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Fofiu A, Tripon RG, Băţagă T, Chirilă TV. Exogenous Crosslinking of Tendons as a Strategy for Mechanical Augmentation and Repair: A Narrative Review. Orthop Res Rev 2023; 15:165-173. [PMID: 37637359 PMCID: PMC10455955 DOI: 10.2147/orr.s421106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023] Open
Abstract
Collagens constitute a family of triple-helical proteins with a high level of structural polymorphism and a broad diversity of structural and chemical characteristics. Collagens are designed to form supporting aggregates in the extracellular spaces of our body, but they can be isolated from animal sources and processed to become available as biomaterials with wide applications in biomedicine and bioengineering. Collagens can be conveniently modified chemically, and their propensity for participating in crosslinking reactions is an important feature. While the crosslinking promoted by a variety of agents provides a range of collagen-based products, there has been minor interest for therapies based on the crosslinking of collagen while located within living connective tissues, known as exogenous crosslinking. Currently, there is only one such treatment in ocular therapeutics (for keratoconus), and another two in development, all based on mechanical augmentation of tissues due to ultraviolet (UV)-induced crosslinking. As seen in this review, there was some interest to employ exogenous crosslinking in order to reinforce mechanically the lax tendons with an aim to arrest tear propagation, stabilize the tissue, and facilitate the healing. Here we reviewed in details both the early stages and the actual status of the experimental research dedicated to the topic. Many results have not been encouraging, however there is sufficient evidence that tendons can be mechanically reinforced by chemical or photochemical exogenous crosslinking. We also compare the exogenous crosslinking using chemical agents, which was predominant in the literature reviewed, to that promoted by UV radiation, which was rather neglected but might have some advantages.
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Affiliation(s)
- Alexandru Fofiu
- Department of Orthopedics-Traumatology, Emergency County Hospital Bistriţa, Bistriţa Năsăud, Romania
- School of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania
| | - Robert G Tripon
- Department of Ophthalmology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania
| | - Tiberiu Băţagă
- Department of Orthopedics-Traumatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania
| | - Traian V Chirilă
- School of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania
- Department of Research, Queensland Eye Institute, South Brisbane, QLD, Australia
- School of Chemistry and Physics, Queensland University of Technology, Brisbane, QLD, Australia
- Australian Institute of Bioengineering and Nanotechnology, University of Queensland, St Lucia, QLD, Australia
- School of Molecular Science, University of Western Australia, Crawley, WA, Australia
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Sarkovich S, Issa PP, Longanecker A, Martin D, Redondo K, McTernan P, Simkin J, Marrero L. Minoxidil weakens newly synthesized collagen in fibrotic synoviocytes from osteoarthritis patients. J Exp Orthop 2023; 10:84. [PMID: 37605092 PMCID: PMC10441905 DOI: 10.1186/s40634-023-00650-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/09/2023] [Indexed: 08/23/2023] Open
Abstract
PURPOSE Synovial fibrosis (SFb) formation and turnover attributable to knee osteoarthritis (KOA) can impart painful stiffness and persist following arthroplasty. To supplement joint conditioning aimed at maximizing peri-operative function, we evaluated the antifibrotic effect of Minoxidil (MXD) on formation of pyridinoline (Pyd) cross-links catalyzed by Plod2-encoded lysyl hydroxylase (LH)2b that strengthen newly synthesized type-I collagen (COL1) in fibroblastic synovial cells (FSCs) from KOA patients. MXD was predicted to decrease Pyd without significant alterations to Col1a1 transcription by FSCs stimulated with transforming growth factor (TGF)β1. METHODS Synovium from 10 KOA patients grouped by SFb severity was preserved for picrosirius and LH2b histology or culture. Protein and RNA were purified from fibrotic FSCs after 8 days with or without 0.5 µM MXD and/or 4 ng/mL of TGFβ1. COL1 and Pyd protein concentrations from ELISA and expression of Col1a1, Acta2, and Plod2 genes by qPCR were compared by parametric tests with α = 0.05. RESULTS Histological LH2b expression corresponded to SFb severity. MXD attenuated COL1 output in KOA FSCs but only in the absence of TGFβ1 and consistently decreased Pyd under all conditions with significant downregulation of Plod2 but minimal alterations to Col1a1 and Acta2 transcripts. CONCLUSIONS MXD is an attractive candidate for local antifibrotic pharmacotherapy for SFb by compromising the integrity of newly formed fibrous deposits by FSCs during KOA and following arthroplasty. Targeted antifibrotic supplementation could improve physical therapy and arthroscopic lysis strategies aimed at breaking down joint scarring. However, the effect of MXD on other joint-specific TGFβ1-mediated processes or non-fibrotic components requires further investigation.
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Affiliation(s)
- Stefan Sarkovich
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, 2021 Perdido St., Center for Advanced Learning and Simulation, 7th floor, New Orleans, LA, 70112, USA
| | - Peter P Issa
- School of Medicine, Louisiana State University Health Sciences Center, 2020 Gravier St., Lions Building, 5th floor, New Orleans, LA, 70112, USA
| | - Andrew Longanecker
- School of Medicine, Louisiana State University Health Sciences Center, 2020 Gravier St., Lions Building, 5th floor, New Orleans, LA, 70112, USA
| | - Davis Martin
- School of Medicine, Louisiana State University Health Sciences Center, 2020 Gravier St., Lions Building, 5th floor, New Orleans, LA, 70112, USA
| | - Kaitlyn Redondo
- Morphology and Imaging Core, Louisiana State University Health Sciences Center, 533 Bolivar St., Clinical Sciences Research Building, 5th floor, New Orleans, LA, 70112, USA
| | - Patrick McTernan
- Department of Physiology, Louisiana State University Health Sciences Center, 533 Bolivar St., Clinical Sciences Research Building, 4th floor, New Orleans, LA, 70112, USA
| | - Jennifer Simkin
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, 2021 Perdido St., Center for Advanced Learning and Simulation, 7th floor, New Orleans, LA, 70112, USA
| | - Luis Marrero
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, 2021 Perdido St., Center for Advanced Learning and Simulation, 7th floor, New Orleans, LA, 70112, USA.
- School of Medicine, Louisiana State University Health Sciences Center, 2020 Gravier St., Lions Building, 5th floor, New Orleans, LA, 70112, USA.
- Morphology and Imaging Core, Louisiana State University Health Sciences Center, 533 Bolivar St., Clinical Sciences Research Building, 5th floor, New Orleans, LA, 70112, USA.
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Hippensteel KJ, Uppstrom TJ, Rodeo SA, Warren RF. Comprehensive Review of Multidirectional Instability of the Shoulder. J Am Acad Orthop Surg 2023:00124635-990000000-00667. [PMID: 37071881 DOI: 10.5435/jaaos-d-22-00983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/19/2023] [Indexed: 04/20/2023] Open
Abstract
Multidirectional instability of the shoulder can result from underlying atraumatic laxity, from repetitive microtrauma, or from a traumatic injury and often occurs in association with generalized ligamentous laxity or underlying connective tissue disorders. It is critical to differentiate multidirectional instability from unidirectional instability with or without generalized laxity to maximize treatment success. Although rehabilitation is still considered the primary treatment method for this condition, surgical treatment in the form of open inferior capsular shift or arthroscopic pancapsulolabral plication is indicated if conservative treatment fails. Recent biomechanical and clinical research has shown that there is still room for improvement in the treatment methods offered to this specific patient cohort. Potential treatment options, such as various methods to improve cross-linking of native collagen tissue, electric muscle stimulation to retrain the abnormally functioning dynamic stabilizers of the shoulder, and alternative surgical techniques such as coracohumeral ligament reconstruction and bone-based augmentation procedures, are brought forth in this article as potential avenues to explore in the future.
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Affiliation(s)
- K J Hippensteel
- From the Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD (Hippensteel) and Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Uppstrom, Rodeo, and Warren)
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