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Multiple vertebral fractures after antiosteoporotic medications discontinuation: A comparative study to evaluate the potential rebound effect of denosumab 停用抗骨质疏松药物后的多发性椎体骨折:评估地诺单抗潜在反弹效应的比较研究。
IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-07 DOI: 10.1016/j.bone.2024.117325
Mar Martín-Pérez , Beatriz Sánchez-Delgado , Patricia García-Poza , Sergio López-Álvarez , Elisa Martín-Merino

Background

Discontinuation of anti-osteoporotic medications (AOM), except for bisphosphonates (BP), is not favorable for the bone, being especially negative for Prolia® (60 mg denosumab-DMAb). DMAb withdrawal leads to a rapid and significant increase in bone turnover markers, and to an important loss in bone mineral density, which has been associated with an increased risk of multiple vertebral fractures (MVF).

Objective

To assess the risk of MVF (≥2 VF) recorded at the same time) after discontinuation of different AOM.

Methods

A case-control analysis nested in a cohort of new users of DMAb, BP, Teriparatide (TPTD), Strontium Ranelate (SrRan), or selective estrogen receptor modulators (SERM), aged ≥18 years from 2011 to 2018 with ≥1 year of prior available data, was performed using the Pharmacoepidemiological Research Database for the Public Health System (BIFAP) in Spain. Cases were first MVF recorded after AOM initiation (index date). Up to 4 controls per case, matched on index date, age, sex, and location, were randomly selected among non-cases from the cohort. Adjusted conditional OR (AOR) and 95 % CI: between discontinuation of a given AOM (supply of the last prescription ended >90 days before the index date) and occurrence of MVF was assessed compared with their current use and alternatively, with discontinuation of BP, among individuals who did not switch therapy in the study.

Results

A total of 532 incident cases of MVF were identified and matched to 2121 controls (86 % women; median age 73 years). AOR of MVF after DMAb discontinuation was 2.82 (1.73–4.60) compared with DMAb current use. No risk was seen for the other AOM. The AOR was highest between 3 and 9 months after discontinuation of denosumab (8.58; 3.98–18.48) and after >1 year of cumulative use (5- and 11-times increased risk when discontinuing after 1–2 years and 2–5 years of use, respectively). Compared with BP discontinuers, discontinuation of DMAb (2.73, 1.66–4.50), TPTD (2.06, 1.09–3.88) and SrRan (1.93, 1.23–3.05) showed an increased risk of MVF; current use of DMAb showed no protective effect (1.44; 0.95–2.17).

Conclusions

Discontinuation of DMAb was associated with an immediate increased risk of MVF, especially after longest treatments compared with patients who continued therapy or discontinued BP. Although there were increased risks after discontinuation of other AOM in comparison with first- line therapy (BP), these were not found when the reference was current users. Confounding by indication cannot be discarded. Larger studies should investigate reasons for discontinuation and preventive retreatment options.
背景:除双磷酸盐(BP)外,停用抗骨质疏松药物(AOM)对骨骼不利,尤其是对Prolia®(60毫克地诺单抗-DMAb)。停用 DMAb 会导致骨转换标志物(BTMs)迅速显著增加,并导致骨矿物质密度显著下降,这与罹患多发性椎体纤维化的风险增加有关:评估停用不同AOM后发生多发性椎体骨折(MVF;同时记录≥2处VF)的风险:方法:利用西班牙公共卫生系统药物流行病学研究数据库(BIFAP),对2011年至2018年期间年龄≥18岁、之前可用数据≥1年的DMAb、BP、特立帕肽(TPTD)、雷酸锶(SrRan)或选择性雌激素受体调节剂(SERM)新用户队列进行病例对照分析。病例为 AOM 开始(指数日期)后记录的首个 MVF。从队列中的非病例中随机抽取每个病例最多 4 个对照组,对照组与病例的发病日期、年龄、性别和地点相匹配。与目前使用的AOM相比,或与研究中未转换疗法的个人中停止使用BP相比,评估了停止使用特定AOM(最后一次处方的供应在指数日期前90天结束)与MVF发生率之间的调整条件OR(AOR)和95 % CI:结果:共发现了 532 例 MVF 病例,并与 2121 例对照者(86% 为女性;中位年龄为 73 岁)进行了配对。与目前使用 DMAb 的情况相比,停用 DMAb 后 MVF 的 AOR 为 2.82(1.73-4.60)。其他 AOM 无风险。停用地诺单抗 3 至 9 个月之间(8.58;3.98-18.48)和累计使用超过 1 年后的 AOR 最高(使用 1-2 年和 2-5 年后停用的风险分别增加 5 倍和 11 倍)。与停用血压计者相比,停用DMAb(2.73,1.66-4.50)、TPTD(2.06,1.09-3.88)和SrRan(1.93,1.23-3.05)显示MVF风险增加;目前使用DMAb没有保护作用(1.44;0.95-2.17):结论:与继续治疗或停用 BP 的患者相比,停用 DMAb 会立即增加 MVF 风险,尤其是在最长治疗后。虽然与一线疗法(BP)相比,停用其他AOM后的风险会增加,但如果以当前使用者为参照,则不会出现这种情况。不能排除适应症的干扰。更大规模的研究应对停药原因和预防性再治疗方案进行调查。
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引用次数: 0
Tertiary hyperparathyroidism in two paediatric patients with X-linked hypophosphatemia during Burosumab treatment 两名患有X连锁低磷血症的儿科患者在接受Burosumab治疗期间出现三级甲状旁腺功能亢进。
IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-06 DOI: 10.1016/j.bone.2024.117324
Raja Padidela , Lauren Rayner , Annemieke M. Boot

Introduction

Although secondary hyperparathyroidism is known in X-linked hypophosphatemia (XLH) patients receiving treatment, tertiary hyperparathyroidism with hypercalcemia is rare, especially in children. We report two paediatric XLH patients treated with Burosumab who developed this rare complication.

Case descriptions

1: A female patient with XLH on conventional therapy (phosphate and active vitamin D) since one year of age was switched to Burosumab at 10 years. At 14 years of age, she developed tertiary hyperparathyroidism with hypercalcaemia. Burosumab was continued. Post-parathyroidectomy her hypercalcaemia resolved and 4 years post-surgery her calcium levels continue to remain normal.
2: A female patient with XLH on conventional therapy since 4 months of age was switched to Burosumab at 4 years of age. At 7 years of age, she developed secondary hyperparathyroidism and within 6 months she developed tertiary hyperparathyroidism. Burosumab was discontinued at 7.5 years of age, and she was commenced on Cinacalcet but, hypercalcaemia failed to resolve. Post-parathyroidectomy her tertiary hyperparathyroidism resolved. However, within 2 weeks, PTH increased which normalised with Cinacalcet. Burosumab has been recommenced and she continues cinacalcet.

Discussion

The cause of tertiary hyperparathyroidism is not clear in these patients. Higher post-dose phosphate levels or a direct effect of PHEX mutation on the parathyroid gland could have triggered PTH secretion.

Conclusion

XLH patients treated with Burosumab can develop hyperparathyroidism and should be regularly monitored for the development of secondary and tertiary hyperparathyroidism.
简介虽然在接受治疗的X-连锁低磷血症(XLH)患者中已经发现了继发性甲状旁腺功能亢进,但伴有高钙血症的三级甲状旁腺功能亢进却非常罕见,尤其是在儿童中。我们报告了两名接受布罗苏单抗治疗的XLH儿童患者,他们都出现了这种罕见的并发症:1:一名女性XLH患者,自一岁起接受常规治疗(磷酸盐和活性维生素D),10岁时改用Burosumab治疗。14岁时,她患上了伴有高钙血症的三级甲状旁腺功能亢进症。继续使用了布洛索单抗。甲状旁腺切除术后,她的高钙血症得到缓解,术后4年,她的血钙水平一直保持正常。2:一名女性 XLH 患者从 4 个月大开始接受常规治疗,4 岁时改用布罗苏单抗。7岁时,她患上了继发性甲状旁腺功能亢进症,6个月内又患上了三级甲状旁腺功能亢进症。她在7.5岁时停用了布罗苏单抗,并开始服用西那卡塞,但高钙血症仍未缓解。甲状旁腺切除术后,她的三级甲状旁腺功能亢进症得到缓解。但在两周内,她的PTH升高,服用西那卡塞后恢复正常。她已重新开始使用布罗苏单抗,并继续服用西那卡塞:讨论:这些患者出现三级甲状旁腺功能亢进的原因尚不明确。用药后较高的磷酸盐水平或PHEX基因突变对甲状旁腺的直接影响可能引发PTH分泌:结论:接受布罗苏单抗治疗的XLH患者可能会出现甲状旁腺功能亢进,应定期监测是否出现继发性和三发性甲状旁腺功能亢进。
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引用次数: 0
Exposure to fluoride and risk of primary bone cancer: A systematic review 接触氟化物与原发性骨癌的风险:系统综述。
IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-05 DOI: 10.1016/j.bone.2024.117320
Natalie Hajduga , Murali Perumbakkam Subramanian , Hannah Brown , Richard McNally , Vida Zohoori , Vikki Rand
Fluoride has long been considered essential in the prevention of dental caries, however, its relationship with bone cancer remains unclear. With little improvements in survival from primary bone cancers, it is important to understand the underlying drivers. The focus of this systematic review was, therefore, to assess the association between fluoride exposure and the development of primary bone cancer. The review was conducted as per the PRISMA guidelines and was registered on PROSPERO (CRD42021296109) with a search cut-off of March 2024. In total, 14 studies, involving 8680 participants across all age groups, were identified examining the effects of fluoride exposure on humans investigated for primary bone cancer. Of the 14 studies, only two reported a positive association between fluoride and primary bone cancer. One study including 88 participants reported a positive association between water fluoridation and osteosarcoma development (in young males between 0 and 20 years of age), and the second study, with an unreported number of participants, reported this positive association with bone cancers in males. No association between fluoridation and bone cancer development was reported in the remaining studies. Across all 14 studies, data was presented in a narrative synthesis with subgroup analysis conducted on study design, age, sex, fluoride level and quality score. Both studies reporting a positive association between fluoride and bone cancer identified this association in males, however, both studies concluded that further research is needed. Here we report the most comprehensive systematic review to date examining associations between fluoride exposure and primary bone cancer. We also highlight some of the methodological limitations of some studies, and identify the need, and opportunity, to conduct a large, prospective study to address this and other health issues associated with fluoride.
长期以来,氟一直被认为是预防龋齿的基本物质,然而,氟与骨癌的关系仍不明确。由于原发性骨癌的存活率几乎没有改善,因此了解其根本原因非常重要。因此,本系统综述的重点是评估氟暴露与原发性骨癌发生之间的关系。综述按照 PRISMA 指南进行,并在 PROSPERO(CRD42021296109)上注册,检索截止日期为 2024 年 3 月。总共确定了 14 项研究,涉及各年龄组的 8680 名参与者,这些研究探讨了氟暴露对原发性骨癌患者的影响。在这 14 项研究中,只有两项研究报告氟与原发性骨癌之间存在正相关。一项包括 88 名参与者的研究报告了氟化水与骨肉瘤(0 至 20 岁的年轻男性)之间的正相关关系,而第二项参与者人数未报告的研究报告了氟化水与男性骨癌之间的正相关关系。其余研究均未报告氟化物与骨癌发病之间的关系。对所有 14 项研究的数据进行了叙述性综合,并对研究设计、年龄、性别、氟含量和质量评分进行了分组分析。报告氟与骨癌之间存在正相关关系的两项研究都确定这种关系发生在男性身上,但是,这两项研究都得出结论,认为还需要进一步的研究。在此,我们报告了迄今为止对氟暴露与原发性骨癌之间关系进行研究的最全面的系统性综述。我们还强调了一些研究在方法上的局限性,并指出了开展大型前瞻性研究的必要性和机遇,以解决这一问题以及与氟有关的其他健康问题。
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引用次数: 0
Role of the PGAM5-CypD mitochondrial pathway in methylglyoxal-induced bone loss in diabetic osteoporosis PGAM5-CypD 线粒体途径在甲基乙二醛诱导的糖尿病骨质疏松症骨质流失中的作用。
IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-05 DOI: 10.1016/j.bone.2024.117322
Wanying Jiang , Xinyi Ma , Bin Li , Tianle Jiang , Haopu Jiang , Wenxia Chen , Jia Gao , Yixin Mao , Xiaoyu Sun , Zhou Ye , Shufan Zhao , Shengbin Huang , Yang Chen
Diabetic osteoporosis (DOP) is a skeletal complication with a high rate of disability. It results in a great burden to the patient's family and society. Methylglyoxal (MG) is a toxic by-product of the glycolytic process that occurs during diabetic conditions. It causes osteoblastic injury and con-tributes to the initiation and development of DOP. Disruption of mitochondrial homeostasis has been implicated as a cause of dysregulated osteo-blastogenesis, an essential step in bone formation. It is unclear whether mitochondrial dysfunction is involved in MG-induced osteoblast dysfunction. In this study, we showed that mitochondrial dysfunction contributes to MG-induced MC3T3-E1 cell apoptosis and impaired differentiation. A significant reduction of mitochondrial membrane potential (MMP) and ATP production occurred in MG-induced osteoblasts as well as increasing mitochondrial reactive oxygen species (mtROS) and intracellular Ca2+. Classical antioxidant N-Acetylcysteine (NAC) significantly attenuated mitochondrial dysfunction as well as osteoblast apoptosis and osteogenic differentiation damage induced by MG. More importantly, we found that activating phosphoglycerate mutase family member 5 (PGAM5) and cyclophilin D (CypD), which contributes to mitochondrial homeostasis, is involved in MG-induced osteoblast injury. Both PGAM5 and CypD knockdown effectively reversed osteoblast viability and function, whereas PGAM5 or CypD overexpression aggravated osteoblast injury caused by MG. Moreover, the result of co-transfection revealed that PGAM5 is an upstream signaling molecule of CypD. By constructing type I diabetes mouse models, we further found that the expression of PGAM5 and CypD were both increased in the femur along with a reduction of ATP and increased TUNEL-positive cells. These results, for the first time, suggest that MG-induced mitochondrial dysfunction induces osteoblast injury through the PGAM5-CypD pathway. This study provides insight into the prevention and treatment of DOP.

Lay summary

This study highlights the role of mitochondria in regulating osteoblast viability and function under conditions of diabetic osteoporosis (DOP). We found that the PGAM5-CypD mitochondrial pathway is activated following glycolytic by-product methylglyoxal (MG) treatment, which contributes to mitochondrial dysfunction and osteogenic dysfunction. This mechanism implicates mitochondria as a potential therapeutic target for osteoporosis.
糖尿病骨质疏松症(DOP)是一种骨骼并发症,致残率很高。它给患者家庭和社会造成了巨大负担。甲基乙二醛(MG)是糖尿病患者糖酵解过程中产生的一种有毒副产物。它会导致成骨细胞损伤,并导致 DOP 的发生和发展。线粒体平衡的破坏被认为是骨细胞生成失调的一个原因,而骨细胞生成是骨形成的一个重要步骤。目前尚不清楚线粒体功能障碍是否与 MG 诱导的成骨细胞功能障碍有关。在这项研究中,我们发现线粒体功能障碍导致了 MG 诱导的 MC3T3-E1 细胞凋亡和分化受损。在 MG 诱导的成骨细胞中,线粒体膜电位(MMP)和 ATP 生成明显降低,线粒体活性氧(mtROS)和细胞内 Ca2+ 增加。经典抗氧化剂 N-乙酰半胱氨酸(NAC)能显著减轻线粒体功能障碍以及 MG 诱导的成骨细胞凋亡和成骨分化损伤。更重要的是,我们发现活化磷酸甘油酸突变酶家族成员 5(PGAM5)和环嗜酸蛋白 D(CypD)参与了 MG 诱导的成骨细胞损伤。PGAM5和CypD的敲除能有效逆转成骨细胞的活力和功能,而PGAM5或CypD的过表达则会加重MG引起的成骨细胞损伤。此外,联合转染的结果显示,PGAM5是CypD的上游信号分子。通过构建 I 型糖尿病小鼠模型,我们进一步发现 PGAM5 和 CypD 在股骨中的表达均增加,同时 ATP 减少,TUNEL 阳性细胞增加。这些结果首次表明,MG 诱导的线粒体功能障碍通过 PGAM5-CypD 途径诱导成骨细胞损伤。这项研究为预防和治疗 DOP 提供了启示。LAY总结:这项研究强调了线粒体在糖尿病骨质疏松症(DOP)条件下调节成骨细胞活力和功能的作用。我们发现,糖酵解副产物甲基乙二醛(MG)处理后,PGAM5-CypD 线粒体通路被激活,从而导致线粒体功能障碍和成骨功能障碍。这一机制使线粒体成为骨质疏松症的潜在治疗靶点。
{"title":"Role of the PGAM5-CypD mitochondrial pathway in methylglyoxal-induced bone loss in diabetic osteoporosis","authors":"Wanying Jiang ,&nbsp;Xinyi Ma ,&nbsp;Bin Li ,&nbsp;Tianle Jiang ,&nbsp;Haopu Jiang ,&nbsp;Wenxia Chen ,&nbsp;Jia Gao ,&nbsp;Yixin Mao ,&nbsp;Xiaoyu Sun ,&nbsp;Zhou Ye ,&nbsp;Shufan Zhao ,&nbsp;Shengbin Huang ,&nbsp;Yang Chen","doi":"10.1016/j.bone.2024.117322","DOIUrl":"10.1016/j.bone.2024.117322","url":null,"abstract":"<div><div>Diabetic osteoporosis (DOP) is a skeletal complication with a high rate of disability. It results in a great burden to the patient's family and society. Methylglyoxal (MG) is a toxic by-product of the glycolytic process that occurs during diabetic conditions. It causes osteoblastic injury and con-tributes to the initiation and development of DOP. Disruption of mitochondrial homeostasis has been implicated as a cause of dysregulated osteo-blastogenesis, an essential step in bone formation. It is unclear whether mitochondrial dysfunction is involved in MG-induced osteoblast dysfunction. In this study, we showed that mitochondrial dysfunction contributes to MG-induced MC3T3-E1 cell apoptosis and impaired differentiation. A significant reduction of mitochondrial membrane potential (MMP) and ATP production occurred in MG-induced osteoblasts as well as increasing mitochondrial reactive oxygen species (mtROS) and intracellular Ca<sup>2+</sup>. Classical antioxidant N-Acetylcysteine (NAC) significantly attenuated mitochondrial dysfunction as well as osteoblast apoptosis and osteogenic differentiation damage induced by MG. More importantly, we found that activating phosphoglycerate mutase family member 5 (PGAM5) and cyclophilin D (CypD), which contributes to mitochondrial homeostasis, is involved in MG-induced osteoblast injury. Both PGAM5 and CypD knockdown effectively reversed osteoblast viability and function, whereas PGAM5 or CypD overexpression aggravated osteoblast injury caused by MG. Moreover, the result of co-transfection revealed that PGAM5 is an upstream signaling molecule of CypD. By constructing type I diabetes mouse models, we further found that the expression of PGAM5 and CypD were both increased in the femur along with a reduction of ATP and increased TUNEL-positive cells. These results, for the first time, suggest that MG-induced mitochondrial dysfunction induces osteoblast injury through the PGAM5-CypD pathway. This study provides insight into the prevention and treatment of DOP.</div></div><div><h3>Lay summary</h3><div>This study highlights the role of mitochondria in regulating osteoblast viability and function under conditions of diabetic osteoporosis (DOP). We found that the PGAM5-CypD mitochondrial pathway is activated following glycolytic by-product methylglyoxal (MG) treatment, which contributes to mitochondrial dysfunction and osteogenic dysfunction. This mechanism implicates mitochondria as a potential therapeutic target for osteoporosis.</div></div>","PeriodicalId":9301,"journal":{"name":"Bone","volume":"190 ","pages":"Article 117322"},"PeriodicalIF":3.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Extracellular vesicles from mouse bone marrow macrophages-derived osteoclasts treated with zoledronic acid contain miR-146a-5p and miR-322-3p, which inhibit osteoclast function 用唑来膦酸处理小鼠骨髓巨噬细胞衍生的破骨细胞的胞外囊泡含有抑制破骨细胞功能的miR-146a-5p和miR-322-3p。
IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-05 DOI: 10.1016/j.bone.2024.117323
Sakura Minami , Yasuyuki Fujii , Yusuke Yoshioka , Ayano Hatori , Kotaro Kaneko , Takahiro Ochiya , Daichi Chikazu
Medication-related osteonecrosis of the jaw (MRONJ) is an intractable form of osteonecrosis of the jaw that rarely occurs in patients using bone resorption inhibitors such as bisphosphonates (BPs). Then, extracellular vesicles (EVs) carry various signaling molecules, such as mRNAs, microRNAs (miRNAs), and proteins, and have attracted attention as intercellular communication tools. Recently, the role of EVs in communication between osteoclasts and surrounding bone cells has been confirmed. This study aimed to elucidate the effects of EVs derived from osteoclasts treated with zoledronic acid (ZA), one of the BPs on osteoclast function. EVs were isolated by ultracentrifugation of the culture supernatant of osteoclasts treated with ZA, and miRNAs were extracted from these EVs. Tartrate-resistant acid phosphatase staining of the ZA treated osteoclasts showed reduced osteoclastogenesis. In addition, pit assay showed that ZA significantly decreased the bone resorption capacity of osteoclasts. miRNA-seq analysis identified 11 upregulated and 5 downregulated differentially expressed genes (DEGs) in the miRNA of EVs derived from ZA-treated osteoclasts compared to EVs derived from osteoclasts not treated with ZA. qRT-PCR analysis confirmed the amount of these specific miRNAs, with miR-146a-5p, and miR-322-3p being significantly upregulated by ZA. Overexpression of miR-146a-5p in osteoclasts inhibited osteoclastogenesis and decreased the mRNA expression of osteoclast markers. In addition, Traf6 was identified as a candidate target gene of miR-146a-5p in several miRNA databases. Indeed, the overexpression of miR-146a-5p decreased the expression level of Traf6 in osteoclasts. Additionally, overexpression of miR-322-3p in the pre-osteoblast, MC3T3-E1 cells, resulted in a significant increase in the mRNA expression levels of Sp7. Our data indicate that BPs attenuate osteoclastogenesis by simultaneously altering the characteristics of osteoclast-derived EVs. Overexpression of miR-146a-5p and miR-322-3p influences osteoclast differentiation, and Traf6 is a target gene of miR-146a-5p. On the other hand, Overexpression of miR-322-3p affects osteoblast differentiation. We suggest that ZA-treated osteoclast-derived EVs may play an important role in osteoclast function and bone resorption.
药物相关性颌骨坏死(MRONJ)是一种难治性颌骨坏死,很少发生在使用双膦酸盐(BPs)等骨吸收抑制剂的患者身上。细胞外囊泡(EVs)携带各种信号分子,如 mRNA、microRNA(miRNA)和蛋白质,作为细胞间通信工具备受关注。最近,EVs 在破骨细胞与周围骨细胞之间的通讯中的作用得到了证实。本研究旨在阐明破骨细胞接受唑来膦酸(ZA)(BPs之一)治疗后产生的EVs对破骨细胞功能的影响。研究人员通过超速离心法分离了用唑来膦酸处理的破骨细胞的培养上清液中的EVs,并从这些EVs中提取了miRNA。对经ZA处理的破骨细胞进行耐酒石酸磷酸酶染色显示破骨细胞生成减少。miRNA-seq 分析发现,与未用 ZA 处理的破骨细胞的 EVs 相比,用 ZA 处理的破骨细胞的 EVs 的 miRNA 中有 11 个上调和 5 个下调的差异表达基因(DEGs)。qRT-PCR 分析证实了这些特定 miRNA 的数量,其中 miR-146a-5p 和 miR-322-3p 受 ZA 的影响显著上调。在破骨细胞中过表达 miR-146a-5p 可抑制破骨细胞的生成,并降低破骨细胞标志物的 mRNA 表达。此外,在多个 miRNA 数据库中,Traf6 被确定为 miR-146a-5p 的候选靶基因。事实上,过表达 miR-146a-5p 会降低破骨细胞中 Traf6 的表达水平。此外,在前成骨细胞 MC3T3-E1 细胞中过表达 miR-322-3p 会导致 Sp7 的 mRNA 表达水平显著增加。我们的数据表明,BPs 可通过同时改变破骨细胞衍生 EVs 的特性来抑制破骨细胞的生成。miR-146a-5p和miR-322-3p的过表达会影响破骨细胞的分化,而Traf6是miR-146a-5p的靶基因。另一方面,miR-322-3p 的过表达会影响成骨细胞的分化。我们认为ZA处理的破骨细胞衍生EVs可能在破骨细胞功能和骨吸收中发挥重要作用。
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引用次数: 0
Biomimetic periosteum-bone scaffolds with codelivery of BMP-2 and PDGF-BB for skull repair 生物仿真骨膜-骨支架与 BMP-2 和 PDGF-BB 共同输送用于颅骨修复。
IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-04 DOI: 10.1016/j.bone.2024.117315
Zihao Zhan , Ran Li , Yiang Wu , Xiaotian Shen , Dongming Fu , Hao Han , Pengrui Jing , Bin Li , Fengxuan Han , Bin Meng
Tissue engineering employs the use of bioactive materials to facilitate the filling and acceleration of bone defect healing, thereby introducing novel concepts to the field of in situ bone repair. Some studies have shown that periosteum plays an important role in bone regeneration and repair. In this study, biomimetic periosteum-bone scaffolds were prepared by depositing poly-L-lactic acid (PLLA) electrospun fibers on the surface of the gelatin/chitosan cryogel to mimic the bone and periosteum structure, respectively. To improve the bioactivity of the scaffold, bone morphogenetic protein-2 (BMP-2) was loaded into a loose porous mesh-like cryogel, while platelet-derived growth factor-BB (PDGF-BB) was encapsulated in the core of PLLA nanofibers with core-shell structure. Both of these two growth factors were released locally at the site of bone defect, where they exert a synergistic effect on osteogenesis, thereby greatly accelerating bone healing. The in vitro experiments demonstrated that the biomimetic periosteum-bone scaffolds exhibited favourable biocompatibility and osteogenesis ability. Furthermore, the in vivo experiments indicated that the composite scaffold repaired rat skull defects in a more rapid and effective manner. In conclusion, biomimetic periosteum-bone scaffolds with codelivery of BMP-2 and PDGF-BB shows significant potential for bone regeneration.
组织工程学利用生物活性材料促进骨缺损的填充和加速愈合,从而为原位骨修复领域引入了新的概念。一些研究表明,骨膜在骨再生和修复中发挥着重要作用。本研究通过在明胶/壳聚糖低温凝胶表面沉积聚左旋乳酸(PLLA)电纺纤维,分别模拟骨和骨膜结构,制备了生物仿真骨膜-骨支架。为了提高支架的生物活性,骨形态发生蛋白-2(BMP-2)被载入疏松多孔的网状冷凝胶中,而血小板衍生生长因子-BB(PDGF-BB)则被包裹在具有核壳结构的 PLLA 纳米纤维的核心中。这两种生长因子在骨缺损部位局部释放,对骨生成产生协同作用,从而大大加速了骨愈合。体外实验表明,仿生骨膜-骨支架具有良好的生物相容性和成骨能力。此外,体内实验表明,复合支架能更快速、更有效地修复大鼠颅骨缺损。总之,共同递送 BMP-2 和 PDGF-BB 的仿生骨膜-骨支架在骨再生方面具有巨大潜力。
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引用次数: 0
Integrin α2β1 deficiency enhances osteogenesis via BMP-2 signaling for accelerated fracture repair 整合素α2β1缺乏症可通过BMP-2信号增强骨生成,从而加速骨折修复。
IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-03 DOI: 10.1016/j.bone.2024.117318
Daniel Kronenberg , Melanie Brand , Jens Everding , Louisa Wendler , Eric Kieselhorst , Melanie Timmen , Michael D. Hülskamp , Richard Stange
Previous studies have shown that the absence of the collagen-binding integrin α2β1 confers protection against osteoporosis, primarily by enhancing osteoblast-mediated matrix formation, with a particular increase in collagen type I production. This study aimed to elucidate the mechanism underlying this increased matrix production. Our findings demonstrate that osteoblasts lacking integrin α2 secrete a pro-osteogenic factor that activates both TGF-β and BMP signaling pathways. Among these, BMP-2 was identified as the key signaling protein responsible for this effect, as its expression was significantly upregulated during osteoblast differentiation. Moreover, integrin α2 deficiency led to earlier and elevated BMP-2 secretion at the cell surface during osteogenesis, which promoted accelerated osteoblast differentiation. This phenomenon likely contributes to enhanced matrix production in aging animals, providing a protective effect against osteoporosis.
To explore the broader implications of this phenotype, we utilized a fracture healing model. In integrin α2-deficient 12 weeks old female mice, elevated serum levels of BMP-2 were detected during the early stages of fracture repair. This upregulation of BMP signaling within the fracture callus accelerated the healing process, resulting in faster formation and mineralization of the cartilaginous callus. Additionally, the elevated BMP-2 levels facilitated earlier differentiation of chondrocytic cells, evidenced by the premature appearance of collagen type II- and type X-positive cells during endochondral ossification. Despite the accelerated healing, the overall biomechanical integrity of the repaired fractures remained uncompromised.
Thus, the modulation of integrin α2β1 presents a promising therapeutic target for enhancing fracture repair by regulating BMP-2 signaling in a physiologically relevant manner.
先前的研究表明,胶原结合整合素α2β1的缺失可预防骨质疏松症,主要是通过增强成骨细胞介导的基质形成,尤其是I型胶原的生成。本研究旨在阐明这种基质生成增加的机制。我们的研究结果表明,缺乏整合素α2的成骨细胞会分泌一种促成骨细胞生成因子,这种因子会激活TGF-β和BMP信号通路。其中,BMP-2 被确定为产生这种效应的关键信号蛋白,因为它的表达在成骨细胞分化过程中显著上调。此外,整合素α2的缺乏导致成骨过程中细胞表面BMP-2的分泌提前和增加,从而促进了成骨细胞的加速分化。这一现象可能有助于增强衰老动物的基质生成,从而对骨质疏松症起到保护作用。为了探索这种表型的广泛影响,我们利用了骨折愈合模型。在整合素α2缺陷的12周龄雌性小鼠中,骨折修复的早期阶段检测到血清中BMP-2水平升高。骨折茧内 BMP 信号的上调加速了愈合过程,使软骨茧的形成和矿化速度加快。此外,BMP-2 水平的升高促进了软骨细胞的提前分化,软骨内骨化过程中胶原蛋白 II 型和 X 型阳性细胞的过早出现就证明了这一点。尽管愈合速度加快,但修复骨折的整体生物力学完整性仍未受损。因此,调节整合素α2β1是一个很有前景的治疗靶点,它能以生理相关的方式调节BMP-2信号,从而增强骨折修复。
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引用次数: 0
Osteoprotegerin secretion and its inhibition by RANKL in osteoblastic cells visualized using bioluminescence imaging 利用生物发光成像技术观察成骨细胞的骨蛋白激酶分泌及其受 RANKL 抑制的情况。
IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-03 DOI: 10.1016/j.bone.2024.117319
Hotsuna Ninomiya , Shinji Fukuda , Hisayo Nishida-Fukuda , Yuto Shibata , Takuma Sato , Yuko Nakamichi , Midori Nakamura , Nobuyuki Udagawa , Ken Miyazawa , Takahiro Suzuki
Bone remodeling is regulated by the interaction between receptor activator of nuclear factor kappa-B ligand (RANKL) and its receptor RANK on osteoblasts and osteoclasts, respectively. Osteoprotegerin (OPG) is secreted from osteoblasts and inhibits osteoclast differentiation by acting as a decoy receptor for RANKL. Despite its importance, the mechanism underlying the secretion of OPG remains poorly understood. Here, we applied a method of video-rate bioluminescence imaging using a fusion protein with Gaussia luciferase (GLase) and visualized the secretion of OPG from living mouse osteoblastic MC3T3-E1 cells. The bioluminescence imaging revealed that the secretion of OPG fused to GLase (OPG-GLase) occurred frequently and widely across the cell surface. Notably, co-expression of RANKL significantly reduced the secretion of OPG-GLase, indicating an inhibitory role of RANKL on OPG secretion within cells. Further imaging and biochemical analyses using deletion mutants of OPG and RANKL, as well as RANKL mutants that cause autosomal recessive osteopetrosis, demonstrated the essential role of protein-protein interaction between OPG and RANKL in the inhibition of OPG secretion. Treatment with proteasome inhibitors resulted in increased levels of OPG in both culture medium and cell lysates. However, the fold-increase of OPG was similar regardless of the presence or absence of RANKL, suggesting that the regulation of OPG secretion by RANKL is independent of proteasome activity. This report visualized the secretion of OPG from living cells and provided evidence for a novel intracellular inhibitory effect of RANKL on OPG secretion.
骨重塑是由成骨细胞和破骨细胞上的核因子卡巴-B 配体受体激活剂(RANKL)及其受体 RANK 之间的相互作用调节的。骨保护素(OPG)由成骨细胞分泌,通过充当 RANKL 的诱饵受体来抑制破骨细胞的分化。尽管 OPG 非常重要,但人们对其分泌机制仍然知之甚少。在这里,我们利用一种与高斯荧光素酶(GLase)融合的视频速率生物发光成像方法,观察了活体小鼠成骨细胞 MC3T3-E1 中 OPG 的分泌情况。生物发光成像显示,与高斯荧光素酶(GLase)融合的 OPG(OPG-GLase)在细胞表面频繁而广泛地分泌。值得注意的是,联合表达 RANKL 能显著减少 OPG-GLase 的分泌,这表明 RANKL 对细胞内 OPG 的分泌有抑制作用。利用 OPG 和 RANKL 的缺失突变体以及导致常染色体隐性骨质疏松症的 RANKL 突变体进行的进一步成像和生化分析表明,OPG 和 RANKL 之间的蛋白质相互作用在抑制 OPG 分泌中起着至关重要的作用。蛋白酶体抑制剂会导致培养基和细胞裂解液中的 OPG 水平升高。然而,无论是否存在 RANKL,OPG 的增加倍数都是相似的,这表明 RANKL 对 OPG 分泌的调控与蛋白酶体活性无关。该报告将活体细胞分泌 OPG 的过程可视化,并为 RANKL 对 OPG 分泌的新型细胞内抑制作用提供了证据。
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引用次数: 0
HarDNet-based deep learning model for osteoporosis screening and bone mineral density inference from hand radiographs 基于 HarDNet 的深度学习模型,用于骨质疏松症筛查和手部 X 光片骨矿密度推断。
IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-03 DOI: 10.1016/j.bone.2024.117317
Chan-Shien Ho , Tzuo-Yau Fan , Chang-Fu Kuo , Tzu-Yun Yen , Szu-Yi Chang , Yu-Cheng Pei , Yueh-Peng Chen

Purpose

Osteoporosis, affecting over 200 million individuals, often remains unrecognized and untreated, increasing the risk of fractures in older adults. Osteoporosis is typically diagnosed with bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA). This study aims to develop DeepDXA-Hand, a deep learning model using the efficient CNN-based deep learning architecture, for opportunistic osteoporosis screening from hand radiographs.

Methods

DeepDXA-Hand utilizes a CNN-based, HarDNet, approach to predict BMD non-invasively. A total of 10,351 hand radiographs and DXA pairs were used for model training and validation. The model's interpretability was enhanced using GradCAM for hotspot analysis to determine the model's attention areas.

Results

The predicted and ground truth BMD were significantly correlated with a correlation coefficient of 0.745. For binary classification of osteoporosis, DeepDXA-Hand demonstrated a sensitivity of 0.73, specificity of 0.83, and accuracy of 0.80, indicating its clinical potential. The model mainly focused on the carpal bones, such as the capitate, trapezoid, hamate, triquetrum, and the head of the second metacarpal bone, suggesting these areas provide radiological features for inferring BMD.

Conclusion

DeepDXA-Hand shows potential for the early detection of osteoporosis with high sensitivity and specificity. Further studies should explore its utility in predicting fracture risks.

Mini abstract

Osteoporosis affects millions and often goes undetected and untreated. DeepDXA-Hand, a HarDNet-based deep learning model, predicted bone mineral density with a correlation of 0.745 and classified osteoporosis with 0.80 accuracy. This model enhances early detection and has significant clinical potential as osteoporosis opportunistic screening tool.
目的:骨质疏松症影响着 2 亿多人,常常不被认识和治疗,增加了老年人骨折的风险。骨质疏松症通常是通过双能 X 射线吸收测量法(DXA)测量骨矿密度(BMD)来诊断的。本研究旨在开发一种深度学习模型 DeepDXA-Hand,该模型采用基于 CNN 的高效深度学习架构,用于通过手部 X 光片进行骨质疏松症的机会性筛查:方法:DeepDXA-Hand 采用基于 CNN 的 HarDNet 方法,无创预测 BMD。共有 10351 张手部 X 光片和 DXA 对用于模型训练和验证。使用 GradCAM 进行热点分析以确定模型的关注区域,从而增强了模型的可解释性:结果:预测的 BMD 与地面真实 BMD 显著相关,相关系数为 0.745。对于骨质疏松症的二元分类,DeepDXA-Hand 的灵敏度为 0.73,特异度为 0.83,准确度为 0.80,显示了其临床潜力。该模型主要集中在腕骨,如头骨、梯形骨、锤骨、三槌骨和第二掌骨的头部,这表明这些部位为推断 BMD 提供了放射学特征:结论:DeepDXA-Hand 具有早期检测骨质疏松症的潜力,灵敏度和特异性都很高。微型摘要:骨质疏松症影响着数百万人,而且经常未被发现和治疗。基于 HarDNet 的深度学习模型 DeepDXA-Hand 预测骨矿密度的相关性为 0.745,骨质疏松症分类的准确性为 0.80。该模型提高了早期检测能力,作为骨质疏松症机会性筛查工具具有巨大的临床潜力。
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引用次数: 0
Teriparatide administration is osteoanabolic but does not impact atherosclerotic plaque calcification and progression in a mouse model of menopause 注册报告第 II 阶段:在更年期小鼠模型中,服用特立帕肽可促进骨合成,但不会影响动脉粥样硬化斑块的钙化和进展。
IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-11-02 DOI: 10.1016/j.bone.2024.117316
Laurence Bessueille , Anne Briolay , Nicolas Guillot , Saïda Mebarek , Solène Viallon , Norbert Laroche , Marie-Hélène Lafage-Proust , David Magne
Menopause exacerbates osteoporosis and increases the risk of atherosclerotic plaque rupture, leading to cardiovascular mortality. Osteoporotic women are increasingly treated with teriparatide (TPTD, 1–34 parathyroid hormone), one of the few treatments that stimulate bone formation. Despite the fact that atherosclerotic plaque calcification is a hallmark of plaque development, the impact of TPTD administration on plaque calcification remain unclear. In this context, we sought to determine the effects of TPTD administration on atherosclerosis in ovariectomized (OVX) apolipoprotein E deficient mice (ApoE−/−), as a model of postmenopausal osteoporosis. OVX ApoE−/− mice, fed a high fat, high cholesterol diet to induce atherosclerosis, received either vehicle or TPTD daily injections (40 μg/kg/d) for 4 or 10 weeks, at which points plaques are respectively weakly and heavily calcified. After sacrifice, bone remodeling was evaluated by serum markers and bone histomorphometry. Bone architectural parameters were measured by μCT. Aortic plaques were analyzed histologically, and their calcification with von Kossa staining and the calcium tracer Osteosense. Plaque inflammation and calcification markers were measured by RT-qPCR. Intermittent TPTD increased bone volume in OVX mice, due to a higher stimulation of bone formation relatively to bone resorption. These effects were not accompanied by changes in serum levels of cholesterol, triglycerides, glucose or insulin. TPTD neither significantly affected aortic plaque size, inflammation, and calcification, even if it slightly increased vascular smooth muscle cell transdifferentiation into calcifying cells. In conclusion, TPTD exhibits osteoanabolic effects in OVX ApoE−/− mice, without significantly influencing atherosclerotic plaque progression or calcification in the short term.
绝经会加剧骨质疏松症,增加动脉粥样硬化斑块破裂的风险,导致心血管疾病死亡。骨质疏松症妇女越来越多地接受特立帕肽(TPTD,1-34 甲状旁腺激素)治疗,这是少数几种刺激骨形成的治疗方法之一。尽管动脉粥样硬化斑块钙化是斑块发展的标志,但服用特立帕肽对斑块钙化的影响仍不清楚。在这种情况下,我们试图确定服用 TPTD 对卵巢切除(OVX)载脂蛋白 E 缺乏小鼠(ApoE-/-)动脉粥样硬化的影响,以此作为绝经后骨质疏松症的模型。卵巢切除载脂蛋白 E 缺失小鼠(ApoE-/-)以高脂肪、高胆固醇饮食诱发动脉粥样硬化,每天注射载脂蛋白 E 或 TPTD(40 μg/kg/d),持续 4 或 10 周,此时斑块分别出现弱钙化和重钙化。牺牲后,通过血清标记物和骨组织形态测量法评估骨重塑情况。骨结构参数通过μCT测量。对主动脉斑块进行了组织学分析,并用von Kossa染色法和钙示踪剂Osteosense分析了斑块的钙化情况。斑块炎症和钙化标记物通过 RT-qPCR 进行测量。间歇性 TPTD 增加了 OVX 小鼠的骨量,这是因为相对于骨吸收而言,TPTD 对骨形成的刺激更大。这些影响并不伴随血清中胆固醇、甘油三酯、葡萄糖或胰岛素水平的变化。TPTD 对主动脉斑块大小、炎症和钙化均无明显影响,即使它能轻微增加血管平滑肌细胞向钙化细胞的转分化。总之,TPTD对OVX载脂蛋白E-/-小鼠具有骨合成代谢作用,但不会在短期内明显影响动脉粥样硬化斑块的进展或钙化。
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引用次数: 0
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Bone
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