1
|
Woloszyk A, Tuong ZK, Perez L, Aguilar L, Bankole AI, Evans CH, Glatt V. Fracture hematoma micro-architecture influences transcriptional profile and plays a crucial role in determining bone healing outcomes. Biomater Adv 2022; 139:213027. [PMID: 35882120 DOI: 10.1016/j.bioadv.2022.213027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
The hematoma that forms between broken fragments of bone serves as a natural fibrin scaffold, and its removal from the defect site delays bone healing. The hypothesis of this study is that the microarchitectural and mechanical properties of the initially formed hematoma has a significant effect on the regulation of the biological process, which ultimately determines the outcome of bone healing. To mimic three healing conditions in the rat femur (normal, delayed, and non-healing bone defects), three different defect sizes of 0.5, 1.5, and 5.0 mm, are respectively used. The analysis of 3-day-old hematomas demonstrates clear differences in fibrin clot micro-architecture in terms of fiber diameter, fiber density, and porosity of the formed fibrin network, which result in different mechanical properties (stiffness) of the hematoma in each model. Those differences directly affect the biological processes involved. Specifically, RNA-sequencing reveals almost 700 differentially expressed genes between normally healing and non-healing defects, including significantly up-regulated essential osteogenic genes in normally healing defects, also differences in immune cell populations, activated osteogenic transcriptional regulators as well as potential novel marker genes. Most importantly, this study demonstrates that the healing outcome has already been determined during the hematoma phase of bone healing, three days post-surgery.
Collapse
Affiliation(s)
- Anna Woloszyk
- Department of Orthopaedics, University of Texas Health Science Center, San Antonio 78229, TX, USA.
| | - Zewen K Tuong
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Woolloongabba 4102, QLD, Australia; Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge CB2 0AW, UK; Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK.
| | - Louis Perez
- Department of Orthopaedics, University of Texas Health Science Center, San Antonio 78229, TX, USA.
| | - Leonardo Aguilar
- Department of Orthopaedics, University of Texas Health Science Center, San Antonio 78229, TX, USA.
| | - Abraham I Bankole
- Department of Orthopaedics, University of Texas Health Science Center, San Antonio 78229, TX, USA.
| | - Christopher H Evans
- Rehabilitation Medicine Research Center, Mayo Clinic, Rochester 55902, MN, USA.
| | - Vaida Glatt
- Department of Orthopaedics, University of Texas Health Science Center, San Antonio 78229, TX, USA.
| |
Collapse
|
2
|
Bravo D, Josephson AM, Bradaschia-Correa V, Wong MZ, Yim NL, Neibart SS, Lee SN, Huo J, Coughlin T, Mizrahi MM, Leucht P. Temporary inhibition of the plasminogen activator inhibits periosteal chondrogenesis and promotes periosteal osteogenesis during appendicular bone fracture healing. Bone 2018; 112:97-106. [PMID: 29680264 PMCID: PMC5970081 DOI: 10.1016/j.bone.2018.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 08/15/2017] [Revised: 02/11/2018] [Accepted: 04/17/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Aminocaproic acid is approved as an anti-fibrinolytic for use in joint replacement and spinal fusion surgeries to limit perioperative blood loss. Previous animal studies have demonstrated a pro-osteogenic effect of aminocaproic acid in spine fusion models. Here, we tested if aminocaproic acid enhances appendicular bone healing and we sought to uncover the effect of aminocaproic acid on osteoprogenitor cells (OPCs) during bone regeneration. METHODS We employed a well-established murine femur fracture model in adult C57BL/6J mice after receiving two peri-operative injections of aminocaproic acid. Routine histological assays, biomechanical testing and micro-CT analyses were utilized to assess callus volume, and strength, progenitor cell proliferation, differentiation, and remodeling in vivo. Two disparate ectopic transplantation models were used to study the effect of the growth factor milieu within the early fracture hematoma on osteoprogenitor cell fate decisions. RESULTS Aminocaproic acid treated femur fractures healed with a significantly smaller cartilaginous callus, and this effect was also observed in the ectopic transplantation assays. We hypothesized that aminocaproic acid treatment resulted in a stabilization of the early fracture hematoma, leading to a change in the growth factor milieu created by the early hematoma. Gene and protein expression analysis confirmed that aminocaproic acid treatment resulted in an increase in Wnt and BMP signaling and a decrease in TGF-β-signaling, resulting in a shift from chondrogenic to osteogenic differentiation in this model of endochondral bone formation. CONCLUSION These experiments demonstrate for the first time that inhibition of the plasminogen activator during fracture healing using aminocaproic acid leads to a change in cell fate decision of periosteal osteoprogenitor cells, with a predominance of osteogenic differentiation, resulting in a larger and stronger bony callus. These findings may offer a promising new use of aminocaproic acid, which is already FDA-approved and offers a very safe risk profile.
Collapse
Affiliation(s)
- D Bravo
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - A M Josephson
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - V Bradaschia-Correa
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - M Z Wong
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - N L Yim
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - S S Neibart
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - S N Lee
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - J Huo
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - T Coughlin
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - M M Mizrahi
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - P Leucht
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States.
| |
Collapse
|
3
|
Hoff P, Gaber T, Strehl C, Schmidt-Bleek K, Lang A, Huscher D, Burmester GR, Schmidmaier G, Perka C, Duda GN, Buttgereit F. Immunological characterization of the early human fracture hematoma. Immunol Res 2017; 64:1195-1206. [PMID: 27629117 DOI: 10.1007/s12026-016-8868-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The initial inflammatory phase of fracture healing is of great importance for the clinical outcome. We aimed to develop a detailed time-dependent analysis of the initial fracture hematoma. We analyzed the composition of immune cell subpopulations by flow cytometry and the concentration of cytokines and chemokines by bioplex in 42 samples from human fractures of long bones <72 h post-trauma. The early human fracture hematoma is characterized by maturation of granulocytes and migration of monocytes/macrophages and hematopoietic stem cells. Both T helper cells and cytotoxic T cells proliferate within the fracture hematoma and/or migrate to the fracture site. Humoral immunity characteristics comprise high concentration of pro-inflammatory cytokines such as IL-6, IL-8, IFNγ and TNFα, but also elevated concentration of anti-inflammatory cytokines, e.g., IL-1 receptor antagonist and IL-10. Furthermore, we found that cells of the fracture hematoma represent a source for key chemokines. Even under the bioenergetically restricted conditions that exist in the initial fracture hematoma, immune cells are not only present, but also survive, mature, function and migrate. They secrete a cytokine/chemokine cocktail that contributes to the onset of regeneration. We hypothesize that this specific microenvironment of the initial fracture hematoma is among the crucial factors that determine fracture healing.
Collapse
Affiliation(s)
- Paula Hoff
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany.
- German Arthritis Research Center (DRFZ), 10117, Berlin, Germany.
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), 13353, Berlin, Germany.
| | - T Gaber
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
- German Arthritis Research Center (DRFZ), 10117, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), 13353, Berlin, Germany
| | - C Strehl
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
- German Arthritis Research Center (DRFZ), 10117, Berlin, Germany
| | - K Schmidt-Bleek
- Julius Wolff Institute, Charité University Hospital, 13353, Berlin, Germany
| | - A Lang
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
- German Arthritis Research Center (DRFZ), 10117, Berlin, Germany
- Berlin-Brandenburg School for Regenerative Therapies (BSRT), 13353, Berlin, Germany
| | - D Huscher
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
- German Arthritis Research Center (DRFZ), 10117, Berlin, Germany
| | - G R Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
- German Arthritis Research Center (DRFZ), 10117, Berlin, Germany
| | - G Schmidmaier
- Department of Orthopedics, University Hospital Heidelberg, 69118, Heidelberg, Germany
| | - C Perka
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), 13353, Berlin, Germany
- Center for Musculoskeletal Surgery, Charité University Hospital, 10117, Berlin, Germany
| | - G N Duda
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), 13353, Berlin, Germany
- Julius Wolff Institute, Charité University Hospital, 13353, Berlin, Germany
| | - F Buttgereit
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
- German Arthritis Research Center (DRFZ), 10117, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), 13353, Berlin, Germany
| |
Collapse
|