Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
J Cell Biochem. 2018 Feb;119(2):1326-1336. doi: 10.1002/jcb.26256. Epub 2017 Nov 20.
Substance P (SP), a neurotransmitter released after injury, has been linked to deregulated tissue repair and fibrosis in musculoskeletal tissues and other organs. Although SP inhibition is an effective treatment for nausea, it has not been previously considered as an anti-fibrotic therapy. Although there are extensive medical records of individuals who have used SP antagonists, our analysis of human registry data revealed that patients receiving these antagonists and arthroplasty are exceedingly rare, thus precluding a clinical evaluation of their potential effects in the context of arthrofibrosis. Therefore, we pursued in vivo studies to assess the effect of SP inhibition early after injury on pro-fibrotic gene expression and contractures in an animal model of post-traumatic joint stiffening. Skeletally mature rabbits (n = 24) underwent surgically induced severe joint contracture, while injected with either fosaprepitant (a selective SP antagonist) or saline (control) early after surgery (3, 6, 12, and 24 h). Biomechanical testing revealed that differences in mean contracture angles between the groups were not statistically significant (P = 0.27), suggesting that the drug neither mitigates nor exacerbates joint contracture. However, microarray gene expression analysis revealed that mRNA levels for proteins related to cell signaling, pro-angiogenic, pro-inflammatory, and collagen matrix production were significantly different between control and fosaprepitant treated rabbits (P < 0.05). Hence, our study demonstrates that inhibition of SP alters expression of pro-fibrotic genes in vivo. This finding will motivate future studies to optimize interventions that target SP to reduce the formation of post-traumatic joint contractures.
神经肽 P(SP)是一种损伤后释放的神经递质,与肌肉骨骼组织和其他器官中失调的组织修复和纤维化有关。尽管 SP 抑制是治疗恶心的有效方法,但它以前并未被认为是一种抗纤维化疗法。尽管有大量关于使用 SP 拮抗剂的个体的医疗记录,但我们对人类登记数据的分析表明,接受这些拮抗剂和关节置换的患者极为罕见,因此无法在关节纤维化的背景下评估它们的潜在效果。因此,我们进行了体内研究,以评估损伤后早期 SP 抑制对创伤后关节僵硬动物模型中促纤维化基因表达和挛缩的影响。成熟的骨骼兔(n=24)接受了手术诱导的严重关节挛缩,同时在手术后早期(3、6、12 和 24 小时)注射 fosaprepitant(一种选择性 SP 拮抗剂)或生理盐水(对照)。生物力学测试表明,组间平均挛缩角度的差异无统计学意义(P=0.27),表明药物既不会减轻也不会加重关节挛缩。然而,微阵列基因表达分析显示,与细胞信号、促血管生成、促炎和胶原基质产生相关的蛋白质的 mRNA 水平在对照组和 fosaprepitant 处理的兔子之间有显著差异(P<0.05)。因此,我们的研究表明 SP 抑制改变了体内促纤维化基因的表达。这一发现将促使未来的研究优化针对 SP 的干预措施,以减少创伤后关节挛缩的形成。