Juxtacortical susceptibility changes in progressive multifocal leukoencephalopathy at the gray-white matter junction correlates with iron-enriched macrophages.

OBJECTIVE: Describe magnetic resonance imaging (MRI) susceptibility changes in progressive multifocal leukoencephalopathy (PML) and identify neuropathological correlates. METHODS: PML cases and matched controls with primary central nervous system lymphoma (PCNSL) were retrospectively identified. MRI brain at 3 T and 7 T were reviewed. MRI-pathology correlations in fixed brain autopsy tissue were conducted in three subjects with confirmed PML. RESULTS: With PML (n = 26 total, n = 5 multiple sclerosis natalizumab-associated), juxtacortical changes on susceptibility-weighted imaging (SWI) or gradient echo (GRE) sequences were noted in 3/3 cases on 7 T MRI and 14/22 cases (63.6%) on 1.5 T or 8/22 (36.4%) 3 T MRI. Similar findings were only noted in 3/25 (12.0%) of PCNSL patients (odds ratio (OR) 12.83, 95% confidence interval (CI), 2.9-56.7, p < 0.001) on 1.5 or 3 T MRI. On susceptibility sequences available prior to diagnosis of PML, 7 (87.5%) had changes present on average 2.7 ± 1.8 months (mean ± SD) prior to diagnosis. Postmortem 7 T MRI showed SWI changes corresponded to areas of increased iron density along the gray-white matter (GM-WM) junction predominantly in macrophages. CONCLUSION: Susceptibility changes in PML along the GM-WM junction can precede noticeable fluid-attenuated inversion recovery (FLAIR) changes and correlates with iron accumulation in macrophages.

Pulsed electromagnetic field treatment enhances healing callus biomechanical properties in an animal model of osteoporotic fracture.

Delayed bone healing has been noted in osteoporosis patients and in the ovariectomized (OVX) rat model of estrogen-depletion osteopenia. Pulsed electromagnetic field (PEMF) devices are clinically approved as an adjunct to cervical fusion surgery in patients at high risk for non-fusion and for the treatment of fracture non-unions. These bone growth stimulating devices also accelerate the healing of fresh fracture repair in skeletally mature normal rats but have not been tested for efficacy to accelerate and/or enhance the delayed bone repair process in OVX rats. The current study tested the hypothesis that daily PEMF treatments would improve the fracture healing response in skeletally mature OVX rats. By 6 weeks of healing, PEMF treatments resulted in improved hard callus elastic modulus across fibula fractures normalizing the healing process in OVX rats with respect to this mechanical property. Radiographic evidence showed an improved hard callus bridging across fibula fractures in OVX rats treated with PEMF as compared to sham treatments. These findings provide a scientific rationale for investigating whether PEMF might improve bone-healing responses in at-risk osteoporotic patients.

A comparison of alendronate to varying magnitude PEMF in mitigating bone loss and altering bone remodeling in skeletally mature osteoporotic rats.

Pulsed electromagnetic field (PEMF) treatments stimulate bone formation activities though further work is needed to optimize its therapeutic benefit. PEMF can generate local potential gradients and electric currents that have been suggested to mimic bone electrochemical responses to load. In line with this reasoning, a recent publication reported that PEMF application on isolated bone tissue induced detectable micro-vibrations (doi:https://doi.org/10.1109/TMAG.2016.2515069). To determine the ability of PEMF to intervene in a rat model of osteoporosis, we tested its effect on trabecular and cortical bone following ovariectomy. Four PEMF treatments, with increasing sinusoidal amplitude rise with time (3850 Hz pulse frequency and 15 Hz repetition rate at 10 tesla/sec (T/s), 30 T/s, 100 T/s, or 300 T/s), were compared to the efficacy of an osteoporosis drug, alendronate, in reducing levels of trabecular bone loss in the proximal tibia. Herein, the novel findings from our study are: (1) 30 T/s PEMF treatment approached the efficacy of alendronate in reducing trabecular bone loss, but differed from it by not reducing bone formation rates; and (2) 30 T/s and 100 T/s PEMF treatments imparted measurable alterations in lacunocanalicular features in cortical bone, consistent with osteocyte sensitivity to PEMF in vivo. The efficacy of specific PEMF doses may relate to their ability to modulate osteocyte function such that the 30 T/s, and to a lesser extent 100 T/s, doses preferentially antagonize trabecular bone resorption while stimulating bone formation. Thus, PEMF treatments of specific magnetic field magnitudes exert a range of measurable biological effects in trabecular and cortical bone tissue in osteoporotic rats.

Mechanical conditioning of cell-seeded small intestine submucosa: a potential tissue-engineering strategy for tendon repair.

Our long-term objective is to enhance tendon repair by delivering cells on natural biologic scaffolds to the repair site. Clinical outcomes may be improved by first preconditioning these cell-seeded constructs in bioreactors to enhance their properties at implantation and to deliver cells expressing a desired phenotype. In this work, we have investigated the effect of in vitro mechanical conditioning on small-intestine submucosa (SIS) scaffolds seeded with primary tendon cells (tenocytes). SIS scaffolds (with and without cells) were conditioned under various loading regimes over a 2-week period. In vitro cyclic loading significantly increased the biomechanical properties (e.g., stiffness) of cell-seeded SIS constructs (129.1 +/- 10.2%) from time 0. The stiffness change of cyclically loaded constructs without cells was 33.9 +/- 13.8% and of statically loaded constructs with cells was 34.0 +/- 15.2% and without cells was 33.4 +/- 10.7%. In the cell-seeded groups, our data demonstrate a direct role (e.g., cell tensioning) for cells in construct stiffening. In addition, the initial stiffness of the cell-seeded, cyclically loaded constructs was found to be a strong predictor of the change in construct stiffness. Despite the mechanical integrity of these constructs being significantly less than native tendon, our data show that structural properties can be improved with in vitro mechanical conditioning. These data provide the basis for future studies investigating in vitro conditioning (mechanical, chemical) of cell-seeded ECM scaffolds and the use of such constructs for enhancing tendon repair in vivo.

Substrate concentration influences effective radial diffusion coefficient in canine cortical bone.

Transport of nutrients and waste across osseous tissue is dependent on the dynamic micro and macrostructure of the tissue; however little quantitative data exists examining how this transport occurs across the entire tissue. Here we investigate in vitro radial diffusion across a section of canine tissue, at dimensions of several hundred microns to millimeters, specifically between several osteons connected through a porous microstructure of Volkmann's canals and canaliculi. The effective diffusion coefficient is measured by a "sample immersion" technique presented here, in which the tissue sample was immersed in solution for 18-30 h, image analysis software was used to quantify the solute concentration profile in the tissue, and the data were fit to a mathematical model of diffusion in the tissue. Measurements of the effective diffusivity of sodium fluorescein using this technique were confirmed using a standard two-chamber diffusion system. As the solute concentration increased, the effective diffusivity decreased, ranging from 1.6 × 10(-7) ± 3.2 × 10(-8) cm(2)/s at 0.3 µM to 1.4 × 10(-8) ± 1.9 × 10(-9) cm(2)/s at 300 µM. The results show that there is no significant difference in mean diffusivity obtained using the two measurement techniques on the same sample, 3.3 × 10(-8) ± 3.3 × 10(-9) cm(2)/s (sample immersion), compared to 4.4 × 10(-8) ± 1.1 × 10(-8) cm(2)/s (diffusion chamber).

Lipids and collagen matrix restrict the hydraulic permeability within the porous compartment of adult cortical bone.

In vivo the hydraulic permeability of cortical bone influences the transport of nutrients, waste products and signaling molecules, thus influencing the metabolic functions of osteocytes and osteoblasts. In the current study two hypotheses were tested: the presence of (1) lipids and (2) collagen matrix in the porous compartment of cortical bone restricts its permeability. Our approach was to measure the radial permeability of adult canine cortical bone before and after extracting lipids with acetone-methanol, and before and after digesting collagen with bacterial collagenase. Our results showed that the permeability of adult canine cortical bone was below 4.0x10(-17) m2, a value consistent with prior knowledge. After extracting lipids, permeability increased to a median value of 8.6x10(-16) m2. After further digesting with collagenase, permeability increased to a median value of 1.4x10(-14) m2. We conclude that the presence of both lipids and collagen matrix within the porous compartment of cortical bone restricts its radial permeability. These novel findings suggest that the chemical composition of the tissue matrix within the porous compartment of cortical bone influences the transport and exchange of nutrients and waste products, and possibly influences the metabolic functions of osteocytes and osteoblasts.

Oxygen diffusion through natural extracellular matrices: implications for estimating "critical thickness" values in tendon tissue engineering.

Oxygen is necessary for maintaining cell proliferation and viability and extracellular matrix (ECM) production in 3-dimensional tissue engineering. Typically, diffusion is the primary mode for oxygen transport in vitro; thus, ensuring an adequate oxygen supply is essential. In this study, we determined the oxygen diffusion coefficients of 3 natural ECMs that are being investigated as construct scaffolds for tendon tissue engineering: small-intestine submucosa (SIS), human dermis (Alloderm), and canine fascia lata. Diffusion coefficients were determined using a standard diffusion cell system. The ranges for each matrix type were: SIS: 7 x 10(-6) - 2 x 10(-5) cm2/s, Alloderm: 1.9 - 3.1 x 10(-5) cm2/s, and canine fascia lata: 1.6 - 4 x 10(-5) cm2/s. We used the experimental oxygen diffusivity data for these natural ECMs in a mathematical model of oxygen diffusion through a cell-seeded scaffold to estimate the critical size of cell-seeded scaffold that can be cultured in vitro.