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Lilja M, Virkkula P, Hammaren-Malmi S, Laulajainen-Hongisto A, Hafren L, Kauppi P, Sahlman J, Fokkens W, Reitsma S, Toppila-Salmi S. The extent of endoscopic sinus surgery in patients with severe chronic rhinosinusitis with nasal polyps (AirGOs Operative). RHINOL 2021. [DOI: 10.4193/rhinol/21.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the nose and paranasal sinuses characterized by intense inflammation, decreased health-related quality of life (HRQoL), and in severe cases high frequency of co-morbidities and recurrence despite treatment. Conservative treatment consists of nasal lavage, intranasal corticosteroids, and courses of oral corticosteroids, and antibiotics in exacerbations. Endoscopic sinus surgery (ESS) and/or biological therapy is considered if appropriate conservative treatment is not sufficient. The optimal extent of ESS in recalcitrant CRSwNP is not known. The aim of this randomized controlled trial is to evaluate and compare the efficacy and safety of limited ESS with partial ethmoidectomy with extended ESS with total ethmoidectomy in patients with severe CRSwNP. Methods: AirGOs Operative is a randomized controlled trial. It is an investigator-driven multicenter trial led by Helsinki University Hospital. The two surgery arms are compared. The primary outcome is the change in the SNOT-22 score at the 12-month follow-up. Secondary outcomes include the change in the SNOT-22 score at 24-months follow-up, the changes in polyp score, Lund-Mackay (LM) CT score, health-related quality of life (HRQoL), loss of productivity, nasal patency (peak nasal inspiratory flow (PNIF) ± acoustic rhinometry (ARM), olfaction test (Sniffin’ Sticks, identification), lung function (spirometry and PEF) and findings in pathological analysis at 12/24-months follow-up. Discussion: AirGOs Operative trial will lead to a better understanding of the optimal extent of ethmoidectomy in the treatment of recalcitrant severe CRSwNP.
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Virkkula P, Penttilä E, Vento SI, Myller J, Koskinen A, Hammarén-Malmi S, Laulajainen-Hongisto A, Hytönen M, Lilja M, Numminen J, Sillanpää S, Sahlman J, Toppila-Salmi S. Assessing Cut-off Points of Eosinophils, Nasal Polyp, and Lund-Mackay Scores to Predict Surgery in Nasal Polyposis: A Real-World Study. Allergy Rhinol (Providence) 2020; 11:2152656720956596. [PMID: 35141001 PMCID: PMC8819805 DOI: 10.1177/2152656720956596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Developing tools to identify chronic rhinosinusitis with nasal polyps
(CRSwNP) patients requiring surgical treatment would help clinicians treat
patients more effectively. The aim of this retrospective cross-sectional
study was to identify cut-off values for eosinophil percentage, nasal
polyps (NP), and Lund-Mackay (LM) scores that may predict the need for
surgical treatment in Finnish CRSwNP patients. Methods Data of CRSwNP patients (N = 378) undergoing consultation for ESS in 2001–19
were used. Data was collected from patient records and Lund-Mackay scores
were determined from sinus computed tomography scans. The percentage of
eosinophils was microscopically evaluated from the polyp samples available
(n = 81). Associations were analyzed by Mann Whitney U test, and cut-off
values by the area under the receiver operating characteristic curve
(AUROC). Results ESS was performed to 293 (77.5%) of patients. Polyp eosinophilia was
associated significantly with ESS (p = 0.001), whereas peripheral blood
eosinophil count, LM- score and endoscopic NP- score were not (p > 0.05).
AUROC values (95% CI) for detecting those needing ESS were for polyp
eosinophilia 0.71 (0.60–0.83), p = 0.001, for LM score 0.59 (0.50–0.67),
p = 0.054; for NP score 0.56 (0.48–0.64), p = 0.17, and for blood eosinophil
count 0.68 (0.46–0.90), p = 0.08. With the threshold value of polyp
eosinophilia (>25%), the sensitivity and specificity were optimal for
detecting the group needing ESS from the group not undergoing ESS. The
cut-off value of blood eosinophil count (>0.26 × 109/L) had
relatively good, yet statistically insignificant (underpowered), predictive
potential. Moderate cut-off values were found for endoscopic LM score
(≥14/24) and NP score (≥4/8). Conclusions Polyp eosinophilia (>25%) predicted ESS among Finnish hospital-level
CRSwNP patients. A future challenge would be to find less invasive and
cost-effective clinical factors predicting uncontrolled CRSwNP.
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Affiliation(s)
- P Virkkula
- Department of Otorhinolaryngology-Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - E Penttilä
- Department of Otorhinolaryngology, University of Eastern Finland, Kuopio, Finland.,Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
| | - S I Vento
- Department of Otorhinolaryngology-Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J Myller
- Department of Otorhinolaryngology, Päijät-Häme Central Hospital, Lahti, Finland
| | - A Koskinen
- Department of Otorhinolaryngology-Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - S Hammarén-Malmi
- Department of Otorhinolaryngology-Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A Laulajainen-Hongisto
- Department of Otorhinolaryngology-Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M Hytönen
- Department of Otorhinolaryngology-Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M Lilja
- Department of Otorhinolaryngology-Head and Neck surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J Numminen
- Department of Otorhinolaryngology, University of Tampere, Tampere, Finland.,Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | - S Sillanpää
- Department of Otorhinolaryngology, University of Tampere, Tampere, Finland.,Faculty of Medicine and Life Sciences and Tampere University Hospital, Tampere, Finland
| | - J Sahlman
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
| | - S Toppila-Salmi
- Department of Allergy, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Haartman Institute, University of Helsinki, Helsinki, Finland
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Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Ikonen A, Järvelä T, Järvinen TAH, Kanto K, Karhunen J, Knifsund J, Kröger H, Kääriäinen T, Lehtinen J, Nyrhinen J, Paloneva J, Päiväniemi O, Raivio M, Sahlman J, Sarvilinna R, Tukiainen S, Välimäki VV, Äärimaa V, Toivonen P, Järvinen TLN. Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial. Ann Rheum Dis 2018; 77:188-195. [PMID: 28522452 PMCID: PMC5867417 DOI: 10.1136/annrheumdis-2017-211172] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/03/2017] [Accepted: 04/13/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess if arthroscopic partial meniscectomy (APM) is superior to placebo surgery in the treatment of patients with degenerative tear of the medial meniscus. METHODS In this multicentre, randomised, participant-blinded and outcome assessor-blinded, placebo-surgery controlled trial, 146 adults, aged 35-65 years, with knee symptoms consistent with degenerative medial meniscus tear and no knee osteoarthritis were randomised to APM or placebo surgery. The primary outcome was the between-group difference in the change from baseline in the Western Ontario Meniscal Evaluation Tool (WOMET) and Lysholm knee scores and knee pain after exercise at 24 months after surgery. Secondary outcomes included the frequency of unblinding of the treatment-group allocation, participants' satisfaction, impression of change, return to normal activities, the incidence of serious adverse events and the presence of meniscal symptoms in clinical examination. Two subgroup analyses, assessing the outcome on those with mechanical symptoms and those with unstable meniscus tears, were also carried out. RESULTS In the intention-to-treat analysis, there were no significant between-group differences in the mean changes from baseline to 24 months in WOMET score: 27.3 in the APM group as compared with 31.6 in the placebo-surgery group (between-group difference, -4.3; 95% CI, -11.3 to 2.6); Lysholm knee score: 23.1 and 26.3, respectively (-3.2; -8.9 to 2.4) or knee pain after exercise, 3.5 and 3.9, respectively (-0.4; -1.3 to 0.5). There were no statistically significant differences between the two groups in any of the secondary outcomes or within the analysed subgroups. CONCLUSIONS In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who have failed initial conservative treatment are more likely to benefit from APM.
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Affiliation(s)
- Raine Sihvonen
- Department of Orthopedics and Traumatology, Hatanpää Hospital, Tampere, Finland
| | - Mika Paavola
- Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Antti Malmivaara
- Center for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
| | - Ari Itälä
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Antti Joukainen
- Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - Heikki Nurmi
- Department of Orthopedics and Traumatology, Central Finland Central Hospital, Jyväskylä, Finland
| | - Juha Kalske
- Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Anna Ikonen
- Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Timo Järvelä
- Arthroscopic and Sports Medicine Center Pohjola Sairaala, Helsinki, Finland
| | - Tero A H Järvinen
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Kari Kanto
- Department of Orthopedics and Traumatology, Hatanpää Hospital, Tampere, Finland
| | - Janne Karhunen
- Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Jani Knifsund
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Heikki Kröger
- Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - Tommi Kääriäinen
- Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - Janne Lehtinen
- Department of Orthopedics and Traumatology, Hatanpää Hospital, Tampere, Finland
| | - Jukka Nyrhinen
- Department of Orthopedics and Traumatology, Central Finland Central Hospital, Jyväskylä, Finland
| | - Juha Paloneva
- Department of Orthopedics and Traumatology, Central Finland Central Hospital, Jyväskylä, Finland
| | - Outi Päiväniemi
- Department of Orthopedics and Traumatology, Hatanpää Hospital, Tampere, Finland
| | - Marko Raivio
- Department of Orthopedics and Traumatology, Hatanpää Hospital, Tampere, Finland
| | - Janne Sahlman
- Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - Roope Sarvilinna
- Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Sikri Tukiainen
- Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | | | - Ville Äärimaa
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Pirjo Toivonen
- Department of Orthopaedics and Traumatology, Helsinki University, Töölö Hospital, Helsinki, Finland
| | - Teppo L N Järvinen
- Department of Orthopaedics and Traumatology, Helsinki University, Töölö Hospital, Helsinki, Finland
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Sahlman J, Matero H, Kärkkäinen H. Pilot study: An on-demand reminder system increases adherence of birth control pill users. ACTA ACUST UNITED AC 2018. [DOI: 10.15761/cogrm.1000217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
BACKGROUND AND AIMS Many kinds of insoles and pads are commonly used as a conservative treatment of metatarsalgia. However, earlier studies of insole treatment provide contradictory results, and the natural progression of metatarsalgia is still unknown. The aims of this study were to (1) determine whether simple custom-made metatarsal pad insoles reduce pain and improve functional ability, (2) find out patients' satisfaction with padding treatment, and (3) investigate predisposing factors for metatarsalgia. MATERIAL AND METHODS All metatarsalgia patients provided with metatarsal pad insoles during a 2-year period at Kuopio University Hospital (n = 45) were included in the study and observed at least a year. In all, 25 patients were interviewed about their situation before and after treatment. The Numeric Rating Scale for pain and American Orthopaedic Foot & Ankle Society forefoot questionnaire included questions about predisposing factors, other diseases, exercise, work, shoes, and satisfaction with insoles. Foot X-rays taken from 45 patients during treatment were analyzed. RESULTS The mean age of the patients was 56 years (range 34-84 years); 87% of them were women. In all, 47% of patients had osteoarthritic changes in the first metatarsophalangeal joint, and 42% had hallux valgus. In the interviewed subgroup (n = 25) body mass index was normal in 44%, and 36% were mildly overweight. High-heeled shoes were used by 40% daily, and 68% had done standing work for several years. Pain decreased significantly on the Numeric Rating Scale: 3.2 points in all patients ( p < 0.001), 3.1 points among women, and 4.25 points among men. The American Orthopaedic Foot & Ankle Society score improved 24.2 points in all patients ( p < 0.001, range 0-100), among women 19 points, and among men 29 points. CONCLUSION Metatarsalgia affects mostly women and is often preceded by extensive use of high heels and standing work. Also, a high association of first metatarsophalangeal arthrosis and hallux valgus was found. Metatarsal pads reduce pain and improve the American Orthopaedic Foot & Ankle Society score. We recommend metatarsal padding as a safe and inexpensive alternative in treating metatarsalgia patients.
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Affiliation(s)
- K Männikkö
- 1 Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland.,2 Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - J Sahlman
- 1 Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
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6
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Kulkas A, Leppänen T, Sahlman J, Tiihonen P, Mervaala E, Kokkarinen J, Randell J, Seppä J, Töyräs J, Tuomilehto H. Weight loss alters severity of individual nocturnal respiratory events depending on sleeping position. Physiol Meas 2014; 35:2037-52. [DOI: 10.1088/0967-3334/35/10/2037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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7
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Kulkas A, Leppänen T, Sahlman J, Tiihonen P, Mervaala E, Kokkarinen J, Randell J, Seppä J, Tuomilehto H, Töyräs J. Novel parameters reflect changes in morphology of respiratory events during weight loss. Physiol Meas 2013; 34:1013-26. [DOI: 10.1088/0967-3334/34/9/1013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sahlman J, Seppä J, Herder C, Peltonen M, Peuhkurinen K, Gylling H, Vanninen E, Tukiainen H, Punnonen K, Partinen M, Uusitupa M, Tuomilehto H. Effect of weight loss on inflammation in patients with mild obstructive sleep apnea. Nutr Metab Cardiovasc Dis 2012; 22:583-590. [PMID: 21193295 DOI: 10.1016/j.numecd.2010.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 09/08/2010] [Accepted: 10/11/2010] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIMS Inflammation may be one mediating mechanism for cardiovascular diseases in obstructive sleep apnea (OSA). However, little is known about subclinical inflammation or the effect of lifestyle intervention on inflammation in early stages of OSA. The aim of this substudy of an existing randomized controlled trial, with post hoc analyses, was to determine the impact of lifestyle changes aimed at weight reduction on inflammatory biomarkers in overweight patients with mild OSA. METHODS AND RESULTS Patients were randomized to supervised intensive lifestyle intervention group (N=28) or to control group (N=31), which received routine lifestyle advices. Circulating concentrations of pro- and anti-inflammatory mediators were measured before and after the 1-year intervention. The concentrations of two pro-inflammatory mediators, high-sensitivity C-reactive protein (hsCRP) and interleukin (IL)-6, decreased significantly in both groups. Although the changes in inflammatory biomarkers favored the supervised lifestyle intervention, the only significant reduction observed between the groups was for the anti-inflammatory IL-1 receptor antagonist (IL-1RA). The change in hsCRP was associated with apnea-hypopnea index, and improving night-time oxygen saturation was related to tumor necrosis factor alpha. IL-1RA and IL-6 were associated with insulin metabolism. CONCLUSION Weight loss resulted in reductions in concentrations of some pro- and anti-inflammatory mediators in overweight patients with mild OSA, overall favoring the supervised lifestyle intervention. These findings suggest that more intensive treatment of obesity in OSA patients might be well-justified.
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Affiliation(s)
- J Sahlman
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland.
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Kaikkonen M, Joukainen A, Sahlman J. [Treatment of plantar fasciopathy]. Duodecim 2012; 128:1777-1785. [PMID: 23033788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Plantar fasciopathy is the most frequent reason for foot pain. It is characterized by degeneration of the insertion of the plantar fascia on the medial process of the calcaneal tuberosity. Palpation over plantar fascia insertion reproduces the pain and may reveal swelling. Conservative treatment is almost always successful. Initial treatment consists of anti-inflammatory medication, stretching exercises, night splints and shoe inserts. If these fail, steroid injections, custom made orthotics, and extra corporeal shock wave therapy may be tried. If disabling pain persists for more than one year, surgery may be indicated.
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Affiliation(s)
- Mira Kaikkonen
- Kuopion yliopistollinen sairaala ja Itä-Suomen yliopisto
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10
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Blomster H, Kemppainen T, Numminen J, Ruoppi P, Sahlman J, Peltonen M, Seppa J, Tuomilehto H. Impaired nasal breathing may prevent the beneficial effect of weight loss in the treatment of OSA. Rhinology 2011. [DOI: 10.4193/rhin11.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kaleva E, Virén T, Saarakkala S, Sahlman J, Sirola J, Puhakka J, Paatela T, Kröger H, Kiviranta I, Jurvelin JS, Töyräs J. Arthroscopic Ultrasound Assessment of Articular Cartilage in the Human Knee Joint: A Potential Diagnostic Method. Cartilage 2011; 2:246-53. [PMID: 26069583 PMCID: PMC4300807 DOI: 10.1177/1947603510391781] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We tested whether an intra-articular ultrasound (IAUS) method could be used to evaluate cartilage status arthroscopically in human knee joints in vivo. DESIGN Seven patients undergoing arthroscopic surgery of the knee were enrolled in this study. An ultrasonic examination was conducted using the same portals as in the arthroscopic surgery. A high-frequency (40-MHz) ultrasound transducer (diameter = 1 mm) was directed to the desired location on the articular surface under arthroscopic control. In addition to ultrasound data, an IAUS video and optical video through the arthroscope were recorded. Classification of cartilage injuries according to International Cartilage Repair Society, as conducted by the orthopedic surgeon, provided reference data for comparison with the IAUS. RESULTS The IAUS method was successful in imaging different characteristics of the articular surfaces (e.g., intact surface, surface fibrillation, and lesions of varying depth). In some cases, also the subchondral bone and abnormal internal cartilage structure were visible in the IAUS images. Specifically, using the IAUS, a local cartilage lesion of 1 patient was found to be deeper than estimated arthroscopically. CONCLUSIONS The IAUS method provided a novel arthroscopic method for quantitative imaging of articular cartilage lesions. The IAUS provided quantitative information about the cartilage integrity and thickness, which are not available in conventional arthroscopy. The present equipment is already approved by the Food and Drug Administration for intravascular use and might be transferred to intra-articular use. The invasiveness of the IAUS method might restrict its wider clinical use but combined with arthroscopy, ultrasonic assessment may enlarge the diagnostic potential of arthroscopic surgery.
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Affiliation(s)
- Erna Kaleva
- Department of Physics and Mathematics, University of Eastern Finland, Kuopio Campus, Kuopio, Finland,Erna Kaleva, PhD, Department of Physics and Mathematics, University of Eastern Finland, Kuopio Campus, PO Box 1627, FI-70211 Kuopio, Finland
| | - Tuomas Virén
- Department of Physics and Mathematics, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - Simo Saarakkala
- Department of Physics and Mathematics, University of Eastern Finland, Kuopio Campus, Kuopio, Finland,Department of Diagnostic Radiology, University of Oulu, Oulu, Finland
| | - Janne Sahlman
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - Joonas Sirola
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
| | - Jani Puhakka
- Orthopaedic Research Laboratory, University of Helsinki, Helsinki, Finland
| | - Teemu Paatela
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Heikki Kröger
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland,Bone and Cartilage Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Ilkka Kiviranta
- Orthopaedic Research Laboratory, University of Helsinki, Helsinki, Finland,Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Jukka S. Jurvelin
- Department of Physics and Mathematics, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - Juha Töyräs
- Department of Physics and Mathematics, University of Eastern Finland, Kuopio Campus, Kuopio, Finland,Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland
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Nieminen J, Sahlman J, Hirvonen T, Lapveteläinen T, Miettinen M, Arnala I, Malluche HH, Helminen HJ. Disturbed synthesis of type II collagen interferes with rate of bone formation and growth and increases bone resorption in transgenic mice. Calcif Tissue Int 2008; 82:229-37. [PMID: 18297226 DOI: 10.1007/s00223-008-9110-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 01/13/2008] [Indexed: 10/22/2022]
Abstract
Transgenic mice carrying an internally deleted human type II collagen gene (COL2A1) were used to study bone growth and development. This mutation has previously been shown to disturb the development of collagen fibrils in articular cartilage, causing chondrodysplasia and osteoarthritis. Type II collagen expression in bones was investigated with immunohistochemistry. The development and mineralization of the skeleton and anthropometric measurements on bones were evaluated using X-rays and dynamic histomorphometry. Type II collagen was expressed in the cartilage of developing bones. The bones of transgenic mice were smaller compared with the controls. The bone mass remained almost unchanged in transgenic mice after 1 month of age, leading to differences of 47% in trabecular bone volume (P = 0.012) and 40% in trabecular thickness (P < 0.01) at the age of 3 months compared with controls. At the age of 3 months the eroded surface per bone volume was 31% greater in transgenic mice compared with controls (P < 0.05). Trabecular thickness correlated positively with body weight (R = 0.71, P < 0.001). Interestingly, body weight correlated with bone volume in control mice (R = 0.27, P < 0.01), but no correlation was observed in transgenic mice. The disturbed synthesis of cartilage-specific type II collagen in growing transgenic mice retarded bone development, increased bone resorption, and altered tissue properties. This led to a negative net bone balance and small bone size. The results support the idea that an altered synthesis of cartilage-specific molecule(s) can disturb postnatal bone development and growth.
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Affiliation(s)
- Jyrki Nieminen
- Coxa Hospital for Joint Replacement, PO Box 652, FIN-33101 Tampere, Finland.
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13
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Kaarniranta K, Ihanamäki T, Sahlman J, Pulkkinen H, Uusitalo H, Arita M, Tammi R, Lammi MJ, Helminen HJ. A mouse model for Stickler's syndrome: ocular phenotype of mice carrying a targeted heterozygous inactivation of type II (pro)collagen gene (Col2a1). Exp Eye Res 2006; 83:297-303. [PMID: 16546167 DOI: 10.1016/j.exer.2005.11.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Revised: 10/11/2005] [Accepted: 11/25/2005] [Indexed: 11/30/2022]
Abstract
The influences of targeted heterozygous inactivation of type II (pro)collagen gene (Col2a1) on eye structures in the 15-month-old C57BL/6JOlaHsd mouse was studied. The eyes were collected from C57BL mice heterozygous for a targeted inactivation of one allele of the Col2a1 gene (Col2a1(+/-) mice). The eyes of C57BL mice with normal gene alleles were used as controls (Col2a1(+/+) mice). Ocular histology was analyzed from tissue sections, stained with hematoxylin and eosin, toluidine blue and alcian blue. Type II collagen was localized by immunohistochemistry. Hyaluronan (HA) was stained utilizing the biotinylated complex of the hyaluronan-binding region of aggrecan and link protein (bHABC). The anterior segment of the eye was well-formed in both genotypes, but typical folding of ciliary processes was decreased, while increased stromal extracellular matrix vacuolization was seen in the Col2a1(+/-) mice. In the lens of these mice, subcapsular extracellular matrix changes were observed. Differences in retinal structures or the number of the eyes with retinal detachment were not detected between the genotypes. In Col2a1(+/-) mice, staining for type II collagen was weaker in cornea, ciliary body, iris, lens, vitreous, retina, choroid and sclera than in the control mice. HA staining was detected in the extraocular tissues, ciliary body, iris and the choroid of both genotypes. HA staining was observed only in the vitreous body of the control animals. Heterozygous inactivation of Col2a1 gene causes structural defects in the murine eye. The observed structural changes in the ciliary body, lens and vitreous of the Col2a1(+/-) mice may represent ocular features found in the human Stickler syndrome, where the abnormalities result from COL2A1 gene mutations which lead to functional haploinsufficiency.
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Affiliation(s)
- Kai Kaarniranta
- Department of Ophthalmology, University of Kuopio, P.O. Box 1627, 70211 Kuopio, Finland.
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Nieminen J, Sahlman J, Hirvonen T, Jämsä T, Tuukkanen J, Kovanen V, Kröger H, Jurvelin J, Arita M, Li SW, Prockop DJ, Hyttinen MM, Helminen HJ, Lapveteläinen T, Puustjärvi K. Abnormal response to physical activity in femurs after heterozygous inactivation of one allele of the Col2a1 gene for type II collagen in mice. Calcif Tissue Int 2005; 77:104-12. [PMID: 15920676 DOI: 10.1007/s00223-004-0069-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2004] [Accepted: 01/12/2005] [Indexed: 11/28/2022]
Abstract
The objective of this study was to evaluate the influence of heterozygous inactivation of one allele of the type II collagen gene (Col2a1) on biomechanical properties and mineral density of bone under physical loading conditions. C57BL/6-TGN mice with heterozygous knockout (HZK) inactivation of Col2a1 gene and their nontransgenic littermate controls were housed in individual cages with running wheels for 9 and 15 months. The running activity of each mouse was monitored continuously throughout the experiment. Bone mineral density (BMD) of mice femora was measured using dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computerized tomography (pQCT). Biomechanical properties were determined using three-point bending tests. Vertebral bone samples were prepared for quantitative polarized light microscopy and digital densitometry of proteoglycans. The concentration of total collagen and collagen cross-links were analyzed using high-performance liquid chromatograpy (HPLC). The average daily running distance was shorter for the HZK mice between the age of 4 and 15 months as compared with normal runners (P < 0.05). The ultimate breaking force was 14.8% and 23.6% (9 vs. 15 months) lower in HZK-runners than in wild-type runners. BMD of the femur was 6.1% lower in HZK-runners at the age of 9 months (P < 0.05). Physical activity increased cortical BMD in wild-type runners but not in the HZK runners at the age of 9 months. The collagen network of the HZK mice was less organized. There were only minor changes in BMD and mechanical and structural properties between sedentary HZK mice and their wild-type controls. Increased physical activity induced significantly lower bone density, mechanical properties, and organization of collagen fibers in male HZK mice. However, there were no major differences in biomechanical parameters between sedentary HZK and wild-type male mice. This suggests an important guiding role of collagen type II in bone remodelling and maturation.
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Affiliation(s)
- J Nieminen
- Department of Surgery, University Hospital of Tampere and Coxa Hospital for Joint Replacement, P.O.B. 652, FIN-33101, Tampere, Finland.
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Sahlman J, Pitkänen MT, Prockop DJ, Arita M, Li SW, Helminen HJ, Långsjö TK, Puustjärvi K, Lammi MJ. A human COL2A1 gene with an Arg519Cys mutation causes osteochondrodysplasia in transgenic mice. ACTA ACUST UNITED AC 2004; 50:3153-60. [PMID: 15476249 DOI: 10.1002/art.20552] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE An arginine-to-cysteine substitution at position 519 of the COL2A1 gene causes early generalized osteoarthritis with mild chondrodysplasia in humans. In this study, a human COL2A1 gene with the same mutation was introduced into a murine genome having 1 or no alleles of the murine Col2a1 gene, and the skeletal phenotypes of the transgenic mice were compared with those of control mice. METHODS Mice with 1 allele of the normal murine Col2a1 gene and 1 allele of the mutated human COL2A1 gene (n = 10), those with no murine Col2a1 gene and 2 alleles of the mutated human COL2A1 gene (n = 13), those with no murine Col2a1 gene and only 1 allele of the mutated COL2A1 gene (n = 9), and normal control mice (n = 11) were studied for skeletal abnormalities, using radiographic imaging and light microscopic analyses of histologic sections. The collagen network of cartilage was also investigated with transmission electron microscopy. RESULTS At 2 months of age, all transgenic mice had dysplastic changes in their long bones, flattened vertebral bodies, and osteoarthritic changes in their joints. The intervertebral discs of the transgenic animals were degenerated, and their histologic structure was disturbed. The changes were more severe in mice with no murine Col2a1 allele. CONCLUSION The human COL2A1 gene with the Arg519Cys mutation causes osteochondrodysplasia in mice, as it does in humans.
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Lapveteläinen T, Hyttinen MM, Säämänen AM, Långsjö T, Sahlman J, Felszeghy S, Vuorio E, Helminen HJ. Lifelong voluntary joint loading increases osteoarthritis in mice housing a deletion mutation in type II procollagen gene, and slightly also in non-transgenic mice. Ann Rheum Dis 2002; 61:810-7. [PMID: 12176806 PMCID: PMC1754230 DOI: 10.1136/ard.61.9.810] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the effects of voluntary running on the incidence and severity of osteoarthritis (OA) and associated changes in cartilage matrix and subchondral bone in a transgenic Del1 mouse model for OA. METHODS Del1 mice and their non-transgenic littermate controls were housed from the age of 5-6 weeks to 15 months in individual cages with running wheels. The running activity of each mouse was monitored for the entire 12 month period. Additional Del1 and control mice were housed in individual cages without running wheels. At the end of the experiment the severity of OA was evaluated by light microscopy, and the articular cartilage matrix changes by digital densitometry and quantitative polarised light microscopy. RESULTS Lifelong voluntary running increased the incidence and severity of OA significantly in Del1 mice (transgenic runners), and slightly also in non-transgenic runners. Severe OA changes increased from 39% in transgenic non-runners to 90% in transgenic runners (p=0.006) in lateral tibial condyles, and from 24% to 80% (p=0.013) in lateral femoral condyles, respectively. The proteoglycan content of articular cartilage was reduced in transgenic runners in comparison with transgenic non-runners (p=0.0167), but a similar effect was not seen in non-transgenic runners compared with non-transgenic non-runners. No attributable differences were seen in the collagen network of articular cartilage or in the subchondral bone between any of the groups. CONCLUSION The Del1 mutation has earlier been shown to disturb the assembly of the cartilage collagen network and thereby increase the incidence and severity of OA with age. In this study, voluntary running was shown to increase further cartilage damage in the lateral compartments of the knee. This suggests that articular cartilage in Del1 mice is less resistant to physical loading than in control mice. Despite severe OA lesions in the knee joint at the age of 15 months, Del1 mice continued to run voluntarily 2-3 km every night.
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Affiliation(s)
- T Lapveteläinen
- Department of Anatomy, University of Kuopio, 70211 Kuopio, Finland
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Sahlman J, Inkinen R, Hirvonen T, Lammi MJ, Lammi PE, Nieminen J, Lapveteläinen T, Prockop DJ, Arita M, Li SW, Hyttinen MM, Helminen HJ, Puustjärvi K. Premature vertebral endplate ossification and mild disc degeneration in mice after inactivation of one allele belonging to the Col2a1 gene for Type II collagen. Spine (Phila Pa 1976) 2001; 26:2558-65. [PMID: 11725236 DOI: 10.1097/00007632-200112010-00008] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Skeletal tissues of mice with an inactivated allele of the Col2a1 gene for Type II collagen ("heterozygous knockout") were studied. OBJECTIVE To determine whether a heterozygous inactivation of the Col2a1 gene has a role in the etiology of spine disorders such as disc degeneration. SUMMARY OF BACKGROUND DATA Mutations in the COL2A1, COL11A1, COL11A2, and COL9A2 genes have been linked to spine disorders. However, the mechanism by which genetic factors lead to disc degeneration still are largely unknown. METHODS Spine tissues were studied using radiograph analyses; conventional, quantitative, and polarized light microscopy; immunohistochemistry for the major extracellular components, and in situ hybridization for procollagens alpha1(I) and alpha1(II). Voluntary running activity also was monitored in half of the mice. RESULTS As the findings showed, 1-month-old heterozygous knockout mice had shorter limb bones, skulls, and spines, as well as thicker and more irregular vertebral endplates, which calcified earlier than in the control mice. They also had a lower concentration of glycosaminoglycans in the anulus fibrosus, in the endplates, and in the vertebral bone than the controls. These features in the heterozygous knockout mice were compensated by the age of 15 months. However, the long bones and skulls of the mature heterozygous mice remained shorter than those of the controls. Gene-deficient mice used the running wheel less. However, physical exercise did not induce any marked structural changes in the skeleton. CONCLUSION Mice with heterozygous knockout of Col2a1 show subtle early skeletal manifestations that bear some resemblance to those of human spine disorders.
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Affiliation(s)
- J Sahlman
- Department of Anatomy, University of Kuopio, FIN-70211 Kuopio, Finland
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