of ABO antigen from fresh human AB plasma (ABP), dependent on antigen concentration and adsorption time. Compared to cells washed in non-immunogenic human serum albumin (HSA), MSCs washed with ABP elicited stronger blood responses after exposure to blood from healthy O donors in vitro, containing high titers of ABO antibodies. Clinical evaluation of hematopoietic stem cell transplant (HSCT) recipients found only very low titers of anti-A/B agglutination in these strongly immunocompromised patients at the time of MSC treatment. Patient analysis revealed a trend for lower clinical response in blood group O recipients treated with ABP-exposed MSC products, but not with HSA-exposed products. We conclude, that clinical grade MSCs are ABO-neutral, but the ABP used for washing and infusion of MSCs can contaminate the cells with immunogenic ABO substance and should therefore be substituted by non-immunogenic HSA, particularly when cells are given to immunocompentent individuals.
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Affiliation(s)
- Guido Moll
- Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Annika Hult
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Lena von Bahr
- Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Hematology Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Jessica J. Alm
- Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nina Heldring
- Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Osama A. Hamad
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Lillemor Stenbeck-Funke
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Stella Larsson
- Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Yuji Teramura
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Helene Roelofs
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Bo Nilsson
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - Willem E. Fibbe
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin L. Olsson
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Katarina Le Blanc
- Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Hematology Center, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Heino TJ, Alm JJ, Moritz N, Aro HT. Comparison of the osteogenic capacity of minipig and human bone marrow-derived mesenchymal stem cells. J Orthop Res 2012; 30:1019-25. [PMID: 22570220 DOI: 10.1002/jor.22049] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 12/05/2011] [Indexed: 02/04/2023]
Abstract
Minipigs are a recommended large animal model for preclinical testing of human orthopedic implants. Mesenchymal stem cells (MSCs) are the key repair cells in bone healing and implant osseointegration, but the osteogenic capacity of minipig MSCs is incompletely known. The aim of this study was to isolate and characterize minipig bone marrow (BM) and peripheral blood (PB) MSCs in comparison to human BM-MSCs. BM sample was aspirated from posterior iliac crest of five male Göttingen minipigs (age 15 ± 1 months). PB sample was drawn for isolation of circulating MSCs. MSCs were selected by plastic-adherence as originally described by Friedenstein. Cell morphology, colony formation, proliferation, surface marker expression, and differentiation were examined. Human BM-MSCs were isolated and cultured from adult fracture patients (n = 13, age 19-60 years) using identical techniques. MSCs were found in all minipig BM samples, but no circulating MSCs could be detected. Minipig BM-MSCs had similar morphology, proliferation, and colony formation capacities as human BM-MSCs. Unexpectedly, minipig BM-MSCs had a significantly lower ability than human BM-MSCs to form differentiated and functional osteoblasts. This observation emphasizes the need for species-specific optimization of MSC culture protocol before direct systematic comparison of MSCs between human and various preclinical large animal models can be made.
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Affiliation(s)
- Terhi J Heino
- Orthopaedic Research Unit, University of Turku, Turku, Finland.
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Laine SK, Alm JJ, Virtanen SP, Aro HT, Laitala-Leinonen TK. MicroRNAs miR-96, miR-124, and miR-199a regulate gene expression in human bone marrow-derived mesenchymal stem cells. J Cell Biochem 2012; 113:2687-95. [DOI: 10.1002/jcb.24144] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Alm JJ, Heino TJ, Hentunen TA, Väänänen HK, Aro HT. Transient 100 nM dexamethasone treatment reduces inter- and intraindividual variations in osteoblastic differentiation of bone marrow-derived human mesenchymal stem cells. Tissue Eng Part C Methods 2012; 18:658-66. [PMID: 22428545 DOI: 10.1089/ten.tec.2011.0675] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The development of in vitro culturing techniques for osteoblastic differentiation of human mesenchymal stem cells (hMSC) is important for cell biology research and the development of tissue-engineering applications. Dexamethasone (Dex) is a commonly used supplement, but the optimal use of Dex treatment is still unclear. By adjusting the timing of Dex supplementation, the negative effects of long-term Dex treatment could be overcome. Transient Dex treatment could contribute toward minimizing broad donor variation, which is a major challenge. We compared the two most widely used Dex concentrations of 10 and 100 nM as transient or continuous treatment and studied inter- and intraindividual variations in osteoblastic differentiation of hMSC. Characterized bone marrow-derived hMSC from 17 female donors of different age groups were used. During osteoblastic induction, the cells were treated with 10 or 100 nM Dex either transiently for different time periods or continuously. Differentiation was evaluated by measuring alkaline phosphatase (ALP) activity and staining for ALP, von Kossa, collagen type I, and osteocalcin. Cell proliferation, cell viability, and apoptosis were also monitored. The strongest osteoblastic differentiation was observed when 100 nM Dex was present for the first week. In terms of inter- and intraindividual coefficients of variations, transient treatment with 100 nM Dex was superior to the other culture conditions and showed the lowest variations in all age groups. This study demonstrates that the temporary presence of 100 nM Dex during the first week of induction culture promotes hMSC osteoblastic differentiation and reduces inter- and intraindividual variations. With this protocol, we can reproducibly produce functional osteoblasts in vitro from the hMSC of different donor populations.
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Affiliation(s)
- Jessica J Alm
- Department of Orthopaedic Surgery and Traumatology, University of Turku and Turku University Hospital, Turku, Finland
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Aro HT, Alm JJ, Moritz N, Mäkinen TJ, Lankinen P. Low BMD affects initial stability and delays stem osseointegration in cementless total hip arthroplasty in women: a 2-year RSA study of 39 patients. Acta Orthop 2012; 83:107-14. [PMID: 22489886 PMCID: PMC3339522 DOI: 10.3109/17453674.2012.678798] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Immediate implant stability is a key factor for success in cementless total hip arthroplasty (THA). Low bone mineral density (BMD) and age-related geometric changes of the proximal femur may jeopardize initial stability and osseointegration. We compared migration of hydroxyapatite-coated femoral stems in women with or without low systemic BMD. PATIENTS AND METHODS 61 female patients with hip osteoarthritis were treated with cementless THA with anatomically designed hydroxyapatite-coated femoral stems and ceramic-ceramic bearing surfaces (ABG-II). Of the 39 eligible patients between the ages of 41 and 78 years, 12 had normal systemic BMD and 27 had osteopenia or osteoporosis. According to the Dorr classification, 21 had type A bone and 18 had type B. Translational and rotational migration of the stems was evaluated with radiostereometric analysis (RSA) up to 2 years after surgery. RESULTS Patients with low systemic BMD showed higher subsidence of the femoral stem during the first 3 months after surgery than did those with normal BMD (difference = 0.6, 95% CI: 0.1-1.1; p = 0.03). Low systemic BMD (odds ratio (OR) = 0.1, CI: 0.006-1.0; p = 0.02), low local hip BMD (OR = 0.3, CI: 0.1-0.7; p = 0.005) and ageing (OR = 1.1, CI: 1.0-1.2; p = 0.02) were risk factors for delayed translational stability. Ageing and low canal flare index were risk factors for delayed rotational stabilization (OR = 3, CI: 1.1-9; p = 0.04 and OR = 1.1, CI: 1.0-1.2; p = 0.02, respectively). Harris hip score and WOMAC score were similar in patients with normal systemic BMD and low systemic BMD. INTERPRETATION Low BMD, changes in intraosseous dimensions of the proximal femur, and ageing adversely affected initial stability and delayed osseointegration of cementless stems in women.
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Affiliation(s)
- Hannu T Aro
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Jessica J Alm
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Niko Moritz
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Tatu J Mäkinen
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Petteri Lankinen
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
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Joensuu K, Paatero I, Alm JJ, Elenius K, Aro HT, Heino TJ, Hentunen TA. Interaction between marrow-derived human mesenchymal stem cells and peripheral blood mononuclear cells in endothelial cell differentiation. Scand J Surg 2011; 100:216-22. [PMID: 22108752 DOI: 10.1177/145749691110000314] [Citation(s) in RCA: 13] [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: 11/16/2022]
Abstract
BACKGROUND AND AIMS In adult connective tissues, mesenchymal stem cells (MSCs) play a key role in normal tissue turnover and repair. MSCs can participate in these processes not only through proliferation and differentiation but also through paracrine/autocrine functions. These characteristics make MSCs the optimal target in the development of cell-based therapies. This study describes a novel interaction between human MSC and blood mononuclear cells (MNCs), resulting in formation of blood vessel-like structures. MATERIALS AND METHODS Human marrow-derived MSCs and peripheral blood MNCs were co-cultured in monolayer cultures as well as in bovine collagen sponge up to 20 days. No exogenously supplied growth factors were applied. Morphological changes and formations of three dimensional structures were detected by light microscopy. The process was further stu-died for the expression of different endothelial cell markers. The expression of PECAM-1 and endoglin was studied by immunohistochemistry and the expression of vascular endothelial growth factor receptors 1 and 2 using quantitative real time PCR. RESULTS In co-cultures of human MSCs and MNCs, the previously nonadherent cells attached and started to elongate and formed tube-like structures within one week. At day 10, elongated PECAM-1 and endoglin expressing cells were detected in co-cultures. At day 20, PECAM-1 and endoglin-positive vessel-like structures were observed. VEGFR1 was up-regulated in co-cultures after 10 days, and expression levels increased with time. No PECAM-1, endoglin or VEGFR1 expressing cells were discovered in MSC-cultures without MNCs at any time point. CONCLUSIONS This study demonstrates induction of endothelial differentiation in co-cultures of human MSCs and MNCs, indicating a mechanism by which local application of MSCs could induce angiogenesis in vivo.
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Affiliation(s)
- K Joensuu
- Department of Cell Biology and Anatomy, Institute of Biomedicine, University of Turku, Turku, Finland.
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Keränen P, Moritz N, Alm JJ, Ylänen H, Kommonen B, Aro HT. Bioactive glass microspheres as osteopromotive inlays in macrotextured surfaces of Ti and CoCr alloy bone implants: Trapezoidal surface grooves without inlay most efficient in resisting torsional forces. J Mech Behav Biomed Mater 2011; 4:1483-91. [DOI: 10.1016/j.jmbbm.2011.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 05/08/2011] [Indexed: 10/18/2022]
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Abstract
We examined the presence of circulating plastic adherent multipotent mesenchymal stem cells (MSCs) in fracture patients. Three patient groups (n = 10-18) were evaluated, including elderly females with a femoral neck fracture treated with cemented hemiarthroplasty, an age- and sex-matched group with hip osteoarthritis (OA) treated with cemented total hip arthroplasty (THA), and younger adults with surgically treated lower extremity fractures. The presence of circulating MSCs pre- and postoperatively was compared to bone marrow (BM) MSCs from the same subjects. Criteria for identifying MSCs included cell surface markers (CD105+, CD73+, CD90+, CD45-, CD14-), proliferation through several passages as well as osteogenic, chondrogenic, and adipogenic differentiation. Plastic adherent MSCs were found in peripheral blood (PB) from 22% of hip fracture patients, 46% of younger fracture patients, and in none of 63 pre- and postmenopausal women with hip OA. When detectable, circulating MSCs appeared between 39 and 101 h after fracture. PB derived MSCs did not differ from BM derived MSCs, except for a small population (<15%) of CD34+ cells among PB derived MSCs. This initial study indicates mobilization of MSCs into the circulation in response to fracture, even in very old patients, while circulating MSCs were not detectable before or after elective THA.
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Affiliation(s)
- Jessica J Alm
- Orthopaedic Research Unit, Department of Orthopaedic Research and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
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Moritz N, Alm JJ, Lankinen P, Mäkinen TJ, Mattila K, Aro HT. Quality of intertrochanteric cancellous bone as predictor of femoral stem RSA migration in cementless total hip arthroplasty. J Biomech 2010; 44:221-7. [PMID: 21074160 DOI: 10.1016/j.jbiomech.2010.10.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 10/12/2010] [Indexed: 01/29/2023]
Abstract
In cementless total hip arthroplasty, osteoporosis may jeopardize the achievement of immediate stability and lead to migration of anatomically shaped femoral stems. Poor quality of proximal cancellous bone per se may also affect the rate of osseointegration. In a selected group of female total hip arthroplasty patients (mean age 64 years) with unremarkable medical history, intertrochanteric cancellous bone biopsy was taken from the site of stem implantation. Local bone quality, determined by structural μCT imaging and destructive compression testing of the biopsy tissue, was used as the predictor of three-dimensional stem migration determined by radiostereometric analysis (RSA) up to 24 months. The patients exhibited major differences in mechanical properties of the intertrochanteric cancellous bone, which were closely related to the structural parameters calculated from μCT data. Unexpectedly, the major differences observed in the quality of trochanteric cancellous bone had only minor reflections in the RSA migration of the femoral stems. In statistical analysis, the μCT-based bone mineral density quartile (low, middle, high) was the only significant predictor for stem translation at 24 months (p=0.022) but only a small portion (R(2)=0.16) of the difference in translation could be explained by changes in bone mineral density quartile. None of the other parameters investigated predicted stem migration in translation or rotation. In conclusion, poor quality of intertrochanteric cancellous bone seems to contribute to the risk of implant migration less than expected. Probably also the importance of surgical preservation of intertrochanteric cancellous bone has been over-emphasized for osseointegration of cementless stem.
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Affiliation(s)
- Niko Moritz
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku, Kiinamyllykatu 10, Turku, Finland
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Alm JJ, Frantzén JPA, Moritz N, Lankinen P, Tukiainen M, Kellomäki M, Aro HT. In vivo testing of a biodegradable woven fabric made of bioactive glass fibers and PLGA80-A pilot study in the rabbit. J Biomed Mater Res B Appl Biomater 2010; 93:573-80. [DOI: 10.1002/jbm.b.31618] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Alm JJ, Mäkinen TJ, Lankinen P, Moritz N, Vahlberg T, Aro HT. Female patients with low systemic BMD are prone to bone loss in Gruen zone 7 after cementless total hip arthroplasty. Acta Orthop 2009; 80:531-7. [PMID: 19916684 PMCID: PMC2823339 DOI: 10.3109/17453670903316801] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Factors that lead to periprosthetic bone loss following total hip arthroplasty (THA) may not only depend on biomechanical implant-related factors, but also on various patient-related factors. We investigated the association between early changes in periprosthetic bone mineral density (BMD) and patient-related factors. PATIENTS AND METHODS 39 female patients underwent cementless THA (ABG II) with ceramic-ceramic bearing surfaces. Periprosthetic BMD in the proximal femur was determined with DXA after surgery and at 3, 6, 12, and 24 months. 27 patient-related factors were analyzed for their value in prediction of periprosthetic bone loss. RESULTS Total periprosthetic BMD was temporarily reduced by 3.7% at 3 months (p < 0.001), by 3.8% at 6 months (p < 0.01), and by 2.6% at 12 months (p < 0.01), but recovered thereafter up to 24 months. Preoperative systemic osteopenia and osteoporosis, but not the local BMD of the operated hip, was predictive of bone loss in Gruen zone 7 (p = 0.04), which was the only region with a statistically significant decrease in BMD (23%, p < 0.001) at 24 months. Preoperative serum markers of bone turnover predicted the early temporary changes of periprosthetic BMD. The other patient-related factors failed to show any association with the periprosthetic BMD changes. INTERPRETATION Female patients with low systemic BMD show greater bone loss in Gruen zone 7 after cementless THA than patients with normal BMD. Systemic DXA screening for osteoporosis in postmenopausal patients before THA could be used to identify patients in need of prophylactic anti-resorptive therapy.
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Affiliation(s)
- Jessica J Alm
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Turku University Central Hospital and University of TurkuFinland
| | - Tatu J Mäkinen
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Turku University Central Hospital and University of TurkuFinland
| | - Petteri Lankinen
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Turku University Central Hospital and University of TurkuFinland
| | - Niko Moritz
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Turku University Central Hospital and University of TurkuFinland
| | - Tero Vahlberg
- Department of Biostatistics, University of TurkuTurkuFinland
| | - Hannu T Aro
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Turku University Central Hospital and University of TurkuFinland
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Mäkinen TJ, Alm JJ, Laine H, Svedström E, Aro HT. The incidence of osteopenia and osteoporosis in women with hip osteoarthritis scheduled for cementless total joint replacement. Bone 2007; 40:1041-7. [PMID: 17239668 DOI: 10.1016/j.bone.2006.11.013] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Revised: 11/19/2006] [Accepted: 11/21/2006] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The co-existence of osteoporosis (OP) and osteoarthritis (OA) remains obscure. No systematic studies have been carried out to exclude the possibility that especially female osteoarthritic patients selected for cementless total hip arthroplasty (THA) suffer from primary or secondary OP. METHODS A subgroup of fifty-three female patients (average age, 64.7 years) with advanced primary hip OA scheduled for cementless THA were recruited for DXA and laboratory screening. Before surgery, bone mineral density (BMD) of the lumbar spine, the proximal femurs and the distal forearm were measured. The serum concentrations of calcium, 25-hydroxyvitamin D, parathyroid hormone and biochemical markers of bone resorption and formation were determined to exclude secondary OP. RESULTS The prevalence of OP (T score <-2.5) and osteopenia (-1.0 >T score >-2.5) were 28% and 45%, respectively. Statistically, OP was related to patient's age, low BMI, postmenopausal status and not having estrogen replacement therapy. Five patients (9%) had laboratory findings of secondary OP. Two of them were found to have a parathyroid adenoma. The prevalence of vitamin D insufficiency [S-25(OH)D levels <or=50 nmol/l] was 36% (n=19). As a sign of high bone turnover, the patients with reduced BMD values showed significantly increased serum levels of osteocalcin (p=0.049), intact procollagen type I N propeptide (p=0.040) and N-terminal crosslinking telopeptide of type I collagen (p=0.046). The BMC of the femoral necks of the osteoarthritic hips were significantly higher (p<0.001) and the BMC of the trochanter regions significantly lower (p=0.005) compared to the contralateral hips. CONCLUSION Against a general belief, OA does not seem to protect a patient from generalized primary OP. The majority (74%) of the female hip OA patients were osteopenic or osteoporotic with signs of increased bone turnover. The observed prevalence of reduced BMD corresponds with the published data of age-matched population. An unexpectedly high number of patients required preoperative consultation with an endocrinologist. The altered distribution of BMD observed in the proximal femurs may explain the lower prevalence of fractures reported in the femoral necks of osteoarthritic hips.
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Affiliation(s)
- Tatu J Mäkinen
- Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, University of Turku, Medisiina B4, Kiinamyllynkatu 10, FIN-20520 Turku, Finland
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