Department of Pharmaceutical Sciences and Experimental Therapeutics, University of Iowa, Iowa City, Iowa, 52242.
Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, 52242.
J Orthop Res. 2020 Mar;38(3):629-638. doi: 10.1002/jor.24499. Epub 2019 Nov 11.
Joint stiffness due to fibrosis/capsule contracture is a seriously disabling complication of articular injury that surgical interventions often fail to completely resolve. Fibrosis/contracture is associated with the abnormal persistence of myofibroblasts, which over-produce and contract collagen matrices. We hypothesized that intra-articular therapy with drugs targeting myofibroblast survival (sulfasalazine), or collagen production (β-aminopropionitrile and cis-hydroxyproline), would reduce joint stiffness in a rabbit model of fibrosis/contracture. Drugs were encapsulated in poly[lactic-co-glycolic] acid pellets and implanted in joints after fibrosis/contracture induction. Capsule α-smooth muscle actin (α-SMA) expression and intimal thickness were evaluated by immunohistochemistry and histomorphometry, respectively. Joint stiffness was quantified by flexion-extension testing. Drawer tests were employed to determine if the drugs induced cruciate ligament laxity. Joint capsule fibroblasts were tested in vitro for contractile activity and α-SMA expression. Stiffness in immobilized joints treated with blank pellets (control) was significantly higher than in non-immobilized, untreated joints (normal) (p = 0.0008), and higher than in immobilized joints treated with sulfasalazine (p = 0.0065). None of the drugs caused significant cruciate ligament laxity. Intimal thickness was significantly lower than control in the normal and sulfasalazine-treated groups (p = 0.010 and 0.025, respectively). Contractile activity in the cells from controls was significantly increased versus normal (p = 0.001). Sulfasalazine and β-aminopropionitrile significantly inhibited this effect (p = 0.005 and 0.0006, respectively). α-SMA expression was significantly higher in control versus normal (p = 0.0021) and versus sulfasalazine (p = 0.0007). These findings support the conclusion that sulfasalazine reduced stiffness by clearing myofibroblasts from fibrotic joints. Statement of clinical significance: The results provide proof-of-concept that established joint stiffness can be resolved non-surgically. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:629-638, 2020.
由于纤维化/囊挛缩导致的关节僵硬是关节损伤的一种严重致残并发症,手术干预往往无法完全解决。纤维化/挛缩与肌成纤维细胞的异常持续存在有关,肌成纤维细胞过度产生和收缩胶原基质。我们假设,关节内给予靶向肌成纤维细胞存活(柳氮磺胺吡啶)或胶原产生(β-氨基丙腈和反式羟脯氨酸)的药物治疗,将减少兔纤维化/挛缩模型中的关节僵硬。药物被包裹在聚(乳酸-共-乙醇酸)酸颗粒中,并在纤维化/挛缩诱导后植入关节。通过免疫组织化学和组织形态计量法分别评估囊α-平滑肌肌动蛋白(α-SMA)表达和内膜厚度。通过屈伸试验定量评估关节僵硬。抽屉试验用于确定药物是否引起交叉韧带松弛。体外测试关节囊成纤维细胞的收缩活性和α-SMA 表达。与未固定、未经处理的关节(正常)相比,用空白颗粒(对照)治疗的固定关节的僵硬程度显著更高(p=0.0008),与用柳氮磺胺吡啶治疗的固定关节相比也更高(p=0.0065)。这些药物都没有引起交叉韧带明显松弛。与对照组相比,正常组和柳氮磺胺吡啶治疗组的内膜厚度明显更低(p=0.010 和 0.025)。对照细胞的收缩活性明显高于正常(p=0.001)。柳氮磺胺吡啶和β-氨基丙腈显著抑制了这种作用(p=0.005 和 0.0006)。与正常组相比,对照组的α-SMA 表达明显更高(p=0.0021),与柳氮磺胺吡啶治疗组相比也更高(p=0.0007)。这些发现支持了柳氮磺胺吡啶通过清除纤维化关节中的肌成纤维细胞来减轻僵硬的结论。临床意义声明:这些结果提供了一个概念验证,即已建立的关节僵硬可以通过非手术方式解决。2019 年骨科研究协会。由 Wiley Periodicals,Inc. 出版。J Orthop Res 38:629-638,2020 年。