The effects of mechanical stability on the macromolecules of the connective tissue matrices produced during fracture healing. II. The glycosaminoglycans

Summary The glycosaminoglycans secreted into the matrices associated with fractures of the rabbit tibia healing under stable and unstable mechanical conditions have been characterized histochemically using the dye Alcian Blue at pH 5.7 in the presence of increasing concentrations of magnesium chloride, and after enzymatic extractions. These results are compared with those of immunohistochemical experiments using monoclonal antibodies which recognize epitopes specific to various glycosaminoglycans.The results indicate that the fibrous tissues, including those of the cavities of the cancellous bone and periosteum, possess hyaluronate and chondroitin sulphate, but the amounts present are small. The glycosaminoglycans detected in the cortical bone are located mainly around the osteocyte lacunae where chondroitin and keratan sulphates are found. The developing trabeculae of cancellous bone in the callus contain chondroitin and keratan sulphates, but as the trabeculae mature, these glycosaminoglycans are no longer present throughout the matrix; they are found particularly around the osteocyte lacunae.The cartilage in the callus of mechanically unstable fractures contains chondroitin, chondroitin-4- and 6-sulphates and keratan sulphate, though their distribution is variable. The small, transient areas of cartilage in the callus of mechanically stable fractures also contain those glycosaminoglycans, but they appear to be less highly sulphated.The mechanical stability of the fractures appears to affect the amount and degree of sulphation of the glycosaminoglycans, rather than the types of glycosaminoglycan produced. The glycosaminoglycans produced during fracture healing are compared with those produced during embryonic development and other healing processes.     

The effects of alpha amylase on collagen-proteoglycans and collagen-glycoprotein complexes in connective tissue matrices

Summary Different connective tissues were digested with Bacillus subtilis -amylase in an effort to determine the effects of this enzyme on the glycoprotein-collagen complexes. It was found that in some tissues insoluble collagen could not be attacked by Clostridium histolyticum collagenase unless a glycoprotein fraction, strongly associated with the fibers, was removed. This removal was achieved by -amylase, thus supporting earlier observations that sugar-containing compounds are strongly bound to collagen. Using alpha amylase an unexpected and interesting result demonstrated that this enzyme(s) releases acid glycosaminoglycans from the various connective tissues. Chemical studies have shown that the -amylase preparation was not contaminated to any significant extent by hyaluronidase or by a protease.Supported by Grant DE-02110-05 of the National Institutes for Public Health, Bethesda, Maryland.     

The microfibrils of connective tissue: I. Ultrastructure

The ultrastructure of connective tissue microfibrils was examined in two sites: the ciliary zonule of the eye and the foot pad, in 20-day-old mice perfused with glutaraldehyde. The microfibrils were classified into two categories, referred to as typical and atypical. Typical microfibrils predominate in both sites; they are unbranched, straight or gently curving, tubular structures of indefinite length with an overall diameter of 12.8 +/- 1.7 nm in the zonule and 13.8 +/- 2.8 nm in the foot pad. They are composed of two parts: tubule proper and surface band. The tubule is 7- to 10-nm wide and characterized in cross section by an approximately pentagonal wall and an electron-lucent lumen containing a 1- to 2-nm bead referred to as a spherule. When longitudinal sections of microfibrils are examined at high magnification, the wall of the tubule does not appear as a continuous line but as a series of successive dots. The interpretation of these findings is that the tubule is composed of successive annular segments with an approximately pentagonal outline. The surface band is a 3-nm-wide, ribbon-like structure wrapped around the tubule. The band has dense borders called tracks. Along the tracks, densely stained, 4.6-nm-long "spikes" are attached at 4.0-nm intervals. The wrapping of the bands is somewhat irregular. They may be in a transverse position across single or several microfibrils, in which case each band might constitute a distinct belt; more frequently, the bands are oblique and appear to form a continuous helix. It is proposed that surface bands play a role in holding together the juxtaposed segments making up a tubule. A model has been constructed to represent the association of tubule and band into a typical microfibril. Atypical microfibrils, which are more common in foot pad than in ciliary zonule, appear wavy, lack a definite tubule, and are characterized by distorted, irregular surface bands. They are attributed to proteolysis of typical microfibrils.     

Flexibility of type I collagen and mechanical property of connective tissue

The hierarchical organization of the connective tissue, more specifically, the musculoskeletal soft tissue, has been extensively studied. With advancements in experimental methodology, investigation of the structure-function relationship has provided more insight into how the mechanical integrity of the tissue is created. Such information is essential in the linking the macroscopic loading environment of the tissue to the microscopic level of the tissue to be experienced by the cell. The flexibility and elastic modulus of gross connective tissue, the fascicle, the fiber and then the collagen molecule are compared based on the data available in the literature.     

On the theory of the spatial organization of macromolecules in connective tissue

The radial distribution function characterizing the spatial organization of the long fibrils of connective tissue is obtained by mathematical analysis of molecular models. The models are based on the assumption that polymeric chains form bridges between the fibrils, thereby providing the long range interactions responsible for the quasi-ordered spatial disposition of the fibrils. The theory is applied to rabbit cornea for which an empirical radial distribution has been obtained previously by analysis of electron micrographs. General agreement is found between theory and experiment for parameter values that are thought to be representative of stroma. The analysis constitutes a step toward the development of the physical basis of the ultrastructure of connective tissue and the way in which that structure affects physiological behavior.     

The mechanical properties of the rabbit carpal tunnel subsynovial connective tissue

The rabbit model is commonly used to study carpal tunnel syndrome (CTS). It has been proposed that the subsynovial connective tissue (SSCT) in the carpal tunnel may play a role in the etiology of CTS, but the material properties of the rabbit SSCT are unknown. The purpose of this study was to develop a method to measure the shear properties of the rabbit SSCT. In six rabbit cadaver forepaws, the excursion of the third digit flexor digitorum superficialis (FDS) and load to failure of the SSCT were measured in a custom device. The mean excursion to full flexion in this model was 7.08 mm (S.D. 0.77). The mean shearing force at full flexion was 317 mN (S.D. 166). At full flexion percentage of maximum shear force in the SSCT was 54.5% (S.D. 19.4). The mean energy absorbed at full flexion was 0.29 mJ (S.D. 0.31). The mean excursion needed to reach 5% of the maximum shear force was 3.04 mm (S.D. 0.99). The testing model presented in this study demonstrates structural parameters to evaluate the shear properties of the SSCT in a rabbit model. The data presented could be used for estimating sample sizes in a more comprehensive study of the effect of CTS on the SSCT properties.     

A study of connective tissue macromolecules in skin of mice with goldthioglucose-induced obesity.

The effect of obesity on the connective tissue composition of skin was investigated in mice with goldthioglucose (GTG)-induced obesity. Four months after GTG treatment, the obese animals were sacrificed. Acid mucopolysaccharides, glycoproteins, collagen, and elastin were analyzed in the skin and compared to the controls. Total MPS in the skin from obese animals decreased, reflected mostly in hyaluronic acid. Chondroitin showed an increase over controls. The content of soluble glycoproteins varied; total carbohydrate and sialic acid of the glycoprotein tended to increase with obesity. Collagen and elastin both tended to decrease with obesity.     

Comparison of biophysical stimuli for mechano-regulation of tissue differentiation during fracture healing

Most long-bone fractures heal through indirect or secondary fracture healing, a complex process in which endochondral ossification is an essential part and bone is regenerated by tissue differentiation. This process is sensitive to the mechanical environment, and several authors have proposed mechano-regulation algorithms to describe it using strain, pore pressure and/or interstitial fluid velocity as biofeedback variables. The aim of this study was to compare various mechano-regulation algorithms' abilities to describe normal fracture healing in one computational model. Additionally, we hypothesized that tissue differentiation during normal fracture healing could be equally well regulated by the individual mechanical stimuli, e.g. deviatoric strain, pore pressure or fluid velocity. A biphasic finite element model of an ovine tibia with a 3mm fracture gap and callus was used to simulate the course of tissue differentiation during normal fracture healing. The load applied was regulated in a biofeedback loop, where the load magnitude was determined by the interfragmentary movement in the fracture gap. All the previously published mechano-regulation algorithms studied, simulated the course of normal fracture healing correctly. They predicted (1) intramembranous bone formation along the periosteum and callus tip, (2) endochondral ossification within the external callus and cortical gap, and (3) creeping substitution of bone towards the gap from the initial lateral osseous bridge. Some differences between the effects of the algorithms were seen, but they were not significant. None of the volumetric components, i.e. pore pressure or fluid velocity, alone were able to correctly predict spatial or temporal tissue distribution during fracture healing. However, simulation as a function of only deviatoric strain accurately predicted the course of normal fracture healing. This suggests that the deviatoric component may be the most significant mechanical parameter to guide tissue differentiation during indirect fracture healing.     

The expression of the fibrillar collagen genes during fracture healing: heterogeneity of the matrices and differentiation of the osteoprogenitor cells

The cells that express the genes for the fibrillar collagens, types I, II, III and V, during callus development in rabbit tibial fractures healing under stable and unstable mechanical conditions were localized. The fibroblast-like cells in the initial fibrous matrix express types I, III and V collagen mRNAs. Osteoblasts, and osteocytes in the newly formed membranous bone under the periosteum, express the mRNAs for types I, III and V collagens, but osteocytes in the mature trabeculae express none of these mRNAs. Cartilage formation starts at 7 days in calluses forming under unstable mechanical conditions. The differentiating chondrocytes express both types I and II collagen mRNAs, but later they cease expression of type I collagen mRNA. Both types I and II collagens were located in the cartilaginous areas. The hypertrophic chondrocytes express neither type I, nor type II, collagen mRNA. Osteocalcin protein was located in the bone and in some cartilaginous regions. At 21 days, irrespective of the mechanical conditions, the callus consists of a layer of bone; only a few osteoblasts lining the cavities now express type I collagen mRNA.We suggest that osteoprogenitor cells in the periosteal tissue can differentiate into either osteoblasts or chondrocytes and that some cells may exhibit an intermediate phenotype between osteoblasts and chondrocytes for a short period. The finding that hypertrophic chondrocytes do not express type I collagen mRNA suggests that they do not transdifferentiate into osteoblasts during endochondral ossification in fracture callus.     

Differential effects of static and cyclic stretching during elastase digestion on the mechanical properties of extracellular matrices.

Enzyme activity plays an essential role in many physiological processes and diseases such as pulmonary emphysema. While the lung is constantly exposed to cyclic stretching, the effects of stretch on the mechanical properties of the extracellular matrix (ECM) during digestion have not been determined. We measured the mechanical and failure properties of elastin-rich ECM sheets loaded with static or cyclic uniaxial stretch (40% peak strain) during elastase digestion. Quasistatic stress-strain measurements were taken during 30 min of digestion. The incremental stiffness of the sheets decreased exponentially with time during digestion. However, digestion in the presence of static stretch resulted in an accelerated stiffness decrease, with a time constant that was nearly 3 x smaller (7.1 min) than during digestion alone (18.4 min). These results were supported by simulations that used a nonlinear spring network model. The reduction in stiffness was larger during static than cyclic stretch, and the latter also depended on the frequency. Stretching at 20 cycles/min decreased stiffness less than stretching at 5 cycles/min, suggesting a rate-dependent coupling between mechanical forces and enzyme activity. Furthermore, pure digestion reduced the failure stress of the sheets from 88 +/- 21 kPa in control to 29 +/- 15 kPa (P < 0.05), while static and cyclic stretch resulted in a failure stress of 7 +/- 5 kPa (P < 0.05). We conclude that not only the presence but the dynamic nature of mechanical forces have a significant impact on enzyme activity, hence the deterioration of the functional properties of the ECM during exposure to enzymes.     

A current viewpoint on structure and evolution of collagens. I. Fibrillar collagens

This review summarizes current data of structure of the most representative group of superfamily of collagens—fibrillar collagens. The attention is focused on structural organization of individual domains and their functional role in the hierarchical stacking of collagen α-chains. There are presented characteristics of the main stages of biosynthesis and the supramolecular processing of fibrillar collagens. Also considered are some aspects of evolution of fibrillar collagens. The role of duplication of genome and genes, intergene combination, and translocation of exons in evolution of collagen genes is discussed.     

A modern viewpoint on structure and evolution of collagens. I. Fibrillar collagens

This review summarizes current data on structure of the most representative group of the collagen family--fibrillar collagens. Attention has been focused on structural organization of individual domains and their functional role in the hierarchical stacking of alpha-chains of collagens. There is presented characteristics of the main stages of biosynthesis and of supramolecular processing of fibrillar collagens. Also considered are some aspects of evolution of fibrillar collagens. The role of duplication of genome and genes, intergene rearrangements, and exon shuffling in evolution of collagen genes is discussed.     

The effects of thermal and mechanical material properties on tumorous tissue during hyperthermia treatment

Although there have been numerous reports in several articles about the viscoelastic properties of biological tissues, no effort has been made to investigate the combined thermal and mechanical behavior of the viscoelastic tissue. At present, the model of thermo-viscoelasticity theory with variable thermal conductivity and rheological properties of the volume is considered to investigate bio-thermo-mechanics behavior in living tissue within the context of the Lord-Shulman theory. The model is applied to a limited thickness, cancerous layer problem. The problem was solved analytically in the transformed domain using Laplace transform as a tool. The exact solution is obtained in the context of transformation Laplace. Numerical results are given and illustrated graphically for the distributions of temperature, displacement, and stress. Some correlations are produced with the results obtained for the absence of the thermal relaxation parameter. The effects of variable thermal and volume materials properties, blood perfusion rate on the behavior of various fields are examined.     

The effect of muscle flap transposition to the fracture site on TNFalpha levels during fracture healing

The trauma and sepsis that follow open fractures and wounds may lead to the production of various cytokines. Understanding wound healing requires a direct knowledge of the specific cytokines and the respective wound fluid levels that are present at the wound site. An animal model was designed that mimics the open fracture and the clinical repair of the human, high-energy open fracture. Canine right tibiae were fractured with a penetrating, captive-bolt device, then repaired in a standard clinical fashion using an interlocking intramedullary nail. Before primary wound closure, microdialysis probes were placed at the fracture site and in a muscle located at a contralateral site. Canines received one of the following experimental protocols: (1) tibial fracture (n = 5); (2) tibial fracture plus Staphylococcus aureus inoculation at the fracture site (n = 5); and (3) tibial fracture, S. aureus inoculation, and a rotational gastrocnemius muscle flap (n = 5). Microdialysis fluid samples were collected intermittently for 7 days. Tumor necrosis factor alpha (TNFalpha) levels at the fracture site were significantly elevated 3 to 34-fold (p<0.02), as compared with respective serum levels at all time points for all treatment groups. Fracture site TNFalpha levels were elevated (p<0.02) in days 1 through 6, as compared with the baseline and contralateral in all treatment groups. At days 1 through 6, the TNFalpha levels of the muscle flap group fracture site were significantly decreased by approximately 50 percent (p<0.05), as compared with the fractures without muscle flaps and regardless of additional S. aureus inoculation. On day 7, fracture site TNFalpha levels in all animal groups were similar, yet remained well above those of baseline TNFalpha. These results demonstrate that S. aureus does not further elevate TNFalpha levels in the presence of an open fracture and that a muscle flap reduces pro-inflammatory TNFalpha levels during early wound healing. This experimental model allows for the characterization of specific biological signals and cellular pathways that are influenced by bacterial infection and surgical closure. These data provide a scientific framework on which to judge or validate therapeutic regimens for open-fracture wound healing.