Try a new search

Format these results:

Searched for:

in-biosketch:yes

person:atturm01

Total Results:

185


Synovial fibroblast mechanosensing of fluid shear is modulated by factors in the osteoarthritic environment [Meeting Abstract]

Estell, E G; Silverstein, A M; Murphy, L A; Sobczak, E; Shah, R P; Attur, M; Ateshian, G A; Hung, C T
INTRODUCTION: The synovial membrane encapsulates diarthrodial joints to create a fluid-filled cavity that provides a lubricating environment for the articulating cartilage surfaces within. Fibroblast-like synoviocytes (FLS) regulate the composition of this synovial fluid, maintaining its viscous and lubricating properties. Fluid shear arising during joint articulation is recognized as a relevant stimulus for FLS in both healthy and pathologic conditions1. Gentle oscillatory shear has been shown to influence the response of FLS to inflammatory cytokines overexpressed in osteoarthritis (OA)2. Cartilage wear particles (CWP) are also recognized as a key factor in OA3,4, but their influence on FLS mechanosensing sensing is unknown. The specific mechanisms of FLS shear sensing and its downstream consequences, as well as the influence of the OA environment on this sensing are still unknown. This work seeks to characterize the real-time intracellular calcium ([Ca2+]i) response of FLS to physiologic fluid shear and determine how this response is modulated by both chemical and physical OA factors, Interleukin-1alpha (IL1) and CWP. Intracellular calcium is an important cell signaling molecule in cell mechanotransduction. The aim of the current study is to test the hypothesis that these OA factors heighten FLS shear sensitivity as determined using an in vitro model system. METHODS: Cell Culture. FLS were isolated from juvenile bovine synovium, expanded in alphaMEM containing 10% fetal bovine serum (FBS), 100 U/mL penicillin, 100 mg/mL streptomycin, and 5 ng/mL bovine FGF for two passages to obtain a pure population, and plated into silicone wells on 5 mug/cm2 collagen type 1 coated glass slides at high density to obtain a confluent monolayer after 24hr attachment. To mitigate artifacts due to cellular starvation the media was switched to 0.5% FBS for 12hr prior to imaging, with 10 ng/mL IL1 or CWP at 50 particles/cell for preconditioned groups. CWP were generated by mechanical abrasion of cartilage explants and sorting via Coulter counter to obtain a size of 0.9 mum5. Calcium Signaling. FLS were loaded with 5muM Fura Red to track relative [Ca2+]i in real time, where increasing [Ca2+]i results in decreasing fluorescence. A parallel plate flow chamber was employed to expose cells to 1 dyne/cm2 shear stress. Hank's Buffered Salt Solution with 0.1% FBS was flowed, with 10 ng/mL IL1 or 1 mM octanol for indicated groups. Fluorescence intensity over time was determined for individual cells and normalized as relative [Ca2+]i with respect to average intensity during equilibrium period prior to flow. Cells were considered responders if relative [Ca2+]i rose 20% above equilibrium level, which was found to be sufficient to exclude any false responses due to natural variation in equilibrium levels. Percentile response, peak magnitude, area, and latency were determined for 100 cells/slide across 3 slides/group. Dye Transfer Assay. 'Parachute' FLS were loaded with Calcein and DiI and plated at low density onto a non-dyed FLS monolayer, where Calcein transfer to neighboring cells was quantified after 4hr as a measure of gap junction communication, for 40 parachute cells (identified by non-transferable DiI) across triplicate slides per group. Preconditioned monolayers received 10 ng/mL IL1, or 50 particle/cell CWP for 24hr prior, while 1 mM octanol was applied during imaging for the negative control. Statistical Analysis. Parametric statistics were performed via ANOVA with Tukey HSD post-hoc testing (alpha<0.05), and nonparametric statistics via Fischer Exact Test with Holms-Sidak correction (alpha<0.05). RESULTS: FLS display a single Ca2+ peak in response to fluid shear (Figure 1a) coordinated among a percentage of the population, dependent upon a minimum level of serum. IL1 showed differing effects on shear response depending on timing of exposure (Figure 1b). Exposure during flow alone (CTL/IL1) significantly decreased percentile response, while preconditioning had no significant effect alone (IL1/CTL) but abolished the decreasing effect of IL exposure during flow when combined (IL1/IL1). A separate vehicle-controlled experiment showed that FLS do not respond to IL exposure itself. CWP attachment to FLS (Figure 2b,c) also significantly increased percentile response (Figure 2a) as well as peak magnitude, area, and latency. The proposed mechanism for both IL1 and CWP preconditioning enhancement of shear sensing is increase gap junction formation and communication. Gap junction blocking via octanol significantly reduced percentile response by 22%, indicating that cell-cell passing of Ca2+ signals makes up a percentage of responding cells in normal conditions, while dye transfer experiments showed that IL1 and CWP both increased gap junction communication compared to control (Figure 3). DISCUSSION: FLS demonstrate a robust Ca2+ signaling response to fluid shear which is modulated by chemical and physical factors of the OA environment, namely by increasing percentile response and thus confirming the hypothesis of heightened sensitivity. While mechanisms for the suppressing influence of IL1 exposure alone are still being explored, the influence of IL1 and CWP preconditioning may be explained by an increase in gap junction communication leading to more cell-cell signaling and higher percentile response, which supports previous implications of increased gap junction communication between FLS in the pathology of OA6. Future work will focus on the mechanisms for individual cell shear sensing, and how they are influenced by OA factors, thus contributing to the phenomenon observed in the present study. The primary cilium is of particular interest as it is both involved in mechanosensing in other cell types7, and implicated in OA pathology in its modulation by the inflammatory environment8. (Figure Presented)
EMBASE:616813734
ISSN: 1554-527x
CID: 2610442

Toward understanding the role of cartilage particulates in synovial inflammation

Silverstein, Amy M; Stefani, Robert M; Sobczak, Evie; Tong, Eric L; Attur, Mukundan G; Shah, Roshan P; Bulinski, J Chloe; Ateshian, Gerard A; Hung, Clark T
OBJECTIVE: Arthroscopy with lavage and synovectomy can remove tissue debris from the joint space and the synovial lining to provide pain relief to patients with osteoarthritis (OA). Here, we developed an in vitro model to study the interaction of cartilage wear particles with fibroblast-like synoviocytes (FLS) to better understand the interplay of cartilage particulates with cytokines on cells of the synovium. METHOD: In this study sub-10mum cartilage particles or 1mum latex particles were co-cultured with FLS +/- 10 ng/mL interleukin-1alpha (IL-1 alpha) or tumor necrosis factor- alpha (TNF-alpha). Samples were analyzed for DNA, glycosaminoglycan (GAG), and collagen and media samples were analyzed for media GAG, nitric oxide (NO) and prostaglandin-E2 (PGE2). The nature of the physical interaction between the particles and FLS was determined by microscopy. RESULTS: Both latex and cartilage particles could be phagocytosed by FLS. Cartilage particles were internalized and attached to the surface of both dense monolayers and individual cells. Co-culture of FLS with cartilage particulates resulted in a significant increase in cell sheet DNA and collagen content as well as NO and PGE2 synthesis compared to control and latex treated groups. CONCLUSION: The proliferative response of FLS to cartilage wear particles resulted in an overall increase in ECM content, analogous to the thickening of the synovial lining observed in OA patients. Understanding how cartilage particles interface with the synovium may provide insight into how this interaction contributes to OA progression and may guide the role of lavage and synovectomy for degenerative disease.
PMCID:5554538
PMID: 28365462
ISSN: 1522-9653
CID: 2521292

Serum Urate Levels Predict Joint Space Narrowing in Non-gout Patients with Medial Knee Osteoarthritis

Krasnokutsky, Svetlana; Oshinsky, Charles; Attur, Mukundan; Ma, Sisi; Zhou, Hua; Zheng, Fangfei; Chen, Meng; Patel, Jyoti; Samuels, Jonathan; Pike, Virginia C; Regatte, Ravinder; Bencardino, Jenny; Rybak, Leon; Abramson, Steven; Pillinger, Michael H
OBJECTIVE: OA pathogenesis includes both mechanical and inflammatory features. Studies have implicated synovial fluid urate (UA) as a potential OA biomarker, possibly reflecting chondrocyte damage. Whether serum urate (sUA) levels reflect/contribute to OA is unknown. We investigated whether sUA predicts OA progression in a non-gout knee OA population. METHODS: Eighty-eight subjects with medial knee OA (BMI <33) but without gout were included. Baseline sUA was measured in previously banked serum. At 0 and 24 months, subjects underwent standardized weight-bearing fixed-flexion posteroanterior knee radiographs to determine joint space width (JSW) and Kellgren-Lawrence (KL) grades. Joint space narrowing (JSN) was determined as JSW change from 0 to 24 months. Twenty-seven subjects underwent baseline contrast-enhanced 3T knee MRI for synovial volume (SV) assessment. RESULTS: sUA correlated with JSN in both univariate (r=0.40, p/=6.8; JSN of 0.31 mm for sUA<6.8, p<0.01). Baseline sUA distinguished progressors (JSN>0.2mm) and fast progressors (JSN>0.5mm) from nonprogressors (JSN
PMCID:5449226
PMID: 28217895
ISSN: 2326-5205
CID: 2460142

Human chondrocyte migration behaviour to guide the development of engineered cartilage

O'Connell, Grace D; Tan, Andrea R; Cui, Victoria; Bulinski, J Chloe; Cook, James L; Attur, Mukundan; Abramson, Steven B; Ateshian, Gerard A; Hung, Clark T
Tissue-engineering techniques have been successful in developing cartilage-like tissues in vitro using cells from animal sources. The successful translation of these strategies to the clinic will likely require cell expansion to achieve sufficient cell numbers. Using a two-dimensional (2D) cell migration assay to first identify the passage at which chondrocytes exhibited their greatest chondrogenic potential, the objective of this study was to determine a more optimal culture medium for developing three-dimensional (3D) cartilage-like tissues using human cells. We evaluated combinations of commonly used growth factors that have been shown to promote chondrogenic growth and development. Human articular chondrocytes (AC) from osteoarthritic (OA) joints were cultured in 3D environments, either in pellets or encapsulated in agarose. The effect of growth factor supplementation was dependent on the environment, such that matrix deposition differed between the two culture systems. ACs in pellet culture were more responsive to bone morphogenetic protein (BMP2) alone or combinations containing BMP2 (i.e. BMP2 with PDGF or FGF). However, engineered cartilage development within agarose was better for constructs cultured with TGFbeta3. These results with agarose and pellet culture studies set the stage for the development of conditions appropriate for culturing 3D functional engineered cartilage for eventual use in human therapies
PMCID:4531108
PMID: 25627968
ISSN: 1932-7005
CID: 2330892

Increased activity of chondrocyte translational apparatus accompanies osteoarthritis

Katsara, Olga; Attur, Mukundan; Ruoff, Rachel; Abramson, Steven B; Kolupaeva, Victoria
Objectives Degeneration of articular cartilage is central to OA pathology; however, the molecular mechanisms leading to these irreversible changes are still poorly understood. Here, we investigated how changes in the chondrocyte translational apparatus may contribute to the pathology of OA. Methods Normal and OA human knee cartilage was used to analyze the activity of different components of the translational machinery. Chondrocytes isolated from lesional and non-lesional areas of OA cartilage were used to estimate relative rate of protein synthesis by metabolic labeling. Experimental OA was induced by transection of the anterior cruciate ligament in rats to investigate changes in the translational apparatus associated with OA. The role of IL-1beta signaling was assessed in vitro using rat articular chondrocytes. Expression of mRNAs was analyzed by qPCR and protein levels by immunohistochemistry and Western blotting. Results We identified several novel traits of OA chondrocytes, including upregulation of the Serine/Threonine kinases AKT2 and AKT3 at the post-transcriptional level and increased rate of total protein synthesis, likely due to inactivation of 4E-BP1, a known repressor of cap-dependent translation. We found that 4E-BP1 inactivation is mTOR-dependent and crucial for upregulation of protein synthesis in general and in particular for MMP13 and ADAMTS5 expression. In addition, IL-1beta treatment led to 4E-BP1 inactivation and upregulation of protein synthesis in articular chondrocytes. Conclusions Precise control of protein synthesis is vital for cartilage homeostasis and its dysregulation contributes to the molecular pathology of OA. Our study therefore identifies a novel set of potential therapeutic targets
PMCID:5329137
PMID: 27696794
ISSN: 2326-5205
CID: 2273982

Toward understanding mechanisms of cartilage particulate-mediated synovial inflammation [Meeting Abstract]

Silverstein, A M; Tong, E L; Stefani, R M; Attur, M G; Ateshian, G A; Chloe, Bulinksi J; Hung, C T
INTRODUCTION: An increase in the concentration of loose cartilage debris in the joint space has been associated with aging, overuse and obesity resulting in osteoarthritis (OA) [1]. Cartilage and bone particulates have been observed bound to the surface or embedded within the synovium of OA patients who also present with synovial hyperplasia and metaplasia [2]. While the involvement of cartilage debris in synovial inflammation has been long suspected in the clinic and demonstrated in animal models [3], the mechanism of action behind the interaction remains to be elucidated. In the current study, we hypothesize that synovial fibroblasts (SF) have an inflammatory response to sub-lOum cartilage debris that can be further modulated by the presence of pro-inflammatory cytokines and is also mediated by phagocytosis. Using similar sized latex beads as a non-biologic control, we also sought to examine and characterize differences in biosynthetic activity of SF to co-culture with biologic and non-biologic wear particulates in the presence or absence of cytokines. METHODS: Tissue Harvest: Synovial tissue and articular cartilage explants were harvested from the knee joints of bovine calf knees (n=3). Synovial tissue was digested with collagenase IV, and the isolated SF were plated and expanded for two passages with 5 ng/mL bFGF-2. Cartilage explants were maintained in serum free media [4]. Particulate Generation: Cartilage particles were sterilely generated from the superficial and middle zones by manually abrading explants (n=2) with 120 grit sandpaper. The particle solution was filtered with lOum nylon mesh filter. Latex and cartilage wear particles were counted and sized as in [5] (Figure 1 A,B). Imaging: SF were cultured with FITC labeled latex particles or cartilage particles labeled with dichlorotriazinyl aminofluorescein and counterstained with Calcein Red-Orange AM after 48 hours. Dosage Optimization: SF were plated overnight prior to treatment. The optimal particle dosage was defined as the lowest dosage of particles that yielded a significant increase in MTT (metabolism) absorbance normalized to the 0 particle dosage group after 5 days of culture (Figure 1C). Dense Monolayer Co-Culture: SF were plated at a high density overnight and co-cultured with +/- 10 ng/mL IL-la or TNF-a and +/- latex or cartilage particles for 5 days (n=6-8). Particles alone were cultured +/-10 ng/mL IL-la (not shown) or TNF-a. Biochemistry: DNA glycosaminoglycan (GAG), collagen (COL) and nitric oxide (NO) were determined using the Picogreen dsDNA, DMMB dye binding, OHP and Griess assays, respectively. Biochemical content of wear particles alone was subtracted from the measured values of the resulting SF sheet with particles to determine the contribution of SF alone. Statistics: Comparisons were analyzed using ANOVA with Fisher's LSD post-hoc test (p<0.05). RESULTS: Latex and cartilage wear particles had average diameters of 1.05 +/- 0.28 um and 0.85 +/- 0.45 um, respectively. For both latex and cartilage wear particles the lowest concentration that increased cellular metabolism was 250 particles per cell or <0.002%v/v for both particle types. Latex particles were readily phagocytosed by the majority of SF, with 5-20 particles internalized per cell (Figure 2A). Meanwhile, cartilage wear particles were selectively phagocytosed by SF, with positive cells only internalizing 1-5 particles (Figure 2A). Cartilage wear particles were also observed on the surface of the SF (not shown). With cartilage particle co-culture, cellular proliferation was significantly increased compared to non-treated controls or latex treated cells regardless of cytokine treatment (Figure 3A). The DNA content of the cartilage wear particles themselves constituted <1% that of the DNA of the final cell monolayer (not shown). Cell monolayer GAG and GAG synthesis decreased with cytokine treatment and was increased after cartilage wear particle treatment without cytokines only (Figure 3B). Cellular COL was significantly elevated in cartilage particle treated groups. However, COL synthesis was decreased compared to the control for latex and cartilage particle treated groups. Cell monolayer COL and COL synthesis per cell decreased with cytokine treatment across all groups. However, with TNF treatment, only cartilage particle synthesis was increased compared to the control (Figure 3C). Media GAG increased with cartilage treatment and cytokine treatment. However, in TNF treated groups, media GAG per cell was decreased in latex and cartilage treated groups (Figure 3D). NO in the media increased with cytokine and cartilage particle treated groups (Figure 3E). Across all cell and media biochemical measurements, cartilage particle treated groups had a muted response to cytokine treatment, compared to control and latex treated groups. DISCUSSION: Based on the results, we reject our hypothesis that the inflammatory response caused by cartilage wear particles is synergistic with cytokine insult, implicating perhaps a shift in the anabolic-catabolic balance of treated SF. Notably, the proliferative response of SF to cartilage wear particles resulted in an overall increase in extracellular matrix content, which may be suggestive of synovial hyperplasia often reported in OA. Treatment of SF with cartilage wear particles had an inflammatory effect, resulting in decreased anabolic synthesis (less overall matrix normalized by DNA) and increased catabolic activity (increased media GAG/DNA and NO/DNA). This observation is consistent with previous work that reported co-culture with cartilage particles results in increased TNF-a gene expression [1] and the release of proteinases [6]. This effect was not observed following phagocytosis of latex particles, suggesting that the inflammatory response of SF to cartilage wear particles is mediated by a mechanism beyond non-specific phagocytosis. Further characterization of the inflammatory response will investigate other factors upregulated in OA including prostaglandin E2, IL-6, and matrix metalloproteinases. Efforts to better understand the cartilage particle-induced proliferative response is ongoing, including study of the cadherin-11, which regulates synovial architecture [8]. SIGNIFICANCE: Cartilage wear debris play a role in the onset of synovium-mediated inflammation in OA. An in vitro model that can explore the interaction between cartilage particles and the synovium will foster the development of effective strategies to mitigate their negative interactions
EMBASE:616819800
ISSN: 1554-527x
CID: 2609982

Membrane-type 1 matrix metalloproteinase controls osteo-and chondrogenesis by a proteolysis-independent mechanism mediated by its cytoplasmic tail [Meeting Abstract]

Qing, Y; Attur, M; Kirsch, T; Lee, Y J; Yakar, S; Liu, Z; Abramson, S B; Mignatti, P
Background/Purpose: We aimed to understand the mechanism by which membrane-type 1 matrix metalloproteinase (MT1-MMP, MMP-14) controls bone and cartilage homeostasis. MT1-MMP, a cell-membrane-bound proteinase with an extracellular catalytic site and a 20-amino acid cytoplasmic tail, plays a key role in postnatal bone formation. The genetic deficiency of MT1-MMP in the mouse causes dwarfism, osteopenia and severe arthritis. Deletion of MT1-MMP in bone marrow-derived mesenchymal progenitor cells (BM-MSC) recapitulates this phenotype, showing that MT1-MMP controls osteogenic differentiation in MSC. The phenotype of MT1-MMP-/- mice has been proposed to result from lack of MT1-MMP proteolytic activity. However, mounting evidence shows a variety of proteolysis-independent signaling functions of MT1-MMP. The unique tyrosine (Y573) in the MT1-MMP cytoplasmic tail is fundamental for the control of intracellular signaling. Methods: We generated a mouse with the Y573D mutation in MT1-MMP (MT1-MMP Y573D) and characterized its skeletal phenotype by histological and microCT analyses. Isolated BM-MSC were induced to differentiate into osteoblasts, chondrocytes and adipocytes, using qRT-PCR to analyze gene expression. Mouse C3H10T1/2 MSC were transfected with MT1-MMP cDNA and analyzed for Wnt signaling by luciferase reporter assays. Results: MT1-MMP Y573D mice had increased trabecular bone relative to wt littermates, marked thinning of articular cartilage with disorganized tissue architecture, clustering and cloning of chondrocytes, and pronounced decrease in bone marrow-associated and total body fat. We induced BM-MSC from wt and MT1-MMP Y573D littermates to differentiate into osteoblast and chondrocytes, and myeloid precursors into osteoclasts. The Y573D mutation dramatically increased MSC expression of osteoblast markers and strongly downregulated chondrocyte and osteoclast markers. These findings indicated that Wnt signaling is upregulated in MT1-MMP Y573D-expressing MSC. Therefore, we analyzed Wnt signaling. We transiently transfected C3H10T1/2 MSC cells in osteoblast medium with the cDNAs for wt MT1-MMP and MT1-MMP Y573D. As controls the cells were transfected with the empty vector (pcDNA) or with MT1-MMP E240A, a mutant devoid of proteolytic activity. MT1-MMP Y573D dramatically upregulated Wnt signaling relative to wt MT1-MMP and MT1-MMP E240A. Conclusion: MT1-MMP controls Wnt signaling by a mechanism independent of extracellular proteolysis and mediated by its cytoplasmic tail. MT1-MMP is a bifunctional protein, with an extracellular proteolytic activity that promotes bone formation through ECM remodeling and a cytoplasmic tail that controls osteogenesis by interacting with a key pro-osteogenic signaling pathway
EMBASE:613888758
ISSN: 2326-5205
CID: 2397902

Binding of periostin to discoidin domain receptor-1 (DDR1) promotes cartilage degeneration by inducing MMP-13 expression [Meeting Abstract]

Qing, Y; Mignatti, P; Ramme, A; Kirsch, T; Patel, J; Attur, M
Background/Purpose: We and others have previously shown that periostin (Postn) expression is dramatically elevated in cartilage and sub-chondral bone in OA patients and surgical models of OA (medial meniscectomy and anterior crucial ligament resection or PMX, partial meniscectomy) in rodents. In vitro Postn promotes collagen and proteoglycan degradation in human chondrocytes by upregulating MMP-13 and ADAMTS4 expression. Postn controls gene expression in bone cells by interacting with avb3 integrin. However, the nature of periostin receptor(s) in chondrocytes is unknown. DDR1, a collagen-binding receptor tyrosine kinase highly expressed in chondrocytes, controls MMP-13 expression during chondrogenesis. Therefore, we hypothesized that the effect of Postn on chondrocytes is mediated by DDR1 and Postn-deficient mice (Postn-/-) are protected from surgically-induced post-traumatic OA. Methods: (Postn-/-) mice were purchased from Jackson Laboratory (B6;129-Postntm1Jmol/J Stock No: 009067). We subjected 3- months old littermates (Postn+/+, Postn+/- and Postn-/-) to partial medial meniscectomy (PMX) or sham surgery, and harvested the knee joints 8 week post-surgery for histological assessment of OA progression. Human OA chondrocytes cultures were incubated in the presence or absence of the DDR1 inhibitor DDR1-IN-1 dihydrochloridein (100-500 nM) for 2 h before addition of Postn (1 mug/ml) or control vehicle to the culture medium. MMP-13 levels were determined by ELISA 24 h post stimulation. Results: We observed abundant expression of DDR1 mRNA in human chondrocytes and we found comparable levels of DDR1 in OA and normal cartilage. However, Postn expression was 3-4 times as high in OA than in normal cartilage. Pre-incubation of human cartilage explants or cultured chondrocytes with DDR1-IN-1 dihydrochloridein inhibited both constitutive and Postn-induced MMP-13 expression in a dose-dependent manner. In contrast, neutralizing antibody to alphavbeta3 integrin had no effect on Postn induction of MMP-13 expression. Co-immunoprecipitation experiments showed that Postn physically interacts with DDR1 in human chondrocytes. Furthermore, Postn-/- mice showed reduced PMX-induced cartilage degeneration and osteophyte formation, and both Postn+/- and Postn-/- mice had reduced subchondral bone thickening, relative to Postn+/+ mice. Conclusion: Postn-/- mice are protected from surgically-induced post-traumatic OA, showing that Postn promotes cartilage degeneration. DDR1 mediates the stimulatory effect of Postn on MMP-13 expression. Further studies are in progress to investigate the potential of periostin as a druggable target for the treatment of OA
EMBASE:613888787
ISSN: 2326-5205
CID: 2397892

Genetic polymorphism of IL-1RN encoding the IL-1 receptor antagonist predicts radiographic severity of symptomatic knee OA [Meeting Abstract]

Attur, M; Ma, S; Samuels, J; Samuels, S K; Zhou, H; Bencardino, J; Hochberg, M C; Mitchell, B; Kraus, V B; Jordan, J M; Abramson, S B
Background/Purpose: Growing numbers of studies show increased expression in Osteoarthritis (OA) of inflammatory cytokines, such as IL-1beta and TNFalpha, in joint tissues and peripheral blood mononuclear (PBM) cells. The IL1 receptor antagonist (IL1RN) gene cluster region has been associated with susceptibility to knee OA, thereby further implicating inflammation in OA pathogenesis. In these studies, we examined the association of IL-1RN haplotype with the radiographic severity of symptomatic knee OA (SKOA). Methods: Genomic DNA from SKOA patients from three cohorts (NYU I, NYU-II and O
EMBASE:613886515
ISSN: 2326-5205
CID: 2398292

The impact of obesity on knee osteoarthritis symptoms and related biomarker profiles in a bariatric surgery cohort [Meeting Abstract]

Mukherjee, T; Bomfim, F; Wilder, E; Browne, L; Toth, K; Aharon, S; Lin, J; Vieira, R L R; Ren-Fielding, C; Parikh, M; Abramson, S B; Attur, M; Samuels, J
Background/Purpose: Obesity is a common risk factor for knee osteoarthritis (KOA). While it is intuitive that bariatric weight loss improves knee pain, it is not clear how much is due to decreased mechanical load vs metabolic changes. Methods: Patients were screened for knee pain prior to sleeve gastrectomy, gastric bypass, or laparoscopic gastric banding. We required pain for >15 days/month and VAS pain > 30, excluding lupus, inflammatory arthritis, crystal disease, psoriasis, and bilateral knee replacement. Enrolled patients took standing knee xrays for Kellgren-Lawrence (KL) grading. We measured BMI and used the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire at baseline and 1, 3, 6 and 12 months, calculating % excess weight loss (%EWL) and deltaKOOS. We collected blood at baseline and followup to study biomarkers for predicting KOOS scores. Results: Of 536 patients considering bariatric surgery, we found 308 with knee pain and enrolled 176 (91.5% female; BMI 43.6 kg/m2+/-7, 32-61; age 42 +/-11, 18-73) well distributed in xray severity (KL0-4). For the 150 patients who had surgery, knee improvement paralleled weight loss at the followups. At 1 year, %EWL correlated well with deltaKOOS pain (R = .262, n = 114, p = 0.005), similar to other intervals and to other KOOS measures. The sleeve and bypass (n=72 and 27) vs banding (n=15) resulted in higher deltaKOOS pain at 1 year: 32.9 +/-21.3 and 30.7 +/-22.6 vs 10.2 +/-21.4, p=0.001. Sleeve and bypass patients also achieved a higher % of their potential deltaKOOS pain improvement than did banding (65.2% and 60.1% vs 16.8% of remaining KOOS points to 100), and a higher % of patients improved to any degree (93.1% and 88.9% vs 66.7%). Radiographic severity did not predict deltaKOOS at 1 year, nor did the presence of key comorbidities. Patients lost weight in a near-linear fashion through 1 year (Fig. 1), but their KOOS improvements plateaued at 1 month. This held true in sleeve and bypass subgroups (with altered anatomy), while banding showed less consistent deltaKOOS despite a similar trend in %EWL. Baseline leptin levels in obese KOA were higher than non-obese KOA and non-obese/non-OA controls from other cohorts (100.2 +/-61.9 vs 26.2 +/-16.7 and 15.4+/-13.8, p<0.001). Similarly, IL-1Ra, a potential marker of OA progression, was much higher than non-obese KOA or controls (1123+/-940 vs 324.0+/-145.6 and 272+/-130.0, p<0.001). Within obese KOA, higher leptin levels predicted worse xrays (KL0/1 vs KL2/3/4, p = 0.037). After 1 year, mean leptin and IL1-Ra from obese KOA patients had decreased (p<0.001). Conclusion: Bariatric surgery improves knee OA symptoms proportionally to %EWL. Most relief occurs during the 1st month before much weight loss, suggesting a metabolic impact beyond mechanical load reduction on joints - at least with the sleeve and bypass that alter digestive anatomy. Leptin and IL-1Ra serum levels are elevated in obese KOA vs non-obese KOA and controls - and fall after bariatric surgery which could contribute to knee pain relief
EMBASE:613889129
ISSN: 2326-5205
CID: 2397822