Samuel B Adams1, Lori A Setton2, Richard D Bell3, Mark E Easley3, Janet L Huebner4, Thomas Stabler4, Virginia B Kraus4, Elizabeth M Leimer5, Steven A Olson3, Dana L Nettles5. 1. Duke University Medical Center, Durham, NC, USA samuel.adams@duke.edu. 2. Duke University Medical Center, Durham, NC, USA Department of Biomedical Engineering, Duke University, Durham, NC, USA. 3. Duke University Medical Center, Durham, NC, USA. 4. Duke University Medical Center, Durham, NC, USA Duke Molecular Physiology Institute, Durham, NC, USA. 5. Department of Biomedical Engineering, Duke University, Durham, NC, USA.
Abstract
BACKGROUND: Posttraumatic osteoarthritis (PTOA) can occur after intra-articular fracture despite anatomic fracture reduction. It has been hypothesized that an early inflammatory response after intra-articular injury could lead to irreversible cartilage damage that progresses to PTOA. Therefore, in addition to meticulous fracture reduction, it would be ideal to prevent this initial inflammatory response but little is known about the composition of the synovial environment after intra-articular fracture. The purpose of this work was to characterize the inflammatory cytokine and matrix metalloproteinase (MMP) composition in the synovial fluid (SF) of patients with acute intra-articular ankle fractures. METHODS: Twenty-one patients with an intra-articular ankle fracture were included in this study. All patients had a contralateral ankle joint that was pain free, had no radiographic evidence of arthritis, and no history of trauma. The uninjured ankle served as a matched control. SF was obtained from bilateral ankles at the time of surgery which occurred at a mean of 17 days post-fracture (range 8-40). The SF was analyzed for granulocyte macrophage colony-stimulating factor (GM-CSF), interferon-gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10, IL-12p70, MMP-1, MMP-2, MMP-3, MMP-9, MMP-10, CTXII, sGAG, and bilirubin/biliverdin (markers of hemearthrosis) using either multiplex assay or ELISA using commercially available kits. Mean concentrations of each factor were compared between SF from fractured and control ankles, and correlation analysis was done to determine potential relationships between levels of cytokines and time from fracture and age at fracture. RESULTS: Twelve of 18 measured factors including GM-CSF, IL-10, IL-1β, IL-6, IL-8, TNF-α, MMP-1, MMP-2, MMP-3, MMP-9, MMP-10, and bilirubin/biliverdin were found to be significantly higher in the fractured ankles. Mean concentrations of ECM degradation markers (sGAG and CTXII) were not found to be significatnly different between groups. CONCLUSION: These data indicate that after intra-articular ankle fracture the SF exhibits a largely pro-inflammatory and extra-cellular matrix degrading environment similar to that described in idiopathic osteoarthritis. IL-6, IL-8, MMP-1, MMP-2, MMP-3, MMP-9, and MMP-10 were significantly elevated and may play a role in the development of PTOA. CLINICAL RELEVANCE: In addition to anatomic fracture reduction, these data lend credence to reducing acute intra-articular inflammation through the development of antagonists to these pro-inflammatory and degrading mediators. Likewise, intra-articular lavage might reduce this inflammatory burden.
BACKGROUND:Posttraumatic osteoarthritis (PTOA) can occur after intra-articular fracture despite anatomic fracture reduction. It has been hypothesized that an early inflammatory response after intra-articular injury could lead to irreversible cartilage damage that progresses to PTOA. Therefore, in addition to meticulous fracture reduction, it would be ideal to prevent this initial inflammatory response but little is known about the composition of the synovial environment after intra-articular fracture. The purpose of this work was to characterize the inflammatory cytokine and matrix metalloproteinase (MMP) composition in the synovial fluid (SF) of patients with acute intra-articular ankle fractures. METHODS: Twenty-one patients with an intra-articular ankle fracture were included in this study. All patients had a contralateral ankle joint that was pain free, had no radiographic evidence of arthritis, and no history of trauma. The uninjured ankle served as a matched control. SF was obtained from bilateral ankles at the time of surgery which occurred at a mean of 17 days post-fracture (range 8-40). The SF was analyzed for granulocyte macrophage colony-stimulating factor (GM-CSF), interferon-gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10, IL-12p70, MMP-1, MMP-2, MMP-3, MMP-9, MMP-10, CTXII, sGAG, and bilirubin/biliverdin (markers of hemearthrosis) using either multiplex assay or ELISA using commercially available kits. Mean concentrations of each factor were compared between SF from fractured and control ankles, and correlation analysis was done to determine potential relationships between levels of cytokines and time from fracture and age at fracture. RESULTS: Twelve of 18 measured factors including GM-CSF, IL-10, IL-1β, IL-6, IL-8, TNF-α, MMP-1, MMP-2, MMP-3, MMP-9, MMP-10, and bilirubin/biliverdin were found to be significantly higher in the fractured ankles. Mean concentrations of ECM degradation markers (sGAG and CTXII) were not found to be significatnly different between groups. CONCLUSION: These data indicate that after intra-articular ankle fracture the SF exhibits a largely pro-inflammatory and extra-cellular matrix degrading environment similar to that described in idiopathic osteoarthritis. IL-6, IL-8, MMP-1, MMP-2, MMP-3, MMP-9, and MMP-10 were significantly elevated and may play a role in the development of PTOA. CLINICAL RELEVANCE: In addition to anatomic fracture reduction, these data lend credence to reducing acute intra-articular inflammation through the development of antagonists to these pro-inflammatory and degrading mediators. Likewise, intra-articular lavage might reduce this inflammatory burden.
Authors: Elizabeth M Leimer; Kirk L Pappan; Dana L Nettles; Richard D Bell; Mark E Easley; Steven A Olson; Lori A Setton; Samuel B Adams Journal: J Orthop Res Date: 2016-03-14 Impact factor: 3.494
Authors: Keiko Amano; Janet L Huebner; Thomas V Stabler; Matthew Tanaka; Charles E McCulloch; Iryna Lobach; Nancy E Lane; Virginia B Kraus; C Benjamin Ma; Xiaojuan Li Journal: Am J Sports Med Date: 2018-01-24 Impact factor: 6.202
Authors: Betty Liu; Adam P Goode; Teralyn E Carter; Gangadhar M Utturkar; Janet L Huebner; Dean C Taylor; Claude T Moorman; William E Garrett; Virginia B Kraus; Farshid Guilak; Louis E DeFrate; Amy L McNulty Journal: Connect Tissue Res Date: 2016-11-04 Impact factor: 3.417
Authors: Elizabeth M Leimer; Laura M Tanenbaum; Dana L Nettles; Richard D Bell; Mark E Easley; Lori A Setton; Samuel B Adams Journal: Foot Ankle Int Date: 2018-08-15 Impact factor: 2.827
Authors: Adam P Goode; Todd A Schwartz; Virginia B Kraus; Janet L Huebner; Steven Z George; Rebecca J Cleveland; Richard Gracely; Maria Jimenez; Louis E DeFrate; Jun Chen; Yvonne M Golightly; Joanne M Jordan Journal: J Orthop Res Date: 2019-12-04 Impact factor: 3.494