Efficacy of anakinra in acute hydroxyapatite calcification-induced joint pain: A retrospective study of 23 cases

Anakinra treatment of acute calcium deposits in hand and wrist

Acute calcium deposit (ACD) in the hand and wrist is a cause of acute pain due to crystal-induced soft-tissue inflammation. There are no standard management guidelines for this condition, which is frequently treated with non-steroidal anti-inflammatory drugs (NSAIDs), with variable efficacy, some patients presenting symptoms for several months. We retrospectively analyzed the results of all patients treated with anakinra for hand or wrist ACD in our department in 2020. We extracted data on treatment duration, pain, range of motion, skin erythema, hypervascularization, edema, and X-ray findings. Ten patients were treated for hand or wrist ACD with anakinra 100 mg per day for a mean 2.7 days. We observed rapid and significant improvement in pain, range of motion, local erythema and edema from day 2 and a decrease in skin temperature from day 3. Calcifications significantly decreased in size or disappeared in the majority of the patients. There were no adverse events or recurrences at 1 year's follow-up. Anakinra was associated with significant clinical improvement after only two days' treatment and may be considered to treat patients with hand or wrist ACD, especially in case of contraindications to NSAIDs or glucocorticoids. Further controlled studies are needed to confirm the present observations.

Morphological features and mechanical properties of nanofibers scaffolds of polylactic acid modified with hydroxyapatite/CdSe for wound healing applications

Ternary nanocomposites, including graphene oxide (GO), hydroxyapatite (HAP), and cadmium selenite (CdSe) have been encapsulated into nanofibrous scaffolds of polylactic acid. These compositions were indexed as HAP@PLA (C1), CdSe@PLA (C2), HAP/CdSe@PLA (C3), HAP/GO@PLA (C4), and HAP/CdSe/GO@PLA (C5). Structural confirmation is executed by XRD and XPS techniques, while FESEM performs morphological characteristics. CdSe and GO dopants cause a significant increase in nanofiber diameter, HAP/GO@PLA (C4), showing thin surface fibers with fiber diameter up to 3.1 μm, followed by HAP/CdSe/GO@PLA (C4) composite that belongs to filament size up to 2.1 μm. On the other hand, the mechanical properties reveal that the dual dopant composites HAP/CdSe@PLA (C3) and HAP/GO@PLA (C4) hit the maximum tensile fracture values with 1.49 ± 0.3 and 0.99 ± 0.2 MPa. Further, the ternary C5 composite represents the lowest contact angle of 86.1 ± 3.7°. The antibacterial activity increased from 32.4 ± 9.7 and 28.4 ± 6.5% to be 85.3 ± 4.6 and 88.1 ± 5.6% for C1 and C5, respectively, against both E. coli and S. aureus in dark conditions. Moreover, the antibacterial potency enhanced from 75.4 ± 7.6 to be 83.5 ± 6.5 from dark to light conditions against E. coli for the composition of PLA containing the binary composition of HAP/CdSe.

Antibacterial potency, cell viability and morphological implications of copper oxide nanoparticles encapsulated into cellulose acetate nanofibrous scaffolds

It is generally believed that the most challenging impediment for the utilization of cellulose acetate (CA) in the medical field is its hydrophobicity and disability to poison the harmful microbes. Therefore, in this contribution, we aimed to prepare an environmentally scaffold-based CA loaded with copper nanoparticles (CuONPs), which are expected to not only improve the hydrophilicity of the prepared nanofibers, but also have an effective ability to kill such harmful and infectious microbes that are abundant in wounds. The obtained results attested that the generated nanofibers became thicker with increasing the content of CuONPs in CA nanofibers. The roughness average increased from 143.2 to 157.1 nm, whereas the maximum height of the roughness (Rt) increased from 400.8 to 479.9 nm as going from the lowest to the highest content of CuONPs. Additionally, the contact angle of the prepared nanofibers decreased from 105.3° (CA alone) to 85.4° for CuONPs@CA. Significantly, biological studies revealed that cell viability and anti-bacterial potency were improved upon incorporating CuONPs into CA solution. Correspondingly, their inhibition zones reached 18 ± 3 mm, and 16 ± 2 mm for nanofibrous scaffolds having 12.0CuO@CA, besides raising the cell viability from 91.3 ± 4% to 96.4 ± 4% for 0.0CuO@CA, and 12.0CuO@CA, respectively, thereby implying that the fabricated CuONPs@CA nanocomposite has biocompatibility towards fibroblast cells. Thus, introducing biological activity into CA nanofibers via loading with CuONPs makes it suitable for numerous biomedical applications, particularly as an environmentally benign wound dressing fibers.

Pro-inflammatory effects of human apatite crystals extracted from patients suffering from calcific tendinopathy

BACKGROUND

Calcific tendonitis of the rotator cuff is due to carbonated apatite deposits in the shoulder tendons. During the evolution of the disease, an acute inflammatory episode may occur leading to the disappearance of the calcification. Although hydroxyapatite crystal-induced inflammation has been previously studied with synthetic crystals, no data are available with calcifications extracted from patients suffering from calcific tendinopathy. The objective of the study was to explore the inflammatory properties of human calcifications and the pathways involved.

METHODS

Human calcifications and synthetic hydroxyapatite were used in vitro to stimulate human monocytes and macrophages, the human myeloid cell line THP-1, and human tenocytes. The release of IL-1β, IL-6, and IL-8 by cells was quantified by ELISA. The gene expression of pro- and anti-inflammatory cytokines was evaluated by quantitative PCR. NF-kB activation and NLRP3 involvement were assessed in THP-1 cells using a NF-kB inhibitor and a caspase-1 inhibitor. The inflammatory properties were then assessed in vivo using a mouse air pouch model.

RESULTS

Human calcifications were able to induce a significant release of IL-1β when incubated with monocytes, macrophages, and THP-1 only if they were first primed with LPS (monocytes and macrophages) or PMA (THP-1). Stimulation of THP-1 by human calcifications led to similar levels of IL-1β when compared to synthetic hydroxyapatite although these levels were significantly inferior in monocytes and macrophages. The patient's crystals enhanced mRNA expression of pro-IL-1β, as well as IL-18, NF-kB, and TGFβ when IL-6 and TNFα expression were not. IL-1β production was reduced by the inhibition of caspase-1 indicating the role of NLRP3 inflammasome. In vivo, injection of human calcifications or synthetic hydroxyapatite in the air pouch led to a significant increase in membrane thickness although significant overexpression of IL-1β was only observed for synthetic hydroxyapatite.

CONCLUSIONS

As synthetic hydroxyapatite, human calcifications were able to induce an inflammatory response resulting in the production of IL-1β after NF-kB activation and through NLRP3 inflammasome. In some experiments, IL-1β induction was lower with human calcifications compared to synthetic apatite. Differences in size, shape, and protein content may explain this observation.

Off-label use of anti-IL-1 drugs in rheumatic diseases

Interleukin-1 (IL-1) plays a key role in the pathogenesis of different rheumatic diseases. There are now several agents available on the market capable of blocking IL-1. The proven effectiveness and excellent safety of these drugs makes them a possible therapeutic option in the treatment of IL-1 driven diseases, when previous therapies are contraindicated or ineffective. This article discusses the European wide off-label use of these drugs for the treatment of rheumatic diseases.

Nanofibers of cellulose acetate containing ZnO nanoparticles/graphene oxide for wound healing applications

A combination of nanostructured zinc oxide (ZnO) or graphene oxide or both of them with cellulose acetate (CA) enhances a new functionality of nanofibers aiming to improve bio-composite materials for wound healing application. The obtained nanofibers have been investigated using XRD, FTIR, and FESEM. It was observed that the maximum height of the roughness increased from 253 to 651.9 nm for both GO and ZnO/GO in the powdered phase, while it plunged from 613 to 482 nm and developed to 801 nm for ZnO@CA, GO@CA, and ZnO/GO@CA, receptively. Further, the mechanical properties of the obtained scaffolds have been tested and displayed a tremendous variation of tensile strength from 5.44 ± 0.81 to 12.87 ± 0.93 and 8.82 ± 1.2 MPa, while the toughness increased from 23.29 ± 1.4 to 68.95 ± 4.5 and 57.75 ± 3.6 MJ/m³ for ZnO@CA, GO@CA and ZnO/GO@CA, receptively. Moreover, the cell viability was investigated and showed a progression of 97.38 ± 3.9% for ZnO/GO@CA. Furthermore, the adhesion of human fibroblasts cell line towards the obtained nanofibrous scaffolds were examined and displayed that cells were proliferated and spread considerably through the scaffolds, whereas their filopodia have followed the morphology of the fibers.