RESUMO
In Taiwan, the incidence and prevalence of psoriatic arthritis (PsA) have risen significantly in recent years. Moreover, data from the Taiwan National Health Insurance Research Database (NHIRD) show that more than 85% of PsA patients are treated with just non-steroidal anti-inflammatory drugs (NSAIDs) and/or conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). Taiwanese clinicians have also expressed concerns regarding uncertainties in the diagnosis of PsA and the delayed, interrupted, and/or tapered use of biologics, as well as differences in therapeutic preferences between and within dermatologists and rheumatologists. To address these issues, the Taiwan Rheumatology Association and the Taiwanese Association for Psoriasis and Skin Immunology jointly convened a committee of 28 clinicians from the fields of rheumatology, dermatology, orthopedics, and rehabilitation, to develop evidence-based consensus recommendations for the practical management of PsA in Taiwan. A total of six overarching principles and 13 recommendations were developed and approved, as well as a treatment algorithm with four separate tracks for axial PsA, peripheral PsA, enthesitis, and dactylitis. Psoriasis (PsO) management was not discussed here, as the Taiwanese Dermatological Association has recently published a comprehensive consensus statement on the management of PsO. Together, these recommendations provide an up-to-date, evidence-based framework for PsA care in Taiwan.
Assuntos
Artrite Psoriásica , Psoríase , Antirreumáticos/uso terapêutico , Artrite Psoriásica/tratamento farmacológico , Artrite Psoriásica/epidemiologia , Humanos , Psoríase/tratamento farmacológico , Psoríase/epidemiologia , Reumatologia , Taiwan/epidemiologiaRESUMO
BACKGROUND: During the onset of osteoarthritis (OA), certain biochemical events have been shown to accelerate cartilage degradation, including the dysregulation of cartilage ECM anabolism, abnormal generation of reactive oxygen species (ROS) and overproduction of proteolytic enzymes and inflammatory cytokines. The potency of aucubin in protecting cellular components against oxidative stress, inflammation and apoptosis effects are well documented, which makes it a potential candidate for OA treatment. In this study, we aimed to evaluate the protective benefits of aucubin against OA using H2O2 and compression induced OA-like chondrocyte models. METHODS: The effects of aucubin were studied in porcine chondrocytes after 1 mM H2O2 stimulation for 30 min or sustained compression for 24 h. Effects of aucubin on cell proliferation and cytotoxicity of chondrocytes were measured with WST-1 and LDH assays. ROS production was evaluated by the Total ROS/Superoxide Detection Kit. Caspase-3 activity was evaluated by the CaspACE assay system. The levels of apoptosis were evaluated by the Annexin V-FITC apoptosis detection kit. OA-related gene expression was measured by reverse transcription quantitative polymerase chain reaction (RT-qPCR). Total DNA quantification was evaluated by the DNeasy Blood and Tissue kit. Sulfated-glycosaminoglycans (sGAGs) production and content were evaluated by DMMB assay and Alcian blue staining. RESULTS: The results showed that the ROS scavenge effects of aucubin appeared after 1 h of pretreatment. Aucubin could reduce the caspase-3 activity induced by H2O2, and reduced the apoptosis cell population in flowcytometry. In RT-qPCR results, aucubin could maintain ACAN and COL2A1 gene expressions, and prevent IL6 and MMP13 gene up-regulation induced by H2O2 and compression stimulations. In the DMMB assay and Alcian blue staining, aucubin could maintain the sGAG content and protect chondrocytes against compressive stress, but not oxidative stress from H2O2. CONCLUSIONS: These results indicated that aucubin has protective effects in an osteoarthritic chondrocyte model induced by H2O2 and mechanical stimulus.
Assuntos
Condrócitos/efeitos dos fármacos , Glucosídeos Iridoides/uso terapêutico , Osteoartrite/tratamento farmacológico , Agrecanas/genética , Animais , Apoptose/efeitos dos fármacos , Caspase 3/metabolismo , Proliferação de Células/efeitos dos fármacos , Colágeno Tipo II/genética , Modelos Animais de Doenças , Expressão Gênica/efeitos dos fármacos , Peróxido de Hidrogênio , Técnicas In Vitro , Interleucina-6/genética , Glucosídeos Iridoides/toxicidade , Metaloproteinase 13 da Matriz/genética , Osteoartrite/genética , Estimulação Física , Espécies Reativas de Oxigênio/metabolismo , SuínosRESUMO
BACKGROUND: Rotational alignment of the distal femur is important in total knee arthroplasty. The purpose of this study is to use a roentgenographic technique to evaluate the accuracy of mini-incision total knee arthroplasty (MIS TKA) performed based on the transepicondylar line from the kneeling view. METHODS: Totally 32 patients (aged from 64 to 80 years with an average of 70.9 years) with 46 cases of knee osteoarthritis received MIS TKA were registered. Before surgery, the condylar twist angle was measured from the kneeling view. The bone cut for the external rotation was completed, with regard to the condylar twist angle. The control group including 26 patients (aged from 50 to 89 years with an average of 69.7 years) with 42 cases of knee osteoarthritis underwent TKA with built-in cutting jig design 3 degrees of femoral external rotation. This study is a prospective continuous-time duration analysis study. The level of evidence is IIc. RESULTS: The mean condylar twist angle was 5.1° in the experimental group and 5.4° in the control group. The mean postoperative angle between the clinical epicondylar axis and the posterior condylar line of the femoral component was 0.46°. The same postoperative angle of the built-in external rotation in the control group was 2.7°. The condylar twist angle was significantly more accurate than the built-in design. CONCLUSION: Our result substantiates that the kneeling view is practicable and reproducible as the cutting reference for femoral external rotation. The accuracy of the kneeling view shows that the epicondylar axis can be used in smaller wound surgery, such as MIS TKA. LEVEL OF EVIDENCE: Level IIc.
Assuntos
Fêmur/cirurgia , Articulação do Joelho/cirurgia , Prótese do Joelho , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Monitorização Intraoperatória/métodos , Osteoartrite do Joelho/cirurgia , Anormalidade Torcional/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Artroplastia do Joelho/métodos , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Feminino , Fêmur/diagnóstico por imagem , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Anormalidade Torcional/diagnósticoRESUMO
Total knee arthroplasty (TKA) approaches affect recovery outcomes, with different levels of residual loss of muscle strength and functional deficits. The current study compared the gait balance control in older individuals 3 months after TKA via the lateral parapatellar approach (LPPA) and mid-vastus approach (MVA) in terms of the inclination angle (IA) of the center of pressure (COP) to the body's center of mass (COM) vector, and the rate of change of IA (RCIA). In a gait laboratory, 12 patients with severe medial knee osteoarthritis who had undergone bilateral TKA via LPPA and 12 via MVA were evaluated and compared against 12 healthy controls for their balance control during gait 3 months after surgery. The participants' kinematic data and ground reaction forces were measured synchronously using an 8-camera motion capture system and three forceplates, respectively, from which the COM, COP, IA and RCIA were calculated using a 13-body-segment model. The LPPA group showed significantly greater sagittal IA during DLS (p < 0.01) but less sagittal and frontal RCIA throughout the gait cycle (p < 0.04) compared to controls. The MVA showed better recovery in the balance control with most IA and RCIA variables similar to those of the healthy controls throughout the gait cycle. The patients with LPPA walked with a compromised balance control throughout the gait cycle while the MVA group showed close-to-normal balance control with a slight decrease in sagittal RCIA during SLS. The current between-approach findings were likely related to the differences in the muscles involved during surgery, suggesting that MVA may be a better choice than LPPA when taking short-term gait balance control into consideration.
RESUMO
Osteoarthritis (OA) of the knee is characterized by progressive deterioration and loss of articular cartilage with associatedstructural and performance changes in the entire joint, and current treatments for OA only aim to relieve symptoms, rather than to prevent or reverse disease progression. Recently, treatments targeting "early osteoarthritis" (EOA) have attracted attention. However, during EOA stage, chondrocytes may change behaviors to express pro-inflammatory cytokines and free radicals, which would cause detrimental effects to the synovial cavity and further cartilage wear. In this study, we combined resveratrol (Res) and Bletilla striata polysaccharide (BSP) as anti-inflammatories and antioxidants to diffuse free radicals and to alleviate inflammation from the synovial cavity both short term and long term. The current study introduced a new method for harvesting BSP from as-received Bletilla striata to achieve high yields, shortened extraction times, and maintained structure/functions. In addition, it combined Res and home-extracted BSP (Res-BSP) to alleviate oxidative stress and inflammation in a Lipopolysaccharide (LPS)-induced OA model. The gene expressions of inflammatory genes iNOs, IL-1ß, IL-6, and MMP-13 were upregulated 5.7-fold, 6.5-fold, 8.6-fold, and 4.5-fold, respectively on OA-like chondrocytes and the gene expressions were significantly downregulated to 3.3-fold, 2.1-fold, 4.9-fold, and 0.1-fold, respectively, once OA-like chondrocytes were treated with Res-BSP (p < 0.05, compared with OA-like chondrocytes). The gene expressions of chondrogenic genes TGFß1, SOX9, and type II collagen were downregulated by 0.8-fold, 2.2-fold, and 0.8-fold, respectively, based on the control group as a baseline. While it was significantly upregulated by 3.4-fold, 0.32-fold, and 0.4-fold, respectively, once OA-like chondrocytes were treated with Res-BSP. (p < 0.05, compared with OA-like chondrocytes). Finally, we elucidated the role of Res-BSP in EOA in suppressing COX-2 and activating p-Smad 2/3 and p-Erk1/2. We believe that the combination of Res and BSP has great potential as an alternative therapeutic strategy for EOA treatment in future.
RESUMO
AIM: This article is a report on a pilot study conducted to determine the effects of cognitively stimulating activities in older patients undergoing elective hip and/or knee replacement. BACKGROUND: Cognitive decline occurs in 16-35·5% of older hospitalized patients. In-hospital interventions, such as cognitively stimulating activities, might combat cognitive decline. However, evidence supporting such interventions is limited. METHODS: For this randomized pilot trial, 50 older patients (90% women with a mean age of 72·8 years) were recruited in 2008 from a tertiary medical centre in Taiwan. While hospitalized, participants in the intervention group received a daily nurse-led, individual-based, cognitive-stimulation intervention. The comparison group received usual care. Cognitive function was assessed using Mini-Mental State Examination at admission, discharge and 1 month after discharge. RESULTS: The incidence of cognitive decline (≥2-point decline in cognitive score) by hospital discharge was significantly lower for the intervention group (12%) than the usual care group (44%). The intervention group also had better cognitive scores following hospitalization. Upon discharge, participants in the intervention group scored 1·28 points higher than at admission, whereas participants in the usual care declined by 0·76 points. Improvement in cognitive status persisted for the intervention group (+1·33 points) vs. usual care (-0·26 points) at 1 month after discharge. Group differences in changes were statistically significant both at discharge and 1 month afterwards. CONCLUSION: Our cognitive-stimulation intervention benefited global cognitive function among older patients undergoing elective hip and/or knee replacement. The benefit persisted at 1 month after discharge.
Assuntos
Artroplastia de Quadril/enfermagem , Artroplastia do Joelho/enfermagem , Transtornos Cognitivos/terapia , Terapia Cognitivo-Comportamental/métodos , Hospitalização , Idoso , Artroplastia de Quadril/psicologia , Artroplastia do Joelho/psicologia , Cognição/fisiologia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/prevenção & controle , Feminino , Humanos , Testes de Inteligência , Masculino , Pesquisa em Avaliação de Enfermagem , Projetos Piloto , Padrões de Prática em Enfermagem , TaiwanRESUMO
Older adults are at higher risk of falling following total knee arthroplasty (TKA). However, it remains unclear how long a full recovery of the balance control during gait post-TKA will take. The current study aimed to bridge this knowledge gap via long-term follow-up gait analyses. Twelve older adults with severe bilateral medial knee osteoarthritis (OA) before, 3 and 12 months after TKA, and twelve healthy controls were evaluated for their balance control during level walking, in terms of the inclination angle (IA) of the center of pressure to center of mass vector, and the rate of change of IA (RCIA). The patients before TKA showed significantly increased sagittal IA but decreased RCIA throughout the gait cycle (p < 0.04) compared to controls, suggesting a compromised balance control. Three months post-TKA, deviations in IA remained, although those in RCIA were improved to normal. One-year post-TKA, no significant differences were found in any of the IA- and RCIA-related variables between patient and Control groups. The results show that TKA surgery was effective in reducing the deviations in the center of mass-center of pressure control in patients with severe bilateral knee OA, and full recovery of balance control can be expected 1 year after surgery.
Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Idoso , Artroplastia do Joelho/métodos , Marcha , Humanos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , CaminhadaRESUMO
We performed a genome-wide linkage analysis to identify susceptibility loci in a large six-generation extended family previously reported with early-onset osteoarthritis (OA) DNA sequencing was performed to investigate involvement of the COMP (Cartilage oligomeric matrix protein) gene in this family. The region covering D19S884, D19S226, and D19S414 on chromosome 19p following genome-wide scan from 70 individuals of this kindred showed significant linkage, with a maximum point LOD (logarithm of the odds ratio) score of 2.51 at D19S226. Direct sequencing of the COMP gene, the most plausible candidate gene in the region, identified a c.2152C>T substitution in exon 18 which resulted in a substitution of tryptophan for arginine at position 718 located in the C terminal globular domain of the gene product. A total of 26 individuals were identified with this mutation of which 21 affected individuals had the mutation, and the other five younger individuals (18.6 ± 11.3 years of age) carried the mutation without symptoms. The results indicate that COMP is the disease susceptibility gene and the c.2152C>T mutation in exon 18 could cause early-onset OA phenotypes in this kindred, which is compatible with a previous report that this mutation also causes a mild form of multiple epiphyseal dysplasia (MED).
Assuntos
Proteínas da Matriz Extracelular/genética , Glicoproteínas/genética , Mutação , Osteoartrite/genética , Adolescente , Adulto , Idade de Início , Proteína de Matriz Oligomérica de Cartilagem , Criança , Feminino , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Humanos , Masculino , Proteínas MatrilinasRESUMO
About half of the elderly population has knee osteoarthritis (OA), showing altered gait patterns with increased fall risk. The current study aimed to identify the effects of severe bilateral medial knee osteoarthritis on gait balance control, in terms of the inclination angle (IA) of the center of pressure to center of mass vector, and the rate of change of IA (RCIA). Fifteen older adults with severe bilateral medial knee OA and 15 healthy controls walked at their preferred walking speed while the kinematic and forceplate data were measured to calculate IA, RCIA and temporal-spatial parameters. The OA group showed compromised gait balance control, due to a decreased average and range of sagittal RCIA over double-limb support (DLS, p < 0.002) and single-limb support (SLS, p < 0.002), as well as an increased sagittal IA (DLS, p < 0.005). Significantly decreased frontal RCIA averages during DLS, heel-strike and toe-off, and decreased RCIA ranges during SLS and swing (p < 0.027) were also observed. Reducing RCIA during DLS appeared to help reduce the loading rate and pain at the knees, and reduced RCIA at the subsequent SLS. The results indicated an increased risk of loss of balance in the OA group, and may warrant regular monitoring for reduced RCIA during gait to determine fall risk.
Assuntos
Marcha/fisiologia , Osteoartrite do Joelho/fisiopatologia , Equilíbrio Postural/fisiologia , Acidentes por Quedas/prevenção & controle , Idoso , Feminino , Análise da Marcha/métodos , Humanos , Articulação do Joelho/fisiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Caminhada/fisiologia , Velocidade de Caminhada/fisiologiaRESUMO
We demonstrated the safety and efficacy of autologous chondrocyte precursor (CP) cell therapy in repairing Grade 4 cartilage defects of medial femoral condyles. The autologous bone marrow mesenchymal stem cells of each participant were isolated, amplified, and then differentiated into CPs in atelocollagen. Neotissues made of CPs were implanted into cartilage defects with an average cell density of 4.9 ± 2.1 × 106 cells/cm2 through arthrotomy. The knee function was evaluated with the International Knee Documentation Committee (IKDC) subjective knee form. Patients' knee functions significantly improved by the 28th week (IKDC score = 68.3 ± 12.1), relative to the initial functionality before the CP therapy (IKDC score = 46.1 ± 16.4, p-value = 0.0014). Nine of these twelve patients maintained good knee functions for 9 years post-implantation (IKDC score = 69.8 ± 12.3) at levels higher than the pre-implantation values (p-value = 0.0018). Patients were evaluated with MRI and arthroscopy, and the defective sites exhibited a smooth surface without a gap between the implant and host tissue. This study demonstrates that autologous CPs successfully engraft into the host tissue and result in the re-formation of hyaline-like cartilage, thereby improving the impaired knee functions. Most importantly, no adverse event was reported during this long-term follow-up period.
Assuntos
Cartilagem Articular/efeitos dos fármacos , Cartilagem Articular/diagnóstico por imagem , Condrócitos/transplante , Colágeno/administração & dosagem , Fêmur/efeitos dos fármacos , Fêmur/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Cartilagem Articular/cirurgia , Condrócitos/fisiologia , Feminino , Fêmur/cirurgia , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/efeitos dos fármacos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
Here, we aimed to investigate the safety and preliminary efficacy of Kartigen®, a matrix with autologous bone marrow mesenchymal stem cell-derived chondrocyte precursors embedded in atelocollagen. As a surgical graft, Kartigen® was implanted onto the cartilage defects at the weight-bearing site of the medial femoral condyle of the knee. Fifteen patients were enrolled and stratified into two groups, undergoing either Kartigen® implantation (n = 10) or microfracture (control group, n = 5). The primary endpoint was to evaluate the safety of Kartigen® by monitoring the occurrence of adverse events through physician queries, physical examinations, laboratory tests, and radiological analyses for 2 years. There were no infections, inflammations, adhesions, loose body, or tumor formations in the Kartigen®-implanted knees. The preliminary efficacy was assessed using the International Knee Documentation Committee (IKDC) score, visual analog scale, and second-look arthroscopy. The postoperative IKDC scores of the Kartigen® group significantly improved in the 16th week (IKDC = 62.1 ± 12.8, p = 0.025), kept increasing in the first year (IKDC = 78.2 ± 15.4, p < 0.005), and remained satisfactory in the second year (IKDC = 73.6 ± 13.8, p < 0.005), compared to the preoperative condition (IKDC = 47.1 ± 17.0), while the postoperative IKDC scores of the control group also achieved significant improvement in the 28th week (IKDC = 68.5 ± 6.1, p = 0.032) versus preoperative state (IKDC = 54.0 ± 9.1). However, the IKDC scores decreased in the first year (IKDC = 63.5 ± 11.6) as well as in the second year (IKDC = 52.6 ± 16.4). Thirteen patients underwent second-look arthroscopy and biopsy one year after the operation. The Kartigen® group exhibited integration between Kartigen® and host tissue with a smooth appearance at the recipient site, whereas the microfracture group showed fibrillated surfaces. The histological and immunohistochemical analyses of biopsy specimens demonstrated the columnar structure of articular cartilage and existence of collagen type II and glycosaminoglycan mimic hyaline cartilage. This study indicates that Kartigen® is safe and effective in treating cartilage defects.
RESUMO
BACKGROUND: Autogenic bone graft is the first choice for managing bone defects. However, donor site-associated morbidity and limited bone volume are constraints in clinical applications. Allografts can provide sufficient amounts for bone defects but have a high risk of infection. Bone substitute composed of hydroxyapatite (HA) is an alternative material for avoiding the aforementioned risks. Sintered bovine bone is a naturally occurring HA that has been proved to have excellent bioactivity for inducing osteoblastic expression and new bone formation in animal studies. The objective of this study was to evaluate the interactions between the tissue and the bone substitute composed of HA (sintered from bovine bone) in the human body. METHODS: From 2003 to 2005, a total of 33 patients were enrolled to receive the sintered bovine HA as a bone substitute. Inclusion criteria were fractures with bony defects, benign bone tumors with a cavity, and spinal fusions. Bone healing was monitored by a series of radiographs, and bone microstructure was checked by scanning electron microscopy (SEM) and von Kossa staining. RESULTS: In 81.8% (27/33) of cases, significant fusion mass formation was visible in the radiographs after 6-12 months. New bone formation on the surface of the sintered bovine HA was seen under microscopic observation. Tight bonding between the interface of the bone and the sintered bovine HA was shown with SEM/energy-dispersive spectroscopy and von Kossa staining. CONCLUSIONS: Sintered bovine HA is a suitable material as a bone substitute to provide bone growth and promote bone healing.
Assuntos
Materiais Biocompatíveis/uso terapêutico , Substitutos Ósseos , Durapatita/uso terapêutico , Fraturas Ósseas/cirurgia , Fusão Vertebral/métodos , HumanosRESUMO
OBJECTIVES: To characterize a large extended family with early-onset OA of the knee and investigate its associations with the COL2A1 gene. METHODS: Phenotype assessments were conducted in a six-generation family to identify individuals affected with OA. Short tandem repeat polymorphic (STRP) markers and DNA sequencing were performed to investigate the involvement of the COL2A1 gene in this family. RESULTS: The kindred affected with OA showed autosomal dominant inheritance. The mean age of onset was 37.3 +/- 19.2, 29.8 +/- 13.7 and 12.0 +/- 7.2 years for generations IV, V and VI, respectively, and 25 +/- 16.1 years for males and 34.3 +/- 15.5 years for females. The height of the affected males was shorter than the unaffected males (155.9 +/- 11.4 vs 164.5 +/- 16.0 cm, P = 0.010). Arm span in the affected males was also significantly shorter than the unaffected males (158.4 +/- 12.5 vs 165.3 +/- 16.7 cm, P = 0.027). However, both height and arm span were not reduced in the affected female OA patients. STRP markers surrounding COL2A1 locus did not show linkage of the COL2A1 locus with the OA. Sequencing of COL2A1 gene revealed three single nucleotide polymorphisms but no mutation was found in the affected patients. CONCLUSIONS: The COL2A1 was not a susceptibility gene responsible for the OA phenotype in a large extended kindred with familial early-onset OA. The availability of DNA samples will allow genome-wide linkage study to identify the susceptibility locus.
Assuntos
Colágeno Tipo II/genética , Osteoartrite/genética , Polimorfismo de Nucleotídeo Único , Adulto , Idade de Início , Idoso , Mapeamento Cromossômico , Feminino , Genes Dominantes , Genótipo , Articulação do Quadril/diagnóstico por imagem , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Osteoartrite/diagnóstico por imagem , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/genética , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/genética , Linhagem , Fenótipo , Radiografia , Análise de Sequência de DNARESUMO
Colles's fracture is the most common type of distal radius fracture. Surgically, it remains a challenge to restore radial height and volar tilt in order to regain optimal wrist function. Ulson's procedure provides a dynamic effect on fixing fractured fragments and restoring joint function using two wires. However, the biomechanical influences of bone and wire remain critical issues for fracture reduction and bone union in Ulson's procedure. Based on elastic beam and foundation theory, this study formulated a closed-form mathematical model to investigate the effects of bone and wire parameters on wire deflection and bony reaction. The wire deflection and bony reaction were chosen as the indices of wrist stability and reduction within the post-operative period. The predicted results showed that greater bone strength, higher wire stiffness, and longer wire contact length provide a more stable wire-bone construct, thus facilitating fracture reduction and bone union. The wire stiffness had a much more significant effect on the construct stability compared with bone quality and contact length. In terms of entry point and insertion angle, surgical planning for the contact length was more important than bony quality for stabilizing the whole wire-bone construct.
Assuntos
Fios Ortopédicos , Modelos Teóricos , Traumatismos do Punho , Articulação do Punho/cirurgia , Fenômenos Biomecânicos , Humanos , Fraturas do RádioRESUMO
Human mesenchymal stem cells (hMSCs) can differentiate into cells of connective tissue lineages, including cartilage. To overcome the limiting autogenous chondrocyte populations available in cartilage repair, various methods have been developed to maximize chondrogenesis of hMSCs in vitro, most of which use cells derived from primary culture. In this study, we compared chondrogenesis of immortalized hMSCs embedded in collagen gel to those grown in pellet culture. The hMSCs in collagen scaffolds expressed more glycosaminoglycan than those in pellet culture. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) analysis demonstrated that the expression of genes encoding sox-9, aggrecan, and types I and II collagen increased in pellet culture over time. However, in the collagen cultures, only type II collagen and aggrecan expression increased over time, whereas sox-9 expression remained unchanged and type I collagen expression decreased. These results indicate that the immortalized hMSC line is a promising tool for further in vitro chondrogenic studies.
Assuntos
Condrogênese/fisiologia , Colágeno Tipo II/genética , Células-Tronco Mesenquimais/fisiologia , Engenharia Tecidual/métodos , Agrecanas/genética , Técnicas de Cultura de Células , Linhagem Celular , Colágeno Tipo I/genética , DNA/análise , Expressão Gênica , Glicosaminoglicanos/genética , Proteínas de Grupo de Alta Mobilidade/genética , Humanos , Imuno-Histoquímica , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Transcrição SOX9 , Alicerces Teciduais , Fatores de Transcrição/genéticaRESUMO
The aims of the present study were to fabricate a novel porous polylactic acid (PLLA) composite scaffold and evaluate the capacity of the scaffold in carrying recombinant bone morphogenetic protein 2 (rhBMP2) for engineering bone formation. The structures of the PLLA scaffolds were evaluated by SEM and the controlled release of rhBMP2 from the composite scaffolds was assayed by ELISA. Bone induction by the scaffolds loaded with or without rhBMP2 was performed in the calf muscle of twenty Wistar rats for 3, 7, 10, 14, and 28 days. Tissue specimens were examined by Masson's trichrome and von Kossa stainings, and immunohistochemistry of bone proteins. Our results indicated that a moderate foreign body reaction was found in control scaffolds, which lasted for 4 weeks. The addition of rhBMP2 to this novel scaffold dramatically alleviated the adverse responses to PLLA. Enhanced deposition of collagen matrix and endochondral formation were observed in rhBMP2-PLLA scaffolds at 7-10 days, compatible with an early release of rhBMP2 in the composite scaffolds. Bone sialoprotein and osteopontin were demonstrated simultaneously. Von Kossa staining was observed in the test group at 10-14 days. In conclusion, the PLLA scaffolds exhibited the capability of carrying rhBMP2 for inducing bone formation within 2 weeks. These results suggest that rhBMP2-PLLA scaffold may be applicable in tissue engineering.
Assuntos
Materiais Biocompatíveis/metabolismo , Proteínas Morfogenéticas Ósseas/farmacologia , Osso e Ossos/efeitos dos fármacos , Ácido Láctico/farmacologia , Polímeros/farmacologia , Proteínas Recombinantes/farmacologia , Engenharia Tecidual/instrumentação , Engenharia Tecidual/métodos , Fator de Crescimento Transformador beta/farmacologia , Animais , Proteína Morfogenética Óssea 2 , Proteínas Morfogenéticas Ósseas/metabolismo , Calcificação Fisiológica/efeitos dos fármacos , Colágeno/metabolismo , Células do Tecido Conjuntivo/citologia , Células do Tecido Conjuntivo/efeitos dos fármacos , Regulação da Expressão Gênica/efeitos dos fármacos , Sialoproteína de Ligação à Integrina , Músculos/citologia , Osteogênese/efeitos dos fármacos , Osteopontina/genética , Osteopontina/metabolismo , Poliésteres , Ratos , Ratos Wistar , Proteínas Recombinantes/metabolismo , Sialoglicoproteínas/genética , Sialoglicoproteínas/metabolismo , Fator de Crescimento Transformador beta/metabolismoRESUMO
BACKGROUND: Bone morphogenic proteins (BMPs) are important bone-induction factors, and the development of a suitable carrier for BMPs is a critical step to achieve osteoinductive function. The aims of the present study were to evaluate, at the cellular and molecular levels, the feasibility of recombinant human BMP-2 (rhBMP-2)-collagen composite scaffold and its efficiency for carrying BMP-2 in ectopic bone formation in rats. METHODS: Scaffolds with (test) or without rhBMP-2 (control) were made and implanted into the calf muscle of 16 5-week-old rats. The tissue responses to the scaffolds were examined by histology. Masson's trichrome and von Kossa stainings were performed to examine collagen matrix deposition and calcification at 3, 7, 10, and 14 days. Expressions of bone phenotypic markers, alkaline phosphatase, osteocalcin, osteopontin, and bone sialoprotein were detected by reverse transcription-polymerase chain reaction and immunohistochemistry. RESULTS: No detectable adverse responses were noted around the implanted scaffolds, and the area of the resorbed scaffold had been replaced by young connective tissue by 3 to 7 days in both groups. In the rhBMP-2 composite scaffold, collagen matrix deposition was found in the implanted site on day 7 and initial signs of endochondral differentiation also appeared. Mineralization and the expressions of key bone proteins were demonstrated in chondroblasts and osteoblasts at 7 to 14 days. Molecular cascades of bone induction were not shown in control specimens. CONCLUSION: The rhBMP-2-atelocollagen scaffold showed excellent biocompatibility and possessed a bone-inducing capacity in rat within 2 weeks, and, thus, may provide a potential application in tissue engineering of bone tissue.
Assuntos
Implantes Absorvíveis , Proteínas Morfogenéticas Ósseas , Colágeno , Portadores de Fármacos , Osteogênese , Proteínas Recombinantes , Engenharia Tecidual/métodos , Fator de Crescimento Transformador beta , Animais , Proteína Morfogenética Óssea 2 , Condrogênese , Estudos de Viabilidade , Humanos , Técnicas Imunoenzimáticas , Implantes Experimentais , Sialoproteína de Ligação à Integrina , Osteoblastos/metabolismo , Osteocalcina/biossíntese , Osteopontina/biossíntese , Ratos , Ratos Wistar , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sialoglicoproteínas/biossínteseRESUMO
We previously showed that cartilage tissue can be engineered in vitro with porcine chondrocytes and gelatin/chondoitin-6-sulfate/hyaluronan tri-copolymer which mimic natural cartilage matrix for use as a scaffold. In this animal study, 15 miniature pigs were used in a randomized control study to compare tissue engineering with allogenous chondrocytes, autogenous osteochondral (OC) transplantation, and spontaneous repair for OC articular defects. In another study, 6 pigs were used as external controls in which full thickness (FT) and OC defects were either allowed to heal spontaneously or were filled with scaffold alone. After exclusion of cases with infection and secondary arthritis, the best results were obtained with autogenous OC transplantation, except that integration into host cartilage was poor. The results for the tissue engineering-treated group were satisfactory, the repair tissue being hyaline cartilage and/or fibrocartilage. Spontaneous healing and filling with scaffold alone did not result in good repair. With OC defects, the subchondral bone plate was not restored by cartilage tissue engineering. These results show that tri-copolymer can be used in in vivo cartilage tissue engineering for the treatment of FT articular defects.
Assuntos
Cartilagem Articular/fisiologia , Condrócitos/transplante , Condroitina/administração & dosagem , Ácido Hialurônico/análogos & derivados , Ácido Hialurônico/administração & dosagem , Osteocondrite/terapia , Regeneração , Engenharia Tecidual , Animais , Cartilagem Articular/patologia , Feminino , Articulação do Joelho/patologia , Masculino , Osteocondrite/tratamento farmacológico , Sus scrofa , Transplante HomólogoRESUMO
This study compares the mechanisms of ultrasound (US) on osteoblast proliferation with those of pulsed electromagnetic field (PEMF), by different signal transduction pathway inhibitors. The cells were stimulated for 15 min under US or for 2 h under PEMF exposure. Twenty-four h after the beginning of stimulation, the cells were harvested and used for mitochondrial activity test (MTT) analysis. The results showed that there are different transduction pathways for US and PEMF stimulation that lead to an upgrade of osteoblast proliferation, although their pathways all lead to an increase in cytocolic Ca2+ and activation of calmodulin. These findings offer a biochemical mechanism to support the process of ultrasound and PEMF-induced enhanced healing of bone fractures.
Assuntos
Campos Eletromagnéticos , Osteoblastos/citologia , Terapia por Ultrassom , Animais , Cálcio/metabolismo , Calmodulina/metabolismo , Divisão Celular/fisiologia , Divisão Celular/efeitos da radiação , Sobrevivência Celular/fisiologia , Sobrevivência Celular/efeitos da radiação , Mitocôndrias/fisiologia , Mitocôndrias/efeitos da radiação , Óxido Nítrico Sintase/fisiologia , Osteoblastos/metabolismo , Osteoblastos/efeitos da radiação , Ratos , Ratos Wistar , Transdução de Sinais/fisiologia , Transdução de Sinais/efeitos da radiaçãoRESUMO
Chitosan scaffolds were modified with RGDS (Arg-Gly-Asp-Ser) in the present work via an imide-bond forming reaction between amino groups in chitosan and carboxyl groups in peptides. Successful immobilization was verified with FTIR spectroscopy, and the immobilized amount was determined to be on the order of 10(-12) mol/cm2 through analysis of the immobilized amino acids. Results of experiments of cell culture with rat osteosarcoma (ROS) cells demonstrated that RGDS immobilization could enhance the attachment of ROS cells onto the chitosan, resulting in higher cell density attached to the RGDS-modified scaffold than to the unmodified scaffold. It should be noted that only RGDS, but not other peptide such as RGES, is effective in enhancing cell attachment and possible proliferation. Experiments of in vitro mineralization indicated that there were more cells on the RGDS-modified scaffold than on the unmodified scaffold, which tended to form bone-like tissues. The results presented in this work suggest that immobilization of RGDS can make chitosan scaffolds more compatible for the culture of osteoblast-like cells and the regeneration of bone-like tissues.