Background: Osteoarthritis (OA), characterized by articular cartilage degeneration, is exacerbated by diabetes mellitus (DM), an independent risk factor whose molecular mechanisms remain incompletely understood. This study investigates novel regulators and pathways underlying DM-associated OA pathogenesis.
Methods: We used bioinformatic analysis of transcriptomic data from OA and diabetic OA (DM-OA) cohorts to identify differentially expressed genes. We constructed functional enrichment and protein-protein interaction (PPI) networks. In vivo, we modeled diabetic OA in mice via high-fat diet/streptozotocin induction combined with destabilization of the medial meniscus surgery. In vitro, we exposed chondrocytes to high glucose to mimic diabetic conditions. We genetically modulated leucine-rich repeat-containing G-protein coupled receptor 6 (LGR6) through chondrocyte-specific knockout (KO) in LGR6-deficient mice and overexpression (OE) via intra-articular delivery of adeno-associated virus serotype 9. We validated key molecular changes using quantitative reverse transcription polymerase chain reaction, Western blotting, immunohistochemistry, and ferroptosis-associated assays (reactive oxygen species, glutathione, malondialdehyde [MDA], and mitochondrial morphology).
Results: LGR6 expression was significantly downregulated in DM-OA cartilage. PPI analysis highlighted interactions between LGR6, collagen type II (COL2A1), and matrix metalloproteinase (MMP)13. LGR6 KO exacerbated OA severity, cartilage degradation, and inflammatory markers (MMP3, MMP13, and nitric oxide synthase-2) while reducing extracellular matrix (ECM) components (COL2A1 and SRY-box transcription factor 9). Conversely, LGR6 OE attenuated cartilage damage, suppressed catabolic factors, and restored ECM synthesis. Mechanistically, LGR6 deficiency intensified ferroptosis, evidenced by elevated lipid peroxidation (MDA), mitochondrial cristae disruption, and dysregulation of glutathione peroxidase 4/prostaglandin-endoperoxide synthase 2. LGR6 activation reversed these effects, restoring redox homeostasis and mitochondrial integrity.
Innovation: This study identifies LGR6 as a pivotal inhibitor of chondrocyte ferroptosis in DM-OA, revealing a previously unexplored link between hyperglycemia, mitochondrial dysfunction, and iron-dependent cell death.
Conclusion: LGR6 safeguards cartilage by suppressing ferroptosis and maintaining mitochondrial biogenesis in diabetic conditions. Targeting the LGR6 pathway offers a promising therapeutic strategy for DM-associated OA. Antioxid. Redox Signal. 00, 000-000.
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