A search for type 1 diabetes susceptibility genes in families from the United Kingdom.

Genetic analysis of a mouse model of major histocompatability complex (MHC)-associated autoimmune type 1 (insulin-dependent) diabetes mellitus (IDDM) has shown that the disease is caused by a combination of a major effect at the MHC and at least ten other susceptibility loci elsewhere in the genome. A genome-wide scan of 93 affected sibpair families (ASP) from the UK (UK93) indicated a similar genetic basis for human type 1 diabetes, with the major genetic component at the MHC locus (IDDM1) explaining 34% of the familial clustering of the disease (lambda(s)=2.5; refs 3,4). In the present report, we have analysed a further 263 multiplex families from the same population (UK263) to provide a total UK data set of 356 ASP families (UK356). Only four regions of the genome outside IDDM1/MHC, which was still the only major locus detected, were not excluded at lambda(s)=3 and lod=-2, of which two showed evidence of linkage: chromosome 10p13-p11 (maximum lod score (MLS)=4.7, P=3x10(-6), lambda(s)=1.56) and chromosome 16q22-16q24 (MLS=3.4, P=6.5x10(-5), lambda(s)=1.6). These and other novel regions, including chromosome 14q12-q21 and chromosome 19p13-19q13, could potentially harbour disease loci but confirmation and fine mapping cannot be pursued effectively using conventional linkage analysis. Instead, more powerful linkage disequilibrium-based and haplotype mapping approaches must be used; such data is already emerging for several type 1 diabetes loci detected initially by linkage.

A study of the relationship between mineral content and mechanical properties of turkey gastrocnemius tendon.

The vertebrate skeletal system undergoes adaptation in response to external forces, but the relation between the skeletal changes and such forces is not understood. In this context, the variation in the amount and location of calcification has been compared with changes in mechanical properties of the normally mineralizing turkey gastrocnemius tendon using ash weight measurements, X-ray radiography, and mechanical testing. Radiographic evidence from 12- to 17-week-old birds showed calcification in only portions of gastrocnemius tendons proximal to the tarsometatarsal joint. Mechanical testing of these dissected proximal regions demonstrated an increased ultimate stress and modulus and a decreased maximum strain that appeared to parallel calcification. Further, stress-strain curves of portions of uncalcified turkey gastrocnemius tendon were shaped similar to those of other typical unmineralized tendon curves while highly calcified tendons yielded curves resembling those of bone. The proximal portions of the gastrocnemius where mineralization begins were observed to have a decreased tendon cross-sectional area compared with distal portions which do not mineralize. Based on the resultant measures of mineral content and location and mechanical properties, it is hypothesized that increased calcification is a result of increased stresses at certain locations of the tendon, perhaps the consequence of the natural forces exerted by the large leg muscles of the bird into which the gastrocnemius inserts. More specifically, tendon calcification may be the result of stress-induced exposure of charged sites on the surfaces of collagen molecules, fibrils, or fibers so that deposition of mineral and subsequent mechanical reinforcement occur in the tissue.(ABSTRACT TRUNCATED AT 250 WORDS)

Mechanical analysis of hypertrophic scar tissue: structural basis for apparent increased rigidity.

The mechanical behavior of normal human skin and hypertrophic scar tissue (HST) is compared using constant-strain-rate and successive stress-relaxation uniaxial loading programs in vitro. HST is less extensible, requires more energy to be stretched in the physiologic range, and stores strain energy less efficiently than normal skin. The explanations for the differences observed between the mechanical behavior of normal skin and HST are based on the differences in their composition and structure. We suggest that the collagen fiber network is partially "prealigned" in a crimped tendon-like organization in HST, which reduces its extensibility and raises the strain energy required to stretch it. It is further hypothesized that an incomplete elastic fiber network, an abnormal glycosaminoglycan content, and/or abnormal collagen fiber slippage are responsible for the reduced capacity to return strain energy in the hypertrophic scar tissue. The results of these studies indicate that although HST has been described as stiffer than normal skin, the maximum stiffness of skin and HST are similar. The "apparent" increased rigidity of HST is a result of reduced extensibility rather than a change in its stiffness. This inexensibility may manifest itself by limiting joint mobility in the patient with HST.

Intraosseous incorporation of composite collagen prostheses designed for ligament reconstruction.

Composite collagen prostheses are potentially useful for reconstruction of the anterior cruciate ligament (ACL). We evaluated the intraosseous response to composite collagen prostheses to determine if "biological fixation" could be used to secure the prostheses within surgical bone tunnels. The rate of degradation of the prosthesis and the response of the tissue were evaluated, as a function of collagen crosslinking agent and time, in nonloaded bone tunnels in rabbits. Prostheses were fabricated by the alignment of 200 reconstituted type-I collagen fibers (60 microns in diameter) and the embedding of the fibers within a collagen matrix. The prostheses degraded rapidly within the bone tunnels in comparison with soft-tissue implantation sites. Dehydrothermal-cyanamide crosslinked collagen fibers were completely degraded by 8 weeks. Only 10% of glutaraldehyde cross-linked collagen fibers remained intact at 12 weeks. Fibrous tissue and inflammatory cells rapidly infiltrated the prostheses, and new bone surrounded the circumference of the prostheses, advancing toward the center at longer times. At the lateral cortex, where fibrous tissue emerged, the bone/soft-tissue interface was delineated by a tidemark, similar to that observed in a normal ligament insertion site. Preliminary pull-out testing of the soft tissue from the bone was discontinued because failure consistently occurred in the soft tissue; this suggests rapid incorporation of the prostheses within the bone tunnels. Composite collagen prostheses designed for ACL reconstruction degrade rapidly in bone and induce rapid ingrowth of fibrous tissue and bone. These results suggest that tissue ingrowth in the bone tunnels might provide biological fixation for collagen prostheses used for ACL reconstruction.

Viability of fibroblast-seeded ligament analogs after autogenous implantation.

Fibroblast-seeded collagen scaffolds or ligament analogs are potentially useful for reconstruction of the anterior cruciate ligament of the knee. To provide lasting benefits, the seeded cells must survive implantation within the harsh synovial environment of the knee joint. Our objective was to determine the in vivo fate of autogenous fibroblast-seeded ligament analogs as a function of fibroblast source (anterior cruciate ligament or skin), implantation site (knee joint or subcutaneous space), and time after implantation (1, 2, 4, 6, or 8 weeks). Before implantation, fibroblasts were labeled with PKH26-GL, a fluorescent membrane dye. Immediately after retrieval of the implant, the viability of the labeled seeded cells was assessed under a fluorescent microscope. Viable seeded fibroblasts remained attached to the collagen fibers within the ligament analogs for at least 4 weeks (skin fibroblasts) or 6 weeks (anterior cruciate ligament fibroblasts) after implantation. A larger number of viable seeded cells were consistently observed in the subcutaneous space than in the knee joint. Scaffold resorption prevented observation at the 8-week time period. Fibroblast-seeded ligament analogs remained viable for prolonged periods in the knee joint and therefore have the potential to influence the formation and remodeling of neoligament tissue after reconstruction of the anterior cruciate ligament.

Regeneration of Achilles tendon with a collagen tendon prosthesis. Results of a one-year implantation study.

We previously reported on the short-term biocompatibility of a reconstituted type-I collagen prosthesis that had been tested in the Achilles tendons of rabbits. Preliminary results indicated that, by ten weeks after implantation, carbodiimide-cross-linked implants had been replaced by neotendon in a manner that was similar to that of autogenous tendon grafts that had been used as controls. Also by ten weeks after implantation, glutaraldehyde-cross-linked collagen implants were encapsulated and appeared to have caused an acute inflammatory response. In the present study, carbodiimide and glutaraldehyde-cross-linked collagen implants and autogenous grafts that served as controls were implanted for fifty-two weeks as a replacement for a three-centimeter section of the Achilles tendon of rabbits. The absence of a crimp in a cross-linked implant and the presence of a crimp in normal tendon and in tendon that formed after an implant had been resorbed made it possible to distinguish between a cross-linked implant and new host tendon that had replaced the implant after it was resorbed. New collagen that had replaced the implant and autogenous (control) tendon graft were compared with normal Achilles tendon with respect to the angle and length of the crimp. The autogenous grafts and the carbodiimide-cross-linked collagen implants had been completely resorbed and replaced by neotendon. The neotendon that was present fifty-two weeks after implantation was similar, but not identical, to normal tendon. In contrast, the glutaraldehyde-cross-linked implant was essentially inert, had not been resorbed, and was surrounded by a capsule of collagenous connective tissue. The neotendon in the capsule was also similar, but not identical, to normal tendon. There were more cells in the capsule than in the autogenous grafts or in the carbodiimide-cross-linked implants. The results of the present study indicate that rapid repair is achieved with a carbodiimide-cross-linked collagenous implant that has a structure and mechanical properties that are similar to those of an autogenous tendon graft and that biodegrades at a similar rate. Prolonged biodegradation of a glutaraldehyde-cross-linked collagenous implant results in formation of a capsule and only limited formation of neotendon.

Anterior cruciate ligament reconstruction using a composite collagenous prosthesis. A biomechanical and histologic study in rabbits.

We evaluated a prototype composite collagenous anterior cruciate ligament replacement device designed to possess the advantages of biological grafts and synthetic materials. Collagenous anterior cruciate ligament prostheses were made by embedding 225 reconstituted type I collagen fibers in a type I collagen matrix, and placing polymethylmethacrylate bone fixation plugs on the ends. The collagenous prosthesis was used to replace the anterior cruciate ligament of 31 mature rabbits. At 4 and 20 weeks postimplantation, histologic and mechanical studies were performed on the developing neoligament tissue, and compared to values for the contralateral sham-operated control. At 4 weeks, neoligament tissue infiltrated the collagen fibers of the prostheses. The tibial bone tunnel attachment site contained new bone approaching the fibrous neoligament. The glutaraldehyde-treated prosthetic fibers appeared intact, while the carbodiimide-treated prosthetic fibers began to resorb. The ultimate load and ultimate tensile strength of femur-neoligament-tibia complexes had decreased. At 20 weeks, glutaraldehyde-treated fibers appeared partially intact; in contrast, the carbodiimide-treated prostheses appeared to be completely degraded, and were replaced by organized, crimped neoligament tissue. The ultimate tensile strength and ultimate load increased substantially due to deposition and remodeling of neoligament tissue. The neoligament ultimate load was 2 to 4 times the initial load value of the prosthesis. Implantation of a resorbable, composite collagenous anterior cruciate ligament prosthesis encourages the development of functional neoligament tissue. Studies are underway to optimize the mechanical and biological properties of the prostheses.

Heme oxygenase-1 gene expression as a stress index to ocular irritation.

PURPOSE: Predicting the toxic potential of compounds to the ocular surface has depended on the Draize test for the past half century. Alternatives to Draize testing have recently been sought for a number of reasons. Stress gene expression has emerged as a means of quantifying cellular reaction and, thus, the toxic potential of the compound in question. This study examines the expression of the major stress response gene heme oxygenase-1 (HO-1) in a human corneal epithelial cell line (HCE-T) following challenges with a number of known ocular irritants. METHODS: HCE-T was used to investigate the effect of ocular irritants on cell viability and HO-1 expression. Irritants tested included hydrogen peroxide, isopropyl alcohol, sodium hydroxide and trichloroacetic acid. HCE-T cells were grown to 80% confluency and treated with the listed irritants at a concentration range of 10-100 microM. Cell viability and northern blot analysis were performed following a 24 and 48 hr incubation period. RESULTS: HCE-T cells expressed HO-1 mRNA and HO activity similar to other human cell lines. Northern blot analysis demonstrated that levels of HO-1 mRNA transcripts increased regularly after exposure to the irritants in a concentration-dependent manner. Studies on the effect of various inhibitors and inducers of HO-1 on cell viability showed that inhibition of HO-1 potentiates the cytotoxic effect of ocular irritants. In contrast, pre-induction of HO-1 in HCE-T decreases the effect of various irritants on cell viability. CONCLUSIONS: These results are consistent with the idea that HO-1 mRNA levels may be used as an indicator of toxicity resulting from ocular irritants and that HCE-T cells respond to stress in a fashion similar to other human cell lines. This strategy for testing may be important in the development of an alternative to Draize testing. The results of this study also suggest that HO-1 may constitute a part of the protective defense mechanism against chemical injury.

Hydroxyapatite-coated orthopedic implants.

Hydroxyapatite (HA)-coated metal implants were developed in order to capitalize on the excellent biological properties of HA, and minimize the potential for mechanical failure of the HA in vivo. Results of implantation studies suggest that synthetic HA is osteoconductive (enhances local bone healing) and becomes osteointegrated (forms an intimate bond with bone). HA-coated prostheses are currently being evaluated for use in cementless total joint arthroplasty. The purpose of this article is to review the experimental studies leading to the development of HA-coated orthopedic devices, and to summarize the current status of clinical studies. Finally, the concerns and future directions for HA-coated implants are addressed.

Anterior cruciate ligament replacement: a review.

The anterior cruciate ligament (ACL) is the major intra-articular mechanical element that limits motion of the tibia with respect to the femur. It is a multi-fasciculated structure composed of crimped aligned collagen fibers. The purpose of this paper is to review the literature on ACL structure and mechanical properties in an effort to stimulate the development of a new generation of more effective replacement devices. Replacement of the ACL is achieved using biologic and synthetic grafts. Biologic grafts include illiotibial band, semitendinosus and gracilis tendons, patellar tendon, and meniscus. Bone-patellar-bone complexes used to replace the ACL are revascularized and ultimately replaced by neo-ligament. Synthetic implants including the Integraft, Leads-Keio ligament, Gore-Tex¿ ligament and Kennedy Ligament Augmentation Device (LAD) have either not been approved or approved by the FDA for limited use as a replacement for the ACL. The Kennedy LAD has been found to increase the strength of autogenous tissue during revascularization. Based on the success of autografts and the Kennedy LAD, we conclude that the next generation of ACL replacement devices will consist of a scaffold and a biodegradable augmentation device. The scaffold will have a structure that mimics the normal ACL as well as stimulates revascularization and healing. A biodegradable augmentation device will be employed to mechanically reinforce the scaffold without stress shielding the neo-ligament. By combining the advantages of autografts and a biodegradable augmentation device, a new generation of ACL replacements will be achieved.

Effects of hydrogen peroxide cleaning procedures on bone graft osteoinductivity and mechanical properties.

Bone allografts are frequently used during orthopaedic trauma cases or other reconstructive procedures. Most allografts are processed and cleaned before use. Our goals were to determine if an improved cleaning procedure compromises the strength or osteoinductivity of a graft. We compared our improved cleaning procedure to our standard cleaning procedure on cortical bone allograft. The cleaning procedures are generally composed of a series of chemical steps with nonionic detergents, hydrogen peroxide, and alcohol under time and temperature control, subjected to ultrasonic agitation. We tested the compressive strength, impact strength, and shear strength following the standard and improved cleaning procedures. Osteoinductivity was tested in 4 groups, using the improved cleaning procedure with four different hydrogen peroxide cleaning times: 0, 1, 3, and 5 h. Osteoinductivity was evaluated in vivo, using a 28-day implant in the hamstring muscle of an athymic, nude mouse. Results demonstrated that osteoinductivity is maintained with cleaning in hydrogen peroxide for up to 1 h, and that compressive strength, impact strength, and shear strength were all unaffected by the improved cleaning procedure. The improved cleaning procedure therefore did not compromise the strength or osteoinductivity of cortical bone allografts in comparison to the standard procedure.

Identification of two sequence elements associated with the gene encoding the 24-kDa crystalline component in Bacillus thuringiensis ssp. fukuokaensis: an example of transposable element archaeology.

A 6.5-kb fragment of plasmid DNA from Bacillus thuringiensis (Bt) ssp. fukuokaensis that encodes a 24-kDa crystalline component was analyzed to identify additional open reading frames (orfs). A novel Bt IS240-like element was found upstream of this gene and is considered to be a vestige of a once active insertion sequence due to a stop codon that interrupts the long orf encoding the putative transposase. This element was bounded by 17-bp terminal inverted repeats that defined the length of the insertion sequence as 802 bp. Further upstream of this element two tandem overlapping and out of phase open reading frames (orfX and orfY) were identified which represent the first example of an IS150-like element in Bt containing both orfs. orfX and orfY are not bounded by terminal inverted repeats but are associated with a gene encoding a putative site-specific recombinase of a type found in Staphylococcus aureus Class II transposons but not previously in Bt.

Viscoelastic behavior of human connective tissues: relative contribution of viscous and elastic components.

Stress-relaxation tests were performed at successive strain levels on strips of human aorta, skin, psoas tendon, dura mater, and pericardium. The elastic fraction, the equilibrium force divided by the initial force, was calculated at each strain increment. In the aorta, the elastic fraction decreased with strain and was modeled as the transfer of stress from elastic to collagen fibers, while in skin it increased with strain, probably due to the rearrangement of individual collagen fiber orientations, resulting in an aligned collagen network at high strains. The strain-independent elastic fractions for tendon, dura mater, and pericardium were similar, and approximately equal to the values found for aorta and skin at high strains. It was hypothesized that the elastic fraction is related to the type of fiber loaded, and the tissue geometry. This analysis may be useful in studying disease-induced changes in the mechanical properties of connective tissues.

Effect of chemical treatments on tendon cellularity and mechanical properties.

Removal of cells may decrease the antigenicity and risk of disease transmission associated with tendon allografts and xenografts. An ideal cell removal method would not compromise graft structure and mechanical properties. This study compared the effects of three extraction chemicals [t-octyl-phenoxypolyethoxyethanol (Triton X-100), tri(n-butyl)phosphate (TnBP), and sodium dodecyl sulfate (SDS)] on tendon cellularity, structure, nativity, and mechanical properties. Rat tail tendons were soaked in extraction solutions for various time periods (12-48 h) and concentrations (0.5-2%), then they were rinsed with distilled water and ethyl alcohol. Histological analysis and tensile tests were performed on control and chemically treated tendons. Changes in collagen nativity were estimated by mechanical testing following incubation in a trypsin solution. Treatment of tendons with 1% Triton X-100 for 24 h disrupted the collagen fiber structure and did not remove cells. Treatment with 1% SDS for 24 h or 1% TnBP for 48 h resulted in an acellular tendon matrix with retention of near normal structure and mechanical properties. Consistent with previous studies demonstrating cell removal from other tissue types using SDS and TnBP, our preliminary results suggest these treatments are potentially useful for removing cells from tendon allografts or xenografts without compromising the graft structure or mechanical properties.

Optimization of extruded collagen fibers for ACL reconstruction.

Collagen fibers used in a scaffolding device for ligament reconstruction must be thin, strong, and degradable. The purpose of this study was to determine the effects of fiber diameter (20, 50, or 90 microns), crosslinking agent (uncrosslinked, dehydrothermal-cyanamide, or glutaraldehyde), and hydration on the initial mechanical properties, biocompatibility, and subcutaneous degradation rates of fibers extruded from an acidic dispersion of insoluble type I collagen. The wet tensile strength of extruded collagen fibers was significantly improved by decreasing the fiber diameter. Low-diameter, crosslinked fibers had wet tensile strengths ranging from 75-110 MPa. In contrast, high diameter fibers had wet strength values of about 30 MPa. The degradation rate of the implanted fibers, in contrast, was not significantly prolonged by changing the initial fiber diameter. This result is important because prolonged degradation of the fibers can lead to implant encapsulation instead of neoligament formation. By minimizing the diameter, fiber strength can be increased without prolonging the fiber degradation rate. Low-diameter, dehydrothermal-cyanamide crosslinked fibers have greater tensile strength and a more rapid degradation rate than medium-diameter, glutaraldehyde crosslinked fibers, and are therefore more suitable for use in a degradable ligament reconstruction device.

Mechanical and histological evaluation of amorphous calcium phosphate and poorly crystallized hydroxyapatite coatings on titanium implants.

The effect of amorphous calcium phosphate (Ca/P) and poorly crystallized (60% crystalline) hydroxyapatite (HA) coatings on bone fixation to "smooth" and "rough" (Ti-6A1-4V powder sprayed) titanium-6Al-4V (Ti) implants was investigated. Implants were evaluated histologically, mechanically, and by scanning electron microscopy (SEM) after 4 and 12 weeks of implantation in a rabbit transcortical femoral model. Histological evaluation of amorphous vs. poorly crystallized HA coatings showed significant differences in bone apposition (for rough-coated implants only) and coating resorption (for smooth- and rough-coated implants) that were increased within cortical compared to cancellous bone. The poorly crystallized HA coatings showed most degradation and least bone apposition. Mechanical evaluation, however, showed no significant differences in push-out shear strengths between the two types of coatings evaluated. Differences between 4 and 12 weeks were significant for coating resorption and push-out shear strength but not for bone apposition. Significant enhancement in interfacial shear strengths for bioceramic coated as compared to uncoated implants were seen for smooth-surfaced implants (3.5-5 times greater) but not for rough-surfaced implants at 4 and 12 weeks. Rough implants showed greater mean interfacial strengths than uncoated smooth implants at 4 and 12 weeks (seven times greater) and to coated smooth implants at 12 weeks only (two times greater). Mechanical failure of the bone/coating/implant interface consistently occurred within the bone, even in the case of the poorly crystallized HA coatings, which had almost completely resorbed on rough implants. These results suggest that once early osteointegration is achieved biodegradation of a bioactive coating should not be detrimental to the bone/coating/implant fixation.

In vitro evaluation of amorphous calcium phosphate and poorly crystallized hydroxyapatite coatings on titanium implants.

Studies of various apatite coatings on metal orthopaedic prostheses suggest that coating dissolution may promote enhanced bone bonding. Little is known concerning the effects of crystallinity and the underlying roughness on calcium phosphate (Ca/P) coating dissolution rate. To address these issues, the surface chemistry of amorphous Ca/P and poorly crystallized hydroxyapatite (HA) coatings on "smooth" and "rough" titanium (Ti) alloy (Ti-6A1-4V) implants was studied following immersion in Hank's physiologic solution at pH 7.2 and 5.2 for 0-, 4-, and 12-week periods. Changes in Calcium (Ca) ion concentrations in the solutions, coating chemistry, and surface morphology were studied by ion selective electrode, x-ray diffraction (XRD), and scanning electron microscopy (SEM) respectively. The amount of Ca dissolved from Ca/P-coated implants was strongly dependent on the chemistry of the coating and less dependent on pH or time of incubation. The effect of the underlying surface (smooth vs. rough) was not significant. The poorly crystallized HA coating underwent the most degradation, greatest crystallographic alteration, and greatest surface film formation. The amorphous coating was more stable in the saline environment, and may be more suitable in vivo if coating longevity is desired. These results suggest that this in vitro method is an effective way of determining differences in HA coating integrity.