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Endothelin-1/endothelin B receptor signalling mediates Prx1+ skeletal stem cells senescence: A driver of osteoporotic bone loss 内皮素-1/内皮素B受体信号介导Prx1+骨干细胞衰老:骨质疏松性骨质流失的驱动因素。
IF 5.9 1区 医学 Q1 ORTHOPEDICS Pub Date : 2026-03-01 Epub Date: 2026-02-18 DOI: 10.1016/j.jot.2026.101048
Zhou Zou , Weiyuan Gong , Xuan Lu , Yuqi Zhang , Manting Au , Junxin Lin , Hongwei Ouyang , Guozhi Xiao , Bin Tang , Chunyi Wen

Background

Stem cells residing in the perivascular niche are critical for skeletal homeostasis. Vascular endothelin-1 (ET-1) controls stem cell fate in development, but its role in the exhaustion of skeletal stem cells (SSCs) and subsequent bone degeneration in osteoporosis remains poorly understood. This study aimed to determine whether ET-1 signalling drives SSCs senescence and to elucidate the underlying mechanisms.

Methods

We utilised a combination of human single-cell RNA sequencing datasets, murine models of ageing and ovariectomy (OVX), and an endothelial-specific ET-1 overexpression transgenic (TET-1) mouse model. In vitro studies on mesenchymal stem cells (MSCs) employed ET-1 challenge with and without receptor-specific antagonists (BQ123 for ETAR, BQ788 for ETBR). The mechanism was further probed using transcriptomic profiling and validated in vivo through Prx1+ SSCs-specific ETBR knockout (Prx1-Cre;ETBRfl/fl) and pharmacological inhibition with the ETBR antagonist BQ788.

Results

In aged and OVX mice, ETBR expression was significantly upregulated in SSCs concurrent with bone loss. Transgenic ET-1 overexpression recapitulated an aged bone phenotype, inducing SSCs senescence and accelerating bone loss. In vitro, ET-1 triggered MSCs senescence and reactive oxygen species (ROS) accumulation. Such effects were specifically abrogated by ETBR, but not ETAR. Transcriptomic analysis revealed that ET-1/ETBR signalling synergistically dysregulates the PI3K-AKT and p53 pathways to orchestrate senescence. Critically, both genetic knockout of ETBR in Prx1+ SSCs and pharmacological inhibition with BQ788 mitigated oxidative stress, reduced cellular senescence, and preserved bone mass in OVX and aged mice.

Conclusion

This study identified the ET-1/ETBR signalling axis as a critical driver of osteoporosis by promoting ROS-mediated SSCs senescence. We established a link between vascular ageing and skeletal decline.

The translational potential of this article

This study positioned ETBR blockade as a promising novel therapeutic strategy for osteoporosis. By targeting the upstream driver of SSCs exhaustion, ETBR inhibition offers a potential paradigm shift from palliative care to proactive rejuvenation of the osteogenic niche. This approach could counteract both postmenopausal and age-related bone loss by restoring the bone-forming potential of the skeleton, addressing a significant unmet clinical need.
背景:居住在血管周围生态位的干细胞对骨骼稳态至关重要。血管内皮素-1 (ET-1)在发育过程中控制着干细胞的命运,但其在骨质疏松症中骨骼干细胞(SSCs)耗竭和随后的骨变性中的作用仍然知之甚少。本研究旨在确定ET-1信号是否驱动ssc衰老并阐明其潜在机制。方法:我们利用人类单细胞RNA测序数据集、小鼠衰老和卵巢切除术模型(OVX)以及内皮特异性ET-1过表达转基因(ET-1)小鼠模型的组合。在间充质干细胞(MSCs)的体外研究中,使用ET-1攻击,有或没有受体特异性拮抗剂(BQ123用于ETAR, BQ788用于ETBR)。利用转录组学分析进一步探讨了其机制,并通过Prx1+ sscs特异性ETBR敲除(Prx1- cre;ETBR fl/fl)和ETBR拮抗剂BQ788的药理抑制在体内进行了验证。结果:在老年和OVX小鼠中,ETBR在ssc中表达显著上调,同时伴有骨质流失。转基因ET-1过表达重现骨老化表型,诱导ssc衰老,加速骨质流失。体外,ET-1触发MSCs衰老和活性氧(ROS)积累。ETBR特别废除了这些影响,但ETAR没有。转录组学分析显示,ET-1/ETBR信号通路协同失调PI3K-AKT和p53通路,协调衰老。关键的是,Prx1+ SSCs中ETBR的基因敲除和BQ788的药理抑制都可以减轻OVX和衰老小鼠的氧化应激,减少细胞衰老,并保存骨量。结论:本研究发现ET-1/ETBR信号轴通过促进ros介导的ssc衰老而成为骨质疏松症的关键驱动因素。我们建立了血管老化和骨骼衰退之间的联系。本文的转化潜力:该研究将ETBR阻断定位为一种有前景的骨质疏松症治疗新策略。通过靶向ssc耗竭的上游驱动因素,ETBR抑制提供了从姑息治疗到成骨生态位主动恢复的潜在范式转变。这种方法可以通过恢复骨骼的骨形成潜力来抵消绝经后和年龄相关的骨质流失,解决了一个重要的未满足的临床需求。
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引用次数: 0
Medical large language models and systems in the clinical application of spinal diseases: Current status, challenges, and future prospects 医学大语言模型和系统在脊柱疾病的临床应用:现状、挑战和未来展望
IF 5.9 1区 医学 Q1 ORTHOPEDICS Pub Date : 2026-03-01 Epub Date: 2026-02-18 DOI: 10.1016/j.jot.2026.101050
Wenyan Tang , Ruizhi Chen , Xiao Long , Dongdong Yu , Shen Zhao , Bin Chen
Large Language Models (LLMs), represented by the Generative Pretrained Transformer (GPT), are profoundly transforming the healthcare sector. Spine medicine, a discipline heavily reliant on complex imaging data, detailed clinical records, and evidence-based medical practice, serves as an ideal testing ground for exploring and applying these advanced artificial intelligence technologies. It holds the promise of optimizing clinical workflows, enhancing the quality of diagnosis and treatment decisions, and improving patient communication.
We systematically searched PubMed and Embase from January 2023 to September 2025 for studies investigating LLMs in spinal diseases. Original research articles published in English with a Journal Impact Factor (JIF) ≥ 3.0 were included. Reviews, case reports, animal studies, and non-orthopedic topics were excluded. Data from eligible studies were extracted and narratively synthesized.
This review aims to systematically and comprehensively examine the current state of clinical applications of medical large models and related intelligent systems in the field of spinal diseases. The focus is on analyzing their core technical pathways, specific clinical application scenarios, and their medical value, and performance evaluation results, thereby identifying current opportunities and key challenges. Furthermore, it anticipates future developments, from leveraging general-purpose models to constructing specialized models based on high-quality, large-scale, multimodal spine-specific datasets.
The translational potential of this article: The translational potential of this article lies in its provision of a comprehensive roadmap and practical framework for implementing artificial intelligence in spinal surgery. It systematically synthesizes core application scenarios for large language models—including clinical documentation assistance and preoperative planning—while explicitly addressing four critical challenges requiring resolution for successful clinical integration: regulatory compliance, data privacy protection, algorithmic bias mitigation, and workflow integration. It establishes an actionable foundation for collaborative efforts among clinicians, developers, and policymakers to deploy safe, effective, and compliant AI tools in spinal care.
以生成式预训练转换器(GPT)为代表的大型语言模型(llm)正在深刻地改变医疗保健行业。脊柱医学是一门高度依赖于复杂影像数据、详细临床记录和循证医学实践的学科,是探索和应用这些先进人工智能技术的理想试验场。它有望优化临床工作流程,提高诊断和治疗决策的质量,并改善患者沟通。从2023年1月到2025年9月,我们系统地检索了PubMed和Embase关于脊柱疾病法学硕士的研究。纳入期刊影响因子(JIF)≥3.0的英文原创研究文章。综述、病例报告、动物研究和非骨科主题被排除在外。从符合条件的研究中提取数据并进行叙述性综合。本文旨在系统、全面地综述医学大模型及相关智能系统在脊柱疾病领域的临床应用现状。重点分析其核心技术路径、具体临床应用场景、医疗价值和绩效评估结果,从而识别当前的机遇和主要挑战。此外,它还预测了未来的发展,从利用通用模型到基于高质量、大规模、多模态脊柱特定数据集构建专门模型。本文的翻译潜力:本文的翻译潜力在于它提供了在脊柱外科中实施人工智能的全面路线图和实用框架。它系统地综合了大型语言模型的核心应用场景,包括临床文档辅助和术前规划,同时明确解决了成功临床集成所需解决的四个关键挑战:法规遵从性、数据隐私保护、算法偏见缓解和工作流集成。它为临床医生、开发人员和政策制定者之间的协作努力奠定了可操作的基础,以便在脊柱护理中部署安全、有效和合规的人工智能工具。
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引用次数: 0
A novel multimodal AI-based radiomics approach for precision assessment of pain intensity in chronic nonspecific low back pain 一种新的基于人工智能的多模式放射组学方法,用于精确评估慢性非特异性腰痛的疼痛强度。
IF 5.9 1区 医学 Q1 ORTHOPEDICS Pub Date : 2026-03-01 Epub Date: 2026-02-26 DOI: 10.1016/j.jot.2026.101062
Moran Suo , Changjun Ma , Xin Chen , Yu Guan , Xiulin Wang , Zhonghai Li

Background

Chronic nonspecific low back pain (cNLBP) is a prevalent global health concern. Radiomics enables the extraction of high-dimensional quantitative features from medical images and has shown promise in disease diagnosis, prognostic assessment, and therapeutic response evaluation. To construct and validate an artificial intelligence (AI)-based evaluation model for clinical symptoms in cNLBP patients, leveraging both clinical and radiomics features. The clinical utility of this approach was evaluated in identifying patients at high risk for severe pain.

Methods

A total of 148 patients with cNLBP were enrolled and stratified by VAS into mild and severe pain groups. Radiomics features from the paraspinal muscles were extracted from lumbar MRI scans. Multiple AI algorithms were applied to construct evaluation models. Logistic regression was used to construct clinical models, radiomics models, and combined clinical - radiomics models, respectively, to compare the predictive power of different models. Model performance was evaluated by multiple methods.

Results

Fat infiltration rate of multifidus muscles as significant predictors of pain intensity. The Bagging decision tree model and random forest model achieved higher area under the ROC curve (AUC) values and F1 scores, respectively, in radiomics models. The combined models integrating radiomics and clinical features further increased AUCs.

Conclusion

AI algorithms have a significant advantage over traditional algorithms in improving the performance of predictive models. Integrating radiomics features with clinical variables significantly enhances the predictive performance for pain intensity in cNLBP. Multimodal data integration compensates for the limitations of single-modality models, improving both accuracy and stability.

The translational potential of this article

This study facilitates early risk stratification of cNLBP patients in clinical practice, enabling clinicians to prioritize intervention for high-risk individuals and optimize the allocation of medical resources. Moreover, the validated high-performance AI models and the multimodal integration strategy lay a foundation for the development of clinical auxiliary tools. Such tools can be integrated into existing clinical workflows to assist clinicians in accurately identifying patients with severe pain at high risk, thereby supporting early intervention and personalized treatment decision-making.
背景:慢性非特异性腰痛(cNLBP)是一个普遍的全球健康问题。放射组学能够从医学图像中提取高维定量特征,并在疾病诊断、预后评估和治疗反应评估方面显示出前景。利用临床和放射组学特征,构建并验证基于人工智能(AI)的cNLBP患者临床症状评估模型。这种方法的临床效用被评估,以确定患者在高风险的严重疼痛。方法:选取148例cNLBP患者,采用VAS分层法分为轻度和重度疼痛组。从腰椎MRI扫描中提取棘旁肌肉的放射组学特征。采用多种人工智能算法构建评价模型。采用Logistic回归分别构建临床模型、放射组学模型和临床-放射组学联合模型,比较不同模型的预测能力。采用多种方法对模型性能进行评价。结果:多裂肌脂肪浸润率是疼痛强度的重要预测因子。在放射组学模型中,Bagging决策树模型和随机森林模型分别获得了更高的ROC曲线下面积(AUC)值和F1分数。结合放射组学和临床特征的联合模型进一步增加了auc。结论:人工智能算法在提高预测模型性能方面比传统算法有明显优势。将放射组学特征与临床变量相结合可显著提高cNLBP疼痛强度的预测性能。多模态数据集成弥补了单模态模型的局限性,提高了精度和稳定性。本文的翻译潜力:本研究有助于临床实践中cNLBP患者的早期风险分层,使临床医生能够优先考虑高危人群的干预,优化医疗资源的配置。此外,经过验证的高性能人工智能模型和多模式集成策略为临床辅助工具的开发奠定了基础。这些工具可以整合到现有的临床工作流程中,以帮助临床医生准确识别高风险的严重疼痛患者,从而支持早期干预和个性化治疗决策。
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引用次数: 0
Engineering multifunctional microspheres for sequential regulation of osteoimmune microenvironment and bone remodeling balance to promote regeneration of osteoporotic bone defects 工程多功能微球序列调节骨免疫微环境和骨重塑平衡,促进骨质疏松性骨缺损再生
IF 5.9 1区 医学 Q1 ORTHOPEDICS Pub Date : 2026-03-01 Epub Date: 2026-03-03 DOI: 10.1016/j.jot.2026.101054
Zhiheng Luo , Jianxiong Ma , Yipei Yang , HongJie Zhang , Yuhan Du , Jing Dai , Yan Wang , Wei Zhang , Xinlong Ma , Yuxiao Lai

Objectives

Osteoporotic bone defect repair remains clinically challenging due to persistent low-grade inflammation, excessive reactive oxygen species (ROS), and dysregulated bone metabolism. Approaches relying solely on osteoclast inhibition are often insufficient, particularly for irregular osteoporotic bone voids. This study aimed to develop a multifunctional microsphere system capable of sequential osteoimmune regulation and bone metabolic remodeling.

Methods

Gelatin microspheres grafted with alendronate and loaded with epigallocatechin gallate (Gel@ALN@E) were fabricated via an emulsion–chemical crosslinking method to enable controlled dual-drug release. In vitro evaluations included ROS scavenging, inflammatory modulation, macrophage polarization, osteoclast differentiation, and osteogenic responses of rat bone marrow mesenchymal stem cells. Transcriptomic analysis was conducted to investigate immunoregulatory mechanisms. An osteoporotic rat bone defect model was used for in vivo assessment.

Results

Gel@ALN@E effectively reduced oxidative stress and inflammatory responses by promoting macrophage M2 polarization, while concurrently suppressing osteoclastogenesis and restoring bone metabolic balance. This coordinated regulation significantly enhanced osteogenic differentiation. Transcriptomic analysis revealed the downregulation of related inflammatory pathways. In vivo, Gel@ALN@E markedly improved new bone formation, trabecular organisation, and cortical bone healing in osteoporotic defects.

Conclusion

This sequential drug release system offers a promising platform for both immunomodulation and bone regeneration in osteoporotic defect repair.

The Translational Potential of this Article

The composite engineered microsphere system Gel@ALN@E integrates local immunomodulatory and osteoclast-inhibitory functions to directly address key pathological microenvironmental features of osteoporotic bone defects. This integrative design highlights its comprehensive pro-regenerative capacity and provides support for its translational application in the clinical treatment of irregular osteoporotic bone defects.
由于持续的低度炎症、活性氧(ROS)过多和骨代谢失调,骨质疏松性骨缺损修复在临床上仍然具有挑战性。仅依靠破骨细胞抑制的方法往往是不够的,特别是对于不规则的骨质疏松性骨空洞。本研究旨在开发一种具有序列骨免疫调节和骨代谢重塑功能的多功能微球系统。方法采用乳化液-化学交联法制备阿仑膦酸酯接枝明胶微球,并负载没食子儿茶素没食子酸酯(Gel@ALN@E),实现双药控释。体外评价包括ROS清除、炎症调节、巨噬细胞极化、破骨细胞分化和大鼠骨髓间充质干细胞的成骨反应。转录组学分析探讨免疫调节机制。采用骨质疏松大鼠骨缺损模型进行体内评价。ResultsGel@ALN@E通过促进巨噬细胞M2极化,有效降低氧化应激和炎症反应,同时抑制破骨细胞生成,恢复骨代谢平衡。这种协调调节显著增强了成骨分化。转录组学分析显示相关炎症通路下调。在体内,Gel@ALN@E显著改善骨质疏松性缺陷的新骨形成、小梁组织和皮质骨愈合。结论该药物序贯释放系统为骨质疏松缺损修复中免疫调节和骨再生提供了一个有前景的平台。复合工程微球系统Gel@ALN@E整合了局部免疫调节和破骨细胞抑制功能,直接解决骨质疏松性骨缺损的关键病理微环境特征。这种一体化设计突出了其全面的促再生能力,并为其在临床治疗不规则骨质疏松性骨缺陷的转化应用提供了支持。
{"title":"Engineering multifunctional microspheres for sequential regulation of osteoimmune microenvironment and bone remodeling balance to promote regeneration of osteoporotic bone defects","authors":"Zhiheng Luo ,&nbsp;Jianxiong Ma ,&nbsp;Yipei Yang ,&nbsp;HongJie Zhang ,&nbsp;Yuhan Du ,&nbsp;Jing Dai ,&nbsp;Yan Wang ,&nbsp;Wei Zhang ,&nbsp;Xinlong Ma ,&nbsp;Yuxiao Lai","doi":"10.1016/j.jot.2026.101054","DOIUrl":"10.1016/j.jot.2026.101054","url":null,"abstract":"<div><h3>Objectives</h3><div>Osteoporotic bone defect repair remains clinically challenging due to persistent low-grade inflammation, excessive reactive oxygen species (ROS), and dysregulated bone metabolism. Approaches relying solely on osteoclast inhibition are often insufficient, particularly for irregular osteoporotic bone voids. This study aimed to develop a multifunctional microsphere system capable of sequential osteoimmune regulation and bone metabolic remodeling.</div></div><div><h3>Methods</h3><div>Gelatin microspheres grafted with alendronate and loaded with epigallocatechin gallate (Gel@ALN@E) were fabricated via an emulsion–chemical crosslinking method to enable controlled dual-drug release. In <em>vitro</em> evaluations included ROS scavenging, inflammatory modulation, macrophage polarization, osteoclast differentiation, and osteogenic responses of rat bone marrow mesenchymal stem cells. Transcriptomic analysis was conducted to investigate immunoregulatory mechanisms. An osteoporotic rat bone defect model was used for in <em>vivo</em> assessment.</div></div><div><h3>Results</h3><div>Gel@ALN@E effectively reduced oxidative stress and inflammatory responses by promoting macrophage M2 polarization, while concurrently suppressing osteoclastogenesis and restoring bone metabolic balance. This coordinated regulation significantly enhanced osteogenic differentiation. Transcriptomic analysis revealed the downregulation of related inflammatory pathways. In <em>vivo</em>, Gel@ALN@E markedly improved new bone formation, trabecular organisation, and cortical bone healing in osteoporotic defects.</div></div><div><h3>Conclusion</h3><div>This sequential drug release system offers a promising platform for both immunomodulation and bone regeneration in osteoporotic defect repair.</div></div><div><h3>The Translational Potential of this Article</h3><div>The composite engineered microsphere system Gel@ALN@E integrates local immunomodulatory and osteoclast-inhibitory functions to directly address key pathological microenvironmental features of osteoporotic bone defects. This integrative design highlights its comprehensive pro-regenerative capacity and provides support for its translational application in the clinical treatment of irregular osteoporotic bone defects.</div></div>","PeriodicalId":16636,"journal":{"name":"Journal of Orthopaedic Translation","volume":"57 ","pages":"Article 101054"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147425003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Magnesium ions facilitate osteogenic differentiation and intervertebral fusion via m6A methylation of RhoA mRNA 镁离子通过RhoA mRNA的m6A甲基化促进成骨分化和椎间融合。
IF 5.9 1区 医学 Q1 ORTHOPEDICS Pub Date : 2026-03-01 Epub Date: 2026-02-18 DOI: 10.1016/j.jot.2026.101056
Haocheng Xu , Linli Li , Fan Zhang , Minghao Shao , Chenyan Li , Yitong Xue , Dachuan Li , Zhidi Lin , Zhaoyang Gong , Jiongdong Wu , Zhiwen Luo , Zhicai Shi , Xinlei Xia , Hongli Wang , Xiaosheng Ma , Jianyuan Jiang , Xiaochuan Gu , Yang Liu , Xiao Lu , Feizhou Lyu

Background

Magnesium-based implants facilitate bone regeneration via degradation. However, the epigenetic mechanisms, particularly N6-methyladenosine (m6A) modification regulated by Mg2+, remain incompletely understood. This study investigated the role of Mg2+ in osteogenic differentiation through the METTL3-RhoA axis and evaluated its potential in intervertebral fusion.

Methods

The optimal Mg2+ concentration was identified using MC3T3-E1 cells. Methylated RNA immunoprecipitation sequencing (MeRIP-seq) and MeRIP-PCR were employed to identify m6A target genes. Functional assays (knockdown, overexpression, and rescue) validated the METTL3-YTHDF1-RhoA pathway. A rat tail intervertebral fusion model with magnesium implants was used to assess in vivo effects.

Results

Treatment with 4 mM Mg2+ significantly enhanced osteogenic activity and increased METTL3 levels. Mechanistically, METTL3 promoted m6A methylation of RhoA mRNA, which was subsequently bound by YTHDF1, enhancing translation and activating the RhoA/ROCK pathway. In vivo, magnesium implants accelerated fusion and improved trabecular bone quality; however, these effects were inhibited by METTL3 or RhoA inhibitors.

Conclusion

Mg2+ enhances osteogenic differentiation through the METTL3-YTHDF1-RhoA/ROCK pathway.

The translational potential of this article

This study provides an epigenetic framework for optimizing magnesium-based orthopedic implants and suggests that targeting the m6A-RhoA axis could improve spinal fusion outcomes.
背景:镁基种植体通过降解促进骨再生。然而,表观遗传机制,特别是Mg2+调控的n6 -甲基腺苷(m6A)修饰,仍然不完全清楚。本研究通过METTL3-RhoA轴研究了Mg2+在成骨分化中的作用,并评估了其在椎间融合中的潜力。方法:采用MC3T3-E1细胞筛选最佳Mg2+浓度。采用甲基化RNA免疫沉淀测序(MeRIP-seq)和MeRIP-PCR鉴定m6A靶基因。功能分析(敲除、过表达和挽救)验证了METTL3-YTHDF1-RhoA通路。采用大鼠尾巴椎间融合术模型对镁植入物进行体内效果评估。结果:4 mM Mg2+治疗显著增强成骨活性,增加METTL3水平。在机制上,METTL3促进RhoA mRNA的m6A甲基化,随后与YTHDF1结合,增强翻译并激活RhoA/ROCK途径。在体内,镁植入物加速融合,改善骨小梁质量;然而,这些作用被METTL3或RhoA抑制剂抑制。结论:Mg2+通过METTL3-YTHDF1-RhoA/ROCK途径促进成骨分化。本文的转化潜力:该研究为优化镁基骨科植入物提供了表观遗传学框架,并表明靶向m6A-RhoA轴可以改善脊柱融合结果。
{"title":"Magnesium ions facilitate osteogenic differentiation and intervertebral fusion via m6A methylation of RhoA mRNA","authors":"Haocheng Xu ,&nbsp;Linli Li ,&nbsp;Fan Zhang ,&nbsp;Minghao Shao ,&nbsp;Chenyan Li ,&nbsp;Yitong Xue ,&nbsp;Dachuan Li ,&nbsp;Zhidi Lin ,&nbsp;Zhaoyang Gong ,&nbsp;Jiongdong Wu ,&nbsp;Zhiwen Luo ,&nbsp;Zhicai Shi ,&nbsp;Xinlei Xia ,&nbsp;Hongli Wang ,&nbsp;Xiaosheng Ma ,&nbsp;Jianyuan Jiang ,&nbsp;Xiaochuan Gu ,&nbsp;Yang Liu ,&nbsp;Xiao Lu ,&nbsp;Feizhou Lyu","doi":"10.1016/j.jot.2026.101056","DOIUrl":"10.1016/j.jot.2026.101056","url":null,"abstract":"<div><h3>Background</h3><div>Magnesium-based implants facilitate bone regeneration <em>via</em> degradation. However, the epigenetic mechanisms, particularly N6-methyladenosine (m6A) modification regulated by Mg<sup>2+</sup>, remain incompletely understood. This study investigated the role of Mg<sup>2+</sup> in osteogenic differentiation through the METTL3-RhoA axis and evaluated its potential in intervertebral fusion.</div></div><div><h3>Methods</h3><div>The optimal Mg<sup>2+</sup> concentration was identified using MC3T3-E1 cells. Methylated RNA immunoprecipitation sequencing (MeRIP-seq) and MeRIP-PCR were employed to identify m6A target genes. Functional assays (knockdown, overexpression, and rescue) validated the METTL3-YTHDF1-RhoA pathway. A rat tail intervertebral fusion model with magnesium implants was used to assess <em>in vivo</em> effects.</div></div><div><h3>Results</h3><div>Treatment with 4 mM Mg<sup>2+</sup> significantly enhanced osteogenic activity and increased METTL3 levels. Mechanistically, METTL3 promoted m6A methylation of RhoA mRNA, which was subsequently bound by YTHDF1, enhancing translation and activating the RhoA/ROCK pathway. <em>In vivo</em>, magnesium implants accelerated fusion and improved trabecular bone quality; however, these effects were inhibited by METTL3 or RhoA inhibitors.</div></div><div><h3>Conclusion</h3><div>Mg<sup>2+</sup> enhances osteogenic differentiation through the METTL3-YTHDF1-RhoA/ROCK pathway.</div></div><div><h3>The translational potential of this article</h3><div>This study provides an epigenetic framework for optimizing magnesium-based orthopedic implants and suggests that targeting the m6A-RhoA axis could improve spinal fusion outcomes.</div></div>","PeriodicalId":16636,"journal":{"name":"Journal of Orthopaedic Translation","volume":"57 ","pages":"Article 101056"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147307014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Foot and ankle biomaterials: a comprehensive review of current applications, challenges, and future directions 足部和踝关节生物材料:当前应用、挑战和未来方向的综合综述。
IF 5.9 1区 医学 Q1 ORTHOPEDICS Pub Date : 2026-03-01 Epub Date: 2026-02-24 DOI: 10.1016/j.jot.2026.101051
Peter Elvin , Amayrani Sanchez , Anthony Allen Reyes , Hagner Andrade , Meelad Karami , Hooman T. Mir , Javier La Fontaine , Danieli C Rodrigues , Claudia Biguetti
Metallic biomaterials enable successful reconstruction and fixation of skeletal tissues by supporting repair, load-bearing function, and anatomical alignment in foot and ankle surgery. However, the unique anatomic and biomechanical demands of this region, combined with challenging pathologies such as flatfoot and Charcot neuroarthropathy, present distinct challenges, with effective intervention requiring targeted biomaterial solutions and precise indications. Furthermore, metallic biomaterials currently represent the most predominant and clinically validated fixation systems in foot and ankle surgical reconstructions, while also generating the largest body of outcome-based evidence. This review summarizes and discusses their contemporary applications, outcomes, limitations, unmeet needs, and future directions based on clinical literature between 2020 and 2024. Emerging innovations, including 3D-printed titanium implants for patient-specific reconstructions, surface-engineered alloys designed to improve osseointegration, with infection mitigation properties for at risk patient populations, and the exploration of bioresorbable/biointegrative magnesium, as well as non-metallic alternative materials (e.g. polymerics) were examined. Persistent unmet needs identified in the literature include hardware challenges in osteoporotic bone and neuropathic patients, ion leeching, cyclic fatigue, economic burden, imaging artifact interference, and lack of long-term data or clinical trials on innovative implant designs and manufacturing approaches. Lastly, scanning electron microscopy (SEM) imaging of titanium, nitinol, and stainless steel is provided to offer an analysis on biomaterial-specific microstructural features, such as surface roughness and porosity, that play a role in influencing tissue integration, corrosion behavior, and mechanical performance in reconstructive surgeries. The Translational Potential of this Article: This review provides clinically actionable guidance for selecting metallic biomaterials tailored to the biomechanical and pathological demands of foot and ankle surgery, supporting evidence-based decisions of selection of hardwares, improved fixation strategies, and reduced complication rates. It also adds recent insights to inform the development and optimization of next-generation devices based on patient- and site-specific requirements, such as 3D-printed constructs and surface-engineered implants, designed to enhance fusion, reconstruction, and limb salvage outcomes.
在足部和踝关节手术中,金属生物材料通过支持修复、承重功能和解剖对齐,使骨骼组织成功重建和固定。然而,该区域独特的解剖和生物力学需求,加上具有挑战性的病理,如扁平足和Charcot神经关节病,提出了独特的挑战,有效的干预需要有针对性的生物材料解决方案和精确的适应症。此外,金属生物材料目前代表了足部和踝关节手术重建中最主要和临床验证的固定系统,同时也产生了最大的基于结果的证据。本文根据2020年至2024年的临床文献,总结并讨论了其在当代的应用、结果、局限性、未满足的需求和未来的发展方向。新兴的创新,包括用于患者特异性重建的3d打印钛植入物,旨在改善骨整合的表面工程合金,具有风险患者群体的感染缓解特性,以及生物可吸收/生物整合镁的探索,以及非金属替代材料(例如聚合物)。文献中发现的持续未满足的需求包括骨质疏松症和神经病变患者的硬件挑战、离子吸收、循环疲劳、经济负担、成像人工干扰,以及缺乏创新植入物设计和制造方法的长期数据或临床试验。最后,我们提供了钛、镍钛诺和不锈钢的扫描电镜(SEM)成像,以分析生物材料特定的微观结构特征,如表面粗糙度和孔隙度,这些特征在重建手术中影响组织整合、腐蚀行为和机械性能。本文的转化潜力:该综述为选择适合足部和踝关节手术生物力学和病理要求的金属生物材料提供了临床可操作的指导,支持基于证据的硬件选择决策,改进固定策略,降低并发症发生率。它还增加了最新的见解,为基于患者和部位特定要求的下一代设备的开发和优化提供信息,例如3d打印结构和表面工程植入物,旨在增强融合、重建和肢体保留结果。
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引用次数: 0
LBX1 alters polyamine pathway in adolescent idiopathic scoliosis – a new therapeutic target to mitigate curve progression LBX1改变青少年特发性脊柱侧凸多胺通路——缓解弯曲进展的新治疗靶点
IF 5.9 1区 医学 Q1 ORTHOPEDICS Pub Date : 2026-03-01 Epub Date: 2026-02-25 DOI: 10.1016/j.jot.2026.101063
Zhe Zhang , Yujia Wang , Zongshan Hu , Wenlin Tian , Mengheng Li , Ziyang Tang , Liang Chang , Hok-him Tang , Gen Tang , Jie Li , Zhichong Wu , Haixia Xu , Elvis Chun-sing Chui , Zhen Liu , Adam Yiu-chung Lau , Tsz-ping Lam , Daniel Kam-wah Mok , Huanxiong Chen , Yong Qiu , Jack Chun-Yiu Cheng , Wayne Yuk-Wai Lee

Background

Adolescent idiopathic scoliosis (AIS) is the most common three-dimensional (3D) spinal deformity occurring during puberty, with girls at a higher risk of curve progression to the surgical threshold. Ladybird homeobox 1 (LBX1) is the most promising AIS predisposing gene based on GWAS studies, but its role in curve progression remains elusive.

Methods

The role of LBX1 in muscle phenotype and curve progression was investigated in clinical samples and mouse models. Additionally, metabolomic analysis was used to explore signaling pathway and potential therapeutic target.

Results

In this study, we found elevated LBX1 and myogenic genes expression, along with increased proportion of type I muscle fibers, in the convex paraspinal muscle (PSM) of AIS patients. Notably, the concave/convex LBX1 ratio in PSM negatively correlates with curve severity. Using a 3D-printed asymmetric hypokyphosing thoracic restrainer, we established AIS-like 3D spinal deformities in young female mice, consistently inducing a thoracic right curve. AAV-mediated Lbx1 knockdown in concave PSM of Lbx1fl/fl mice exacerbated curve progression by 50%. Mechanistically, Lbx1 knockdown inhibited myogenesis and muscle regeneration, and altered polyamine synthesis pathway. Key polyamine pathway enzymes ODC1 and SAT1 were reduced in concave PSM of AIS patients. The resultant lower serum level of spermidine, a key polyamine metabolite, was found in progressive AIS patients at their initial clinical visits. Importantly, daily spermidine supplementation significantly mitigated curve progression in scoliosis-like mice.

Conclusion

Our findings provide new evidence that differential Lbx1 expression in bilateral PSM exacerbates curve progression. The associated altered polyamine pathway and reduced circulating spermidine level represent novel therapeutic target and prognostic biomarker, respectively.

The translational potential of this article

This study presents a straightforward and reproducible protocol for establishing a mouse model of spinal deformity with consistent curvature pattern for AIS research, and illustrates the potential role of the LBX1-mediated polyamine pathway in driving curve progression in AIS, which can be ameliorated by oral spermidine administration. Our findings highlight the modulation of paraspinal muscles as a viable approach to halting curve progression.
背景:青少年特发性脊柱侧凸(AIS)是发生在青春期的最常见的三维(3D)脊柱畸形,女孩发生弯曲进展到手术阈值的风险更高。瓢虫同源盒1 (LBX1)是基于GWAS研究的最有希望的AIS易感基因,但其在曲线进展中的作用尚不清楚。方法通过临床标本和小鼠模型研究LBX1在肌肉表型和曲线进展中的作用。此外,利用代谢组学分析探索信号通路和潜在的治疗靶点。结果在AIS患者的棘旁凸肌(PSM)中,我们发现LBX1和肌源性基因表达升高,I型肌纤维比例增加。值得注意的是,PSM的凹/凸LBX1比与曲线严重程度呈负相关。使用3D打印的不对称后凸胸约束器,我们在年轻雌性小鼠中建立了ais样3D脊柱畸形,持续诱导胸部右弯曲。aav介导的Lbx1在Lbx1fl/fl小鼠凹型PSM中的下调使曲线进展加速50%。在机制上,Lbx1基因敲低抑制了肌肉发生和肌肉再生,并改变了多胺合成途径。AIS凹型PSM患者多胺通路关键酶ODC1和SAT1降低。在进展性AIS患者首次临床就诊时,发现其血清亚精胺(一种关键的多胺代谢物)水平降低。重要的是,每日补充亚精胺可显著缓解脊柱侧凸样小鼠的曲线进展。结论本研究结果为双侧PSM中Lbx1的差异表达加剧了曲线进展提供了新的证据。相关的多胺途径改变和循环亚精胺水平降低分别是新的治疗靶点和预后生物标志物。本研究提出了一种简单、可重复的方案,用于建立具有一致曲率模式的AIS小鼠脊柱畸形模型,并阐明了lbx1介导的多胺途径在驱动AIS曲线进展中的潜在作用,这种作用可以通过口服亚精胺来改善。我们的研究结果强调了椎旁肌肉的调节作为一种可行的方法来阻止弯曲的进展。
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引用次数: 0
Corrigendum to “Bioabsorbable magnesium-based bulk metallic glass composite (BMGC) for improved medial opening wedge high tibial osteotomy in knee osteoarthritis” [J Orthop Transl 50, January 2025, Pages 97-110] “生物可吸收镁基大块金属玻璃复合材料(BMGC)在膝关节骨性关节炎中的应用”[J].中华骨科杂志,2015,page 97-110。
IF 5.9 1区 医学 Q1 ORTHOPEDICS Pub Date : 2026-03-01 Epub Date: 2026-02-23 DOI: 10.1016/j.jot.2025.11.006
Kuan-Hao Chen , Pei-Chun Wong , Lekha Rethi , Wei-Ru Wang , Chieh-Ying Chen , Pei-Hua Tsai , Jason Shian-Ching Jang , Chun-Li Lin , Chih-Hwa Chen , Andrew E.-Y. Chuang
{"title":"Corrigendum to “Bioabsorbable magnesium-based bulk metallic glass composite (BMGC) for improved medial opening wedge high tibial osteotomy in knee osteoarthritis” [J Orthop Transl 50, January 2025, Pages 97-110]","authors":"Kuan-Hao Chen ,&nbsp;Pei-Chun Wong ,&nbsp;Lekha Rethi ,&nbsp;Wei-Ru Wang ,&nbsp;Chieh-Ying Chen ,&nbsp;Pei-Hua Tsai ,&nbsp;Jason Shian-Ching Jang ,&nbsp;Chun-Li Lin ,&nbsp;Chih-Hwa Chen ,&nbsp;Andrew E.-Y. Chuang","doi":"10.1016/j.jot.2025.11.006","DOIUrl":"10.1016/j.jot.2025.11.006","url":null,"abstract":"","PeriodicalId":16636,"journal":{"name":"Journal of Orthopaedic Translation","volume":"57 ","pages":"Article 101030"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147348520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mitochondrial metabolism restoration via Tramiprosate suppresses mitochondrial ROS-driven foamy macrophage senescence post spinal cord injury 曲米前列酸恢复线粒体代谢抑制线粒体ros驱动的泡沫巨噬细胞衰老
IF 5.9 1区 医学 Q1 ORTHOPEDICS Pub Date : 2026-03-01 Epub Date: 2026-03-02 DOI: 10.1016/j.jot.2026.101049
Chaoqin Wu , Qihao Fu , Jianlan Liu , Jiajyu Fu , Buzheng Zhang , Jin Zhou , Jiawen Xu , Ying Zhang , Tianyu Zhu , Lei Yang , Xiaojian Cao , Zhanyang Qian

Background

Myelin debris (MD) engulfment-induced foamy macrophage formation is a core neuropathology following spinal cord injury (SCI). The accumulation of these foamy macrophages within the injured foci sustains neuroinflammation, impeding long-term neuroregeneration and functional recovery. However, the mechanism underlying macrophage deterioration post-foaming remains elusive.

Methods

MD-induced foamy macrophage and SCI model were used to investigated the role of Tramiprosate (TMP) in vivo and in vitro. Histological staining and functional assessments (gait analysis, Basso Mouse Scale, and motor evoked potentials) were conducted to evaluate the therapeutic effects of TMP on SCI. Quantitative PCR, western blotting, flow cytometry, immunofluorescence, seahorse assay and transmission electron microscopy were used to investigate the senescence and mitochondria function in foamy macrophages. RNA sequencing revealed TMP's role in restoring mitochondrial metabolism. And we injected AAV-shRNA to examine the potential molecular mechanism of TMP.

Results

The current study reveals that lipid droplet-laden foamy macrophages exhibit mitochondrial dysfunction and a senescent phenotype, characterized by increased secretion of matrix metalloproteinases and proinflammatory cytokines. Restoring mitochondrial metabolism via TMP—via upregulation of Shmt2—inhibits mitochondrial reactive oxygen species (mtROS) and mitochondrial DNA (mtDNA) leakage. This reduces oxidative damage to nuclear DNA and suppresses the cyclic GMP-AMP synthase (cGAS)-mediated inflammatory response, thereby eliminating senescence in foamy macrophages.

Conclusions

Our work demonstrates that TMP is a potential therapeutic agent targeting mitochondrial dysfunction-induced macrophage senescence post SCI.

The Translational Potential of this Article

This study investigates the mechanisms underlying macrophage senescence following SCI and identifies TMP as a potential therapeutic agent to mitigate this process. Importantly, TMP is a taurine analogue with established blood–brain barrier permeability and a favorable safety profile in prior clinical investigations for neurodegenerative diseases. These characteristics support its potential treatment strategy for SCI.
髓鞘碎片(myelin debris, MD)吞噬诱导泡沫巨噬细胞形成是脊髓损伤(SCI)后的核心神经病理。这些泡沫状巨噬细胞在损伤灶内的积累会维持神经炎症,阻碍长期的神经再生和功能恢复。然而,泡沫后巨噬细胞恶化的机制尚不清楚。方法采用smd诱导的泡沫巨噬细胞和脊髓损伤模型,研究曲米普罗酸(TMP)的体内外作用。通过组织学染色和功能评估(步态分析、Basso小鼠量表和运动诱发电位)来评估TMP对脊髓损伤的治疗效果。采用定量PCR、western blotting、流式细胞术、免疫荧光、海马实验和透射电镜观察泡沫巨噬细胞的衰老和线粒体功能。RNA测序显示TMP在恢复线粒体代谢中的作用。并通过注射AAV-shRNA来研究TMP的潜在分子机制。结果脂滴泡沫巨噬细胞表现出线粒体功能障碍和衰老表型,其特征是基质金属蛋白酶和促炎细胞因子的分泌增加。通过tmp -通过上调shmt2 -恢复线粒体代谢抑制线粒体活性氧(mtROS)和线粒体DNA (mtDNA)泄漏。这减少了核DNA的氧化损伤,抑制了环GMP-AMP合成酶(cGAS)介导的炎症反应,从而消除了泡沫巨噬细胞的衰老。结论研究表明,TMP是一种治疗脊髓损伤后线粒体功能障碍引起的巨噬细胞衰老的潜在药物。本研究探讨了脊髓损伤后巨噬细胞衰老的机制,并确定TMP是缓解这一过程的潜在治疗药物。重要的是,TMP是一种牛磺酸类似物,在神经退行性疾病的临床研究中具有良好的血脑屏障渗透性和安全性。这些特征支持其治疗脊髓损伤的潜在策略。
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引用次数: 0
Gut microbiota and bone aging: Focusing on the gut-X axis modes 肠道菌群与骨骼老化:聚焦于肠道- x轴模式。
IF 5.9 1区 医学 Q1 ORTHOPEDICS Pub Date : 2026-03-01 Epub Date: 2026-02-23 DOI: 10.1016/j.jot.2026.101064
Yuan-Wei Zhang , Rui-Yang Li , Yan Wu , Peng Wang , Qi-Rong Zhou , Jia-Can Su
As studies have continuously advanced, cross-linking interplay between various organs in aging individuals have continuously emerged as research hotspots. The role of gut microbiota in bone aging-related diseases, including osteoporosis, osteoarthritis, and intervertebral disc degeneration, has been extensively probed. This review first summarized the inseparable association between gut microbiota and osteoporosis, osteoarthritis, and intervertebral disc degeneration, which then explored potential mechanisms of gut-X axis through neuromodulation (microbiota-gut-brain-bone axis), immunomodulation (Th17 and Treg balance), endocrine regulation (gut-derived hormones and 5-HT), metabolite-mediated regulation (SCFAs), bacterial extracellular vesicles, and changes in microbial niche and gut microbiome-associated biomarkers. Moreover, potential intervention strategies including diet, probiotics, fecal microbiota transplantation, and physical activity were summarized to enhance clinical translation applicability. This review creatively exhibited integrated concept of “gut-X axis” to explore common, patterned mechanisms underlying “gut-bone axis”, “gut-joint axis”, and “gut-disc axis”. Furthermore, it delves into potential mechanisms by which this shared pattern regulates bone aging-related diseases and prospectively outlines therapeutic strategies for bone aging based on this axis.

The translational potential of this article

This review presents crucial role and regulatory significance of gut-X axis modes in common bone-aging related diseases. By anchoring the gut-X axis as intervention targets, the thinking of gut microbiota and its related metabolites in basic studies and clinical prevention and treatment of bone aging-related diseases might be expanded, and its clinical application transformation and development could be innovated.
随着研究的不断深入,衰老个体各器官间的交联相互作用不断成为研究热点。肠道菌群在骨质疏松症、骨关节炎和椎间盘退变等骨老化相关疾病中的作用已被广泛探讨。本文首先总结了肠道微生物群与骨质疏松、骨关节炎和椎间盘退变之间的不可分离的联系,然后通过神经调节(微生物-肠-脑-骨轴)、免疫调节(Th17和Treg平衡)、内分泌调节(肠源性激素和5-HT)、代谢物介导调节(SCFAs)、细菌细胞外囊泡、微生物生态位和肠道微生物相关生物标志物的变化。此外,还总结了饮食、益生菌、粪便微生物群移植和体育锻炼等潜在的干预策略,以提高临床翻译的适用性。本综述创造性地展示了“肠- x轴”的综合概念,以探索“肠-骨轴”、“肠-关节轴”和“肠-盘轴”的共同模式机制。此外,它还深入研究了这种共享模式调节骨衰老相关疾病的潜在机制,并基于该轴前瞻性地概述了骨衰老的治疗策略。本文的翻译潜力:本文综述了肠- x轴模式在常见骨衰老相关疾病中的重要作用和调控意义。通过锚定肠道- x轴作为干预靶点,拓展肠道菌群及其相关代谢物在骨衰老相关疾病基础研究和临床防治中的思路,创新其临床应用转化与发展。
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引用次数: 0
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Journal of Orthopaedic Translation
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