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Meng X, Chen Z, Li T, Nie Z, Han H, Zhong S, Yin Z, Sun S, Xie J, Shen J, Xu X, Gao C, Ran L, Xu B, Xiang Z, Wang J, Sun P, Xin P, A X, Zhang C, Qiu G, Gao H, Bian Y, Xu M, Cao B, Li F, Zheng L, Zhang X, Xiao L. Role and Therapeutic Potential for Targeting Fibroblast Growth Factor 10/FGFR1 in Relapsed Rheumatoid Arthritis. Arthritis Rheumatol 2024; 76:32-47. [PMID: 37584284 DOI: 10.1002/art.42674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 06/16/2023] [Accepted: 08/02/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE Fibroblast-like synoviocytes (FLSs) contribute to inflammation and joint damage in rheumatoid arthritis (RA). However, the regulatory mechanisms of FLSs in relapse and remission of RA remain unknown. Identifying FLS heterogeneity and their underlying pathogenic roles may lead to discovering novel disease-modifying antirheumatic drugs. METHODS Combining single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics, we sequenced six matched synovial tissue samples from three patients with relapse RA and three patients in remission. We analyzed the differences in the transcriptomes of the FLS subsets between the relapse and remitted phases. We validated several key signaling pathways using quantitative real-time PCR (qPCR) and multiplex immunohistochemistry (mIHC). We further targeted the critical signals in vitro and in vivo using the collagen-induced arthritis (CIA) model in rats. RESULTS Lining and sublining FLS subsets were identified using scRNA-seq. Differential analyses indicated that the fibroblast growth factor (FGF) pathway was highly activated in the lining FLSs from patients with relapse RA for which mIHC confirmed the increased expression of FGF10. Although the type I interferon pathway was also activated in the lining FLSs, in vitro stimulation experiment suggested that it was independent of the FGF10 pathway. FGF10 knockdown by small interfering RNA in FLSs significantly reduced the expression of receptor activator of NF-κB ligand. Moreover, recombinant FGF10 protein enhanced bone erosion in the primary human-derived pannus cell culture, whereas the FGF receptor (FGFR) 1 inhibitor attenuated this process. Finally, administering an FGFR1 inhibitor displayed a therapeutic effect in a CIA rat model. CONCLUSION The FGF pathway is a critical signaling pathway in relapse RA. Targeted tissue-specific inhibition of FGF10/FGFR1 may provide new opportunities to treat patients with relapse RA.
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MESH Headings
- Humans
- Rats
- Animals
- Fibroblast Growth Factor 10/metabolism
- Fibroblast Growth Factor 10/pharmacology
- Fibroblast Growth Factor 10/therapeutic use
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/genetics
- Arthritis, Rheumatoid/metabolism
- Synoviocytes/metabolism
- Inflammation/metabolism
- Fibroblasts/metabolism
- Recurrence
- Cells, Cultured
- Cell Proliferation
- Receptor, Fibroblast Growth Factor, Type 1/genetics
- Receptor, Fibroblast Growth Factor, Type 1/metabolism
- Receptor, Fibroblast Growth Factor, Type 1/therapeutic use
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Affiliation(s)
- Xiaohui Meng
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China
- Wuxi TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Zechuan Chen
- Shanghai Institute of Immunity and Infection, Chinese Academy of Sciences, Shanghai, China, and University of Chinese Academy of Sciences, Beijing, China
| | - Teng Li
- Shanghai Institute of Immunity and Infection, Chinese Academy of Sciences, Shanghai, China, and University of Chinese Academy of Sciences, Beijing, China
| | - Zhixing Nie
- Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China
| | - Haihui Han
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Sheng Zhong
- Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China
| | - Zhinan Yin
- Jinan University, Guangzhou, Guangdong, China
| | - Songtao Sun
- Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China
| | - Jun Xie
- Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China
| | - Jun Shen
- Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China
| | - Xirui Xu
- Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China
| | - Chenxin Gao
- Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China
| | - Lei Ran
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bo Xu
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zheng Xiang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianye Wang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Pengfei Sun
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Pengfei Xin
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xinyu A
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chengbo Zhang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guowei Qiu
- Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China
| | - Huali Gao
- Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China
| | - Yanqin Bian
- Shanghai Guanghua Hospital of Integrative Medicine and Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Minglan Xu
- Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China
| | - Boran Cao
- Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China
| | - Fang Li
- Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China
| | - Lin Zheng
- Shanghai Guanghua Hospital of Integrative Medicine, Shanghai, China
| | - Xiaoming Zhang
- Shanghai Institute of Immunity and Infection, Chinese Academy of Sciences, Shanghai, China, University of Chinese Academy of Sciences, Beijing, China, and Shanghai Huashen Institute of Microbes and Infections, Shanghai, China
| | - Lianbo Xiao
- Shanghai Guanghua Hospital of Integrative Medicine and Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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Xu H, Zhao C, Guo G, Li Y, A X, Qiu G, Wang Y, Kang B, Xu X, Xie J, Xiao L. The Effectiveness of Tuina in Relieving Pain, Negative Emotions, and Disability in Knee Osteoarthritis: A Randomized Controlled Trial. Pain Med 2023; 24:244-257. [PMID: 35997590 DOI: 10.1093/pm/pnac127] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 08/07/2022] [Accepted: 08/11/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of Tuina in relieving the pain, negative emotions, and disability of patients with knee osteoarthritis (KOA). DESIGN Single-center, parallel, randomized controlled trial. SETTING Shanghai Guanghua Integrated Chinese and Western Medicine Hospital, Shanghai, China. SUBJECTS Adult patients with KOA who were able to speak Chinese and self-report symptoms were eligible. METHODS A total of 104 patients were randomly allocated to receive the 6-week treatment of Tuina (Tuina group) or celecoxib (celecoxib group). Data on pain, negative emotions, and disability were collected at baseline, at week 2, 4, and 6, and follow-up (1 month after the last treatment). The primary outcomes were the pressure pain thresholds. The secondary outcomes were: (1) numerical rating scale at rest and with movement; (2) Hamilton Anxiety Scale; (3) Hamilton Depression Scale; (4) Western Ontario and McMaster Universities Osteoarthritis Index; and (5) clinical effective rate. The adverse events of the trial were evaluated. RESULTS In total, 99 patients completed the follow-up. Generalized linear mixed models were constructed to analyse the between-group differences. Statistically significant differences were found in the interaction effects (P < .05). In evaluating the group effect, statistical differences were found at week 6 and follow-up (P < .05). Further, all variables showed a time effect (P < .05). A statistical difference in the clinical effective rate was found between the Tuina and celecoxib groups (P < .05). CONCLUSIONS Tuina produced superior effects for pain, negative emotions, and disability over time, as compared to celecoxib in patients with KOA.
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Affiliation(s)
- Hui Xu
- School of Acupuncture-Moxibustion and Tuina, Henan University of Chinese Medicine, Zhengzhou, China.,Tuina Department, The Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Chi Zhao
- School of Acupuncture-Moxibustion and Tuina, Henan University of Chinese Medicine, Zhengzhou, China.,Orthopedics Department, The Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Guangxin Guo
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yulin Li
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xinyu A
- Guanghua School of Clinical Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guowei Qiu
- Guanghua School of Clinical Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuxia Wang
- Outpatient Office, Rehabilitation Department, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Bingxin Kang
- Rehabilitation Department, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Xirui Xu
- Guanghua School of Clinical Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Xie
- Guanghua School of Clinical Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Joint Surgery Department, Shanghai Guanghua Integrated Chinese and Western Medicine Hospital, Shanghai, China
| | - Lianbo Xiao
- Joint Surgery Department, Shanghai Guanghua Integrated Chinese and Western Medicine Hospital, Shanghai, China.,Arthritis Research Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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Kang B, Zhao C, Ma J, Wang H, Gu X, Xu H, Zhong S, Gao C, Xu X, A X, Xie J, Du M, Shen J, Xiao L. Electroacupuncture alleviates pain after total knee arthroplasty through regulating neuroplasticity: A resting-state functional magnetic resonance imaging study. Brain Behav 2023; 13:e2913. [PMID: 36749304 PMCID: PMC10013951 DOI: 10.1002/brb3.2913] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 07/13/2022] [Revised: 01/10/2023] [Accepted: 01/15/2023] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION We aimed to evaluate the efficacy of electroacupuncture in relieving acute pain after total knee arthroplasty (TKA) and related mechanism. METHODS In this randomized, single-blind, and sham-acupuncture controlled study. Forty patients with postoperative acute pain were recruited and randomly divided electroacupuncture group (n = 20) and sham-acupuncture group (n = 20) from November 2020 to October 2021. All patients received electroacupuncture or sham-acupuncture for 5 days after TKA. Their brain regions were scanned with resting-state functional magnetic resonance imaging before and after intervention. Pain was scaled. Another 40 matched healthy controls underwent scanning once. The amplitude of low-frequency fluctuation (ALFF) values was compared. Pearson's correlation analysis was utilized to explore the correlation of ALFF with clinical variables in patients after intervention. RESULTS Compared with the HCs, patients with acute pain following TKA had significantly decreased ALFF value in right middle frontal gyrus, right supplementary motor area, bilateral precuneus, right calcarine fissure and surrounding cortex, and left triangular part of inferior frontal gyrus (false discovery rate corrected p < .05). Patients had higher ALFF value in bilateral precuneus, right cuneus, right angular gyrus, bilateral middle occipital gyrus, and left middle temporal gyrus after electroacupuncture (AlphaSim corrected p < .01). Correlation analysis revealed that the change (postoperative day 7 to postoperative day 3) of ALFF in bilateral precuneus were negatively correlated with the change of NRS scores (r = -0.706; p = .002; 95% CI = -0.890 to -0.323) in EA group. CONCLUSIONS The functional activities of related brain regions decreased in patients with acute pain after TKA. The enhancement of the functional activity of precuneus may be the neurobiological mechanism of electroacupuncture in treating pain following TKA.
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Affiliation(s)
- Bingxin Kang
- Department of Rehabilitation centersThe First Affiliated Hospital of Henan University of Chinese MedicineZhengzhouChina
| | - Chi Zhao
- Acupuncture Tuina InstituteHenan University of Chinese MedicineZhengzhouChina
| | - Jie Ma
- Center of Rehabilitation MedicineYueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Haiqi Wang
- Department of OrthopaedicsShanghai Guanghua Hospital of Integrative Chinese and Western MedicineShanghaiChina
| | - Xiaoli Gu
- Department of OrthopaedicsShanghai Guanghua Hospital of Integrative Chinese and Western MedicineShanghaiChina
| | - Hui Xu
- Acupuncture Tuina InstituteHenan University of Chinese MedicineZhengzhouChina
| | - Sheng Zhong
- Department of OrthopaedicsShanghai Guanghua Hospital of Integrative Chinese and Western MedicineShanghaiChina
| | - Chenxin Gao
- Department of OrthopaedicsShanghai Guanghua Hospital of Integrative Chinese and Western MedicineShanghaiChina
| | - Xirui Xu
- Department of OrthopaedicsShanghai Guanghua Hospital of Integrative Chinese and Western MedicineShanghaiChina
| | - Xinyu A
- Department of OrthopaedicsShanghai Guanghua Hospital of Integrative Chinese and Western MedicineShanghaiChina
| | - Jun Xie
- Department of OrthopaedicsShanghai Guanghua Hospital of Integrative Chinese and Western MedicineShanghaiChina
| | - Mengmeng Du
- Department of Rehabilitation centersThe First Affiliated Hospital of Henan University of Chinese MedicineZhengzhouChina
- Depart of Peripheral vascularThe First Affiliated Hospital of Henan University of Chinese MedicineZhengzhouChina
| | - Jun Shen
- Department of OrthopaedicsShanghai Guanghua Hospital of Integrative Chinese and Western MedicineShanghaiChina
- Arthritis Institute of Integrated Traditional Chinese and Western MedicineShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Lianbo Xiao
- Department of OrthopaedicsShanghai Guanghua Hospital of Integrative Chinese and Western MedicineShanghaiChina
- Arthritis Institute of Integrated Traditional Chinese and Western MedicineShanghai University of Traditional Chinese MedicineShanghaiChina
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Zhao C, Xu H, A X, Kang B, Xie J, Shen J, Sun S, Zhong S, Gao C, Xu X, Zhou Y, Xiao L. Cerebral mechanism of opposing needling for managing acute pain after unilateral total knee arthroplasty: study protocol for a randomized, sham-controlled clinical trial. Trials 2022; 23:133. [PMID: 35144662 PMCID: PMC8832781 DOI: 10.1186/s13063-022-06066-6] [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] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 01/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Opposing needling is a unique method used in acupuncture therapy to relieve pain, acting on the side contralateral to the pain. Although opposing needling has been used to treat pain in various diseases, it is not clear how opposing needling affects the activity of the central nervous system to relieve acute pain. We herein present the protocol for a randomized sham-controlled clinical trial aiming to explore the cerebral mechanism of opposing needling for managing acute pain after unilateral total knee arthroplasty (TKA). Methods This is a randomized sham-controlled single-blind clinical trial. Patients will be allocated randomly to two parallel groups (A: opposing electroacupuncture group; B: sham opposing electroacupuncture group). The Yinlingquan (SP9), Yanglingquan (GB34), Futu (ST32), and Zusanli (ST36) acupoints will be used as the opposing needling sites in both groups. In group A, the healthy lower limbs will receive electroacupuncture, while in group B, the healthy lower limbs will receive sham electroacupuncture. At 72 h after unilateral TKA, patients in both groups will begin treatment once per day for 3 days. Functional magnetic resonance imaging will be performed on all patients before the intervention, after unilateral TKA, and at the end of the intervention to detect changes in brain activity. Changes in pressure pain thresholds will be used as the main outcome for the improvement of knee joint pain. Secondary outcome indicators will include the visual analogue scale (including pain during rest and activity) and a 4-m walking test. Surface electromyography, additional analgesia use, the self-rating anxiety scale, and the self-rating depression scale will be used as additional outcome indices. Discussion The results will reveal the influence of opposing needling on cerebral activity in patients with acute pain after unilateral TKA and the possible relationship between cerebral activity changes and improvement of clinical variables, which may indicate the central mechanism of opposing needling in managing acute pain after unilateral TKA. Trial registration Study on the brain central mechanism of opposing needling analgesia after total kneearthroplasty based on multimodal MRI ChiCTR2100042429. Registered on January 21, 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06066-6.
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Affiliation(s)
- Chi Zhao
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Hui Xu
- School of Acupuncture-Moxibustion and Tuina, Henan University of Chinese Medicine, Zhengzhou, 450003, China
| | - Xinyu A
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Bingxin Kang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450099, China
| | - Jun Xie
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China
| | - Jun Shen
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China
| | - Songtao Sun
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China
| | - Sheng Zhong
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China
| | - Chenxin Gao
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China
| | - Xirui Xu
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China.,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China
| | - Youlong Zhou
- School of Acupuncture-Moxibustion and Tuina, Henan University of Chinese Medicine, Zhengzhou, 450003, China.
| | - Lianbo Xiao
- Department of Joint Orthopaedics, Guanghua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China. .,Arthritis Institute of Integrated Traditional Chinese and Western Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200050, China. .,Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 200050, China.
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