Serum ß-catenin changes vary among different stages of osteonecrosis of the femoral head: an exploratory biomarker study.

ABSTRACT

BACKGROUND: Wnt/ß-catenin signaling pathway is closely related to the pathogenesis Osteonecrosis of the femoral head (ONFH). ß-catenin, as a major component of Wnt signaling pathway, plays a vital role in the proliferation of osteoblasts. But the effect of altering ß-catenin level on the early diagnosis and staging of ONFH has not been studied. Our purpose is to investigate the role of ß-catenin level in the progress of ONFH. METHOD: One hundred and one patients with three stages of ONFH and fifty healthy controls were recruited between May 2016 and November 2016. We divided the patients into 32 cases of stage II, 41 cases of stage III and 28 cases of stage IV according to the Association Research Circulation Osseous (ARCO) classification. We evaluated the clinical bone histomorphology, expression position and level of ß-catenin as well as the plasma ß-catenin level. We investigated the level of ß-catenin from the serum and tissue samples using ELISA and Western Blot assay. We also evaluated the expression of ß-catenin in bone tissue by immunohistochemistry. Data were analyzed by independent t-test and ANOVA. RESULTS: We found that the mean (± SD) serum level of ß-catenin was 66.99 ± 3.032 ng/ml in the ONFH patients, which was higher than 20.14 ± 1.715 ng/ml observed in the control group (P < 0.001). Moreover, the ß-catenin levels were 49.30 ± 4.649 ng/ml, 72.54 ± 4.864 ng/ml and 79.10 ± 4.773 ng/ml in the ONFH patients with ARCO stage II, stage III and stage IV respectively, showing significant difference among them (P < 0.001). We also found that the area under the curve (AUC) calculated by ROC curve analysis to determine the values for ß-catenin levels in ONFH compared with those in the control group was 0.9358 (P < 0.001), where the sensitivity was 77.23% and specificity was 98.00%. CONCLUSION: Our results indicate that the increased ß-catenin may play a vital role in the progress of ONFH and the level of ß-catenin is correlated with ARCO stages. The cut-off concentration may be used as one of the sensitive marks to assess the disease process of ONFH.