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Haffner-Luntzer M, Weber B, Morioka K, Lackner I, Fischer V, Bahney C, Ignatius A, Kalbitz M, Marcucio R, Miclau T. Altered early immune response after fracture and traumatic brain injury. Front Immunol 2023; 14:1074207. [PMID: 36761764 PMCID: PMC9905106 DOI: 10.3389/fimmu.2023.1074207] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction Clinical and preclinical data suggest accelerated bone fracture healing in subjects with an additional traumatic brain injury (TBI). Mechanistically, altered metabolism and neuro-endocrine regulations have been shown to influence bone formation after combined fracture and TBI, thereby increasing the bone content in the fracture callus. However, the early inflammatory response towards fracture and TBI has not been investigated in detail so far. This is of great importance, since the early inflammatory phase of fracture healing is known to be essential for the initiation of downstream regenerative processes for adequate fracture repair. Methods Therefore, we analyzed systemic and local inflammatory mediators and immune cells in mice which were exposed to fracture only or fracture + TBI 6h and 24h after injury. Results We found a dysregulated systemic immune response and significantly fewer neutrophils and mast cells locally in the fracture hematoma. Further, local CXCL10 expression was significantly decreased in the animals with combined trauma, which correlated significantly with the reduced mast cell numbers. Discussion Since mast cells and mast cell-derived CXCL10 have been shown to increase osteoclastogenesis, the reduced mast cell numbers might contribute to higher bone content in the fracture callus of fracture + TBI mice due to decreased callus remodeling.
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Affiliation(s)
- Melanie Haffner-Luntzer
- Institute of Orthopaedic Research and Biomechanics, University Medical Center Ulm, Ulm, Germany.,Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Birte Weber
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, University of California, San Francisco, San Francisco, CA, United States.,Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, University Medical Center Ulm, Ulm, Germany.,Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Kazuhito Morioka
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurological Surgery, Weill Institute for Neurosciences, Brain and Spinal Injury Center (BASIC), University of California, San Francisco (UCSF), San Francisco, CA, United States
| | - Ina Lackner
- Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, University Medical Center Ulm, Ulm, Germany
| | - Verena Fischer
- Institute of Orthopaedic Research and Biomechanics, University Medical Center Ulm, Ulm, Germany
| | - Chelsea Bahney
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, University of California, San Francisco, San Francisco, CA, United States.,Steadman Phillipon Research Institute, Vail, CO, United States
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, University Medical Center Ulm, Ulm, Germany
| | - Miriam Kalbitz
- Department of Traumatology, Hand-, Plastic- and Reconstructive Surgery, University Medical Center Ulm, Ulm, Germany
| | - Ralph Marcucio
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Theodore Miclau
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, University of California, San Francisco, San Francisco, CA, United States
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2
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Ragipoglu D, Bülow J, Hauff K, Voss M, Haffner-Luntzer M, Dudeck A, Ignatius A, Fischer V. Mast Cells Drive Systemic Inflammation and Compromised Bone Repair After Trauma. Front Immunol 2022; 13:883707. [PMID: 35558068 PMCID: PMC9086903 DOI: 10.3389/fimmu.2022.883707] [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: 02/25/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
There is evidence that mast cells contribute to inflammation induced by hemorrhagic shock, severe tissue injury or sepsis. Mast cells are highly responsive to alarm signals generated after trauma, and release many inflammatory mediators including interleukin-6, a key mediator of posttraumatic inflammation. An overwhelming posttraumatic inflammation causes compromised bone healing; however, the underlying cellular and molecular mechanisms are poorly understood. Recently, we found that mast cells trigger local and systemic inflammation after isolated fracture leading to uneventful bone repair. Here, we investigated whether mast cells critically contribute to trauma-induced compromised bone healing. Male Mcpt5-Cre+ R-DTA mice, which lack connective tissue type mast cells, and their mast cell-competent Cre- littermates underwent a femur fracture with/without thoracic trauma. Posttraumatic systemic and local inflammation and bone repair were assessed 3 h and 21 d post injury. Both, the systemic and pulmonary inflammation was significantly increased in mast cell-competent mice upon combined trauma compared to isolated fracture. In mast cell-deficient mice, the increase of inflammatory mediators in the circulation induced by the severe trauma was abolished. In the bronchoalveolar lavage fluid, the trauma-induced increase of inflammatory cytokines was not reduced, but the neutrophil invasion into the lungs was significantly diminished in the absence of mast cells. Locally in the fracture hematoma, mast cell-competent mice displayed reduced inflammatory mediator concentrations after combined trauma compared to isolated fracture, which was abolished in mast cell-deficient mice. Notably, while combined trauma resulted in compromised bone repair in mast cell-competent mice, indicated by significantly reduced bone and increased cartilage fracture callus contents, this was abolished in Mcpt5-Cre+ R-DTA mice. Therefore, mast cells contribute to trauma-induced compromised bone repair and could be a potential target for new treatment options to improve fracture healing in multiply injured patients.
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Affiliation(s)
- Deniz Ragipoglu
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm (ZTF), Ulm University Medical Center, Ulm, Germany
| | - Jasmin Bülow
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm (ZTF), Ulm University Medical Center, Ulm, Germany
| | - Kristin Hauff
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm (ZTF), Ulm University Medical Center, Ulm, Germany
| | - Martin Voss
- Medical Faculty, Institute for Molecular and Clinical Immunology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Melanie Haffner-Luntzer
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm (ZTF), Ulm University Medical Center, Ulm, Germany
| | - Anne Dudeck
- Medical Faculty, Institute for Molecular and Clinical Immunology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm (ZTF), Ulm University Medical Center, Ulm, Germany
| | - Verena Fischer
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm (ZTF), Ulm University Medical Center, Ulm, Germany
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3
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Schoppa AM, Chen X, Ramge JM, Vikman A, Fischer V, Haffner-Luntzer M, Riegger J, Tuckermann J, Scharffetter-Kochanek K, Ignatius A. Osteoblast lineage Sod2 deficiency leads to an osteoporosis-like phenotype in mice. Dis Model Mech 2022; 15:274992. [PMID: 35394023 PMCID: PMC9118037 DOI: 10.1242/dmm.049392] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/25/2022] [Indexed: 12/19/2022] Open
Abstract
Osteoporosis is a systemic metabolic skeletal disease characterized by low bone mass and strength associated with fragility fractures. Oxidative stress, which results from elevated intracellular reactive oxygen species (ROS) and arises in the aging organism, is considered one of the critical factors contributing to osteoporosis. Mitochondrial (mt)ROS, as the superoxide anion (O2−) generated during mitochondrial respiration, are eliminated in the young organism by antioxidant defense mechanisms, including superoxide dismutase 2 (SOD2), the expression and activity of which are decreased in aging mesenchymal progenitor cells, accompanied by increased mtROS production. Using a mouse model of osteoblast lineage cells with Sod2 deficiency, we observed significant bone loss in trabecular and cortical bones accompanied by decreased osteoblast activity, increased adipocyte accumulation in the bone marrow and augmented osteoclast activity, suggestive of altered mesenchymal progenitor cell differentiation and osteoclastogenesis. Furthermore, osteoblast senescence was increased. To date, there are only a few studies suggesting a causal association between mtROS and cellular senescence in tissue in vivo. Targeting SOD2 to improve redox homeostasis could represent a potential therapeutic strategy for maintaining bone health during aging. Summary: Osteoblast-lineage specific Sod2 deficiency in mice leads to increased mtROS, impaired osteoblast function, increased adipogenesis, increased osteoclast activity and increased osteoblast senescence, resulting in bone loss.
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Affiliation(s)
- Astrid M Schoppa
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, 89081 Ulm, Germany
| | - Xiangxu Chen
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, 89081 Ulm, Germany
| | - Jan-Moritz Ramge
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, 89081 Ulm, Germany
| | - Anna Vikman
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, 89081 Ulm, Germany
| | - Verena Fischer
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, 89081 Ulm, Germany
| | - Melanie Haffner-Luntzer
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, 89081 Ulm, Germany
| | - Jana Riegger
- Department of Orthopedics, Division for Biochemistry of Joint and Connective Tissue Diseases, Ulm University Medical Center, 89081 Ulm, Germany
| | - Jan Tuckermann
- Institute of Comparative Molecular Endocrinology, Ulm University, 89081 Ulm, Germany
| | | | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, 89081 Ulm, Germany
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4
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Timm K, Walter N, Heinrich M, Knapp G, Thormann U, El Khassawna T, Alt V, Heiss C, Rupp M. Influence of Thoracic Trauma on Fracture Healing in Long Bones-A Retrospective Analysis. J Clin Med 2022; 11:jcm11030717. [PMID: 35160169 PMCID: PMC8837065 DOI: 10.3390/jcm11030717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose: Pre-clinical studies indicate that concomitant thoracic trauma impairs fracture healing of long bones and reduces callus formation. The aim of this study was to investigate whether patients with accompanying chest trauma suffer from delayed fracture healing of long bones in comparison with patients with fractures of two long bones or isolated fractures. Patients and Methods: This is a clinical retrospective study from a level I trauma center. The patients were divided into three groups: (1) thoracic trauma and fracture of a long bone, (2) fractures of two long bones, (3) isolated fracture of a long bone. The fracture consolidation was defined using the radiographic union scale in tibial fractures (RUST). A RUST value of ≥10 six-to-eight months after definitive operative intervention represented complete fracture healing. Results: In the first group 19 (43.2%) fractures did not show full consolidation, in the second group 14 (45.2%) and 13 (41.9%) and in the third group 14 (36.8%). The analysis revealed no statistically significant differences between the groups regarding consolidation of the fractures six-to-eight months after definitive operative intervention (p = 0.84). Conclusions: Unlike previously reported pre-clinical data, this study did not demonstrate a negative effect on fracture consolidation in long bones when accompanied by thoracic trauma. Furthermore, the results demonstrated that concomitant fractures of two long bones does not have a negative effect on fracture consolidation.
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Affiliation(s)
- Karsten Timm
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
| | - Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Martin Heinrich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
| | - Gero Knapp
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
| | - Ulrich Thormann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
| | - Thaqif El Khassawna
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
- Laboratory for Experimental Trauma Surgery, Justus-Liebig-University Giessen, 35392 Giessen, Germany
| | - Volker Alt
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany;
| | - Christian Heiss
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
- Laboratory for Experimental Trauma Surgery, Justus-Liebig-University Giessen, 35392 Giessen, Germany
| | - Markus Rupp
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen GmbH, 35392 Giessen, Germany; (K.T.); (M.H.); (G.K.); (U.T.); (T.E.K.); (V.A.); (C.H.)
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany;
- Correspondence:
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5
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Fischer V, Ragipoglu D, Diedrich J, Steppe L, Dudeck A, Schütze K, Kalbitz M, Gebhard F, Haffner-Luntzer M, Ignatius A. Mast Cells Trigger Disturbed Bone Healing in Osteoporotic Mice. J Bone Miner Res 2022; 37:137-151. [PMID: 34633111 DOI: 10.1002/jbmr.4455] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/21/2021] [Accepted: 10/03/2021] [Indexed: 12/16/2022]
Abstract
Mast cells are important tissue-resident sensor and effector immune cells but also play a major role in osteoporosis development. Mast cells are increased in numbers in the bone marrow of postmenopausal osteoporotic patients, and mast cell-deficient mice are protected from ovariectomy (OVX)-induced bone loss. In this study, we showed that mast cell-deficient Mcpt5-Cre R-DTA mice were protected from OVX-induced disturbed fracture healing, indicating a critical role for mast cells in the pathomechanisms of impaired bone repair under estrogen-deficient conditions. We revealed that mast cells trigger the fracture-induced inflammatory response by releasing inflammatory mediators, including interleukin-6, midkine (Mdk), and C-X-C motif chemokine ligand 10 (CXCL10), and promote neutrophil infiltration into the fracture site in OVX mice. Furthermore, mast cells were responsible for reduced osteoblast and increased osteoclast activities in OVX mice callus, as well as increased receptor activator of NF-κB ligand serum levels in OVX mice. Additional in vitro studies with human cells showed that mast cells stimulate osteoclastogenesis by releasing the osteoclastogenic mediators Mdk and CXCL10 in an estrogen-dependent manner, which was mediated via the estrogen receptor alpha on mast cells. In conclusion, mast cells negatively affect the healing of bone fractures under estrogen-deficient conditions. Hence, targeting mast cells might provide a therapeutic strategy to improve disturbed bone repair in postmenopausal osteoporosis. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Verena Fischer
- Institute of Orthopedic Research and Biomechanics, University Medical Center Ulm, Ulm, Germany
| | - Deniz Ragipoglu
- Institute of Orthopedic Research and Biomechanics, University Medical Center Ulm, Ulm, Germany
| | - Johanna Diedrich
- Institute of Orthopedic Research and Biomechanics, University Medical Center Ulm, Ulm, Germany
| | - Lena Steppe
- Institute of Orthopedic Research and Biomechanics, University Medical Center Ulm, Ulm, Germany
| | - Anne Dudeck
- Institute for Molecular and Clinical Immunology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Konrad Schütze
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, University Medical Center Ulm, Ulm, Germany
| | - Miriam Kalbitz
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, University Medical Center Ulm, Ulm, Germany.,Department of Trauma and Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Germany
| | - Florian Gebhard
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, University Medical Center Ulm, Ulm, Germany
| | - Melanie Haffner-Luntzer
- Institute of Orthopedic Research and Biomechanics, University Medical Center Ulm, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, University Medical Center Ulm, Ulm, Germany
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6
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Dong Y, Ma WM, Yang W, Hao L, Zhang SQ, Fang K, Hu CH, Zhang QJ, Shi ZD, Zhang WD, Fan T, Xia T, Han CH. Identification of C3 and FN1 as potential biomarkers associated with progression and prognosis for clear cell renal cell carcinoma. BMC Cancer 2021; 21:1135. [PMID: 34688260 PMCID: PMC8539775 DOI: 10.1186/s12885-021-08818-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/27/2021] [Indexed: 12/28/2022] Open
Abstract
Background Clear cell renal cell carcinoma (ccRCC) is one of the most lethal urological malignancies, but the pathogenesis and prognosis of ccRCC remain obscure, which need to be better understand. Methods Differentially expressed genes were identified and function enrichment analyses were performed using three publicly available ccRCC gene expression profiles downloaded from the Gene Expression Omnibus database. The protein-protein interaction and the competing endogenous RNA (ceRNA) networks were visualized by Cytoscape. Multivariate Cox analysis was used to predict an optimal risk mode, and the survival analysis was performed with the Kaplan-Meier curve and log-rank test. Protein expression data were downloaded from Clinical Proteomic Tumor Analysis Consortium database and Human Protein Atlas database, and the clinical information as well as the corresponding lncRNA and miRNA expression data were obtained via The Cancer Genome Atlas database. The co-expressed genes and potential function of candidate genes were explored using data exacted from the Cancer Cell Line Encyclopedia database. Results Of the 1044 differentially expressed genes shared across the three datasets, 461 were upregulated, and 583 were downregulated, which significantly enriched in multiple immunoregulatory-related biological process and tumor-associated pathways, such as HIF-1, PI3K-AKT, P53 and Rap1 signaling pathways. In the most significant module, 36 hub genes were identified and were predominantly enriched in inflammatory response and immune and biotic stimulus pathways. Survival analysis and validation of the hub genes at the mRNA and protein expression levels suggested that these genes, particularly complement component 3 (C3) and fibronectin 1 (FN1), were primarily responsible for ccRCC tumorigenesis and progression. Increased expression of C3 or FN1 was also associated with advanced clinical stage, high pathological grade, and poor survival in patients with ccRCC. Univariate and multivariate Cox regression analysis qualified the expression levels of the two genes as candidate biomarkers for predicting poor survival. FN1 was potentially regulated by miR-429, miR-216b and miR-217, and constructed a bridge to C3 and C3AR1 in the ceRNA network, indicating a critical position of FN1. Conclusions The biomarkers C3 and FN1 could provide theoretical support for the development of a novel prognostic tool to advance ccRCC diagnosis and targeted therapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08818-0.
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Affiliation(s)
- Yang Dong
- Department of Urology, Xuzhou Central Hospital, Xuzhou, China.,Medical College of Soochow University, Suzhou, China
| | - Wei-Ming Ma
- Department of Urology, Xuzhou Central Hospital, Xuzhou, China.,Medical College of Soochow University, Suzhou, China
| | - Wen Yang
- Department of Nephrology, The First Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan, China
| | - Lin Hao
- Department of Urology, Xuzhou Central Hospital, Xuzhou, China.,Medical College of Soochow University, Suzhou, China
| | - Shao-Qi Zhang
- Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Kun Fang
- Department of Nephrology, The First Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan, China.,Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Chun-Hui Hu
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Qian-Jin Zhang
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhen-Duo Shi
- Department of Urology, Xuzhou Central Hospital, Xuzhou, China
| | - Wen-da Zhang
- Department of Urology, Xuzhou Central Hospital, Xuzhou, China
| | - Tao Fan
- Department of Urology, Xuzhou Central Hospital, Xuzhou, China
| | - Tian Xia
- Department of Urology, Xuzhou Central Hospital, Xuzhou, China
| | - Cong-Hui Han
- Department of Urology, Xuzhou Central Hospital, Xuzhou, China. .,Department of Nephrology, The First Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan, China. .,Jiangsu Normal University, Xuzhou, China.
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7
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Hachemi Y, Rapp AE, Lee S, Dorn AK, Krüger BT, Kaiser K, Ignatius A, Tuckermann J. Intact Glucocorticoid Receptor Dimerization Is Deleterious in Trauma-Induced Impaired Fracture Healing. Front Immunol 2021; 11:628287. [PMID: 33679723 PMCID: PMC7927427 DOI: 10.3389/fimmu.2020.628287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/29/2020] [Indexed: 11/13/2022] Open
Abstract
Following severe trauma, fracture healing is impaired because of overwhelming systemic and local inflammation. Glucocorticoids (GCs), acting via the glucocorticoid receptor (GR), influence fracture healing by modulating the trauma-induced immune response. GR dimerization-dependent gene regulation is essential for the anti-inflammatory effects of GCs. Therefore, we investigated in a murine trauma model of combined femur fracture and thoracic trauma, whether effective GR dimerization influences the pathomechanisms of trauma-induced compromised fracture healing. To this end, we used mice with decreased GR dimerization ability (GRdim). The healing process was analyzed by cytokine/chemokine multiplex analysis, flow cytometry, gene-expression analysis, histomorphometry, micro-computed tomography, and biomechanical testing. GRdim mice did not display a systemic or local hyper-inflammation upon combined fracture and thorax trauma. Strikingly, we discovered that GRdim mice were protected from fracture healing impairment induced by the additional thorax trauma. Collectively and in contrast to previous studies describing the beneficial effects of intact GR dimerization in inflammatory models, we report here an adverse role of intact GR dimerization in trauma-induced compromised fracture healing.
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Affiliation(s)
- Yasmine Hachemi
- Institute of Comparative Molecular Endocrinology, Ulm University, Ulm, Germany
| | - Anna E Rapp
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Sooyeon Lee
- Institute of Comparative Molecular Endocrinology, Ulm University, Ulm, Germany
| | - Ann-Kristin Dorn
- Institute of Comparative Molecular Endocrinology, Ulm University, Ulm, Germany
| | - Benjamin T Krüger
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Kathrin Kaiser
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Jan Tuckermann
- Institute of Comparative Molecular Endocrinology, Ulm University, Ulm, Germany
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8
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Duclos G, Rivory A, Rességuier N, Hammad E, Vigne C, Meresse Z, Pastène B, D'journo XB, Jaber S, Zieleskiewicz L, Leone M. Effect of early hyperoxemia on the outcome in servere blunt chest trauma: A propensity score-based analysis of a single-center retrospective cohort. J Crit Care 2020; 63:179-186. [PMID: 32958352 DOI: 10.1016/j.jcrc.2020.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/10/2020] [Accepted: 09/09/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Our study aimed to explore the association between early hyperoxemia of the first 24 h on outcomes in patients with severe blunt chest trauma. MATERIALS AND METHODS In a level I trauma center, we conducted a retrospective study of 426 consecutive patients. Hyperoxemic groups were classified in severe (average PaO2 ≥ 200 mmHg), moderate (≥150 and < 200 mmHg) or mild (≥ 100 and < 200 mmHg) and compared to control group (≥60 and < 100 mmHg) using a propensity score based analysis. The first endpoint was the incidence of a composite outcome including death and hospital-acquired pneumonia occurring from admission to day 28. The secondary endpoints were the incidence of death, the number of hospital-acquired pneumonia, mechanical ventilation-free days and intensive care unit-free day at day 28. RESULTS The incidence of the composite endpoint was lower in the severe hyperoxemia group(OR, 0.25; 95%CI, 0.09-0.73; P < 0.001) compared with control. The 28-day mortality incidence was lower in severe (OR, 0.23; 95%CI, 0.08-0.68; P < 0.001) hyperoxemia group (OR, 0.41; 95%CI, 0.17-0.97; P = 0.04). Significant association was found between hyperoxemia and secondary outcomes. CONCLUSION In our cohort early hyperoxemia during the first 24 h of admission after severe blunt chest trauma was not associated with worse outcome.
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Affiliation(s)
- Gary Duclos
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Anesthesiology and Critical Care, Marseille, France.
| | - Adrien Rivory
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Anesthesiology and Critical Care, Marseille, France
| | - Noémie Rességuier
- Support Unit for Clinical Research and Economic Evaluation, Assistance Publique-Hôpitaux de Marseille, Marseille 13385, France; Aix-Marseille University, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Emmanuelle Hammad
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Anesthesiology and Critical Care, Marseille, France
| | - Coralie Vigne
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Anesthesiology and Critical Care, Marseille, France
| | - Zoé Meresse
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Anesthesiology and Critical Care, Marseille, France
| | - Bruno Pastène
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Anesthesiology and Critical Care, Marseille, France
| | - Xavier-Benoit D'journo
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Thoracic Surgery, Marseille, France
| | - Samir Jaber
- Medical-Surgical Intensive Care Unit, University Hospital of Montpellier and INSERM U1046, Montpellier, France
| | - Laurent Zieleskiewicz
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Anesthesiology and Critical Care, Marseille, France; Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille Université, INSERM, INRA, Marseille, France
| | - Marc Leone
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Nord Hospital, Department of Anesthesiology and Critical Care, Marseille, France
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9
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Hofman M, Andruszkow H, Heyer FL, Kobbe P, Hildebrand F, Poeze M. Risk factors of non-union in intramedullary stabilized diaphyseal long bone fractures: identifying the role of fracture stabilization strategies and concomitant injuries. Eur J Trauma Emerg Surg 2020; 47:1903-1910. [PMID: 32140749 PMCID: PMC8629802 DOI: 10.1007/s00068-020-01335-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/18/2020] [Indexed: 12/01/2022]
Abstract
Purpose Concomitant chest injury is known to negatively affect bone metabolism and fracture healing, whereas traumatic brain injury (TBI) appears to have positive effects on bone metabolism. Osteogenesis can also be influenced by the timing of fracture stabilization. We aimed to identify how chest injuries, TBI and fracture stabilization strategy influences the incidence of non-union. Methods Patients with long bone fractures of the lower extremities who had been treated between 2004 and 2014 were retrospectively analysed. Non-union was defined as fracture healing not occurring in the expected time period and in which neither progression of healing nor successful union is expected without intervention. Diverse clinical and radiological parameters were statistically analysed using the Statistical Package for the Social Sciences (SPSS). Results The total number of operations before consolidation was an independent predictor (odds ratio [OR] = 6.416, p < 0.001) for the development of non-union in patients with long bone fractures. More specifically, patients treated according to the damage control orthopaedics (DCO) principle had a significantly higher risk of developing a non-union than patients treated according to the early total care (ETC) principle (OR = 7.878, p = 0.005). Concomitant chest injury and TBI could not be identified as influencing factors for non-union development. Conclusion Our results indicate that the number of operations performed in patients with long bone fractures should be kept as low as possible and that the indication for and the timing of DCO treatment should be meticulously noted to minimize the risk of non-union development.
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Affiliation(s)
- Martijn Hofman
- Department of Orthopedic Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Hagen Andruszkow
- Department of Orthopedic Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Frans L. Heyer
- Division of Traumasurgery,, Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Philipp Kobbe
- Department of Orthopedic Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopedic Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Martijn Poeze
- Division of Traumasurgery,, Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
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10
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Bläsius FM, Link BC, Beeres FJP, Iselin LD, Leu BM, Gueorguiev B, Klos K, Ganse B, Nebelung S, Modabber A, Eschbach D, Weber CD, Horst K, Knobe M. Impact of surgical procedures on soft tissue microcirculation in calcaneal fractures: A prospective longitudinal cohort study. Injury 2019; 50:2332-2338. [PMID: 31630780 DOI: 10.1016/j.injury.2019.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/10/2019] [Accepted: 10/02/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Wound healing complications are a major concern after open reduction and internal fixation (ORIF) in patients with calcaneal fractures. Microcirculation is known to play a key role in bone and soft tissue healing. The present study aimed to characterize and contrast the dynamics of changes in microcirculation comparing two different surgical procedures: A) ORIF and B) a minimally invasive approach (MIA). METHODS Blood flow (BF[AU]), oxygen saturation (sO2[%]) and relative amount of haemoglobin (rHb[AU]) were measured at two depths (2 mm and 8 mm) non-invasively by spectrophotometry (Micro-Lightguide O2C®, LEA Medizintechnik, Giessen, Germany) before surgery and every 24 h after surgery for a duration of six days. A linear mixed model (LMM) was used to analyse longitudinal data and repeated measurements. RESULTS Nineteen patients (44 years, range 21.9-71.0 years) were enrolled in the study. Surgical treatment consisted of ORIF (n = =15) and MIA (n = =9). The postoperative BF and sO2 at the 2 mm and 8 mm depths were higher in the ORIF group (BF: p < 0.001, p = =0.003; sO2: p = =0.001, p = =0.011). The BF at the 2 mm and 8 mm depths increased after surgery (2 mm: p = =0.003, 8 mm: p = =0.001) in both groups. This increase did not correlate with the surgical technique. sO2 and rHb values at the 8 mm depth decreased after surgery (sO2: p = =0.008, rHb: p < 0.001) in both groups, whereas sO2 at the 2 mm depth increased after surgery (p = =0.003). Furthermore, the surgical technique correlated with the postsurgical course of sO2 values at the 2 mm depth (p = =0.042). CONCLUSIONS The spectrophotometry results were in line with the generally accepted phases of soft tissue wound healing. Postsurgical changes in microcirculation are predominantly independent of surgical techniques and may be primarily determined by wound and fracture healing. Future studies should focus on the potential of spectrophotometry to monitor wound healing after surgery. Moreover, studies with longer observation periods are needed in order to examine the changes in microcirculation during all wound-healing phases.
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Affiliation(s)
- Felix M Bläsius
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074 Aachen, Germany.
| | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Switzerland.
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Switzerland.
| | - Lukas D Iselin
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Switzerland.
| | - Benjamin Moritz Leu
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074 Aachen, Germany.
| | | | - Kajetan Klos
- Department of Foot and Ankle Surgery, Catholic Hospital Mainz, Germany.
| | - Bergita Ganse
- Research Centre for Musculoskeletal Science & Sports Medicine, Faculty of Science and Engineering, School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom.
| | - Sven Nebelung
- Department of Radiology, University Hospital RWTH Aachen, Germany.
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Germany.
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Germany.
| | - Christian David Weber
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074 Aachen, Germany.
| | - Klemens Horst
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074 Aachen, Germany.
| | - Matthias Knobe
- Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, D-52074 Aachen, Germany; Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Switzerland.
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11
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Guillon A, Preau S, Aboab J, Azabou E, Jung B, Silva S, Textoris J, Uhel F, Vodovar D, Zafrani L, de Prost N, Radermacher P. Preclinical septic shock research: why we need an animal ICU. Ann Intensive Care 2019; 9:66. [PMID: 31183570 PMCID: PMC6557957 DOI: 10.1186/s13613-019-0543-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/03/2019] [Indexed: 12/14/2022] Open
Abstract
Animal experiments are widely used in preclinical medical research with the goal of disease modeling and exploration of novel therapeutic approaches. In the context of sepsis and septic shock, the translation into clinical practice has been disappointing. Classical animal models of septic shock usually involve one-sex-one-age animal models, mostly in mice or rats, contrasting with the heterogeneous population of septic shock patients. Many other factors limit the reliability of preclinical models and may contribute to preclinical research failure in critical care, including the host specificity of several pathogens, the fact that laboratory animals are raised in pathogen-free facilities and that organ support techniques are either absent or minimal. Advanced animal models have been developed with the aim of improving the clinical translatability of experimental findings. So-called animal ICUs refer to the preclinical investigation of adult or even aged animals of either sex, using—in case of rats and mice—miniaturized equipment allowing for reproducing an ICU environment at a small animal scale and integrating chronic comorbidities to more closely reflect the clinical conditions studied. Strength and limitations of preclinical animal models designed to decipher the mechanisms involved in septic cardiomyopathy are discussed. This article reviews the current status and the challenges of setting up an animal ICU.
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Affiliation(s)
- Antoine Guillon
- Service de Médecine Intensive - Réanimation, CHRU de Tours, Tours, France.,Centre d'Etude des Pathologies Respiratoires (CEPR), UMR 1100, INSERM, Faculté de Médecine, Université de Tours, Tours, France
| | - Sebastien Preau
- Service de Médecine Intensive, Hôpital Salengro, CHU Lille, Lille, France.,Lille Inflammation Research International Center (LIRIC), U 995, School of Medicine, INSERM, Univ. Lille, Lille, France
| | - Jérôme Aboab
- Service de Réanimation, Hôpital Delafontaine, Saint-Denis, France
| | - Eric Azabou
- Service de Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond Poincaré, 92380, Garches, France
| | - Boris Jung
- Service de Réanimation, CHU de Montpellier, Montpellier, France
| | - Stein Silva
- Service de Réanimation, CHU Purpan, 31300, Toulouse, France
| | - Julien Textoris
- Département d'Anesthésie-Réanimation, hôpital Édouard-Herriot, Hospices Civils de Lyon, CHU de Lyon, 69437, Lyon, France.,EA 7426 Pathophysiology of Injury-induced Immunosuppression, University of Lyon1-Hospices Civils de Lyon - bioMérieux, Hôpital Edouard Herriot, 69437, Lyon, France
| | - Fabrice Uhel
- Service de Réanimation Médicale et Maladies Infectieuses, CHU de Rennes, Hôpital Pontchaillou, Rennes, France
| | - Dominique Vodovar
- Centre Antipoison et de Toxicovigilance de Paris - Fédération de Toxicologie, Hôpital Fernand-Widal, Assistance Publique-Hôpitaux de Paris, Paris, France.,UMRS 1144, Faculté de Pharmacie, INSERM, Paris, France
| | - Lara Zafrani
- Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Nicolas de Prost
- Service de Réanimation Médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.
| | - Peter Radermacher
- Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum, Ulm, Germany
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12
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Chronic psychosocial stress compromises the immune response and endochondral ossification during bone fracture healing via β-AR signaling. Proc Natl Acad Sci U S A 2019; 116:8615-8622. [PMID: 30948630 DOI: 10.1073/pnas.1819218116] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Chronic psychosocial stress/trauma represents an increasing burden in our modern society and a risk factor for the development of mental disorders, including posttraumatic stress disorder (PTSD). PTSD, in turn, is highly comorbid with a plethora of inflammatory disorders and has been associated with increased bone fracture risk. Since a balanced inflammatory response after fracture is crucial for successful bone healing, we hypothesize that stress/trauma alters the inflammatory response after fracture and, consequently, compromises fracture healing. Here we show, employing the chronic subordinate colony housing (CSC) paradigm as a clinically relevant mouse model for PTSD, that mice subjected to CSC displayed increased numbers of neutrophils in the early fracture hematoma, whereas T lymphocytes and markers for cartilage-to-bone transition and angiogenesis were reduced. At late stages of fracture healing, CSC mice were characterized by decreased bending stiffness and bony bridging of the fracture callus. Strikingly, a single systemic administration of the β-adrenoreceptor (AR) blocker propranolol before femur osteotomy prevented bone marrow mobilization of neutrophils and invasion of neutrophils into the fracture hematoma, both seen in the early phase after fracture, as well as a compromised fracture healing in CSC mice. We conclude that chronic psychosocial stress leads to an imbalanced immune response after fracture via β-AR signaling, accompanied by disturbed fracture healing. These findings offer possibilities for clinical translation in patients suffering from PTSD and fracture.
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13
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Fitschen-Oestern S, Lippross S, Klueter T, Weuster M, Varoga D, Tohidnezhad M, Pufe T, Rose-John S, Andruszkow H, Hildebrand F, Steubesand N, Seekamp A, Neunaber C. Correction to: A new multiple trauma model of the mouse. BMC Musculoskelet Disord 2019; 20:72. [PMID: 30744619 PMCID: PMC6371601 DOI: 10.1186/s12891-018-2330-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Stefanie Fitschen-Oestern
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Sebastian Lippross
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Tim Klueter
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Matthias Weuster
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Deike Varoga
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Mersedeh Tohidnezhad
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - Thomas Pufe
- Department of Anatomy and Cell Biology, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - Stefan Rose-John
- Department of Biochemistry, Medical Faculty, Olshausenstr. 40, 24098, Kiel, Germany
| | - Hagen Andruszkow
- Department of Trauma Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Trauma Surgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nadine Steubesand
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Andreas Seekamp
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Claudia Neunaber
- Department of Trauma Surgery, Hannover Medical School, Hannover, Germany
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14
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Mödinger Y, Rapp AE, Vikman A, Ren Z, Fischer V, Bergdolt S, Haffner-Luntzer M, Song WC, Lambris JD, Huber-Lang M, Neidlinger-Wilke C, Brenner RE, Ignatius A. Reduced Terminal Complement Complex Formation in Mice Manifests in Low Bone Mass and Impaired Fracture Healing. THE AMERICAN JOURNAL OF PATHOLOGY 2018; 189:147-161. [PMID: 30339839 DOI: 10.1016/j.ajpath.2018.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/01/2018] [Accepted: 09/17/2018] [Indexed: 12/20/2022]
Abstract
The terminal complement complex (TCC) is formed on activation of the complement system, a crucial arm of innate immunity. TCC formation on cell membranes results in a transmembrane pore leading to cell lysis. In addition, sublytic TCC concentrations can modulate various cellular functions. TCC-induced effects may play a role in the pathomechanisms of inflammatory disorders of the bone, including rheumatoid arthritis and osteoarthritis. In this study, we investigated the effect of the TCC on bone turnover and repair. Mice deficient for complement component 6 (C6), an essential component for TCC assembly, and mice with a knockout of CD59, which is a negative regulator of TCC formation, were used in this study. The bone phenotype was analyzed in vivo, and bone cell behavior was analyzed ex vivo. In addition, the mice were subjected to a femur osteotomy. Under homeostatic conditions, C6-deficient mice displayed a reduced bone mass, mainly because of increased osteoclast activity. After femur fracture, the inflammatory response was altered and bone formation was disturbed, which negatively affected the healing outcome. By contrast, CD59-knockout mice only displayed minor skeletal alterations and uneventful bone healing, although the early inflammatory reaction to femur fracture was marginally enhanced. These results demonstrate that TCC-mediated effects regulate bone turnover and promote an adequate response to fracture, contributing to an uneventful healing outcome.
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Affiliation(s)
- Yvonne Mödinger
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Anna E Rapp
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Anna Vikman
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Zhaozhou Ren
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Verena Fischer
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Stephanie Bergdolt
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Melanie Haffner-Luntzer
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Wen-Chao Song
- Department of Pharmacology and Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John D Lambris
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Markus Huber-Lang
- Institute of Clinical and Experimental Trauma-Immunology, Ulm University Medical Center, Ulm, Germany
| | | | - Rolf E Brenner
- Division for Biochemistry of Joint and Connective Tissue Diseases, Department of Orthopedics, Trauma Research Center Ulm, Ulm University Medical Center, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany.
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15
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Influence of Menopause on Inflammatory Cytokines during Murine and Human Bone Fracture Healing. Int J Mol Sci 2018; 19:ijms19072070. [PMID: 30013010 PMCID: PMC6073246 DOI: 10.3390/ijms19072070] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/12/2018] [Accepted: 07/15/2018] [Indexed: 12/15/2022] Open
Abstract
Postmenopausal females display a chronic inflammatory phenotype with higher levels of circulating pro-inflammatory cytokines. Furthermore, the inflammatory response to injury may be altered under estrogen-deficiency, because it was shown previously that estrogen-deficient mice displayed increased levels of the inflammatory cytokines Midkine (Mdk) and Interleukin-6 (IL-6) in the early fracture hematoma. Because a balanced immune response to fracture is required for successful bone regeneration, this might contribute to the delayed fracture healing frequently observed in osteoporotic, postmenopausal fracture patients. In this study, we aimed to investigate whether further cytokines in addition to Mdk and IL-6 might be affected by estrogen-deficiency after fracture in mice and whether these cytokines are also relevant during human fracture healing. Additionally, we aimed to investigate whether serum from male vs. female fracture patients affects osteogenic differentiation of human mesenchymal stem cells (MSCs). To address these questions, female mice were either sham-operated or ovariectomized (OVX) and subjected to standardized femur osteotomy. A broad panel of pro- and anti-inflammatory cytokines was determined systemically and locally in the fracture hematoma. In a translational approach, serum was collected from healthy controls and patients with an isolated fracture. Mdk and IL-6 serum levels were determined at day 0, day 14 and day 42 after fracture. Subgroup analysis was performed to investigate differences between male and female fracture patients after menopause. In an in vitro approach, human MSCs were cultured with the collected patient serum and osteogenic differentiation was assessed by qPCR and alkaline-phosphatase staining. Our results suggest an important role for the pro-inflammatory cytokines Mdk and IL-6 in the response to fracture in estrogen-deficient mice among all of the measured inflammatory mediators. Notably, both cytokines were also significantly increased in the serum of patients after fracture. However, only Mdk serum levels differed significantly between male and female fracture patients after menopause. MSCs cultivated with serum from female fracture patients displayed significantly reduced osteogenic differentiation, which was attenuated by Mdk-antibody treatment. In conclusion, our study demonstrated increased Mdk levels after fracture in OVX mice and female fracture patients after menopause. Because Mdk is a negative regulator of bone formation, this might contribute to impaired osteoporotic fracture healing.
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16
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Kaiser K, Prystaz K, Vikman A, Haffner-Luntzer M, Bergdolt S, Strauss G, Waetzig GH, Rose-John S, Ignatius A. Pharmacological inhibition of IL-6 trans-signaling improves compromised fracture healing after severe trauma. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2018; 391:523-536. [PMID: 29497762 PMCID: PMC5889421 DOI: 10.1007/s00210-018-1483-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/19/2018] [Indexed: 01/01/2023]
Abstract
Patients with multiple injuries frequently suffer bone fractures and are at high risk to develop fracture healing complications. Because of its key role both in systemic posttraumatic inflammation and fracture healing, the pleiotropic cytokine interleukin-6 (IL-6) may be involved in the pathomechanisms of trauma-induced compromised fracture healing. IL-6 signals are transmitted by two different mechanisms: classic signaling via the membrane-bound receptor (mIL-6R) and trans-signaling via its soluble form (sIL-6R). Herein, we investigated whether IL-6 classic and trans-signaling play different roles in bone regeneration after severe injury. Twelve-week-old C57BL/6J mice underwent combined femur osteotomy and thoracic trauma. To study the function of IL-6, either an anti-IL-6 antibody, which inhibits both IL-6 classic and trans-signaling, or a soluble glycoprotein 130 fusion protein (sgp130Fc), which selectively blocks trans-signaling, were injected 30 min and 48 h after surgery. Bone healing was assessed using cytokine analyses, flow cytometry, histology, micro-computed tomography, and biomechanical testing. Selective inhibition of IL-6 trans-signaling significantly improved the fracture healing outcome after combined injury, as confirmed by accelerated cartilage-to-bone transformation, enhanced bony bridging of the fracture gap and improved mechanical callus properties. In contrast, global IL-6 inhibition did not affect compromised fracture healing. These data suggest that classic signaling may mediate beneficial effects on bone repair after severe injury. Selective inhibition of IL-6 trans-signaling might have therapeutic potential to treat fracture healing complications in patients with concomitant injuries.
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Affiliation(s)
- Kathrin Kaiser
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm, University Medical Center Ulm, 89081, Ulm, Germany
| | - Katja Prystaz
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm, University Medical Center Ulm, 89081, Ulm, Germany
| | - Anna Vikman
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm, University Medical Center Ulm, 89081, Ulm, Germany
| | - Melanie Haffner-Luntzer
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm, University Medical Center Ulm, 89081, Ulm, Germany
| | - Stephanie Bergdolt
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm, University Medical Center Ulm, 89081, Ulm, Germany
| | - Gudrun Strauss
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, 89075, Ulm, Germany
| | | | - Stefan Rose-John
- Institute of Biochemistry, Christian-Albrechts-University of Kiel, 24118, Kiel, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Trauma Research Center Ulm, University Medical Center Ulm, 89081, Ulm, Germany.
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17
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Neutrophils in Tissue Trauma of the Skin, Bone, and Lung: Two Sides of the Same Coin. J Immunol Res 2018; 2018:8173983. [PMID: 29850639 PMCID: PMC5937416 DOI: 10.1155/2018/8173983] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/21/2018] [Indexed: 12/12/2022] Open
Abstract
Following severe tissue injury, patients are exposed to various danger- and microbe-associated molecular patterns, which provoke a strong activation of the neutrophil defense system. Neutrophils trigger and modulate the initial posttraumatic inflammatory response and contribute critically to subsequent repair processes. However, severe trauma can affect central neutrophil functions, including circulation half-life, chemokinesis, phagocytosis, cytokine release, and respiratory burst. Alterations in neutrophil biology may contribute to trauma-associated complications, including immune suppression, sepsis, multiorgan dysfunction, and disturbed tissue regeneration. Furthermore, there is evidence that neutrophil actions depend on the quality of the initial stimulus, including trauma localization and severity, the micromilieu in the affected tissue, and the patient's overall inflammatory status. In the present review, we describe the effects of severe trauma on the neutrophil phenotype and dysfunction and the consequences for tissue repair. We particularly concentrate on the role of neutrophils in wound healing, lung injury, and bone fractures, because these are the most frequently affected tissues in severely injured patients.
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18
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Haffner-Luntzer M, Kovtun A, Fischer V, Prystaz K, Hainzl A, Kroeger CM, Krikki I, Brinker TJ, Ignatius A, Gatzka M. Loss of p53 compensates osteopenia in murine Mysm1 deficiency. FASEB J 2018; 32:1957-1968. [PMID: 29203593 DOI: 10.1096/fj.201700871r] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Histone modifications critically contribute to the epigenetic orchestration of bone homeostasis-in part, by modifying the access of transcription factors to specific genes involved in the osteogenic differentiation process of bone marrow mesenchymal stem cells (MSCs) and osteoblasts. Based on our previous finding that histone H2A deubiquitinase 2A-DUB/Mysm1 interacts with the p53 axis in hematopoiesis and tissue development, we analyzed the molecular basis of the skeletal phenotype of Mysm1-deficient mice and dissected the underlying p53-dependent and -independent mechanisms. Visible morphologic, skeletal deformations of young Mysm1-deficient mice-including a kinked and truncated tail and shortened long bones-were associated with osteopenia of long bones. On the cellular level, Mysm1-deficient primary osteoblasts displayed reduced potential to differentiate into mature osteoblasts, as indicated by decreased expression of osteogenic markers. Reduced osteogenic differentiation capacity of Mysm1-deficient osteoblasts was accompanied by an impaired induction of osteogenic transcription factor Runx2. Osteogenic differentiation of Mysm1-/- MSCs, however, was not compromised in vitro. In line with defective hematopoietic development of Mysm1-deficient mice, Mysm1-/- osteoclasts had reduced resorption activity and were more prone to apoptosis in TUNEL assays. Skeletal alterations and osteopenia of Mysm1-deficient mice were phenotypically completely rescued by simultaneous ablation of p53 in p53-/-Mysm1-/- double-deficient mice-although p53 deficiency did not restore Runx2 expression in Mysm1-/- osteoblasts on the molecular level but, instead, enhanced proliferation and osteogenic differentiation of MSCs. In summary, our results demonstrate novel roles for Mysm1 in osteoblast differentiation and osteoclast formation, resulting in osteopenia in Mysm1-deficient mice that could be abrogated by the loss of p53 from increased osteogenic differentiation of Mysm1-/-p53-/- MSCs.-Haffner-Luntzer, M., Kovtun, A., Fischer, V., Prystaz, K., Hainzl, A., Kroeger, C. M., Krikki, I., Brinker, T. J., Ignatius, A., Gatzka, M. Loss of p53 compensates osteopenia in murine Mysm1 deficiency.
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Affiliation(s)
- Melanie Haffner-Luntzer
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Ulm, Germany.,Trauma Research Centre, University of Ulm, Ulm, Germany
| | - Anna Kovtun
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Ulm, Germany.,Trauma Research Centre, University of Ulm, Ulm, Germany
| | - Verena Fischer
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Ulm, Germany.,Trauma Research Centre, University of Ulm, Ulm, Germany
| | - Katja Prystaz
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Ulm, Germany.,Trauma Research Centre, University of Ulm, Ulm, Germany
| | - Adelheid Hainzl
- Department of Dermatology and Allergic Diseases, University of Ulm, Ulm, Germany
| | - Carsten M Kroeger
- Department of Dermatology and Allergic Diseases, University of Ulm, Ulm, Germany
| | - Ioanna Krikki
- Department of Dermatology and Allergic Diseases, University of Ulm, Ulm, Germany
| | - Titus J Brinker
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany.,Department of National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Ulm, Germany.,Trauma Research Centre, University of Ulm, Ulm, Germany
| | - Martina Gatzka
- Department of Dermatology and Allergic Diseases, University of Ulm, Ulm, Germany
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19
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Complement receptors C5aR1 and C5aR2 act differentially during the early immune response after bone fracture but are similarly involved in bone repair. Sci Rep 2017; 7:14061. [PMID: 29070810 PMCID: PMC5656620 DOI: 10.1038/s41598-017-14444-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/10/2017] [Indexed: 12/31/2022] Open
Abstract
Severely injured patients frequently suffer compromised fracture healing because of systemic post-traumatic inflammation. An important trigger of the posttraumatic immune response is the complement anaphylatoxin C5a, which acts via two receptors, C5aR1 and C5aR2, expressed on immune and bone cells. The blockade of C5a-mediated inflammation during the early inflammatory phase was demonstrated to improve fracture healing after severe injury. However, the distinct roles of the two complement receptors C5aR1 and C5aR2 in bone has to date not been studied. Here, we investigated bone turnover and regeneration in mice lacking either C5aR1 or C5aR2 in a model of isolated fracture and after severe injury, combining the fracture with an additional thoracic trauma. Both C5aR1−/− and C5aR2−/− mice displayed an increased bone mass compared to wild-type controls due to reduced osteoclast formation and increased osteoblast numbers, respectively. Following fracture, the inflammatory response was differently affected in these strains: It was decreased in C5aR1−/− mice but enhanced in C5aR2−/− mice. Both strains exhibited impaired fracture healing, disturbed osteoclastogenesis and delayed cartilage-to-bone transformation. Thus, our data suggest that C5aR1 and C5aR2 differentially regulate the immune response after fracture and are required for effective cartilage-to-bone transformation in the fracture callus and for undisturbed bone healing.
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20
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Hypercapnic Conditions After Experimental Blunt Chest Trauma Increase Efferocytosis of Alveolar Macrophages and Reduce Local Inflammation. Shock 2017; 48:104-111. [DOI: 10.1097/shk.0000000000000813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Claes L, Gebhard F, Ignatius A, Lechner R, Baumgärtel S, Kraus M, Krischak GD. The effect of a combined thoracic and soft-tissue trauma on blood flow and tissue formation in fracture healing in rats. Arch Orthop Trauma Surg 2017; 137:945-952. [PMID: 28429082 DOI: 10.1007/s00402-017-2695-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Previously, it was found that fracture healing is impaired by blunt chest trauma and an additional soft-tissue trauma. The mechanisms leading to this disturbance are largely unknown. Here, we investigated the effect of thoracic and soft-tissue trauma on blood flow of the injured lower leg and on tissue differentiation and callus formation during fracture healing. MATERIALS AND METHODS Male Wistar rats received either a mid-shaft fracture of the tibia alone (group A), an additional chest trauma (group B), or additional chest and soft-tissue traumas (group C). Peripheral blood flow was determined by Laser Doppler Flowmetry before and after the injury, and on observation days 1, 3, 7, 14, and 28. Quantitative histological analysis was performed to assess callus size and composition. RESULTS All groups displayed an initial decrease in blood flow during the first 3 days post-trauma. A recovery of the blood flow that even exceeded preoperative levels occurred in group A and later and to a lesser degree in group B, but not in group C. The amount of callus formation decreased with increasing trauma load. More cartilage was formed after 7 days in groups B and C than in group A. At later healing time points, callus composition did not differ significantly. CONCLUSIONS An increasing injury burden causes a decreasing blood supply capacity and revascularization, and leads to impaired callus formation and an increasing delay in bone healing.
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Affiliation(s)
- Lutz Claes
- Centre of Musculoskeletal Research, Institute of Orthopaedic Research and Biomechanics, Ulm University, Helmholtzstrasse 14, 89081, Ulm, Germany.
| | - Florian Gebhard
- Department of Trauma Surgery, Hand, Plastic and Reconstructive Surgery, Centre of Surgery, Ulm University, Ulm, Germany
| | - Anita Ignatius
- Centre of Musculoskeletal Research, Institute of Orthopaedic Research and Biomechanics, Ulm University, Helmholtzstrasse 14, 89081, Ulm, Germany
| | | | | | - Michael Kraus
- Department of Trauma Surgery, Hand, Plastic and Reconstructive Surgery, Centre of Surgery, Ulm University, Ulm, Germany
| | - Gert D Krischak
- Institute for Rehabilitation Research at Ulm University, Ulm, Germany
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22
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Bergdolt S, Kovtun A, Hägele Y, Liedert A, Schinke T, Amling M, Huber-Lang M, Ignatius A. Osteoblast-specific overexpression of complement receptor C5aR1 impairs fracture healing. PLoS One 2017; 12:e0179512. [PMID: 28614388 PMCID: PMC5470759 DOI: 10.1371/journal.pone.0179512] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/30/2017] [Indexed: 01/08/2023] Open
Abstract
The anaphylatoxin receptor C5aR1 plays an important role not only in innate immune responses, but also in bone metabolism and fracture healing, being highly expressed on immune and bone cells, including osteoblasts and osteoclasts. C5aR1 induces osteoblast migration, cytokine generation and osteoclastogenesis, however, the exact role of C5aR1-mediated signaling in osteoblasts is not entirely known. Therefore, we hypothesized that osteoblasts are essential target cells for C5a and that fracture healing should be disturbed in mice with an osteoblast-specific C5aR1 overexpression (Col1a1-C5aR1). Osteoblast activity in vitro, bone phenotype and fracture healing after isolated osteotomy and after combined osteotomy with additional thoracic trauma were analyzed. The systemic and local inflammatory reactions were analyzed by determining C5a and IL-6 concentrations in blood, bronchoalveolar lavage fluid and fracture callus and the recruitment of immune cells. In vitro, osteoblast proliferation and differentiation were similar to wildtype cells, and phosphorylation of p38 and expression of IL-6 and RANKL were increased in osteoblasts derived from Col1a1-C5aR1 mice. Bone phenotype and the inflammatory reaction were unaffected in Col1a1-C5aR1 mice. Fracture healing was significantly impaired as demonstrated by significantly reduced bone content, bone mineral density and flexural rigidity, possibly due to significantly increased osteoclast numbers. C5aR1 signaling in osteoblasts might possibly affect RANKL/OPG balance, leading to increased bone resorption. Additional trauma significantly impaired fracture healing, particularly in Col1a1-C5aR1 mice. In conclusion, the data indicate that C5aR1 signaling in osteoblasts plays a detrimental role in bone regeneration after fracture.
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Affiliation(s)
- Stephanie Bergdolt
- Institute of Orthopedic Research and Biomechanics, University of Ulm, Ulm, Germany
| | - Anna Kovtun
- Institute of Orthopedic Research and Biomechanics, University of Ulm, Ulm, Germany
| | - Yvonne Hägele
- Institute of Orthopedic Research and Biomechanics, University of Ulm, Ulm, Germany
| | - Astrid Liedert
- Institute of Orthopedic Research and Biomechanics, University of Ulm, Ulm, Germany
| | - Thorsten Schinke
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Huber-Lang
- Institute of Clinical and Experimental Traumaimmunology, University of Ulm, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, University of Ulm, Ulm, Germany
- * E-mail:
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23
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Miclau KR, Brazina SA, Bahney CS, Hankenson KD, Hunt TK, Marcucio RS, Miclau T. Stimulating Fracture Healing in Ischemic Environments: Does Oxygen Direct Stem Cell Fate during Fracture Healing? Front Cell Dev Biol 2017; 5:45. [PMID: 28523266 PMCID: PMC5416746 DOI: 10.3389/fcell.2017.00045] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/12/2017] [Indexed: 01/27/2023] Open
Abstract
Bone fractures represent an enormous societal and economic burden as one of the most prevalent causes of disability worldwide. Each year, nearly 15 million people are affected by fractures in the United States alone. Data indicate that the blood supply is critical for fracture healing; as data indicate that concomitant bone and vascular injury are major risk factors for non-union. However, the various role(s) that the vasculature plays remains speculative. Fracture stabilization dictates stem cell fate choices during repair. In stabilized fractures stem cells differentiate directly into osteoblasts and heal the injury by intramembranous ossification. In contrast, in non-stable fractures stem cells differentiate into chondrocytes and the bone heals through endochondral ossification, where a cartilage template transforms into bone as the chondrocytes transform into osteoblasts. One suggested role of the vasculature has been to participate in the stem cell fate decisions due to delivery of oxygen. In stable fractures, the blood vessels are thought to remain intact and promote osteogenesis, while in non-stable fractures, continual disruption of the vasculature creates hypoxia that favors formation of cartilage, which is avascular. However, recent data suggests that non-stable fractures are more vascularized than stable fractures, that oxygen does not appear associated with differentiation of stem cells into chondrocytes and osteoblasts, that cartilage is not hypoxic, and that oxygen, not sustained hypoxia, is required for angiogenesis. These unexpected results, which contrast other published studies, are indicative of the need to better understand the complex, spatio-temporal regulation of vascularization and oxygenation in fracture healing. This work has also revealed that oxygen, along with the promotion of angiogenesis, may be novel adjuvants that can stimulate healing in select patient populations.
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Affiliation(s)
- Katherine R Miclau
- Department of Orthopaedic Surgery, University of CaliforniaSan Francisco, CA, USA.,Zuckerberg San Francisco General Hospital, Orthopaedic Trauma InstituteSan Francisco, CA, USA.,Harvard CollegeCambridge, MA, USA
| | - Sloane A Brazina
- Department of Orthopaedic Surgery, University of CaliforniaSan Francisco, CA, USA.,Zuckerberg San Francisco General Hospital, Orthopaedic Trauma InstituteSan Francisco, CA, USA
| | - Chelsea S Bahney
- Department of Orthopaedic Surgery, University of CaliforniaSan Francisco, CA, USA.,Zuckerberg San Francisco General Hospital, Orthopaedic Trauma InstituteSan Francisco, CA, USA
| | - Kurt D Hankenson
- Department of Small Animal Clinical Science and Department of Physiology, Michigan State UniversityEast Lansing, MI, USA.,Department of Orthopaedic Surgery, University of PennsylvaniaPhiladelphia, PA, USA
| | - Thomas K Hunt
- Department of Surgery, University of CaliforniaSan Francisco, CA, USA
| | - Ralph S Marcucio
- Department of Orthopaedic Surgery, University of CaliforniaSan Francisco, CA, USA.,Zuckerberg San Francisco General Hospital, Orthopaedic Trauma InstituteSan Francisco, CA, USA
| | - Theodore Miclau
- Department of Orthopaedic Surgery, University of CaliforniaSan Francisco, CA, USA.,Zuckerberg San Francisco General Hospital, Orthopaedic Trauma InstituteSan Francisco, CA, USA
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24
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Ehrnthaller C, Huber-Lang M, Kovtun A, Rapp AE, Kemmler J, Gebhard F, Ignatius A. C5aR inhibition in the early inflammatory phase does not affect bone regeneration in a model of uneventful fracture healing. Eur J Med Res 2016; 21:42. [PMID: 27784330 PMCID: PMC5081665 DOI: 10.1186/s40001-016-0236-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/16/2016] [Indexed: 01/06/2023] Open
Abstract
Background Recent studies were able to demonstrate involvement of the complement cascade in bone biology. Further studies analyzed the role of complement in traumatic injuries and demonstrated negative effects after excessive systemic activation of the inflammatory response with early abrogation of complement activation after application of a C5aR-antagonist exerting beneficial effects upon bone regeneration. In contrast, own fracture healing experiments with complement-deficient animals implied a crucial role of the complement cascade for sufficient fracture healing. Methods To analyze the effect of a short abrogation of the complement system in the local process of fracture healing, a fracture healing experiment with wild-type mice (C57BL6), femoral osteotomy, consecutive external fixation for 21 days and blockade of the early complement activation (C5aRA) directly after trauma and after 12 h was performed. Control animals received a peptide without any biological effects. After 1–3 days, the inflammatory response was monitored with IL-6 immunostaining, serum analyses of C5a and after 3 days with histological evaluation of PMN. Fracture healing was examined with biomechanical, radiological and histological methods after 21 days. Results While a decrease of the early inflammatory response was seen on day 1 of the C5aRA-treated group regarding immunostaining for IL-6 and after 3 days in the histological evaluation of PMN, no significant differences were demonstrated between both experimental groups after 21 days in the biomechanical, radiological and histological evaluation. Conclusions The present results demonstrate that the short-term inhibition of complement activation immediately after fracture does not significantly affect bone regeneration in an experimental model of regular fracture healing. Whereas other studies demonstrated that the early posttraumatic blockade of the C5aR improves fracture healing in a scenario of combined trauma, the present findings implicate that the same treatment has no effect in uneventful bone healing.
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Affiliation(s)
- Christian Ehrnthaller
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Albert-Einstein Allee 23, 89081, Ulm, Germany.
| | - Markus Huber-Lang
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Albert-Einstein Allee 23, 89081, Ulm, Germany
| | - Anna Kovtun
- Institute of Orthopedic Research and Biomechanics, Center of Musculoskeletal Research, University of Ulm, Ulm, Germany
| | - Anna Elise Rapp
- Institute of Orthopedic Research and Biomechanics, Center of Musculoskeletal Research, University of Ulm, Ulm, Germany
| | - Julia Kemmler
- Institute of Orthopedic Research and Biomechanics, Center of Musculoskeletal Research, University of Ulm, Ulm, Germany
| | - Florian Gebhard
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Albert-Einstein Allee 23, 89081, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Center of Musculoskeletal Research, University of Ulm, Ulm, Germany
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25
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Haffner-Luntzer M, Kovtun A, Rapp AE, Ignatius A. Mouse Models in Bone Fracture Healing Research. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s40610-016-0037-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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