Development of the human elbow joint

The CS Sulfation Motifs 4C3, 7D4, 3B3[-]; and Perlecan Identify Stem Cell Populations and Their Niches, Activated Progenitor Cells and Transitional Areas of Tissue Development in the Fetal Human Elbow

We compared the immunohistochemical distribution of (1) the novel chondroitin sulfate (CS) sulfation motifs 7D4, 4C3, and 3B3[-], (2) native heparan sulfate (HS) and Δ-HS "stubs" generated by heparitinase III digestion and (3) the HS-proteoglycan (PG), perlecan, in the fetal human elbow joint. Putative stem cell populations associated with hair bulbs, humeral perichondrium, humeral and ulnar rudiment stromal/perivascular tissues expressed the CS motifs 4C3, 7D4, and 3B3[-] along with perlecan in close association but not colocalized. Chondrocytes in the presumptive articular cartilage of the fetal elbow expressed the 4C3 and 7D4 CS sulfation motifs consistent with earlier studies on the expression of these motifs in knee cartilage following joint cavitation. This study also indicated that hair bulbs, skin, perichondrium, and rudiment stroma were all perlecan-rich progenitor cell niches that contributed to the organization and development of the human fetal elbow joint and associated connective tissues. One of the difficulties in determining the precise role of stem cells in tissue development and repair processes is their short engraftment period and the lack of specific markers, which differentiate the activated stem cell lineages from the resident cells. The CS sulfation motifs 7D4, 4C3, and 3B3[-] decorate cell surface PGs on activated stem/progenitor cells and thus can be used to identify these cells in transitional areas of tissue development and in repair tissues and may be applicable to determining a more precise mode of action of stem cells in these processes. Isolation of perlecan from 12 to 14 week gestational age fetal knee rudiments demonstrated that perlecan in these fetal tissues was a HS-CS hybrid PG further supporting roles for CS in tissue development.

CT arthrography and anatomical correlation of the bare area of the ulnar trochlear fossa: a risk of misdiagnosis of cartilage ulcerations

AIMS

There is a variable bare area on the ulnar trochlear fossa that may be somehow interpreted as a cartilage defect. We aimed to correlate radiological images and dissections of this bare spot with CT arthrography imaging.

MATERIALS AND METHODS

We conducted a double study that included 10 unpaired fresh-frozen human cadaveric elbows (CT arthrography + dissection) and 40 CT arthrography of patients to investigate the 3-D architecture of the trochlear fossa of the ulna. Positioning, shape and measurements of the bare spot of each ulna were measured and correlated. A total of 40 were analyzed with this protocol of measurements to validate the anatomical findings.

RESULTS

The bare spot area is located 15.8 mm from the tip of the olecranon and 13.8 mm from the coronoid process (mean values). This area measures 4.1 mm in cranio-caudal plane, 2.2 mm in transversal plane. This area is located above a small subchondral tubercle that measures 1.0 mm in antero-posterior axis. No significant difference has been found between left and right elbow regarding its positioning and shape. A significant difference has been found between genders regarding the positioning of this area but not according to its shape.

CONCLUSION

The ulnar trochlear notch has a small area without cartilage. This bare area is located at the site of fusion of the different ossification center of the proximal ulna. It should not be interpreted as a chondral lesion. The existence of a subchondral tubercle clearly indicates that this uncovered zone is normal. Radiologist should consider this when interpreting elbow CT arthrography.

Regeneration of the elbow joint in the developing chick embryo recapitulates development

Synovial joints are among the most important structures that give us complex motor abilities as humans. Degenerative joint diseases, such as arthritis, cause loss of normal joint functioning and affect over 40 million people in the USA and approximately 350 million people worldwide. Therapies based on regenerative medicine hold the promise of effectively repairing or replacing damaged joints permanently. Here, for the first time, we introduce a model for synovial joint regeneration utilizing the chick embryo. In this model, a block of tissue that contains the prospective elbow is excised, leaving a window with strips of anterior and posterior tissue intact (window excision, WE). In contrast, we also slice out the same area containing the elbow and the distal piece of the limb is pinned back onto the stump (slice excision, SE). Interestingly, when the elbow is removed via WE, regeneration of the joint takes place, whereas the elbow joint does not regenerate following SE. In order to investigate whether the regeneration response recapitulates the developmental program of forming joints, we used GDF-5 and Autotaxin (Atx) as joint tissue specific markers, and Sox-9 and Col-9 as cartilage markers for in situ hybridization on sections at different time points after WE and SE surgeries. Re-expression of GDF-5 and Atx is observed in the WE samples by 60h after surgery. In contrast, the majority of the samples that underwent SE surgery did not express GDF-5 and Atx. Also, in SE fusion of cartilage elements takes place and the joint interzone does not form. This is indicated by continuous Col-9 expression in SE limbs, whereas Col-9 is downregulated at the joint interzone in the regenerating WE samples. This order and pattern of gene expression observed in regenerates is similar to the development of a joint suggesting that regeneration recapitulates development at the molecular level. This model defines some of the conditions required for inducing joint regeneration in an otherwise nonregenerating environment. This knowledge can be useful for designing new therapeutic approaches for joint loss or for conditions affecting joint integrity in humans.