Gait risk factors for disease progression differ between non-traumatic and post-traumatic knee osteoarthritis.

OBJECTIVE: To examine if relationships between knee osteoarthritis (OA) progression with knee moments and muscle activation during gait vary between patients with non-traumatic and post-traumatic knee OA. DESIGN: This longitudinal study included participants with non-traumatic (n = 17) and post-traumatic (n = 18) knee OA; the latter group had a previous anterior cruciate ligament rupture. Motion capture cameras, force plates, and surface electromyography measured knee moments and lower extremity muscle activation during gait. Cartilage volume change were determined over 2 years using magnetic resonance imaging in four regions: medial and lateral plateau and condyle. Linear regression analysis examined relationships between cartilage change with gait metrics (moments, muscle activation), group, and their interaction. RESULTS: Measures from knee adduction and rotation moments were related to lateral condyle cartilage loss in both groups, and knee adduction moment to lateral plateau cartilage loss in the non-traumatic group only [ß = -1.336, 95% confidence intervals (CI) = -2.653 to -0.019]. Generally, lower levels of stance phase muscle activation were related to greater cartilage loss. The relationship between cartilage loss in some regions with muscle activation characteristics varied between non-traumatic and post-traumatic groups including for: lateral hamstring (lateral condyle ß = 0.128, 95%CI = 0.003 to 0.253; medial plateau ß = 0.199, 95%CI = 0.059 to 0.339), rectus femoris (medial condyle ß = -0.267, 95%CI = -0.460 to -0.073), and medial hamstrings (medial plateau; ß = -0.146, 95%CI = -0.244 to -0.048). CONCLUSION: Findings indicate that gait risk factors for OA progression may vary between patients with non-traumatic and post-traumatic knee OA. These OA subtypes should be considered in studies that investigate gait metrics as risk factors for OA progression.

Relationship between alignment and cartilage thickness in patients with non-traumatic and post-traumatic knee osteoarthritis.

OBJECTIVE: To compare cartilage thickness between patients with non-traumatic and post-traumatic knee osteoarthritis (OA) and healthy controls and to determine if disease severity and alignment impact these differences. DESIGN: Participants with non-traumatic (n = 22) and post-traumatic (n = 19) knee OA, and healthy controls (n = 22) were recruited for this cross-sectional study. Participants underwent 3T magnetic resonance imaging (T1-weighted, 3D sagittal gradient echo sequence) and cartilage thickness was determined in four regions: medial and lateral condyle, and medial and lateral plateau. Lower extremity alignment (mechanical axis angle) and disease severity (Kellgren-Lawrence scores) were measured from full length radiographs. Statistical analysis included one-way analysis of variance (ANOVA) and modified Bonferroni test adjusting for multiple pairwise comparisons. Linear regression analyses examined the relationship between cartilage thickness and knee OA group after controlling for disease severity, meniscal status, and alignment. RESULTS: In participants with predominantly medial compartment knee OA, compared to healthy controls, those with non-traumatic knee OA had diminished cartilage thickness in the medial plateau (p = 0.035) and those with post-traumatic knee OA had greater cartilage thickness in the lateral condyle (p = 0.044). In the lateral condyle, data revealed that alignment accounted for the variance in cartilage thickness (p = 0.035), in which a stronger relationship was found in the non-traumatic (r = -0.61) than the post-traumatic (r = -0.12) OA group. CONCLUSIONS: Emerging data demonstrated that participants with non-traumatic knee OA have a stronger relationship between alignment and cartilage thickness than those with post-traumatic knee OA. This indicates that factors involved in knee OA initiation and progression may differ between these OA subtypes.

A comparison of muscle activation and knee mechanics during gait between patients with non-traumatic and post-traumatic knee osteoarthritis.

OBJECTIVE: The objective was to compare muscle activation and knee mechanics during gait between participants with non-traumatic knee osteoarthritis (OA), post-traumatic knee OA, and healthy adults. DESIGN: Participants with non-traumatic knee OA (n = 22), post-traumatic knee OA (n = 19), and healthy adults (n = 22) completed gait trials for this observational, cross-sectional study. Post-traumatic OA group had a history of traumatic anterior cruciate ligament (ACL) rupture. Surface electromyography (EMG) measured activation of seven lower extremity muscles. Motion capture cameras and force plates measured motion and force data. Principal component analysis (PCA) determined waveform characteristics (principal components) from EMG, knee angle, and knee external moment waveforms. Analysis of variance (ANOVA) examined group differences in principal component scores (PC-scores). Regression analyses examined if a variable that coded for OA group could predict PC-scores after accounting for disease severity, alignment, and lateral OA. RESULTS: There was lower gastrocnemius EMG amplitudes (P < 0.01; ANOVA) in the post-traumatic OA group compared to healthy group. Non-traumatic OA group had higher vastus lateralis, vastus medialis, and rectus femoris EMG compared to post-traumatic OA group (P = 0.01 to 0.04) in regression analyses. Also, non-traumatic OA group had higher and prolonged lateral hamstring EMG compared to healthy (P = 0.03; ANOVA) and post-traumatic OA (P = 0.04; regression) groups respectively. The non-traumatic OA group had lower knee extension (P < 0.05) and medial rotation (P < 0.05) moments than post-traumatic and healthy groups. CONCLUSIONS: Muscle activation and knee mechanics differed between participants with non-traumatic and post-traumatic knee OA and healthy adults. These OA subtypes had differences in disease characteristics that may impact disease progression.

Osteoarthritis year in review 2014: rehabilitation and outcomes.

OBJECTIVE: To highlight research studies examining rehabilitation for hip and knee osteoarthritis (OA), as well as the outcome measures used to assess treatment efficacy, published in 2013. DESIGN: A systematic search was performed in Medline, CIHAHL and Embase databases from January to December 2013. The search was limited to 2013, human studies, and English. Rehabilitation intervention studies included were prospective controlled designs. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the quality of evidence. First, individual articles were rated for quality. Second, articles were grouped based on outcome: OA disease markers, pain, physical function (self-reported, performance), and health. RESULTS: Of 503 titles reviewed, 36 studies were included. The outcome measures related to OA disease markers were organized into subthemes of anthropometrics, biomechanics and physiology. The quality of evidence was of moderate, high, and low quality for anthropometric, biomechanical and physiological measures respectively. These studies supported the use of diet for weight loss combined with exercise. Bodies of evidence that showed the efficacy of exercise and passive strategies (thermal/electrical modalities, traction, manual therapy) for reducing pain were of low and moderate quality respectively. The evidence supporting diet and exercise, physiotherapy, and passive strategies to improve physical function was of moderate quality. Evidence supporting exercise to improve psychological factors was of moderate quality. CONCLUSIONS: Exercise combined with diet for weight loss should be the mainstays of rehabilitation for people with knee and hip OA to provide benefit to OA disease markers, pain, physical function, and health.

Comparison of measurement properties of the P4 pain scale and disease specific pain measures in patients with knee osteoarthritis.

OBJECTIVE: To compare measurement properties of the P4 pain scale, Western Ontario and McMaster Universities Arthritis Index pain subscale (WOMAC-pain), and Intermittent and Constant Osteoarthritis Pain (ICOAP) measure in patients with knee osteoarthritis (OA). DESIGN: A secondary analysis from a randomized controlled trial included participants (n = 156) with knee OA that were consulting with a surgeon regarding knee arthroplasty. They completed pain measures (P4, WOMAC-pain, ICOAP) and WOMAC-function subscale (WOMAC-function) at baseline and 2 weeks. Measurement properties assessed in various subgroups included floor/ceiling effects, test-retest reliability using intraclass correlation coefficients (ICC2,1), internal consistency using Cronbach's ɑ, factorial structure of each pain measure combined with WOMAC-function using principal component analysis, and responsiveness using standardized response mean (SRM). RESULTS: P4 had low floor and ceiling effects (<1%). P4 test-retest reliability (ICC2,1 = 0.72), internal consistency (Chronbach's ɑ = 0.91), and responsiveness (SRM = 0.56) were similar to the values for WOMAC-pain and ICOAP. Factorial structure of P4 and ICOAP were separate from WOMAC-function items. WOMAC-pain and WOMAC-function items loaded on similar factors. ICOAP-constant subscale had a large floor effect (33%). CONCLUSIONS: P4 should be used to measure pain in patients with knee OA. It had acceptable measurement properties which is comparable to more widely used pain measures. WOMAC-pain shared a factorial structure with WOMAC-function indicating these measures might be capturing the same construct, questioning its validity to measure pain separately from function. ICOAP had acceptable properties. More work should compare pain measures in less severely affected OA populations.

Lower-limb coordination and variability during gait: The effects of age and walking surface.

BACKGROUND: Falls among community-dwelling older adults are often triggered by uneven walkways. Joint coordination and its variability change with age and may place older adults at risk of falling. It is unclear how irregular surfaces impact lower-limb joint coordination and if such changes are exacerbated by aging. RESEARCH QUESTION: To what extent do lower-limb inter-joint coordination and its variability, over flat and uneven brick walkways, differ between older and young healthy adults? METHODS: A motion-capture system collected kinematic data from walking trials on flat and uneven walkways in seventeen older (72.0 ±â€¯4.2 years) and eighteen younger (27.0 ±â€¯4.7 years) healthy adults. Continuous relative phase analyses were performed for the Knee-Hip and Ankle-Knee joint pairs. Mean Absolute Relative Phase (MARP) quantified coordination amplitude. Deviation Phase (DP) quantified coordinative variability. Two-way mixed ANOVA's tested for effects of age, surface, and age × surface interactions. RESULTS: Uneven surfaces prompted more in-phase MARP inter-joint coordination in adults during most gait phases (p ≤ 0.024). Age × surface interactions were observed during initial contact (Ankle-Knee: p = 0.021, Knee-Hip: p = 0.001) and loading response (Knee-Hip: p = 0.017), with post-hoc analyses showing coordination accentuated in older adults. Uneven surfaces induced higher DP in Knee-Hip (p = 0.017) and Ankle-Knee joint coupling (p < 0.001) during gait, largely independent of age. An age × surface interaction was observed during mid-swing (p = 0.050), with post-hoc analysis revealing increased variability in older adults. SIGNIFICANCE: More in-phase and variable lower-limb gait behavior was observed on uneven walkways. These differences were accentuated in older adults during early stance phase (more tightly coordinated) and mid-swing (more variable). This may reflect a cautious gait strategy on challenging walkways to maintain stability and help prevent falls.

Inter-joint coordination and the flexion-relaxation phenomenon among adults with low back pain during bending.

BACKGROUND: Altered inter-joint coordination and reduced flexion-relaxation at end-range trunk flexion are common in people with low back pain. Inconsistencies in these behaviors, however, make assessment and treatment challenging for this population. RESEARCH QUESTION: The study objective was to investigate patterns of regional lumbo-pelvic coordination and flexion-relaxation in adults with and without low back pain, during a bending task. METHODS: Adults with low back pain (n = 16) and a healthy group (n = 21) performed three trials of a bending task. Motion capture and surface electromyography systems measured joint kinematics (hip, lower and upper lumbar spine) and muscle activity (erector spinae longissimus, iliocostalis, and multifidus). Continuous relative phase analysis determined inter-joint coordination of the hip/lower lumbar and lower lumbar/upper lumbar joint pairs, during flexion and extension periods. Flexion-relaxation ratios using normalized surface electromyography data determined the extent of flexion-relaxation for each muscle, during each period. For inter-joint coordination, two-way repeated measure mixed ANOVAs calculated the effects of group (healthy/low back pain), period, and their interactions. Separate hierarchical linear models were constructed and tested relationships between flexion-relaxation ratios and our independent variables, group and muscle, while controlling for patient characteristics. RESULTS: The low back pain group had more out-of-phase coordination of the hip/lower lumbar joint pair compared to the healthy group (mean difference = 24.7°; 95 % confidence interval = 3.93-45.4), independent of movement period. No significant between group differences in lower lumbar/upper lumbar coordination were observed. The low back pain group demonstrated reduced flexion-relaxation of all muscles during full flexion (21.7 % reduction on average), with multifidus showing the least relaxation. SIGNIFICANCE: Regional differences in the lumbar spine and the possibility of subgroups with distinct movement pattern should be considered when analyzing coordination in people with low back pain. Multifidus showed the largest changes in flexion-relaxation and should be included when measuring this construct.

Association of pRas and pRaf-1 in a complex correlates with activation of a signal transduction pathway.

BACKGROUND: A key pathway for transduction of proliferative, developmental and oncogenic stimuli from receptors at the cell surface to transcription factors located in the nucleus involves the activation of pRas and pRaf-1. Recent publications have described a physical interaction between pRas and pRaf-1, either as ectopic proteins in yeast or as recombinant proteins added to cellular extracts. Until now, however, physical complexes that include pRas and pRaf-1 have not been identified as native structures in mammalian cells. RESULTS: We have directly identified a pRas-pRaf-1 complex in extracts of mammalian cells. Formation of the complex is augmented in neoplastically transformed cells expressing constitutively activated pRas. Moreover, the complexes form in concert with the activation of pRas during intracellular signalling through the T-cell receptor in T-leukemia cells. CONCLUSIONS: We propose that, pRas signals to pRaf-1 in vivo by means of a direct physical interaction that results in activation of the pRaf-1 protein kinase.

Myristoylation and differential palmitoylation of the HCK protein-tyrosine kinases govern their attachment to membranes and association with caveolae.

The human proto-oncogene HCK encodes two versions of a protein-tyrosine kinase, with molecular weights of 59,000 (p59hck) and 61,000 (p61hck). The two proteins arise from a single mRNA by alternative initiations of translation. In this study, we explored the functions of these proteins by determining their locations within cells and by characterizing lipid modifications required for the proteins to reach those locations. We found that p59hck is entirely associated with cellular membranes, including the organelles known as caveolae; in contrast, only a portion of p61hck is situated on membranes, and none is detectable in preparations of caveolae. These distinctions can be attributed to differential modification of the two HCK proteins with fatty acids. Both proteins are at least in part myristoylated, p59hck more so than p61hck. In addition, however, p59hck is palmitoylated on cysteine 3 in the protein. Palmitoylation of the protein requires prior myristoylation and, in turn, is required for targeting to caveolae. These findings are in accord with recent reports for other members of the SRC family of protein-tyrosine kinases. Taken together, the results suggest that HCK and several of its relatives may participate in the functions of caveolae, which apparently include the transduction of signals across the plasma membrane to the interior of the cell.

Regulation of DdrasG gene expression during Dictyostelium development.

DdrasG gene expression during the early development of Dictyostelium discoideum has been examined in detail. The amount of DdrasG-specific mRNA increased approximately twofold during the first 2 to 3 h of development and then declined rapidly, reaching negligible levels by the aggregation stage. The increase in mRNA levels that occurred during the first 2 to 3 h of development also occurred during differentiation in cell suspensions and was enhanced when cells were shaken rapidly. This initial increase was unaffected by cell density. When cells were set up to differentiate on filters, the addition of a glucose-amino acid mixture slightly delayed differentiation and had a similar effect on the expression of the gene. The decline in DdrasG expression during development did not occur when cells were treated with cycloheximide, suggesting that the expression of a developmentally regulated gene product is essential for the reduction of DdrasG gene mRNA. There was no decrease in DdrasG mRNA level during differentiation in shake suspension, but the decrease did occur upon application of pulses of cyclic AMP to shaking cultures. The application of a continuously high level of cyclic AMP delayed the increase in expression of the gene and did not result in the subsequent decline. These results suggest that the induction of a functional cyclic AMP relay system is important in reducing DdrasG gene mRNA levels.

The Role of Neurotrophin Signaling in Gliomagenesis: A Focus on the p75 Neurotrophin Receptor (p75NTR/CD271).

The p75 neurotrophin receptor (p75NTR, a.k.a. CD271), a transmembrane glycoprotein and a member of the tumor necrosis family (TNF) of receptors, was originally identified as a nerve growth factor receptor in the mid-1980s. While p75NTR is recognized to have important roles during neural development, its presence in both neural and nonneural tissues clearly supports the potential to mediate a broad range of functions depending on cellular context. Using an unbiased in vivo selection paradigm for genes underlying the invasive behavior of glioma, a critical characteristic that contributes to poor clinical outcome for glioma patients, we identified p75NTR as a central regulator of glioma invasion. Herein we review the expanding role that p75NTR plays in glioma progression with an emphasis on how p75NTR may contribute to the treatment refractory nature of glioma. Based on the observation that p75NTR is expressed and functional in two critical glioma disease reservoirs, namely, the highly infiltrative cells that evade surgical resection, and the radiation- and chemotherapy-resistant brain tumor-initiating cells (also referred to as brain tumor stem cells), we propose that p75NTR and its myriad of downstream signaling effectors represent rationale therapeutic targets for this devastating disease. Lastly, we provide the provocative hypothesis that, in addition to the well-documented cell autonomous signaling functions, the neurotrophins, and their respective receptors, contribute in a cell nonautonomous manner to drive the complex cellular and molecular composition of the brain tumor microenvironment, an environment that fuels tumorigenesis.

Glioma invasion mediated by the p75 neurotrophin receptor (p75(NTR)/CD271) requires regulated interaction with PDLIM1.

The invasive nature of glioblastoma renders them incurable by current therapeutic interventions. Using a novel invasive human glioma model, we previously identified the neurotrophin receptor p75(NTR) (aka CD271) as a mediator of glioma invasion. Herein, we provide evidence that preventing phosphorylation of p75(NTR) on S303 by pharmacological inhibition of PKA, or by a mutational strategy (S303G), cripples p75(NTR)-mediated glioma invasion resulting in serine phosphorylation within the C-terminal PDZ-binding motif (SPV) of p75(NTR). Consistent with this, deletion (ΔSPV) or mutation (SPM) of the PDZ motif results in abrogation of p75(NTR)-mediated invasion. Using a peptide-based strategy, we identified PDLIM1 as a novel signaling adaptor for p75(NTR) and provide the first evidence for a regulated interaction via S425 phosphorylation. Importantly, PDLIM1 was shown to interact with p75(NTR) in highly invasive patient-derived glioma stem cells/tumor-initiating cells and shRNA knockdown of PDLIM1 in vitro and in vivo results in complete ablation of p75(NTR)-mediated invasion. Collectively, these data demonstrate a requirement for a regulated interaction of p75(NTR) with PDLIM1 and suggest that targeting either the PDZ domain interactions and/or the phosphorylation of p75(NTR) by PKA could provide therapeutic strategies for patients with glioblastoma.

Differential activation of ERKs to focal adhesions by PKC epsilon is required for PMA-induced adhesion and migration of human glioma cells.

Protein kinase C (PKC) is a family of serine/threonine kinases involved in the transduction of a variety of signals. There is increasing evidence to indicate that specific PKC isoforms are involved in the regulation of distinct cellular processes. In glioma cells, PKC alpha was found to be a critical regulator of proliferation and cell cycle progression, while PKC epsilon was found to regulate adhesion and migration. Herein, we report that specific PKC isoforms are able to differentially activate extracellular-signal regulated kinase (ERK) in distinct cellular locations: while PKC alpha induces the activation of nuclear ERK, PKC epsilon induces the activation of ERK at focal adhesions. Inhibition of the ERK pathway completely abolished the PKC-induced integrin-mediated adhesion and migration. Thus, we present the first evidence that PKC epsilon is able to activate ERK at focal adhesions to mediate glioma cell adhesion and motility, providing a molecular mechanism to explain the different biological functions of PKC alpha and epsilon in glioma cells.

Cloning and characterization of the Dictyostelium discoideum rasG genomic sequences.

A Dictyostelium discoideum genomic DNA clone containing the ras-related gene, rasG was isolated using the rasG cDNA as a probe. The genomic clone encompasses the entire coding region of the gene and 1.5 kb of 5' flanking region. The rasG gene contains a single intron as determined by sequence comparison with the cDNA, whereas the highly related rasD gene contains three introns. Primer extension analysis showed that transcription of the rasG gene initiates at multiple sites. Sequence analysis of the 5' flanking region of the gene revealed a stretch of thymine residues upstream from the transcription start sites but there is no evidence for a TATA box sequence.

Anergy and human immunodeficiency virus infection.

Human immunodeficiency virus (HIV), the retrovirus associated with acquired immune deficiency syndrome (AIDS), induces a spectrum of immune abnormalities including a state of anergy in the host. This state is due to the binding of HIV envelope glycoprotein moieties to CD4 molecules and chemokine receptors. Resulting decrease in antigen presenting cell function and the interference with functioning of positive and negative regulatory molecules involved in signal transduction have an anergizing effect on the immune system. This effect is exemplified by diminished production of interleukin-2 (IL-2) and interferon-gamma and reduced expression of IL-2 receptor by CD4 helper cells of HIV patients. These immune abnormalities lead to clinically relevant immunological phenomena such as Type-1 to Type-2 switch, decrease in delayed-type hypersensitivity dermal reaction, etc. Insight into these interesting phenomena could pave the path for favorably altering the immunological milieu for drug and vaccine trials.

Anergy and acquired immune deficiency syndrome.

Human immunodeficiency virus (HIV), the retrovirus associated with acquired immune deficiency syndrome (AIDS), acts as a super-antigen by binding to the variable region of the beta (V beta) chain of T-cell receptor (TCR). It's binding to CD4 molecules and chemokine receptors induces a spectrum of immune abnormalities including 'a state of anergy' in the host. This state is due to a defective function of T-helper cell-1 (Th-1), a reduction in production of lymphokines required for signal transduction, an impaired cytotoxic cell activation and a decrease in antigen presenting function of monocyte-macrophage cell lineage. These immune abnormalities form the basis for severe opportunistic infections and malignancies in the host. Malnutrition, micronutrient abnormalities, concomitant infections and genetic factors, etc., are some of the compounding co-factors that further contribute to 'the state of anergy'.

Ephrin A5 expression promotes invasion and transformation of murine fibroblasts.

Emerging evidence suggests involvement of the ephrin/Eph receptor system in tumourigenesis. Research on this new role has centred on the contribution of Eph receptors. In contrast, we focused on the elucidation of the role of ephrins, specifically ephrin A5. Results indicated an increase in invasive potential of ephrin A5-expressing murine fibroblasts, which was abolished by addition of a Src family kinase inhibitor. Furthermore, anchorage-independent growth was increased in ephrin A5-expressing cells. Stimulation with EphA5-Fc receptor increased colony size, but not colony number in ephrin A5 transfectants. Moreover, we observed morphogenetic transformation of ephrin A5-expressing 3T3 cells into a branching network when plated onto Matrigel. This behaviour was specific to ephrin A5 transfectants, as 3T3 cells expressing ephrin B1 displayed a phenotype similar to control 3T3 cells. We conclude that ectopic expression of ephrin A5 in murine fibroblasts elevates oncogenic potential, including increased invasive behaviour, anchorage-independent growth, and morphological transformation.

Ephrin-A5 modulates cell adhesion and morphology in an integrin-dependent manner.

The ephrins are membrane-tethered ligands for the Eph receptor tyrosine kinases, which play important roles in patterning of the nervous and vascular systems. It is now clear that ephrins are more than just ligands and can also act as signalling-competent receptors, participating in bidirectional signalling. We have recently shown that ephrin-A5 signals within caveola-like domains of the plasma membrane upon engagement with its cognate Eph receptor, leading to increased adhesion of the cells to fibronectin. Here we show that ephrin-A5 controls sequential biological events that are consistent with its role in neuronal guidance. Activation of ephrin-A5 induces an initial change in cell adhesion followed by changes in cell morphology. Both effects are dependent on the activation of beta1 integrin involving members of the Src family of protein tyrosine kinases. The prolonged activation of ERK-1 and ERK-2 is required for the change in cell morphology. Our work suggests a new role for class A ephrins in specifying the affinity of the cells towards various extracellular substrates by regulating integrin function.