Association between osteoarthritis-related serum biochemical markers over 11 years and knee MRI-based imaging biomarkers in middle-aged adults

OBJECTIVE

To describe the associations between osteoarthritis (OA)-related biochemical markers (COMP, MMP-3, HA) and MRI-based imaging biomarkers in middle-aged adults over 10-13 years.

METHODS

Blood serum samples collected during the Childhood Determinants of Adult Health (CDAH)-1 study (year:2004-06; n = 156) and 10-13 year follow-up at CDAH-3 (n = 167) were analysed for COMP, MMP-3, and HA using non-isotopic ELISA. Knee MRI scans obtained during the CDAH-knee study (year:2008-10; n = 313) were assessed for cartilage volume and thickness, subchondral bone area, cartilage defects, and BML.

RESULTS

In a multivariable linear regression model describing the association of baseline biochemical markers with MRI-markers (assessed after 4-years), we found a significant negative association of standardised COMP with medial femorotibial compartment cartilage thickness (β:-0.070; 95%CI:-0.138,-0.001), and standardised MMP-3 with patellar cartilage volume (β:-141.548; 95%CI:-254.917,-28.179) and total bone area (β:-0.729; 95%CI:-1.340,-0.118). In multivariable Tobit regression model, there was a significant association of MRI-markers with biochemical markers (assessed after 6-9 years); a significant negative association of patellar cartilage volume (β:-0.001; 95%CI:-0.002,-0.00004), and total bone area (β:-0.158; 95%CI-0.307,-0.010) with MMP-3, and total cartilage volume (β:-0.001; 95%CI:-0.001,-0.0001) and total bone area (β:-0.373; 95%CI:-0.636,-0.111) with COMP. No significant associations were observed between MRI-based imaging biomarkers and HA.

CONCLUSION

COMP and MMP-3 levels were negatively associated with knee cartilage thickness and volume assessed 4-years later, respectively. Knee cartilage volume and bone area were negatively associated with COMP and MMP-3 levels assessed 6-9 years later. These results suggest that OA-related biochemical markers and MRI-markers are interrelated in early OA.

The interactions between MRI-detected osteophytes and bone marrow lesions or effusion-synovitis on knee symptom progression: an exploratory study

OBJECTIVES

To investigate the longitudinal association between MRI-detected osteophyte scores and progression of knee symptoms, and whether the association was modified in the presence of bone marrow lesions (BMLs) or effusion-synovitis.

METHODS

Data from Vitamin D Effects on Osteoarthritis (VIDEO) study, a randomized, double-blinded and placebo-controlled clinical trial in symptomatic knee osteoarthritis (OA) patients, were analyzed as an exploratory study. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess knee symptoms. Osteophytes, BMLs and effusion-synovitis were measured using MRI.

RESULTS

334 participants with MRI information and WOMAC score (baseline and follow-up) were included in the analyses, with 24.3% of them having knee pain increased 2 years later. Statistically significant interactions were found between MRI-detected osteophytes and BMLs or effusion-synovitis on increased knee symptoms. In participants with BMLs, higher baseline scores of MRI-detected osteophytes in most compartments were significantly associated with increased total knee pain, weight-bearing pain, stiffness, and physical dysfunction, after adjustment for age, sex, body mass index, intervention and effusion-synovitis. In participants with effusion-synovitis, higher baseline scores of MRI-detected osteophytes in almost all the compartments were significantly associated with increased total knee pain, weight-bearing pain, stiffness, and physical dysfunction, after adjustment for age, sex, body mass index, intervention and BMLs. In contrast, MRI-detected osteophyte scores were generally not associated with knee symptom progression in participants without baseline BMLs or effusion-synovitis.

CONCLUSIONS

MRI-detected OPs are associated with increased total knee pain, weight-bearing knee pain, stiffness and physical dysfunction in participants presenting BMLs or effusion-synovitis, but not in participants lacking BMLs or effusion-synovitis. This suggests they could interact with bone or synovial abnormalities to induce symptoms in knee OA.

Genome-wide scanning for CHD1L gene in papillary thyroid carcinoma complicated with type 2 diabetes mellitus

PURPOSE

Papillary thyroid carcinoma (PTC) represents the most common subtype of thyroid cancer (TC). This study was set out to explore the potential effect of CHD1L on PTC and type 2 diabetes mellitus (T2DM).

METHODS

We searched for T2DM susceptibility genes through the GWAS database and obtained T2DM-related differentially expressed gene from the GEO database. The expression and clinical data of TC and normal samples were collated from the TCGA database. Receiver operating characteristic (ROC) curve analysis was subsequently applied to assess the sensitivity and specificity of the CHD1L for the diagnosis of PTC. The MCP-counter package in R language was then utilized to generate immune cell score to evaluate the relationship between CHD1L expression and immune cells. Then, we performed functional enrichment analysis of co-expressed genes and DEGs to determine significantly enriched GO terms and KEGG to predict the potential functions of CHD1L in PTC samples and T2DM adipose tissue.

RESULTS

From two genes (ABCB9, CHD1L) were identified to be DEGs (p < 1 * 10^-5) that exerted effects on survival (HR > 1, p < 0.05) in PTC and served as T2DM susceptibility genes. The gene expression matrix-based scoring of immunocytes suggested that PTC samples with high and low CHD1L expression presented with significant differences in the tumor microenvironment (TME). The enrichment analysis of CHD1L co-expressed genes and DEGs suggested that CHD1L was involved in multiple pathways to regulate the development of PTC. Among them, Kaposi sarcoma-associated herpesvirus infection, salmonella infection and TNF signaling pathways were highlighted as the three most relevant pathways. GSEA analysis, employed to analyze the genome dataset of PTC samples and T2DM adipose tissue presenting with high and low expression groups of CHD1L, suggests that these differential genes are related to chemokine signaling pathway, leukocyte transendothelial migration and TCELL receptor signaling pathway.

CONCLUSION

CHD1L may potentially serve as an early diagnostic biomarker for PTC, and a target of immunotherapy for PTC and T2DM.

LncRNA FOXD2-AS1 knockdown inhibits the resistance of human osteosarcoma cells to cisplatin by inhibiting miR-143 expression

OBJECTIVE

The aim of this study was to explore the effect of long non-coding ribonucleic acid (lncRNA) FOXD2-adjacent opposite strand RNA 1 (FOXD2-AS1) on the sensitivity of osteosarcoma cells to cisplatin and its possible underlying mechanism. Our findings might help to provide a certain reference for clinically preventing the drug resistance of osteosarcoma cells.

MATERIALS AND METHODS

Cisplatin with a certain concentration gradient was used to induce the stable acquired resistance of human osteosarcoma U2-OS cell line. Subsequently, the expression level of lncRNA FOXD2-AS1 was determined in osteosarcoma cells in non-resistance group (Control group) and Cisplatin-resistance group (Cisplatin-RES group), respectively. Next, the cell line with stable lncRNA FOXD2-AS1 knockdown was constructed in Cisplatin-RES group using small interfering RNA (siRNA). The effects of stable knockdown of lncRNA FOXD2-AS1 on the proliferation of human osteosarcoma cells and the half-maximal inhibitory concentration (IC50) of cisplatin were detected by Cell Counting Kit-8 (CCK-8) assay. 5-ethynyl-2'-deoxyuridine (EdU) staining was performed to measure deoxyribonucleic acid (DNA) replication level in each group of cells. The protein expression levels of apoptosis-associated genes B-cell lymphoma 2 (Bcl-2) and Bcl-2 associated X protein (Bax) in each group of cells were measured via Western blotting. The migration and invasion abilities of cells in each group were determined using wound-healing assay and transwell assay. In addition, the expression of micro RNA (miR)-143 in each group of cells was detected via Reverse Transcription-Polymerase Chain Reaction (RT-PCR).

RESULTS

Compared with Control group, the expression level of lncRNA FOXD2-AS1 rose significantly in cells in Cisplatin-RES group (p<0.05). Knockdown of FOXD2-AS1 evidently decreased the IC50 of cisplatin in human osteosarcoma cells (p<0.05). According to EdU staining results, the knockdown of FOXD2-AS1 distinctly inhibited the proliferation of osteosarcoma cells (p<0.05). Western blotting results demonstrated that the knockdown of FOXD2-AS1 remarkably upregulated the expression of pro-apoptotic protein Bax and repressed that of anti-apoptotic protein Bcl-2 in drug-resistant human osteosarcoma cells (p<0.05). Moreover, the knockdown of FOXD2-AS1 significantly weakened the migration and invasion abilities of drug-resistant human osteosarcoma cells (p<0.05). Finally, it was found that the expression level of miR-143 was distinctly elevated in drug-resistant human osteosarcoma cells after knockdown of FOXD2-AS1 (p<0.05).

CONCLUSIONS

LncRNA FOXD2-AS1 knockdown inhibits the resistance of human osteosarcoma cells to cisplatin, promotes their apoptosis and weakens their invasion and migration abilities. The possible underlying mechanism may be related to the inhibition of miR-143 expression by lncRNA FOXD2-AS1 in drug-resistant cell lines.

Virtual reality as a learning tool in spinal anatomy and surgical techniques

Background

Surgical simulation is a valuable educational tool for trainees to practice in a safe, standardized, and controlled environment. Interactive feedback-based virtual reality (VR) has recently moved to the forefront of spine surgery training, with most commercial products focusing on instrumentation. There is a paucity of learning tools directed at decompression principles. The purpose of this study was to evaluate the efficacy of VR simulation and its educational role in learning spinal anatomy and decompressive techniques.

Methods

A VR simulation module was created with custom-developed software. Orthopaedic and neurosurgical trainees were prospectively enrolled and interacted with patient-specific 3D models of lumbar spinal stenosis while wearing a headset. A surgical toolkit allowed users to perform surgical decompression, specifically removing soft tissues and bone. The module allowed users to perform various techniques in posterior decompressions and comprehend anatomic areas of stenosis. Pre- and post-module testing, and utility questionnaires were administered to provide both quantitative and qualitative evaluation of the module as a learning device.

Results

28 trainees were enrolled (20-orthopaedic, 8-neurosurgery) in the study. Pre-test scores on anatomic knowledge progressively improved and showed strong positive correlation with year-in-training (Pearson's r = 0.79). Following simulation, the average improvement in post-test scores was 11.4% in junior trainees (PGYI-III), and 1.0% in senior trainees (PGYIII-Fellows). Knowledge improvement approached statistical significance amongst junior trainees (p = 0.0542). 89% of participants found the VR module useful in understanding and learning the pathology of spinal stenosis. 71% found it useful in comprehending decompressive techniques. 96% believed it had utility in preoperative planning with patient-specific models.

Conclusions

Our original VR spinal decompression simulation has shown to be overwhelmingly positively received amongst trainees as both a learning module of patho-anatomy and patient-specific preoperative planning, with particular benefit for junior trainees.

POS0190 ASSOCIATION BETWEEN OSTEOARTHRITIS-RELATED SERUM BIOCHEMICAL MARKERS OVER 11 YEARS AND KNEE SYMPTOMS IN MIDDLE-AGED ADULTS

Background:

Serum levels of cartilage and joint-specific biochemical markers such as cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP)-3, and hyaluronan (HA) are associated with cartilage degradation, joint tissue degradation, and synovitis in patients with OA. Change in these biomarkers may precede the morphological and clinical manifestations of OA and therefore have been explored as predictive markers in OA. However, few studies have evaluated the association of OA-related biomarkers with knee symptoms in general population-based middle-aged adults

Objectives:

To describe the associations between OA-related biomarkers and knee symptoms in middle-aged adults followed up over 10-13 years

Methods:

Blood samples were collected during the Childhood Determinants of Adult Health (CDAH)-1 study at baseline (year: 2004-06, age: 26–36 years) and 10-13 year follow-up (CDAH-3; year: 2014–2019, age: 36–49 years). Serum samples from baseline (n=156) and follow-up (n= 167) were analyzed for three OA-related biomarkers – namely COMP, MMP-3, and HA– using ELISA. Knee symptoms (pain, stiffness, and dysfunction) were assessed using the WOMAC scale during the CDAH-3 phase. Univariable and multivariable (adjusted for age, sex, and body mass index (BMI)) zero-inflated Poisson regression models with random effects were used to describe the above associations

Results:

The prevalence of knee pain was 46%. In the multivariable model, adjusted for age, sex, and BMI, there was a significant positive association between COMP (ɞ=1.156, 95%CI: 0.989,1.324; p=0.04), MMP-3 (ɞ=1.013, 95%CI: 1.001,1.025; p=0.02), and HA (ɞ=1.008, 95%CI: 1.002,1.015, p=0.01) with knee pain and WOMAC-total score (Table 1) in middle-aged adults. The increase in knee pain per ng/ml increase in COMP, MMP-3, and HA was 15.7%, 1.3%, and 0.8%, respectively. The overall mean biomarker levels decreased over 10-13 years; however, the mean WOMAC-total scores were higher in participants whose COMP and HA levels increased (COMP: 24 (27.31), HA: 14.20 (22.60)) compared to those in whom it decreased or remained stable (COMP: 9.84 (16.83), and HA: 8.28 (13.22)) during this period. There was a significant positive association between COMP (ɞ=1.026, 95%CI: 1.002,1.050, p=0.03) and MMP-3 (ɞ=1.020, 95%CI: 1.009,1.030, p<0.01) measured at baseline and knee pain assessed after 10-13 year in the middle-aged adults (Table 1)

Table 1.

Cross-sectional and longitudinal association between WOMAC symptoms and OA-related biomarkers

VariablesLongitudinal Biomarker at CDAH-1, knee symptom at CDAH-3Cross-sectional Biomarker at CDAH-3, knee symptom at CDAH-3Adjusted. Coef. (95%CI) p-valueAdjusted. Coef. (95%CI) p-valueCOMP (Predictor)WOMAC-total1.047 (1.035, 1.060)1.088 (1.017, 1.159)p<0.01p=0.01Stiffness1.019 (0.988, 1.051)0.877 (0.708, 1.057)p=0.23p=0.12Dysfunction1.045 (1.030, 1.061)1.040 (0.949, 1.130)p<0.01p=0.38MMP3 (Predictor)WOMAC-total1.026 (1.020, 1.031)1.017 (1.010, 1.023)p<0.01p<0.01Pain1.020 (1.009, 1.030)1.013 (1.001, 1.025)p<0.01p=0.03Stiffness1.020 (1.004, 1.035)1.004 (.987, 1.021)p=0.01p=0.66Dysfunction1.029 (1.022, 1.037)1.019 (1.010, 1.026)p<0.01p<0.01HA (Predictor)WOMAC-total0.995 (0.991, 0.999)1.007 (1.003, 1.010)p=0.01p<0.01Pain0.999 (0.991, 1.006)1.008 (1.002, 1.015)p=0.75p=0.01Stiffness0.989 (0.980, 0.998)0.997 (0.989, 1.007)p=0.03p=0.65Dysfunction1.003 (0.998, 1.009)1.015 (1.010, 1.020)p= 0.22p<0.01

Bold denotes statistically significant. Model adjusted for age, sex, and BMI

Conclusion:

OA-related biochemical markers such as COMP and MMP-3 were positively associated with knee pain in population-based middle-aged adults. These results suggest biochemical markers measured in middle-aged adults may be used as a marker of joint pain

Acknowledgements:

AS is supported by International Graduate Research Scholarship, University of Tasmania.

Disclosure of Interests:

Ambrish Singh Employee of: Has worked in the past for Abbott and Eli Lilly and Company, Leigh Blizzard: None declared, Alison Venn: None declared, Graeme Jones: None declared, John Burgess: None declared, Venkat Parameswaran: None declared, Changhai Ding: None declared, Benny Antony: None declared

The cross-sectional and longitudinal associations of dietary patterns with knee symptoms and MRI detected structure in patients with knee osteoarthritis

OBJECTIVES

To examine the cross-sectional and longitudinal associations of dietary patterns with knee symptoms and structures in patients with knee osteoarthritis (OA).

METHODS

Participants with symptomatic knee OA were recruited from a randomised, placebo-controlled trial conducted in Tasmania (N = 259) and Victoria (N = 133). Diet was assessed by the Anti-Cancer Council of Victoria food frequency questionnaire. Factor analysis was used to identify dietary patterns. Knee symptoms were assessed using Western Ontario and McMaster Universities Arthritis Index (WOMAC) and structures using MRI. Multivariable linear regressions were used to examine associations.

RESULTS

Three dietary patterns ("high-fat", "healthy" and "mixed") were identified in whole sample. Participants with higher "healthy pattern" score had lower total WOMAC, pain, function and stiffness scores at baseline but the associations were not significant over 24 months. Three ("western", "vegetable and meat" and "mediterranean") and two ("processed" and "vegetable") patterns were identified in Tasmania and Victoria, respectively. Cross-sectionally, only "mediterranean pattern" and "vegetable pattern" scores were significantly and negatively associated with total WOMAC or function scores. Longitudinally, participants with higher "western pattern" had worsening function (β: 0.35, 95%CI: 0.03, 0.67) and total WOMAC (β: 0.40, 95%CI: 0.07, 0.72) scores; furthermore, "vegetable pattern" was associated with decreased WOMAC stiffness score (β: -0.47, 95%CI: -0.93, -0.02). In contrast, dietary patterns were largely not associated with structural changes.

CONCLUSION

Some healthy dietary patterns were associated with reduced joint symptoms but dietary patterns were not associated with joint structure in this sample with knee OA. Further studies are required to confirm these findings.

The Prophylactic Use of Tirofiban versus Oral Antiplatelet Medications in Stent-Assisted Coiling of Intracranial Aneurysms: A Meta-analysis

BACKGROUND

The protocol for optimal antiplatelet therapy to prevent thromboembolic and hemorrhagic complications in patients with cerebral aneurysms using an endovascular approach is not clear.

PURPOSE

Our study analyzed the safety and efficacy of prophylactic tirofiban administration compared with oral antiplatelet drug therapy.

DATA SOURCES

We used the PubMed, EMBASE, MEDLINE, and Cochrane library data bases.

STUDY SELECTION

Our study consisted of all case series with >5 patients that reported treatment-related outcomes of patients undergoing endovascular procedures pretreated with tirofiban or oral antiplatelet drug therapy.

DATA ANALYSIS

Random effects or fixed effects meta-analysis was used to pool the cumulative rate of complications, perioperative mortality, and good clinical outcomes.

DATA SYNTHESIS

Fifteen studies with 1981 patients were registered. Thromboembolic complications were significantly lower in the tirofiban group (3.6%; 95% CI, 1.9%-5.8%) compared with the dual-antiplatelet therapy group (8.5%, 95% CI, 4.5%-13%; P = .04). Pretreatment with tirofiban did not remarkably increase the rate of hemorrhagic complications (3.5%; 95% CI, 1.8%-5.6%) compared with dual-antiplatelet therapy (5.1%; 95% CI, 2.6%-8.5%; P = .371). There was a trend toward lower perioperative mortality with tirofiban (0.8%; 95% CI, 0.2%-1.6%) compared with dual-antiplatelet therapy (1.2%; 95% CI, 0.7%-2.0%; P = .412). There was no significant difference in the safety and efficacy between the tirofiban bolus plus drip and drip alone.

LIMITATIONS

The limitations are selection and publication biases.

CONCLUSIONS

Prophylactic therapy with tirofiban resulted in significantly lower rates of thromboembolic complications with no increase in hemorrhagic events or mortality than the prophylactic use of dual-antiplatelet therapy.

Single-cell RNA expression profiling of SARS-CoV-2-related ACE2 and TMPRSS2 in human trophectoderm and placenta

OBJECTIVES

To examine the characteristics and distribution of possible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) target cells in the human trophectoderm (TE) and placenta.

METHODS

Bioinformatics analysis was performed based on published single-cell transcriptomic datasets of early TE and first- and second-trimester human placentae. We conducted the transcriptomic analysis of 4198 early TE cells, 1260 first-trimester placental cells and 189 extravillous trophoblast cells (EVTs) from 24-week placentae (EVT_24W) using the SMART-Seq2 method. In addition, to confirm the bioinformatic results, we performed immunohistochemical staining of three first-trimester, three second-trimester and three third-trimester placentae from nine women recruited prospectively to this study. We evaluated the expression of the SARS-CoV-2-related molecules angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2).

RESULTS

Via bioinformatic analysis, we identified the existence of ACE2 and TMPRSS2 expression in human TE as well as in first- and second-trimester placentae. In the human TE, 54.4% of TE1 cells, 9.0% of cytotrophoblasts (CTBs), 3.2% of EVTs and 29.5% of syncytiotrophoblasts (STBs) were ACE2-positive. In addition, 90.7% of TE1 cells, 31.5% of CTBs, 22.1% of EVTs and 70.8% of STBs were TMPRSS2-positive. In placental cells, 20.4% of CTBs, 44.1% of STBs, 3.4% of EVTs from 8-week placentae (EVT_8W) and 63% of EVT_24W were ACE2-positive, while 1.6% of CTBs, 26.5% of STBs, 1.9% of EVT_8W and 20.1% of EVT_24W were TMPRSS2-positive. Pathway analysis revealed that EVT_24W cells that were positive for both ACE2 and TMPRSS2 (ACE2 + TMPRSS2-positive) were associated with morphogenesis of branching structure, extracellular matrix interaction, oxygen binding and antioxidant activity. The ACE2 + TMPRSS2-positive TE1 cells were correlated with an increased capacity for viral invasion, epithelial-cell proliferation and cell adhesion. Expression of ACE2 and TMPRSS2 was observed on immunohistochemical staining in first-, second- and third-trimester placentae.

CONCLUSIONS

ACE2- and TMPRSS2-positive cells are present in the human TE and placenta in all three trimesters of pregnancy, which indicates the possibility that SARS-CoV-2 could spread via the placenta and cause intrauterine fetal infection. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Gas detection in sodium cooled fast reactors: determination of a transfer function

To keep the dependability of Sodium Cooled Fast Reactor, the “clean sodium concept” is demanded, which means that the sodium is free from contamination. The release of fission products is searched for by a contamination measuring system. We need to have a comprehensive description of cladding failures and the detection of contamination, including the failure occurrence on the fuel pin, the transfer process through the sodium and cover gas, the measurement efficiency, etc. We aim to identify the important parameters of physical phenomena, with modelling and simulations based on the return of experiments from past reactors such as PHENIX. There have been a total of 15 open pin failures in PHENIX reactor. Through studying these detected signals, we can get a better physical explanation and description of the evolution of failures. The detection system is related to different stages of the evolution of fuel pin, with different types of fission products, various release mechanism and physical properties. During the evolution of the failed fuel pin, gaseous fission products is released on the first stage of failure and the gas detection system is aimed for the gaseous fission products monitoring. We proposed a quantitative modeling of transfer function to describe the time broadening of the gas release from the fuel pin to the detector. The result matches well with PHENIX experiment data, with the same order of magnitude of the time broadening and the same shape of exponential decreasing. A determination of the transfer function of this gas detection system is validated in this paper.

[Effects of preoperative segmental mobility on the clinical and radiographic outcomes following one-level artificial cervical disc replacement]

Objective: To investigate the effects of preoperative segmental range of motion (ROM) on clinical and radiographical outcomes after artificial cervical disc replacement (ACDR) and explore whether ACDR could be indicated for patients with preoperative limited or excessive segmental ROM. Methods: From January 2008 to December 2017, patients who underwent Prestige-LP ACDR in West China Hospital were retrospectively reviewed. The preoperative and postoperative X-rays of the cervical spine were collected to measure the radiographic parameters, including cervical lordosis (CL), C(2-7) ROM, disc height (DH), disc angle (DA) and ROM at the arthroplasty level. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) and the Neck Disability Index (NDI) scores. The correlation between preoperative segmental ROM and postoperative clinical and radiographical outcomes were also analyzed. Results: A total of 161 patients were analyzed, with 73 males and 88 females. The mean age was (44±8) years, and the follow-up period was 34 months (12-120 months). JOA and NDI scores improved after ACDR (P<0.05). However, postoperative C(2-7) ROM and ROM at the arthroplasty level were comparable with preoperative counterparts (both P>0.05). Preoperative segmental ROM positively correlated with C(2-7) ROM and ROM at the arthroplasty segment (r=0.213、0.271, both P<0.05), but was negatively correlated with the change of ROM (r=-0.534, P<0.05). The segmental ROM was 4.0°±1.0° in the limited-ROM group (A) and 14.6°±1.3° in the excessive-ROM group (B), respectively. There were significantly more patients diagnosed with cervical spondylosis in group A than in group B (35.5% vs 10.7%, P<0.05). The level-distribution was statistically different between the two groups. C(5/6) and C(6/7) were prone to limited motion in group A, while C(4/5) and C(5/6) were predisposed to excessive motion in group B (all P<0.05). After surgery, C(2-7) ROM increased for 14.2°±16.8° in group A, while paradoxically decreased for 2.2°±14.4° in group B. However, C(2-7) ROM in group B was still larger than that in group A (P<0.05). Similarly, the ROM at the arthroplasty level increased by 3.1°±3.7° in group A, whereas the values decreased by 4.4°±4.2° in group B postoperatively. In addition, group A still had less segmental ROM than group B (P<0.05). The preoperative DH in group A was less than that in group B (P<0.05). The rates of ASD, HO, and high-grade HO in group A were all higher than those in group B but without significant differences (all P>0.05). Conclusion: Preoperative segmental ROM has no significant effects on clinical outcomes after ACDR; it has a positive correlation with postoperative global and segmental ROM while is negatively correlated with ROM change.

MiR-146 regulates the repair and regeneration of intervertebral nucleus pulposus cells via Notch1 pathway

OBJECTIVE

The aim of this study was to investigate the effects of regulation of micro-ribonucleic acid (miR)-146 expression targeting the Notch1 pathway on the repair and regeneration of intervertebral nucleus pulposus cells, and to explore the possible underlying mechanism.

MATERIALS AND METHODS

Intervertebral nucleus pulposus cells were harvested from rats and cultured in vitro. All cells were randomly divided into 4 groups, including the normal group, the miR-146 inhibitor group, the miR-146 over-expression group and the negative control group. The cells in the normal group were cultured normally. Meanwhile, the cells in the miR-146 inhibitor group and miR-146 over-expression group were transfected with inhibitor-containing plasmid and miR-146-containing plasmid, respectively. However, the cells in the negative control group were transfected with empty plasmid. 24 h after transfection, the cells were collected for subsequent experiments. The differentiation of nucleus pulposus cells was detected via toluidine blue staining. The relative protein expression levels of Notch1, aggrecan (ACAN) and COL II were detected via Western blotting. Meanwhile, the mRNA expressions of miR-146 and Notch1 were detected via quantitative Polymerase Chain Reaction (qPCR). Furthermore, the apoptosis and proliferation of cells were detected via terminal deoxynucleotidyl transferase-mediated dUTP Nick End Labeling (TUNEL) and Cell Counting Kit-8 (CCK-8; Dojindo, Kumamoto, Japan) assay, respectively.

RESULTS

Compared with the normal group, toluidine blue positive staining was significantly increased in miR-146 overexpression group (p<0.05), whereas was significantly decreased in the miR-146 inhibitor group (p<0.05). The results of Western blotting revealed that compared with normal group, the protein expression of Notch1 was markedly decreased in miR-146 over-expression group (p<0.05), whereas the expression levels of ACAN and COL II were notably increased (p<0.05). However, the miR-146 inhibitor group exhibited significantly increased the protein expression level of Notch1 (p<0.05), as well as markedly decreased the expressions of ACAN and COL II (p<0.05). The results of qPCR showed that compared with the normal group, the expression level of miR-146 was significantly increased in the miR-146 over-expression group. However, the mRNA expression level of Notch1 was remarkably decreased (p<0.05). Similarly, the miR-146 inhibitor group exhibited significantly decreased expression level of miR-146, as well as markedly increased mRNA expression level of Notch1 (p<0.05). Compared with those in the normal group, the cell proliferation rate was markedly increased, whereas cell apoptosis was remarkably decreased (p<0.05) in the miR-146 over-expression group. Furthermore, the cell proliferation rate was significantly decreased, while the cell apoptosis was remarkably increased (p<0.05) in the miR-146 inhibitor group.

CONCLUSIONS

Regulating miR-146 expression can target the Notch1 signaling pathway, thereby exerting important influences on the repair and regeneration of intervertebral nucleus pulposus cells.

Interleukin-6 and severity of COVID-19 patients in Hefei, China

•

Twenty-four out of 75 patients developed into severe condition in the course of the infection.

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The prominent laboratory abnormalities of COVID patients were lymphopenia, elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH).

•

Elevated interleukin 6 (IL-6) correlated with decrease of LYM%, CD4⁺ and CD8⁺ T cell counts, and increase of CRP, LDH and Procalcitonin (PCT) levels.

FRI0383 A RANDOMISED PLACEBO-CONTROLLED CLINICAL TRIAL OF CURCUMA LONGA EXTRACT FOR TREATING SYMPTOMS AND EFFUSION-SYNOVITIS OF KNEE OSTEOARTHRITIS (CURKOA TRIAL)

Background:

Pharmacological therapies are limited, associated with off-target effects, are frequently contraindicated, and only modestly effective for pain in osteoarthritis (OA). Effusion and synovitis are common in OA and are associated with symptomatic and structural progression of OA.Curcuma longa(Turmeric) extract has anti-inflammatory effects and is gaining popularity in the treatment of OA despite the lack of high-quality evidence.

Objectives:

The CurKOA trial aimed to determine the efficacy ofCurcuma longaextract for reducing knee symptoms and effusion-synovitis in patients with symptomatic knee OA and knee effusion-synovitis.

Methods:

In this randomised, double-blind, placebo-controlled trial, participants with significant knee pain (≥ 40 mm on a 100-mm visual analog scale [VAS]), symptomatic knee OA (by ACR criteria) and ultrasound defined effusion-synovitis were randomised to receiveCurcuma longaextract (80% aqueous based extract standardized to turmerosaccharides + 20% curcuminoids, 2 × 500 mg capsules/day) or identical placebo for 12 weeks. Knee MRI scans were obtained at baseline and 12 weeks. Coprimary outcomes were changes in knee pain assessed by VAS and change in knee effusion-synovitis volume assessed by MRI over 12 weeks.

Results:

Among 70 participants (36 receivedCurcuma longa, 34 received placebo, age 61.8±8.6 years, 56% female),Curcuma longasignificantly improved VAS knee pain compared to placebo (-9.11mm, 95% confidence interval [CI] [- 17.79 to -0.44]) over 12 weeks, equivalent to a standardised effect size of 0.50. There was no significant between group difference in change in effusion-synovitis volume (3.24 mL [-0.33, 6.82]). There were significantly greater reductions in WOMAC knee pain (-47.22mm [-81.22, -13.22]), WOMAC function (-112.26mm [-222.79 to -1.74]) and significantly more OARSI-OMERACT treatment responders (63% treatment vs. 38% placebo [Risk Ratio=1.64 (1.00 to 2.70)]) in theCurcuma longagroup compared to the placebo group. There was no significant between-group difference in lateral femoral cartilage T2 relaxation time (-0.38 ms [- 1.10 to 0.34]) assessed from compositional MRI. The incidence of adverse events was similar in theCurcuma longa(n=14 (39%)) and placebo (n=18 (53%)) groups over 12 weeks (P=0.24).

Conclusion:

An extract ofCurcuma longasignificantly improved knee pain in an inflammatory phenotype of knee OA patients over 12 weeks compared to placebo but had no effect on knee effusion-synovitis and cartilage composition assessed using MRI. The moderate effect size of the treatment supports the use ofCurcuma longaextract for the symptomatic management of knee OA.

Figure 1.

Disclosure of Interests:

None declared

OP0246 MIR-214-3P PROTECTS AGAINST OSTEOARTHRITIS BY DIRECTLY TARGETING NF-ĸB PATHWAY

Background:

Osteoarthritis (OA) is a degenerative disease associated with changes in the articular cartilage and bone, severely affecting patients’ mobility and quality of life. Multiple factors including mechanical stress, metabolic alteration and inflammatory mediators are involved in the complex pathogenesis of OA[1]. Interventions targeting these pathogenic factors may contribute to the treatment of OA. MiRNAs are single strand non-coding small RNAs, which are regulated in chondrogenesis and OA[2,3]. Recent studies demonstrated that miRNAs are involved in the regulation of NF-κB signaling pathway by different mechanisms[4]. These interactions suggest that NF-κB related miRNAs may be used as potential biomarkers and drug therapeutic targets in clinical treatment of OA. However, the relationship between miR-214-3p and NF-κB pathway remains poorly understood in OA.

Objectives:

This study aimed to test the expression and biological function of miR-214-3p in OA, and explore its mechanism in osteoarthritic chondrocytes.

Methods:

Articular primary chondrocytes were isolated from human cartilage samples, which were acquired from patients with end-stage knee OA at the time of total knee replacement surgery (n = 27), according to protocols approved by the Ethic Committee of Zhujiang Hospital. Real time PCR (RT-PCR) and in situ hybridization (ISH) were used to detect the expression of miR-214-3p in OA and non-OA cartilage tissues. Interference of miR-214-3p was conducted using inhibitor, while overexpression of miR-214-3p was performed with mimics. Metabolism of extracellular matrix was detected by RT-PCR, western blotting and immunofluorescence in vitro. Flow cytometry were conducted to determine cell apoptosis. A luciferase reporter assay, was used to evaluate the interaction between miR-214-3p and its downstream target. Human chondrocytes were cotransfected with miR-214-3p and the IKBKB-overexpressing plasmid to confirm the interaction between miR-214-3p and NF-ĸB pathway. For in vivo studies, experimental OA was induced in 12-week-old male C57BL/6J mice by destabilization of the medial meniscus (DMM) surgery with miR-214-3p agomir intra-articular (IA) injection (once weekly for 12 days) or by IA injection (once weekly for 12 days) of miR-214-3p antiagomir. Mice were sacrificed 10 weeks after the first IA injection, and subjected to histological analyses.

Results:

MiR-214-3p was significantly reduced in human OA cartilage. The decreased expression of miR-214-3p in the OA cartilage tissues was directly associated with excessive apoptosis and imbalance between anabolic and catabolic factors of ECM. Mechanistically, we determined that miR-214-3p directly targeted IKBKB/IKK-b and thereby suppressed the activation of NF-ĸB pathway. IKBKB overexpression attenuated the inhibitory effect of miR-214-3p on NF-ĸB pathway. Furthermore, inhibition of miR-214-3p in mice joints triggered spontaneous cartilage loss and OA development, while IA injection of miRNA-214-3p agomir alleviated OA in the DMM mouse model.

Conclusion:

Our results reveal an important role of miR-214-3p in OA progression. MiR-214-3p was down-regulated while IKBKB was upregulated in OA. MiR-214-3p inhibits the NF-kB signaling pathway and suppresses the progression of OA through targeting IKBKB. Thus, miR-214-3p maybe a therapeutic target for OA.

References:

[1]Glyn-Jones S, Palmer AJR, Agricola R, Price AJ, Vincent TL, Weinans H, Carr AJ:Osteoarthritis.The Lancet2015,386(9991):376-387.

[2]Nugent M:MicroRNAs: exploring new horizons in osteoarthritis.Osteoarthritis and cartilage2016,24(4):573-580.

[3]Vicente R, Noel D, Pers YM, Apparailly F, Jorgensen C:Deregulation and therapeutic potential of microRNAs in arthritic diseases.Nature reviews Rheumatology2016,12(4):211-220.

[4]Xu B, Li YY, Ma J, Pei FX:Roles of microRNA and signaling pathway in osteoarthritis pathogenesis.Journal of Zhejiang University Science B2016,17(3):200-208.

Disclosure of Interests:

None declared

Qualitative and quantitative measures of prefemoral and quadriceps fat pads are associated with incident radiographic osteoarthritis: data from the Osteoarthritis Initiative

OBJECTIVE

To determine if qualitative and quantitative measures of prefemoral fat pad (PFP) and quadriceps fat pad (QFP) are associated with incident radiographic osteoarthritis (iROA) over 4 years in the Osteoarthritis Initiative (OAI) study.

DESIGN

Participants in this nested case-control study were selected from the OAI study with knees that had Kellgren Lawrence grades (KLG) of 0 or 1 at baseline. Case knees were defined by iROA (KLG≥ 2) over 4 years. Control knees without iROA were matched 1:1 with case knees. Magnetic resonance images (MRIs) were read at P0 (time of onset of iROA), P-1 (1 year prior to P0) and baseline, and used to assess PFP (i.e., prefemoral hyperintensity alteration, patellofemoral hyperintensity alteration, maximum axial area) and QFP (i.e., hyperintensity alteration, mass effect, maximum axial area). Conditional logistic regression analyses were performed to study the associations between PFP/QFP measures and iROA, after adjustment for covariates.

RESULTS

354 case knees with iROA were matched to 354 control knees. 66.9% of the participants were female, with an average age of 60.1 years. PFP prefemoral hyperintensity alteration measured at three time points (OR [95%CI]: 1.46 [1.18-1.82], 1.50 [1.20-1.88], 1.52 [1.22-1.89] respectively), PFP maximum axial area (OR [95%CI]: 1.07 [1.01-1.14], 1.08 [1.01-1.15], 1.08 [1.02-1.15] respectively) and QFP hyperintensity alteration (OR [95%CI]: 1.59 [1.27-2.00], 1.44 [1.13-1.82], 1.38 [1.09-1.73] respectively) were significantly associated with iROA in multivariable conditional logistic analyses. QFP mass effect measured at BL and P-1 (OR [95%CI]: 1.42 [1.11-1.82], 1.33 [1.01-1.73] respectively) were significantly associated with iROA.

CONCLUSIONS

Qualitative and quantitative measures of PFP and QFP are associated with increased iROA over 4 years.