Periostin regulates lysyl oxidase through ERK1/2 MAPK-dependent serum response factor in activated cardiac fibroblasts.

Collagen crosslinking, mediated by lysyl oxidase, is an adaptive mechanism of the cardiac repair process initiated by cardiac fibroblasts postmyocardial injury. However, excessive crosslinking leads to cardiac wall stiffening, which impairs the contractile properties of the left ventricle and leads to heart failure. In this study, we investigated the role of periostin, a matricellular protein, in the regulation of lysyl oxidase in cardiac fibroblasts in response to angiotensin II and TGFß1. Our results indicated that periostin silencing abolished the angiotensin II and TGFß1-mediated upregulation of lysyl oxidase. Furthermore, the attenuation of periostin expression resulted in a notable reduction in the activity of lysyl oxidase. Downstream of periostin, ERK1/2 MAPK signaling was found to be activated, which in turn transcriptionally upregulates the serum response factor to facilitate the enhanced expression of lysyl oxidase. The periostin-lysyl oxidase association was also positively correlated in an in vivo rat model of myocardial infarction. The expression of periostin and lysyl oxidase was upregulated in the collagen-rich fibrotic scar tissue of the left ventricle. Remarkably, echocardiography data showed a reduction in the left ventricular wall movement, ejection fraction, and fractional shortening, indicative of enhanced stiffening of the cardiac wall. These findings shed light on the mechanistic role of periostin in the collagen crosslinking initiated by activated cardiac fibroblasts. Our findings signify periostin as a possible therapeutic target to reduce excessive collagen crosslinking that contributes to the structural remodeling associated with heart failure.

Outcome of combined trabeculectomy with cataract surgery in patients on prostaglandin analogs and aqueous suppressants.

PURPOSE: To compare the effect of prostaglandin analogs (PGA) against other glaucoma medications (non-PGA) on the intraocular pressure (IOP) outcomes of combined trabeculectomy with phacoemulsification, and the conjunctival cell profile in persons with primary open-angle (POAG) and pseudoexfoliation glaucoma (PXFG). METHODS: A prospective cohort study was conducted among 116 patients with POAG or PXFG on glaucoma medications for a minimum of 3 months undergoing glaucoma triple procedure. Patients were divided into two groups (PGA and non-PGA) based on preoperative exposure to PGA. IOP outcomes were assessed for up to 2 years. Conjunctival biopsy specimens were obtained at the time of surgery, and histopathological analysis was performed. RESULTS: Forty-two patients were in the PGA group, 67 were in the non-PGA group, and seven were lost to follow-up. The non-PGA group had lesser mean postoperative IOP and needed fewer postoperative medications compared to the PGA group in all visits up to 2 years. The non-PGA group had better complete success rate (50.7% vs. 14.3%, P < 0.001). Kaplan-Meier survival estimates showed a significant difference in cumulative complete success rate between non-PGA (67%) and PGA (26%) by 24 months ( P < 0.001). The Cox proportional model showed the type of drug to be significantly associated with surgical failure. Histopathological analysis revealed that the PGA group had higher numbers for each type of inflammatory cell (except mast cells) compared to the non-PGA group. CONCLUSION: Patients on PGA are likely to have a higher postoperative IOP and may need more medications for IOP control after a glaucoma triple procedure.

The Sociodemographic Profile of Community-Dwelling Older Adults With Serious Mental Illness in Kerala - A Cross-Sectional Study.

Background: Older adults with serious mental illness (OASMI) have to manage the twin challenges of old age and mental illness. Understanding their characteristics will help policymakers and researchers plan tailored interventions. The profile of OASMI is not described in any publication from India, and this paper addresses that gap. The information from this study will serve as a baseline for the planned periodic follow-up of the study participants. Methods: This study employed a cross- sectional design among a sample of OASMI identified through multistage cluster sampling from three districts in Kerala. We interviewed them in their households and collected sociodemographic data using a pretested tool. Results: Among the 917 OASMI participants, 66% were females, 18% were the 'oldest-old' (≥80 years), 94.1% were unemployed, 51.7% were socially backward, 68.5% were financially weak, 10.1% were living alone, 59.4% were living without partners, and 63.7% had caregivers. Conclusion: Compared to the general population of older adults in Kerala, the OASMI have poorer socioeconomic status and higher rates of social isolation, and males are dying earlier. The profile of the OASMI depicts their multiple vulnerabilities and the need to address those.

A systematic approach to the management of microspherophakia.

Microspherophakia is a rare developmental abnormality of the crystalline lens with a myriad of ocular and systemic associations. Glaucoma is a serious complication associated with this disorder. Early identification of the disease, timely visual rehabilitation, and appropriate management of the lens and glaucoma can help us prevent blindness from this condition. Multidisciplinary care with lifelong follow-up is recommended, as this typically affects the younger population. Current treatment protocols for this condition are mainly based on case reports and retrospective studies with shorter follow-up. Due to the rarity of this disease, designing a large randomized controlled trial to identify the merits and demerits of each management strategy is challenging. With cataract, glaucoma, and vitreoretinal specialists, each having their preferred way of managing microspherophakic lenses, we decided to do a comprehensive review of the existing literature to devise an integrated approach toward effective management of these patients. This review will collate all evidence and provide a very practical decision-making tree for its management.

Newer advances in medical management of glaucoma.

The burden of irreversible vision loss from Glaucoma continues to rise. While the disease pathogenesis is not well understood, intraocular pressure (IOP) is the only modifiable risk factor identified to prevent glaucomatous vision loss. Medical management remains the first-line of treatment in most adult glaucomas and the evolution of medical therapy for glaucoma has followed an exponential curve. This review tracks the rapid development of new medications and drug delivery systems in the recent years. Introduction of Rho kinase inhibitors with an entirely new mechanism of action from that of the currently used anti glaucoma medications has been a significant milestone. Latanoprostene Bunod is a novel, single molecule which provides two active metabolites that work through two different pathways for reducing intra ocular pressure. Bimatoprost implants and travoprost punctum plugs attempt to ease chronic medication use in glaucoma patients. Nanotechnology is an evolving route of drug delivery. Role of cannabinoids in medical management of glaucoma remain equivocal. The relatively short term effect on IOP, the risks of developing tolerance and side effects impacting patients' neurocognitive health greatly outweigh the potential benefit. Research on Latrunculin B, Adenosine receptor agonists, Specific gene silencing and Stem cell therapy are poised to make an impact on glaucoma treatment. While there is some evidence to support the role of Brimonidine in neuroprotection, further research is needed to clarify the role of Memantine and Neurotrophins. Evidence for benefit from dietary supplementation with Alpha lipoic acid, Forskolin , and Ginko Biloba is limited.

Polymer-coated microparticle scaffolds engineered for potential use in musculoskeletal tissue regeneration.

Biomaterials constructed exclusively of sintered microspheres have great potential in tissue engineering scaffold applications, offering the ability to create shape-specific scaffolds with precise controlled release yet to be matched by traditional additive manufacturing methods. The problem is that these microsphere-based scaffolds are limited in their stiffness for applications such as bone regeneration. Our vision to solve this problem was borne from a hierarchical structure perspective, focusing on the individual unit of the structure: the microsphere itself. In a core-shell approach, we envisioned a stiff core to create a stiff microsphere unit, with a polymeric shell that would enable sintering to the other microsphere units. Therefore, the current study provided a comparison of macroscopic biomaterials built on either polymer microspheres or polymer-coated hard glass microspheres. Identical polycaprolactone (PCL) polymer solutions were used to fabricate microspheres and as a thin coating on soda lime glass microspheres (hard phase). The materials were characterized as loose particles and as scaffolds via scanning electron microscopy, thermogravimetry, differential scanning calorimetry, Raman spectroscopy, mechanical testing, and a live/dead analysis with human umbilical cord-derived Wharton's jelly cells. The elastic modulus of the scaffolds with the thinly coated hard phase was about five times higher with glass microspheres (up to about 25 MPa) than pure polymer microspheres, while retaining the structure, cell adhesion, and chemical properties of the PCL polymer. This proof-of-concept study demonstrated the ability to achieve at least a five-fold increase in macroscopic stiffness via altering the core microsphere units with a core-shell approach.

A rare case of neurofibromatosis type I with unilateral congenital ectropion uveae and glaucoma.

PURPOSE: Neurofibromatosis Type I (NF-1) is a neurocutaneous disease affecting the skin, eye and peripheral nervous system. Congenital glaucoma is a rare association, but can be a prelude to the diagnosis of NF-1 later in life. We report this unusual association in a child and discuss the possible underlying pathophysiologic mechanisms. OBSERVATIONS: A nine year old female child on treatment for glaucoma in the right eye was referred to us for definitive management. Her ocular evaluation was remarkable for reduced visual acuity, megalocornea with buphthalmos, congenital ectropionuveae, Lisch nodules and glaucomatous optic neuropathy in the right eye. Systemic evaluation revealed café-au-lait spots on the chest and back. A diagnosis of Neurofibromatosis Type I with congenital ectropion uveae and glaucoma was arrived at and neuroimaging failed to detect any optic pathway gliomas. In view of advanced glaucomatous neuropathy, a conservative therapy was recommended. CONCLUSIONAND IMPORTANCE: Unilateral congenital glaucomas with ectropion uveae are likely to be associated with NF-1. These children should be monitored closely for glaucoma progression and may require neurological evaluation including imaging studies to exclude optic pathway gliomas.

A hybrid method for fundamental heart sound segmentation using group-sparsity denoising and variational mode decomposition.

Segmentation of fundamental heart sounds-S1 and S2 is important for automated monitoring of cardiac activity including diagnosis of the heart diseases. This pa-per proposes a novel hybrid method for S1 and S2 heart sound segmentation using group sparsity denoising and variation mode decomposition (VMD) technique. In the proposed method, the measured phonocardiogram (PCG) signals are denoised using group sparsity algorithm by exploiting the group sparse (GS) property of PCG signals. The denoised GS-PCG signals are then decomposed into subsequent modes with specific spectral characteristics using VMD algorithm. The appropriate mode for further processing is selected based on mode central frequencies and mode energy. It is then followed by the extraction of Hilbert envelope (HEnv) and a thresholding on the selected mode to segment S1 and S2 heart sounds. The performance advantage of the proposed method is verified using PCG signals from benchmark databases namely eGeneralMedical, Littmann, Washington, and Michigan. The proposed hybrid algorithm has achieved a sensitivity of 100%, positive predictivity of 98%, accuracy of 98% and detection error rate of 1.5%. The promising results obtained suggest that proposed approach can be considered for automated heart sound segmentation.

Hyaluronic Acid Dictates Chondrocyte Morphology and Migration in Composite Gels.

Tissue equivalent collagen-hyaluronic acid-based hydrogels are widely used for cartilage tissue engineering; however, not much importance has been given to investigate how cellular responses are altered with varying concentrations of hyaluronic acid in gels. In this study, different concentrations of hyaluronic acid dialdehyde (HAD) were combined with collagen to fabricate collagen-HAD composite (CH) gels, and the influence of HAD on cell shape, migration, viability, cytoskeletal organization, and gel contraction was examined. The microstructure and the mechanical strength of the composite gels were altered by varying HAD concentrations. Morphology of chondrocytes cultured on CH gels showed a significant increase in their aspect ratio and decrease in number of cell protrusions with increase in concentration of HAD. The organization of the cytoskeleton at the cellular protrusions was vimentin localized at the base, microtubules at the tip, and actin localized throughout the cell body. Changes in HAD concentrations altered hydrogel mechanical strength, cytoskeletal organization, and formation of cellular protrusions, all of which contributed to changes in cell morphology and migration. These changes were more evident in 3D cell-encapsulated gels than chondrocytes cultured over the 2D gels. However, viability of cells and matrix contraction, staining for adhesion protein vinculin, and hyaluronic acid receptor CD44 remained similar in all CH compositions. The changes in cell responses further influenced extracellular matrix deposition during in vitro culture. Cell responses in low HAD gels mimic the cellular behavior in damaged cartilage, whereas those in high HAD gels resembled the behavior in healthy cartilage tissue. Our study illustrates the importance of careful formulations of hydrogel compositions in designing biomimetic matrices that are used as in vitro models to study chondrocyte behavior.

Chitosan-hyaluronic acid hydrogel for cartilage repair.

The current study investigates the potential of chitosan-hyaluronic acid dialdehyde hydrogels for in vivo cartilage regeneration following two different approaches: Gel alone for cartilage regeneration or combination of chondrocytes and gel for cartilage repair. Critical size osteochondral defects were created in knee joints of Newzealand White rabbits. Allogenic rabbit chondrocytes were encapsulated in hydrogels and gel or gel+cells were implanted in defects aseptically. The regenerated cartilage was analyzed after 12 weeks of implantation. The morphological scoring indicates that repair tissue was formed in all the animals by 12 weeks irrespective of whether they were sham, received gel, or gel with cells as implant. However the repair tissue formed in sham appeared fibrous and opaque, where as those that received gel had texture similar to the surrounding native cartilage and animals with gel+cells showed varied response. Histology staining, score distribution and immunostaining for collagen Type II showed animals that received gel alone as the implant had a mixture of hyaline and fibro cartilage. The animals with cell encapsulated gels had more fibrous cells with weak staining for collagen type II. There was no significant enhancement in the quality of regenerated cartilage in presence of encapsulated chondrocytes.

Material characterization of microsphere-based scaffolds with encapsulated raw materials.

"Raw materials," or materials capable of serving both as building blocks and as signals, which are often but not always natural materials, are taking center stage in biomaterials for contemporary regenerative medicine. In osteochondral tissue engineering, a field leveraging the underlying bone to facilitate cartilage regeneration, common raw materials include chondroitin sulfate (CS) for cartilage and ß-tricalcium phosphate (TCP) for bone. Building on our previous work with gradient scaffolds based on microspheres, here we delved deeper into the characterization of individual components. In the current study, the release of CS and TCP from poly(D, L-lactic-co-glycolic acid) (PLGA) microsphere-based scaffolds was evaluated over a time period of 4 weeks. Raw material encapsulated groups were compared to 'blank' groups and evaluated for surface topology, molecular weight, and mechanical performance as a function of time. The CS group may have led to increased surface porosity, and the addition of CS improved the mechanical performance of the scaffold. The finding that CS was completely released into the surrounding media by 4 weeks has a significant impact on future in vivo studies, given rapid bioavailability. The addition of TCP seemed to contribute to the rough external appearance of the scaffold. The current study provides an introduction to degradation patterns of homogenous raw material encapsulated scaffolds, providing characterization data to advance the field of microsphere-based scaffolds in tissue engineering.

Microsphere-based gradient implants for osteochondral regeneration: a long-term study in sheep.

BACKGROUND: The microfracture technique for cartilage repair has limited ability to regenerate hyaline cartilage. AIM: The current study made a direct comparison between microfracture and an osteochondral approach with microsphere-based gradient plugs. MATERIALS & METHODS: The PLGA-based scaffolds had opposing gradients of chondroitin sulfate and ß-tricalcium phosphate. A 1-year repair study in sheep was conducted. RESULTS: The repair tissues in the microfracture were mostly fibrous and had scattered fissures with degenerative changes. Cartilage regenerated with the gradient plugs had equal or superior mechanical properties; had lacunated cells and stable matrix as in hyaline cartilage. CONCLUSION: This first report of gradient scaffolds in a long-term, large animal, osteochondral defect demonstrated potential for equal or better cartilage repair than microfracture.

Microsphere-Based Scaffolds Carrying Opposing Gradients of Chondroitin Sulfate and Tricalcium Phosphate.

Extracellular matrix (ECM) components, such as chondroitin sulfate (CS) and tricalcium phosphate, serve as raw materials, and thus spatial patterning of these raw materials may be leveraged to mimic the smooth transition of physical, chemical, and mechanical properties at the bone-cartilage interface. We hypothesized that encapsulation of opposing gradients of these raw materials in high molecular weight poly(d,l-lactic-co-glycolic acid) (PLGA) microsphere-based scaffolds would enhance differentiation of rat bone marrow-derived stromal cells. The raw material encapsulation altered the microstructure of the microspheres and also influenced the cellular morphology that depended on the type of material encapsulated. Moreover, the mechanical properties of the raw material encapsulating microsphere-based scaffolds initially relied on the composition of the scaffolds and later on were primarily governed by the degradation of the polymer phase and newly synthesized ECM by the seeded cells. Furthermore, raw materials had a mitogenic effect on the seeded cells and led to increased glycosaminoglycan (GAG), collagen, and calcium content. Interestingly, the initial effects of raw material encapsulation on a per-cell basis might have been overshadowed by medium-regulated environment that appeared to favor osteogenesis. However, it is to be noted that in vivo, differentiation of the cells would be governed by the surrounding native environment. Thus, the results of this study demonstrated the potential of the raw materials in facilitating neo-tissue synthesis in microsphere-based scaffolds and perhaps in combination with bioactive signals, these raw materials may be able to achieve intricate cell differentiation profiles required for regenerating the osteochondral interface.

Hybrid scaffold bearing polymer-siloxane Schiff base linkage for bone tissue engineering.

Scaffolds that can provide the requisite biological cues for the fast regeneration of bone are highly relevant to the advances in tissue engineering and regenerative medicine. In the present article, we report the fabrication of a chitosan-gelatin-siloxane scaffold bearing interpolymer-siloxane Schiff base linkage, through a single-step dialdehyde cross-linking and freeze-drying method using 3-aminopropyltriethoxysilane as the siloxane precursor. Swelling of the scaffolds in phosphate buffered saline indicates enhancement with increase in siloxane concentration, whereas compressive moduli of the wet scaffolds reveal inverse dependence, owing to the presence of siloxane, rich in silanol groups. It is suggested that through the strategy of dialdehyde cross-linking, a limiting siloxane loading of 20 wt.% into a chitosan -gelatin matrix should be considered ideal for bone tissue engineering, because the scaffold made with 30 wt.% siloxane loading degrades by 48 wt.%, in 21 days. The hybrid scaffolds bearing Schiff base linkage between the polymer and siloxane, unlike the stable linkages in earlier reports, are expected to give a faster release of siloxanes and enhancement in osteogenesis. This is verified by the in vitro evaluation of the hybrid scaffolds using rabbit adipose mesenchymal stem cells, which revealed osteogenic cell-clusters on a polymer-siloxane scaffold, enhanced alkaline phosphatase activity and the expression of bone-specific genes, whereas the control scaffold without siloxane supported more of cell-proliferation than differentiation. A siloxane concentration dependent enhancement in osteogenic differentiation is also observed.

Biomimetic fiber assembled gradient hydrogel to engineer glycosaminoglycan enriched and mineralized cartilage: An in vitro study.

The study investigated the potential of electrospun fiber assembled hydrogel, with physical gradients of chondroitin sulfate (CS) and sol-gel-derived bioactive glass (BG), to engineer hyaline and mineralized cartilage in a single 3D system. Electrospun poly(caprolactone) (PCL) fibers incorporated with 0.1% w/w of CS (CSL) and 0.5% w/w of CS (CSH), 2.4% w/w of BG (BGL) and 12.5% w/w of BG (BGH) were fabricated. The CS showed a sustained release up to 3 days from CSL and 14 days from CSH fibers. Chondrocytes secreted hyaline like matrix with higher sulfated glycosaminoglycans (sGAG), collagen type II and aggrecan on CSL and CSH fibers. Mineralization was observed on BGL and BGH fibers when incubated in simulated body fluid for 14 days. Chondrocytes cultured on these fibers secreted a mineralized matrix that consisted of sGAG, hypertrophic proteins, collagen type X, and osteocalcin. The CS and BG incorporated PCL fiber mats were assembled in an agarose-gelatin hydrogel to generate a 3D hybrid scaffold. The signals in the fibers diffused and generated continuous opposing gradients of CS (chondrogenic signal) and BG (mineralization) in the hydrogel. The chondrocytes were encapsulated in hybrid scaffolds; live dead assay at 48 h showed viable cells. Cells maintained their phenotype and secreted specific extracellular matrix (ECM) in response to signals within the hydrogel. Continuous opposing gradients of sGAG enriched and mineralized ECM were observed surrounding each cell clusters on gradient hydrogel after 14 days of culture in response to the physical gradients of raw materials CS and BG. A construct with gradient mineralization might accelerate integration to subchondral bone during in vivo regeneration.

The potential of encapsulating "raw materials" in 3D osteochondral gradient scaffolds.

Scaffolds with continuous gradients in material composition and bioactive signals enable a smooth transition of properties at the interface. Components like chondroitin sulfate (CS) and bioactive glass (BG) in 3D scaffolds may serve as "raw materials" for synthesis of new extracellular matrix (ECM), and may have the potential to completely or partially replace expensive growth factors. We hypothesized that scaffolds with gradients of ECM components would enable superior performance of engineered constructs. Raw material encapsulation altered the appearance, structure, porosity, and degradation of the scaffolds. They allowed the scaffolds to better retain their 3D structure during culture and provided a buffering effect to the cells in culture. Following seeding of rat mesenchymal stem cells, there were several instances where glycosaminoglycan (GAG), collagen, or calcium contents were higher with the scaffolds containing raw materials (CS or BG) than with those containing transforming growth factor (TGF)-ß3 or bone morphogenetic protein (BMP)-2. It was also noteworthy that a combination of both CS and TGF-ß3 increased the secretion of collagen type II. Moreover, cells seeded in scaffolds containing opposing gradients of CS/TGF-ß3 and BG/BMP-2 produced clear regional variations in the secretion of tissue-specific ECM. The study demonstrated raw materials have the potential to create a favorable microenvironment for cells; they can significantly enhance the synthesis of certain extracellular matrix (ECM) components when compared to expensive growth factors; either alone or in combination with growth factors they can enhance the secretion of tissue specific matrix proteins. Raw materials are promising candidates that can be used to either replace or be used in combination with growth factors. Success with raw materials in lieu of growth factors could have profound implications in terms of lower cost and faster regulatory approval for more rapid translation of regenerative medicine products to the clinic.