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Liu Z, Lu H, Zhang X, Tang S, Lin A, Han S, Ma X. NOXA exacerbates endoplasmic-reticulum-stress-induced intervertebral disc degeneration by activating apoptosis and ECM degradation. Cell Death Discov 2025; 11:257. [PMID: 40436859 PMCID: PMC12119965 DOI: 10.1038/s41420-025-02539-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2025] [Revised: 05/06/2025] [Accepted: 05/19/2025] [Indexed: 06/01/2025] Open
Abstract
Intervertebral disc degeneration (IVDD) is a prevalent condition leading to low back pain. Endoplasmic reticulum stress (ERS) is strongly linked to IVDD progression, although the underlying mechanisms remain unclear. In this study, we investigated the effects of NOXA on ERS-induced IVDD. Primary nucleus pulposus cells (NPCs) were stimulated with Thapsigargin to mimic the ERS microenvironment in IVDD. Western blot analysis, PCR, immunofluorescence, and immunohistochemistry assay were performed to measure the expression levels of PERK, NOXA, and cell apoptosis- and extracellular-matrix-degradation-relevant proteins. JC-1 fluorescent probes, terminal deoxynucleotidyl transferase dUTP nick end labeling staining, and flow cytometry were used to measure mitochondrial function and apoptosis in NPCs under ERS conditions. Magnetic resonance imaging, Safranin O staining, alcian blue staining, and immunohistochemistry were performed to estimate the effects of NOXA knockdown on acupuncture-mediated IVDD in rats at both imaging and histological levels. The results showed that ERS induced and activated the PERK pathway during IVDD development. Mechanically, ERS induced NPC apoptosis and ECM degradation by upregulating PERK expression and activating NOXA expression. The genetic overexpression of NOXA inhibited cell proliferation and increased apoptosis, whereas its knockdown decreased MCL-1 expression and alleviated IVDD degeneration in human NPCs and rat models. NOXA plays a crucial role in the PERK/NOXA/MCL-1 axis, mediating the link between ERS and IVDD. Targeting NOXA expression may be an effective method for treating IVDD, laying the foundation for future research on molecular mechanisms and the development of new therapies.
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Affiliation(s)
- Zhiming Liu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Hui Lu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xianjuan Zhang
- Department of Clinical Laboratory, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuai Tang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Antao Lin
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuo Han
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Xuexiao Ma
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Yang S, Soheilmoghaddam F, Pivonka P, Li J, Rudd S, Yeo T, Tu J, Zhu Y, Cooper-White JJ. Engineering Intervertebral Disc Regeneration: Biomaterials, Cell Sources and Animal Models. Cell Prolif 2025:e70046. [PMID: 40389238 DOI: 10.1111/cpr.70046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2025] [Revised: 03/28/2025] [Accepted: 04/15/2025] [Indexed: 05/21/2025] Open
Abstract
Intervertebral disc (IVD) degeneration is an age-related problem triggering chronic spinal issues, such as low back pain and IVD herniation. Standard surgical treatment for such spinal issues is the removal of the degenerated or herniated IVD and fusion of adjacent vertebrae to stabilise the joint and locally decompress the spinal cord and/or nerve roots to relieve pain. However, a key challenge of current surgical strategies is the increasing risk of adjacent segment degeneration due to the disruption of native biomechanics of the functional spinal unit, dominated by the loss of the IVD. In the past two decades, research has focused on developing a number of bioengineering approaches to repair and regenerate the IVD; in particular, tissue engineering of the IVD, using bioscaffolds and stem cells represents a promising area. This review highlights the current tissue engineering approaches utilising biomaterials, animal models and cell sources for IVD regeneration and discusses future opportunities.
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Affiliation(s)
- Sidong Yang
- Tissue Engineering and Microfluidics Laboratory (TE&M), Australian Institute for Bioengineering and Nanotechnology (AIBN), The University of Queensland, St Lucia, Queensland, Australia
- Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China
- Hebei International Joint Research Centre for Spine Diseases, Shijiazhuang, China
| | - Farhad Soheilmoghaddam
- Tissue Engineering and Microfluidics Laboratory (TE&M), Australian Institute for Bioengineering and Nanotechnology (AIBN), The University of Queensland, St Lucia, Queensland, Australia
| | - Peter Pivonka
- School of Mechanical Medical & Process Engineering, Queensland University of Technology, Brisbane City, Queensland, Australia
| | - Joan Li
- Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - Samuel Rudd
- School of Chemical Engineering, The University of Queensland, St Lucia, Queensland, Australia
| | - Trifanny Yeo
- Tissue Engineering and Microfluidics Laboratory (TE&M), Australian Institute for Bioengineering and Nanotechnology (AIBN), The University of Queensland, St Lucia, Queensland, Australia
- Institute for Health Innovation & Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Ji Tu
- Spine Labs, St. George & Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Yibo Zhu
- School of Chemical Engineering, The University of Queensland, St Lucia, Queensland, Australia
| | - Justin J Cooper-White
- Tissue Engineering and Microfluidics Laboratory (TE&M), Australian Institute for Bioengineering and Nanotechnology (AIBN), The University of Queensland, St Lucia, Queensland, Australia
- School of Chemical Engineering, The University of Queensland, St Lucia, Queensland, Australia
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Guo Y, Wang F, Zhou Y, Wang B, Wang C, Hu T, Wu D. Exploring Negative Feedback Mechanisms in the PTEN-ACE Axis: Application of Electrosorb Hydrogel-Based Gene Delivery for Intervertebral Disc Regeneration. Int J Biol Sci 2025; 21:3416-3443. [PMID: 40520007 PMCID: PMC12160554 DOI: 10.7150/ijbs.111898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Accepted: 04/23/2025] [Indexed: 06/18/2025] Open
Abstract
Intervertebral disc degeneration (IDD), along with associated low back pain, stands as a primary cause of disability. The renin-angiotensin-aldosterone system has been linked to IDD; however, the mechanisms underlying this relationship have not been determined. In this study, the role of angiotensin-converting enzyme (ACE), a key synthetase in the system, in IDD and its regulatory mechanism were evaluated. Our findings revealed that downregulating ACE alleviates IDD. Additionally, phosphatase and tensin homolog (PTEN) regulated ACE through tripartite motif-containing 63 (TRIM63)-mediated K48-linked ubiquitination. PTEN dephosphorylated TRIM63, while polo-like kinase 1 (PLK1) phosphorylated TRIM63 at Ser67 and Ser69, two crucial sites for the interaction between ACE and TRIM63. Importantly, this regulatory axis also influenced endoplasmic reticulum autophagy by modulating O-GlcNAc modification, highlighting its significant role in the regulation of IDD. Furthermore, we developed a chitosan-virus electrosorb hydrogel for IDD repair therapy using lentivirus-mediated gene editing. The hydrogel exhibited excellent swelling, degradation, release rates, and biocompatibility. Specific gene editing by the chitosan-virus electrosorb hydrogel could reduce IDD in rats. These findings support the efficacy of modulating the PTEN-ACE pathway and O-GlcNAc modification and the therapeutic value of chitosan-virus electrosorb hydrogels for IDD.
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Affiliation(s)
- Youfeng Guo
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Feng Wang
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Yu Zhou
- Department of Medical Genetics, School of Medicine, Tongji University, Shanghai 200092, China
| | - Bijun Wang
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Chao Wang
- School of Materials Science and Engineering, Shanghai University, Shanghai 200444, China
| | - Tao Hu
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Desheng Wu
- Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
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Xu X, Liu Y, Jiang C, Jia P, Cao P, He Y, Zhang Y. Mechanism of microRNA-124-3p targeting calpain-1 to affect the function of intervertebral disc nucleus pulposus cells. Cytotechnology 2025; 77:53. [PMID: 39897108 PMCID: PMC11785900 DOI: 10.1007/s10616-024-00693-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 12/19/2024] [Indexed: 02/04/2025] Open
Abstract
Intervertebral disc degeneration (IVDD) represents a major cause of lower back pain, whose prevalence rises with age. This study probed into the mechanism of microRNA (miR)-124-3p regulating function of nucleus pulposus cells (NPCs) by targeting calpain-1 (CAPN1). Rat IVD NPCs were cultured in vitro and transfected with miR-124-3p mimics, miR-124-3p inhibitor, oe-CAPN1 and their negative controls. The mRNA levels of miR-124-3p and CAPN1 were assessed by RT-qPCR. Cell proliferation, apoptosis and migration were evaluated by CCK-8, flow cytometry and Transwell assays. Levels of CAPN1 protein, apoptosis-related proteins (BAX, Cleaved-Caspase3, BCL-2) and extracellular matrix (ECM) proteins (Collagen II, Aggrecan, Fibronectin, Collagen I, matrix metalloproteinase [MMP]-13) were determined by Western blot. The target binding relationship between miR-124-3p and CAPN1 was verified by dual-luciferase assay. miR-124-3p overexpression facilitated NPC function and the maintenance of ECM homeostasis, as evidenced by increased NPC proliferation and migration, decreased apoptosis, elevated apoptosis-related protein BCL-2 level, diminished BAX and Cleaved-Caspase3 levels, reduced levels of ECM homeostasis-associated factors Collagen I and MMP-13 proteins, as well as raised levels of Collagen II, Aggrecan and Fibronectin proteins. Conversely, miR-124-3p knockdown brought about the opposite results. miR-124-3p targeted CAPN1. Furthermore, overexpression of CAPN1 partially reversed the regulatory effects of miR-124-3p on the ECM homeostasis, proliferation and migration in NPCs, and promoted apoptosis. miR-124-3p contributed to proliferation and migration of IVD NPCs, and reduced their apoptosis by inhibiting CAPN1 expression, thereby modulating ECM homeostasis and maintaining the function of IVD NPCs.
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Affiliation(s)
- Xunan Xu
- Department of Orthopedics, People’s Hospital, Suzhou High-tech Zone, No.95 Huashan Road, Suzhou, 215129 Jiangsu China
| | - Yong Liu
- Department of Orthopedics, People’s Hospital, Suzhou High-tech Zone, No.95 Huashan Road, Suzhou, 215129 Jiangsu China
| | - Chun Jiang
- Department of Orthopedics, People’s Hospital, Suzhou High-tech Zone, No.95 Huashan Road, Suzhou, 215129 Jiangsu China
| | - Peng Jia
- Department of Orthopedics, People’s Hospital, Suzhou High-tech Zone, No.95 Huashan Road, Suzhou, 215129 Jiangsu China
| | - Pengfei Cao
- Department of Orthopedics, People’s Hospital, Suzhou High-tech Zone, No.95 Huashan Road, Suzhou, 215129 Jiangsu China
| | - Yi He
- Department of Orthopedics, People’s Hospital, Suzhou High-tech Zone, No.95 Huashan Road, Suzhou, 215129 Jiangsu China
| | - Yin Zhang
- Department of Orthopedics, People’s Hospital, Suzhou High-tech Zone, No.95 Huashan Road, Suzhou, 215129 Jiangsu China
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Zhang W, Chen S, Huang S, Li Z, Wang Z, Dai Z, Liang J, Rong H, Ouyang Q, Guo W, Wei Y, Wei J. 3D printed PGCL@PLA/10CSPL composite scaffolds loaded with fibronectin 1 for intervertebral disc degeneration treatment. Biofabrication 2024; 17:015032. [PMID: 39668784 DOI: 10.1088/1758-5090/ad998f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 12/02/2024] [Indexed: 12/14/2024]
Abstract
Restoration of disc height and biomechanical function is essential for intervertebral disc degeneration (IDD) treatment. Removing abnormal nucleus pulposus (NP) tissue is an important step to facilitate bony fusion during the healing process. We analyzed publicly available single-cell transcriptome data for human normal and degenerative NP to identify genes associated with NP degeneration. A novel poly(glycolide-co-caprolactone)@polylactide (PLA)-b-aniline pentamer (AP)-b-PLA/chitosan-ϵ-polylysine (PGCL@1PAP/10CSPL) scaffold with good biocompatibility and electroactivity was designed and fabricated as an implant for IDD treatment using 3D printing technology. The PGCL@1PAP/10CSPL scaffold exhibited superior hydrophilicity, mechanical properties, cytocompatibility, and antibacterial activity compared to PGCL. Fibronectin 1 (FN1), identified from single-cell transcriptome analysis, was loaded into the PGCL@1PAP/10CSPL scaffold to accelerate the abnormal NP degeneration.In vitroandin vivoexperiments indicated that the PGCL@1PAP/10CSPL-FN1 scaffold enhanced osteogenic differentiation, promoted angiogenesis, and facilitated the removal of damaged disc tissue. This study introduces a novel implant system with desirable mechanical strength and unique bone-promoting and vascularizing properties for lumbar interbody fusion in IDD treatment.
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Affiliation(s)
- Weilin Zhang
- Department of Spinal Degeneration and Deformity Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, People's Republic of China
| | - Siyuan Chen
- Department of Spinal Degeneration and Deformity Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, People's Republic of China
| | - Shengbang Huang
- Department of Spinal Degeneration and Deformity Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, People's Republic of China
| | - Zhencong Li
- Department of Spinal Degeneration and Deformity Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, People's Republic of China
| | - Zhongwei Wang
- Department of Spinal Degeneration and Deformity Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, People's Republic of China
| | - Zhiwen Dai
- Department of Spinal Degeneration and Deformity Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, People's Republic of China
| | - Jinguo Liang
- Department of Spinal Degeneration and Deformity Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, People's Republic of China
| | - Hongrui Rong
- Department of Spinal Degeneration and Deformity Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, People's Republic of China
| | - Qianqian Ouyang
- The Marine Biomedical Research Institute, Guangdong Medical University, Zhanjiang 524023, People's Republic of China
| | - Weixiong Guo
- Department of Spinal Degeneration and Deformity Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, People's Republic of China
| | - Yen Wei
- The Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology (Ministry of Education), Department of Chemistry, Tsinghua University, Beijing 100084, People's Republic of China
- School of Materials Science and Engineering, North Minzu University, Yinchuan 750021, People's Republic of China
- Department of Chemistry and Center for Nanotechnology, Chung Yuan Christian University, Chung Li District, Taoyuan City 32023, Taiwan
| | - Jinsong Wei
- Department of Spinal Degeneration and Deformity Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, People's Republic of China
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Wang D, Li Z, Huang W, Cao S, Xie L, Chen Y, Li H, Wang L, Chen X, Yang JR. Single-cell transcriptomics reveals heterogeneity and intercellular crosstalk in human intervertebral disc degeneration. iScience 2023; 26:106692. [PMID: 37216089 PMCID: PMC10192848 DOI: 10.1016/j.isci.2023.106692] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 02/14/2023] [Accepted: 04/13/2023] [Indexed: 05/24/2023] Open
Abstract
The complexity of the human intervertebral disc (IVD) has hindered the elucidation of the microenvironment and mechanisms underlying IVD degeneration (IVDD). Here we determined the landscapes of nucleus pulposus (NP), annulus fibrosus (AF), and immunocytes in human IVD by scRNA-seq. Six NP subclusters and seven AF subclusters were identified, whose functional differences and distribution during different stages of degeneration (Pfirrmann I-V) were investigated. We found MCAM+ progenitor in AF, as well as CD24+ progenitor and MKI67+ progenitor in NP, forming a lineage trajectory from CD24+/MKI67+ progenitors to EffectorNP_⅓ during IVDD. There is a significant increase in monocyte/macrophage (Mφ) in degenerated IVDs (p = 0.044), with Mφ-SPP1 exclusively found in IVDD but not healthy IVDs. Further analyses of the intercellular crosstalk network revealed interactions between major subpopulations and changes in the microenvironment during IVDD. Our results elucidated the unique characteristics of IVDD, thereby shedding light on therapeutic strategies.
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Affiliation(s)
- Dandan Wang
- College of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250000, China
| | - ZiZhang Li
- Department of Biomedical Informatics, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | | | - Shengnan Cao
- Neck-Shoulder and Lumbocrural Pain Hospital of Shandong First Medical University, Jinan 250062, China
| | - Liangyu Xie
- Neck-Shoulder and Lumbocrural Pain Hospital of Shandong First Medical University, Jinan 250062, China
| | - Yuanzhen Chen
- Neck-Shoulder and Lumbocrural Pain Hospital of Shandong First Medical University, Jinan 250062, China
| | - Huazhong Li
- Neck-Shoulder and Lumbocrural Pain Hospital of Shandong First Medical University, Jinan 250062, China
| | - Lei Wang
- 960th Hospital of PLA, Jinan 250031, China
| | - Xiaoshu Chen
- Department of Medical Genetics, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Jian-Rong Yang
- Department of Biomedical Informatics, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
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Xu J, Shao T, Lou J, Zhang J, Xia C. Aging, cell senescence, the pathogenesis and targeted therapies of intervertebral disc degeneration. Front Pharmacol 2023; 14:1172920. [PMID: 37214476 PMCID: PMC10196014 DOI: 10.3389/fphar.2023.1172920] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
Intervertebral disc degeneration (IVDD) refers to the aging and degenerative diseases of intervertebral disc components such as nucleus pulposus, annulus fibrosus, and cartilage endplate, and is the main cause of chronic low back pain. Over the past few years, many researchers around the world concerned that the degeneration of nucleus pulposus (NP) cells plays the main role in IVDD. The degeneration of NP cells is caused by a series of pathological processes, including oxidative stress, inflammatory response, apoptosis, abnormal proliferation, and autophagy. Interestingly, many studies have found a close relationship between the senescence of NP cells and the progression of NP degeneration. The classical aging pathways also have been confirmed to be involved in the pathological process of IVDD. Moreover, several anti-aging drugs have been used to treat IVDD by inhibiting NP cells senescence, such as proanthocyanidins, resveratrol and bone morphogenetic protein 2. Therefore, this article will systematically list and discuss aging, cell senescence, the pathogenesis and targeted therapies of IVDD, in order to provide new ideas for the treatment of IVDD in the future.
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Affiliation(s)
- Jiongnan Xu
- Center for Plastic and Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital Hangzhou Medical College, Hangzhou, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ting Shao
- Center for Plastic and Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital Hangzhou Medical College, Hangzhou, China
| | - Jianfen Lou
- Center for Plastic and Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital Hangzhou Medical College, Hangzhou, China
| | - Jun Zhang
- Department of Orthopedics, Zhejiang Provincial People’s Hospital Bijie Hospital, Bijie, Guizhou, China
| | - Chen Xia
- Center for Plastic and Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital Hangzhou Medical College, Hangzhou, China
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Cui X, Liu X, Kong P, Du T, Li T, Yang G, Zhang W, Jing X, Wang W. PTEN inhibitor VO-OHpic protects endplate chondrocytes against apoptosis and calcification via activating Nrf-2 signaling pathway. Aging (Albany NY) 2023; 15:2275-2292. [PMID: 36971687 PMCID: PMC10085618 DOI: 10.18632/aging.204612] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/15/2023] [Indexed: 04/07/2023]
Abstract
Cartilage endplate (CEP) degeneration and calcification is an important contributor to the onset and pathogenesis of intervertebral disc degeneration (IDD). However, the underlying mechanisms of CEP degeneration remain elusive, let alone according treatment strategies to prevent CEP degeneration. Phosphatase and tensin homolog (PTEN) is a tumor suppressor gene that promotes cell apoptosis, and recent studies indicated that PTEN is overexpressed in degenerated intervertebral disc. However, whether direct inhibition of PTEN attenuates CEP degeneration and IDD development remains largely unknown. In the present study, our in vivo experiments demonstrated that VO-OHpic could attenuate IDD progression and CEP calcification. We also found that VO-OHpic inhibited oxidative stress induced chondrocytes apoptosis and degeneration by activating Nrf-2/HO-1 pathway, thus promoted parkin mediated mitophagy process and inhibited chondrocytes ferroptosis, alleviated redox imbalance and eventually improved cell survival. Nrf-2 siRNA transfection significantly reversed the protective effect of VO-OHpic on endplate chondrocytes. In conclusion, our study demonstrated that inhibition of PTEN with VO-OHpic attenuates CEP calcification and IDD progression. Moreover, VO-OHpic protects endplate chondrocytes against apoptosis and degeneration via activating Nrf-2/HO-1 mediated mitophagy process and ferroptosis inhibition. Our results suggest that VO-OHpic may be a potential effective medicine for IDD prevention and treatment.
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Affiliation(s)
- Xingang Cui
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250000, China
| | - Xiaoyang Liu
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250000, China
| | - Peng Kong
- Department of Orthopaedics, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250000, China
| | - Ting Du
- Department of Medical, Yidu Cloud (Beijing) Technology Co. Ltd., Beijing 100191, China
| | - Tao Li
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250000, China
| | - Guihe Yang
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250000, China
| | - Weimin Zhang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250000, China
| | - Xingzhi Jing
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250000, China
| | - Wenchao Wang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250000, China
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Lu Z, Chen P, Xu Q, Li B, Jiang S, Jiang L, Zheng X. Constitutive and conditional gene knockout mice for the study of intervertebral disc degeneration: Current status, decision considerations, and future possibilities. JOR Spine 2023; 6:e1242. [PMID: 36994464 PMCID: PMC10041386 DOI: 10.1002/jsp2.1242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023] Open
Abstract
There have been an increasing number of patients with degenerative disc diseases due to the aging population. In light of this, studies on the pathogenesis of intervertebral disc degeneration have become a hot topic, and gene knockout mice have become a valuable tool in this field of research. With the development of science and technology, constitutive gene knockout mice can be constructed using homologous recombination, zinc finger nuclease, transcription activator-like effector nuclease technology and clustered regularly interspaced short palindromic repeats/Cas9 (CRISPR/Cas9) system, and conditional gene knockout mice can be constructed using the Cre/LoxP system. The gene-edited mice using these techniques have been widely used in the studies on disc degeneration. This paper reviews the development process and principles of these technologies, functions of the edited genes in disc degeneration, advantages, and disadvantages of different methods and possible targets of the specific Cre recombinase in intervertebral discs. Recommendations for the choice of suitable gene-edited model mice are presented. At the same time, possible technological improvements in the future are also discussed.
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Affiliation(s)
- Ze‐Yu Lu
- Spine CenterXinhua Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Peng‐Bo Chen
- Spine CenterXinhua Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Qing‐Yin Xu
- Spine CenterXinhua Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Bo Li
- Spine CenterXinhua Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Sheng‐Dan Jiang
- Spine CenterXinhua Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Lei‐Sheng Jiang
- Spine CenterXinhua Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Xin‐Feng Zheng
- Spine CenterXinhua Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
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10
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Hydroxysafflor Yellow A (HSYA) Protects Endplate Chondrocytes Against IL-1 β-Induced Injury Through Promoting Autophagy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6326677. [PMID: 35832517 PMCID: PMC9273358 DOI: 10.1155/2022/6326677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 12/04/2022]
Abstract
Background Intervertebral disc degeneration (IDD) refers to intractable pain in patients' waist and legs, which is caused by internal structural disorder and degeneration of intervertebral. This disease severely affects the quality-of-life of people. It has been reported that hydroxysafflor yellow A (HSYA), the active ingredient in safflower extract, could inhibit IL-1β-induced apoptosis of endplate chondrocytes. However, the mechanism by which HSYA regulates the occurrence and progression of IDD remains unclear. Methods Rat endplate chondrocytes were isolated from the intervertebral disc. Next, toluidine blue staining and collagen II immunofluorescence staining were used to identify endplate chondrocytes. Then, MDC staining was used to detect the autophagy of endplate chondrocytes. In addition, Western blot was used to measure the expression of cleaved caspase 3, LC-3I/II and ATG7 in endplate chondrocytes. Results IL-1β obviously inhibited the viability and proliferation of endplate chondrocytes, while these phenomena were notably reversed by HSYA. Additionally, HSYA was able to inhibit IL-1β-induced apoptosis of endplate chondrocytes. Moreover, HSYA protected endplate chondrocytes against IL-1β-induced inflammation via inducing autophagy. Conclusion HSYA protected rat endplate chondrocytes against IL-1β-induced injury via promoting autophagy. Therefore, the present study might provide some theoretical basis for exploring novel and effective methods for patients with IDD.
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BRD4 Inhibition Suppresses Senescence and Apoptosis of Nucleus Pulposus Cells by Inducing Autophagy during Intervertebral Disc Degeneration: An In Vitro and In Vivo Study. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:9181412. [PMID: 35308165 PMCID: PMC8933081 DOI: 10.1155/2022/9181412] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 12/10/2021] [Accepted: 02/06/2022] [Indexed: 01/10/2023]
Abstract
Intervertebral disc degeneration (IDD) is the most common chronic skeletal muscle degeneration disease. Although the underlying mechanisms remain unclear, nucleus pulposus (NP) autophagy, senescence, and apoptosis are known to play a critical role in this process. Previous studies suggest that bromodomain-containing protein 4 (BRD4) promotes senescent and apoptotic effects in several age-related degenerative diseases. It is not known, however, if BRD4 inhibition is protective in IDD. In this study, we explored whether BRD4 influenced IDD. In human clinical specimens, the BRD4 level was markedly increased with the increasing Pfirrmann grade. At the cellular level, BRD4 inhibition prevented IL-1β-induced senescence and apoptosis of NP cells and activated autophagy via the AMPK/mTOR/ULK1 signaling pathway. Inhibition of autophagy by 3-methyladenine (3-MA) partially reversed the antisenescence and antiapoptotic effects of BRD4. In vivo, BRD4 inhibition attenuated IDD. Taken together, the results of this study showed that BRD4 inhibition reduced NP cell senescence and apoptosis by induced autophagy, which ultimately alleviated IDD. Therefore, BRD4 may serve as a novel potential therapeutic target for the treatment of IDD.
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Herbal Formula Modified Bu-Shen-Huo-Xue Decoction Attenuates Intervertebral Disc Degeneration via Regulating Inflammation and Oxidative Stress. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4284893. [PMID: 35154344 PMCID: PMC8828322 DOI: 10.1155/2022/4284893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/15/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
Objective This study aims to clarify the potential mechanism of modified Bu-Shen-Huo-Xue decoction (MBSHXD) in treating intervertebral disc degeneration (IDD) with methods of network pharmacology and molecular docking. Methods An MBSHXD and IDD-related common target gene set was established through TCMSP, UniProt, and two disease gene databases. GO and KEGG enrichment analysis and protein-protein interaction (PPI) networks were performed through the R platform and STRING to discover the potential mechanism. Molecular docking between the active ingredients and the core genes is used to calculate the binding energy. Results A total of 147 active ingredients and 79 common genes (including 10 core genes, TNF, VEGFA, IL6, MAPK3, AKT1, MAPK8, TP53, JUN, MMP9, and CXCL8) were identified. The results of GO and KEGG enrichment analysis showed that MBSHXD plays an essential role in regulating inflammation and oxidative stress. The meaningful pathways are the AGE-RAGE signaling pathway in diabetic complications, the IL-17 signaling pathway, the TNF signaling pathway, the PI3K-Akt signaling pathway, the MAPK signaling pathway, and apoptosis. In addition, the PPI network and molecular docking further demonstrated the roles that nine bioactive ingredients of MBSHXD play in IDD treatment through their interference with core target proteins. Conclusion This study reveals that MBSHXD has the characteristics of a “multi-component, multi-target, and multi-pathway” in the treatment of IDD by regulating inflammation and oxidative stress, and network pharmacology may provide a feasible method to verify the molecular mechanism of MBSHXD for IDD by combining with molecular docking.
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Wu ZL, Chen YJ, Zhang GZ, Xie QQ, Wang KP, Yang X, Liu TC, Wang ZQ, Zhao GH, Zhang HH. SKI knockdown suppresses apoptosis and extracellular matrix degradation of nucleus pulposus cells via inhibition of the Wnt/β-catenin pathway and ameliorates disc degeneration. Apoptosis 2022; 27:133-148. [PMID: 35147801 DOI: 10.1007/s10495-022-01707-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 01/18/2023]
Abstract
This study aimed to determine the effects of SKI on interleukin (IL)-1β-induced apoptosis of nucleus pulposus (NP) cells, intervertebral disc degeneration (IDD), and the Wnt signaling pathway. NP tissue specimens of different Pfirrmann grades (II-V) were collected from patients with different grades of IDD. Real-time polymerase chain reaction and western blotting were used to compare SKI mRNA and protein expression in NP tissues from patients. Using the IL-1β-induced IDD model, NP cells were infected with lentivirus-coated si-SKI to downregulate the expression of SKI and treated with LiCl to evaluate the involvement of the Wnt/β-catenin signaling pathway. Western blotting, immunofluorescence, and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining were used to detect NP cell apoptosis, extracellular matrix (ECM) metabolism, and related protein expression changes in the Wnt/β-catenin signaling pathway. To investigate the role of SKI in vivo, a rat IDD model was established by needle puncture of the intervertebral disc. Rats were injected with lentivirus-coated si-SKI and evaluated by magnetic resonance imaging (MRI), and hematoxylin and eosin (HE) and safranin O staining. SKI expression positively correlated with the severity of human IDD. In the IL-1β-induced NP cell degeneration model, SKI expression increased significantly and reached a peak at 24 h. SKI knockdown protected against IL-1β-induced NP cell apoptosis and ECM degradation. LiCl treatment reversed the protective effects of si-SKI on NP cells. Furthermore, lentivirus-coated si-SKI injection partially reversed the NP tissue damage in the IDD model in vivo. SKI knockdown reduced NP cell apoptosis and ECM degradation by inhibiting the Wnt/β-catenin signaling pathway, ultimately protecting against IDD. Therefore, SKI may be an effective target for IDD treatment.
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Affiliation(s)
- Zuo-Long Wu
- Department of Orthopaedics, Second Hospital of Lanzhou University, Gansu, 730000, China
- Key Laboratory of Orthopaedics Disease of Gansu Province, Gansu, 730000, China
- Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Ya-Jun Chen
- Lanzhou University, Lanzhou, 730000, Gansu, China
- Lanzhou Maternal and Child Health Hospital, Lanzhou, 730000, Gansu, China
| | - Guang-Zhi Zhang
- Department of Orthopaedics, Second Hospital of Lanzhou University, Gansu, 730000, China
- Key Laboratory of Orthopaedics Disease of Gansu Province, Gansu, 730000, China
- Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Qi-Qi Xie
- Department of Orthopaedics, Second Hospital of Lanzhou University, Gansu, 730000, China
- Key Laboratory of Orthopaedics Disease of Gansu Province, Gansu, 730000, China
- Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Ke-Ping Wang
- Department of Orthopaedics, Second Hospital of Lanzhou University, Gansu, 730000, China
- Key Laboratory of Orthopaedics Disease of Gansu Province, Gansu, 730000, China
- Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Xin Yang
- Department of Orthopaedics, Second Hospital of Lanzhou University, Gansu, 730000, China
- Key Laboratory of Orthopaedics Disease of Gansu Province, Gansu, 730000, China
- Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Tai-Cong Liu
- Department of Orthopaedics, Second Hospital of Lanzhou University, Gansu, 730000, China
- Key Laboratory of Orthopaedics Disease of Gansu Province, Gansu, 730000, China
- Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Zhi-Qiang Wang
- Department of Orthopaedics, Second Hospital of Lanzhou University, Gansu, 730000, China
- Key Laboratory of Orthopaedics Disease of Gansu Province, Gansu, 730000, China
- Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Guang-Hai Zhao
- Department of Orthopaedics, Second Hospital of Lanzhou University, Gansu, 730000, China
- Key Laboratory of Orthopaedics Disease of Gansu Province, Gansu, 730000, China
- Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Hai-Hong Zhang
- Department of Orthopaedics, Second Hospital of Lanzhou University, Gansu, 730000, China.
- Key Laboratory of Orthopaedics Disease of Gansu Province, Gansu, 730000, China.
- Lanzhou University, Lanzhou, 730000, Gansu, China.
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Chen WK, Zhang HJ, Zou MX, Wang C, Yan YG, Zhan XL, Li XL, Wang WJ. LncRNA HOTAIR influences cell proliferation via miR-130b/PTEN/AKT axis in IDD. Cell Cycle 2022; 21:323-339. [PMID: 34974804 PMCID: PMC8855842 DOI: 10.1080/15384101.2021.2020042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Intervertebral disc degeneration (IDD) constitutes the pathological foundation of most musculoskeletal disorders of the spine. Previous studies have noted that cell proliferation is a common feature of IDD. Bioinformatics indicated that aberrantly expressed long non-coding RNAs (lncRNAs) were involved in the development of IDD. In this study, we aimed to investigate the function of lncRNA HOTAIR in the proliferation of human nucleus pulposus (NP) cells of IDD in vitro and further clarified its mechanism. The expression of HOTAIR and miR-130b was quantified by qRT-PCR in nucleus pulposus (NP) tissues. Furthermore, NP cells proliferation were assayed by CCK8 and Immunostaining. Dual-luciferase reporter and RIP assay were used to examine the expression of HOTAIR, PTEN, and their co-target gene miR-130b. Western blotting was used to test AKT expression. Our in vitro experiments on human normal NP cells observed that HOTAIR was significantly dysregulated in IDD. Further, HOTAIR can suppress proliferation by directly targeting miR-130b. In addition, Both HOTAIR and PTEN were confirmed to target miR-130b, and miR-130b upregulation reversed the phenomenon of ectopic expression of HOTAIR. More importantly, HOTAIR upregulation significantly reduced CyclinD1 protein expression by PTEN/AKT signaling pathway. Our findings suggest that HOTAIR may bind to miR-130b and subsequently increased CyclinD1 expression via PTEN/Akt pathway. Thereby, HOTAIR could become a potential target for the treatment of IDD.Abbreviations : IDD; intervertebral disc degeneration ncRNAs; non-coding RNAs lncRNAs; long non-coding RNAs miRNAs; microRNAs NP; nucleus pulposus qRT-PCR; quantitative reverse transcription-PCR LBP; Low back pain ORF; open reading frame HOTAIR; Hox transcript antisense intergenic RNA FAF1; Fas-associated protein factor-1 Erk; extracellular signal-regulated kinase TUG1; Taurine Up-regulated Gene 1 HIF1A hypoxia-inducible factor 1-alpha PI3K; phosphoinositide-3 kinase AIS; adolescent idiopathic scoliosis ECM; extracellular matrix LN;lupus nephritis CT;computed tomography MRI; magnetic resonance imaging PBS; phosphate-buffered salin PBS; phosphate-buffered salin PVDF; polyvinylidene fluoride TBST; Tris-buffered saline Tween ECL; enhanced chemiluminescence RIP; RNA immunoprecipitation.
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Affiliation(s)
- Wen-Kang Chen
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China,The First Clinical Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Han-Jing Zhang
- The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Ming-Xiang Zou
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Cheng Wang
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yi-Guo Yan
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Xin-Li Zhan
- The First Clinical Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xue-Lin Li
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China,CONTACT Xue-Lin Li ; Wen-Jun Wang Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan421001, China
| | - Wen-Jun Wang
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
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Mechanism of Long Noncoding RNA HOTAIR in Nucleus Pulposus Cell Autophagy and Apoptosis in Intervertebral Disc Degeneration. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:8504601. [PMID: 35027936 PMCID: PMC8752263 DOI: 10.1155/2022/8504601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/03/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022]
Abstract
Objective Intervertebral disc degeneration (IDD) contributes to cervical and lumbar diseases. Long noncoding RNAs (lncRNAs) are implicated in IDD. This study explored the mechanism of lncRNA HOTAIR in IDD. Methods Normal and degenerative nucleus pulposus (NP) cells were isolated from NP tissues obtained in intervertebral disc surgery. Cell morphology was observed by immunocytochemistry staining and toluidine blue staining. NP cell markers were detected by RT-qPCR. Proliferation was detected by MTT assay. Autophagy-related proteins were detected by Western blot. Autophagosome was observed by monodansylcadaverine fluorescence staining. Apoptosis was detected by TUNEL staining and flow cytometry. si-HOTAIR and/or miR-148a inhibitor was introduced into degenerative NP cells. Binding relationships among HOTAIR, miR-148a, and PTEN were predicted and verified by dual-luciferase reporter assay and RNA pull-down. Finally, IDD rat models were established. Rat caudal intervertebral discs were assessed by HE staining. Expressions of HOTAIR, miR-148a, and PTEN were determined by RT-qPCR. Results HOTAIR was highly expressed in degenerative NP cells (p < 0.05). si-HOTAIR inhibited degenerative NP cell apoptosis and autophagy (p < 0.05). HOTAIR upregulated PTEN as a sponge of miR-148a. miR-148a was poorly expressed in degenerative NP cells. miR-148a deficiency partially reversed the inhibition of si-HOTAIR on degenerative NP cell autophagy and apoptosis (all p < 0.05). In vivo assay confirmed that si-HOTAIR impeded autophagy and apoptosis in intervertebral disc tissues, thus improving pathological injury in IDD rats (all p < 0.05). Conclusion LncRNA HOTAIR promoted NP cell autophagy and apoptosis via promoting PTEN expression as a ceRNA of miR-148a in IDD.
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Zhao Y, Li A. miR-19b-3p relieves intervertebral disc degeneration through modulating PTEN/PI3K/Akt/mTOR signaling pathway. Aging (Albany NY) 2021; 13:22459-22473. [PMID: 34554926 PMCID: PMC8507280 DOI: 10.18632/aging.203553] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 09/03/2021] [Indexed: 12/13/2022]
Abstract
Emerging studies have revealed that non-coding RNAs contribute to regulating intervertebral disc degeneration (IVDD). Here, we intended to probe into the function of miR-19b-3p in IVDD evolvement. The miR-19b-3p level in the intervertebral disc (IVD) tissues of IVDD patients and IL-1β/TNF-α/hydrogen peroxide-treated human nucleus pulposus cells (HNPCs) was determined by quantitative real-time polymerase chain reaction (qRT-PCR). Also, qRT-PCR was conducted to examine the profiles of MMP-3, MMP-9, MMP-13, ADAMTS-4 and ADAMTS-5. The PTEN/PI3K/Akt/mTOR pathway was examined by Western blot (WB). The miR-19b-3p overexpression assay was carried out, and HNPC proliferation and apoptosis were compared by the cell counting kit-8 (CCK-8) assay and flow cytometry (FCM). In addition, the mechanism of action of miR-19b-3p was clarified using the PTEN inhibitor (VO-Ohpic triphosphate) or the mTOR inhibitor (Rapamycin) on the basis of IL-1β intervention and miR-19b-3p mimics transfection. Our results testified that miR-19b-3p expression was curbed in IVD tissues of the IVDD patients (vs. normal IVD tissues) and IL-1β-, TNF-α, or hydrogen peroxide-treated HNPCs. Up-regulating miR-19b-3p enhanced HNPC proliferation and hampered its apoptosis. Moreover, miR-19b-3p dampened the PTEN profile and activated the PI3K/Akt/mTOR pathway. Interestingly, attenuating PTEN reduced IL-1β-, TNF-α-, or hydrogen peroxide-mediated HNPC apoptosis and up-regulated PI3K/Akt/mTOR, while inhibiting the mTOR pathway offset the protective function of miR-19b-3p. Further mechanism studies illustrated that miR-19b-3p targeted the 3'untranslated region (UTR) of PTEN and abated the PTEN level. This research confirmed that miR-19b-3p suppressed HNPC apoptosis in the in-vitro model of IVDD by regulating PTEN/PI3K/Akt/mTOR pathway.
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Affiliation(s)
- Yulin Zhao
- Department of Spine Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, ShanDong University, Qingdao 266035, ShanDong, China
| | - Aimin Li
- Department of Spine Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, ShanDong University, Qingdao 266035, ShanDong, China
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Tan L, Xie Y, Yuan Y, Hu K. LncRNA GAS5 as miR-26a-5p Sponge Regulates the PTEN/PI3K/Akt Axis and Affects Extracellular Matrix Synthesis in Degenerative Nucleus Pulposus Cells in vitro. Front Neurol 2021; 12:653341. [PMID: 34413821 PMCID: PMC8369364 DOI: 10.3389/fneur.2021.653341] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/30/2021] [Indexed: 12/23/2022] Open
Abstract
The role of lncRNA growth arrest specific 5 (GAS5) in degenerative nucleus pulposus cell (NPC) apoptosis has been reported, but the mechanism of GAS5 in extracellular matrix (ECM) synthesis in intervertebral disc degeneration (IDD) remains unknown. We aimed to investigate the mechanism of GAS5 in ECM synthesis in degenerative NPCs. GAS5 expression was measured in degenerative NPCs (CP-H170) and normal NPCs (CP-H097). siRNA-mediated GAS5 knockdown was transfected to NPCs to detect cell viability and the expression of ECM-related genes (Collagen II, aggrecan, Collagen I, and MMP-3). Subcellular localization of GAS5 was analyzed. The downstream gene and pathway of GAS5 in degenerative NPCs were explored. As our results indicated, lncRNA GAS5 was upregulated in degenerative NPCs. Silencing GAS5 improved the viability of degenerative NPCs and increased ECM synthesis. GAS5 was mainly located in the cytoplasm of NPCs. LncRNA GAS5 sponged miR-26a-5p to regulate PTEN. Overexpression of miR-26a-5p promoted ECM synthesis in degenerative NPCs. Akt inhibitor LY294002 reversed the promotion of silencing GAS5 on ECM synthesis of degenerative NPCs. In conclusion, lncRNA GAS5 sponged miR-26a-5p to upregulate PTEN and inhibit the PI3K/Akt pathway, thus inhibiting ECM synthesis of degenerative NPCs.
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Affiliation(s)
- Liang Tan
- Department of Spine Surgery, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou, China
| | - Yifang Xie
- Department of Spine Surgery, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou, China
| | - Ye Yuan
- Department of Spine Surgery, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou, China
| | - Kai Hu
- Department of Spine Surgery, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou, China
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Zhang G, Liu M, Chen H, Wu Z, Gao Y, Ma Z, He X, Kang X. NF-κB signalling pathways in nucleus pulposus cell function and intervertebral disc degeneration. Cell Prolif 2021; 54:e13057. [PMID: 34028920 PMCID: PMC8249791 DOI: 10.1111/cpr.13057] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/25/2021] [Accepted: 05/01/2021] [Indexed: 02/06/2023] Open
Abstract
Intervertebral disc degeneration (IDD) is a common clinical degenerative disease of the spine. A series of factors, such as inflammation, oxidative stress and mechanical stress, promote degradation of the extracellular matrix (ECM) of the intervertebral discs (IVD), leading to dysfunction and structural destruction of the IVD. Nuclear factor-κB (NF-κB) transcription factor has long been regarded as a pathogenic factor of IDD. Therefore, NF-κB may be an ideal therapeutic target for IDD. As NF-κB is a multifunctional functional transcription factor with roles in a variety of biological processes, a comprehensive understanding of the function and regulatory mechanism of NF-κB in IDD pathology will be useful for the development of targeted therapeutic strategies for IDD, which can prevent the progression of IDD and reduce potential risks. This review discusses the role of the NF-κB signalling pathway in the nucleus pulposus (NP) in the process of IDD to understand pathological NP degeneration further and provide potential therapeutic targets that may interfere with NF-κB signalling for IDD therapy.
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Affiliation(s)
- Guang‐Zhi Zhang
- Department of OrthopedicsLanzhou University Second HospitalLanzhouChina
- The Second Clinical Medical CollegeLanzhou UniversityLanzhouChina
- Key Laboratory of Orthopedics Disease of Gansu ProvinceLanzhou University Second HospitalLanzhouChina
| | - Ming‐Qiang Liu
- Department of OrthopedicsLanzhou University Second HospitalLanzhouChina
- The Second Clinical Medical CollegeLanzhou UniversityLanzhouChina
- Key Laboratory of Orthopedics Disease of Gansu ProvinceLanzhou University Second HospitalLanzhouChina
| | - Hai‐Wei Chen
- Department of OrthopedicsLanzhou University Second HospitalLanzhouChina
- The Second Clinical Medical CollegeLanzhou UniversityLanzhouChina
- Key Laboratory of Orthopedics Disease of Gansu ProvinceLanzhou University Second HospitalLanzhouChina
| | - Zuo‐Long Wu
- Department of OrthopedicsLanzhou University Second HospitalLanzhouChina
- The Second Clinical Medical CollegeLanzhou UniversityLanzhouChina
- Key Laboratory of Orthopedics Disease of Gansu ProvinceLanzhou University Second HospitalLanzhouChina
| | - Yi‐Cheng Gao
- Department of OrthopedicsLanzhou University Second HospitalLanzhouChina
- The Second Clinical Medical CollegeLanzhou UniversityLanzhouChina
- Key Laboratory of Orthopedics Disease of Gansu ProvinceLanzhou University Second HospitalLanzhouChina
| | - Zhan‐Jun Ma
- Department of OrthopedicsLanzhou University Second HospitalLanzhouChina
- The Second Clinical Medical CollegeLanzhou UniversityLanzhouChina
- Key Laboratory of Orthopedics Disease of Gansu ProvinceLanzhou University Second HospitalLanzhouChina
| | - Xue‐Gang He
- Department of OrthopedicsLanzhou University Second HospitalLanzhouChina
- The Second Clinical Medical CollegeLanzhou UniversityLanzhouChina
- Key Laboratory of Orthopedics Disease of Gansu ProvinceLanzhou University Second HospitalLanzhouChina
| | - Xue‐Wen Kang
- Department of OrthopedicsLanzhou University Second HospitalLanzhouChina
- The Second Clinical Medical CollegeLanzhou UniversityLanzhouChina
- Key Laboratory of Orthopedics Disease of Gansu ProvinceLanzhou University Second HospitalLanzhouChina
- The International Cooperation Base of Gansu Province for the Pain Research in Spinal DisordersLanzhouChina
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Wang X, Li Z, Cui Y, Cui X, Chen C, Wang Z. Exosomes Isolated From Bone Marrow Mesenchymal Stem Cells Exert a Protective Effect on Osteoarthritis via lncRNA LYRM4-AS1-GRPR-miR-6515-5p. Front Cell Dev Biol 2021; 9:644380. [PMID: 34124036 PMCID: PMC8193855 DOI: 10.3389/fcell.2021.644380] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/19/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives The aim of this study was to investigate the effects of exosomes isolated from human bone marrow mesenchymal stem cells (BMSCs) on osteoarthritis (OA) and a competitive endogenous RNA (ceRNA) network. Methods Exosomes were isolated from human BMSCs and characterized by transmission electron microscopy (TEM), Nanosight (NTA), and western blotting. Chondrocytes were treated with interleukin-1β (IL-1β) and then transfected with exosomes. Cell viability and apoptosis were determined using Cell Counting Kit-8 (CCK-8) and flow cytometry, respectively. Cells with IL-1β and exosomes were sequenced, and differentially expressed lncRNAs (DE-lncRNAs) and miRNAs (DE-miRNAs) were identified. Thereafter, a ceRNA network (LYRM4-AS1-GRPR-miR-6515-5p) was chosen for further validation. Results TEM, NTA, and western blotting showed that exosomes were successfully isolated, and PKH67 staining showed that exosomes could be taken up by IL-1β-induced chondrocytes. Compared with the control group, IL-1β significantly decreased cell viability and promoted apoptosis (P < 0.05), while exosomes reversed the changes induced by IL-1β. For MMP3, AKT, and GRPR, IL-1β upregulated their expression, while exosomes downregulated their expression. For PTEN, there was no significant difference in PTEN expression between the control and IL-1β groups; however, exosomes markedly upregulated PTEN expression. By sequencing, 907 DE-lncRNAs and 25 DE-miRNAs were identified, and a ceRNA network was constructed. The dual-luciferase reporter gene indicated that LYRM4-AS1, miR-6515-5, and GRPR interacted with each other. The results of cell experiments showed that LYRM4-AS1 regulated the growth of IL-1β-induced chondrocytes by GRPR/miR-6515-5p. Conclusion Exosomes may alleviate OA inflammation by regulating the LYRM4-AS1/GRPR/miR-6515-5p signaling pathway.
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Affiliation(s)
- Xiuhui Wang
- Department of Orthopedics, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Zhuokai Li
- Department of Orthopedics, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yin Cui
- Department of Orthopedics, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xu Cui
- Department of Orthopedics, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Cheng Chen
- Department of Orthopedics, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Zhe Wang
- Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, China
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Cyclic Mechanical Stretch Ameliorates the Degeneration of Nucleus Pulposus Cells through Promoting the ITGA2/PI3K/AKT Signaling Pathway. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6699326. [PMID: 33815660 PMCID: PMC7990548 DOI: 10.1155/2021/6699326] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/16/2021] [Accepted: 02/24/2021] [Indexed: 12/16/2022]
Abstract
Background Intervertebral disc degeneration (IVDD) is one of the major causes of low back pain and motor deficiency. Nucleus pulposus (NP) degeneration plays a key role in the process of IVDD. The mechanical and biological interactions involved in NP degeneration have not been elucidated. The present study is aimed at investigating the effect and mechanism of cyclic mechanical stretch in regulating the function and degeneration of NP cells. Methods NP cells were subjected to cyclic tensile stress (10% deformation) of 0.1 Hz for 8640 cycles. Cell proliferation was conducted through the MTT assay. The cell cycle and apoptosis were detected by flow cytometry. A gene expression profile chip was used to analyze the differentially expressed genes between the tensile stress group and the control group. Enrichment analysis of Gene Ontology (GO) annotation and signaling pathways were analyzed. Western blot and RNA interference were carried out to investigate the role of the ITGA2/PI3K/AKT pathway in the effect of cyclic mechanical stretch on NP cells. Results NP cells exhibited a greater (P < 0.05) growth rate in the tensile stress group compared to the control group. Cyclic mechanical stress significantly promoted the cell cycle transition of NP cells from the S phase to the G2/M phase. A fewer proportion of apoptotic cells were found in the tensile stress group (P < 0.05), indicating that cyclic mechanical stretch inhibits NP cell apoptosis. Microarray analysis revealed 689 significant differentially expressed genes between the two groups (P < 0.05), of which 333 genes were upregulated and another 356 genes were downregulated. Cyclic mechanical stretch altered the expression of 31 genes involved in the ITGA2/PI3K/AKT pathway and remarkably promoted this pathway in NP cells. Downregulation of ITGA2 and AKT further demonstrated that the PI3K/AKT pathway was responsible for the proliferation and COL2A1 expression of NP cells upon cyclic mechanical stretch. Conclusions Cyclic mechanical stretch promoted the proliferation and cell cycle and reversely inhibited the apoptosis of NP cells. Cyclic mechanical stretch promoted COL2A1 expression and ameliorated the degeneration of NP cells via regulation of the ITGA2/PI3K/AKT signaling pathway. Our results may provide a potential target and a possibility of IVDD disease treatment by ameliorating the degenerative changes.
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Qi W, Ren D, Wang P, Song Z, Wu H, Yao S, Geng L, Su Y, Bai X. Upregulation of Sirt1 by tyrosol suppresses apoptosis and inflammation and modulates extracellular matrix remodeling in interleukin-1β-stimulated human nucleus pulposus cells through activation of PI3K/Akt pathway. Int Immunopharmacol 2020; 88:106904. [PMID: 32866785 DOI: 10.1016/j.intimp.2020.106904] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/24/2020] [Accepted: 08/13/2020] [Indexed: 12/20/2022]
Abstract
Intervertebral disc degeneration (IDD) is the major pathogenesis of lower back pain. Tyrosol is a polyphenolic compound that exhibits anti-oxidant, anti-apoptotic, and anti-inflammatory effects. Herein, we explored the effects and mechanisms of tyrosol on IDD progression in interleukin (IL)-1β-stimulated human nucleus pulposus cells (HNPCs). Cell viability and apoptosis were detected by CCK-8 and flow cytometry analysis, respectively. The production of tumor necrosis factor-α (TNF-α), IL-6, nitric oxide (NO), and prostaglandin E2 (PGE2) was examined to evaluate inflammation. The mRNA expression of matrix metalloproteinases (MMPs) (MMP-3/9/13), collagen type II, SRY-related high mobility group box 9 (SOX-9), and aggrecan was measured by qRT-PCR. Protein levels of silent information regulator 2 homolog 1 (Sirt1), phosphorylated protein kinase B (p-Akt), Akt, collagen type II, SOX-9, and aggrecan were determined by western blot. Results showed that tyrosol attenuated IL-1β-induced viability reduction, apoptosis, and caspase-3/7 activity in HNPCs. The increase in the production of TNF-α, IL-6, NO, and PGE2 in IL-1β-treated HNPCs was abolished by tyrosol treatment. Tyrosol treatment reversed IL-1β-induced upregulation of MMP-3, MMP-9, and MMP-13, and downregulation of collagen II, SOX-9, and aggrecan in HNPCs. Additionally, tyrosol treatment activated the phosphatidylinositol 3-kinase (PI3K)/Akt pathway in IL-1β-stimulated HNPCs. Sirt1 was upregulated by tyrosol, and Sirt1 silencing inhibited Akt phosphorylation in HNPCs. Sirt1 knockdown attenuated the effects of tyrosol on IL-1β-induced apoptosis, inflammation, and ECM remodeling in HNPCs. In summary, upregulation of Sirt1 by tyrosol suppressed apoptosis and inflammation and regulated ECM remodeling in IL-1β-stimulated HNPCs through activation of PI3K/Akt pathway.
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Affiliation(s)
- Wei Qi
- Emergency Center of Orthopedic Trauma, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Dong Ren
- Emergency Center of Orthopedic Trauma, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Pengcheng Wang
- Emergency Center of Orthopedic Trauma, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China.
| | - Zhaohui Song
- Emergency Center of Orthopedic Trauma, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Haotian Wu
- Emergency Center of Orthopedic Trauma, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Shuangquan Yao
- Emergency Center of Orthopedic Trauma, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Lindan Geng
- Emergency Center of Orthopedic Trauma, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Yunshan Su
- Emergency Center of Orthopedic Trauma, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Xiaoliang Bai
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
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Hu S, Fu Y, Yan B, Shen Z, Lan T. Analysis of key genes and pathways associated with the pathogenesis of intervertebral disc degeneration. J Orthop Surg Res 2020; 15:371. [PMID: 32873329 PMCID: PMC7465721 DOI: 10.1186/s13018-020-01902-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/19/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Intervertebral disc degeneration (IDD) is widely known as the main contributor to low back pain which has a negative socioeconomic impact worldwide. However, the underlying mechanism remains unclear. This study aims to analyze the dataset GSE23130 using bioinformatics methods to identify the pivotal genes and pathways associated with IDD. MATERIAL/METHODS The gene expression data of GSE23130 was downloaded, and differentially expressed genes (DEGs) were extracted from 8 samples and 15 controls. GO and KEGG pathway enrichment analyses were performed. Also, protein-protein interaction (PPI) network was constructed and visualized, followed by identification of hub genes and key module. RESULTS A total of 30 downregulated and 79 upregulated genes were identified. The DEGs were mainly enriched in the regulation of protein catabolic process, extracellular matrix organization, collagen fibril organization, and extracellular structure organization. Meanwhile, we found that most DEGs were primarily enriched in the PI3K-Akt signaling pathway. The top 10 hub genes were FN1, COL1A2, SPARC, COL3A1, CTGF, LUM, TIMP1, THBS2, COL5A2, and TGFB1. CONCLUSIONS In summary, key candidate genes and pathways were identified by using integrated bioinformatics analysis, which may provide insights into the underlying mechanisms and offer potential target genes for the treatment of IDD.
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Affiliation(s)
- Shiyu Hu
- Department of Neurology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Yucheng Fu
- Department of Orthopedics, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bin Yan
- Department of Neurology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Zhe Shen
- Department of Spine Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
| | - Tao Lan
- Department of Spine Surgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
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Zhang HJ, Ma XH, Xie SL, Qin SL, Liu CZ, Zhang ZG. Knockdown of miR-660 protects nucleus pulposus cells from TNF-a-induced apoptosis by targeting serum amyloid A1. J Orthop Surg Res 2020; 15:7. [PMID: 31907065 PMCID: PMC6945720 DOI: 10.1186/s13018-019-1538-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/20/2019] [Indexed: 12/27/2022] Open
Abstract
Background Intervertebral disc degeneration (IVDD) is a well-known cause of lower back pain, which is induced by multiple factors including increased apoptosis and decreased survival of nucleus pulposus cells. In this study, we evaluate the effect and potential mechanism of miR-660 on the nucleus pulposus cells apoptosis induced by TNF-α. Methods First, we collected tissue of nucleus pulposus from IVDD and healthy controls. General characteristic of the IVDD and healthy control was also collected. And, we also collected nucleus pulposus cells that stimulated by TNF-α or control. miRNA microarray was performed to identify the differentially expressed miRNAs. Apoptosis rate and miR-660 relative expression was measured after stimulated with different concentration of TNF-α to identify the optimal concentration of TNF-α. Second, we successfully constructed antigomiR-660 to block the miR-660 expression in nucleus pulposus cells and then stimulated with TNF-α (100 ng/ml, 12 h). The apoptosis rates and relative protein expression were then measured again. The target association between miR-660 and SAA1 was confirmed by dual-luciferase reporter. Results There was no significant difference between the age (IVDD: 39 ± 10 years, healthy controls: 36 ± 7 years), BMI and sex between IVDD and healthy controls. Microarray analysis found that miR-660 was significantly up-regulated in IVDD and TNF-α treated groups, which was further identified by PCR. We found that the rate of apoptosis and miR-660 expression increased with TNF-α concentration increased. Finally, TNF-a with 100 ng/ml was used for further experiment. Compared with TNF-α group, TNF-α + antigomiR-660 could significantly down-regulated the apoptosis rate and relative protein (c-Caspase3 and c-Caspase7). Dual-luciferase reporter revealed that miR-660 could directly binding to the SAA1 at 80–87 sites. Compared with TNF-α alone group, TNF-α + antigomiR-660 significantly up-regulated the SAA1 expression (P < 0.05). Conclusion These results indicated that knockdown of miR-660 protected the nucleus pulposus from apoptosis that induced TNF-α via up-regulation of SAA1. Further studies should focus on the role of miR-660 in protecting IVDD in vivo.
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Affiliation(s)
- Hao Jie Zhang
- Department of Orthopedics, Huai An Hospital of Huai An City, No.161, Zhen Huai Lou East Road, Huai An District, Huai An City, 223200, JiangSu Province, China
| | - Xue Hai Ma
- Department of Orthopedics, Huai An Hospital of Huai An City, No.161, Zhen Huai Lou East Road, Huai An District, Huai An City, 223200, JiangSu Province, China
| | - Song Lin Xie
- Department of Orthopedics, Huai An Hospital of Chinese Medicine, No.3.He Ping Road, Qing Jiang Pu District, Huai An City, 223200, Jiang Su Province, China
| | - Shu Lian Qin
- Department of Orthopedics, Huai An Hospital of Chinese Medicine, No.3.He Ping Road, Qing Jiang Pu District, Huai An City, 223200, Jiang Su Province, China
| | - Cong Zhi Liu
- Department of Orthopedics, Huai An Hospital of Huai An City, No.161, Zhen Huai Lou East Road, Huai An District, Huai An City, 223200, JiangSu Province, China
| | - Zhen Guo Zhang
- Department of Orthopedics, Huai An Hospital of Chinese Medicine, No.3.He Ping Road, Qing Jiang Pu District, Huai An City, 223200, Jiang Su Province, China.
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