Faculty Bibliography

PURPOSE: To correlate the intraoperative concentrations of 20 synovial fluid biomarkers with preoperative symptoms, intraoperative findings, and postoperative outcomes in patients undergoing knee arthroscopy, with comparisons made to samples obtained from asymptomatic knees. METHODS: Synovial fluid samples were obtained from 81 patients undergoing knee arthroscopy meeting the inclusion criteria, which included 70 samples from operative knees and 32 samples from contralateral knees. Preoperatively, baseline data obtained from clinical questionnaires including a visual analog scale (VAS) score, the Lysholm score, and the Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form were recorded. Synovial fluid was collected from both the operative knee and asymptomatic contralateral knee. Synovial fluid was stored with a protease inhibitor at -80 degrees C until analysis. Intraoperative findings, procedures performed, and International Cartilage Repair Society (ICRS) cartilage status scores in all operative knees were documented. The concentrations of the following 20 biomarkers were measured using a multiplex magnetic bead immunoassay: matrix metalloproteinase (MMP) 3; MMP-13; tissue inhibitor of metalloproteinase (TIMP) 1; TIMP-2; TIMP-3; TIMP-4; fibroblast growth factor 2; eotaxin; interferon gamma; interleukin (IL) 10; platelet-derived growth factor BB; IL-1 receptor antagonist; IL-1beta; IL-6; monocyte chemotactic protein 1 (MCP-1); macrophage inflammatory protein 1alpha; macrophage inflammatory protein 1beta; RANTES (regulated upon activation, normal T cell expressed and secreted); tumor necrosis factor alpha; and vascular endothelial growth factor. Clinical outcome scores were obtained in 83% of patients at a mean of 17 months' follow-up postoperatively. Analysis of variance and Pearson correlation analysis were performed to determine statistical significance between preoperative data, intraoperative findings, postoperative outcomes, and synovial fluid biomarker concentrations compared with asymptomatic contralateral knees. RESULTS: Analysis was performed on 70 operative and 32 contralateral samples. There were strong positive correlations between ICRS score and age, symptom duration, VAS score, and Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form. A strong positive correlation was found between MCP-1 and IL-6 concentrations, intraoperative ICRS score, and continued pain at the time of final follow-up. MCP-1 and IL-6 were the strongest predictors of severe cartilage lesions, whereas IL-1 receptor antagonist was inversely related. MMP-3 levels were consistently elevated in all operative samples and directly correlated to increased preoperative VAS scores. RANTES, vascular endothelial growth factor, and platelet-derived growth factor BB were the strongest predictors of postoperative improvement at final follow-up regardless of injury and cartilage status. CONCLUSIONS: Synovial fluid biomarkers have the capacity to reflect the intra-articular environment before surgery and potentially predict postoperative clinical outcomes. Recognition of key molecular players may yield future therapeutic targets, and large clinical trials exploring these discoveries are anticipated. LEVEL OF EVIDENCE: Level III, therapeutic case-control study.

INTRODUCTION: PI3K/AKT/mTOR up-regulation results in accelerated activation of the primordial follicle (PMF) pool and has been implicated in cyclophosphamide (CY)-induced 'follicular exhaustion'. We compared follicular dynamics in murine models of CY-induced POI and age-related DOR, hypothesizing that 'follicular exhaustion' may occur similarly in both groups. METHODS: C57BL/6 female mice aged 8 wks (n=25) housed in identical conditions were assigned to 5 groups: 150mg/kg CY intraperitoneal (IP) x1, 75mg/kg CY IP weekly x3, control (8 wks and 11 wks), and DOR (13 months). Blood was extracted by terminal cardiac puncture for anti-mullerian hormone (AMH). Ovaries were paraffin-embedded, sectioned, and H&E stained; blinded follicle counts were confirmed by two reviewers. Follicle counts are presented as follicles/section area (mm2); data presented as mean+/-SEM. One-way ANOVA and student's t-test were used for statistical analysis (p<0.05). 'Follicular exhaustion' was calculated as the ratio of total growing follicles (primary, secondary, antral) to PMFs. RESULTS: A DOR murine model was confirmed by low AMH in 13-mth-old mice compared to controls (7.2+/-0.1 vs. 12.1+/-0.5, p<0.05) and fewer PMFs/mm2 (0.6+/-0.2) compared to 8-wk (7.7+/-1.2) and 11 wk controls (6.0+/-1) (p<0.05). A CY-induced POI model was confirmed by lower AMH in 150mg/kg CY-exposed mice compared to age-matched controls (9.6+/-0.9 vs. 12.1+/-0.5) and fewer PMFs/mm2 (2.5+/-0.4 vs. 7.7+/-1.2, p<0.05). CY-treated mice had more primary & secondary follicles/mm2 compared to controls (p<0.05), suggesting increased follicle activation. PMF counts were similar in POI [75mg/kg CY (2.4 +/- 0.5) and 150mg/ kg CY (1.9+/-0.3)] compared to DOR (0.6+/-0.2) despite an 11-mth age difference. Importantly, similar rates of 'follicular exhaustion' were seen in CY-exposed POI mice (75mg/kg CY ratio 1.9; 150mg/kg CY ratio 2.6) and DOR mice (ratio 2.4). In contrast, low 'follicular exhaustion' ratios were seen in both control groups (8-wks ratio 0.64; 11-wks ratio 0.89) signifying maintenance of follicles as PMFs. CONCLUSIONS: Accelerated PMF activation and subsequent follicular exhaustion occur similarly in murine models of CY-induced POI and age-related DOR. Future studies should investigate if PI3K/AKT/mTOR up-regulation is also involved in DOR, suggesting possible implications for prevention

Radiation therapy is a mainstay in the treatment of many malignancies, but also results in collateral obliteration of microvasculature and dermal/subcutaneous fibrosis. Soft tissue reconstruction of hypovascular, irradiated recipient sites through fat grafting remains challenging, however a coincident improvement in surrounding skin quality has been noted. Cell-assisted lipotransfer (CAL), the enrichment of fat with additional adipose-derived stem cells (ASCs) from the stromal vascular fraction, has been shown to improve fat volume retention, and enhanced outcomes may also be achieved with CAL at irradiated sites. Supplementing fat grafts with additional ASCs may also augment the regenerative effect on radiation-damaged skin. In this study, we demonstrate the ability for CAL to enhance fat graft volume retention when placed beneath the irradiated scalps of immunocompromised mice. Histologic metrics of fat graft survival were also appreciated, with improved structural qualities and vascularity. Finally, rehabilitation of radiation-induced soft tissue changes were also noted, as enhanced amelioration of dermal thickness, collagen content, skin vascularity, and biomechanical measures were all observed with CAL compared to unsupplemented fat grafts. Supplementation of fat grafts with ASCs therefore shows promise for reconstruction of complex soft tissue defects following adjuvant radiotherapy

Birds have a distally reduced, splinter-like fibula that is shorter than the tibia. In embryonic development, both skeletal elements start out with similar lengths. We examined molecular markers of cartilage differentiation in chicken embryos. We found that the distal end of the fibula expresses Indian hedgehog (IHH), undergoing terminal cartilage differentiation, and almost no Parathyroid-related protein (PTHrP), which is required to develop a proliferative growth plate (epiphysis). Reduction of the distal fibula may be influenced earlier by its close contact with the nearby fibulare, which strongly expresses PTHrP. The epiphysis-like fibulare however then separates from the fibula, which fails to maintain a distal growth plate, and fibular reduction ensues. Experimental downregulation of IHH signaling at a postmorphogenetic stage led to a tibia and fibula of equal length: The fibula is longer than in controls and fused to the fibulare, whereas the tibia is shorter and bent. We propose that the presence of a distal fibular epiphysis may constrain greater growth in the tibia. Accordingly, many Mesozoic birds show a fibula that has lost its distal epiphysis, but remains almost as long as the tibia, suggesting that loss of the fibulare preceded and allowed subsequent evolution of great fibulo-tibial disparity.

Circulating levels of low-density lipoprotein cholesterol (LDL), and high-density lipoprotein cholesterol (HDL) are two of the most important risk factors for the development of cardiovascular disease (CVD), the leading cause of death worldwide. Recently, miRNAs have emerged as critical regulators of cholesterol metabolism and promising therapeutic targets for the treatment of CVD. A great deal of work has established numerous miRNAs as important regulators of HDL metabolism. This includes miRNAs that target ABCA1, a critical factor for HDL biogenesis and reverse cholesterol transport (RCT), the process through which cells, including arterial macrophages, efflux cellular cholesterol for transport to and removal by the liver. The most well studied of these miRNAs, miR-33, has been demonstrated to target ABCA1, as well as numerous other genes involved in metabolic function and RCT, and therapeutic inhibition of miR-33 was found to increase HDL levels in mice and non-human primates. Moreover, numerous studies have demonstrated the beneficial effects of miR-33 inhibition or knockout on reducing atherosclerotic plaque burden. Even more recent work has identified miRNAs that regulate LDL cholesterol levels, including direct modulation of LDL uptake in the liver through targeting of the LDL receptor. Among these, inhibition of miR-128-1, miR-148a, or miR-185 was found to reduce plasma LDL levels, and inhibition of miR-185 was further demonstrated to reduce atherosclerotic plaque size in ApoE(-/-) mice. Due to their ability to target many different genes, miRNAs have the ability to mediate complex physiologic changes through simultaneous regulation of multiple interrelated pathways. Of particular importance for CVD, inhibition of miR-148a may prove an important therapeutic approach for combating dyslipidemia, as this has been demonstrated to both raise plasma HDL levels and lower LDL levels in mice by targeting both ABCA1 and LDLR, respectively. In this review we highlight recent advances in our understanding of how miRNAs regulate cholesterol metabolism and the development of atherosclerotic plaques and discuss the potential of anti-miRNA therapies for the treatment and prevention of CVD.

The epithelial Na channel (ENaC) forms a pathway for Na(+) reabsorption in the distal nephron, and regulation of these channels is essential for salt homeostasis. In the rat kidney, ENaC subunits reached the plasma membrane in both immature and fully processed forms, the latter defined by either endoglycosidase H-insensitive glycosylation or proteolytic cleavage. Animals adapted to a low-salt diet have increased ENaC surface expression that is specific for the mature forms of the subunit proteins and is similar (three- to fourfold) for alpha, beta, and gammaENaC. Kidney membranes were fractionated using differential centrifugation, sucrose-gradient separation, and immunoabsorption. Endoplasmic reticulum membranes, isolated using an antibody against calnexin, expressed immature gammaENaC, and the content decreased with Na depletion. Golgi membranes, isolated with an antibody against the cis-Golgi protein GM130, expressed both immature and processed gammaENaC; Na depletion increased the content of processed gammaENaC in this fraction by 3.8-fold. An endosomal compartment isolated using an antibody against Rab11 contained both immature and processed gammaENaC; the content of processed subunit increased 2.4-fold with Na depletion. Finally, we assessed the content of gammaENaC in the late endocytic compartments indirectly using urinary exosomes. All of the gammaENaC in these exosomes was in the fully cleaved form, and its content increased by 4.5-fold with Na depletion. These results imply that stimulation of ENaC surface expression results at least in part from increased rates of formation of fully processed subunits in the Golgi and subsequent trafficking to the apical membrane.

beta-amyloid precursor protein (APP) and amyloid beta peptide (Abeta) are strongly implicated in Alzheimer's disease (AD) pathogenesis, although recent evidence has linked APP-betaCTF generated by BACE1 (beta-APP cleaving enzyme 1) to the development of endocytic abnormalities and cholinergic neurodegeneration in early AD. We show that partial BACE1 genetic reduction prevents these AD-related pathological features in the Ts2 mouse model of Down syndrome. Partially reducing BACE1 by deleting one BACE1 allele blocked development of age-related endosome enlargement in the medial septal nucleus, cerebral cortex, and hippocampus and loss of choline acetyltransferase (ChAT)-positive medial septal nucleus neurons. BACE1 reduction normalized APP-betaCTF elevation but did not alter Abeta40 and Abeta42 peptide levels in brain, supporting a critical role in vivo for APP-betaCTF in the development of these abnormalities. Although ameliorative effects of BACE1 inhibition on beta-amyloidosis and synaptic proteins levels have been previously noted in AD mouse models, our results highlight the additional potential value of BACE1 modulation in therapeutic targeting of endocytic dysfunction and cholinergic neurodegeneration in Down syndrome and AD.