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Gibbons MC, Silldorff M, Okuno H, Esparza MC, Migdal C, Johnson S, Schenk S, Ward SR. The effect of tenotomy, neurotomy, and dual injury on mouse rotator cuff muscles: Consequences for the mouse as a preclinical model. J Orthop Res 2024; 42:1170-1179. [PMID: 38245849 DOI: 10.1002/jor.25786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024]
Abstract
A common animal model of muscle pathology following rotator cuff tear (RCT) is a tenotomy of the supraspinatus and infraspinatus, often combined with neurotomy of the suprascapular nerve, which induces a more robust atrophy response than tenotomy alone. However, the utility of this model depends on its similarity to human muscle pathology post-RCT, both in terms of the disease phenotype and mechanisms of muscle atrophy and fatty infiltration. Given the clinical prevalence of nerve injury is low and the muscular response to denervation is distinct from mechanical unloading in other models, an understanding of the biological influence of the nerve injury is critical for interpreting data from this RCT model. We evaluated the individual and combined effect of tenotomy and neurotomy across multiple biological scales, in a robust time-series in the mouse supraspinatus. Muscle composition, histological, and gene expression data related to muscle atrophy, degeneration-regeneration, fatty infiltration, and fibrosis were evaluated. Broadly, we found tenotomy alone caused small, transient changes in these pathological features, which resolved over the course of the study, while neurotomy alone caused a significant fatty atrophy phenotype. The dual injury group had a similar fatty atrophy phenotype to the neurotomy group, though the addition of tenotomy did marginally enhance the fat and connective tissue. Overall, these results suggest the most clinically relevant injury model, tenotomy alone, does not produce a clinically relevant phenotype. The dual injury model partially recapitulates the human condition, but it does so through a nerve injury, which is not well justified clinically.
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Affiliation(s)
- Michael C Gibbons
- Department of Bioengineering, University of California San Diego, San Diego, California, USA
| | - Morgan Silldorff
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Hiroshi Okuno
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Mary C Esparza
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Christopher Migdal
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Seth Johnson
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Simon Schenk
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
- Department of Radiology, University of California San Diego, San Diego, California, USA
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Fowler A, Knaus KR, Khuu S, Khalilimeybodi A, Schenk S, Ward SR, Fry AC, Rangamani P, McCulloch AD. Network model of skeletal muscle cell signalling predicts differential responses to endurance and resistance exercise training. Exp Physiol 2024. [PMID: 38643471 DOI: 10.1113/ep091712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/20/2024] [Indexed: 04/22/2024]
Abstract
Exercise-induced muscle adaptations vary based on exercise modality and intensity. We constructed a signalling network model from 87 published studies of human or rodent skeletal muscle cell responses to endurance or resistance exercise in vivo or simulated exercise in vitro. The network comprises 259 signalling interactions between 120 nodes, representing eight membrane receptors and eight canonical signalling pathways regulating 14 transcriptional regulators, 28 target genes and 12 exercise-induced phenotypes. Using this network, we formulated a logic-based ordinary differential equation model predicting time-dependent molecular and phenotypic alterations following acute endurance and resistance exercises. Compared with nine independent studies, the model accurately predicted 18/21 (85%) acute responses to resistance exercise and 12/16 (75%) acute responses to endurance exercise. Detailed sensitivity analysis of differential phenotypic responses to resistance and endurance training showed that, in the model, exercise regulates cell growth and protein synthesis primarily by signalling via mechanistic target of rapamycin, which is activated by Akt and inhibited in endurance exercise by AMP-activated protein kinase. Endurance exercise preferentially activates inflammation via reactive oxygen species and nuclear factor κB signalling. Furthermore, the expected preferential activation of mitochondrial biogenesis by endurance exercise was counterbalanced in the model by protein kinase C in response to resistance training. This model provides a new tool for investigating cross-talk between skeletal muscle signalling pathways activated by endurance and resistance exercise, and the mechanisms of interactions such as the interference effects of endurance training on resistance exercise outcomes.
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Affiliation(s)
- Annabelle Fowler
- Department of Bioengineering, University of California San, Diego, La Jolla, California, USA
| | - Katherine R Knaus
- Department of Bioengineering, University of California San, Diego, La Jolla, California, USA
| | - Stephanie Khuu
- Department of Bioengineering, University of California San, Diego, La Jolla, California, USA
| | - Ali Khalilimeybodi
- Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, California, USA
| | - Simon Schenk
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
| | - Andrew C Fry
- Department of Health, Sport and Exercise Sciences, University of Kansas, Lawrence, Kansas, USA
| | - Padmini Rangamani
- Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, California, USA
| | - Andrew D McCulloch
- Department of Bioengineering, University of California San, Diego, La Jolla, California, USA
- Department of Medicine, University of California San Diego, La Jolla, California, USA
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Haldeman PB, Ward SR, Osorio J, Shahidi B. An evidence based conceptual framework for the multifactorial understanding of proximal junctional kyphosis. Brain Spine 2024; 4:102807. [PMID: 38712018 PMCID: PMC11070827 DOI: 10.1016/j.bas.2024.102807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/22/2024] [Accepted: 04/04/2024] [Indexed: 05/08/2024]
Abstract
Introduction Adult spinal deformity (ASD) is a debilitating pathology that arises from a variety of etiologies. Spinal fusion surgery is the mainstay of treatment for those who do not achieve symptom relief with conservative interventions. Fusion surgery can be complicated by a secondary deformity termed proximal junctional kyphosis (PJK). Research question This scoping review evaluates the modern body of literature analyzing risk factors for PJK development and organizes these factors according to a multifactorial framework based on mechanical, tissue or demographic components. Materials and methods An extensive search of the literature was performed in PubMed and Embase back to the year 2010. Articles were assessed for quality. All risk factors that were evaluated and those that significantly predicted the development of PJK were compiled. The frequency that a risk factor was predictive compared to the number of times it was evaluated was calculated. Results 150 articles were reviewed. 57.3% of papers were of low quality. 76% of risk factors analyzed were focusing on the mechanical contribution to development of PJK versus only 5% were focusing on the tissue-based contribution. Risk factors that were most frequently predictive compared to how often they were analyzed were Hounsfield Units of vertebrae, UIV disc degeneration, paraspinal muscle cross sectional area and fatty infiltration, ligament augmentation, instrument characteristics, postoperative hip and lower extremity radiographic metrics, and postoperative teriparatide supplementation. Discussion and conclusion This review finds a multifactorial framework accounting for mechanical, patient and tissue-based risk factors will improve the understanding of PJK development.
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Affiliation(s)
| | - Samuel R. Ward
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, CA, USA
| | - Joseph Osorio
- Department of Neurological Surgery, UC San Diego, La Jolla, CA, USA
| | - Bahar Shahidi
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, CA, USA
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Balayan A, DeBoutray M, Molley TG, Ruoss S, Maceda M, Sevier A, Robertson CM, Ward SR, Engler AJ. Dispase/collagenase cocktail allows for coisolation of satellite cells and fibroadipogenic progenitors from human skeletal muscle. Am J Physiol Cell Physiol 2024; 326:C1193-C1202. [PMID: 38581669 DOI: 10.1152/ajpcell.00023.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 04/08/2024]
Abstract
Satellite cells (SCs) and fibroadipogenic progenitors (FAPs) are progenitor populations found in muscle that form new myofibers postinjury. Muscle development, regeneration, and tissue-engineering experiments require robust progenitor populations, yet their isolation and expansion are difficult given their scarcity in muscle, limited muscle biopsy sizes in humans, and lack of methodological detail in the literature. Here, we investigated whether a dispase and collagenase type 1 and 2 cocktail could allow dual isolation of SCs and FAPs, enabling significantly increased yield from human skeletal muscle. Postdissociation, we found that single cells could be sorted into CD56 + CD31-CD45- (SC) and CD56-CD31-CD45- (FAP) cell populations, expanded in culture, and characterized for lineage-specific marker expression and differentiation capacity; we obtained ∼10% SCs and ∼40% FAPs, with yields twofold better than what is reported in current literature. SCs were PAX7+ and retained CD56 expression and myogenic fusion potential after multiple passages, expanding up to 1012 cells. Conversely, FAPs expressed CD140a and differentiated into either fibroblasts or adipocytes upon induction. This study demonstrates robust isolation of both SCs and FAPs from the same muscle sample with SC recovery more than two times higher than previously reported, which could enable translational studies for muscle injuries.NEW & NOTEWORTHY We demonstrated that a dispase/collagenase cocktail allows for simultaneous isolation of SCs and FAPs with 2× higher SC yield compared with other studies. We provide a thorough characterization of SC and FAP in vitro expansion that other studies have not reported. Following our dissociation, SCs and FAPs were able to expand by up to 1012 cells before reaching senescence and maintained differentiation capacity in vitro demonstrating their efficacy for clinical translation for muscle injury.
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Affiliation(s)
- Alis Balayan
- Biomedical Sciences Program, UC San Diego, La Jolla, California, United States
| | - Marie DeBoutray
- Department of ENT and Maxillofacial Surgery, Montpellier University, Montpellier, France
| | - Thomas G Molley
- Chien-Lay Department of Bioengineering, UC San Diego, La Jolla, California, United States
| | - Severin Ruoss
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, California, United States
| | - Matthew Maceda
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, California, United States
| | - Ashley Sevier
- California State University, Bakersfield, Bakersfield, California, United States
| | - Catherine M Robertson
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, California, United States
| | - Samuel R Ward
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, California, United States
- Department of Radiology, UC San Diego, La Jolla, California, United States
| | - Adam J Engler
- Biomedical Sciences Program, UC San Diego, La Jolla, California, United States
- Chien-Lay Department of Bioengineering, UC San Diego, La Jolla, California, United States
- Sanford Consortium for Regenerative Medicine, La Jolla, California, United States
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Son J, Ward SR, Lieber RL. Scaling relationships between human leg muscle architectural properties and body size. J Exp Biol 2024; 227:jeb246567. [PMID: 38357776 DOI: 10.1242/jeb.246567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
A skeletal muscle's peak force production and excursion are based on its architectural properties that are, in turn, determined by its mass, muscle fiber length and physiological cross-sectional area (PCSA). In the classic interspecific study of mammalian muscle scaling, it was demonstrated that muscle mass scales positively allometrically with body mass whereas fiber length scales isometrically with body mass, indicating that larger mammals have stronger leg muscles than they would if they were geometrically similar to smaller ones. Although this relationship is highly significant across species, there has never been a detailed intraspecific architectural scaling study. We have thus created a large dataset of 896 muscles across 34 human lower extremities (18 females and 16 males) with a size range including approximately 90% and 70% of the United States population height and mass, respectively, across the range 36-103 years. Our purpose was to quantify the scaling relationships between human muscle architectural properties and body size. We found that human muscles depart greatly from isometric scaling because muscle mass scales with body mass1.3 (larger exponent than isometric scaling of 1.0) and muscle fiber length scales with negative allometry with body mass0.1 (smaller exponent than isometric scaling of 0.33). Based on the known relationship between architecture and function, these results suggest that human muscles place a premium on muscle force production (mass and PCSA) at the expense of muscle excursion (fiber length) with increasing body size, which has implications for understanding human muscle design as well as biomechanical modeling.
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Affiliation(s)
- Jongsang Son
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ 07102, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA 92093, USA
- Department of Radiology, University of California San Diego, La Jolla, CA 92093, USA
| | - Richard L Lieber
- Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Department of Physiology, Northwestern University, Chicago, IL 60611, USA
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL 60611, USA
- Research Service, Hines VA Hospital, Maywood, IL 60153, USA
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Shahidi B, Anderson B, Ordaz A, Berry DB, Ruoss S, Zlomislic V, Allen RT, Garfin SR, Farshad M, Schenk S, Ward SR. Paraspinal muscles in individuals undergoing surgery for lumbar spine pathology lack a myogenic response to an acute bout of resistance exercise. JOR Spine 2024; 7:e1291. [PMID: 38222805 PMCID: PMC10782077 DOI: 10.1002/jsp2.1291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 01/16/2024] Open
Abstract
Background Lumbar spine pathology (LSP) is a common source of low back or leg pain, and paraspinal muscle in these patients demonstrates fatty and fibrotic infiltration, and cellular degeneration that do not reverse with exercise-based rehabilitation. However, it is unclear of this lack of response is due to insufficient exercise stimulus, or an inability to mount a growth response. The purpose of this study was to compare paraspinal muscle gene expression between individuals with LSP who do and do not undergo an acute bout of resistance exercise. Methods Paraspinal muscle biopsies were obtained from 64 individuals with LSP undergoing spinal surgery. Eight participants performed an acute bout of machine-based lumbar extension resistance exercise preoperatively. Gene expression for 42 genes associated with adipogenic/metabolic, atrophic, fibrogenic, inflammatory, and myogenic pathways was measured, and differential expression between exercised and non-exercised groups was evaluated for (a) the full cohort, and (b) an age, gender, acuity, and etiology matched sub-cohort. Principal components analyses were used to identify gene expression clustering across clinical phenotypes. Results The exercised cohort demonstrated upregulation of inflammatory gene IL1B, inhibition of extracellular matrix components (increased MMP3&9, decreased TIMP1&3, COL1A1) and metabolic/adipogenic genes (FABP4, PPARD, WNT10B), and downregulation of myogenic (MYOD, ANKRD2B) and atrophic (FOXO3) genes compared to the non-exercised cohort, with similar patterns in the matched sub-analysis. There were no clinical phenotypes significantly associated with gene expression profiles. Conclusion An acute bout of moderate-high intensity resistance exercise did not result in upregulation of myogenic genes in individuals with LSP. The response was characterized by mixed metabolic and fibrotic gene expression, upregulation of inflammation, and downregulation of myogenesis.
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Affiliation(s)
- Bahar Shahidi
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
| | - Bradley Anderson
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
| | - Angel Ordaz
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
| | - David B. Berry
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
- UC San Diego Department of RadiologyLa JollaCaliforniaUSA
| | - Severin Ruoss
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
| | - Vinko Zlomislic
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
| | - R. Todd Allen
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
| | - Steven R. Garfin
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
| | - Mazda Farshad
- Balgrist University HospitalUniversity of ZurichZürichSwitzerland
| | - Simon Schenk
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
| | - Samuel R. Ward
- UC San Diego Department of Orthopaedic SurgeryLa JollaCaliforniaUSA
- UC San Diego Department of RadiologyLa JollaCaliforniaUSA
- UC San Diego Department of BioengineeringLa JollaCaliforniaUSA
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Berry DB, Galinsky VL, Hutchinson EB, Galons JP, Ward SR, Frank LR. Double pulsed field gradient diffusion MRI to assess skeletal muscle microstructure. Magn Reson Med 2023; 90:1582-1593. [PMID: 37392410 DOI: 10.1002/mrm.29751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/28/2023] [Accepted: 05/21/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Preliminary study to determine whether double pulsed field gradient (PFG) diffusion MRI is sensitive to key features of muscle microstructure related to function. METHODS The restricted diffusion profile of molecules in models of muscle microstructure derived from histology were systematically simulated using a numerical simulation approach. Diffusion tensor subspace imaging analysis of the diffusion signal was performed, and spherical anisotropy (SA) was calculated for each model. Linear regression was used to determine the predictive capacity of SA on the fiber area, fiber diameter, and surface area to volume ratio of the models. Additionally, a rat model of muscle hypertrophy was scanned using a single PFG and a double PFG pulse sequence, and the restricted diffusion measurements were compared with histological measurements of microstructure. RESULTS Excellent agreement between SA and muscle fiber area (r2 = 0.71; p < 0.0001), fiber diameter (r2 = 0.83; p < 0.0001), and surface area to volume ratio (r2 = 0.97; p < 0.0001) in simulated models was found. In a scanned rat leg, the distribution of these microstructural features measured from histology was broad and demonstrated that there is a wide variance in the microstructural features observed, similar to the SA distributions. However, the distribution of fractional anisotropy measurements in the same tissue was narrow. CONCLUSIONS This study demonstrates that SA-a scalar value from diffusion tensor subspace imaging analysis-is highly sensitive to muscle microstructural features predictive of function. Furthermore, these techniques and analysis tools can be translated to real experiments in skeletal muscle. The increased dynamic range of SA compared with fractional anisotropy in the same tissue suggests increased sensitivity to detecting changes in tissue microstructure.
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Affiliation(s)
- D B Berry
- Department of Orthopedic Surgery, University of California, San Diego, California, USA
- Department of Nanoengineering, University of California, San Diego, San Diego, California, USA
| | - V L Galinsky
- Center for Scientific Computation in Imaging, University of California, San Diego, San Diego, California, USA
| | - E B Hutchinson
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA
| | - J P Galons
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - S R Ward
- Department of Orthopedic Surgery, University of California, San Diego, California, USA
- Department of Radiology, University of California, San Diego, California, USA
- Department of Bioengineering, University of California, San Diego, California, USA
| | - L R Frank
- Center for Scientific Computation in Imaging, University of California, San Diego, San Diego, California, USA
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Shahidi B, Padwal JA, Su JJ, Regev G, Zlomislic V, Allen RT, Garfin SR, Kim C, Lieber RL, Ward SR. The effect of fatty infiltration, revision surgery, and sex on lumbar multifidus passive mechanical properties. JOR Spine 2023; 6:e1266. [PMID: 37780825 PMCID: PMC10540820 DOI: 10.1002/jsp2.1266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/10/2023] [Accepted: 05/28/2023] [Indexed: 10/03/2023] Open
Abstract
Purpose Previous research has demonstrated increased stiffness in the multifidus muscle compared to other paraspinal muscles at the fiber bundle level. We aimed to compare single fiber and fiber bundle passive mechanical properties of multifidus muscle: (1) in 40 patients undergoing primary versus revision surgery and (2) in muscle with mild versus severe fatty infiltration. Methods The degree of muscle fatty infiltration was graded using the patients' spine magnetic resonance images. Average single fiber and fiber bundle passive mechanical properties across three tests were compared between primary (N = 30) and revision (N = 10) surgery status, between mild and severe fatty infiltration levels, between sexes, and with age from passive stress-strain tests of excised multifidus muscle intraoperative biopsies. Results At the single fiber level, elastic modulus was unaffected by degree of fatty infiltration or surgery status. Female sex (p = 0.001) and younger age (p = 0.04) were associated with lower multifidus fiber elastic modulus. At the fiber bundle level, which includes connective tissue around fibers, severe fatty infiltration (p = 0.01) and younger age (p = 0.06) were associated with lower elastic modulus. Primary surgery also demonstrated a moderate, but non-significant effect for lower elastic modulus (p = 0.10). Conclusions Our results demonstrate that female sex is the primary driver for reduced single fiber elastic modulus of the multifidus, while severity of fatty infiltration is the primary driver for reduced elastic modulus at the level of the fiber bundle in individuals with lumbar spine pathology.
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Affiliation(s)
- Bahar Shahidi
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
- Departments of RadiologyUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - Jennifer A. Padwal
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - Jeannie J. Su
- Departments of RadiologyUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - Gilad Regev
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - Vinko Zlomislic
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - R. Todd Allen
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - Steven R. Garfin
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - Choll Kim
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - Richard L. Lieber
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
- Departments of BioengineeringUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
| | - Samuel R. Ward
- Departments of Orthopaedic SurgeryUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
- Departments of RadiologyUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
- Departments of BioengineeringUniversity of California and Veterans Administration Medical CentersSan DiegoCaliforniaUSA
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Goldin AN, Dwight KD, Hentzen ER, Leek BT, Hughes-Austin JM, Ward SR, Abrams RA. A Simple and Versatile Test for Elbow Posterolateral Rotatory Instability. Hand (N Y) 2023:15589447231185585. [PMID: 37489098 DOI: 10.1177/15589447231185585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
BACKGROUND Posterolateral rotatory instability (PLRI) results from lateral ulnar collateral ligament (LCL) deficiency. The lateral pivot shift test is used to diagnose PLRI but can be difficult to perform and is poorly tolerated. We present a new maneuver, the Posterior Radiocapitellar Subluxation Test (PRST), that we believe is easier to perform. The purpose of this study was to compare the efficacy and reproducibility of the PRST with the lateral pivot shift test. METHODS We obtained 10 cadaveric upper extremity specimens, performed a Kocher approach on each, released the LCL origin in 5, then closed. The specimens were randomized, and 3 attending orthopedic surgeons and 1 resident blindly performed the PRST then the lateral pivot shift test after re-randomization and assessed presence or absence of PLRI. This process was repeated the following day. The data for each test were analyzed for sensitivity, specificity, and accuracy. RESULTS For the blinded testing when comparing PRST with the pivot shift test, overall accuracy was 77.5%, compared with 67.5% (P = .03), sensitivity was 75.0%, compared with 50.0% (P = .003), and specificity was 80.0%, compared with 85.0% (P = .55). Conclusions: The PRST appears to be at least as accurate as the lateral pivot shift test, with comparable intraobserver and interobserver reliability.
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Affiliation(s)
| | | | | | - Bryan T Leek
- University of California San Diego, La Jolla, USA
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Vasquez-Bolanos LS, Gibbons MC, Ruoss S, Wu IT, Esparza MC, Fithian DC, Lane JG, Singh A, Nasamran CA, Fisch KM, Ward SR. Transcriptional time course after rotator cuff repair in 6 month old female rabbits. Front Physiol 2023; 14:1164055. [PMID: 37228812 PMCID: PMC10203179 DOI: 10.3389/fphys.2023.1164055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/25/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction: Rotator cuff tears are prevalent in the population above the age of 60. The disease progression leads to muscle atrophy, fibrosis, and fatty infiltration, which is not improved upon with surgical repair, highlighting the need to better understand the underlying biology impairing more favorable outcomes. Methods: In this study, we collected supraspinatus muscle tissue from 6 month old female rabbits who had undergone unilateral tenotomy for 8 weeks at 1, 2, 4, or 8 weeks post-repair (n = 4/group). RNA sequencing and enrichment analyses were performed to identify a transcriptional timeline of rotator cuff muscle adaptations and related morphological sequelae. Results: There were differentially expressed (DE) genes at 1 (819 up/210 down), 2 (776/120), and 4 (63/27) weeks post-repair, with none at 8 week post-repair. Of the time points with DE genes, there were 1092 unique DE genes and 442 shared genes, highlighting that there are changing processes in the muscle at each time point. Broadly, 1-week post-repair differentially expressed genes were significantly enriched in pathways of metabolism and energetic activity, binding, and regulation. Many were also significantly enriched at 2 weeks, with the addition of NIF/NF-kappaB signaling, transcription in response to hypoxia, and mRNA stability alongside many additional pathways. There was also a shift in transcriptional activity at 4 weeks post-repair with significantly enriched pathways for lipids, hormones, apoptosis, and cytokine activity, despite an overall decrease in the number of differentially expressed genes. At 8 weeks post-repair there were no DE genes when compared to control. These transcriptional profiles were correlated with the histological findings of increased fat, degeneration, and fibrosis. Specifically, correlated gene sets were enriched for fatty acid metabolism, TGF-B-related, and other pathways. Discussion: This study identifies the timeline of transcriptional changes in muscle after RC repair, which by itself, does not induce a growth/regenerative response as desired. Instead, it is predominately related to metabolism/energetics changes at 1 week post-repair, unclear or asynchronous transcriptional diversity at 2 weeks post-repair, increased adipogenesis at 4 weeks post-repair, and a low transcriptional steady state or a dysregulated stress response at 8 weeks post-repair.
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Affiliation(s)
- Laura S. Vasquez-Bolanos
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Michael C. Gibbons
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Severin Ruoss
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Isabella T. Wu
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Mary C. Esparza
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Donald C. Fithian
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - John G. Lane
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Anshuman Singh
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
- Department of Orthopaedic Surgery, Kaiser Permanente, San Diego, CA, United States
| | - Chanond A. Nasamran
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Kathleen M. Fisch
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California, San Diego, San Diego, CA, United States
- Department of Obstetrics, Gynecology and Reproductive Science, University of California, San Diego, San Diego, CA, United States
| | - Samuel R. Ward
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
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11
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Ordaz A, Anderson B, Zlomislic V, Allen RT, Garfin SR, Schuepbach R, Farshad M, Schenk S, Ward SR, Shahidi B. Paraspinal muscle gene expression across different aetiologies in individuals undergoing surgery for lumbar spine pathology. Eur Spine J 2023; 32:1123-1131. [PMID: 36740606 PMCID: PMC10448537 DOI: 10.1007/s00586-023-07543-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 12/12/2022] [Accepted: 01/13/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to understand potential baseline transcriptional expression differences in paraspinal skeletal muscle from patients with different underlying lumbar pathologies by comparing multifidus gene expression profiles across individuals with either disc herniation, facet arthropathy, or degenerative spondylolisthesis. METHODS Multifidus biopsies were obtained from patients (n = 44) undergoing lumbar surgery for either disc herniation, facet arthropathy, or degenerative spondylolisthesis. Diagnostic categories were based on magnetic resonance images, radiology reports, and intraoperative reports. Gene expression for 42 genes was analysed using qPCR. A one-way analysis of variance was performed for each gene to determine differences in expression across diagnostic groups. Corrections for multiple comparisons across genes (Benjamini-Hochberg) and for between-group post hoc comparisons (Sidak) were applied. RESULTS Adipogenic gene (ADIPOQ) expression was higher in the disc herniation group when compared to the facet arthropathy group (p = 0.032). Adipogenic gene (PPARD) expression was higher in the degenerative spondylolisthesis group when compared to the disc herniation group (p = 0.013), although absolute gene expression levels for all groups was low. Fibrogenic gene (COL3A1) had significantly higher expression in the disc herniation group and facet arthropathy group when compared to the degenerative spondylolisthesis group (p < 0.001 and p = 0.038, respectively). When adjusted for multiple comparisons, only COL3A1 remained significant (p = 0.012). CONCLUSION Individuals with disc herniation and facet arthropathy demonstrate higher COL3A1 gene expression compared to those with degenerative spondylolisthesis. Future research is required to further understand the biological relevance of these transcriptional differences.
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Affiliation(s)
- Angel Ordaz
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA.
| | - Brad Anderson
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Vinko Zlomislic
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - R Todd Allen
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Steven R Garfin
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Regula Schuepbach
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Simon Schenk
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Bahar Shahidi
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
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12
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Ruoss S, Nasamran CA, Singh A, Lane JG, Ward SR. Are there sex-dependent transcriptional differences in human subacromial bursa from traumatic versus degenerative rotator cuff tears? J Orthop Res 2022; 40:2705-2707. [PMID: 36250743 DOI: 10.1002/jor.25450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Severin Ruoss
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, California, USA
| | - Chanond A Nasamran
- Center for Computational Biology and Bioinformatics, UC San Diego, La Jolla, California, USA
| | - Anshuman Singh
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, California, USA.,Southern California Kaiser Permanente, San Diego, California, USA
| | - John G Lane
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, California, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, UC San Diego, La Jolla, California, USA.,Department of Bioengineering, UC San Diego, La Jolla, California, USA.,Department of Radiology, UC San Diego, La Jolla, California, USA
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13
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Kiratitanaporn W, Berry DB, Mudla A, Fried T, Lao A, Yu C, Hao N, Ward SR, Chen S. 3D printing a biocompatible elastomer for modeling muscle regeneration after volumetric muscle loss. Biomaterials Advances 2022; 142:213171. [PMID: 36341746 DOI: 10.1016/j.bioadv.2022.213171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/21/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
Volumetric muscle loss (VML) injuries due to trauma, tumor ablation, or other degenerative muscle diseases are debilitating and currently have limited options for self-repair. Advancements in 3D printing allow for the rapid fabrication of biocompatible scaffolds with designer patterns. However, the materials chosen are often stiff or brittle, which is not optimal for muscle tissue engineering. This study utilized a photopolymerizable biocompatible elastomer - poly (glycerol sebacate) acrylate (PGSA) - to develop an in vitro model of muscle regeneration and proliferation into an acellular scaffold after VML injury. Mechanical properties of the scaffold were tuned by controlling light intensity during the 3D printing process to match the specific tension of skeletal muscle. The effect of both geometric (channel sizes between 300 and 600 μm) and biologic (decellularized muscle extracellular matrix (dECM)) cues on muscle progenitor cell infiltration, proliferation, organization, and maturation was evaluated in vitro using a near-infrared fluorescent protein (iRFP) transfected cell line to assess cells in the 3D scaffold. Larger channel sizes and dECM coating were found to enhance cell proliferation and maturation, while no discernable effect on cell alignment was observed. In addition, a pilot experiment was carried out to evaluate the regenerative capacity of this scaffold in vivo after a VML injury. Overall, this platform demonstrates a simple model to study muscle progenitor recruitment and differentiation into acellular scaffolds after VML repair.
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14
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Ruoss S, Esparza MC, Vasquez-Bolanos LS, Nasamran CA, Fisch KM, Engler AJ, Ward SR. Spatial transcriptomics tools allow for regional exploration of heterogeneous muscle pathology in the pre-clinical rabbit model of rotator cuff tear. J Orthop Surg Res 2022; 17:440. [PMID: 36195913 PMCID: PMC9531386 DOI: 10.1186/s13018-022-03326-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 06/28/2022] [Accepted: 09/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background Conditions affecting skeletal muscle, such as chronic rotator cuff tears, low back pain, dystrophies, and many others, often share changes in muscle phenotype: intramuscular adipose and fibrotic tissue increase while contractile tissue is lost. The underlying changes in cell populations and cell ratios observed with these phenotypic changes complicate the interpretation of tissue-level transcriptional data. Novel single-cell transcriptomics has limited capacity to address this problem because muscle fibers are too long to be engulfed in single-cell droplets and single nuclei transcriptomics are complicated by muscle fibers’ multinucleation. Therefore, the goal of this project was to evaluate the potential and challenges of a spatial transcriptomics technology to add dimensionality to transcriptional data in an attempt to better understand regional cellular activity in heterogeneous skeletal muscle tissue. Methods The 3′ Visium spatial transcriptomics technology was applied to muscle tissue of a rabbit model of rotator cuff tear. Healthy control and tissue collected at 2 and 16 weeks after tenotomy was utilized and freshly snap frozen tissue was compared with tissue stored for over 6 years to evaluate whether this technology is retrospectively useful in previously acquired tissues. Transcriptional information was overlayed with standard hematoxylin and eosin (H&E) stains of the exact same histological sections. Results Sequencing saturation and number of genes detected was not affected by sample storage duration. Unbiased clustering matched the underlying tissue type-based on H&E assessment. Connective-tissue-rich areas presented with lower unique molecular identifier counts are compared with muscle fibers even though tissue permeabilization was standardized across the section. A qualitative analysis of resulting datasets revealed heterogeneous fiber degeneration–regeneration after tenotomy based on (neonatal) myosin heavy chain 8 detection and associated differentially expressed gene analysis. Conclusions This protocol can be used in skeletal muscle to explore spatial transcriptional patterns and confidently relate them to the underlying histology, even for tissues that have been stored for up to 6 years. Using this protocol, there is potential for novel transcriptional pathway discovery in longitudinal studies since the transcriptional information is unbiased by muscle composition and cell type changes.
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Affiliation(s)
- Severin Ruoss
- Department of Orthopaedic Surgery, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0863, USA
| | - Mary C Esparza
- Department of Orthopaedic Surgery, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0863, USA
| | - Laura S Vasquez-Bolanos
- Department of Orthopaedic Surgery, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0863, USA.,Department of Bioengineering, UC San Diego, La Jolla, CA, USA
| | - Chanond A Nasamran
- Center for Computational Biology and Bioinformatics, UC San Diego, La Jolla, CA, USA
| | - Kathleen M Fisch
- Center for Computational Biology and Bioinformatics, UC San Diego, La Jolla, CA, USA.,Department of Obstetrics, Gynecology and Reproductive Sciences, UC San Diego, La Jolla, CA, USA
| | - Adam J Engler
- Department of Bioengineering, UC San Diego, La Jolla, CA, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0863, USA. .,Department of Bioengineering, UC San Diego, La Jolla, CA, USA. .,Department of Radiology, UC San Diego, La Jolla, CA, USA.
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15
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Gurusamy P, Larsen BA, Allen RT, Ward SR, Allison MA, Hughes-Austin JM. Density and Fat Fraction of the Psoas, Paraspinal, and Oblique Muscle Groups Are Associated With Lumbar Vertebral Bone Mineral Density in a Multi-Ethnic Community-Living Population: The Multi-Ethnic Study of Atherosclerosis. J Bone Miner Res 2022; 37:1537-1544. [PMID: 35690917 PMCID: PMC9682975 DOI: 10.1002/jbmr.4634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/25/2022] [Accepted: 06/09/2022] [Indexed: 11/06/2022]
Abstract
Low vertebral bone mass is a major risk factor for vertebral compression fractures. Although sarcopenia has been shown to be associated with low bone mineral density (BMD), it is not known whether trunk musculature is directly associated with lumbar BMD, and whether exercise modifies this association. Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we sought to determine the association of muscle density and fat fraction of the psoas, paraspinal, and oblique muscle groups with L3 lumbar volumetric BMD, and whether these associations were modified by exercise. We obtained L3 vBMD measurements, and fat and muscle measurements (in Hounsfield units [HU]) from abdominal computed tomography (CT) scans spanning the L2 -L4 intervertebral disc spaces. Muscle density was defined as the mean HU value for a muscle group area. Fat fraction was calculated as the mean HU value for the muscle group fat area/total muscle group area (cm2 ). Exercise data were self-reported (MET-minute/week). We utilized multivariable linear regression to evaluate these associations, stratified by gender, and adjusting for demographics, body mass index (BMI), smoking status, impaired fasting glucose, and corticosteroid and anti-resorptive medication use. Among 1923 MESA participants, mean ± standard deviation (SD) age was 62 ± 10 years, 49% were female, 40% white, 21% black, 26% Hispanic/Latino, and 13% Chinese. In fully adjusted analysis, for every 1-SD higher psoas fat fraction, there was a 3.19-SD lower L3 vBMD in men and 4.3-SD lower L3 vBMD in women (p < 0.001). For every 1-SD higher psoas density, there was a 0.2-SD higher L3 vBMD (p < 0.001) in men and 0.19-SD higher L3 vBMD (p < 0.001) in women. Findings were similar for paraspinal and oblique muscles. Intentional exercise did not modify these associations. In men and women, trunk muscle density was positively associated with higher lumbar BMD, suggesting a local association. Future studies are warranted to determine the temporality of this association. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Pradyumna Gurusamy
- Department of Orthopaedic Surgery, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Britta A Larsen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Richard T Allen
- Department of Orthopaedic Surgery, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, School of Medicine, University of California, San Diego, La Jolla, CA, USA.,Department of Radiology, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Matthew A Allison
- Division of Preventive Medicine, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Jan M Hughes-Austin
- Department of Orthopaedic Surgery, School of Medicine, University of California, San Diego, La Jolla, CA, USA
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16
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Emanuelsson EB, Berry DB, Reitzner SM, Arif M, Mardinoglu A, Gustafsson T, Ward SR, Sundberg CJ, Chapman MA. MRI characterization of skeletal muscle size and fatty infiltration in long-term trained and untrained individuals. Physiol Rep 2022; 10:e15398. [PMID: 35854646 PMCID: PMC9296904 DOI: 10.14814/phy2.15398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/21/2022] [Accepted: 07/02/2022] [Indexed: 06/15/2023] Open
Abstract
This study investigated body composition measures in highly trained and untrained individuals using whole-body magnetic resonance imaging (MRI). Additionally, correlations between these measures and skeletal muscle gene expression were performed. Thirty-six individuals were included: endurance-trained males (ME, n = 8) and females (FE, n = 7), strength-trained males (MS, n = 7), and untrained control males (MC, n = 8) and females (FC, n = 6). MRI scans were performed, and resting M. vastus lateralis (VL) biopsies were subjected to RNA sequencing. Liver fat fraction, visceral adipose tissue volume (VAT), total body fat, and total lean tissue were measured from MRI data. Additionally, cross-sectional area (CSA) and fat signal fraction (FSF) were calculated from Mm. pectoralis, M. erector spinae and M. multifidus combined, Mm. quadriceps, and Mm. triceps surae (TS). Liver fat fraction, VAT, and total body fat relative to body weight were lower in ME and FE compared with corresponding controls. MS had a larger CSA across all four muscle groups and lower FSF in all muscles apart from TS compared with MC. ME had a lower FSF across all muscle groups and a larger CSA in all muscles except TS than MC. FE athletes showed a higher CSA in Mm. pectoralis and Mm. quadriceps and a lower CSA in TS than FC with no CSA differences found in the back muscles investigated. Surprisingly, the only difference in FSF between FE and FC was found in Mm. pectoralis. Lastly, correlations between VL gene expression and VL CSA as well as FSF showed that genes positively correlated with CSA revealed an enrichment of the oxidative phosphorylation and thermogenesis pathways, while the genes positively correlated with FSF showed significant enrichment of the spliceosome pathway. Although limited differences were found with training in females, our study suggests that both regular endurance and resistance training are useful in maintaining muscle mass, reducing adipose tissue deposits, and reducing muscle fat content in males.
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Affiliation(s)
- Eric B. Emanuelsson
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
| | - David B. Berry
- Department of NanoengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of Orthopaedic SurgeryUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of RadiologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Stefan M. Reitzner
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
- Department for Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Muhammad Arif
- Science for Life LaboratoryKTH – Royal Institute of TechnologyStockholmSweden
| | - Adil Mardinoglu
- Science for Life LaboratoryKTH – Royal Institute of TechnologyStockholmSweden
- Centre for Host–Microbiome InteractionsFaculty of Dentistry, Oral & Craniofacial Sciences, King's College LondonLondonUK
| | - Thomas Gustafsson
- Department of Laboratory MedicineKarolinska InstitutetHuddingeSweden
- Unit of Clinical PhysiologyKarolinska University HospitalStockholmSweden
| | - Samuel R. Ward
- Department of Orthopaedic SurgeryUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of RadiologyUniversity of California San DiegoLa JollaCaliforniaUSA
- Department of BioengineeringUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Carl Johan Sundberg
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
- Department of Laboratory MedicineKarolinska InstitutetHuddingeSweden
- Department of Learning, Informatics, Management and EthicsKarolinska InstitutetStockholmSweden
| | - Mark A. Chapman
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
- Department of Integrated EngineeringUniversity of San DiegoSan DiegoCaliforniaUSA
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17
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Anderson B, Ordaz A, Zlomislic V, Allen RT, Garfin SR, Schuepbach R, Farshad M, Schenk S, Ward SR, Shahidi B. Paraspinal Muscle Health is Related to Fibrogenic, Adipogenic, and Myogenic Gene Expression in Patients with Lumbar Spine Pathology. BMC Musculoskelet Disord 2022; 23:608. [PMID: 35739523 PMCID: PMC9229083 DOI: 10.1186/s12891-022-05572-7] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/14/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Lumbar spine pathology is a common feature of lower back and/or lower extremity pain and is associated with observable degenerative changes in the lumbar paraspinal muscles that are associated with poor clinical prognosis. Despite the commonly observed phenotype of muscle degeneration in this patient population, its underlying molecular mechanisms are not well understood. The aim of this study was to investigate the relationships between groups of genes within the atrophic, myogenic, fibrogenic, adipogenic, and inflammatory pathways and multifidus muscle health in individuals undergoing surgery for lumbar spine pathology. METHODS Multifidus muscle biopsies were obtained from patients (n = 59) undergoing surgery for lumbar spine pathology to analyze 42 genes from relevant adipogenic/metabolic, atrophic, fibrogenic, inflammatory, and myogenic gene pathways using quantitative polymerase chain reaction. Multifidus muscle morphology was examined preoperatively in these patients at the level and side of biopsy using T2-weighted magnetic resonance imaging to determine whole muscle compartment area, lean muscle area, fat cross-sectional areas, and proportion of fat within the muscle compartment. These measures were used to investigate the relationships between gene expression patterns and muscle size and quality. RESULTS Relationships between gene expression and imaging revealed significant associations between decreased expression of adipogenic/metabolic gene (PPARD), increased expression of fibrogenic gene (COL3A1), and lower fat fraction on MRI (r = -0.346, p = 0.018, and r = 0.386, p = 0.047 respectively). Decreased expression of myogenic gene (mTOR) was related to greater lean muscle cross-sectional area (r = 0.388, p = 0.045). CONCLUSION Fibrogenic and adipogenic/metabolic genes were related to pre-operative muscle quality, and myogenic genes were related to pre-operative muscle size. These findings provide insight into molecular pathways associated with muscle health in the presence of lumbar spine pathology, establishing a foundation for future research that addresses how these changes impact outcomes in this patient population.
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Affiliation(s)
- Brad Anderson
- Department of Orthopaedic Surgery, University of California San Diego, 350 Dickinson Street, Suite 121, Mail Code 8894, San Diego, CA, 92103-8894, USA
| | - Angel Ordaz
- Department of Orthopaedic Surgery, University of California San Diego, 350 Dickinson Street, Suite 121, Mail Code 8894, San Diego, CA, 92103-8894, USA.
| | - Vinko Zlomislic
- Department of Orthopaedic Surgery, University of California San Diego, 350 Dickinson Street, Suite 121, Mail Code 8894, San Diego, CA, 92103-8894, USA
| | - R Todd Allen
- Department of Orthopaedic Surgery, University of California San Diego, 350 Dickinson Street, Suite 121, Mail Code 8894, San Diego, CA, 92103-8894, USA
| | - Steven R Garfin
- Department of Orthopaedic Surgery, University of California San Diego, 350 Dickinson Street, Suite 121, Mail Code 8894, San Diego, CA, 92103-8894, USA
| | - Regula Schuepbach
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Simon Schenk
- Department of Orthopaedic Surgery, University of California San Diego, 350 Dickinson Street, Suite 121, Mail Code 8894, San Diego, CA, 92103-8894, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, University of California San Diego, 350 Dickinson Street, Suite 121, Mail Code 8894, San Diego, CA, 92103-8894, USA
| | - Bahar Shahidi
- Department of Orthopaedic Surgery, University of California San Diego, 350 Dickinson Street, Suite 121, Mail Code 8894, San Diego, CA, 92103-8894, USA
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18
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Englund EK, Berry DB, Behun JJ, Ward SR, Frank LR, Shahidi B. IVIM Imaging of Paraspinal Muscles Following Moderate and High-Intensity Exercise in Healthy Individuals. Front Rehabilit Sci 2022; 3. [PMID: 35959464 PMCID: PMC9365030 DOI: 10.3389/fresc.2022.910068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Quantification of the magnitude and spatial distribution of muscle blood flow changes following exercise may improve our understanding of the effectiveness of various exercise prescriptions. Intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) is a technique that quantifies molecular diffusion and microvascular blood flow, and has recently gained momentum as a method to evaluate a muscle's response to exercise. It has also been shown to predict responses to exercise-based physical therapy in individuals with low back pain. However, no study has evaluated the sensitivity of IVIM-MRI to exercise of varying intensity in humans. Here, we aimed to evaluate IVIM signal changes of the paraspinal muscles in response to moderate and high intensity lumbar extension exercise in healthy individuals. Methods IVIM data were collected in 11 healthy volunteers before and immediately after a 3-min bout of moderate and high-intensity resisted lumbar extension. IVIM data were analyzed to determine the average perfusion fraction (f), pseudo-diffusion coefficient (D*), and diffusion coefficient (D) in the bilateral paraspinal muscles. Changes in IVIM parameters were compared between the moderate and high intensity exercise bouts. Results Exercise increased all IVIM parameters, regardless of intensity (p < 0.003). Moderate intensity exercise resulted in a 11.2, 19.6, and 3.5% increase in f, D* and D, respectively. High intensity exercise led to a similar increase in f (12.2%), but much greater changes in D* (48.6%) and D (7.9%). Conclusion IVIM parameter increases suggest that both the moderate and high-intensity exercise conditions elicited measurable changes in blood flow (increased f and D*) and extravascular molecular diffusion rates (increased D), and that there was a dose-dependence of exercise intensity on D* and D.
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Affiliation(s)
- Erin K. Englund
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, United States
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - David B. Berry
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, United States
- Department of Nanoengineering, University of California, San Diego, La Jolla, CA, United States
| | - John J. Behun
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, United States
| | - Samuel R. Ward
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, United States
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Lawrence R. Frank
- Department of Radiology, University of California, San Diego, La Jolla, CA, United States
| | - Bahar Shahidi
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, United States
- *Correspondence: Bahar Shahidi
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19
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Vargas-Vila MA, Gibbons MC, Wu IT, Esparza MC, Kato K, Johnson SD, Masuda K, Ward SR. Progression of muscle loss and fat accumulation in a rabbit model of rotator cuff tear. J Orthop Res 2022; 40:1016-1025. [PMID: 34392563 PMCID: PMC8844305 DOI: 10.1002/jor.25160] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/09/2021] [Accepted: 07/30/2021] [Indexed: 02/04/2023]
Abstract
Rotator cuff (RC) tears present a treatment challenge due to muscle atrophy and degeneration, fatty infiltration, and fibrosis. The purpose of this study was to generate a high time-resolution model of RC tear in rabbits and to characterize the progression of architectural and histological changes. Thirty-five female New Zealand White rabbits (age: 6 months) underwent left supraspinatus tenotomy. Five rabbits were used to evaluate immediate muscle architectural changes. The remaining 30 rabbits underwent right shoulder sham surgery and sacrifice at 1, 2, 4, 8, or 16 weeks. Histology was used to quantify muscle fiber cross-sectional area (CSA), muscle degeneration and regeneration, and fat localized to inter- versus intrafascicular regions. Muscle fiber CSA decreased by 26.5% compared to sham at 16 weeks (effect of treatment, p < 0.0001). Muscle degeneration increased after tenotomy (effect of treatment, p = 0.0006) without any change in regeneration. Collagen and fat content increased by 4 weeks and persisted through 16 weeks. Interfascicular fat was increased at all time points, but intrafascicular fat was increased only at 1, 4, and 16 weeks posttenotomy. Intrafascicular fat adjacent to degenerating muscle fibers increased as well (effect of treatment, p < 0.0001; effect of time, p = 0.0102). Statement of clinical relevance: Rabbit supraspinatus tenotomy recapitulates key features of the pathophysiology of human RC tears, including muscle atrophy and degeneration, lack of regeneration, fat accumulation, and fibrosis.
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Affiliation(s)
| | | | - Isabella T. Wu
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Mary C. Esparza
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Kenji Kato
- Department of Orthopaedic Surgery, Nagoya City University, Nagoya, Japan
| | - Seth D. Johnson
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Koichi Masuda
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Samuel R. Ward
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA,Department of Bioengineering, UC San Diego, La Jolla CA, USA,Department of Radiology, UC San Diego, La Jolla CA, USA
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20
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Wu IT, Gibbons MC, Esparza MC, Vasquez-Bolanos LS, Hyman SA, Dorn SN, Singh A, Lane JG, Fithian DC, Ruoss S, Ward SR. The “Second Hit” of Repair in a Rabbit Model of Chronic Rotator Cuff Tear. Front Physiol 2022; 13:801829. [PMID: 35350696 PMCID: PMC8958027 DOI: 10.3389/fphys.2022.801829] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/28/2022] [Indexed: 01/04/2023] Open
Abstract
The rabbit supraspinatus is a useful translational model for rotator cuff (RC) repair because it recapitulates muscle atrophy and fat accumulation observed in humans after a chronic tear (the “first hit”). However, a timeline of RC tissue response after repair, especially with regard to recent evidence of muscle degeneration and lack of regeneration, is currently unavailable. Thus, the purpose of this study was to characterize the progression of muscle and fat changes over time after the repair of a chronic RC tear in the rabbit model. Two rounds of experiments were conducted in 2017–2018 and 2019–2020 with N = 18 and 16 skeletally mature New Zealand White rabbits, respectively. Animals underwent left supraspinatus tenotomy with repair 8 weeks later. The unoperated right shoulder served as control. The rabbits were sacrificed at 1-, 2-, 4-, and 8-weeks post-repair for histological and biochemical analysis. Atrophy, measured by fiber cross-sectional area and muscle mass, was greatest around 2 weeks after repair. Active muscle degeneration peaked at the same time, involving 8% of slide areas. There was no significant regeneration at any timepoint. Fat accumulation and fibrosis were significantly increased across all time points compared to contralateral. Statement of Clinical Significance: These results demonstrate model reproducibility and a “second hit” phenomenon of repair-induced muscle atrophy and degeneration which partially recovers after a short time, while increased fat and fibrosis persist.
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Affiliation(s)
- Isabella T. Wu
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Michael C. Gibbons
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
| | - Mary C. Esparza
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Laura S. Vasquez-Bolanos
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
| | - Sydnee A. Hyman
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
| | - Shanelle N. Dorn
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Anshuman Singh
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
- Department of Orthopaedic Surgery, Kaiser Permanente, San Diego, CA, United States
| | - John G. Lane
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Donald C. Fithian
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Severin Ruoss
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Samuel R. Ward
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
- *Correspondence: Samuel R. Ward,
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21
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Fridén J, Stankovic N, Ward SR, Lieber RL. Increased muscle fiber size and pathology with botulinum toxin treatment of upper extremity muscles in cerebral palsy. Curr Top Toxicol 2022; 18:167-178. [PMID: 36999118 PMCID: PMC10049878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
Intramuscular injections of botulinum toxin A (BTX) are regularly used to treat skeletal muscle spasticity and relieve pain during rehabilitation therapy. However, while numerous preclinical studies have shown dramatic atrophic changes in muscle, little is known about the long-term effect of toxin on human skeletal muscle. In this study, muscle morphology was analyzed in biopsies taken from spastic upper extremity muscles of 8 cerebral palsy patients treated with BTX 5 months to 4 years prior sampling and was compared to muscles from 7 patients who had not ever received BTX treatment (overall 25 muscle biopsies obtained from 6 different muscles.). The most important (and surprising) finding was that BTX-treated muscles contained significantly larger fibers compared to untreated muscles. A strong correlation between fiber size and age was observed but the growth rate in the BTX group was larger. Pathological signs such as central nuclei, neonatal myosin heavy chain expression, angular fibers and hybrid fibers (expressing both slow and fast myosin heavy chain fibers) were significantly greater in BTX-treated muscles compared to untreated muscles. Capillarization was also increased in BTX-treated muscle compared to untreated muscles and was the best predictor of fiber size. We suggest that, in the context of spasticity, BTX may block negative, atrophy-inducing pressure of the central nervous system on skeletal muscle or may allow an altered use pattern that should be considered a positive adjuvant to current rehabilitation therapies.
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Affiliation(s)
- Jan Fridén
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
- Department of Tetrahand Surgery and Hand Surgery, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Nenad Stankovic
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Samuel R. Ward
- Department of Radiology, University of California and Veterans Affairs Medical Centers, San Diego, California, USA
- Departments of Orthopaedic Surgery and Bioengineering, University of California and Veterans Affairs Medical Centers, San Diego, California, USA
| | - Richard L. Lieber
- Departments of Physical Medicine and Rehabilitation, Physiology and Biomedical Engineering, Northwestern University, Chicago IL, USA
- Shirley Ryan AbilityLab, Chicago IL, USA
- Hines Veterans Affairs Medical Center, Maywood IL, USA
- Corresponding author:
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22
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Hyman SA, Wu IT, Vasquez-Bolanos LS, Norman MB, Esparza MC, Bremner SN, Dorn SN, Ramirez I, Fithian DC, Lane JG, Singh A, Ward SR. Supraspinatus muscle architecture and physiology in a rabbit model of tenotomy and repair. J Appl Physiol (1985) 2021; 131:1708-1717. [PMID: 34647843 PMCID: PMC8828274 DOI: 10.1152/japplphysiol.01119.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 09/20/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022] Open
Abstract
Chronic rotator cuff tears can cause severe functional deficits. Addressing the chronic fatty and fibrotic muscle changes is of high clinical interest; however, the architectural and physiological consequences of chronic tear and repair are poorly characterized. We present a detailed architectural and physiological analysis of chronic tear and repair (both over 8 and 16 wk) compared with age-matched control rabbit supraspinatus (SSP) muscles. Using female New Zealand White Rabbits (n = 30, n = 6/group) under 2% isoflurane anesthesia, the SSP was surgically isolated and maximum isometric force was measured at four to six muscle lengths. Architectural analysis was performed, and maximum isometric stress was computed. Whole muscle length-tension curves were generated using architectural measurements to compare experimental physiology to theoretical predictions. Architectural measures are consistent with persistent radial and longitudinal atrophy over time in tenotomy that fails to recover after repair. Maximum isometric force was significantly decreased after 16 wk tenotomy and not significantly improved after repair. Peak isometric force reported here are greater than prior reports of rabbit SSP force after tenotomy. Peak stress was not significantly different between groups and consistent with prior literature of SSP stress. Muscle strain during contraction was significantly decreased after 8 wk of tenotomy and repair, indicating effects of tear and repair on muscle function. The experimental length-tension data were overlaid with predicted curves for each experimental group (generated from structural data), exposing the altered structure-function relationship for tenotomy and repair over time. Data presented here contribute to understanding the physiological implications of disease and repair in the rotator cuff.NEW & NOTEWORTHY We utilize an established method to measure the length-tension relationship for the rabbit supraspinatus in normal, torn, and repaired muscles. We then perform architectural analysis to evaluate structural changes after tear and repair. Although peak isometric force is lower in the tear and repair groups, there are no differences in peak stresses across groups. These findings indicate persistent structural changes (both radial and longitudinal atrophy) and physiological deficiencies (decreased peak force and uncoupling structure-function relationship) after tenotomy that do not significantly recover after repair.
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Affiliation(s)
- Sydnee A Hyman
- Department of Bioengineering, University of California, San Diego, California
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Isabella T Wu
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Laura S Vasquez-Bolanos
- Department of Bioengineering, University of California, San Diego, California
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Mackenzie B Norman
- Department of Orthopaedic Surgery, University of California, San Diego, California
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Mary C Esparza
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Shannon N Bremner
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Shanelle N Dorn
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Ivan Ramirez
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Donald C Fithian
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - John G Lane
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Anshuman Singh
- Department of Orthopaedic Surgery, University of California, San Diego, California
- Department of Orthopaedic Surgery, Kaiser Permanente, San Diego, California
| | - Samuel R Ward
- Department of Bioengineering, University of California, San Diego, California
- Department of Orthopaedic Surgery, University of California, San Diego, California
- Department of Radiology, University of California, San Diego, California
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23
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Vasquez-Bolanos LS, Gibbons MC, Ruoss S, Wu IT, Vargas-Vila M, Hyman SA, Esparza MC, Fithian DC, Lane JG, Singh A, Nasamran CA, Fisch KM, Ward SR. Corrigendum: Transcriptional Time Course After Rotator Cuff Tear. Front Physiol 2021; 12:775297. [PMID: 34777027 PMCID: PMC8589024 DOI: 10.3389/fphys.2021.775297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Laura S Vasquez-Bolanos
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Michael C Gibbons
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Severin Ruoss
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Isabella T Wu
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Mario Vargas-Vila
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Sydnee A Hyman
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Mary C Esparza
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Donald C Fithian
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - John G Lane
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Anshuman Singh
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States.,Department of Orthopedic Surgery, Kaiser Permanente, San Diego, CA, United States
| | - Chanond A Nasamran
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Kathleen M Fisch
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Samuel R Ward
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States.,Department of Radiology, University of California, San Diego, San Diego, CA, United States
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24
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Lawrence RL, Ludewig PM, Ward SR. An Integrated Approach to Musculoskeletal Performance, Disease, and Recovery. Phys Ther 2021; 101:6374810. [PMID: 34636897 PMCID: PMC8651066 DOI: 10.1093/ptj/pzab225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/11/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Rebekah L Lawrence
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA,Address all correspondence to Dr Lawrence at:
| | - Paula M Ludewig
- Divisions of Physical Therapy and Rehabilitation Science, University of Minnesota, Minneapolis, Minnesota, USA
| | - Samuel R Ward
- Departments of Radiology, Orthopaedic Surgery, and Bioengineering, University of California San Diego, San Diego, California, USA
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25
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Hughes-Austin JM, Ix JH, Ward SR, Weisman MH, ODell JR, Mikuls TR, Buckner JH, Gregersen PK, Keating RM, Demoruelle MK, Deane KD, Holers VM, Norris JM. Evaluating associations of joint swelling, joint stiffness and joint pain with physical activity in first-degree relatives of patients with rheumatoid arthritis: Studies of the Aetiology of Rheumatoid Arthritis (SERA), a prospective cohort study. BMJ Open 2021; 11:e050883. [PMID: 34521672 PMCID: PMC8442039 DOI: 10.1136/bmjopen-2021-050883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Physical activity (PA) in preclinical rheumatoid arthritis (RA) is associated with lower RA risk and disease severity. As joint signs and symptoms of inflammatory arthritis serve as a barrier to PA in RA, it is important to consider whether they affect PA in the time prior to RA. Therefore, we investigated whether joint swelling, stiffness or pain were associated with PA in first-degree relatives (FDRs) of patients with RA, a population at higher risk for future RA. DESIGN Prospective study design. SETTING We recruited FDRs of patients with RA from academic centres, Veterans' hospitals and rheumatology clinics or through responses to advertising from six sites across the USA. PARTICIPANTS We evaluated associations of joint stiffness, joint swelling and joint pain with PA time in 268 FDRs with ≥2 visits over an average 1.2 years. Clinicians confirmed joint swelling. Participants self-reported joint stiffness and/or pain. PRIMARY OUTCOME MEASURES PA during a typical 24-hour day was quantified via questionnaire, weighted to reflect metabolic expenditure, where 24 hours was the minimum PA time. Linear mixed models evaluated associations between symptoms and change in PA over time, adjusting for age, sex, race, body mass index, smoking and RA-related autoantibodies. RESULTS Average weighted PA time was 37±7 hours. In the cross-sectional analysis, PA time was 1.3±0.9 hours higher in FDRs reporting joint pain (p=0.15); and 0.8±1.6 and 0.4±1 hours lower in FDRs with joint swelling (p=0.60) and stiffness (p=0.69), respectively. Longitudinally, adjusting for baseline PA time, baseline symptoms were not significantly associated with changes in PA time. However, on average over time, joint stiffness and pain were associated with lower PA time (pinteraction=0.0002, pinteraction=0.002), and joint swelling was associated with higher PA time (pinteraction <0.0001). CONCLUSION Baseline symptoms did not predict future PA time, but on average over time, joint symptoms influenced PA time.
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Affiliation(s)
- Jan M Hughes-Austin
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California, USA
| | - Joachim H Ix
- Department of Medicine, Division of Nephrology-Hypertension, University of California, San Diego, La Jolla, California, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California, USA
- Department of Radiology, University of California, San Diego, La Jolla, California, USA
| | - Michael H Weisman
- School of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - James R ODell
- College of Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ted R Mikuls
- College of Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jane H Buckner
- Translational Research Institute, Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA
| | - Peter K Gregersen
- Roberts S Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Richard M Keating
- Division of Rheumatology, Scripps Green Hospital, La Jolla, California, USA
| | - M Kristen Demoruelle
- School of Medicine, Department of Rheumatology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kevin D Deane
- School of Medicine, Department of Rheumatology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - V Michael Holers
- School of Medicine, Department of Rheumatology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
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26
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Shahidi B, Yoo A, Farnsworth C, Newton PO, Ward SR. Paraspinal muscle morphology and composition in adolescent idiopathic scoliosis: A histological analysis. JOR Spine 2021; 4:e1169. [PMID: 34611591 PMCID: PMC8479518 DOI: 10.1002/jsp2.1169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 05/25/2021] [Revised: 08/02/2021] [Accepted: 08/21/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is a condition resulting in spinal deformity and tissue adaptation of the paraspinal muscles. Although prior studies have demonstrated asymmetries in fiber type and other energetic features of muscle on the concave side of the curve, muscle morphology, architecture, and composition have not been evaluated. Therefore, the purpose of this study was to compare differences in paraspinal muscle microarchitecture and composition between concave and convex sides of a scoliotic curve in individuals with AIS. METHODS Paraspinal muscle biopsies were obtained at the apex of the scoliotic curve in 29 individuals with AIS undergoing surgical deformity correction. Histological assays were performed to quantify fiber size, evidence of muscle degeneration and regeneration, and tissue composition (proportion of muscle, collagen, and fat). Differences between contralateral muscle samples were compared using two-tailed paired Student's t tests, and relationships between clinical characteristics (age and curve severity) and muscle characteristics were investigated using Pearson correlations. RESULTS Muscle fibers were significantly larger on the convex side of the curve apex (P = .001), but were lower than literature-based norms for healthy paraspinal muscle. There were no differences in amount of degeneration/regeneration (P = .490) or the proportion of muscle and collagen (P > .350) between the concave and convex sides, but high levels of collagen were observed. There was a trend toward higher fat content on the concave side (P = .074). Larger fiber size asymmetries were associated with greater age (r = .43, P = .046), and trended toward an association with greater curve severity (r = .40, P = .069). CONCLUSIONS This study demonstrates that although muscle fibers are larger on the convex side of the scoliotic curve in AIS, muscles on both sides are atrophic compared to non-scoliotic individuals, and demonstrate levels of collagen similar to severe degenerative spinal pathologies. These findings provide insight into biological maladaptations occurring in paraspinal muscle in the presence of AIS.
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Affiliation(s)
- Bahar Shahidi
- Department of Orthopaedic SurgeryUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Andrew Yoo
- Department of Orthopaedic SurgeryUniversity of California San DiegoLa JollaCaliforniaUSA
| | | | - Peter O. Newton
- Department of Orthopaedic SurgeryUniversity of California San DiegoLa JollaCaliforniaUSA
- Rady Children's HospitalSan DiegoCaliforniaUSA
| | - Samuel R. Ward
- Department of Orthopaedic SurgeryUniversity of California San DiegoLa JollaCaliforniaUSA
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27
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Vasquez-Bolanos LS, Gibbons MC, Ruoss S, Wu IT, Vargas-Vila M, Hyman SA, Esparza MC, Fithian DC, Lane JG, Singh A, Nasamran CA, Fisch KM, Ward SR. Transcriptional Time Course After Rotator Cuff Tear. Front Physiol 2021; 12:707116. [PMID: 34421646 PMCID: PMC8378535 DOI: 10.3389/fphys.2021.707116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/06/2021] [Indexed: 12/13/2022] Open
Abstract
Rotator cuff (RC) tears are prevalent in the population above the age of 60. The disease progression leads to muscle atrophy, fibrosis, and fatty infiltration in the chronic state, which is not improved with intervention or surgical repair. This highlights the need to better understand the underlying dysfunction in muscle after RC tendon tear. Contemporary studies aimed at understanding muscle pathobiology after RC tear have considered transcriptional data in mice, rats and sheep models at 2–3 time points (1 to 16 weeks post injury). However, none of these studies observed a transition or resurgence of gene expression after the initial acute time points. In this study, we collected rabbit supraspinatus muscle tissue with high temporal resolution (1, 2, 4, 8, and 16 weeks) post-tenotomy (n = 6/group), to determine if unique, time-dependent transcriptional changes occur. RNA sequencing and analyses were performed to identify a transcriptional timeline of RC muscle changes and related morphological sequelae. At 1-week post-tenotomy, the greatest number of differentially expressed genes was observed (1,069 up/873 down) which decreases through 2 (170/133), 4 (86/41), and 8 weeks (16/18), followed by a resurgence and transition of expression at 16 weeks (1,421/293), a behavior which previously has not been captured or reported. Broadly, 1-week post-tenotomy is an acute time point with expected immune system responses, catabolism, and changes in energy metabolism, which continues into 2 weeks with less intensity and greater contribution from mitochondrial effects. Expression shifts at 4 weeks post-tenotomy to fatty acid oxidation, lipolysis, and general upregulation of adipogenesis related genes. The effects of previous weeks’ transcriptional dysfunction present themselves at 8 weeks post-tenotomy with enriched DNA damage binding, aggresome activity, extracellular matrix-receptor changes, and significant expression of genes known to induce apoptosis. At 16 weeks post-tenotomy, there is a range of enriched pathways including extracellular matrix constituent binding, mitophagy, neuronal activity, immune response, and more, highlighting the chaotic nature of this time point and possibility of a chronic classification. Transcriptional activity correlated significantly with histological changes and were enriched for biologically relevant pathways such as lipid metabolism. These data provide platform for understanding the biological mechanisms of chronic muscle degeneration after RC tears.
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Affiliation(s)
- Laura S Vasquez-Bolanos
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Michael C Gibbons
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Severin Ruoss
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Isabella T Wu
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Mario Vargas-Vila
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Sydnee A Hyman
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Mary C Esparza
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Donald C Fithian
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - John G Lane
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Anshuman Singh
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States.,Department of Orthopedic Surgery, Kaiser Permanente, San Diego, CA, United States
| | - Chanond A Nasamran
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Kathleen M Fisch
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Samuel R Ward
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States.,Department of Radiology, University of California, San Diego, San Diego, CA, United States
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28
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Jerban S, Ma Y, Kasibhatla A, Wu M, Szeverenyi N, Guma M, Covey D, D'lima D, Ward SR, Sah RL, Chang EY, Du J, Chung CB. Ultrashort echo time adiabatic T 1ρ (UTE-Adiab-T 1ρ) is sensitive to human cadaveric knee joint deformation induced by mechanical loading and unloading. Magn Reson Imaging 2021; 80:98-105. [PMID: 33945858 PMCID: PMC10858706 DOI: 10.1016/j.mri.2021.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 04/13/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The development of ultrashort echo time (UTE) MRI sequences has led to improved imaging of tissues with short T2 relaxation times, such as the deep layer cartilage and meniscus. UTE combined with adiabatic T1ρ preparation (UTE-Adiab-T1ρ) is an MRI measure with low sensitivity to the magic angle effect. This study aimed to investigate the sensitivity of UTE-Adiab-T1ρ to mechanical load-induced deformations in the tibiofemoral cartilage and meniscus of human cadaveric knee joints. METHODS Eight knee joints from young (42 ± 12 years at death) donors were evaluated on a 3 T scanner using the UTE-Adiab-T1ρ sequence under four sequential loading conditions: load = 0 N (Load0), load = 300 N (Load1), load = 500 N (Load2), and load = 0 N (Unload). UTE-Adiab-T1ρ was measured in the meniscus (M), femoral articular cartilage (FAC), tibial articular cartilage (TAC), articular cartilage regions uncovered by meniscus (AC-UC), and articular cartilage regions covered by meniscus (AC-MC) within region of interests (ROIs) manually selected by an experienced MR scientist. The Kruskal-Wallis test, with corrected significance level for multiple comparisons, was used to examine the UTE-Adiab-T1ρ differences between different loading conditions. RESULTS UTE-Adiab-T1ρ decreased in all grouped ROIs under both Load1 and Load2 conditions (-18.7% and - 16.9% for M, -18.8% and - 12.6% for FAC, -21.4% and - 10.7% for TAC, -26.2% and - 13.9% for AC-UC, and - 16.9% and - 10.7% for AC-MC). After unloading, average UTE-Adiab-T1ρ increased across all ROIs and within a lower range compared with the average UTE-Adiab-T1ρ decreases induced by the two previous loading conditions. The loading-induced differences were statistically non-significant. CONCLUSIONS While UTE-Adiab-T1ρ reduction by loading is likely an indication of tissue deformation, the increase of UTE-Adiab-T1ρ within a lower range by unloading implies partial tissue restoration. This study highlights the UTE-Adiab-T1ρ technique as an imaging marker of tissue function for detecting deformation patterns under loading.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, CA, USA.
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, CA, USA
| | - Akhil Kasibhatla
- Department of Radiology, University of California, San Diego, CA, USA
| | - Mei Wu
- Department of Radiology, University of California, San Diego, CA, USA
| | | | - Monica Guma
- Department of Medicine, School of Medicine, University of California, San Diego, CA, USA
| | - Dana Covey
- Orthopaedic Service, VA San Diego Healthcare System, San Diego, CA, USA; Department of Orthopedic Surgery, University of California, San Diego, CA, USA
| | - Darryl D'lima
- Shiley Center for Orthopedic Research and Education at Scripps Clinic, CA, USA
| | - Samuel R Ward
- Department of Orthopedic Surgery, University of California, San Diego, CA, USA; Department of Bioengineering, University of California, San Diego, CA, USA
| | - Robert L Sah
- Department of Orthopedic Surgery, University of California, San Diego, CA, USA; Department of Bioengineering, University of California, San Diego, CA, USA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, CA, USA; Research Service, VA San Diego Healthcare System, San Diego, La Jolla, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA, USA
| | - Christine B Chung
- Department of Radiology, University of California, San Diego, CA, USA
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Berry DB, Englund EK, Galinsky V, Frank LR, Ward SR. Varying diffusion time to discriminate between simulated skeletal muscle injury models using stimulated echo diffusion tensor imaging. Magn Reson Med 2021; 85:2524-2536. [PMID: 33226163 PMCID: PMC8204931 DOI: 10.1002/mrm.28598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Evaluate the relationship between muscle microstructure, diffusion time (Δ), and the diffusion tensor (DT) to identify the optimal Δ where changes in muscle fiber size may be detected. METHODS The DT was simulated in models with histology informed geometry over a range of Δ with a stimulated echo DT imaging (DTI) sequence using the numerical simulation application DifSim. The difference in the DT at each Δ between healthy and injured skeletal muscle models was calculated, to identify the optimal Δ at which changes in muscle fiber size may be detected. The random permeable barrier model (RPBM) was used to estimate muscle microstructure from the simulated DT measurements, which were compared to the ground truth. RESULTS Across all models, fractional anisotropy provided greater contrast between injured and control models than diffusivity measurements. Compared to control models, in atrophic injury models, the greatest difference in the DT was found between 90 ms and 250 ms. In models with acute edema, the contrast between injured and control muscle increased with increasing diffusion time, although these models had smaller mean fiber areas. RPBM systematically underestimated fiber size but accurately estimated surface area-to-volume ratio of simulated models. CONCLUSION These findings may better inform pulse sequence parameter selection when performing DTI experiments in vivo. If only a single diffusion experiment can be performed, the selected Δ should be ~170 ms to maximize the ability to discriminate between different injury models. Ideally several diffusion times between 90 ms and 500 ms should be sampled in order to maximize diffusion contrast, particularly when the disease process is unknown.
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Affiliation(s)
- David B. Berry
- Department of Nanoengineering, University of California San Diego, San Diego, California, USA
| | - Erin K. Englund
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Vitaly Galinsky
- Department of Electrical and Computer Engineering, University of California San Diego, San Diego, California, USA
- Center for Scientific Computation in Imaging, University of California San Diego, San Diego, California, USA
| | - Lawrence R. Frank
- Center for Scientific Computation in Imaging, University of California San Diego, San Diego, California, USA
- Center for Functional MRI, University of California San Diego, San Diego, California, USA
| | - Samuel R. Ward
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
- Department of Radiology, University of California San Diego, San Diego, California, USA
- Department of Bioengineering, University of California San Diego, San Diego, California, USA
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Ruoss S, Walker JT, Nasamran CA, Fisch KM, Paez C, Parekh JN, Ball ST, Chen JL, Ahmed SS, Ward SR. Strategies to Identify Mesenchymal Stromal Cells in Minimally Manipulated Human Bone Marrow Aspirate Concentrate Lack Consensus. Am J Sports Med 2021; 49:1313-1322. [PMID: 33646886 PMCID: PMC8409176 DOI: 10.1177/0363546521993788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a need to identify and quantify mesenchymal stromal cells (MSCs) in human bone marrow aspirate concentrate (BMAC) source tissues, but current methods to do so were established in cultured cell populations. Given that surface marker and gene expression change in cultured cells, it is doubtful that these strategies are valid to quantify MSCs in fresh BMAC. PURPOSE To establish the presence, quantity, and heterogeneity of BMAC-derived MSCs in minimally manipulated BMAC using currently available strategies. STUDY DESIGN Descriptive laboratory study. METHODS Five published strategies to identify MSCs were compared for suitability and efficiency to quantify clinical-grade BMAC-MSCs and cultured MSCs at the single cell transcriptome level on BMAC samples being used clinically from 15 orthopaedic patients and on 1 cultured MSC sample. Strategies included (1) the guidelines by the International Society for Cellular Therapy (ISCT), (2) CD271 expression, (3) the Ghazanfari et al transcriptional profile, (4) the Jia et al transcriptional profile, and (5) the Silva et al transcriptional profile. RESULTS ISCT guidelines did not identify any MSCs in BMAC at the transcriptional level and only 1 in 9 million cells at the protein level. Of 12,850 BMAC cells, 9 expressed the CD271 gene. Only 116 of 396 Ghazanfari genes were detected in BMAC, whereas no cells expressed all of them. No cells expressed all Jia genes, but 25 cells expressed at least 13 of 22. No cells expressed all Silva genes, but 19 cells expressed at least 8 of 23. Most importantly, the liberalized strategies tended to identify different cells and most of them clustered with immune cells. CONCLUSION Currently available methods need to be liberalized to identify any MSCs in fresh human BMAC and lack consensus at the single cell transcriptome and protein expression levels. These different cells should be isolated and challenged to establish phenotypic differences. CLINICAL RELEVANCE This study demonstrated that improved strategies to quantify MSC concentrations in BMAC for clinical applications are urgently needed. Until then, injected minimally manipulated MSC doses should be reported as rough estimates or as unknown.
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Affiliation(s)
- Severin Ruoss
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - J. Todd Walker
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Chanond A. Nasamran
- Center for Computational Biology and Bioinformatics, Department of Medicine, UC San Diego, La Jolla CA, USA
| | - Kathleen M. Fisch
- Center for Computational Biology and Bioinformatics, Department of Medicine, UC San Diego, La Jolla CA, USA
| | - Conner Paez
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Jesal N. Parekh
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Scott T. Ball
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Jeffrey L. Chen
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Sonya S. Ahmed
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Samuel R. Ward
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
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Chavez J, Shah NA, Ruoss S, Cuomo RE, Ward SR, Mackey TK. Online marketing practices of regenerative medicine clinics in US-Mexico border region: a web surveillance study. Stem Cell Res Ther 2021; 12:189. [PMID: 33736697 PMCID: PMC7977255 DOI: 10.1186/s13287-021-02254-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction The potential of regenerative medicine to improve human health has led to the rapid expansion of stem cell clinics throughout the world with varying levels of regulation and oversight. This has led to a market ripe for stem cell tourism, with Tijuana, Mexico, as a major destination. In this study, we characterize the online marketing, intervention details, pricing of services, and assess potential safety risks through web surveillance of regenerative medicine clinics marketing services in Tijuana. Methods We conducted structured online search queries from March to April 2019 using 296 search terms in English and Spanish on two search engines (Google and Bing) to identify websites engaged in direct-to-consumer advertising of regenerative medicine services. We performed content analysis to characterize three categories of interest: online presence, tokens of scientific legitimacy, and intervention details. Results Our structured online searches resulted in 110 unique websites located in Tijuana corresponding to 76 confirmed locations. These clinics’ online presence consisted of direct-to-consumer advertising mainly through a dedicated website (94.5%) or Facebook page (65.5%). The vast majority of these websites (99.1%) did not mention any affiliation to an academic institutions or other overt tokens of scientific legitimacy. Most clinics claimed autologous tissue was the source of treatments (67.3%) and generally did not specify route of administration. Additionally, of the Tijuana clinics identified, 13 claimed licensing, though only 1 matched with available licensing information. Conclusions Regenerative medicine clinics in Tijuana have a significant online presence using direct-to-consumer advertising to attract stem-cell tourism clientele in a bustling border region between Mexico and the USA. This study adds to existing literature evidencing the unregulated nature of online stem cell offerings and provides further evidence of the need for regulatory harmonization, particularly to address stem cell services being offered online across borders. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-021-02254-4.
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Affiliation(s)
- Javier Chavez
- Masters Program in Clinical Research, UC San Diego - School of Medicine, San Diego, CA, USA
| | - Neal A Shah
- Department of Healthcare Research and Policy, UC San Diego - Extension, 8950 Villa La Jolla Drive Suite A124, San Diego, CA, 92037, USA.,Global Health Policy and Data Institute, San Diego, CA, USA
| | - Severin Ruoss
- Department of Orthopaedic Surgery, UC San Diego - School of Medicine, San Diego, CA, USA
| | - Raphael E Cuomo
- Global Health Policy and Data Institute, San Diego, CA, USA.,Department of Anesthesiology and Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery and Department of Radiology, UC San Diego - School of Medicine, San Diego, CA, USA
| | - Tim K Mackey
- Department of Healthcare Research and Policy, UC San Diego - Extension, 8950 Villa La Jolla Drive Suite A124, San Diego, CA, 92037, USA. .,Global Health Policy and Data Institute, San Diego, CA, USA. .,Department of Anesthesiology and Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA. .,S-3 Research, LLC, San Diego, CA, USA.
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O'Connor SM, Kaufman KR, Ward SR, Lieber RL. Sensor Anchoring Improves the Correlation Between Intramuscular Pressure and Muscle Tension in a Rabbit Model. Ann Biomed Eng 2021; 49:912-921. [PMID: 33001290 PMCID: PMC8083084 DOI: 10.1007/s10439-020-02633-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
Intramuscular pressure (IMP) shows promise for estimating individual muscle tension in vivo. However, previous pressure measurements show high variability during isometric contraction and poor correlation with tension during dynamic contraction. We hypothesized that enhanced sensor anchoring/orientation would improve tension estimation and thus developed a novel pressure sensor with a barbed housing. Sensors were inserted into the tibialis anterior (TA) of New Zealand White rabbits (N = 8) both parallel and perpendicular to the fiber orientation. We measured muscle stress and IMP during both isometric and dynamic contractions. Passive stress showed good agreement for both insertion directions across muscle lengths (ICC > 0.8). Active stress and IMP agreement were good (ICC = 0.87 ± 0.04) for perpendicular insertions but poor (ICC = 0.21 ± 0.22) for parallel insertions across both dynamic contractions and isometric contractions within the muscle's range of motion. These findings support use of IMP measurements to estimate muscle tension across a range of contraction conditions.
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Affiliation(s)
- Shawn M O'Connor
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Kenton R Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Richard L Lieber
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA.
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA.
- Veteran's Administration San Diego Healthcare System, San Diego, CA, USA.
- Shirley Ryan AbilityLab and Northwestern University, 355 E. Erie Street, Chicago, IL, 60611, USA.
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Abstract
Advancement of tissue engineering and regenerative medicine (TERM) strategies to replicate tissue structure and function has led to the need for noninvasive assessment of key outcome measures of a construct's state, biocompatibility, and function. Histology based approaches are traditionally used in pre-clinical animal experiments, but are not always feasible or practical if a TERM construct is going to be tested for human use. In order to transition these therapies from benchtop to bedside, rigorously validated imaging techniques must be utilized that are sensitive to key outcome measures that fulfill the FDA standards for TERM construct evaluation. This review discusses key outcome measures for TERM constructs and various clinical- and research-based imaging techniques that can be used to assess them. Potential applications and limitations of these techniques are discussed, as well as resources for the processing, analysis, and interpretation of biomedical images.
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Affiliation(s)
- David B Berry
- Departments of NanoEngineering, University of California, San Diego, USA.
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Omoumi P, Gondim Teixeira PA, Ward SR, Trudell D, Resnick D. Practical ultrasonographic technique to precisely identify and differentiate tendons and ligaments of the elbow at the level of the humeral epicondyles: anatomical study. Skeletal Radiol 2021; 50:1369-1377. [PMID: 33313976 PMCID: PMC8119275 DOI: 10.1007/s00256-020-03693-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To develop a practical step-by-step technique to precisely identify and differentiate tendons and ligaments attaching to the humeral epicondyles, to confirm through gross anatomical study the accurate structure identification provided by this technique and to determine the frequency at which each structure can be identified in healthy volunteers. MATERIALS AND METHODS First, ten fresh frozen cadavers (6 men, age at death = 58-92 years) were examined by two musculoskeletal radiologists and a step-by-step technique for the identification of tendons and ligaments at the level of humeral epicondyles was developed. Second, the accurate identification of structures was confirmed through gross anatomical study including anatomical sections on five specimens and layer-by-layer dissection technique on five others. Finally, 12 healthy volunteers (6 men, average age = 36, range = 28-52) were scanned by two radiologists following the same technique. RESULTS An ultrasonographic technique based on the recognition of bony landmarks and the use of ultrasonographic signs to differentiate overlapping structures was developed and validated through gross anatomical study. In healthy volunteers, most tendons and ligaments were identified and well-defined in ≥ 80% of cases, except for the extensor carpi radialis brevis and extensor digiti minimi tendons on the lateral epicondyle (having common attachments with the extensor digitorum communis) and the palmaris longus tendon on the medial epicondyle (absent, or common attachment with the flexor carpi radialis). CONCLUSION A step-by-step approach to the ultrasonographic assessment of tendons and ligaments at the humeral epicondyles allowed accurate identification of and differentiation among these structures, in particular those relevant to pathological conditions.
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Affiliation(s)
- Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | | | - Samuel R Ward
- Departments of Orthopaedic Surgery and Radiology, UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0863, USA
| | - Debbie Trudell
- Department of Radiology, Teleradiology / HCOP - University of California, 408 Dickinson Street, San Diego, CA, 92103, USA
| | - Donald Resnick
- Department of Radiology, Teleradiology / HCOP - University of California, 408 Dickinson Street, San Diego, CA, 92103, USA
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Hyman SA, Norman MB, Dorn SN, Bremner SN, Esparza MC, Lieber RL, Ward SR. In vivo supraspinatus muscle contractility and architecture in rabbit. J Appl Physiol (1985) 2020; 129:1405-1412. [PMID: 33031015 DOI: 10.1152/japplphysiol.00609.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The rotator cuff (RC) muscles are crucial in moving and stabilizing the glenohumeral joint, and tears can be functionally devastating. Chronic fatty and fibrotic muscle changes, which are nonresponsive to surgical tendon repair, are a focus of contemporary research. The rabbit model recapitulates key biological features of human RC tears, but function and physiology are poorly characterized; limited force and stress data are inconsistent with literature norms in other mammalian species. Here, we present an improved method to assess the physiology of the rabbit supraspinatus muscle (SSP), and we report values for healthy SSP architecture and physiology. Using female New Zealand White Rabbits (n = 6) under 2% isoflurane anesthesia, we surgically isolated the SSP and maximum isometric force measured at 4-6 muscle lengths. Architectural analysis was performed, and maximum isometric stress was computed. Whole muscle length-tension curves were generated using architectural measurements to compare experimental physiology to theoretical predictions. Maximum isometric force (80.87 ± 5.58 N) was dramatically greater than previous reports (11.06 and 16.1 N; P < 0.05). Architectural measurement of fiber length (34.25 ± 7.18 mm), muscle mass (9.9 ± 0.93 g), pennation angle (23.67 ± 8.32°), and PCSA (2.57 ± 0.20 cm2) were consistent with prior literature. Isometric stress (30.5 ± 3.07 N/cm2) was greater than previous reports of rabbit SSP (3.10 and 4.51 N/cm2), but similar to mammalian skeletal muscles (15.7-30.13 N/cm2). Previous studies underestimated peak force by ∼90%, which has profound implications for interpreting physiological changes as a function of disease state. The data that are presented here enable understanding the physiological implications of disease and repair in the RC of the rabbit.NEW & NOTEWORTHY We introduce an improved method to assess rabbit supraspinatus muscle physiology. Maximum isometric force measured for the rabbit supraspinatus was dramatically greater than previous reports in the literature. Consequently, the isometric contractile stress reported is almost 10 times greater than previous reports of rabbit supraspinatus, but similar to available literature of other mammalian skeletal muscle. We show that previous reports of peak supraspinatus isometric force were subphysiological by ∼90.
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Affiliation(s)
- Sydnee A Hyman
- Department of Bioengineering, University of California, San Diego, California.,Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Mackenzie B Norman
- Department of Orthopaedic Surgery, University of California, San Diego, California.,Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Shanelle N Dorn
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Shannon N Bremner
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Mary C Esparza
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Richard L Lieber
- Shirley Ryan Ability Lab, Northwestern University, Chicago, Illinois
| | - Samuel R Ward
- Department of Bioengineering, University of California, San Diego, California.,Department of Orthopaedic Surgery, University of California, San Diego, California.,Department of Radiology, University of California, San Diego, California
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Gupta R, Chan JP, Uong J, Palispis WA, Wright DJ, Shah SB, Ward SR, Lee TQ, Steward O. Human motor endplate remodeling after traumatic nerve injury. J Neurosurg 2020:1-8. [PMID: 32947259 DOI: 10.3171/2020.8.jns201461] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/17/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Current management of traumatic peripheral nerve injuries is variable with operative decisions based on assumptions that irreversible degeneration of the human motor endplate (MEP) follows prolonged denervation and precludes reinnervation. However, the mechanism and time course of MEP changes after human peripheral nerve injury have not been investigated. Consequently, there are no objective measures by which to determine the probability of spontaneous recovery and the optimal timing of surgical intervention. To improve guidance for such decisions, the aim of this study was to characterize morphological changes at the human MEP following traumatic nerve injury. METHODS A prospective cohort (here analyzed retrospectively) of 18 patients with traumatic brachial plexus and axillary nerve injuries underwent biopsy of denervated muscles from the upper extremity from 3 days to 6 years after injury. Muscle specimens were processed for H & E staining and immunohistochemistry, with visualization via confocal and two-photon excitation microscopy. RESULTS Immunohistochemical analysis demonstrated varying degrees of fragmentation and acetylcholine receptor dispersion in denervated muscles. Comparison of denervated muscles at different times postinjury revealed progressively increasing degeneration. Linear regression analysis of 3D reconstructions revealed significant linear decreases in MEP volume (R = -0.92, R2 = 0.85, p = 0.001) and surface area (R = -0.75, R2 = 0.56, p = 0.032) as deltoid muscle denervation time increased. Surprisingly, innervated and structurally intact MEPs persisted in denervated muscle specimens from multiple patients 6 or more months after nerve injury, including 2 patients who had presented > 3 years after nerve injury. CONCLUSIONS This study details novel and critically important data about the morphology and temporal sequence of events involved in human MEP degradation after traumatic nerve injuries. Surprisingly, human MEPs not only persisted, but also retained their structures beyond the assumed 6-month window for therapeutic surgical intervention based on previous clinical studies. Preoperative muscle biopsy in patients being considered for nerve transfer may be a useful prognostic tool to determine MEP viability in denervated muscle, with surviving MEPs also being targets for adjuvant therapy.
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Affiliation(s)
- Ranjan Gupta
- 1Peripheral Nerve Research Lab, Department of Orthopaedic Surgery, University of California, Irvine
| | - Justin P Chan
- 1Peripheral Nerve Research Lab, Department of Orthopaedic Surgery, University of California, Irvine
| | - Jennifer Uong
- 1Peripheral Nerve Research Lab, Department of Orthopaedic Surgery, University of California, Irvine
| | - Winnie A Palispis
- 1Peripheral Nerve Research Lab, Department of Orthopaedic Surgery, University of California, Irvine
| | - David J Wright
- 1Peripheral Nerve Research Lab, Department of Orthopaedic Surgery, University of California, Irvine
| | - Sameer B Shah
- 2Department of Orthopaedic Surgery, University of California, San Diego
| | - Samuel R Ward
- 2Department of Orthopaedic Surgery, University of California, San Diego
| | - Thay Q Lee
- 3Congress Medical Foundation, Pasadena; and
| | - Oswald Steward
- 4Reeve-Irvine Research Center, University of California, Irvine, California
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Negrão JR, Mogami R, Ruiz FAR, Wagner FV, Haghighi P, Ward SR, Resnick DL. Correction to: Distal insertional anatomy of the triceps brachii muscle: MRI assessment in cadaveric specimens employing histologic correlation and Play-doh ® models of the anatomic findings. Skeletal Radiol 2020; 49:1069-1071. [PMID: 32248445 DOI: 10.1007/s00256-020-03414-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Figures 9, 10, 11, 12 and 15 corrected.
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Affiliation(s)
- José Renato Negrão
- Radiology Department, Musculoskeletal Division, VA Healthcare System, University of California San Diego, San Diego, 3350, La Jolla Village Drive, San Diego, CA, 92161, USA. .,University of Sao Paulo Medical School, 450 Tito Street, Vila Romana, São Paulo, São Paulo, 05051-000, Brazil.
| | - Roberto Mogami
- Radiology Department, Musculoskeletal Division, VA Healthcare System, University of California San Diego, San Diego, 3350, La Jolla Village Drive, San Diego, CA, 92161, USA.,Radiology Department of Hospital Universitário Pedro Ernesto, State University of Rio de Janeiro, Av 28 de setembro 77, Rio de Janeiro, RJ, 20551-030, Brazil.,Division of Musculoskeletal Radiology, Clinica Felippe Mattoso Américas - Fleury, Av. das Américas 4303, Rio de Janeiro, RJ, 22640-903, Brazil
| | - Francisco Alejandro Ramirez Ruiz
- Radiology Department, Musculoskeletal Division, VA Healthcare System, University of California San Diego, San Diego, 3350, La Jolla Village Drive, San Diego, CA, 92161, USA.,Radiology Department, Pablo Tobon Uribe Hospital, Medellin, Colombia
| | - Felipe Victora Wagner
- Radiology Department, Musculoskeletal Division, VA Healthcare System, University of California San Diego, San Diego, 3350, La Jolla Village Drive, San Diego, CA, 92161, USA.,Moinhos de Vento Hospital, Porto Alegre, Rio Grande do Sul, Brazil
| | - Parviz Haghighi
- Radiology Department, Musculoskeletal Division, VA Healthcare System, University of California San Diego, San Diego, 3350, La Jolla Village Drive, San Diego, CA, 92161, USA.,Department of Pathology, VA Healthcare System San Diego, University of California San Diego, San Diego, CA, USA
| | - Samuel R Ward
- Orthopedic Surgery, Radiology University of California San Diego, San Diego, CA, USA
| | - Donald L Resnick
- Radiology Department, Musculoskeletal Division, VA Healthcare System, University of California San Diego, San Diego, 3350, La Jolla Village Drive, San Diego, CA, 92161, USA
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Shahidi B, Gibbons MC, Esparza M, Zlomislic V, Allen RT, Garfin SR, Ward SR. Cell populations and muscle fiber morphology associated with acute and chronic muscle degeneration in lumbar spine pathology. JOR Spine 2020; 3:e1087. [PMID: 32613162 PMCID: PMC7323470 DOI: 10.1002/jsp2.1087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 12/31/2022] Open
Abstract
Many chronic musculoskeletal conditions are associated with loss of muscle volume and quality, resulting in functional decline. While atrophy has long been implicated as the mechanism of muscle loss in these conditions, recent evidence has emerged demonstrating a degenerative phenotype of muscle loss consisting of disrupted muscle fiber membranes, infiltration of cells into muscle fibers, and as previously describer, possible replacement of muscle fibers by adipose tissue. Here, we use human lumbar spine pathology as a model system to provide a more comprehensive analysis of the morphological features of this mode of muscle loss between early and late stages of disease, including an analysis of the cell populations found in paraspinal muscle biopsies from humans with acute vs chronic lumbar spine pathology. Using longitudinal sections, we show that degeneration of muscle fibers is localized within a fiber (ie, focal), and is characterized by discontinuous or ragged membrane disruption, cellular infiltration, and apparently vacant space containing limited numbers of nuclei and hyper-contractile cell debris. Samples from patients with acute and chronic pathology demonstrate similar magnitudes of muscle degeneration, however, larger proportions of PDGFRβ-positive progenitor cells and leukocytes were observed in the acute group, with no differences in myogenic cells, macrophages, or T-cells. By better understanding the cell population behaviors over the course of disease, therapies can be optimized to address the appropriate targets and timing of administration to minimize the functional consequences of muscle degeneration in lumbar spine pathology.
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Affiliation(s)
- Bahar Shahidi
- Department of Orthopaedic SurgeryUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Michael C. Gibbons
- Department of BioengineeringUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Mary Esparza
- Department of Orthopaedic SurgeryUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Vinko Zlomislic
- Department of Orthopaedic SurgeryUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Richard Todd Allen
- Department of Orthopaedic SurgeryUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Steven R. Garfin
- Department of Orthopaedic SurgeryUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Samuel R. Ward
- Department of Orthopaedic SurgeryUniversity of California San DiegoSan DiegoCaliforniaUSA
- Department of BioengineeringUniversity of California San DiegoSan DiegoCaliforniaUSA
- Department of RadiologyUniversity of California San DiegoSan DiegoCaliforniaUSA
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Berry DB, Rodriguez‐Soto AE, Englund EK, Shahidi B, Parra C, Frank LR, Kelly KR, Ward SR. Multiparametric MRI characterization of level dependent differences in lumbar muscle size, quality, and microstructure. JOR Spine 2020; 3:e1079. [PMID: 32613159 PMCID: PMC7323468 DOI: 10.1002/jsp2.1079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
Magnetic resonance imaging (MRI) is a diagnostic tool that can be used to noninvasively assess lumbar muscle size and fatty infiltration, important biomarkers of muscle health. Diffusion tensor imaging (DTI) is an MRI technique that is sensitive to muscle microstructural features such as fiber size (an important biomarker of muscle health), which is typically only assessed using invasive biopsy techniques. The goal of this study was to establish normative values of level-dependent lumbar muscle size, fat signal fraction, and restricted diffusion assessed by MRI in a highly active population. Forty-two active-duty Marines were imaged using a (a) high-resolution anatomical, (b) fat-water separation, and (c) DT-MRI scan. The multifidus and erector spinae muscles were compared at each level using two-way repeated measures ANOVA. Secondary analysis included Three dimensional (3D) reconstructions to qualitatively assess lumbar muscle size, fatty infiltration, and fiber orientation via tractography. The erector spinae was found to be larger than the multifidus above L5, with lower fat signal fraction above L3, and a less restricted diffusion profile than the multifidus above L4, with this pattern reversed in the lower lumbar spine. 3D reconstructions demonstrated accumulations of epimuscular fat in the anterior and posterior regions of the lumbar musculature, with minimal intramuscular fatty infiltration. Tractography images demonstrated different orientations of adjacent lumbar musculature, which cannot be visualized with standard MRI pulse sequences. The level dependent differences found in this study provide a normative baseline, for which to better understand whole muscle and microstructural changes associated with aging, low back pain, and pathology.
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Affiliation(s)
- David B. Berry
- Department of BioengineeringUniversity of CaliforniaSan DiegoCalifornia
- Department of NanoengineeringUniversity of CaliforniaSan DiegoCalifornia
| | - Ana E. Rodriguez‐Soto
- Department of BioengineeringUniversity of CaliforniaSan DiegoCalifornia
- Department of RadiologyUniversity of CaliforniaSan DiegoCalifornia
| | - Erin K. Englund
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan DiegoCalifornia
| | - Bahar Shahidi
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan DiegoCalifornia
| | - Callan Parra
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan DiegoCalifornia
| | | | - Karen R. Kelly
- Department of Exercise and Nutritional SciencesSan Diego State UniversitySan DiegoCalifornia
- Warfighter Performance DepartmentNaval Health Research CenterSan DiegoCalifornia
| | - Samuel R. Ward
- Department of BioengineeringUniversity of CaliforniaSan DiegoCalifornia
- Department of RadiologyUniversity of CaliforniaSan DiegoCalifornia
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan DiegoCalifornia
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Svensson K, LaBarge SA, Sathe A, Martins VF, Tahvilian S, Cunliffe JM, Sasik R, Mahata SK, Meyer GA, Philp A, David LL, Ward SR, McCurdy CE, Aslan JE, Schenk S. p300 and cAMP response element-binding protein-binding protein in skeletal muscle homeostasis, contractile function, and survival. J Cachexia Sarcopenia Muscle 2020; 11:464-477. [PMID: 31898871 PMCID: PMC7113519 DOI: 10.1002/jcsm.12522] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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] [Received: 07/08/2019] [Revised: 10/22/2019] [Accepted: 11/14/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Reversible ε-amino acetylation of lysine residues regulates transcription as well as metabolic flux; however, roles for specific lysine acetyltransferases in skeletal muscle physiology and function are unknown. In this study, we investigated the role of the related acetyltransferases p300 and cAMP response element-binding protein-binding protein (CBP) in skeletal muscle transcriptional homeostasis and physiology in adult mice. METHODS Mice with skeletal muscle-specific and inducible knockout of p300 and CBP (PCKO) were generated by crossing mice with a tamoxifen-inducible Cre recombinase expressed under the human α-skeletal actin promoter with mice having LoxP sites flanking exon 9 of the Ep300 and Crebbp genes. Knockout of PCKO was induced at 13-15 weeks of age via oral gavage of tamoxifen for 5 days to both PCKO and littermate control [wildtype (WT)] mice. Body composition, food intake, and muscle function were assessed on day 0 (D0) through 5 (D5). Microarray and tandem mass tag mass spectrometry analyses were performed to assess global RNA and protein levels in skeletal muscle of PCKO and WT mice. RESULTS At D5 after initiating tamoxifen treatment, there was a reduction in body weight (-15%), food intake (-78%), stride length (-46%), and grip strength (-45%) in PCKO compared with WT mice. Additionally, ex vivo contractile function [tetanic tension (kPa)] was severely impaired in PCKO vs. WT mice at D3 (~70-80% lower) and D5 (~80-95% lower) and resulted in lethality within 1 week-a phenotype that is reversed by the presence of a single allele of either p300 or CBP. The impaired muscle function in PCKO mice was paralleled by substantial transcriptional alterations (3310 genes; false discovery rate < 0.1), especially in gene networks central to muscle contraction and structural integrity. This transcriptional uncoupling was accompanied by changes in protein expression patterns indicative of impaired muscle function, albeit to a smaller magnitude (446 proteins; fold-change > 1.25; false discovery rate < 0.1). CONCLUSIONS These data reveal that p300 and CBP are required for the control and maintenance of contractile function and transcriptional homeostasis in skeletal muscle and, ultimately, organism survival. By extension, modulating p300/CBP function may hold promise for the treatment of disorders characterized by impaired contractile function in humans.
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Affiliation(s)
- Kristoffer Svensson
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Samuel A LaBarge
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Abha Sathe
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Vitor F Martins
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA.,Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, CA, USA
| | - Shahriar Tahvilian
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Jennifer M Cunliffe
- Department of Biochemistry and Molecular Biology, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Roman Sasik
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Sushil K Mahata
- VA San Diego Healthcare System, San Diego, CA, USA.,Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Gretchen A Meyer
- Program in Physical Therapy and Departments of Neurology, Biomedical Engineering and Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Andrew Philp
- Garvan Institute of Medical Research, Darlinghurst, Sydney, New South Wales, Australia
| | - Larry L David
- Department of Biochemistry and Molecular Biology, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA.,Department of Radiology, University of California San Diego, La Jolla, CA, USA.,Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Carrie E McCurdy
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Joseph E Aslan
- Department of Biochemistry and Molecular Biology, School of Medicine, Oregon Health and Science University, Portland, OR, USA.,Knight Cardiovascular Institute, School of Medicine, Oregon Health and Science University, Portland, OR, USA.,Department of Biomedical Engineering, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Simon Schenk
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA.,Biomedical Sciences Graduate Program, University of California San Diego, La Jolla, CA, USA
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Ward SR, Winters TM, O'Connor SM, Lieber RL. Non-linear Scaling of Passive Mechanical Properties in Fibers, Bundles, Fascicles and Whole Rabbit Muscles. Front Physiol 2020; 11:211. [PMID: 32265730 PMCID: PMC7098999 DOI: 10.3389/fphys.2020.00211] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/24/2020] [Indexed: 01/26/2023] Open
Abstract
Defining variations in skeletal muscle passive mechanical properties at different size scales ranging from single muscle fibers to whole muscles is required in order to understand passive muscle function. It is also of interest from a muscle structural point-of-view to identify the source(s) of passive tension that function at each scale. Thus, we measured passive mechanical properties of single fibers, fiber bundles, fascicles, and whole muscles in three architecturally diverse muscles from New Zealand White rabbits (n = 6) subjected to linear deformation. Passive modulus was quantified at sarcomere lengths across the muscle’s anatomical range. Titin molecular mass and collagen content were also quantified at each size scale, and whole muscle architectural properties were measured. Passive modulus increased non-linearly from fiber to whole muscle for all three muscles emphasizing extracellular sources of passive tension (p < 0.001), and was different among muscles (p < 0.001), with significant muscle by size-scale interaction, indicating quantitatively different scaling for each muscle (p < 0.001). These findings provide insight into the structural basis of passive tension and suggest that the extracellular matrix (ECM) is the dominant contributor to whole muscle and fascicle passive tension. They also demonstrate that caution should be used when inferring whole muscle properties from reduced muscle size preparations such as muscle biopsies.
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Affiliation(s)
- Samuel R Ward
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States.,Department of Radiology, University of California, San Diego, San Diego, CA, United States
| | - Taylor M Winters
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
| | - Shawn M O'Connor
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States
| | - Richard L Lieber
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States.,Veteran's Administration San Diego Healthcare System, San Diego, CA, United States.,Shirley Ryan AbilityLab, Northwestern University, Chicago, IL, United States
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Shahidi B, Fisch KM, Gibbons MC, Ward SR. Increased Fibrogenic Gene Expression in Multifidus Muscles of Patients With Chronic Versus Acute Lumbar Spine Pathology. Spine (Phila Pa 1976) 2020; 45:E189-E195. [PMID: 31513095 PMCID: PMC6994378 DOI: 10.1097/brs.0000000000003243] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 02/07/2023]
Abstract
STUDY DESIGN Prospective observational study-basic science (Level 1). OBJECTIVE The aim of this study was to compare expression of functional groups of genes within the atrophic, myogenic, fibrogenic, adipogenic, and inflammatory pathways between paraspinal muscle biopsies from individuals with acute and chronic lumbar spine pathology. SUMMARY OF BACKGROUND DATA Low back pain is a complex and multifactorial condition that affects a majority of the general population annually. Changes in muscle tissue composition (i.e., fatty and fibrotic infiltration) are a common feature in individuals with lumbar spine pathology associated with low back pain, which often results in functional loss. Understanding the molecular underpinnings of these degenerative changes in different phases of disease progression may improve disease prevention and treatment specificity. METHODS Intraoperative biopsies of the multifidus muscle were obtained from individuals undergoing surgery for acute (<6-month duration) or chronic (>6-month duration) lumbar spine pathology. Expression of 42 genes related to myogenesis, atrophy, adipogenesis, metabolism, inflammation, and fibrosis were measured in 33 samples (eight acute, 25 chronic) using qPCR, and tissue composition of fat, muscle, and fibrosis was quantified using histology. RESULTS We found that tissue composition of the biopsies was heterogeneous, resulting in a trend toward lower RNA yields in biopsies with higher proportions of fat (r <-0.39, P < 0.1). There were no significant differences in gene expression patterns for atrophy (P > 0.635), adipogenesis (P > 0.317), myogenesis (P > 0.320), or inflammatory (P > 0.413) genes after adjusting for the proportion of muscle, fat, and connective tissue. However, in the fibrogenesis pathway, we found significant upregulation of CTGF (P = 0.046), and trends for upregulation of COL1A1 (P = 0.061), and downregulation of MMP1 and MMP9 (P = 0.061) in the chronic group. CONCLUSION There is increased fibrogenic gene expression in individuals with chronic disease when compared to acute disease, without significant differences in atrophic, myogenic, adipogenic, or inflammatory pathways, suggesting increased efforts should be made to prevent or reverse fibrogenesis to improve patient function in this population. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Bahar Shahidi
- University of California San Diego Department of Orthopaedic Surgery, San Diego USA
| | - Kathleen M. Fisch
- University of California San Diego, Center for Computational Biology & Bioinformatics, Department of Medicine, San Diego, USA
| | - Michael C. Gibbons
- University of California San Diego Department of Bioengineering, San Diego, USA
| | - Samuel R. Ward
- University of California San Diego Department of Orthopaedic Surgery, San Diego USA
- University of California San Diego Department of Bioengineering, San Diego, USA
- University of California San Diego Department of Radiology, San Diego, USA
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Chan JP, Clune J, Shah SB, Ward SR, Kocsis JD, Mozaffar T, Steward O, Gupta R. Examination of the human motor endplate after brachial plexus injury with two-photon microscopy. Muscle Nerve 2019; 61:390-395. [PMID: 31820462 DOI: 10.1002/mus.26778] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/28/2019] [Accepted: 12/03/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION After traumatic nerve injury, neuromuscular junction remodeling plays a key role in determining functional outcomes. Immunohistochemical analyses of denervated muscle biopsies may provide valuable prognostic data regarding clinical outcomes to supplement electrodiagnostic studies. METHODS We performed biopsies on nonfunctioning deltoid muscles in two patients after gunshot wounds and visualized the neuromuscular junctions using two-photon microscopy with immunohistochemistry. RESULTS Although the nerves in both patients showed evidence of acute Wallerian degeneration, some of the motor endplates were intact but exhibited significantly decreased surface area and volume. Both patients exhibited substantial recovery of motor function over several weeks postinjury. DISCUSSION Two-photon microscopic assessment of neuromuscular junction integrity and motor endplate morphometry in muscle biopsies provided evidence of partial sparing of muscle innervation. This finding supported the clinical judgment that eventual recovery would occur. With further study, this technique may help to guide operative decisionmaking after traumatic nerve injuries.
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Affiliation(s)
- Justin P Chan
- Department of Orthopaedic Surgery, University of California, Irvine, California
| | - James Clune
- Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Sameer B Shah
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California.,Department of Bioengineering, University of California, San Diego, La Jolla, California
| | - Samuel R Ward
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, California.,Department of Bioengineering, University of California, San Diego, La Jolla, California
| | - Jeffery D Kocsis
- Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Tahseen Mozaffar
- Department of Neurology, University of California, Irvine, Irvine, California
| | - Oswald Steward
- Reeve-Irvine Research Center, University of California, Irvine, Irvine, California
| | - Ranjan Gupta
- Department of Orthopaedic Surgery, University of California, Irvine, California
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Parvaresh KC, Chang C, Patel A, Lieber RL, Ball ST, Ward SR. Architecture of the Short External Rotator Muscles of the Hip. BMC Musculoskelet Disord 2019; 20:611. [PMID: 31862009 PMCID: PMC6925491 DOI: 10.1186/s12891-019-2995-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Received: 08/15/2019] [Accepted: 12/09/2019] [Indexed: 11/24/2022] Open
Abstract
Background Muscle architecture, or the arrangement of sarcomeres and fibers within muscles, defines functional capacity. There are limited data that provide an understanding of hip short external rotator muscle architecture. The purpose of this study was thus to characterize the architecture of these small hip muscles. Methods Eight muscles from 10 independent human cadaver hips were used in this study (n = 80 muscles). Architectural measurements were made on pectineus, piriformis, gemelli, obturators, quadratus femoris, and gluteus minimus. Muscle mass, fiber length, sarcomere length, and pennation angle were used to calculate the normalized muscle fiber length, which defines excursion, and physiological cross-sectional area (PCSA), which defines force-producing capacity. Results Gluteus minimus had the largest PCSA (8.29 cm2) followed by obturator externus (4.54 cm2), whereas superior gemellus had the smallest PCSA (0.68 cm2). Fiber lengths clustered into long (pectineus - 10.38 cm and gluteus minimus - 10.30 cm), moderate (obturator internus - 8.77 cm and externus - 8.04 cm), or short (inferior gemellus - 5.64 and superior gemellus - 4.85). There were no significant differences among muscles in pennation angle which were all nearly zero. When the gemelli and obturators were considered as a single functional unit, their collective PCSA (10.00 cm2) exceeded that of gluteus minimus as a substantial force-producing group. Conclusions The key findings are that these muscles have relatively small individual PCSAs, short fiber lengths, and low pennation angles. The large collective PCSA and short fiber lengths of the gemelli and obturators suggest that they primarily play a stabilizing role rather than a joint rotating role.
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Affiliation(s)
- Kevin C Parvaresh
- Departments of Orthopaedic Surgery, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0863, USA
| | - Charles Chang
- Departments of Orthopaedic Surgery, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0863, USA
| | - Ankur Patel
- Departments of Orthopaedic Surgery, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0863, USA
| | - Richard L Lieber
- Departments of Orthopaedic Surgery, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0863, USA.,Departments of Bioengineering, University of California, San Diego, USA
| | - Scott T Ball
- Departments of Orthopaedic Surgery, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0863, USA
| | - Samuel R Ward
- Departments of Orthopaedic Surgery, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0863, USA. .,Departments of Bioengineering, University of California, San Diego, USA. .,Departments of Radiology, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA, 92093-0863, USA.
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Berry DB, Padwal J, Johnson S, Englund EK, Ward SR, Shahidi B. The effect of high-intensity resistance exercise on lumbar musculature in patients with low back pain: a preliminary study. BMC Musculoskelet Disord 2019; 20:290. [PMID: 31208400 PMCID: PMC6580468 DOI: 10.1186/s12891-019-2658-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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] [Received: 03/12/2019] [Accepted: 05/28/2019] [Indexed: 12/19/2022] Open
Abstract
Background Muscle atrophy and fatty infiltration of the lumbar extensors is associated with LBP. Exercise-based rehabilitation targets strengthening these muscles, but few studies show consistent changes in muscle quality with standard-of-care rehabilitation. The goal of this study was to assess the effect of high-intensity resistance exercise on lumbar extensor muscle size (cross sectional area) and quality (fat fraction) in individuals with low back pain (LBP). Methods Fourteen patients with LBP were recruited from a local rehabilitation clinic. Patients underwent MRI scanning before and after a standardized 10-week high-intensity machine-based, resistance exercise program. Patient pain, disability, anxiety/depression, satisfaction, strength, and range of motion was compared pre- and post-rehabilitation using analysis of covariance (covariates: age, gender). Exercise-induced changes in MRI, and patient functional outcome measures were correlated using Pearson’s correlation test. Results No significant differences were found in muscle size or fatty infiltration of the lumbar extensors over the course of rehabilitation (p > 0.31). However, patients reported reduced pain (p = 0.002) and were stronger (p = 0.03) at the conclusion of the program. Improvements in muscle size and quality for both multifidus and erector spinae correlated with improvements in disability, anxiety/depression, and strength. Conclusion While average muscle size and fatty infiltration levels did not change with high-intensity exercise, the results suggest that a subgroup of patients who demonstrate improvements in muscle health demonstrate the largest functional improvements. Future research is needed to identify which patients are most likely to respond to this type of treatment.
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Affiliation(s)
- David B Berry
- Departments of Bioengineering, University of California San Diego, La Jolla, California, USA.,Departments of Nanoengineering, University of California San Diego, La Jolla, California, USA
| | - Jennifer Padwal
- Departments of Medicine, University of California San Diego, La Jolla, California, USA
| | - Seth Johnson
- Departments of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
| | - Erin K Englund
- Departments of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA
| | - Samuel R Ward
- Departments of Bioengineering, University of California San Diego, La Jolla, California, USA.,Departments of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA.,Departments of Radiology, University of California San Diego, La Jolla, California, USA
| | - Bahar Shahidi
- Departments of Orthopaedic Surgery, University of California San Diego, La Jolla, California, USA.
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Shahidi B, Ward SR. Selective Fatty Replacement of Paraspinal Muscles in Facioscapulohumeral Muscular Dystrophy. J Orthop Sports Phys Ther 2019; 49:483. [PMID: 31151375 PMCID: PMC10448540 DOI: 10.2519/jospt.2019.8815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A 65-year-old man with a history of facioscapulohumeral muscular dystrophy presented to his physician with a complaint of new-onset low back pain, bilateral foot numbness, and left lower extremity radicular symptoms with foot drop. He subsequently underwent magnetic resonance imaging of the lumbar spine, which revealed complete fatty replacement of the erector spinae musculature throughout the lumbar spine. Preservation of the lumbar multifidus muscles above the L4 level was observed, which has not previously been reported in patients with this condition. The patient's lower extremity symptoms were consistent with left L5-S1 radiculopathy, and the magnetic resonance images indicated mild to moderate central canal stenosis at L2-L3 with severe bilateral L5-S1 foraminal narrowing. J Orthop Sports Phys Ther 2019;49(6):483. doi:10.2519/jospt.2019.8815.
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Onodera K, Berry DB, Shahidi B, Kelly KR, Ward SR. Intervertebral disc kinematics in active duty Marines with and without lumbar spine pathology. JOR Spine 2019; 2:e1057. [PMID: 31463467 PMCID: PMC6686816 DOI: 10.1002/jsp2.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 11/06/2018] [Revised: 04/01/2019] [Accepted: 05/16/2019] [Indexed: 11/06/2022] Open
Abstract
Military members are required to carry heavy loads frequently during training and active duty combat. We investigated if operationally relevant axial loads affect lumbar disc kinematics in forty-one male active duty Marines with no previous clinically diagnosed pathology. Marines were imaged standing upright with and without load. From T2-weighted magnetic resonance images, intervertebral disc (IVD) health and kinematic changes between loading conditions and across lumbar levels were evaluated using two-way repeated measures analysis of variance tests. IVD kinematics with loading were compared between individuals with and without signs of degeneration on imaging. Linear regression analyses were performed to determine associations between IVD position and kinematic changes with loading. Fifty-eight percent (118/205) of IVDs showed evidence of degeneration and 3% (7/205) demonstrated a disc bulge. IVD degeneration was not related to posterior annular position (P > .205). Changes in sagittal intervertebral angle were not associated with changes in posterior annular position between baseline and loaded conditions at any lumbar level (r < 0.267; P = .091-.746). Intervertebral angles were significantly larger in the lower regions of the spine (P < .001), indicating increased local lordosis when moving in the caudal direction Disc height at the L5/S1 level was significantly smaller (6.3 mm, mean difference = 1.20) than all other levels (P < .001) and baseline posterior disc heights tended to be larger at baseline (7.43 mm ± 1.46) than after loading (7.18 ± 1.57, P = .071). Individuals with a larger baseline posterior annular position demonstrated greater reduction with load at all levels (P < .002), with the largest reductions at L5/S1 level. Overall, while this population demonstrated some signs of disc degeneration, operationally relevant loading did not significantly affect disc kinematics.
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Affiliation(s)
- Keenan Onodera
- Department of Orthopaedic SurgeryUniversity of California San DiegoLa JollaCalifornia
| | - David B. Berry
- Department of BioengineeringUniversity of California San DiegoLa JollaCalifornia
| | - Bahar Shahidi
- Department of Orthopaedic SurgeryUniversity of California San DiegoLa JollaCalifornia
- Department of RadiologyUniversity of California San DiegoLa JollaCalifornia
| | - Karen R. Kelly
- Warfighter Performance DepartmentNaval Health Research CenterSan DiegoCalifornia
| | - Samuel R. Ward
- Department of Orthopaedic SurgeryUniversity of California San DiegoLa JollaCalifornia
- Department of BioengineeringUniversity of California San DiegoLa JollaCalifornia
- Department of RadiologyUniversity of California San DiegoLa JollaCalifornia
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Berry DB, Hernandez A, Onodera K, Ingram N, Ward SR, Gombatto SP. Lumbar spine angles and intervertebral disc characteristics with end-range positions in three planes of motion in healthy people using upright MRI. J Biomech 2019; 89:95-104. [PMID: 31047693 DOI: 10.1016/j.jbiomech.2019.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/02/2019] [Accepted: 04/12/2019] [Indexed: 12/17/2022]
Abstract
Understanding changes in lumbar spine (LS) angles and intervertebral disc (IVD) behavior in end-range positions in healthy subjects can provide a basis for developing more specific LS models and comparing people with spine pathology. The purposes of this study are to quantify 3D LS angles and changes in IVD characteristics with end-range positions in 3 planes of motion using upright MRI in healthy people, and to determine which intervertebral segments contribute most in each plane of movement. Thirteen people (average age = 24.4 years, range 18-51 years; 9 females; BMI = 22.4 ± 1.8 kg/m2) with no history of low back pain were scanned in an upright MRI in standing, sitting flexion, sitting axial rotation (left, right), prone on elbows, prone extension, and standing lateral bending (left, right). Global and local intervertebral LS angles were measured. Anterior-posterior length of the IVD and location of the nucleus pulposus was measured. For the sagittal plane, lower LS segments contribute most to change in position, and the location of the nucleus pulposus migrated from a more posterior position in sitting flexion to a more anterior position in end-range extension. For lateral bending, the upper LS contributes most to end-range positions. Small degrees of intervertebral rotation (1-2°) across all levels were observed for axial plane positions. There were no systematic changes in IVD characteristics for axial or coronal plane positions.
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Affiliation(s)
- David B Berry
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA
| | - Alejandra Hernandez
- Doctor of Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Keenan Onodera
- Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Noah Ingram
- Doctor of Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Samuel R Ward
- Department of Bioengineering, University of California San Diego, La Jolla, CA, USA; Department of Orthopaedic Surgery, University of California San Diego, La Jolla, CA, USA; Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Sara P Gombatto
- Doctor of Physical Therapy Program, School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA.
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Mukund K, Ward SR, Lieber RL, Subramaniam S. Co-Expression Network Approach to Studying the Effects of Botulinum Neurotoxin-A. IEEE/ACM Trans Comput Biol Bioinform 2018; 15:2009-2016. [PMID: 29053464 DOI: 10.1109/tcbb.2017.2763949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Botulinum Neurotoxin A (BoNT-A) is a potent neurotoxin with several clinical applications. The goal of this study was to utilize co-expression network theory to analyze temporal transcriptional data from skeletal muscle after BoNT-A treatment. Expression data for 2000 genes (extracted using a ranking heuristic) served as the basis for this analysis. Using weighted gene co-expression network analysis (WGCNA), we identified 19 co-expressed modules, further hierarchically clustered into five groups. Quantifying average expression and co-expression patterns across these groups revealed temporal aspects of muscle's response to BoNT-A. Functional analysis revealed enrichment of group 1 with metabolism; group 5 with contradictory functions of atrophy and cellular recovery; and groups 2 and 3 with extracellular matrix (ECM) and non-fast fiber isoforms. Topological positioning of two highly ranked, significantly expressed genes-Dclk1 and Ostalpha-within group 5 suggested possible mechanistic roles in recovery from BoNT-A induced atrophy. Phenotypic correlations of groups with titin and myosin protein content further emphasized the effect of BoNT-A on the sarcomeric contraction machinery in early phase of chemodenervation. In summary, our approach revealed a hierarchical functional response to BoNT-A induced paralysis with early metabolic and later ECM responses and identified putative biomarkers associated with chemodenervation. Additionally, our results provide an unbiased validation of the response documented in our previous work.
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