Total glucosides of white paeony capsule alleviate articular cartilage degeneration and aberrant subchondral bone remodeling in knee osteoarthritis

Knee osteoarthritis (KOA) is a prevalent degenerative joint disease that is primarily managed by improving the destroyed cartilage and reversing subchondral bone remodeling. Total glucosides of white paeony (TGP) capsule primarily contains extracts from the white peony root and has been shown to have various pharmacological effects, but its role in KOA still requires comprehensive evaluation. In this study, we aimed to investigate the protective effect of TGP on knee cartilage and subchondral bone, as well as elucidate the underlying molecular mechanisms. The effect of TGP on KOA progression was evaluated in the destabilization of the medial meniscus (DMM)-induced KOA model of mouse and interleukin (IL)-1β-induced KOA model of primary mouse chondrocytes. In vivo and in vitro experiments demonstrated that TGP had a protective effect on the cartilage. Treatment with TGP could induce the synthesis of critical elements in the cartilage extracellular matrix and downregulate the synthesis of degrading enzymes in the extracellular matrix. Regarding the underlying mechanisms, TGP inhibited the phosphorylation and nuclear translocation of p65 by regulating the nuclear factor-kappa B (NF-κB) signaling pathway. In addition, TGP could reduce the secretion of IL-1β, IL-6, and tumor necrosis factor-α (TNF-α). Moreover, it has a sustained effect on coupled subchondral bone remodeling through regulation of the OPG/RANKL/RANK pathway. In conclusion, TGP may protect articular cartilage by downregulating the NF-κB signaling pathway and may support coupled subchondral bone remodeling by regulating OPG/RANKL/RANK signaling pathway in the DMM-induced KOA model of mouse, suggesting a new therapeutic potential for KOA treatment.

Casticin ameliorates osteoarthritic cartilage damage in rats through PI3K/AKT/HIF-1α signaling

Knee osteoarthritis (KOA) is a chronic, disabling knee joint lesion in which degeneration and defects in articular cartilage are the most important features. Casticin (CAS) is a flavonoid extracted from the Chinese herb Vitex species that has anti-inflammatory and antitumor effects. The aim of this study was to investigate the therapeutic and mechanistic effects of CAS on cartilage damage in KOA. A KOA rat model was established by anterior cruciate ligament transection (ACLT), and cartilage morphological changes were assessed by histological analysis and micro-CT scans. Subsequently, chondrocytes were treated with 10 ng/mL IL-1β to establish an OA model. CCK-8 assays and EdU assays were performed to assess the viability of CAS-treated chondrocytes. Western blotting, flow cytometry and Hoechst 33342/PI Double Stain were used to detect chondrocyte apoptosis. Western blotting, qRT‒PCR and ELISA were used to detect changes in inflammatory mediators. In addition, cartilage matrix-related indices were detected by Western blotting, qRT‒PCR and immunofluorescence (IF) analysis. Immunohistochemistry (IHC) and Western blotting were performed to detect the expression of p-PI3K, p-AKT and HIF-1α in vivo and in vitro. Micro-CT, pathological sections and related scores showed that CAS improved the alterations in bony structures and reduced cartilage damage and osteophyte formation in the ACLT model. In vivo, CAS attenuated IL-1β-induced cartilage matrix degradation, apoptosis and the inflammatory response. In addition, CAS inhibited the expression of the PI3K/AKT/HIF-1α signaling pathway in the ACLT animal model and IL-1β cell model. CAS may ameliorate cartilage damage in OA by inhibiting the PI3K/AKT/HIF-1α signaling pathway, suggesting that CAS is a potential strategy for the treatment of OA.

The potential causal relationship between various lifestyles and depression: a univariable and multivariable Mendelian randomization study

Background

Previous studies have shown that lifestyle was associated with depression. Thus, the aim of this study was to examine the causality between multiple lifestyles and depression by Mendelian randomization (MR) analysis.

Methods

The single-nucleotide polymorphisms (SNPs) of depression, alcoholic drinks per week, sleeplessness or insomnia, body mass index (BMI), mood swings, weekly usage of mobile phone in the last 3 months, beef intake, cooked vegetable intake, and "smoking status: never" were acquired from the Integrative Epidemiology Unit Open genome-wide association study database. Causal effects of eight exposure factors and depression were investigated using MR-Egger, weighted median, inverse variance weighted (IVW), simple mode, and weighted mode, and results were primarily referred to IVW. Subsequently, univariable MR (UVMR) analysis was performed on eight exposure factors and depression, separately. In addition, sensitivity analysis, including heterogeneity test, horizontal pleiotropy, and leave-one-out (LOO) methods, was conducted to evaluate the stability of MR results. Furthermore, multivariable MR (MVMR) analysis was carried out.

Results

UVMR analysis revealed that all eight exposure factors were causally associated with depression; alcoholic drinks per week, sleeplessness or insomnia, BMI, mood swings, weekly usage of mobile phone in the last 3 months, and cooked vegetable intake were risk factors, and beef intake and "smoking status: never" were protection factors. Heterogeneity tests revealed no heterogeneity for alcoholic drinks per week, sleeplessness or insomnia, mood swings, weekly usage of mobile phone in the last 3 months, and cooked vegetable intake. Meanwhile, there was no horizontal pleiotropy in UVMR, and LOO analysis verified that univariable analysis results were reliable. Moreover, MVMR analysis indicated that mood swings and weekly usage of mobile phone in the last 3 months were risk factors, and beef intake was a protection factor for depression when multiple factors occurred at the same time.

Conclusion

Alcoholic drinks per week, sleeplessness or insomnia, BMI, mood swings, weekly usage of mobile phone in the last 3 months, and cooked vegetable intake were risk factors, and beef intake and "smoking status: never" were protection factors. In addition, mood swings, weekly usage of mobile phone in the last 3 months, and beef intake had a direct effect on depression when multiple factors occurred simultaneously.

NGF Signaling Exacerbates KOA Peripheral Hyperalgesia via the Increased TRPV1-Labeled Synovial Sensory Innervation in KOA Rats

Objectives

Knee osteoarthritis (KOA) pain is caused by nociceptors, which are actually sensory nerve fiber endings that can detect stimuli to produce and transmit pain signals, and high levels of NGF in synovial tissue led to peripheral hyperalgesia in KOA. The purpose of this study is to investigate how sensory nerve fibers respond to the NGF/TrKA signal pathway and mediate the peripheral hyperalgesia in KOA rats.

Methods

Forty SD male rats were randomly divided into 4 groups: normal, KOA, KOA + NGF, and KOA + siRNA TrKA. KOA model rats were induced by anterior cruciate ligament transection (ACLT). Mechanical and cold withdrawal thresholds (MWT and CWT) were measured 4 times in each group. The synovial tissues were harvested on day 28, and the expressions of NGF, TrKA, TRPV1, IL-1β, and PGP9.5 were determined using western blot, qPCR, and immunofluorescence staining. The primary rat fibroblast-like synoviocytes (FLSs) and DRG cells were divided into 4 groups as in vivo. The expressions of NGF, TrKA, TRPV1, and CGRP in vitro were determined using western blot and qPCR.

Results

KOA and intra-articular injection with NGF protein increased both mRNA and protein levels, not only TRPV1, PGP 9.5, and IL-1β in the synovial tissue, but also TRPV1, PGP 9.5, and S100 in the DRG tissue, while above changes were partly reversed after siRNA TrKA intervention. Besides, siRNA TrKA could improve peripheral hyperalgesia and decreased the TRPV1 positive nerve fiber innervation in synovial tissue. The results in vitro were consistent with those in vivo.

Conclusion

This study showed the activation of the NGF/TrKA signaling pathway in KOA promoted the release of pain mediators, increased the innervation of sensory nerve fibers in the synovium, and worsened peripheral hyperalgesia. It also showed increased TRPV1 positive sensory innervation in KOA was mediated by NGF/TrKA signaling and exacerbated peripheral hyperalgesia.

Clinical and Animal Studies of Waist and Knee Scraping Therapy for Knee Osteoarthritis

BACKGROUND

Knee osteoarthritis (KOA) is a degenerative condition with knee pain as the main clinical manifestation. Scraping is one of the commonly used traditional Chinese medicine treatment methods, which activates blood circulation, removes blood stasis, reduces inflammation, and so on. Although scholars have proposed that the synergistic treatment of the waist and knee for KOA is superior to simple knee treatment, there is no relevant reference literature on the application of scraping therapy. Therefore, this study aims to explore the effectiveness and potential mechanisms of waist and knee scraping therapy for treating KOA through clinical and animal studies in order to promote its clinical application.

OBJECTIVE

To explore the clinical efficacy of waist and knee scraping therapy in the treatment of KOA from clinical study and increase animal study on this basis to preliminarily explore its mechanism, providing an objective basis for better treatment of KOA.

METHOD

The clinical study recruited 90 KOA patients and divided them into a control group, a knee scraping group, and a waist and knee scraping group using a random number table method. All patients were evaluated for clinical efficacy, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), and Traditional Chinese Medicine Syndrome Score. The KOA rat model was established using the Hulth method. The rats were randomly divided into a control group, KOA group, waist scraping group, knee scraping group, and waist and knee scraping group. During the intervention process of rats, the pain sensitivity threshold was measured, and HE staining was performed on the synovium and cartilage. The protein and mRNA expression levels of TNF-α, IL- 1β, IL-6, PGP9.5, SP and TRPA1, TRPV4, SP, and NGF were measured by Western blot and real-time PCR.

RESULTS

In the clinical study, the clinical efficacy of the 2 scraping groups was significantly higher than that of the control group. The clinical efficacy of the waist and knee scraping group on the 60th day of treatment was significantly higher than that of the knee scraping group. In terms of improving WOMAC scores, all 3 groups had significance; The function and total score of the waist and knee scraping group on the 28th day of treatment, as well as the pain, function, and total score on the 60th day, were lower than those of the knee scraping group. In terms of improving pain while standing, pain when walking on flat ground, and total score, the scraping group had significant differences. The score of heavy limbs in the waist and knee scraping group was lower than that in the knee scraping group. In an animal study, during the 4th week after modeling, there were differences in the pain sensitivity threshold between the KOA group and the waist scraping group compared to the control group, while there were differences in the pain sensitivity threshold between the knee scraping group and the waist and knee scraping group compared to the KOA group. The expression levels of various proteins and genes in the KOA group and waist scraping group increased compared to the control group; The knee scraping group and the waist and knee scraping group were lower than those in the KOA group.

CONCLUSION

Scraping therapy can significantly alleviate knee joint pain and stiffness, improve joint function, and improve clinical efficacy, and the short-term and long-term effects of waist and knee scraping therapy are more significant. The scraping therapy has a definite therapeutic effect on KOA rats, which can improve the threshold of cold hyperalgesia and mechanical hyperalgesia, and the waist and knee scraping therapy is more obvious. This may be related to reducing inflammatory reactions in synovial and ganglion tissues.

CLINICAL TRIAL REGISTRATION NUMBER

ChiCTR230070623.

Activation of vascular endothelial cells by synovial fibrosis promotes Netrin-1-induced sensory nerve sprouting and exacerbates pain sensitivity

Synovial fibrosis is one of the most dominant histopathological changes in osteoarthritis of the knee (KOA), and activation of vascular endothelial cells in synovial fibrosis is both an important factor in mediating pain in KOA and a major contributor to the generation of pain signals. At the same time, angiogenesis and nerve fibres are more likely to underlie the pathology of pain induced by synovial fibrosis. In the present study, we established a co-culture model of human umbilical vein endothelial cells (HUVECs) with dorsal root ganglion (DRG) and detected tissue and cellular Netrin-1, vascular cell adhesion molecule-1 (VCAM-1), intercellular cell adhesion molecule-1 (ICAM-1), growth-associated protein-43 (GAP43), colorectal cancer deleted (DCC), uncoordinated 5 (UNC5), and the related expression of calcitonin gene-related peptide (CGRP), substance P (SP) and nerve growth factor (NGF) in supernatant by ELISA to investigate the intervention of vascular endothelial cell activation on sensory nerve sprouting exacerbating peripheral pain sensitivity and to investigate the effect of Netrin-1 from the perspective of Netrin-1 secretion to illustrate its effector mechanism.

A Multicentered, Randomized Phase III Study of Definitive vs. Palliative Radiotherapy to Primary Tumor for Stage IV Non-Small Cell Lung Cancer with Less than Three Metastatic Organs: CSWOG China

PURPOSE/OBJECTIVE(S)

To investigate the local-regional progression-free survival (LPFS), overall survival (OS), progression-free survival (PFS), local control rate of primary tumor (LCRP), and toxicity of definitive radiotherapy (concurrent chemoradiotherapy of 63 Gy) compared with palliative radiotherapy (concurrent chemoradiotherapy of 45 Gy) to primary tumor in newly diagnosed stage Ⅳ non-small cell lung cancer with less than three metastatic organs.

MATERIALS/METHODS

A randomized, multicentered phase Ⅲ study (ChicTR-TRC-13003749), in a 1:1 ratio, included patients with newly diagnosed stage Ⅳ NSCLC with less than three metastatic organs. The EGFR mutation was wide type or unknown mainly. The patients were divided into 63 Gy of definitive radiotherapy (D63) and 45 Gy of palliative radiotherapy (P45). The primary endpoints were LPFS, OS. Secondary endpoints included PFS, LCRP, objective response rate (ORR) and toxicity.

RESULTS

Three hundred forty-four patients were enrolled in 14 cancer centers. The median LPFS for group D63 was 18 months (95% CI, 13.02 to 22.98) better than 13 months for group P45 (95% CI, 10.13 to 15.87). LPFS for 1, 2, and 5 years were 62.9% vs. 50.4%, 36.9% vs. 24%, 20.5% vs. 5.5%, respectively (χ2 = 9.997, P = 0.002). The 36.1% reduction in the hazard ratio for local-regional progression or death for D63. The MST for group D63 was 19 months (95% CI, 14.59 to 23.41) better than 15 months for group P45 (95% CI, 10.72 to 19.28), and the 1-, 2-, and 5-years OS were 70.2% vs. 52.2%, 41.3% vs. 30.7%, 16.2% vs. 11.3%, respectively (χ2 = 3.874, P = 0.049). PFS was 37% reduction in the hazard ratio for disease progression or death for D63 (χ2 = 12.49, P = 0.000). The 1, 2, 5-year LCRP of group D63 is better than group P45 (χ2 = 8.747, P = 0.003). The incidences of RE and grade Ⅲ-Ⅳ RP in group D63 were higher than in group P45 (P<0.05).

CONCLUSION

Phase Ⅲ clinical trials achieved satisfactory results. LPFS, OS and PFS was longer with definitive than palliative radiotherapy of primary tumor for stage Ⅳ NSCLC with less than three metastatic organs. Significantly prolonged. The toxicity was accepted.

The mechanism of palmatine-mediated intestinal flora and host metabolism intervention in OA-OP comorbidity rats

Background

ErXian decoction is a Chinese herbal compound that can prevent and control the course of osteoarthritis (OA) and osteoporosis (OP). OP and OA are two age-related diseases that often coexist in elderly individuals, and both are associated with dysregulation of the gut microbiome. In the initial study, Palmatine (PAL) was obtained by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and network pharmacological screening techniques, followed by 16S rRNA sequencing and serum metabolomics of intestinal contents, to explore the mechanism of PAL in the treatment of OA and OP.

Methods

The rats selected for this study were randomly divided into three groups: a sham group, an OA-OP group and a PAL group. The sham group was intragastrically administered normal saline solution, and the PLA group was treated with PAL for 56 days. Through microcomputed tomography (micro-CT), ELISA, 16S rRNA gene sequencing and non-targeted metabonomics research, we explored the potential mechanism of intestinal microbiota and serum metabolites in PAL treatment of OA-OP rats.

Results

Palmatine significantly repair bone microarchitecture of rat femur in OA-OP rats and improved cartilage damage. The analysis of intestinal microflora showed that PAL could also improve the intestinal microflora disorder of OA-OP rats. For example, the abundance of Firmicutes, Bacteroidota, Actinobacteria, Lactobacillus, unclassified_f_Lachnospiraceae, norank_f_Muribaculaceae, Lactobacillaceae, Lachnospiraceae and Muribaculaceae increased after PAL intervention. In addition, the results of metabolomics data analysis showed that PAL also change the metabolic status of OA-OP rats. After PAL intervention, metabolites such as 5-methoxytryptophol, 2-methoxy acetaminophen sulfate, beta-tyrosine, indole-3-carboxylic acid-O-sulfate and cyclodopa glucoside increased. Association analysis of metabolomics and gut microbiota (GM) showed that the communication of multiple flora and different metabolites played an important role in OP and OA.

Conclusion

Palmatine can improve cartilage degeneration and bone loss in OA-OP rats. The evidence we provided supports the idea that PAL improves OA-OP by altering GM and serum metabolites. In addition, the application of GM and serum metabolomics correlation analysis provides a new strategy for uncovering the mechanism of herbal treatment for bone diseases.

Calycosin mitigates chondrocyte inflammation and apoptosis by inhibiting the PI3K/AKT and NF-κB pathways

ETHNOPHARMACOLOGICAL RELEVANCE

Shaoyao Gancao Decoction (SG-Tang), originated from the Treatise on Febrile Diseases, is often used to treat OA pain symptoms. Whereas its efficacy has been verified by several clinical studies, the underlying mechanism remained unclear. Network pharmacology and UPLC-QTOF-MS analysis found that calycosin could be regarded as the active components of SG-Tang in treating OA. However, the effect of calycosin on cartilage destruction and the pathogenesis of OA are not known. Therefore, we evaluated the benefits of calycosin for OA and revealed the underlying mechanisms.

AIM OF STUDY

Using network pharmacology, UPLC-QTOF-MS analysis and experiments, the active components of SG-Tang were analyzed to explore their potential therapeutic mechanism in OA.

MATERIALS AND METHODS

The components of SG-Tang were detected by UPLC-QTOF-MS, and the possible active components and mechanism of SG-Tang in the treatment of OA were screened by network pharmacology. The OA mouse model was constructed by DMM. In total, 30 mice were randomly divided into three groups: Sham, DMM, and DMM + Calycosin. H&E, safranin O/fast green staining and the OARSI scores were used to evaluate joint injury in mice. In addition, OA models were established using chondrocytes treated with 10 ng/mL IL-1β. Treatment groups were treated with 100, 200 or 400 μM calycosin. CCK-8 assay was used for assessing the cytotoxic effects of calycosin. TUNEL staining and Western blotting were used to detect chondrocyte apoptosis. In addition, PI3K/Akt and NF-κB signaling pathway-related markers and cartilage matrix-related indicators were also detected.

RESULTS

In vivo studies showed that calycosin inhibited IL-1β-induced IL-6 and TNF-α production, as well as iNOS and COX-2 expression. Meanwhile, calycosin could inhibit IL-1β-induced degradation of cartilage matrix, including downregulation of MMP3, MMP-13, collagen II and aggrecan. NF-κB and PI3K/AKT were also inhibited by calycosin in OA chondrocytes. Furthermore, calycosin inhibited IL-1β-induced apoptosis in mouse chondrocytes. In a mouse model of OA, our results suggest that calycosin has a chondroprotective effect.

CONCLUSIONS

According to this study, calycosin may act as a protective agent against OA by inhibiting the PI3K/AKT and NF-κB pathways. Furthermore, this study suggested that calycosin is a potential candidate for the treatment of OA.

Comprehensive Network Pharmacological Analysis and In Vitro Verification Reveal the Potential Active Ingredients and Potential Mechanisms of Frankincense and Myrrh in Knee Osteoarthritis

Background: Frankincense and myrrh (FM) are often used together to treat knee osteoarthritis (KOA). However, the underlying mechanism of its treatment of KOA remains unclear. Objective: To analyze the active components of FM through network pharmacology and in vitro experiments, and to explore its potential therapeutic mechanism in the treatment of KOA. Materials and methods: The protein mapping relationship between potential drug targets and disease targets was screened and constructed through the database. Gene Ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed using R software. Discovery Studio software was used to perform molecular docking. The active components of FM were identified using liquid chromatography–mass spectrometry (LC-MS). In addition, experimental verification was carried out by Cell Counting Kit-8 detection, Western blot, and immunofluorescence analysis. Results: Combining the results of network pharmacology and LC-MS, 31 active compounds and 94 target genes of FM were identified. The common genes of FM and KOA suggest that FM exerts anti-KOA effect by regulating genes such as Transcription factor Jun (JUN), Interleukin-6 (IL-6), Interleukin-1 beta (IL-1β), C-X-C motif chemokine ligand 8 (CXCL8), Transcription factor p65 (RELA), and Mitogen-activated protein kinase 1 (MAPK1). GO enrichment analysis showed that FM exerted therapeutic effects on KOA by regulating biological processes such as cell proliferation, cell migration, and apoptosis. In addition, KEGG enrichment analysis involved signaling pathways such as fluid shear stress, the TNF, PI3K-Akt, NF-κB, and MAPK. Consistently, in vivo experiments showed that FM inhibited IL-1β-induced MAPK activation and attenuated inflammation in mouse chondrocytes. Furthermore, FM inhibited IL-1β-induced phosphorylation of p65 and the process of p65 translocation from the cytoplasm into the nucleus. Conclusions: Our results provide conclusive evidence and deepen the current understanding of FM in the treatment of KOA and further support its clinical application.

AB0390 COST-EFFECTIVENESS OF IGURATIMOD IN PATIENTS WITH RHEUMATOID ARTHRITIS (RA) BY USING A CLAIMS-BASED ALGORITHM: RETROSPECTIVE ANALYSIS OF REAL‑WORLD DATA

Background

Iguratimod (IGU), as one of the conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), has been approved by National Medical Products Administration (NMPA) to treat Rheumatoid arthritis (RA).

Objectives

This study aimed to compare the cost-effectiveness of well-established RA therapies using a claims-based algorithm in RA patients.

Methods

An electronic medical record (EMR) database from Zhujiang Hospital was utilized to estimate the cost-effectiveness of medication for RA patients, including IGU with MTX, biological DMARDs (bDMARDs) with MTX, and MTX alone for more than 6 months from 2014 to 2020. Patients who were deemed effective must meet all the following criteria according to the algorithm, high adherence; no bDMARDs or IGU switch or addition; no prescription of new csDMARDs; no increase in dose or frequency of index drug; no new use of chronic glucocorticoids or increase in glucocorticoid dose; and no more than one glucocorticoid injection. Average cost was calculated by summing total cost of effective treatment and dividing by number of patients achieving efficacy in each group.

Results

A total of 263 patients were included in the analysis. Based on a claims-based algorithm, the effective rate was 27.1 % (26/96) for IGU with MTX group, 11.2% (7/62) for bDMARDs with MTX group, and 13.3% (14/105) for MTX alone group, respectively. Average cost of effective treatment was $833.46 for IGU with MTX therapy, $2554.57 for bDMARDs with MTX therapy, and $171.48 for MTX alone (Table 1).

Table 1.

Effectiveness and Cost per Effectively Treated Patient with RA

CriteriaAll patients (n=263)IGU with MTX group(n=96)bDMARDs with MTX group (n=62)MTX (n=105)Effectiveness:no. of patients (%)a47(17.87%)26 (27.1%)7 (11.2/%)14 (13.3%)Cost of all RA-related medication per effectively treated patient(SD)$892.75(911.57)$833.46 (252.67)$2554.5 (1273.13)$171.4 (110.33)Average cost of all RA medications postindex (excluding biologic DMARDs) per patient (SD)b$146.38(114.60)$148.81 (123.12)$86.90 (74.53)$171.4 (110.33)Average cost of only biologicDMARDs postindex per patient (SD)b$746.38(926.35)$684.27(188.67)$2468.67(1285.91)/

a χ2showed significant difference in percentage effectiveness for the original algorithm (p<0.05).

bMedication cost was 2020 U.S. dollars.

Conclusion

IGU with MTX therapy was revealed to be both effective and modestly priced, which seemed to be a cost-effective strategy for RA therapy and warranted further cost-effectiveness investigation.

References

[1](2018) [2018 Chinese guideline for the diagnosis and treatment of rheumatoid arthritis]. Zhonghua Nei Ke Za Zhi 57 (4), 242-251. https://doi.org/10.3760/cma.j.issn.0578-1426.2018.04.004

[2]Hitchon, C. A., & El-Gabalawy, H. S. (2011). The synovium in rheumatoid arthritis. The open rheumatology journal, 5, 107–114. https://doi.org/10.2174/1874312901105010107

[3]Smolen, J. S., Landewé, R., Bijlsma, J., Burmester, G. R., Dougados, M., Kerschbaumer, A., McInnes, I. B., Sepriano, A., van Vollenhoven, R. F., de Wit, M., Aletaha, D., Aringer, M., Askling, J., Balsa, A., Boers, M., den Broeder, A. A., Buch, M. H., Buttgereit, F., Caporali, R., Cardiel, M. H., … van der Heijde, D. (2020). EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Annals of the rheumatic diseases, 79(6), 685–699. https://doi.org/10.1136/annrheumdis-2019-216655

[4]Fraenkel, L., Bathon, J. M., England, B. R., St Clair, E. W., Arayssi, T., Carandang, K., Deane, K. D., Genovese, M., Huston, K. K., Kerr, G., Kremer, J., Nakamura, M. C., Russell, L. A., Singh, J. A., Smith, B. J., Sparks, J. A., Venkatachalam, S., Weinblatt, M. E., Al-Gibbawi, M., Baker, J. F., … Akl, E. A. (2021). 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis care & research, 73(7), 924–939. https://doi.org/10.1002/acr.24596

Disclosure of Interests

None declared

GCTOF-MS Combined LC-QTRAP-MS/MS Reveals Metabolic Difference Between Osteoarthritis and Osteoporotic Osteoarthritis and the Intervention Effect of Erxian Decoction

PURPOSE

OP and OA are chronic bone diseases with high incidence in the middle-aged and elderly populations. The latest research shows that the pathological environment of OP may be involved in the aggravation of the pathological process of OA, and the pathological state of OP plays an important role in the aggravation of OA pathology. EXD is a traditional Chinese medicine decoction that has been used to treat osteoporosis. Therefore, we further study whether OA will be aggravated in the OP environment and whether EXD can alleviate OA by intervening in the OP environment. The purpose of this study was to analyze the effect of OP on OA metabolites by using metabolomic methods and to explore the intervention mechanism of EXD on osteoporotic OA.

METHOD

Thirty-two SD rats were randomly divided into normal group, OA group, OP-OA group, and EXD group. EXD was administered by gavage. Histopathological evaluation of cartilage tissue was performed using Saffron fast green and HE staining. Western blot and qRT-PCR were used to detect the expression levels of chondrogenesis genes SOX9, COL2A1, and COMP in cartilage tissue. GC-TOFMS and LC-QTRAP-MS/MS metabolomics methods were used to analyze the changes of metabolites in serum samples of rats in each group.

RESULT

The slice results showed that the cartilage damage in the OP-OA group was more serious than that in the OA group, which was significantly relieved after EXD intervention, indicating that the cartilage damage in the OP-OA group was more severe than that in the OA group and further reduced the protein and gene expressions of cartilage markers SOX9, COL2A1, and COMP. Thirty-seven substances were identified, and gentiopicroside, emodin, quercetin, and diosmetin were analyzed as possible active components of EXD. EXD treatment significantly reduced cartilage damage and reversed the expression of these markers. Metabolomics showed that EXD attenuated cartilage destruction by modulating the expression of cystine, chenodeoxycholate, and D-Turanose, involving glycolysis/gluconeogenesis, pantothenate, and CoA biosynthesis metabolic pathways.

CONCLUSION

The OP environment may promote the progression of OA through metabolic factors. The benign intervention of EXD in osteoporotic OA involves cystine, chenodeoxycholate, and D-Turanose, and their associated glycolysis/gluconeogenesis, pantothenate, and CoA biosynthesis metabolic pathways. Therefore, we have a deep understanding of the metabolic-related intervention of EXD in osteoporotic OA and are eager to better understand the mechanism of multi-targeted intervention of EXD in bone metabolic lesions.

Should synovectomy be performed during total knee arthroplasty for knee osteoarthritis: A protocol for systematic review and meta-analysis

BACKGROUND

To evaluate the effect of synovectomy performed during primary total knee arthroplasty for knee osteoarthritis on patients' postoperative pain and knee function.

METHODS

We will search the following electronic databases from inception to June 2021, including PubMed, EMBASE, Web of Science, the Cochrane Library, the China National Knowledge Infrastructure, the Chinese Scientific Journals Database, the Wanfang database, and the Chinese Biomedicine Database. Eligible references will be all randomized controlled trials of initial total knee arthroplasty for primary knee osteoarthritis with or without synovectomy. Two reviewers will independently extract the data. Reviewer Manager 5.3 software will be used for statistical analysis.

RESULT

It will provide results on the short- and long-term efficacy and safety of synovectomy in total knee arthroplasty by various comprehensive assessments.

CONCLUSION

This study will provide solid evidence on whether and when synovectomy treatment should be performed during total knee arthroplasty.

2′-Deoxyuridines with a 5-Heteroaromatic Substituent: Synthesis and Biological Evaluation

A series of novel 2′-deoxyuridines with a thienyl substituent in the 5-position were synthesized as potential anti-HSV-1 agents. The brominated derivatives (1d, 1e and 3b) were obtained via halogenation reactions of the protected 5-(thien-2-yl)-2′-deoxyuridine and 5-(thien-3-yl)-2′-deoxyuridine, respectively. The palladium-catalysed cross-coupling reaction with stannylated thiophene was used for the synthesis of ( E)-5-(2-thienylvinyl)-2′-deoxyuridine and 5-(5,2′-dithien-2-yl)-2′-deoxyuridine. These compounds show moderate to good activity against herpes simplex virus type 1 (HSV-1) in the order of decreasing activity 1d>4>1e>3b∼5. Finally, two substituted 5-isoxazol derivatives of 2′-deoxyuridine (6a and 6b) were obtained via a 1,3-dipolar cycloaddition of the protected 5-ethynyl-2′-deoxyuridine. These new compounds demonstrated poor affinity for the virus-specific enzyme thymidine kinase.

Association between MTHFR C677T polymorphism and congenital heart disease. A family-based meta-analysis

Congenital heart disease (CHD) is the most common type of birth defect. It is suspected that polymorphisms in folate metabolism are associated with an increased risk of CHD, but the conclusion remains unclear. Studies have reported that the MTHFR C677T polymorphism was associated with the development of structural congenital heart malformations. The objective of this study was to conduct a meta-analysis of available studies to identify common polymorphisms in the MTHFR gene in children with CHD and their mothers and to test for an association between genotype and disease. In all, 19 eligible studies comprising 4,219 cases and 20,123 controls were included in this meta-analysis. A significant association was found between the MTHFR C677T polymorphism and CHD risk (OR: 1.26; 95 % CI = 1.06-1.51; p = 0.009) with no strong evidence of heterogeneity (I(2) = 39 %) in the fetal analysis. In the maternal analysis, the MTHFR C677T polymorphism was significantly associated with CHD risk (OR = 1.52; 95 % CI =  1.09-2.11; p = 0.01) with significant heterogeneity (I(2) = 63 %).

Visualization of the internal cerebral veins on MR phase-sensitive imaging: comparison with 3D gadolinium-enhanced MR venography and fast-spoiled gradient recalled imaging

The purpose of this article is to compare the visualization quality of ICV and their tributaries on PSI-MRV, 3D CE-MRV, and 3D CE-FSPGR. PSI-MRV has been shown to delineate the ICV, TSV, SV, anterior caudate nucleus veins, and medial atrial veins effectively. Due to its advantages of no contrast material injection, acceptable examination times, and no arterial contamination, PSI-MRV should be considered in the evaluation of deep cerebral veins.

Role of vascular endothelial growth factor in protection of intrahepatic cholangiocytes mediated by hypoxic preconditioning after liver transplantation in rats

OBJECTIVE

To investigate the effect on intrahepatic cholangiocytes mediated by hypoxic preconditioning (HP) after liver transplantation and the role of vascular endothelial growth factor (VEGF).

MATERIALS AND METHODS

This experiment was based on a model of rat orthotopic liver autotransplantation. Sprague-Dawley rats were randomly divided into 3 groups: normal control, autotransplantation (AT), and HP. The HP group was subjected to 8% oxygen atmosphere for 90 minutes before surgery. At 6, 12, 24, and 48 hours after autotransplantation, the rats were killed for testing .Serum total bilirubin, direct bilirubin, and alkaline phosphatase concentrations were determined. The microstructure of cholangiocytes and the ultramicrostructure of cholangioles were determined. Immunohistochemistry was used to detect the expression of VEGF and the proliferation rate of cholangiocytes.

RESULTS

Total bilirubin, direct bilirubin, and alkaline phosphatase concentrations in the AT group increased considerably more than in the HP group during the entire interval (P < .05). Light microscopy demonstrated that the microstructure of cholangiocytes in the AT group was damaged more seriously than in the HP group. At transmission electron microscopy, the ultramicrostructure of cholangioles was changed more obviously than in the HP group. The expression of VEGF on cholangiocytes and the proliferation rate of cholangiocytes were higher in the HP group than in the AT group over the entire experiment (P < .05).

CONCLUSION

Hypoxic preconditioning has a protective effect on cholangiocytes after liver autotransplantation. The mechanism may be related to HP-induced overexpression of VEGF on cholangiocytes.

Single-nucleotide polymorphisms in genes predisposing to asthma in children of Chinese Han nationality

BACKGROUND

Research increasingly suggests that asthma is a familial and hereditary disorder in the pathogenesis of which genetic and environmental factors play an important role.

OBJECTIVE

To investigate the single and combined associations between 8 single-nucleotide polymorphism (SNP) loci in 5 genes and the development of asthma in children of Chinese Han nationality.

METHODS

The study population comprised 192 children with asthma and an equal number of healthy controls. Asthma was diagnosed in accordance with American Thoracic Society criteria. Polymerase chain reaction-restriction fragment length polymorphism was used to detect the genotypes of the SNP loci.

RESULTS

No statistically significant differences (P>.05) were found between the experimental and control group in genotype distribution among 6 loci (IL-13 C- 1112T, IL-13 C1923T, IL-4 C-590T, IL-4RA 175V, FcepsilonR1beta E237G, and beta2-ADR Q27E). However, significant diversity was observed among FcepsilonR1beta C-109T (P=.002) and beta2-ADR R16G (P=.000). Furthermore, the frequency of FcepsilonR1beta C-109T T/T and beta2-ADR R16G A/A in the asthma group was significantly higher than in the control group (odds ratio [OR]=1.96, P=.001; OR=2.58, P=.000, respectively). Carriers of both FcepsilonR1beta C-109T T/T and beta2-ADR R16G A/A had a more significant risk of developing asthma than those with only a single polymorphism.

CONCLUSION

The 6 loci (IL-13 C-1112T, IL-13 C1923T, IL-4 C-590T, IL-4RA 175V, FcER1B E237G and 12-ADR Q27E) make little contribution to the development of asthma in children of Chinese Han nationality. FcepsilonR1beta C-109T and beta2-ADR R16G are significantly associated with childhood asthma. FcepsilonR1beta C-109T T/T and beta2-ADR R16G A/A have a significant and combined effect on the development of asthma.

The association of Ala54Thr variant of intestinal fatty acid binding protein gene with general and regional adipose tissue depots

OBJECTIVE

To ascertain the relationship between the Ala54Thr variation of FABP2 gene and general as well as regional adipose tissue depots.

SUBJECTS

165 subjects, in which 86 were subjects with normal glucose tolerance (NGT) [age 54.45+/-9.80, male/female 1.05, body mass index (BMI) 26.48+/-4.01] and 79 were subjects with non-insulin-dependent diabetes mellitus (NIDDM) (age 55.86+/-10.00, male/female 1.08, BMI 26.75+/-3.30).

DESIGN AND MEASUREMENTS

An association study of FABP2-Ala54Thr variation detected by PCR/HhaI digestion with general and regional adipose tissue depots determined by BMI and magnetic resonance imaging [abdominal subcutaneous and visceral adipose tissue area (SA and VA) and femoral subcutaneous adipose tissue area (FA)].

RESULTS

The geneotype and allele frequencies of FABP2-Ala54Thr variation in Chinese were quite close to the frequencies in American Caucasians and Pima Indians reported in the literature. Significant difference in genotype frequency distribution was observed between FA subgroups comparisons (FA > or = 75 cm2 versus FA < 75 cm2) in NIDDM subjects (X2 = 11.460, P = 0.003), with significantly increased in Thr54-carrier [Thr54 (+)] genotype frequency and Thr54 allele frequency in NIDDM subject with FA < 75 cm2 (odd ratio for genotype was 4.62, X2 = 10.112, P = 0.001; and for allele = 2.36, X2 = 5.379, P = 0.020). The FA in NIDDM-Thr54 (+) subgroup was significantly lower than that in subjects with NIDDM-Thr54 (-) subgroup (61.19+/-21.51 cm2 versus 75.36+/-31.70 cm2, P = 0.021). Stepwise regression analysis revealed that FABP2-Thr54 genotype variation was an independent factor contributing to the variation of FA in NIDDM (P = 0.003).

CONCLUSION

FABP2 is associated with regional adipose tissue depot. The decreased femoral subcutaneous adipose tissue depot in NIDDM subjects is related to FABP2-Thr54 variant.

Longitudinal surveillance after filariasis control in Guangdong Province, China

This paper reports the longitudinal surveillance with epidemiology, entomology and serology after filariasis has been controlled. The results showed that the microfilarial rate, natural infection rate of vectors and the positive rate of filarial antibodies decreased year by year.

Expression of a biologically active human granulocyte-macrophage colony stimulating factor fusion protein in Escherichia coli

A gene encoding human granulocyte-macrophage colony stimulating factor(GM-CSF), was cloned into plasmid pEZZ318 and fused to a DNA segment coding for the signal peptide of staphylococcal protein A and a synthetic gene coding for a protein with ability to bind immunoglobulin G(IgG). The fusion protein was expressed in Escherichia coli and biologically actively secreted into the growth medium. Approximately all of the total activity was secreted into the culture medium, where levels of activity approached 1.96 x 10(8) units/liter. Purification of the fusion protein was performed in a single step by affinity chromatography with immobilized IgG to a specific activity of 1.2 x 10(8) units/mg.

Expression of a fibrinolytically active human pro-urokinase fusion protein in Escherichia coli

The gene encoding human pro-urokinase(pro-UK) was cloned into plasmid pEZZ318 and fused to the gene coding for the signal peptide of staphylococcal protein A and IgG bindinging domain. The fusion protein which was synthesized under the control of T7 promoter in Escherichia coli and secreted into the growth medium, was found to be fibrinolytically active. Approximately 60% of the total activity was secreted into the culture medium, where levels of activity approached 150,000 I.U./liter and about 40% of the total activity remained in the cell lysate with levels of activity around 100,000 I.U./liter. The fusion protein was purified in a single step by IgG affinity chromatography. These results demonstrate that human pro-UK can be synthesized and secreted by E. coli as a fibrinolytically active fusion protein.

[Study on infectious mechanism of type 1 fimbriated Escherichia coli in experimental cystitis of mice]

The course of experimental cystitis in mice with Escherichia coli was studied by electron microscopy. The inoculated E. coli did not adhere to the intact bladder epithelium. However, when the mouse bladder was treated with trypsin, superficial cells were exfoliated, and the inoculated type 1 fimbriated E. coli adhered to the exposed intermediate cells and caused cystitis. The nonfimbriated E. coli showing no adherence to the superficial cells or intermediate cells and failed to cause cystitis. The present study demonstrated that the type 1 fimbriated E. coli play a role in causing cystitis, and the bladder superficial cells play a role in resisting the adherence of E. coli. The removal of superficial cells is essential for the adhesion and colonization of type 1 fimbriated E. coli onto the bladder epithelium in vivo.

5'-O-phosphonomethyl-2',3'-dideoxynucleosides: synthesis and anti-HIV activity

5'-O-Phosphonomethylation of different pyrimidine 2',3'-dideoxynucleosides was accomplished by reaction of the latter with diethyl [(p-toylsulfonyl)oxy]methanephosphonate (1) in the presence of sodium hydride. The base-phosphonomethylated (15-19) and sugar-phosphonomethylated (8-12) derivatives could be readily distinguished by 1H and 13C NMR and MS analysis. Protection of the uracil or thymine residue with a N3-benzoyl group failed to prevent base modification. However, O4-methyl-protected 2',3'-dideoxyuridine readily afforded the 5'-O-phosphonomethylated derivative 12, which was converted to both the 2',3'-didoxyuridine analogue 27 and the 2',3'-dideoxycytidine counterpart 29. The 5'-O-phosphonomethyl derivatives of 3'-deoxythymidine (23), 2',3'-dideoxyuridine, (27), 2',3'-dideoxycytidine (29), 3'-O-methylthymidine (26), and 3'-amino-3'-deoxythymidine (28) did not show an appreciable anti-HIV activity in MT-4 cells. In contrast, the 5'-O-phosphonomethyl derivatives of 3'-deoxy-3'-fluorothymidine (24) and 3'-azido-3'-deoxythymidine (25) inhibited HIV-1 cytopathogenicity by 50% at a concentration of approximately 1 microM.

Synthesis and anti-HIV evaluation of 2',3'-dideoxyribo-5-chloropyrimidine analogues: reduced toxicity of 5-chlorinated 2',3'-dideoxynucleosides

In view of the selective anti-HIV activity of 2',3'-dideoxy-3'-fluoro-5-chlorouridine (11), a series of eight 2',3'-dideoxy-5-chloropyrimidines were synthesized and evaluated for their inhibitory activity against human immunodeficiency virus type 1 (HIV-1) replication in MT-4 cells. A marked improvement in selectivity was noted for the 5-chlorouracil derivatives of 2,3-dideoxyribofuranose, 3-azido-2,3-dideoxyribofuranose, and 3-fluoro-2,3-dideoxyribofuranose, mainly due to decreased toxicity of the compounds for the host cells. While chlorination of 2',3'-dideoxycytidine removed the anti-HIV activity, introduction of a chlorine at the C-5 position of 3'-fluoro-, 3'-azido- or 2',3'-didehydro-2',3'-dideoxycytidine led to reduced cytotoxicity with only slightly reduced anti-HIV activity. X-ray analysis showed compound 11 to have two molecules in the asymmetric unit with chi = -168.8 (3) degrees and -131.3 (3) degrees and P = 179 (1) degree and 163 (1) degree, respectively; thus revealing no close resemblance to 3'-azido-3'-deoxythymidine (AZT).