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Polineni S, Resulaj M, Faje AT, Meenaghan E, Bredella MA, Bouxsein M, Lee H, MacDougald OA, Klibanski A, Fazeli PK. Red and White Blood Cell Counts Are Associated With Bone Marrow Adipose Tissue, Bone Mineral Density, and Bone Microarchitecture in Premenopausal Women. J Bone Miner Res 2020; 35:1031-1039. [PMID: 32078187 PMCID: PMC7881438 DOI: 10.1002/jbmr.3986] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/03/2020] [Accepted: 02/13/2020] [Indexed: 12/18/2022]
Abstract
Bone marrow adipose tissue (BMAT) resides within the bone marrow microenvironment where its function remains poorly understood. BMAT is elevated in anorexia nervosa, a disease model of chronic starvation, despite depletion of other fat depots. In addition to BMAT, the marrow microenvironment also consists of osteoblast and hematopoietic progenitors. BMAT is inversely associated with bone mineral density (BMD) in multiple populations including women with anorexia nervosa, and regulates hematopoiesis in animal models. We hypothesized that BMAT would be associated with circulating populations of hematopoietic cells (red and white blood cells) in humans and performed a post hoc analysis of two studies-a cross-sectional study and a longitudinal study-to investigate this hypothesis. We studied 89 premenopausal women cross-sectionally (median age [interquartile range], 27 [24.5, 31.7] years), including 35 with anorexia nervosa. We investigated associations between red blood cell (RBC) and white blood cell (WBC) counts and BMAT assessed by 1 H-magnetic resonance spectroscopy, BMD assessed by DXA, and bone microarchitecture assessed by HR-pQCT. In addition, we analyzed longitudinal data in six premenopausal women with anorexia nervosa treated with transdermal estrogen for 6 months and measured changes in BMAT and blood cell counts during treatment. Cross-sectionally, BMAT was inversely associated with WBC and RBC counts. In contrast, BMD and parameters of bone microarchitecture were positively associated with WBC and RBC. In women with anorexia nervosa treated with transdermal estrogen for 6 months, decreases in BMAT were significantly associated with increases in both RBC and hematocrit (rho = -0.83, p = 0.04 for both). In conclusion, we show that BMAT is inversely associated with WBC and RBC in premenopausal women, and there is a potential association between longitudinal changes in BMAT and changes in RBC. These associations warrant further study and may provide further insight into the role and function of this understudied adipose depot. © 2020 American Society for Bone and Mineral Research.
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Affiliation(s)
- Sai Polineni
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA
| | - Megi Resulaj
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA
| | - Alexander T. Faje
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Miriam A. Bredella
- Harvard Medical School, Boston, MA
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Mary Bouxsein
- Harvard Medical School, Boston, MA
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA
| | - Hang Lee
- Harvard Medical School, Boston, MA
- Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Ormond A. MacDougald
- Department of Molecular & Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Pouneh K. Fazeli
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Resulaj M, Polineni S, Meenaghan E, Eddy K, Lee H, Fazeli PK. Transdermal Estrogen in Women With Anorexia Nervosa: An Exploratory Pilot Study. JBMR Plus 2019; 4:e10251. [PMID: 31956852 PMCID: PMC6957987 DOI: 10.1002/jbm4.10251] [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: 08/23/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 01/10/2023] Open
Abstract
Anorexia nervosa (AN) is a psychiatric disorder characterized by self‐induced starvation, low body weight, and elevated levels of bone marrow adipose tissue (BMAT). BMAT is negatively associated with BMD in AN and more than 85% of women with AN have low bone mass and an increased risk of fracture. Although a majority of women with AN are amenorrheic, which is associated with low BMD, oral contraceptive pills, containing supraphysiologic doses of estrogen, are not effective in increasing bone mass. We performed a 6‐month, open‐label study of transdermal estradiol (0.045 mg/day) + levonorgestrel (0.015 mg/day) in 11 women with AN (mean age ± SEM: 37.2 ± 2.3 years) to investigate the effects of transdermal, physiologic doses of estrogen on BMD and BMAT in women with AN. We measured change in BMD by DXA, change in BMAT at the spine/hip by 1H‐magnetic resonance spectroscopy, and change in C‐terminal collagen cross‐links (CTX), P1NP, osteocalcin, IGF‐1, and sclerostin after 3 and 6 months of transdermal estrogen. Lumbar spine (2.0% ± 0.8%; p = 0.033) and lateral spine (3.2% ± 1.1%; p = 0.015) BMD increased after 6 months of transdermal estrogen. Lumbar spine BMAT decreased significantly after 3 months (−13.9 ± 6.0%; p = 0.046). Increases in lateral spine BMD were associated with decreases in CTX (p = 0.047). In conclusion, short‐term treatment with transdermal, physiologic estrogen increases spine BMD in women with AN. Future studies are needed to assess the long‐term efficacy of this treatment. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Megi Resulaj
- Neuroendocrine Unit Massachusetts General Hospital Boston MA USA
| | - Sai Polineni
- Neuroendocrine Unit Massachusetts General Hospital Boston MA USA
| | - Erinne Meenaghan
- Neuroendocrine Unit Massachusetts General Hospital Boston MA USA
| | - Kamryn Eddy
- Department of Psychiatry Massachusetts General Hospital Boston MA USA.,Harvard Medical School Boston MA USA
| | - Hang Lee
- Biostatistics Center Massachusetts General Hospital Boston MA USA.,Harvard Medical School Boston MA USA
| | - Pouneh K Fazeli
- Neuroendocrine Unit Massachusetts General Hospital Boston MA USA.,Harvard Medical School Boston MA USA.,University of Pittsburgh School of Medicine Pittsburgh PA USA
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Belavy DL, Quittner MJ, Ridgers ND, Shiekh A, Rantalainen T, Trudel G. Specific Modulation of Vertebral Marrow Adipose Tissue by Physical Activity. J Bone Miner Res 2018; 33:651-657. [PMID: 29336053 DOI: 10.1002/jbmr.3357] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 10/10/2017] [Revised: 11/23/2017] [Accepted: 12/02/2017] [Indexed: 11/09/2022]
Abstract
Marrow adipose tissue (MAT) accumulation with normal aging impacts the bone, hemopoiesis, and metabolic pathways. We investigated whether exercise was associated with lower MAT, as measured by vertebral marrow fat fraction (VFF) on magnetic resonance imaging. A total of 101 healthy individuals (54 females) aged 25 to 35 years without spine or bone disease but with distinct exercise histories were studied. Long-distance runners (67 km/wk, n = 25) exhibited lower mean lumbar VFF (27.9% [8.6%] versus 33.5% [6.0%]; p = 0.0048) than non-sporting referents (n = 24). In habitual joggers (28 km/wk, n = 30), mean lumbar VFF was 31.3% (9.0%) (p = 0.22 versus referents) and 6.0 percentage points lower than referents at vertebrae T10 , T11 , and T12 (p ≤ 0.023). High-volume road cycling (275 km/wk, n = 22) did not impact VFF. 3D accelerations corresponding to faster walking, slow jogging, and high-impact activities correlated with lower VFF, whereas low-impact activities and sedentary time correlated with higher mean lumbar VFF (all p ≤ 0.05). Given an estimated adipose bone marrow conversion of 7% per decade of life, long distance runners, with 5.6 percentage points lower VFF, showed an estimated 8-year younger vertebral marrow adipose tissue phenotype. Regression analysis showed a 0.7 percentage point reduction in mean lumbar VFF with every 9.4 km/wk run (p = 0.002). This study presents the first evidence in humans or animals that specific volumes and types of exercise may influence the age-determined adipose marrow conversion and result in low MAT. These results identify a potentially modifiable risk factor for prevalent chronic conditions related to bone metabolism, hemopoietic production, and other metabolic functions with potential global health applications. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Daniel L Belavy
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Matthew J Quittner
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Nicola D Ridgers
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Adnan Shiekh
- Department of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Timo Rantalainen
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Guy Trudel
- Department of Medicine, Division of Physical Medicine and Rehabilitation, Bone and Joint Research Laboratory, University of Ottawa, Ottawa, Canada
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Styner M, Pagnotti GM, McGrath C, Wu X, Sen B, Uzer G, Xie Z, Zong X, Styner MA, Rubin CT, Rubin J. Exercise Decreases Marrow Adipose Tissue Through ß-Oxidation in Obese Running Mice. J Bone Miner Res 2017; 32:1692-1702. [PMID: 28436105 PMCID: PMC5550355 DOI: 10.1002/jbmr.3159] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/17/2017] [Accepted: 04/20/2017] [Indexed: 12/23/2022]
Abstract
The relationship between marrow adipose tissue (MAT) and bone health is poorly understood. We used running exercise to ask whether obesity-associated MAT can be attenuated via exercise and whether this correlates with gains in bone quantity and quality. C57BL/6 mice were divided into diet-induced obesity (DIO, n = 14) versus low-fat diet (LFD, n = 14). After 3 months, 16-week-old mice were allocated to an exercise intervention (LFD-E, DIO-E) or a control group (LFD, DIO) for 6 weeks (4 groups, n = 7/group). Marrow adipocyte area was 44% higher with obesity (p < 0.0001) and after exercise 33% lower in LFD (p < 0.0001) and 39% lower in DIO (p < 0.0001). In LFD, exercise did not affect adipocyte number; however, in DIO, the adipocyte number was 56% lower (p < 0.0001). MAT was 44% higher in DIO measured by osmium-μCT, whereas exercise associated with reduced MAT (-23% in LFD, -48% in DIO, p < 0.05). MAT was additionally quantified by 9.4TMRI, and correlated with osmium-µCT (r = 0.645; p < 0.01). Consistent with higher lipid beta oxidation, perilipin 3 (PLIN3) rose with exercise in tibial mRNA (+92% in LFD, +60% in DIO, p < 0.05). Tibial µCT-derived trabecular bone volume (BV/TV) was not influenced by DIO but responded to exercise with an increase of 19% (p < 0.001). DIO was associated with higher cortical periosteal and endosteal volumes of 15% (p = 0.012) and 35% (p < 0.01), respectively, but Ct.Ar/Tt.Ar was lower by 2.4% (p < 0.05). There was a trend for higher stiffness (N/m) in DIO, and exercise augmented this further. In conclusion, obesity associated with increases in marrow lipid-measured by osmium-μCT and MRI-and partially due to an increase in adipocyte size, suggesting increased lipid uptake into preexisting adipocytes. Exercise associated with smaller adipocytes and less bone lipid, likely invoking increased ß-oxidation and basal lipolysis as evidenced by higher levels of PLIN3. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Maya Styner
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC, USA
| | - Gabriel M Pagnotti
- Department of Biomedical Engineering, State University of New York, Stony Brook, Stony Brook, NY, USA
| | - Cody McGrath
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC, USA
| | - Xin Wu
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC, USA
| | - Buer Sen
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC, USA
| | - Gunes Uzer
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC, USA
- Department of Mechanical and Biomedical Engineering, Boise State University, Boise, ID, USA
| | - Zhihui Xie
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC, USA
| | - Xiaopeng Zong
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Martin A Styner
- Department of Computer Science, University of North Carolina, Chapel Hill, NC, USA
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Clinton T Rubin
- Department of Biomedical Engineering, State University of New York, Stony Brook, Stony Brook, NY, USA
| | - Janet Rubin
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC, USA
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