E S Vasiliadis1, A Kaspiris2, T B Grivas3, L Khaldi4, M Lamprou2, S G Pneumaticos1, K Nikolopoulos1, D S Korres1, E Papadimitriou2. 1. University of Athens, Third Department of Orthopaedic Surgery, KAT Hospital and Medical School, Athens, Greece. 2. University of Patras, Laboratory of Molecular Pharmacology, School of Health Sciences, Greece. 3. Tzanio General Hospital, Department of Trauma and Orthopaedics, Piraeus, Greece. 4. University of Athens, Department of Osteopathology, Laboratory for Research of the Musculoskeletal System, School of Medicine, Athens, Greece.
The goal of this study was to examine whether asymmetric loading
influences macrophage elastase (MMP12) expression in different parts
of a rat tail intervertebral disc and growth plate, and if MMP12 expression
was correlated with the severity of the deformity.Expression ofMMP12 after application of asymmetric loading
in rat tail increased in the intervertebral disc but decreased in
the growth plate and correlated with the degree of the deformity
and the side of the wedged disc.Disc cells were reduced in number after asymmetric loading, identified
with changes in their phenotype, and in a large proportion expressed
MMP12.Strengths: This is an experimental study which detects MMP12
expression after application of asymmetric loading in an animal
model’s intervertebral disc with immunohistochemical analysis, as
well as with western blot analysis and zymography. Application of
asymmetric loading was achieved with an accurate and reproducible
method.Limitation: detection and quantification of the MMP12 gene with
a real-time polymerase chain reaction was not performed.
Introduction
Spinal motion is a complex process in which the spine undergoes
continuous asymmetric loading modes, a process which is associated
with intervertebral disc metabolism and altered growth rate. Application
of loading magnitude above a critical threshold can initiate the degenerative
process, inducing molecular changes and causing structural damage
to the disc.[1] Numerous
factors result in an imbalance between degradation and synthesis
of the extracellular matrix in the intervertebral disc and in vertebral
growth plates. After mechanical compression and distraction forces,
degradation prevails over synthesis and is evident at both the microscopic
and macroscopic level. Possible aetiological factors can be divided
into those that affect the biology and those that affect the biomechanical
environment, both at the disc and the vertebral growth plates, leading
to histological and molecular changes at the chondrocytes of the
hypertrophic zone.[2] A crucial
question that has to be answered is whether metabolism disorders
or changes in biomechanics initiate the cascade of degradation.Matrix metalloproteinases (MMPs) are a family of proteolytic
enzymes that share structural and functional characteristics with
different substrate specificities.[3] Weiler et al[4] have investigated the role of MMPs
in intervertebral disc degeneration. MMPs appear to be involved
in cell attachment, proliferation, differentiation, and apoptosis
of growth plate chondrocytes.[5] Furthermore,
MMP expression is dependent on the duration and intensity of mechanical
loading and thus participates in growth modulation.[6]Macrophage elastase (MMP12) is secreted as a 54 kDa pro-form
and in its active form (22 kDa) degrades mainly elastin.[7] The protein was
originally identified in a conditioned medium from murine peritoneal
inflammatory macrophages, and is expressed in several cell types,
such as human airway smooth muscle cells, corneal epithelial cells
and hypertrophic chondrocytes.[8] Besides
elastin, MMP12 degrades various extracellular matrix proteins, including
type IV collagen, fibronectin, laminin, gelatin, vitronectin and
chondroitin sulfate proteoglycans.[9] It also upregulates other MMPs.[10]The aim of our present study was to examine whether asymmetric
loading produced by an Ilizarov-type mini external fixator influences
MMP12 expression in different parts of a rat tail intervertebral
disc and growth plate and if MMP12 expression was correlated with
the severity of the deformity.
Materials and Methods
Animal model
A total of 45 female eight-week old albino Wistar rats (National
Center for Scientific Research Demokritos, Athens, Greece), weighing
180 g ± 10 g, were included in the study. All animals were selected
after control breeding and were matched for age and weight. Animals
were included in the study before reaching adulthood in order to
take into account the impact of growth in intervertebral disc changes,
and were kept in a safe laboratory environment with stable humidity,
temperature of 21°C and artificial daylight for 12 hours. Animal
procedures were reviewed and approved by the Veterinary Ethics Committee
and performed under the standards of the Greek State and European
Community on the Protection, Care and Use of Animals for experimental
purposes (licence number K/8404/08). All efforts were taken to minimise
pain or discomfort to the animals.The rats were anaesthetised and an Ilizarov-type mini external
fixator was applied under fluoroscopic control. The apparatus was
applied for five weeks between the ninth and tenth vertebrae at
the base of the rat tail. The two rings of the fixator were placed
at a predetermined angle so that an accurate deformity of the intermediate
disc was achieved. The intact intervertebral discs outside of the
fixator were used as controls. According to the degree of the deformity,
the subjects were categorised in three groups, namely group I (10o),
group II (30o) and group III (50o) (Fig. 1).
The reliability of this animal model is well documented in the literature.[1,11,12]Rats
were killed on day 35, when they had reached approximately 90% of
skeletal maturity.[13] From
the total of 45 discs, 30 were randomly selected for immunohistochemical
analysis and 15 were selected for western blot analysis and zymography.
All discs were divided in the above three groups according to the
degree of the deformity.Radiographs of asymmetrically
loaded rat tail intervertebral discs with a) 10°, b) 30° and c)
50° of deformity.
Cartilage homogenisation and western
blot analysis
We evaluated expression of MMP12 in specimens obtained from 15
rat tails, five from each group, which were immediately washed with
normal saline under sterile conditions and stored at -80°C
until used. The discs and the growth plate, which correspond to
the lower third of each vertebra, were homogenised with liquid nitrogen using
a special bone and cartilage homogeniser (BioPulverizer, Biospec
Products, Bartlesville, Oklahoma). Homogenisation was performed
at 4°C in a 2 ml extraction buffer, containing 500 mM
Tris-HCl, pH 7.6, 200 mM NaCl, 1% Triton X-100, 10 mM CaCl2,
PMSF 1 mM and Na3VO4 20 nM. An equal amount
of total proteins from each sample (100 μg) was analysed by SDS-PAGE
and transferred to Immobilon P membranes. Blocking was performed
by incubating the membranes with Tris-buffered saline pH 7.4 supplemented
with 0.1% Tween (TBS-T), containing 5% non-fat dry milk for beta-actin
or 3% bovineserum albumin for MMP12. Membranes were incubated with
primary antibodies for 16 hours at 4°C under continuous agitation,
washed three times with TBS-T, and incubated with secondary antibodies
for one hour at room temperature. Primary antibodies used were rabbit anti-MMP12
(1:1000) and mouse anti-beta-actin (1:1000) (both from Santa Cruz
Biotechnology Inc. Heidelberg, Germany). Detection of immunoreactive bands was performed
using the enhanced chemiluminescence detection kit (Pierce Biotechnology,
Rockford, Illinois). The protein levels that corresponded to the
immunoreactive bands were quantified using the ImagePC image analysis
software (Scion Corp., Frederick, Maryland) and the ratio MMP-2/beta-actin
was calculated for each sample.
Casein zymography
The discs and the growth plate, which correspond to the lower
third of each vertebra, were homogenised as described above and
50 μg of total proteins were analysed by 10% SDS-PAGE containing
1% casein zymography. After electrophoresis, gels were incubated
in 2.5% Triton X-100 (5×20 minutes) at room temperature and then
for 48 hours at 37°C in developing buffer (50 mM Tris-HCI pH 7.5,
200 mM NaCl and 10 mM CaCl2). After incubation, the gels
were stained with Coomassie Brilliant Blue R for 45 minutes at room
temperature, de-stained in methanol-acetic acid-water and photographed
using a digital camera.
Immunohistochemical analysis
The 30 specimens for immunohistochemical analysis, ten from each
group, were surgically prepared and after skin removal were fixed
in 10% buffer formalin for 24 to 36 hours, decalcified in neutral
ethylenediaminetetraacetic acid (EDTA) for six to eight weeks in
room temperature, and embedded in paraffin blocks. Histological
sections 3 µm thick were deparaffinised in xylene and degraded alcohols
and immersed in distilled water. Blockage of endogenous peroxidase
was achieved with 3% H2O2 for 30 minutes in
a dark chamber at room temperature. The sections were then washed
once in distilled water and three times with TBS, incubated for
one hour at room temperature with anti-MMP12 (Santa Cruz sc-30072),
diluted 1:50 in antibody diluent (DAKO REAL S2022), incubated for 45 minutes
at room temperature with peroxidase-labeled anti-mouse/rabbit IgG
(En-vision Kit, DAKO Detection System, Peroxidase/DAB+, Rabbit/Mouse
K5007, Agilent Technologies Dako, Glostrup, Denmark), washed three times
with TBS, and stained for ten minutes in a dark chamber at room
temperature with 3-amino-9-ethylcarbazole/H2O2,
washed in distilled water and counterstained with haematoxylin.Each specimen was scored semi-quantitatively for immunopositivity
by determining the proportion of disc cells that were positive for
MMP12. In both the convex and concave side, the clearly positive
disc cells were counted in ten random high power fields. Each microscope
field was scored as 0, 1, 2 and 3, when the number of positive disc cells
was 0, 1 to 10, 11 to 20 and > 20, respectively.
Statistical analysis
This was performed with the use of an unpaired t-test.
Values (mean value ± standard deviation (sd) or standard
error (sem)) were compared between each group and the control
group.
Results
Western blot analysis and casein
zymography
Pro-MMP12 was detected at 54 kDa and its total expression normalised for
beta-actin was not significantly affected as the deformity progressed
compared with the control group. The increase was found to be significant
in group III (p < 0.01) with severe angulation of 50o (Fig.
2).Representative picture of Western blot
analysis for macrophage elastase (MMP12) and beta-actin from the
growth plate and intervertebral disc of the animal model tails.
The immunoreactive bands were quantified by densitometric analysis
and the ratio MMP12/beta-actin was calculated for each lane. Results
are shown as the mean ±sem compared with the controls.Similarly to pro-MMP12 expression, levels of active MMP12 detected
by zymography at 22 kDa and normalised for beta-actin, were increased
in group III (p < 0.01) (Fig. 3).Representative picture of zymography
analysis for MMP12. The active MMP12 bands were quantified by densitometric
analysis. Results are the mean ±sem of the ratio-active
MMP12/beta-actin compared with the controls.
Immunohistochemistry
MMP12 was detected in disc cells of annulus fibrosus of all the
examined discs with various degrees of deformity and was not detected
in the nucleus pulposus.In the control group, MMP12 was expressed by the chondrocytes
in the hypertrophic zone of the growth plate (Fig. 4) but was not
detected in the intervertebral disc.The growth plate of a control disc with
chondrocytes expressing MMP12 (arrows).In group I (mild deformity of 10o) MMP12 staining
was slightly increased at the concave side of the disc. A chondral
metaplasia at the periphery of annulus fibrosus was noted mainly
at the concave side. Chondrocytes did not stain for MMP12. Approximately 20% of fibroblasts were positively
stained for MMP12 (Fig. 5). On the contrary, MMP12 expression was
decreased in the chondrocytes of the hypertrophic zone compared
with the control group.Immunohistochemical images of
a) the periphery of annulus fibrosus in group I with a small number
of fibroblasts expressing MMP12; b) the periphery of annulus fibrosus
in group II, where the number of disc cells expressing MMP12 is
increased and includes both fibroblasts and chondrocytes and c)
the periphery of annulus fibrosus in group III, where disc cells
are absent from the periphery of the annulus fibrosus and most of
the remaining cells from central area are expressing MMP12.In group II (moderate deformity of 30o) MMP12 quantity
was increased and the number of positive stained MMP12 cells was
more prominent at the concave side of the disc. In this group, there
were roughly 30% of chondrocytes and 50% of fibroblasts positive
for MMP12. Immunopositivity was higher at the periphery of the annulus
fibrosus. A large number of positively stained fibroblasts were
noted at the margin of the intervertebral disc adjacent to the vertebral
end plates. At the periphery of the disc, clusters of disc cells
that were differentiated into chondrocytes and expressing MMP12
were observed (Fig. 5). MMP12 was not detected in the growth plate.In group III (severe deformity of 50o) the proportion
of positively stained fibroblasts was nearly 90%, and 50% of chondrocytes
were positive for MMP12, although there was a significant reduction
in cell population and a severe disorganisation of matrix microstructure,
predominantly at the concave side of the disc. No disc cells could
be viewed at the periphery of the disc (Fig. 5).MMP12 expression in the intervertebral disc rose significantly with the severity
of deformity (p < 0.001). When analysing the difference between
the convex and concave side, it was not statistically significant
in group I (p = 0.36), but was found to be statistically significant
in group II (p < 0.01) and in group III (p < 0.01), with cells
in the concave side predominately expressing MMP12 (Fig. 6). In
contrast, the expression of MMP12 in the hypertrophic zone of the
growth plate was decreased in group I, and eliminated in group II
and III, compared with the control group.Immunohistochemical images of
the annulus fibrosus of the control group with a) absence of expression
of MMP12, b) the convex side of a disc specimen from group III,
where a large number of disc cells, both fibroblasts and chondrocytes
are expressing MMP12: note the disorganisation of microstructure
of the lamellae of annulus fibrosus, and c) the concave side of
the same disc specimen as in Figure 6b, where all disc cells are
expressing MMP12. A reduction of cell population and a complete disorganisation
of microstructure are evident at the concave side.
Discussion
In this study we demonstrate that MMP12 is expressed in the intervertebral
disc and in the growth plate chondrocytes and its expression
depends on the magnitude of the mechanical loading. MMP12, which
was originally found in alveolar macrophages of cigarette smokers,[14] is associated
with many diseases, such as intestinal ulcerations, cutaneous diseases,
breast cancer, skin cancer, emphysema, atherosclerosis, aneurysms[15] and rheumatoid arthritis.
To the best of our knowledge, this is the first study that examines
the role of MMP12 in a vertebrae growth plate and in the intervertebral
disc degeneration.Several in vitro and in vivo studies
have demonstrated the distribution of MMP2, MMP9, MMP13 and MMP14
in the human or animal growth plate, implying an important regulatory
role during normal growth.[6] Moreover,
it has been shown that MMP13 may have a critical role in growth
plate angiogenesis and MMP9 in chondrocyte apoptosis and mineralisation
of the matrix.[16]Mechanical loading induces changes, not only in the orientation
and the morphology of the hypertrophic chondrocytes, but at the
molecular level as well, which are dependent on the duration and
intensity of loading.[6] MMP-expression
is increased when a physiological load is applied. However, long-term
excessive mechanical loading leads to reductive expression of MMPs
in the chondrocytes of the hypertrophic zone.[17] This is in line
with our study which shows significant expression of MMP12 in the
hypertrophic zone of the growth plate in the control group, but
a reduction of MMP12 expression in 10° of asymmetrical
loading and a complete elimination of its expression in 30° and
50°, respectively. These findings indicate that excessive
asymmetrical loading may have a harmful effect on the growth plate.On the other hand, over-expression of MMPs was evidenced in humandisc degeneration.[18] Several
MMPs are upregulated in disc degeneration. MMP1 is over-expressed in
degenerated, especially herniated, discs.[19] A number of MMPs, such as MMP1,
2, 3, 7, 9 and 13 were found to be increased in rat tail discs that
sustained static compression, while asymmetric loading caused a
significant difference of MMP1 gene expression between the convex
and concave side of the wedged discs.[20] In a recent study, MMP12 was detected
in human intervertebral disc and additionally in chondrocytes of
the vertebral endplate of an older sand rat’s degenerating disc.[21] Our study shows
that there is a positive correlation between the degree of the deformity and
the amount of disc cells that express MMP12. Mechanical deformation
after application of asymmetric forces over the intervertebral disc
stimulates MMP12 production, mainly in the outer annulus fibrosus.
A similar pattern was found in a previous study for MMP1.[22] Interestingly,
no MMP12 expression was found in the nucleus pulposus, a finding
which is in agreement with Cui et al,[23] who identified MMP12 as a possible
marker to distinguish bovine nucleus pulposus cells from articular
chondrocytes. The concave side of the disc was found to sustain
increased MMP12 expression in more severe deformations (groups II and
III). Asymmetric loading progressively produced changes in cell
phenotype and reduction of cell number, together with disorganisation
of matrix microstructure similar to disc degeneration. Disc-cell
population was found to be affected by the degree of deformation,
with the population of the cells decreasing as the deformity progresses.
Additionally, at the margins of intervertebral disc adjacent to
the vertebral end plates, a reduction of fibroblast-like cells and
an increased number of chondrocytes positive in MMP12 expression
was observed. Whether this observation could be explained by chondrocyte
migration at the area or by differentiation of fibroblasts to chondrocytes,
or even by fibroblast cell death, it cannot be answered by the present
study. Court et al[24] reported
similar changes in cell phenotype in the inner annulus fibrosus of
the concave side in bent mouse tails.The structure and composition of the extracellular matrix is
responsible for the mechanical properties of the intervertebral
disc.[25] The
main components are the collagen fibres and proteoglycans. Additionally,
elastin is the main structural component of elastic fibres which
form a network within the annulus fibrosus of the intervertebral disc.
They are strongly associated with collagen fibres, a finding which
implies a close functional relationship.[25] They have an indirect mechanical
role in the alignment of collagen fibres in stress.[26] A potential absence
of elastin from matrix may result in a progressive disorganisation after
asymmetric loading and eventually cause disc degeneration, thus
resulting in changes in its mechanical properties.[26] A similar disorganisation
was observed in asymmetric-loaded discs from patients suffering
from scoliosis.[25] Considering
the significant contribution of elastin in disc biomechanics, elastin
degradation should be a key factor in understanding the multifactorial
aetiology of disc degeneration.[26]MMP12 gene detection and quantification was not performed with
a real-time polymerase chain reaction (RT-PCR), which is a limitation
of the present study. A future study could emphasise RT-PCR, providing
us with additional and more detailed information about the expression
of MMP12 following the application of asymmetric forces on the intervertebral
disc.
Conclusion
MMP12 is expressed in the hypertrophic zone of the physiologic
vertebra growth plate. Asymmetrical mechanical loading inhibits
the expression of MMP12 in the growth plate chondrocytes. On the
contrary, the expression of MMP12 in rat tail intervertebral discs
increases after application of asymmetric loading and is correlated
with the degree of the deformity and the side of the wedged disc.
Future research could investigate any potential benefit after inhibition
of MMP12 in patients with disc degeneration.
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