Fackson Mwale

Composition and structure of articular cartilage: a template for tissue repair.

The authors review the structure and composition of articular cartilage. This tissue is composed of an extensive extracellular matrix synthesized by chondrocytes. It contains different zones with respect to depth from the articular surface and has a regional organization around the chondrocytes. Its composition varies regionally and zonally in its collagen and proteoglycan contents and those of other matrix molecules. There is a macrofibrillar collagen network and a microfilamentous network about which other noncollagenous molecules are organized. Its structure and composition are reflective of its special mechanical properties that primarily reflect its tensile strength (collagens) and compressive stiffness (proteoglycan aggrecan) and cell-matrix interactions (noncollagenous proteins).

Metal ion levels in the blood of patients after hip resurfacing: a comparison between twenty-eight and thirty-six-millimeter-head metal-on-metal prostheses.

BACKGROUND Metal ion toxicity, metal hypersensitivity, and metal carcinogenicity are causes for concern for patients with metal-on-metal hip replacements. Thus, understanding the biological fate of metal ions, and consequently their long-term systemic effects, is of great interest to patients and surgeons alike. METHODS Inductively coupled plasma mass spectrometry was used to measure the levels of cobalt, chromium, and molybdenum ions in the blood of control patients (preoperative control pre-resurfacing patients), patients with a metal-on-polyethylene total hip prosthesis, patients with a metal-on-metal total hip prosthesis with either a 28 or 36-mm femoral head, and patients with a hip resurfacing prosthesis. Since cobalt and chromium ions have the potential to induce oxidative stress through irreversible biochemical damage to macromolecules, the levels of ions were correlated to the concentration of three oxidative stress markers in the plasma of these patients. RESULTS The median cobalt level was significantly lower (p < 0.001) in the 36-mm metal-on-metal total hip arthroplasty group (1.8 parts per billion [1.8 microg/L]) compared with the 28-mm metal-on-metal total hip arthroplasty group (2.5 parts per billion [2.5 microg/L]) and the hip resurfacing group (2.3 parts per billion [2.3 microg/L]) at six months postoperatively. The median chromium level was also significantly lower (p < 0.01) in the 36-mm metal-on-metal total hip arthroplasty group (0.25 parts per billion [0.25 microg/L]) compared with the 28-mm metal-on-metal total hip arthroplasty group (0.35 parts per billion [0.35 microg/L]) and the hip resurfacing group (0.50 parts per billion [0.50 microg/L]) at six months postoperatively. However, neither the median cobalt levels nor the median chromium levels were significantly different among the three metal-on-metal groups at one year. The median levels of molybdenum were not significantly different among the three groups at either six months or one year. In addition, there was no significant difference in the plasma concentration of oxidative stress markers in patients with metal-on-metal bearings compared with that in control patients. CONCLUSIONS The blood metal ion levels in the hip resurfacing group were similar to those in the 28 and 36-mm-head metal-on-metal total hip arthroplasty groups. This study suggests that the increased metal ion levels had no effect on oxidative stress markers in the blood of these patients.

Proteolysis involving matrix metalloproteinase 13 (collagenase-3) is required for chondrocyte differentiation that is associated with matrix mineralization

Collagenases are involved in cartilage matrix resorption. Using bovine fetal chondrocytes isolated from physeal cartilages and separated into a distinct prehypertrophic subpopulation, we show that in serum‐free culture they elaborate an extracellular matrix and differentiate into hypertrophic chondrocytes. This is characterized by expression of type X collagen and the transcription factor Cbfa1 and increased incorporation of45Ca2+ in the extracellular matrix, which is associated with matrix calcification. Collagenase activity, attributable only to matrix metalloproteinase (MMP) 13 (collagenase‐3), is up‐regulated on differentiation. A nontoxic carboxylate inhibitor of MMP‐13 prevents this differentiation; it suppresses expression of type X collagen, Cbfa1, and MMP‐13 and inhibits increased calcium incorporation in addition to inhibiting degradation of type II collagen in the extracellular matrix. General synthesis of matrix proteins is unaffected. These results suggest that proteolysis involving MMP‐13 is required for chondrocyte differentiation that occurs as part of growth plate development and which is associated with matrix mineralization.

The Assembly and Remodeling of the Extracellular Matrix in the Growth Plate in Relationship to Mineral Deposition and Cellular Hypertrophy: An In Situ Study of Collagens II and IX and Proteoglycan†

The recent development of new specific immunoassays has provided an opportunity to study the assembly and resorption of type II and IX collagens of the extracellular matrix in relationship to endochondral calcification in situ. Here, we describe how in the bovine fetal physis prehypertrophic chondrocytes deposit an extensive extracellular matrix that, initially, is rich in both type II and type IX collagens and proteoglycan (PG; principally, aggrecan). The majority of the α1(IX)‐chains lack the NC4 domain consistent with our previous studies with cultured chondrocytes. During assembly, the molar ratio of type II/COL2 domain of the α1(IX)‐chain varied from 8:1 to 25:1. An increase in the content of Ca2+ and inorganic phosphate (Pi) was initiated in the prehypertrophic zone when the NC4 domain was removed selectively from the α1(IX)‐chain. This was followed by the progressive loss of the α1(IX) COL2 domain and type II collagen. In the hypertrophic zone, the Ca2+/Pi molar ratio ranged from 1.56 to a maximum of 1.74, closely corresponding to that of mature hydroxyapatite (1.67). The prehypertrophic zone had an average ratio Ca2+/Pi ranging from 0.25 to 1, suggesting a phase transformation. At hypertrophy, when mineral content was maximal, type II collagen was reduced maximally in content coincident with a peak of cleavage of this molecule by collagenase when matrix metalloproteinase 13 (MMP‐13) expression was maximal. In contrast, PG (principally aggrecan) was retained when hydroxyapatite was formed consistent with the view that this PG does not inhibit and might promote calcification in vivo. Taken together with earlier studies, these findings show that matrix remodeling after assembly is linked closely to initial changes in Ca2+ and Pi to subsequent cellular hypertrophy and mineralization. These changes involve a progressive and selective removal of types II and IX collagens with the retention of the PG aggrecan.

Defining the Phenotype of Young Healthy Nucleus Pulposus Cells: Recommendations of the Spine Research Interest Group at the 2014 Annual ORS Meeting

Low back pain is a major physical and socioeconomic problem. Degeneration of the intervertebral disc and especially that of nucleus pulposus (NP) has been linked to low back pain. In spite of much research focusing on the NP, consensus among the research community is lacking in defining the NP cell phenotype. A consensus agreement will allow easier distinguishing of NP cells from annulus fibrosus (AF) cells and endplate chondrocytes, a better gauge of therapeutic success, and a better guidance of tissue‐engineering‐based regenerative strategies that attempt to replace lost NP tissue. Most importantly, a clear definition will further the understanding of physiology and function of NP cells, ultimately driving development of novel cell‐based therapeutic modalities. The Spine Research Interest Group at the 2014 Annual ORS Meeting in New Orleans convened with the task of compiling a working definition of the NP cell phenotype with hope that a consensus statement will propel disc research forward into the future. Based on evaluation of recent studies describing characteristic NP markers and their physiologic relevance, we make the recommendation of the following healthy NP phenotypic markers: stabilized expression of HIF‐1α, GLUT‐1, aggrecan/collagen II ratio >20, Shh, Brachyury, KRT18/19, CA12, and CD24.

Distinct Phases of Coordinated Early and Late Gene Expression in Growth Plate Chondrocytes in Relationship to Cell Proliferation, Matrix Assembly, Remodeling, and Cell Differentiation

Although much has been learned about growth plate development and chondrocyte gene expression during cellular maturation and matrix remodeling in the mouse, there has been a limited study of the interrelationships of gene expression between proteinases, growth factors, and other regulatory molecules in the mouse and in other species. Here we use RT‐PCR of sequential transverse sections to examine the expression profiles of genes involved in chondrocyte growth, differentiation, matrix assembly, remodeling, and mineralization in the bovine proximal tibial growth plate. Specifically, we studied the expression of genes encoding COL2A1 and COL10A1, the latter a marker of cellular hypertrophy, the matrix metalloproteinases (MMP), MMP‐13 and MMP‐9, as well as the transcriptional factors, Sox9 and Cbfa1, the growth factors basic fibroblast growth factor (bFGF), parathyroid hormone‐related peptide (PTHrP), transforming growth factor (TGF)β1, and β2, Indian hedgehog (Ihh), and the matrix protein osteocalcin. These were analyzed in relationship to cell division defined by cyclin B2 expression. Two peaks of gene expression activity were/observed. One was transient, limited, and located immediately before and at the onset of cyclin B2 expression in the early proliferative zone. The other was generally much more pronounced and was located in the early hypertrophic zone. The upregulation of expression of COL2A1, its transcriptional activator Sox9, osteocalcin, MMP‐13, and TGFβ2 was observed immediately before and at the onset of cyclin B2 expression and also in the hypertrophic zones. The upregulation of COL10A1, Cbfa1, MMP‐9, TGFβ‐1, and Ihh gene expression was associated exclusively with the terminal differentiation of chondrocytes at the time of mineral formation in the extracellular matrix. In contrast, bFGF and PTHrP expression was observed in association with the onset of cyclin B2 expression and hypertrophy. This initial cluster of gene expression associated predominantly with matrix assembly and onset of cell proliferation is therefore characterized by expression of regulatory molecules distinct from those involved at hypertrophy. Together these results identify separate phases of coordinated gene expression associated with the development of the physis in endochondral bone formation.

Early degradation of type IX and type II collagen with the onset of experimental inflammatory arthritis

OBJECTIVE To determine whether following the onset of intraarticular inflammation, there is early damage to articular cartilage, specifically to types II and IX collagen, and the proteoglycan (PG) aggrecan, and whether measurement of the degradation products of these molecules in synovial fluid (SF) and serum may permit the detection of cartilage damage. METHODS A rabbit model of rheumatoid arthritis, antigen (ovalbumin)-induced arthritis, was studied. Articular cartilage samples were analyzed by immunoassays for total type II collagen content, its denaturation and cleavage by collagenases, and for type IX collagen content. PG content was determined by colorimetric assay. In serum and SF, total PG content and collagenase-generated peptides of type II collagen were measured. RESULTS After 6 days, both the PG content and the NC4 domain of type IX collagen were reduced in femoral and tibial cartilage, concomitant with the onset of arthritis. In only the tibial cartilage did this reduction in PG persist up to day 20. However, denatured type II collagen was increased in all cartilage samples, but only on day 20. In SF, the PG content was significantly reduced on day 20, and products of type II collagen cleavage by collagenase were significantly increased on both day 6 and day 20. CONCLUSION This study, which is the first of its kind examining changes in both types II and IX collagen and PG content, reveals early damage to both types of collagen as well as to PG in articular cartilage samples following induction of joint inflammation. SF analyses reveal this early damage and may be of value in the study and treatment of inflammatory arthritic diseases such as rheumatoid arthritis.

Value and limitations of using the bovine tail as a model for the human lumbar spine.

Study Design. The contents of DNA, proteoglycan, type II collagen, and denatured type II collagen in the bovine coccygeal intervertebral discs were examined in situ in relation to disc level, age, and tissue region. Objective. To determine whether bovine coccygeal discs are a suitable model to study human lumbar discs. Summary of Background Data. Bovine coccygeal discs have been suggested as a suitable alternative model because they are readily available, in contrast to human discs, and represent a common source of tissue in the disc field. However, it is not known whether the changes in matrix contents in bovine coccygeal discs are similar to those found in the human lumbar spine. Methods. Intervertebral discs from bovine tails were dissected into the nucleus pulposus (NP) and anulus fibrosus (AF). Tissues were weighed and analyzed for matrix contents using specific assays. Results. Similar to water content, the proteoglycan content was higher in the NP than in the AF. Water content of the bovine NP did not change with age, unlike the proteoglycan content, which decreased. type II collagen content was higher in the NP than in the AF, and both did not change overall significantly with age. The percent of denatured type II collagen decreased with age only in the NP. The DNA content did not vary with age in the AF and in the NP. Conclusion. Differences in matrix contents exist between the bovine coccygeal discs and the human lumbar spine. Thus, caution must be exercised when using the bovine tail as a model for the human lumbar spine in biochemical studies.

Calcification in human intervertebral disc degeneration and scoliosis

Calcification is a pathological process that may lead to impairment of nutrient supply and disc metabolism in degenerative and scoliotic intervertebral discs (IVDs). The purpose of this study was to assess the calcification potential of IVDs in degenerative disc disease (DDD) and adolescent idiopathic scoliosis (AIS). For this purpose, 34 IVDs from 16 adult patients with DDD and 25 IVDs from 9 adolescent patients with AIS were obtained at surgery. The concave and convex parts of the scoliotic discs were analyzed separately. Von Kossa staining was performed to visualize calcium deposits, while type X collagen (COL X) expression associated with endochondral ossification was measured by immunohistochemistry. Alkaline phosphatase activity and calcium and inorganic phosphate concentrations were used as indicators of calcification potential. Results showed the presence of calcium deposits and COL X in degenerative and scoliotic IVDs, but not in control discs, and the level of the indicators of calcification potential was consistently higher in degenerative and scoliotic discs than in control discs. The results suggest that disc degeneration in adults is associated with ongoing mineral deposition and that mineralization in AIS discs might reflect a premature degenerative process.

Quantitative MRI as a diagnostic tool of intervertebral disc matrix composition and integrity.

Degenerative disc disease has been implicated as a major component of spine pathology. The current major clinical procedures for treating disc degeneration have been disappointing, because of altered spinal mechanics leading to subsequent degeneration at adjacent disc levels. Disc pathology treatment is shifting toward prevention and treatment of underlying etiologic processes at the level of the disc matrix composition and integrity and the biomechanics of the disc. The ability to perform such treatment relies on one’s ability to accurately and objectively assess the state of the matrix and the effectiveness of treatment by a non-invasive technique. In this review, we will summarize our advances in efforts to develop an objective, accurate, non-invasive diagnostic tool (quantitative MRI) in the detection and quantification of matrix composition and integrity and of biomechanical changes in early intervertebral disc degeneration.