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成骨不全症胶原相关临床前模型中的骨折愈合。

Fracture Healing in Collagen-Related Preclinical Models of Osteogenesis Imperfecta.

机构信息

Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.

Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA.

出版信息

J Bone Miner Res. 2020 Jun;35(6):1132-1148. doi: 10.1002/jbmr.3979. Epub 2020 Mar 12.

Abstract

Osteogenesis imperfecta (OI) is a genetic bone dysplasia characterized by bone deformities and fractures caused by low bone mass and impaired bone quality. OI is a genetically heterogeneous disorder that most commonly arises from dominant mutations in genes encoding type I collagen (COL1A1 and COL1A2). In addition, OI is recessively inherited with the majority of cases resulting from mutations in prolyl-3-hydroxylation complex members, which includes cartilage-associated protein (CRTAP). OI patients are at an increased risk of fracture throughout their lifetimes. However, non-union or delayed healing has been reported in 24% of fractures and 52% of osteotomies. Additionally, refractures typically go unreported, making the frequency of refractures in OI patients unknown. Thus, there is an unmet need to better understand the mechanisms by which OI affects fracture healing. Using an open tibial fracture model, our study demonstrates delayed healing in both Col1a2 and Crtap OI mouse models (dominant and recessive OI, respectively) that is associated with reduced callus size and predicted strength. Callus cartilage distribution and chondrocyte maturation were altered in OI, suggesting accelerated cartilage differentiation. Importantly, we determined that healed fractured tibia in female OI mice are biomechanically weaker when compared with the contralateral unfractured bone, suggesting that abnormal OI fracture healing OI may prime future refracture at the same location. We have previously shown upregulated TGF-β signaling in OI and we confirm this in the context of fracture healing. Interestingly, treatment of Crtap mice with the anti-TGF-β antibody 1D11 resulted in further reduced callus size and predicted strength, highlighting the importance of investigating dose response in treatment strategies. These data provide valuable insight into the effect of the extracellular matrix (ECM) on fracture healing, a poorly understood mechanism, and support the need for prevention of primary fractures to decrease incidence of refracture and deformity in OI patients. © 2020 American Society for Bone and Mineral Research.

摘要

成骨不全症(OI)是一种遗传性骨发育不良,其特征为骨量减少和骨质量受损导致的骨骼畸形和骨折。OI 是一种遗传异质性疾病,最常见的是由于编码 I 型胶原(COL1A1 和 COL1A2)的基因中的显性突变引起的。此外,OI 是隐性遗传的,大多数病例是由于脯氨酰-3-羟化酶复合物成员(包括软骨相关蛋白(CRTAP))的突变引起的。OI 患者一生中骨折的风险增加。然而,有报道称 24%的骨折和 52%的截骨术存在不愈合或愈合延迟。此外,再骨折通常未被报告,因此 OI 患者再骨折的频率尚不清楚。因此,更好地了解 OI 影响骨折愈合的机制是非常有必要的。通过使用开放性胫骨骨折模型,我们的研究表明,Col1a2 和 Crtap 两种 OI 小鼠模型(分别为显性和隐性 OI)均存在愈合延迟,其表现为骨痂体积减小和预测强度降低。OI 中的骨痂软骨分布和软骨细胞成熟发生改变,提示软骨分化加速。重要的是,我们发现与对侧未骨折的骨相比,雌性 OI 小鼠的愈合骨折胫骨在生物力学上更弱,这表明异常的 OI 骨折愈合可能使同一部位更容易发生再骨折。我们之前已经证明了 OI 中 TGF-β 信号的上调,并且我们在骨折愈合的背景下证实了这一点。有趣的是,用抗 TGF-β 抗体 1D11 治疗 Crtap 小鼠导致骨痂体积和预测强度进一步减小,这突出了在治疗策略中研究剂量反应的重要性。这些数据为了解细胞外基质(ECM)对骨折愈合的影响提供了有价值的见解,这是一种了解甚少的机制,并支持预防原发性骨折以降低 OI 患者的再骨折和畸形发生率的必要性。

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