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Ren Y, Wan R, Zhao G, Kuroiwa T, Moran SL, Gingery A, Zhao C. Gene expression of Postn and FGF7 in canine chordae tendineae and their effects on flexor tenocyte biology. J Orthop Res 2024; 42:961-972. [PMID: 37990927 DOI: 10.1002/jor.25745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 11/23/2023]
Abstract
Chordae tendineae, referred to as heart tendinous cords, act as tendons connecting the papillary muscles to the valves in the heart. Their role is analogous to tendons in the musculoskeletal system. Despite being exposed to millions of cyclic tensile stretches over a human's lifetime, chordae tendineae rarely suffer from overuse injuries. On the other hand, musculoskeletal tendinopathy is very common and remains challenging in clinical treatment. The objective of this study was to investigate the mechanism behind the remarkable durability and resistance to overuse injuries of chordae tendineae, as well as to explore their effects on flexor tenocyte biology. The messenger RNA expression profiles of chordae tendineae were analyzed using RNA sequencing and verified by quantitative reverse transcription polymerase chain reaction and immunohistochemistry. Interestingly, we found that periostin (Postn) and fibroblast growth factor 7 (FGF7) were expressed at significantly higher levels in chordae tendineae, compared to flexor tendons. We further treated flexor tenocytes in vitro with periostin and FGF7 to examine their effects on the proliferation, migration, apoptosis, and tendon-related gene expression of flexor tenocytes. The results displayed enhanced cell proliferation ability at an early stage and an antiapoptotic effect on tenocytes, while treated with periostin and/or FGF7 proteins. Furthermore, there was a trend of promoted tenocyte migration capability. These findings indicated that Postn and FGF7 may represent novel cytokines to target flexor tendon healing. Clinical significance: The preliminary discovery leads to a novel idea for treating tendinopathy in the musculoskeletal system using specific molecules identified from chordae tendineae.
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Affiliation(s)
- Ye Ren
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rou Wan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gongyin Zhao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Tomoyuki Kuroiwa
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Steven L Moran
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anne Gingery
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Chunfeng Zhao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Pahuja M, Ranka S, Chauhan K, Patel A, Chehab O, Elmoghrabi A, Mony S, Ando T, Mishra T, Singh M, Abubaker H, Yassin A, Glazier JJ, Afonso L, Kapur NK, Burkhoff D. Rupture of Papillary Muscle and Chordae Tendinae Complicating STEMI: A Call for Action. ASAIO J 2021; 67:907-916. [PMID: 33093383 DOI: 10.1097/mat.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Papillary muscle rupture (PMR) or chordae tendinae rupture (CTR) is a rare but lethal complication after ST elevation myocardial infarction (STEMI). Due to the rarity of this condition, there are limited studies defining its epidemiology and outcomes. This is a retrospective study from Nationwide Inpatient Sample database from 2002 to 2014 of patients with STEMI and PMR/CTR. Outcomes of interest were incidence of in-hospital mortality, cardiogenic shock (CS), utilization of mechanical circulatory support (MCS) devices and mitral valve procedures (MVPs) among patients with and without rupture. We also performed simulation using the cardiovascular model to better understand the hemodynamics of severe mitral regurgitation and effects of different medications and device therapy. We identified 1,888 patients with STEMI complicated with PMR/CTR. Most of the patients were >65 years of age (65.3%), male (63.6%), and white (82.3%). They had significantly higher incidence of CS, cardiac arrest, and utilization of MCS devices. In-hospital mortality was higher in patients with rupture (41% vs. 7.40%, p < 0.001) which remained unchanged over the study period. Hospitalization cost and length of stay was also higher in them. MVP and revascularization led to better survival rates (27.9% vs. 60.6%, adjusted OR: 0.14; 95% CI: 0.10-0.19; p < 0.001). Despite significant advancement in the revascularization strategy, PMR/CTR after STEMI continues to portend poor prognosis with high inpatient mortality. Cardiogenic shock is a common presentation and is associated with significantly inpatient mortality. Future studies are needed determine the best strategies to improve outcomes in patients with STEMI with PMR/CTR and CS.
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Affiliation(s)
- Mohit Pahuja
- From the Department of Cardiology, Medstar Georgetown University/Washington Hospital Center, Washington, DC
| | - Sagar Ranka
- Division of Cardiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Kinsuk Chauhan
- Internal Medicine Department, Wayne State University, Detroit, Michigan
| | - Achint Patel
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Omar Chehab
- Department of Internal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Adel Elmoghrabi
- Department of Internal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Shruti Mony
- Department of Gastroenterology, Johns Hopkins University school of Medicine, Baltimore, Maryland
| | - Tomo Ando
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York
| | - Tushar Mishra
- Department of Internal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Manmohan Singh
- Department of Internal Medicine, Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan
| | - Hossam Abubaker
- Division of Cardiology, Department of Internal Medicine, Loma Linda University Medical Center, Los Angeles, California
| | - Ahmed Yassin
- Internal Medicine Department, Wayne State University, Detroit, Michigan
| | - James J Glazier
- From the Department of Cardiology, Medstar Georgetown University/Washington Hospital Center, Washington, DC
| | - Luis Afonso
- From the Department of Cardiology, Medstar Georgetown University/Washington Hospital Center, Washington, DC
| | - Navin K Kapur
- Division of Cardiology, Department of Internal Medicine, Tufts University Medical Center, Boston, Massachusetts
| | - Daniel Burkhoff
- Division of Cardiology, Department of Internal Medicine, Columbia University Medical Center, New York
- Cardiovascular Research Foundation, New York
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