酸环境对人髓核间充质干细胞生物学活性的影响

目的:观察酸环境对体外培养的成人髓核间充质干细胞(NPMSCs)生物学特征的影响,探讨椎间盘退变的可能机制。方法:用胶原酶消化法从6例脊柱侧凸矫形患者手术摘除的6个腰椎间盘(Pfirrmann椎间盘退变分级为Ⅰ级或Ⅱ级)髓核组织中分离细胞,体外培养,传代并观察细胞形态。取P2代细胞,利用流式细胞仪对分离得到的细胞表型CD34、CD45、CD73、CD90、CD105和人类白细胞抗原(HLA)-DR表达情况进行检测;用成骨、成软骨、成脂培养液诱导培养细胞,2周后分别用茜素红、甲苯胺蓝、油红O对细胞进行染色,观察其成脂、成骨、成软骨能力。按照国际干细胞治疗协会(ISCT)有关间充质干细胞(MSCs)的判定标准,对分离得到的细胞进行综合评估鉴定。在37℃、21%O2、5%CO2的细胞培养箱中用不同p H值(6.2、6.5、6.8、7.1、7.4)的DMEM10%血清培养液培养P2代细胞,1、3、5、7、9、11、13d后利用细胞增殖试剂盒(cell counting kit-8,CCK-8)检测细胞增殖活力(OD值),培养3d时借助流式细胞仪检测细胞凋亡率,不同p H值培养基培养28d时采用实时荧光定量(RT-PCR)检测P2代细胞"干性维持"基因Oct4、Nanog、Jag1、Notch1及酸离子通道家族蛋白基因ASIC1、ASIC2、ASIC3、ASIC4的m RNA表达情况。结果:P0代细胞均贴壁生长。P2代细胞免疫表型鉴定显示MSCs表面分子标记CD90、CD105、CD73表达比例分别高达96%、95%、94%以上,低表达CD45、CD34、HLA-DR(均低于4%)。茜素红染色、油红O染色及甲苯胺蓝染色分别证实分离的细胞均可向骨、脂肪及软骨细胞三系诱导分化。按照ISCT有关MSCs的判定标准,分离得到的细胞即NPMSCs。细胞代谢活性测定示P2代细胞在培养后1、3d各组间细胞OD值差异无统计学意义(P0.05);5d、7d、9d、11d、13d各组间细胞OD值差异有统计学意义(P0.05),且p H值越低细胞的OD值越小。p H值7.4组的细胞凋亡率均小于其余各组,各组间有统计学差异(P0.05)。p H值7.4组"干性维持"基因Oct4、Nanog、Jag1、Notch1及酸离子通道家族蛋白基因ASIC1、ASIC2、ASIC3、ASIC4的m RNA均明显高于p H值7.1、6.8、6.5、6.2组(P0.05)。随着培养液p H值降低,细胞的凋亡率升高,细胞干性维持基因及酸通道家族蛋白基因的m RNA表达降低。结论:低p H值的酸环境培养1、3d对成人NPMSCs增殖无明显影响,培养5d后明显抑制NPMSCs的增殖和基因表达,促进细胞凋亡,且随着p H降低作用越明显。     

不同来源椎间盘髓核间质干细胞特性及其多向分化能力研究

 目的 比较来源于先天性脊柱侧凸与腰椎间盘退变髓核组织中髓核间质干细胞增殖特性及其多向分化能力差别。方法 收集2 例先天性脊柱侧凸与2 例腰椎间盘突出患者的椎间盘组织, 采用酶消化法分离细胞, 在含体积分数为10%胎牛血清的低糖DMEM 完全培养液中培养髓核间质干细胞, 用MTT法及台盼蓝染色检测脊柱侧凸与椎间盘退变来源的两组细胞的代谢活力与增殖能力。流式细胞仪鉴定两组髓核间质干细胞CD44、CD105、CD29、CD24 表达差异, 观察两组细胞成骨、成脂、成软骨分化能力。结果 侧凸组髓核间质干细胞以梭形为主, 退变组髓核间质干细胞以多边形及三角形为主, 传代后两组细胞大多以纺锤梭形为主。MTT及台盼蓝染色法提示侧凸组代谢活力及增殖能力强于退变组。侧凸组和退变组髓核间质干细胞CD44、CD105、CD29 表达比例分别为97%~100%和88.7%~97%, CD24 表达均为阴性, 两者均不表达造血细胞标志物CD45、CD34、CD14、HLA-DR。侧凸组与退变组髓核间质干细胞均可向成骨、成软骨分化, 但均未向成脂分化。结论 先天性脊柱侧凸与椎间盘退变髓 核组织中均存在髓核间质干细胞, 前者的髓核间质干细胞具有较强的细胞代谢活性及增殖能力, 两者成骨、成软骨分化能力无差别, 但均无成脂能力。     

人髓核间充质干细胞的分离提纯方式及生物学活性鉴定

目的 :探索人髓核间充质干细胞(nucleus pulposus mesenchymal stem cells,NPMSCs)的提纯方法并鉴定其生物学活性。方法:收集3例腰椎间盘突出症患者的退变髓核组织(Pfirrmann分级均为Ⅳ级),利用酶消化法分离细胞。采用两种方法分离提纯NPMSCs,一组细胞采用贴壁法培养(贴壁组),另一组通过流式细胞分选技术利用NPMSCs表面阳性标志物CD73、CD90、CD105获得NPMSCs(流式组)。将两种方法获得的NPMSCs进行体外培养扩增,分别进行形态学观察,细胞计数试剂盒(Cell Counting Kit,CCK-8)检测增殖能力。贴壁组NPMSCs采用流式细胞分选仪在进行分选之前检测免疫表型,流式组NPMSCs在生长达80%~90%融合时进行免疫表型的检测。向成骨、成脂、成软骨诱导分化,诱导28d后分别进行茜素红染色观察其成骨能力、油红O染色观察其成脂能力、甲苯胺蓝染色观察其成软骨能力,利用Imag J软件计算染色区域所占的面积百分比。比较两组NPMSCs在形态学、免疫表型及增殖和分化能力的差异。结果:形态学观察发现,两组NPMSCs均呈漩涡状生长,贴壁组NPMSCs可见散在的单个细胞生长;流式组NPMSCs长梭形形态更长,排列更加紧密,少见散在的单个贴壁生长细胞。流式细胞分选后所得的NPMSCs占细胞总数的(89.67±2.52)%,可以进行体外培养扩增,细胞为典型的长梭形特征,漩涡状生长,在接种后12~15d达80%~90%融合,增殖能力在接种后5~13d明显高于贴壁组NPMSCs(P0.05)。流式组NPMSCs的CD73、CD90、CD105的表达率明显高于贴壁组NPMSCs(P0.05),并且低表达CD34、CD45及HLA-DR。两种方法获得的NPMSCs均能完成三系诱导分化,流式组成骨、成脂、成软骨染色区域百分比均明显高于贴壁组(P0.05)。结论:利用流式细胞分选技术从人退变髓核组织中可获得较高纯度的NPMSCs,并能进行后续培养扩增。与贴壁法获得的NPMSCs相比,流式细胞分选的NPMSCs具有更强的增殖与分化能力。     

非接触式共培养下两种同源间充质干细胞对退变髓核细胞生物学影响的比较研究

【摘要】 目的：比较非接触式共培养条件下两种同源间充质干细胞对退变髓核细胞生物学功能的影响。方法：取同一腰椎间盘突出症患者骨髓间充质干细胞（BMSCs）、脂肪间充质干细胞（ADSCs）和退变髓核细胞（NPCs）,两种间充质干细胞分别与髓核细胞在Tanswell 6孔板中进行非接触式共培养,与ADSCs共培养的NPCs为A组,与BMSCs共培养的NPCs为B组,以单独培养的NPCs为对照组。共培养7d后,提取3组髓核细胞总RNA,进行反转录后,利用Real-Time PCR检测其Ⅱ型胶原、蛋白多糖和SOX-9基因的相对表达量。结果：非接触式共培养7d后,Ⅱ型胶原、蛋白多糖和SOX-9基因相对表达量对照组分别是1.03±0.28、1.21±0.40和0.94±0.34,A组分别是3.49±0.55、3.88±2.11和2.41±0.91,B组分别是7.60±1.89、6.26±2.96和4.55±1.88。与对照组相比,A、B组髓核细胞Ⅱ型胶原、蛋白多糖和SOX-9基因相对表达显著增加（P<0.05）;A、B两组间相比也有显著性差异（P<0.05）。结论：非接触式共培养条件下骨髓间充质干细胞和脂肪间充质干细胞对退变髓核细胞均有一定的激活效应;骨髓间充质干细胞对退变髓核细胞的激活效应更强,可能更加适合于椎间盘退行性疾病的生物学治疗。     

兔髓核间充质干细胞与髓核细胞非接触式共培养的生物学效应

[目的]通过非接触式共培养探索兔髓核间充质干细胞(NPMSCs)与兔髓核细胞(NPCs)的间接生物学效应。[方法]将第3代兔来源NPMSCs与NPCs进行非接触共培养,分设三组:NPCs/NPCs自身共培养对照组,NPMSCs/NPMSCs自身共培养对照组,NPMSCs/NPCs共培养组。分别在共培养3、5、7 d后,比较两种细胞增殖情况,ELISA检测上清液中转化生长因子β1(TGF-β1)、胰岛素样生长因子(IGF)的含量;采用RT-PCR检测共培养7 d后NPMSCs与NPCs的Col IIα1、AGG基因表达变化;免疫荧光染色检测NPMSCs中Col II的蛋白表达情况。[结果]在共培养第5 d和第7 d,共培养组NPCs的细胞数量均高于自身对照组(P0.05),在第7d,共培养组NPMSCs的细胞数量均高于自身对照组;在共培养3、5、7 d后,共培养组上清液TGF-β1、IGF的含量均高于自身对照组(P0.05);在培养7 d后,共培养组NPMSCs中Col II免疫荧光强度高于自身对照组,NPCs与NPMSCs的Col IIα1、AGG基因的表达较自身对照组显著升高(P0.05)。[结论] NPMSCs与NPCs非接触共培养可以促进细胞因子分泌、细胞增殖、基质合成与分泌。     

柚苷对髓核间充质干细胞生物学性能的影响及其相关机制

目的:探讨柚苷对人退变腰椎间盘来源髓核间充质干细胞(human nucleus pulposus-derived mesenchymal stem cell,h NPMSC)生物学性能的影响及其可能机制。方法:收集腰椎间盘突出症患者的退变髓核组织,分离培养h NPMSC并进行体外扩增。通过细胞形态学观察、细胞免疫表型检测及三系分化进行间充质干细胞的鉴定。取P3代hNPMSC分为对照组(正常培养基培养)、柚苷组(以含20μg/mL柚苷的培养基培养)和LY294002组(用含20μg/mL柚苷及PI3K/Akt信号通路抑制剂LY294002的培养基培养),培养6d后通过流式细胞仪检测细胞凋亡率,TUNEL荧光检测TUNEL染色阳性细胞率,Western Blot检测凋亡相关蛋白Caspase-3、Bcl-2和Bax及PI3K/Akt信号通路相关蛋白p-Akt、Akt和p53的表达,RT-PCR检测Ⅱ型胶原及蛋白多糖的m RNA表达。结果:来自人退变腰椎间盘髓核的原代细胞贴壁生长,呈不规则多边形,传代后以梭形为主;高表达干细胞相关阳性表面抗原分子CD73、CD90及CD105,低表达CD45及CD34;茜素红染色、油红O染色及甲苯胺蓝染色证实经诱导后可向骨、脂肪及软骨细胞分化,符合间充质干细胞的表型。与对照组比较,柚苷组细胞凋亡率、TUNEL染色阳性细胞率、p53、Caspase-3和Bax蛋白表达显著性下降,p-Akt及抗凋亡蛋白Bcl-2表达显著性增加(P0.05);LY294002干预后可以逆转这种改变(P0.05)。与对照组比较,柚苷组hNPMSC中Ⅱ型胶原及蛋白多糖的m RNA表达显著性增加;LY294002组中Ⅱ型胶原及蛋白多糖的m RNA表达较柚苷组显著性减少(P0.05)。结论:柚苷可通过激活PI3K/Akt信号通路减少细胞凋亡,促进hNPMSC向髓核细胞分化。     

接种密度对大鼠髓核间充质干细胞的影响

[目的]比较不同细胞接种密度传代培养大鼠髓核间充质干细胞(nucleus pulposus-derived mesenchymal stem cells,NPMSCs)对NPMSCs的形态及表面标志物的影响。[方法]取12周龄SD大鼠椎间盘髓核组织体外消化获得原代细胞,待达到60%~70%融合时消化,并按接种密度分为三组,分别为低密度组(5个细胞/cm~2)、中密度组(100个细胞/cm~2)、正常密度组(10 000个细胞/cm~2)。培养至达到传代条件后,各组细胞均按10 000个细胞/cm~2在体外进行传代接种,进行形态学观察并检测干细胞的特征性表面标志(CD29、CD34、CD44、CD45、CD90)的表达情况。[结果]在细胞形态学方面,各接种密度组细胞均可呈旋涡状贴壁生长,但低密度组以集落样生长,细胞多呈长梭形,形态一致;中密度组和高密度组细胞中类圆形、多边形细胞增多,大量细胞出现形态不规则、细胞宽大扁平、折光性差。在细胞表面标志物方面,低密度组CD44、CD90的表达率明显高于中密度组和高密度组(P<0.05),而CD29、CD34、CD45差异无统计学意义(P>0.05)。[结论]低密度接种法可提高大鼠NPMSCs CD44及CD90的阳性率,纯化NPMSCs。     

人退变椎间盘髓核细胞体外平面培养的形态学及活性观察

[目的]观察平面培养体系内人退变椎间盘髓核细胞的形态及活性变化.[方法]收集20例人退变椎间盘髓核,分离髓核细胞行平面培养,倒置相差显微镜和HE染色观察髓核细胞的生长过程与形态变化,流式细胞仪量化细胞周期分布和凋亡率,甲苯胺蓝染色和免疫细胞化学染色髓核细胞聚集蛋白聚糖和Ⅱ型胶原的表达,观察平面培养传代对髓核细胞活性和基质合成能力的影响.[结果]原代髓核细胞呈类圆形或多角形,平均7d贴壁,31 d融合至95％,P1代髓核细胞呈长梭形或多角形,平均12h贴壁,6.6d融合至95％,两代细胞增殖能力的差异有统计学意义(P＜0.01).原代与P1代髓核细胞的细胞浆阳性染色聚集蛋白聚糖和Ⅱ型胶原,生长融合至95％后约90％的细胞分布于G1期,约16％的细胞凋亡,两代细胞的细胞活性和基质合成能力无统计学差异(P＞0.05).[结论]人退变椎间盘髓核细胞体外平面培养将经历显著的形态学变化.传一代后髓核细胞增殖能力提高,但能维持细胞活性以及蛋白聚糖和Ⅱ型胶原的合成能力.     

氧浓度对人髓核间充质干细胞生物学特性的影响

目的 :分离培养髓核来源的间充质干细胞(MSCs),比较不同氧浓度下细胞的生物学特性,探讨氧浓度对椎间盘退变机制的影响。方法:用胶原酶消化法从手术摘除的4个腰椎间盘(椎间盘Pfirrmann分级为Ⅰ级或Ⅱ级)髓核组织中分离MSCs,体外培养、传代,观察记录细胞形态。取P3代细胞,用流式细胞仪对分离得到的细胞表面抗原CD90、CD73、CD105、CD44和CD31、CD34、CD45的表达情况进行检测;用成骨、成脂、成软骨培养液诱导培养细胞,分别在21d、28d、21d时用茜素红、油红O、甲苯胺蓝对细胞进行染色,观察其成骨、成脂、成软骨能力。在三气培养箱的低氧条件(2%O_2、5%CO_2、37℃)和常规细胞培养箱的常氧条件(20%O_2、5%CO_2、37℃)下分别培养P3代细胞。通过细胞计数统计培养1d、2d、3d、4d、5d、6d、7d、8d时的细胞数量,比较不同氧浓度下细胞的生长曲线;使用Architect c8000自动生化检测仪检测培养1d、2d、3d、4d、5d时培养基的pH值和渗透压。实时荧光定量(q RT-PCR)检测不同氧浓度培养下细胞的干性基因POU家族类别5同位序列1(POU5F1,OCT4)、NANOG同位序列(NANOG)、性别决定区Y盒2(SOX2)及扩增基因细胞周期蛋白D1(Cyclin D1,CCND1)、MYC(c-Myc)、低氧诱导基因低氧诱导因子2α(HIF2α,EPAS1)、能量基因三磷酸腺苷合成酶(ATP5A1)、线粒体相关基因细胞色素c氧化酶Ⅳ亚基1型同工酶(COX4I1)、线粒体转录因子A(TFAM)、线粒体编码细胞色素c氧化酶Ⅰ(MT-CO1)、MT-CO_2的mRNA表达情况。结果:分离培养的细胞呈典型的单层贴壁生长,纺锤样;P3代细胞免疫表型鉴定显示MSCs表面分子标记高表达CD90(80.4%)、CD73(99.9%)、CD105(99.8%)、CD44(95.9%),低表达CD31(5.3%)、CD34(4.4%)、CD45(6.8%);茜素红、油红O染色、甲苯胺蓝染色证实细胞可向骨细胞、脂肪细胞、软骨细胞分化。根据国际干细胞治疗协会(ISCT)有关MSCs的判定标准,分离培养的细胞为髓核MSCs(NPMSCs)。低氧环境下培养的细胞形态更小,更接近原始MSCs,细胞增殖更快,低氧时倍增期为31.22±1.98h,常氧时倍增期为39.56±2.02h,差异有统计学意义(P0.05)。不同氧浓度各时间点培养基的pH值、渗透压差异无统计学意义(P0.05),且皆在适合细胞生存的范围。低氧培养下POU5F1(OCT4)、NANOG、SOX2、CCND1、MYC(c-Myc)、EPAS1、ATP5A1较常氧培养时显著性升高(P0.05);COX4I1、TFAM、MT-CO1、MT-CO_2较常氧培养时显著性降低(P0.05)。结论 :低氧条件下培养有利于人NPMSCs的细胞形态、干性基因、增殖能力等生物学活性的维持。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration

Ligament and tendon injuries are common problems in orthopedics. There is a need for treatments that can expedite nonoperative healing or improve the efficacy of surgical repair or reconstruction of ligaments and tendons. Successful biologically-based attempts at repair and reconstruction would require a thorough understanding of normal tendon and ligament healing. The inflammatory, proliferative, and remodeling phases, and the cells involved in tendon and ligament healing will be reviewed. Then, current research efforts focusing on biologically-based treatments of ligament and tendon injuries will be summarized, with a focus on stem cells endogenous to tendons and ligaments. Statement of clinical significance: This paper details mechanisms of ligament and tendon healing, as well as attempts to apply stem cells to ligament and tendon healing. Understanding of these topics could lead to more efficacious therapies to treat ligament and tendon injuries. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:7–12, 2020