Preliminary work on the development of a novel detection method for osteoporosis

Is Raman Spectroscopy of Fingernails a Promising Tool for Diagnosing Systemic and Dermatological Diseases in Adult and Pediatric Populations?

Background: Raman spectroscopy is a well-known tool used in criminology, molecular biology, and histology. It is also applied to diagnose bone mineral disorders by taking advantage of the similarity of the structure of keratin and bone collagen. Raman spectroscopy can also be used in dermatology and diabetology. The purpose of the present review is to critically evaluate the available research about the use of Raman spectroscopy in the mentioned areas of medicine. Methodology: PubMed was searched for peer-reviewed articles on the subject of use of Raman spectroscopy in bone mineral disorders, dermatology, and diabetes mellitus. Results: Nail keratin and bone collagen are related structural proteins that require disulfide bond for structural stability. Therefore, Raman spectroscopy of keratin may have potential as a diagnostic tool for screening bone quality and distinguishing patients at risk of fracture for reasons different from low bone mineral density (BMD) in the adult women population. Raman spectroscopy can also investigate the changes in keratin's structure in nails affected by onychomycosis and distinguish between healthy and onychomycosis nail samples. It could also reduce the need for nail biopsy by distinguishing between dermatophytic and non-dermatophytic agents of onychomycosis. Additionally, Raman spectroscopy could expedite the diagnostic process in psoriasis (by assessing the secondary structure of keratin) and in diabetes mellitus (by examining the protein glycation level). Conclusions: In adult populations, Raman spectroscopy is a promising and safe method for assessing the structure of fingernails. However, data are scarce in the pediatric population; therefore, more studies are required in children.

Effects of two types of surface treatments on the structural elasticity of human fingernails

BACKGROUND

The human nail has a three-layered structure. Although it would be useful to quantitatively evaluate the changes in deformability of the nail due to various surface treatments, few studies have been conducted.

METHODS

The effects of two types of surface treatment-a chemically acting nail softener and a physically acting nail strengthener-on the deformability of human fingernails were investigated. The Young's modulus of each plate of the nail samples before and after softening treatment was determined by nanoindentation. The Young's modulus of the strengthener was determined by conducting a three-point bending test on a polyethylene sheet coated with the strengthener.

RESULTS

Young's modulus decreased in order from the top plate against the softening treatment time, and the structural elasticity for bending deformation (SEB) of the nail sample, which expresses the deformability against bending deformation independent of its external dimensions, decreased to 60% after 6 h of treatment. The Young's modulus of the nail strengthener was 244.5 MPa, which is less than 10% of the SEB of the nail. When the nail strengthener was applied to the nail surface, the SEB decreased to 73%, whereas the flexural rigidity increased to 117%.

CONCLUSION

Changes in nail deformability caused by various surface treatments for softening and hardening were quantitatively evaluated successfully.

Nanoindentation study of human fingernail for determining its structural elasticity

BACKGROUND

Human nails play an important role in transmitting force to the fingertips, and their mechanical properties are important indices. The nail has a three-layered structure consisting of top dorsal, middle intermediate, and under ventral plates, and its internal structure is believed to affect its mechanical properties. However, this has not been investigated in previous studies.

METHODS

The Young's moduli of the top, middle, and under plates were measured using nanoindentation, and a theoretical model was developed to estimate the structural elasticity for the bending deformation of human nails, which is an index describing the deformability of the nail without depending on its external dimensions. The structural elasticity of human nails was compared with that of human hair collected from the same person. The effect of the softening treatment on the nails was also evaluated.

RESULTS

The Young's moduli of the top, middle, and under plates measured using nanoindentation were 2.9, 3.1, and 2.8 GPa, respectively. The structural elasticity of the nail was estimated to be 2.9 GPa, approximately 75% that of hair. Moreover, softening treatment with a urea cream reduced the structural elasticity of the nail to 70%.

CONCLUSION

This paper proposed a method for estimating the structural elasticity of a human nail with a three-layered structure. This index is a mechanical property with "Pa" as a unit, and is useful for comparing deformability with the Young's modulus of other homogeneous materials or for investigating the effect of various treatments quantitatively.

Biomechanical role of cement augmentation in the vibration characteristics of the osteoporotic lumbar spine after lumbar interbody fusion

Under whole body vibration, how the cement augmentation affects the vibration characteristic of the osteoporotic fusion lumbar spine, complications, and fusion outcomes is unclear. A L1-L5 lumbar spine finite element model was developed to simulate a transforaminal lumbar interbody fusion (TLIF) model with bilateral pedicle screws at L4-L5 level, a polymethylmethacrylate (PMMA) cement-augmented TLIF model (TLIF-PMMA) and an osteoporotic TLIF model. A 40 N sinusoidal vertical load at 5 Hz and a 400 N preload were utilized to simulate a vertical vibration of the human body and the physiological compression caused by muscle contraction and the weight of human body. The results showed that PMMA cement augmentation may produce a stiffer pedicle screw/rod construct and decrease the risk of adjacent segment disease, subsidence, and rod failure under whole-body vibration(WBV). Cement augmentation might restore the disc height and segmental lordosis and decrease the risk of poor outcomes, but it might also increase the risk of cage failure and prolong the period of lumbar fusion under WBV. The findings may provide new insights for performing lumbar interbody fusion in patients affected by osteoporosis of the lumbar spine. Graphical abstract.

Raman spectroscopy as a predictive tool for monitoring osteoporosis therapy in a rat model of postmenopausal osteoporosis

Pharmacological therapy of osteoporosis reduces bone loss and risk of fracture in patients. Modulation of bone mineral density cannot explain all effects. Other aspects of bone quality affecting fragility and ways to monitor them need to be better understood. Keratinous tissue acts as surrogate marker for bone protein deterioration caused by oestrogen deficiency in rats. Ovariectomised rats were treated with alendronate (ALN), parathyroid hormone (PTH) or estrogen (E2). MicroCT assessed macro structural changes. Raman spectroscopy assessed biochemical changes. Micro CT confirmed that all treatments prevented ovariectomy-induced macro structural bone loss in rats. PTH induced macro structural changes unrelated to ovariectomy. Raman analysis revealed ALN and PTH partially protect against molecular level changes to bone collagen (80% protection) and mineral (50% protection) phases. E2 failed to prevent biochemical change. The treatments induced alterations unassociated with the ovariectomy; increased beta sheet with E2, globular alpha helices with PTH and fibrous alpha helices with both ALN and PTH. ALN is closest to maintaining physiological status of the animals, while PTH (comparable protective effect) induces side effects. E2 is unable to prevent molecular level changes associated with ovariectomy. Raman spectroscopy can act as predictive tool for monitoring pharmacological therapy of osteoporosis in rodents. Keratinous tissue is a useful surrogate marker for the protein related impact of these therapies.The results demonstrate utility of surrogates where a clear systemic causation connects the surrogate to the target tissue. It demonstrates the need to assess broader biomolecular impact of interventions to examine side effects.

Nail Properties and Bone Health: A Review

Physicochemical properties of nail may offer valuable insight into the health of bone. Currently, dual-energy X-ray absorptiometry (DXA) is the gold standard technique for evaluating bone health through bone mineral density (BMD). However, only 70% of fractures are explained by low BMD according to DXA. Therefore, the World Health Organisation recommended the need for the development of alternative methods of assessing bone health. Keratin and collagen type I are major proteins in nail and bone, respectively. Both of these proteins undergo post-translational modifications, with a possible correlation between the degree of post-translational modifications in keratin and collagen. Raman spectroscopy is a technique used to detect changes in protein composition and structure. As changes in protein function and structure may be associated with the development of osteoporosis, Raman spectroscopy may be a valuable adjunct to assess bone health and fracture risk. This review critically evaluates various methods and techniques to identify the link between nail properties and bone health. The strengths and limitations of various studies and the potential use of nail protein and minerals to evaluate bone health have been also presented.

A Preliminary Evaluation of the Ability of Keratotic Tissue to Act as a Prognostic Indicator of Hip Fracture Risk

Studies have shown that Raman spectroscopic analysis of fingernail clippings can help differentiate between post-menopausal women who have and who have not suffered a fracture. However, all studies to date have been retrospective in nature, comparing the proteins in nails sourced from women, post-fracture. The objective of this study was to investigate the potential of a prospective test for hip fracture based on spectroscopic analysis of nail tissue. Archived toenail samples from post-menopausal women aged 50 to 63 years in the Nurses' Health Study were obtained and analysed by Raman spectroscopy. Nails were matched case-controls sourced from 161 women; 82 who underwent a hip fracture up to 20 years after nail collection and 81 age-matched controls. A number of clinical risk factors (CRFs) from the Fracture Risk Assessment (FRAX) tool had been assessed at toenail collection. Using 80% of the spectra, models were developed for increasing time periods between nail collection and fracture. Scores were calculated from these models for the other 20% of the sample and the ability of the score to predict hip fracture was tested in model with and without the CRFs by comparing the odds ratios (ORs) per 1 SD increase in standardised predictive values. The Raman score successfully distinguished between hip fracture cases and controls. With only the score as a predictor, a statistically significant OR of 2.2 (95% confidence interval [CI]: 1.5-3.1) was found for hip fracture for up to 20 years after collection. The OR increased to 3.8 (2.6-5.4) when the CRFs were added to the model. For fractures limited to 13 years after collection, the OR was 6.3 (3.0-13.1) for the score alone. The test based on Raman spectroscopy has potential for identifying individuals who may suffer hip fractures several years in advance. Higher powered studies are required to evaluate the predictive capability of this test.

Raman Spectroscopic Analysis of Fingernail Clippings Can Help Differentiate Between Postmenopausal Women Who Have and Have Not Suffered a Fracture

Raman spectroscopy was applied to nail clippings from 633 postmenopausal British and Irish women, from six clinical sites, of whom 42% had experienced a fragility fracture. The objective was to build a prediction algorithm for fracture using data from four sites (known as the calibration set) and test its performance using data from the other two sites (known as the validation set). Results from the validation set showed that a novel algorithm, combining spectroscopy data with clinical data, provided area under the curve (AUC) of 74% compared to an AUC of 60% from a reduced QFracture score (a clinically accepted risk calculator) and 61% from the dual-energy X-ray absorptiometry T-score, which is in current use for the diagnosis of osteoporosis. Raman spectroscopy should be investigated further as a noninvasive tool for the early detection of enhanced risk of fragility fracture.

Kaempferol targets Krt-14 and induces cytoskeletal mineralization in osteoblasts: A mechanistic approach

Kaempferol (KEM) has been observed to stimulate Krt-14 protein which subsequently contributes to matrix maturation and mineralization in rat primary osteoblast cells. Incorporation of Krt-14 siRNA results in reduced mRNA and protein expression after 48h post transfection and remained low for 9days. At day 9 Krt-14 siRNA significantly reduced mineralization without concomitant change in the cell number. ColI and OCN gene expression was reduced in Krt-14 siRNA-treated osteoblast cells. Soluble osteocalcin and collagen levels were markedly decreased in conditioned medium as well as in acid-salt soluble cell-ECM layer treated with Krt-14 siRNA compared to control siRNA treated cells corroborated at the ultrastructral level by AFM. Further, knockdown of Krt-14 and inhibitors against AMPK and mTOR, repressed the activation of mTOR and mineralization attenuated by KEM confirmed the role of Krt-14 in mineralization. These findings strongly suggest that Krt-14 regulates osteoblast mineralization by organizing osteoblast derived ECM.

Could the bone mineral density (T-score) be correlated with the Raman spectral features of keratin from women's nails and be used to predict osteoporosis?

Osteoporosis is a disease with great importance in current public health due to the associated risk of fracture; therefore, a rapid and accurate diagnosis becomes increasingly important. Recent literature has described a possible relationship between the changes in the organic phase of bone and the changes in nail keratin measured through Raman spectroscopy, aiming at the development of a standard for measuring bone quality and fracture risk both rapid and accurately. This work evaluated the correlation between the bone mineral density (BMD) scores of women with and without osteoporotic disease with the changes in the Raman spectra of the nail keratin, by assessing the intensity of the peak at 510 cm(-1) (S-S bridge) and the scores of principal component analysis (PCA), correlated with the values of BMD measured at the lumbar and hip. Raman spectra of ex vivo fingernails of 213 women were obtained by means of a dispersive Raman spectrometer (830 nm, 300 mW, in the spectral range between 400 and 1,800 cm(-1)). Peak intensities at ∼510 cm(-1) (assigned to the keratin S-S bridge) were measured, and the scores of first principal component loading vectors were calculated. Results showed no differences in the mean Raman spectra of nails of groups with and without osteoporosis. No correlation was found between the BMD scores and both the intensities of the 510 cm(-1) peak and the scores of the first four principal component vectors. Results suggest that BMD and fracture risk could not be assessed by the nail keratin features.

Association of Zinc, Copper and Magnesium with bone mineral density in Iranian postmenopausal women - a case control study

BACKGROUND

The risk of inadequate nutrition such as trace elements and vitamin deficiencies is considerable in postmenopausal women. The aim of this study was to compare trace elements (Zinc, Copper and Magnesium) concentration in nail, urine and serum among osteoporotic postmenopausal women with control group in Iran.

METHODS

Forty eight postmenopausal women aged 36-60 years, were recruited, consisting 30 osteoporotic patients and 18 healthy controls. Blood, nail and urine concentration of Zinc (Zn), copper (Cu) and magnesium (Mg) were determined using Inductively Coupled Plasma -Atomic Emission Spectrometry (ICP-AES) method. Their Bone Mineral Density was measured by Dual X-ray Absorption (DEXA) method.

RESULTS

The urine level of trace elements had significant difference between osteoporotic groups and controls (p < 0.001). Moreover Mg level significantly differed in serum between two groups (p < 0.04). There was no statistically significant difference in trace minerals in nail beyond groups.

CONCLUSION

Our findings indicate that Urine Zn level could be considerable an appropriate marker for bone absorption, usage of Zn supplements in postmenopausal women may result a beneficial reduction in osteoporotic risk.

Epidermis architecture and material properties of the skin of four snake species

On the basis of structural and experimental data, it was previously demonstrated that the snake integument consists of a hard, robust, inflexible outer surface (Oberhäutchen and β-layer) and softer, flexible inner layers (α-layers). It is not clear whether this phenomenon is a general adaptation of snakes to limbless locomotion or only to specific conditions, such as habitat and locomotion. The aim of the present study was to compare the structure and material properties of the outer scale layers (OSLs) and inner scale layers (ISLs) of the exuvium epidermis in four snake species specialized to live in different habitats: Lampropeltis getula californiae (terrestrial), Epicrates cenchria cenchria (generalist), Morelia viridis (arboreal) and Gongylophis colubrinus (sand-burrowing). Scanning electron microscopy (SEM) of skin cross sections revealed a strong variation in the epidermis structure between species. The nanoindentation experiments clearly demonstrated a gradient of material properties along the epidermis in the integument of all the species studied. The presence of such a gradient is a possible adaptation to locomotion and wear minimization on natural substrates. In general, the difference in both the effective elastic modulus and hardness of the OSL and ISL between species was not large compared with the difference in epidermis thickness and architecture.

Hydroxyapatite-collagen composites. Part I: can the decrease of the interactions between the two components be a physicochemical component of osteoporosis in aged bone?

The interactions of Type I acid soluble collagen (Col) with both carbonate-free hydroxyapatite (HA(1100)) and carbonate-rich one (CHA) were investigated. The aim was to ascertain whether the increase of bone CO(3) (2-) with ageing could relate to the disease known as osteoporosis. HA(1100)-Col and CHA-Col composites with various ratios were prepared and examined. Scanning electron microscopy and differential scanning calorimetry showed a stronger adhesion of the Col matrix to the granules of HA(1100) than to those of CHA. FT-IR spectroscopy showed that with HA(1100) both multiple hydrogen bonds of Col peptide -NH groups with HA PO(4) (3-), and electrochemical interactions between Col peptide -C=O groups and HA Ca(2+) were present. In the presence of CO(3) (2-), the interactions between -NH and phosphate were diminished, and Ca(2+) interacted more strongly with CO(3) (2-) than with peptide -C=O, so causing a separation between the two components of the bone extra-cellular matrix. The results obtained strengthen the hypothesis that the substitution of PO(4) (3-) ions by CO(3) (2-) ions in the HA lattice might be a significant component of osteoporosis, although further investigation is needed.

Material properties of the skin of the Kenyan sand boa Gongylophis colubrinus (Squamata, Boidae)

On the basis of structural data, it has been previously assumed that the integument of snakes consists of a hard, robust, inflexible outer surface (Oberhäutchen and beta-layer) and soft, flexible inner layers (alpha-layers). The aim of this study was to compare material properties of the outer and inner scale layers of the exuvium of Gongylophis colubrinus, to relate the structure of the snake integument to its mechanical properties. The nanoindentation experiments have demonstrated that the outer scale layers are harder, and have a higher effective elastic modulus than the inner scale layers. The results obtained provide strong evidence about the presence of a gradient in the material properties of the snake integument. The possible functional significance of this gradient is discussed here as a feature minimizing damage to the integument during sliding locomotion on an abrasive surface, such as sand.