代谢综合征与骨关节炎

骨关节炎(osteoarthritis,OA)是由关节退行性功能失调引起的慢性疾病,在中老年人群中易出现,是其致畸的主要原因。软骨细胞是软骨内唯一的一种细胞,具有合成胞外蛋白及维持基质稳定的作用。软骨内环境的稳定是软骨细胞执行正常功能的基本条件,而不利因素的刺激可导致合成代谢与分解代谢平衡的破坏,促进OA的发生发展。近年来研究发现,代谢综合征(metabolic syndrome,MS)与OA关系密切。MS目前定义还不是很明确,但其具体表现为胰岛素抵抗、高血压、脂代谢紊乱以及肥胖。而这些因素均可引起软骨内环境的改变,促进OA的病情发展。MS中所有因素可能存在协同作用,其综合作用与OA的发生发展具有显著相关性。它们之间并非因果关系,但潜在一些共同作用基础。MS与OA之间的相互关系目前还不是很明确,仍需要进一步研究。     

低强度脉冲超声在骨关节炎研究中的应用进展

骨关节炎（osteoarthritis，OA）是一种退行性关节疾病，以软骨变性、骨硬化和慢性滑膜炎症为主要病理特征。关节置换术是目前治疗终末期OA的唯一有效方式，但其预后较差，且人工关节寿命有限。因此，OA的研究重点已经转移为疾病预防和早期治疗。低强度脉冲超声（low-intensity pulsed ultrasound，LIPUS）不仅可以促进骨折的愈合和再生，而且在软组织修复、再生和抗炎等方面也发挥重要作用，已有研究证明LIPUS在软组织再生中具有潜在作用。简要介绍了LIPUS的治疗机制及其与OA发病机制的联系，总结了目前LIPUS用于预防OA的发生、发展以及促进关节软骨组织再生的基础和临床研究进展，以期为LIPUS未来做为预防关节软骨退变的潜在治疗方法提供理论依据。     

促进老年退行性骨关节炎软骨内源性修复的化合物研究进展

老年退行性骨关节炎(OA)是由关节损伤、肥胖和衰老等因素引起的一种退行性疾病,最终引起关节软骨损伤,导致运动功能障碍。软骨细胞及细胞外基质是软骨组织的主要成分,它们的损伤是引起OA的根本原因。目前OA的治疗仅限于缓解症状,而随着干细胞的发现及对软骨细胞的深入认识,开发增强软骨内源性修复的药物是OA治疗的重要方向。目前研究发现,kartogenin等化合物可以促进间充质干细胞选择性的分化为软骨细胞而起到修复作用,此外,一些化合物还可以调控软骨细胞的信号通路,起到促进软骨细胞增殖、抑制软骨细胞凋亡、抑制基质金属蛋白酶活性、增加细胞外基质合成等作用,从而维持软骨细胞的数量、促进软骨基质的合成而抑制其降解。这些方法比常规通过微创刺激内源性干细胞或移植自体细胞更加安全、有效。本文就化合物对促进老年退行性骨炎软骨内源性修复的研究进行综述,为发现更多的有效化合物提供基础。     

关节软骨与软骨下骨改变在不同骨关节炎动物模型中的特点

目的 探讨不同骨关节炎(osteoarthritis,OA)动物模型中软骨下骨和关节软骨的病理改变特征。方法 采用三种SD大鼠骨关节炎模型,将24只6月龄雌性大鼠随机分为4组:假手术对照组(Sham,n=6),前交叉韧带切除手术组(ACLT,n=6),木瓜蛋白酶关节腔注射组(Papain,n=6),以及卵巢切除术组(OVX,n=6)。造模后8周取膝关节,胫骨平台行Micro-CT扫描分析,关节软骨行甲苯胺蓝染色、Mankin评分,比较软骨下骨和关节软骨改变情况。结果 造模操作后8周,不同OA模型的软骨破坏程度有所不同。ACLT和Papain组软骨破坏比较严重,OVX组软骨变化较轻。所有OA模型中的软骨下松质骨均发生改变,OVX组相对于Sham对照组,软骨下骨微结构显著疏松,而ACLT组与Papain组相对于Sham对照组,软骨下骨微结构没有显著改变,但相对于OVX组,有显著性差异。三种OA模型的软骨下骨板厚度都较Sham组减少。结论 三种动物模型软骨下骨和关节软骨都发生明显病理改变,并且改变有所不同。不同OA模型代表不同病理,预示着软骨下骨所发挥的作用有所不同,这为进一步研究不同类型OA发生发展的机制,以及将软骨下骨作为OA治疗的可能靶点提供了更多的依据。     

运动干预对肥胖机体体内瘦素等脂肪细胞因子作用的影响

肥胖是近年主要的流行病之一,是危害健康的全球公共卫生问题。肥胖是一种慢性低度全身性炎症,伴随着一些炎性细胞的浸润和改变,并存在脂肪细胞因子分泌紊乱。瘦素是由白色脂肪细胞分泌的一种蛋白类激素,也是促炎细胞因子,在调控体内能量与代谢等方面发挥重要作用。运动干预会使肥胖机体体内促炎因子(瘦素、TNF-α、IL-6)水平含量降低,抗炎因子(脂联素)水平含量升高。运动能够延缓肥胖机体体内炎症反应的发生。本文以体内瘦素的生理功能及作用机制为中心,系统综述了运动对肥胖性慢性炎症的调节,主要包括脂肪细胞因子瘦素、脂联素、IL-6、TNF-α,以此探讨运动干预减重降脂和减轻慢性炎症反应的机制,为防治慢性代谢性疾病提供新视角。     

脂肪因子调控软骨功能在运动改善关节炎中的作用机制研究进展

关节炎主要是由机体的退行性变(类风湿关节炎除外)、代谢紊乱与损伤,以及感染和创伤等因素引起的关节,包括关节周围组织的炎症,一般伴随着关节软骨组织的损伤。研究发现,由脂肪组织分泌的瘦素(Leptin)、脂联素(Adiponectin)、抵抗素(Resistin)、内脂素(Visfatin)、趋化素(Chemerin)、网膜素1(Omentin-1)、脂蛋白2 (Lipocalin 2)和丝氨酸蛋白酶抑制剂(Vaspin)等细胞因子可以通过调控软骨细胞的增殖、分化和凋亡,改善关节软骨功能,降低关节炎症的水平。研究表明,运动能够通过调控相关脂肪因子的分泌,在改善关节软骨功能和关节炎进程中扮演着极为重要的角色。该文通过系统综述运动引起的相关脂肪因子的表达及其调控软骨功能的信号通路,探讨脂肪因子在运动调控软骨功能、改善关节炎中的具体机制,为关节炎的防治和药物靶点的开发提供新的思路。     

压应力对软骨细胞的影响

骨关节炎(osteoarthritis, OA)是一种以关节软骨退变、软骨下骨重塑、骨赘形成、关节内滑膜炎症反应和广泛血管生成为特征的慢性退行性疾病。其发生受遗传、环境、代谢、生物化学和机械应力等诸多因素的共同影响,其中机械应力异常为主要诱因。在机械应力异常导致OA的过程中,软骨组织的稳定状态被打破,软骨细胞作为软骨组织中唯一的细胞也会发生相应的变化。压应力是机械应力的一种,最新研究表明,压应力可对软骨细胞的形态、代谢状态、表型、细胞活性产生影响。因此,该文综述了近年来压应力对软骨细胞影响的相关文献,为OA的机制和治疗有关研究提供理论基础。     

骨桥蛋白在骨关节炎中的研究进展

骨关节炎（osteoarthritis,OA）是临床最常见的一类关节疾病,表现为关节软骨纤维化、皲裂、溃疡、脱失等进行性关节软骨破坏及关节边缘骨赘形成,并伴有不同程度的滑膜炎症。随着我国社会老龄化进程的加剧,OA发病率有逐年增高的趋势。据一项流行病学资料表明,我国40岁以上的中老年群体中,OA发病率高达46.3%,其中大约有80%的人群存在关节活动受限。     

白介素-1β诱导关节软骨细胞凋亡的分子机理

骨关节炎(OA)是一种退行性病变,表现为局限性、进行性关节软骨破坏及关节边缘骨赘形成,并伴有不同程度的滑膜炎症。软骨细胞是成熟关节软骨中唯一的细胞类型,它负责细胞外基质的合成和更新,并维持基质的完整。目前OA的发病机制尚不明确,但越来越多的研究发现致炎细胞因子白细胞介素-1β(IL-1β)起着重要的作用。IL-1β能诱导软骨细胞凋亡,其机制有一氧化氮(NO)、活性氧(ROS)和丝裂原激活的蛋白激酶(MAPK)等途径。IL-1β也是OA病变进展中破坏软骨细胞代谢平衡的主要细胞因子之一。对IL-1β诱导关节软骨细胞凋亡的分子机理的深入研究,将有助于新药的研发和骨关节病的治疗。     

生物磁谱分析技术在OA患者关节液磨屑颗粒评估中的初步应用

目的:随着人群的老龄化,骨关节炎(osteoarthritis,OA)已成为老年人最常见的疾病之一,严重影响老年人生活质量。而OA传统的诊断方法敏感性差,往往在确诊时,疾病已经发展到了晚期。本研究拟运用生物磁谱分析技术(bio-ferrography)来初步分析研究OA患者关节液中磨屑颗粒的参数,进而为OA的早期诊断提供依据。方法:选取符合纳入标准的2017年9月至2017年12月我科住院收治的OA患者。采集患者关节液后,运用bio-ferrography技术分离、收集关节液中的软骨磨屑颗粒和骨性磨屑颗粒,进一步通过扫描电镜(scanning electron microscope,SEM)观测磨屑颗粒的外形、数量和大小等参数。结果:随着患者OA等级的进展,软骨颗粒和骨性颗粒的数量均在增加,磨屑颗粒外形变得越来越锐利和不规则。在Kellgren-Lawrence(K-L)1级OA患者的关节液中,无骨性颗粒的存在,在K-L 1～3级OA患者的关节液中,软骨颗粒数量显著多于骨性颗粒。结论:我们初步探讨了通过bio-ferrography技术观测OA患者关节液中的磨屑颗粒,并评估了不同K-L分级OA患者关节液中磨屑颗粒的统计学特点,为今后建立以bio-ferrography技术为基础的OA早期诊断标准奠定了基础。     

Leptin plays a catabolic role on articular cartilage

Leptin has been shown to play a crucial role in the regulation of body weight. There is also evidence that this adipokine plays a key role in the process of osteoarthritis. However, the precise role of leptin on articular cartilage metabolism is not clear. We investigate the role of leptin on articular cartilage in vivo in this study. Recombinant rat leptin (100 μg) was injected into the knee joints of rats, 48 h later, messenger RNA (mRNA) expression and protein levels of basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), matrix metalloproteinases 2 and 9 (MMP-2, MMP-9), cathepsin D, and collagen II from articular cartilage were analyzed by real-time quantitative polymerase chain reaction (PCR) and western blot. Two important aggrecanases ADAMTS-4 and -5 (a disintegrin and metalloproteinase with thrombospondin motifs 4 and 5) were also analyzed by real-time quantitative PCR. Besides, articular cartilage was also assessed for proteoglycan/GAG content by Safranin O staining. Leptin significantly increased both gene and protein levels of MMP-2, MMP-9, cathepsin D, and collagen II, while decreased bFGF markedly in cartilage. Moreover, the gene expression of ADAMTS-4 and -5 were markedly increased, and histologically assessed depletion of proteoglycan in articular cartilage was observed after treatment with leptin. These results strongly suggest that leptin plays a catabolic role on cartilage metabolism and may be a disadvantage factor involve in the pathological process of OA.     

Small animal models to understand pathogenesis of osteoarthritis and use of stem cell in cartilage regeneration

Osteoarthritis (OA) is one of the most common diseases, which affect the correct functionality of synovial joints and is characterized by articular cartilage degradation. Limitation in the treatment of OA is mostly due to the very limited regenerative characteristic of articular cartilage once is damaged. Small animal models are of particular importance for mechanistic analysis to understand the processes that affect cartilage degradation. Combination of joint injury techniques with the use of stem cells has been shown to be an important tool for understanding the processes of cartilage degradation and regeneration. Implementation of stem cells and small animal models are important tools to help researchers to find a solution that could ameliorate and prevent the symptoms of OA.     

Deficiency of fibroblast activation protein alpha ameliorates cartilage destruction in inflammatory destructive arthritis

IntroductionInflammatory destructive arthritis, like rheumatoid arthritis (RA), is characterized by invasion of synovial fibroblasts (SF) into the articular cartilage and erosion of the underlying bone, leading to progressive joint destruction. Because fibroblast activation protein alpha (FAP) has been associated with cell migration and cell invasiveness, we studied the function of FAP in joint destruction in RA.MethodsExpression of FAP in synovial tissues and fibroblasts from patients with osteoarthritis (OA) and RA as well as from wild-type and arthritic mice was evaluated by immunohistochemistry, fluorescence microscopy and polymerase chain reaction (PCR). Fibroblast adhesion and migration capacity was assessed using cartilage attachment assays and wound-healing assays, respectively. For in vivo studies, FAP-deficient mice were crossed into the human tumor necrosis factor transgenic mice (hTNFtg), which develop a chronic inflammatory arthritis. Beside clinical assessment, inflammation, cartilage damage, and bone erosion were evaluated by histomorphometric analyses.ResultsRA synovial tissues demonstrated high expression of FAP whereas in OA samples only marginal expression was detectable. Consistently, a higher expression was detected in arthritis SF compared to non-arthritis OA SF in vitro. FAP-deficiency in hTNFtg mice led to less cartilage degradation despite unaltered inflammation and bone erosion. Accordingly, FAP^−/− hTNFtg SF demonstrated a lower cartilage adhesion capacity compared to hTNFtg SF in vitro.ConclusionsThese data point to a so far unknown role of FAP in the attachment of SF to cartilage, promoting proteoglycan loss and subsequently cartilage degradation in chronic inflammatory arthritis.     

Lubricin: a novel potential biotherapeutic approaches for the treatment of osteoarthritis

Osteoarthritis (OA) is a multi-factor disorder of sinovial joints, which characterized by escalated degeneration and loss of articular cartilage. Treatment of OA is a critical unmet need in medicine for regeneration of damaged articular cartilage in elderly. On the other hand, lubricin, a glycoprotein specifically synthesized by chondrocytes located at the surface of articular cartilage, has been shown to provide boundary lubrication of congruent articular surfaces under conditions of high contact pressure and near zero sliding speed. Lubrication of these surfaces is critical to normal joint function, while different gene expressions of lubricin had been found in the synovium of rheumatoid arthritis (RA) and OA. Moreover, mutations or lacking of lubricin gene have been shown to link to the joint disease such as camptodactyly-arthropathy-coxa vara-pericarditis syndrome (CACP), synovial hyperplasia and failure of joint function, suggesting an important role of lubricin in the pathogenesis of these joint disease. Recent studies demonstrate that administration with recombinant lubricin in the joint cavity would be effective in the prevention of cartilage degeneration in animal OA models. Therefore, a treatment with lubricin which would protect cartilage in vivo would be desirable. This article reviews recent findings with regard to the possible role of lubricin in the progression of OA, and further discusses lubricin as a novel potential biotherapeutic approaches for the treatment of OA.     

Effects of Hyaluronic Acid and γ–Globulin Concentrations on the Frictional Response of Human Osteoarthritic Articular Cartilage

Synovial fluid plays an important role in lubricating synovial joints. Its main constituents are hyaluronic acid (HA) and γ–globulin, acting as boundary lubricants for articular cartilage. The aim of the study was to demonstrate the concentration-dependent effect of HA and γ–globulin on the boundary-lubricating ability of human osteoarthritis (OA) cartilage. Normal, early and advance stage articular cartilage samples were obtained from human femoral heads and in presence of either HA or γ–globulin, cartilage frictional coefficient (µ) was measured by atomic force microscopy (AFM). In advanced stage OA, the cartilage superficial layer was observed to be completely removed and the damaged cartilage surface showed a higher µ value (∼0.409) than the normal cartilage surface (∼0.119) in PBS. Adsorbed HA and γ–globulin molecules significantly improved the frictional behavior of advanced OA cartilage, while they were ineffective for normal and early OA cartilage. In advanced-stage OA, the concentration-dependent frictional response of articular cartilage was observed with γ–globulin, but not with HA. Our result suggested that HA and γ–globulin may play a significant role in improving frictional behavior of advanced OA cartilage. During early-stage OA, though HA and γ–globulin had no effect on improving frictional behavior of cartilage, however, they might contribute to disease modifying effects of synovial fluid as observed in clinical settings.     

Enzymatic activity and distribution of phospholipase A2 in human cartilage

Extracellular phospholipase A2 (PLA2) with proinflammatory activity has recently been discovered in synovial fluids in inflammatory arthritides. In the search for the sources of synovial fluid PLA2, human synovium and articular cartilage were found to contain large quantities of the enzyme. In rheumatoid arthritis (RA), PLA2 activity in synovium, superficial and deep layers of articular cartilage was 20 +/- 14 (SEM), 168 +/- 62 and 533 +/- 176 nmol/min/mg protein respectively. Corresponding values in osteoarthritis (OA) were 49 +/- 11, 569 +/- 109 and 1709 +/- 243 nmol/min/mg protein, all significantly higher (p less than .01) than in RA. Nasal septal cartilage contained much less PLA2, 19 +/- 5.6. PLA2 in human articular and nasal cartilage has sn-2 specificity, a neutral pH optimum and absolute calcium dependence. High PLA2 concentration in articular cartilage may imply that, at least in part, cartilage is the source of PLA2 in the joint space. Since RA cartilage and synovium have less PLA2 activity than the corresponding OA tissues, additional sources of PLA2 in RA synovial fluids are implicated.     

Degeneration of normal articular cartilage induced by late phase osteoarthritic synovial fluid in beagle dogs

Objective

To investigate the pathogenesis of late phase osteoarthritic (OA) synovial fluid (SF) on normal articular cartilage in vivo and provide an understanding of degenerative cartilage extending in OA joint.

Methods

A random knee, each of 8 beagle dogs, received anterior cruciate ligament transection (ACLT) and was confirmed to have late phase OA degenerative changes at 24 weeks after operation. Thereafter, one random elbow of each canine was injected with autologous late phase OA knee SF. The contralateral elbow was injected with normal saline (NS) of the same volume as SF aspirated from ACLT knee. These two groups of elbows were labeled “SF” and “NS”. 8 other beagle dogs were left intact and placed in Group Control. After aseptic arthrocentesis was performed weekly on both elbows for 24 weeks, morphological changes were observed in the cartilage of the elbows, and expressions of 7 biological etiological factors of chondrocytes of the elbows were determined in Group SF, Group NS and Group Control, respectively.

Results

Morphological changes were observed in articular cartilage of the elbows in Group SF. Levels of unit area of collagen type I in the noncalcified, calcified and full zones of articular cartilage of the elbows in Group SF increased significantly. Level of unit area of collagen type III in the calcified zone of articular cartilage of the elbows in Group SF remained unchanged. Meanwhile, expressions of MMP-1 and MMP-3 of chondrocytes of the elbows in Group SF increased significantly. There was almost no difference between articular cartilage in Group NS and Group Control.

Conclusion

Based on these results, we conclude that OA degeneration of normal articular cartilage can be independently induced by late phase OA SF. Endogenous OA biological etiological factor may be one of the reasons causing degenerative cartilage extending in OA joint.     

Tensile and compressive properties of healthy and osteoarthritic human articular cartilage

Osteoarthritis (OA) is a disease affecting articular cartilage and the underlying bone, resulting from many biological and mechanical interacting factors which change the extracellular matrix (ECM) and cells and lead to increasing levels of cartilage degeneration, like softening, fibrillation, ulceration and cartilage loss. The early diagnosis of the disease is fundamental to prevent pain, further tissue degeneration and reduce hospital costs. Although morphological modifications can be detected by modern non-invasive diagnostic techniques, they may not be evident in the early stages of OA. The mechanical properties of articular cartilage are related to its composition and structure and are sensitive to even small changes in the ECM that could occur in early OA. The aim of the present study was to compare the mechanical properties of healthy and OA cartilage using a combined experimental-numerical approach. Experimental assessments consisted of step wise confined and unconfined compression and tension stress relaxation tests on disks (for compression) or strips (for tension) of cartilage obtained from human femoral heads discarded from the operating room after total hip replacement. The numerical model was based on the biphasic theory and included the tension-compression non-linearity. Considering OA samples vs normal samples, the static compressive modulus was 55-68% lower, the permeability was 60-80% higher, the dynamic compressive modulus was 59-64% lower, the static tension modulus was 72-83% lower. The model successfully simulated the experimental tests performed on healthy and OA cartilage and was used in combination with the experimental tests to evaluate the role of different ECM components in the mechanical response of normal and OA cartilage.