Journal of Orthopaedic Research

ObjectivesTo identify synovial transcriptional clusters in human knee osteoarthritis (OA) and determine how these relate to synovial histologic features, cell-type-associated gene expression, and cartilage degeneration severity. MethodsBulk RNA sequencing (RNA-seq) of synovial tissue from n = 135 patients with knee OA was analyzed using consensus clustering. Clusters were compared by clinical and histologic features, including cartilage degeneration severity (OARSI score). Single-cell RNA-seq (n = 18) and spatial transcriptomics were used to relate cartilage degeneration-associated gene expression patterns to synovial cell populations. ResultsFour synovial transcriptional clusters that differed in synovial histologic features and cartilage degeneration severity were identified. Greater cartilage degeneration was associated with enrichment of lining fibroblast- and inflammatory myeloid-associated gene expression, whereas lesser cartilage degeneration was associated with enrichment of sublining fibroblast, endothelial, mural cell, and adipocyte-associated gene expression. ConclusionsHuman knee OA synovium segregates into transcriptional clusters associated with cartilage degeneration severity. Synovial transcriptional heterogeneity corresponds to cell-type-associated gene expression. Key messagesO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIOsteoarthritis synovium exhibits marked histologic and molecular heterogeneity. C_LIO_LISynovial inflammation detected by MRI correlates with cartilage degeneration and predicts progressive cartilage loss in knee OA. C_LIO_LIPrior transcriptomic studies have identified molecular subsets of OA synovium, but their relationship to cartilage degeneration severity remains unclear. C_LI What this study addsO_LIOA synovium segregates into four transcriptional clusters: Sublining (C1), Lymphomyeloid (C2), Myeloid (C3), and Major trauma (C4). C_LIO_LIGreater cartilage degeneration is associated with enrichment of inflammatory myeloid and lining fibroblast gene expression, whereas lesser degeneration is associated with enrichment of adipocyte, sublining fibroblast, endothelial, and mural cell-associated gene expression. C_LI How this study might affect research, practice or policyO_LIProvides a framework for a clinically relevant biological stratification of OA patients based on synovial molecular features. C_LIO_LIInforms future efforts to link synovial biology with OA prognosis, cartilage degeneration, treatment allocation, and development of targeted therapeutic strategies. C_LI

Anterior cruciate ligament (ACL) injuries disproportionately affect female adolescent athletes, with hormonal influences implicated in this sex disparity. However, the relationship between pubertal hormonal changes and ACL gene and protein expression remains poorly understood. This study characterized hormone receptor expression and transcriptional profiles in the anteromedial (AM) and posterolateral (PL) bundles of female porcine ACLs before and after puberty. ACL bundles were collected from pre-pubescent (8 weeks) and post-pubescent (>8 months) female Yorkshire cross-breed pigs (n=6/group) and analyzed using gene expression profiling, western blotting, and immunofluorescence. Pre-pubescent ACLs exhibited greater expression of primary matrix genes (COL1A1, COL1A2, ELN, TNMD), suggesting active matrix synthesis, while post-pubescent ACLs showed elevated secondary matrix genes (COL3A1, LUM, COMP), indicating a homeostatic state. Notably, estrogen receptor alpha (ER) gene and protein expression were significantly greater in post-pubescent ACLs, particularly in AM bundles, whereas G-protein coupled estrogen receptor (GPR30) expression was elevated pre-puberty. Both receptors were distributed homogeneously throughout the tissue. Progesterone receptor protein expression was not detected in any samples. Histologically, post-pubescent ACLs demonstrated decreased cellularity and thicker fascicles compared to pre-pubescent tissues. These findings indicate that ACL sensitivity to estrogen varies across development, with increased ER expression post-puberty potentially rendering the ligament more responsive to circulating estrogen. This work provides foundational evidence for age-dependent hormonal responsiveness in the ACL and motivates further investigation into how sex hormones influence ACL injury risk in adolescent females.

Rotator cuff tendinopathy is highly prevalent in aging populations, yet the mechanisms leading to age-dependent tendon degeneration are not well understood. In addition to tensile loading, tendons are subjected to compressive forces at certain anatomical sites (e.g., Achilles, rotator cuff), where altered adaptive responses may contribute to degenerative remodeling. The objective of this study was to investigate age-related differences in tendon responses to dynamic compressive loading using an ex vivo model. Murine flexor tendon explants from young and aged animals were cultured in a biaxial bioreactor and subjected to different levels of dynamic compressive loading. We then observed changes in metabolic activity, matrix composition, matrix biosynthesis, matrix structure, and gene expression. Young tendons exposed to moderate levels of compression maintained homeostasis, whereas high compression induced a robust adaptive response characterized by increased glycosaminoglycan accumulation, elevated collagen content, and upregulation of remodeling-associated genes including collagen I, decorin, and MMP-9, as well as inflammatory and apoptotic markers. In contrast, aged tendons demonstrated a qualitatively different response, with transcriptional downregulation of key remodeling markers alongside elevated secretion of matrix-degrading enzymes and pro-inflammatory cytokines, indicative of a maladaptive mechanobiological response even at low compressive levels. These findings reveal that impaired mechanosensitivity and a lower threshold for injury may predispose chronically loaded tissues to degenerative pathology associated with excessive compressive loading.

Patellar osteochondral allograft (OCA) transplantation is widely used to treat large full-thickness cartilage defects, yet long-term failure and reoperation rates remain high. Although surface congruity and osseous integration are emphasized clinically, cartilage thickness and mechanical compatibility between donor and recipient are not considered. Our previous work suggests that cartilage thickness mismatch can amplify local deformation at the graft boundary, potentially compromising graft longevity. This study investigates how combined mismatches in cartilage thickness and mechanical properties influence the local strain environment at the patellar OCA interface. Simplified two-dimensional axisymmetric finite element models of patellar OCA repair were developed in ABAQUS. Donor-to-recipient cartilage thickness ratios ranging from 0.33 to 3.25 were evaluated together with donor-recipient Youngs modulus mismatches (2.5-7.0 MPa). Cartilage was modeled using homogeneous linear elastic and functionally graded material formulations to account for depth-dependent stiffness. A compressive pressure of 1.0 MPa was applied to represent patellofemoral joint loading, and peak compressive and shear strains were quantified at the graft boundary. Cartilage thickness mismatch produced localized high-strain regions (HSR) of compressive and shear strain at the donor-recipient interface that were absent in thickness-matched constructs. Strain amplification increased with both thickness and mechanical property mismatch. Compressive strain exhibited directional asymmetry, with donor-side-thicker configurations producing greater amplification than recipient-side-thicker configurations. Incorporating depth-dependent cartilage stiffness reduced peak strain magnitudes but did not eliminate mismatch-driven strain amplification. These findings demonstrate that cartilage thickness and mechanical disparity can create HSR at the patellar OCA graft boundary that may predispose grafts to impaired integration and long-term failure.

ObjectiveAnterior cruciate ligament (ACL) tears increase the risk for developing posttraumatic osteoarthritis (PTOA). Females have greater risk for both. However, studies defining sex-specific protein responses in human cartilage after ACL injury are lacking. We hypothesize that articular cartilages response to an injurious environment differs depending on sex. DesignWe compared the proteomic profiles of normal cartilage with injured cartilage harvested from the intercondylar area during ACL surgery. Sex-specific injury effects were estimated through contrasts between Injured Male and Normal Male and between Injured Female and Normal Female. Pathway enrichment analysis was done using gene ontology (GO) and compared against the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. Extracellular matrix (ECM) proteins were further analyzed using the Matrisome AnalyzeR. ResultsFrom the 2,188 proteins identified, males and females shared 1,121 upregulated and 23 downregulated proteins in injured compared to normal cartilage. Analysis of ECM proteins and enriched pathways revealed mostly similar male and female responses to an injurious environment, with evidence of early cartilage remodeling in both sexes. Nevertheless, more than 240 proteins were affected specifically by sex, and significant sex differences were found in inflammation, ECM-related, and metabolic pathways. Males were enriched mostly in "ECM-receptor interaction", while females were enriched in "Citrate cycle (TCA cycle)", "Fatty acid degradation", and "Fatty acid metabolism" pathways. ConclusionArticular cartilage shows signs of remodeling soon after ACL injury, even when only exposed to an injurious environment rather than being physically impacted. Sex differences were observed in inflammation, metabolic pathways, and ECM synthesis.

ObjectiveRecently, alternatives to animal testing, such as new approach methodologies, are being developed in the orthopedic research field; animal models still provide valuable insights into the pathogenesis of knee osteoarthritis (OA). However, commonly used models develop OA much more rapidly and severely than those observed in human patients. We aimed to develop a novel murine model that closely mimics the slow progression of human OA with posterior Cruciate ligament (PCL) rupture. Design12-week-old C57BL/6 mice were induced to PCL-rupture (PCL-R) by manually applying an external tibial posterior translation force. We analyzed joint kinematics, histological observations, and bone structure to confirm the absence of concurrent injury on day 0. Then, joint stability and the pathophysiological progression of knee OA were analyzed at 8, 16, and 34 weeks post-PCL-R. The destabilized medial meniscus (DMM) model was also analyzed to compare the OA progression. ResultsNon-invasive PCL-R intervention induced the complete rupture in the central region of PCL without concurrent injury. The PCL-R group showed larger posterior tibial deviation than the INTACT (P=0.008). Regarding the range of motion in the PCL-R group, there was no limitation in range of motion on day 0, but extension limitations occurred at weeks 16 and 34 weeks. Histologically, articular cartilage degeneration in PCL-R was milder than DMM. In the subchondral bone, micro-CT reconstruction images indicated that, compared with the INTACT group, the DMM group observed progressive subchondral bone formation from 16 weeks post-surgery. In contrast, the PCLR group maintained the subchondral bone structure even at 34 weeks. ConclusionsPCL-R model induced mild abnormal mechanical stress depending on posterior instability, and cartilage degeneration occurred more slowly in this model than in DMM models.

Intervertebral disc degeneration (IVDD) compromises disc structures and mechanics, yet systematic evaluations of the mechanical responses and their relationship to morphological changes in preclinical models remain limited. This systematic review and meta-analysis synthesized mechanical and morphological alterations following experimental disc injury in in vivo animal models. Searches of MEDLINE, EMBASE and Web of Science databases were conducted in accordance with PRISMA guidelines. Study quality and risk of bias were assessed using modified CAMARADES and SYRCLE tools. Twenty-eight studies were included. Pooled analyses showed significant reductions in stiffness, Youngs modulus, and disc height, and significant increases in range of motion and degeneration grade, indicating both mechanical and structural deterioration. Youngs modulus appeared to be the most sensitive marker of functional degeneration. By contrast, creep and other viscoelastic responses showed non-significant changes. High heterogeneity was evident across studies, reflecting variability in injury models, species, timepoints, and testing methods. Evidence of publication bias was detected in several domains, and moderate methodological quality was noted with overall insufficient blinding and lack of sample size calculations. In vivo animal models of IVDD demonstrate robust and consistent mechanical and morphological degeneration after injury. Youngs modulus is a sensitive mechanical indicator, supporting its use in future preclinical research. Standardization of outcome definitions, methodology, and reporting is essential to improve comparability and enhance translation of preclinical findings to clinical research.

BackgroundPain with movement is common in adults with knee osteoarthritis (OA), but the effect of movement-evoked pain on gait is not well understood. This relationship is vital to understand as gait mechanics are associated with OA initiation and progression. Our current understanding of acute changes in pain and gait stems from extended bouts of walking, however these bouts likely dont represent real-world behavior. Therefore, understanding how gait changes with shorter, more intense bouts of activity may provide valuable insight into the pain experience. MethodsAdults with (n=19) and without (n=19) knee OA wore inertial measurement units (IMUs) while completing bouts of walking before and after two bouts of stair navigation (two flights). We tested whether pain and gait (speed, stride length, and lower extremity joint ranges of motion (ROM)) changed differently between adults with and without knee OA in response to multiple bouts of stair activity. FindingsThere were no significant interactions between group and stair bouts for any variable. When stratifying the OA group by those who did and did not experience pain, those who experienced a change in pain also had a greater change in early stance knee ROM in response to bouts of stairs. InterpretationThe observed changes suggest that knee kinematics may be more sensitive to acute changes in pain than gait speed or stride length. These differences were detectable using IMUs and therefore our results support the use of IMUs to measure concurrent pain and gait mechanics in less controlled and real-world settings.

The osteochondral junction is a specialized region ensuring the biomechanical and biological integration of the unmineralized articular cartilage with the subchondral bone through an intermediate layer of mineralized cartilage. This location is of clinical relevance, being the target of osteoarthritis. While aging is considered a risk factor for osteoarthritis, the interplay between microstructural and material changes during aging and predisposing to joint degeneration is not fully clear. This is especially true for mineralized cartilage, which remains understudied despite its critical role in load transfer from unmineralized articular cartilage to bone. We investigate age-related alterations of mineralized cartilage and subchondral bone in rat tibiae of adult and aged animals using a multimodal, high-resolution, correlative analysis. Our approach includes micro-computed tomography to measure microstructural features, second harmonic generation imaging to visualize collagen organization, quantitative backscattered electron imaging to map local mineral content, and nanoindentation to obtain mechanical properties. Mineralized cartilage and subchondral bone exhibited distinct age-related modifications. At the architectural level, the subchondral plate thickened and the trabecular network became coarser, those changes being different from those observed in the metaphysis. At the tissue level, mineralized cartilage was less mineralized than bone but exhibits a greater relative increase of mineral content with age, underlying differences in mineralization. A central observation is that aging led to an abrupt transition in mineral content and mechanical properties across the interface between unmineralized and mineralized cartilage, with a conceivable impact on stress localization. Overall, these changes may alter load transfer and contribute to age-related joint degeneration.

ObjectiveAdults with knee osteoarthritis often experience movement-evoked pain (MEP), and that pain has the potential to alter gait mechanics and influence disease progression. However, the associations between MEP and gait biomechanics have only been assessed in typical lab settings. Gait mechanics differ in the lab compared to in the real-world, thus it is unknown whether these associations between pain and gait translate to real-world settings. Therefore, this study aimed to measure concurrent changes in MEP and gait mechanics across three days of typical real-world activity. DesignSeventeen participants with self-reported physician-diagnosed symptomatic knee osteoarthritis wore inertial measurement units on their more symptomatic limbs thigh and shank, as well as on both feet for three days of typical activity. Participants were sent 5 automated text messages a day and were instructed to complete a short 3-5 minute walk and self-report their MEP via a Numeric Rating Scale (0-10) during each of the walks. A random coefficients model was used to determine how gait speed, stride length, and knee and ankle range of motion was related to changes in pain intensity. ResultsThe average MEP experienced during the instructed walks was 1.4 {+/-} 1.3 with individual participant average pain intensities ranging from 0 to 4.8. Greater MEP was associated with a 2.7{degrees} decrease in knee range of motion per unit increase in pain (95% CI [-4.8 -0.5], p = 0.02). Seven of the seventeen participants never reported a pain level of 0. Speed, stride length, and ankle range of motion did not differ by pain intensity. ConclusionsIncreases in MEP were associated with decreases in knee range of motion. A 2.7{degrees} decrease in knee range of motion in response to a 1-unit change in pain is meaningful as 5{degrees} is generally considered the threshold for a meaningful difference in joint angles. With a change in pain intensity of 2 being common with daily activity, individuals may be experiencing meaningful changes in knee joint angles regularly. With gait mechanics being associated with disease progression, these daily acute fluctuations in pain may be influencing disease progression rates.

BackgroundExcessive accumulation of fibrillar collagen causes pathological scarring and fibrosis. A promising anti-fibrotic strategy targets the extracellular assembly of collagen fibrils rather than intracellular synthesis pathways. We previously developed a chimeric monoclonal antibody targeting the C-terminal telopeptide of the 2(I) chain of human collagen I that effectively disrupts fibrillogenesis. This study details the engineering of a humanized antibody variant optimized for therapeutic application, augmented with a collagen-binding peptide (CBP) to enhance targeted retention in fibrotic tissues. MethodsA humanized ACA was engineered by in silico homology modeling, complementarity-determining region grafting, and sequence optimization to eliminate chemical liabilities. Variants were expressed in mammalian cells and evaluated for binding kinetics and specificity. To improve spatial localization, the CBP was fused to the antibody. The lead variant was assessed for in vitro cytotoxicity, matrix retention, and in vivo efficacy using a rabbit model of post-traumatic knee arthrofibrosis. ResultsThe humanized ACA variants maintained high specificity and affinity for the 2Ct target domain. Fusing the CBP to the C-terminus of the light chain (C-cbpACA) successfully enhanced matrix retention without compromising target engagement or causing cellular toxicity. In the rabbit arthrofibrosis model, intra-articular C-cbpACA delivery significantly reduced flexion contracture and decreased total collagen deposition in the joint capsule compared to untreated controls. ConclusionWe successfully engineered a clinically viable, humanized, and matrix-targeted anti-fibrotic antibody that specifically inhibited extracellular collagen assembly and exhibited enhanced localization within fibrotic tissues. This construct represents a promising therapeutic strategy for mitigating pathological scarring and improving post-traumatic functional outcomes.

IntroductionTrabecular bone exhibits brittle behaviour governed by microscale deformation and damage processes, yet quantitative characterisation of crack progression remains challenging because classical fracture mechanics approaches do not apply to architecturally discontinuous porous tissues. This study evaluates whether synchrotron X-ray computed tomography (XCT) combined with digital volume correlation (DVC) can provide a practical experimental approach for quantifying crack opening behaviour in human trabecular bone. MethodSemicylindrical specimens harvested from femoral heads of hip-fracture donors (n = 5) and non-fracture controls (n = 5) underwent stepwise three-point-bending during XCT imaging. Full-field displacement maps enabled direct measurement of crack mouth opening displacement (CMOD), crack length (a), and their ratio, CMOD/a, used here as a geometry-normalised comparative descriptor of brittle response. Automated crack segmentation using phase-congruency crack detection (PCCD) was compared against manual measurements. ResultsXCT-DVC successfully resolved three-dimensional displacement discontinuities during crack initiation and propagation in all specimens. Hip-fracture donors exhibited significantly lower critical crack-opening ratios (CMOD/a)* than Controls (0.31 vs 0.47; p = 0.008) and reached mechanical instability at lower applied loads, consistent with a more brittle structural response under this test configuration. Despite these differences, total crack extension ({Delta}a*) was similar between groups. Automated crack tracking using phase-congruency-based segmentation showed excellent agreement with manual measurements (r{superscript 2} = 0.98), confirming reliable extraction of crack geometry from DVC displacement fields. DiscussionThese results indicate that XCT-DVC can provide a practical approach for quantifying crack-opening behaviour in trabecular bone when classical fracture-mechanics parameters are not applicable in anatomically constrained specimens. The reduced critical crack-opening ratios and earlier instability observed in Hip-fracture donors are consistent with a more brittle comparative mechanical response that is not captured by crack extension alone. The strong agreement between automated and manual crack measurements further supports displacement-based descriptors as reliable comparative indicators of brittle behaviour in porous, architecturally discontinuous tissues. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=76 SRC="FIGDIR/small/714043v1_ufig1.gif" ALT="Figure 1"> View larger version (28K): org.highwire.dtl.DTLVardef@31c5d7org.highwire.dtl.DTLVardef@1b3d9a4org.highwire.dtl.DTLVardef@95df7borg.highwire.dtl.DTLVardef@1834216_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOGraphical abstractC_FLOATNO C_FIG

BackgroundLongitudinal bone growth occurs via the process of endochondral ossification, involving a complex interplay of chondrocyte proliferation, differentiation, and matrix remodelling. As with all mammalian cells, chondrocytes require dynamin for mitochondrial fission, to shuttle vesicles from the Golgi apparatus, and for both clathrin- and caveolin-mediated endocytosis. Here, we aimed to test the functions of dynamin on bone growth. To do so, we applied dynasore - a small molecule that is a reversible dynamin inhibitor - to mouse metatarsal bones cultured ex vivo. We assessed gross changes using bone length measurements and histomorphometry, and combined this with EdU detection, immunostaining, super-resolution microscopy and transmission electron microscopy. ResultsDynasore induced a dose-dependent hormetic effect on bone elongation: while high concentrations (220 {micro}M) impaired growth and abolished chondrocyte proliferation, low-dose treatment (40 {micro}M) significantly increased longitudinal bone growth. Histological analysis demonstrated that low dose dynasore augmented epiphyseal cartilage expansion and matrix accumulation, particularly within the resting and proliferative zones, while reducing chondrocyte proliferation. Immunostaining indicated that 40 {micro}M dynasore preserved collagen type X synthesis, activated mTORC1 signalling, and blocked autophagy, based on SQSTM1 accumulation. Low dose dynasore treatment expanded the thickness of the filamentous actin layer at the plasma membrane and deepened collagen fiber-containing endocytic pits, indicating that impaired cartilage remodelling was associated with growth-associated matrix accumulation. ConclusionsThis study reveals that dynasore exerts hormetic effects on growth plate chondrocytes, wherein low doses stimulate bone elongation, and high doses impair chondrocyte function.

While bone mineral density (BMD) remains the clinical standard for assessing age-related fracture risk, accumulating evidence indicates that bone quality, including matrix properties and microarchitecture, contributes to fracture susceptibility in ways not captured by BMD alone. As matrix-targeted therapeutics emerge, preclinical models that exhibit translationally relevant bone quality changes are needed. Here, we evaluated the Fischer 344 x Brown Norway (F344xBN) F1 rat, a strain characterized by hybrid vigor and non-pathological aging, as a model for studying matrix-related mechanisms of skeletal aging. Femurs from male and female rats aged 7, 15, and 22 months were analyzed to quantify age- and sex-dependent changes in bone microarchitecture, fracture resistance, and matrix properties. Microcomputed tomography analyses revealed sexually dimorphic aging trajectories. From 7 to 22 months, females exhibited moderate declines in trabecular microarchitecture and no change in cortical porosity, whereas males showed pronounced trabecular deterioration and increased cortical porosity. Whole-bone flexural testing demonstrated age-related declines in material properties that were not attributable to changes in geometry, while females maintained geometry-scaled bone strength. Both sexes exhibited reduced bone toughness with age. Raman spectroscopy identified matrix-level alterations in males by 15 months, whereas systemic markers of bone turnover remained unchanged across age or sex. Together, these findings indicate that males exhibit combined tissue-scale and whole-bone deterioration by midlife, while females exhibit declining fracture resistance preceding substantial cortical bone loss or overt matrix deterioration. These results support the F344xBN F1 rat as a translational model for investigating matrix-driven skeletal aging. Lay summaryF344 x BN F1 hybrid rats provide a healthy, matrix-driven skeletal aging model. This strain exhibits distinct aging trajectories dependent on sex. Strength and toughness decrease in both sexes by midlife. Fracture resistance declines in females prior to substantial bone loss.

Intervertebral disc degeneration is associated with loss of nucleus pulposus (NP) cell phenotype and extracellular matrix, both processes linked to changes in cytoskeletal contractility and cell shape. Here, we tested whether microenvironment-specific modulation of RhoA signaling can restore NP-like morphology and gene expression in NP cells cultured in 2D and in 3D alginate. In 2D monolayer culture, where cells are spread and mechanically activated, pharmacologic inhibition of RhoA with CT04 reduced RhoA activity, decreased actomyosin contractility gene expression, and shifted morphology toward a smaller, more circular phenotype. Bulk RNA sequencing showed that CT04 treatment increased expression of NP phenotypic and matrix-related genes including ACAN, GDF5, CHST3, and MUSTN1 while decreasing expression of catabolic and fibroblast-associated genes including ADAMTS1/9 and COL1, consistent with enrichment of extracellular matrix pathways. In contrast, RhoA activation with CN03 in 2D culture increased actin and phosphorylated myosin light chain intensity but produced limited phenotypic improvement. In 3D alginate, which minimizes integrin-mediated adhesion, baseline actomyosin markers were reduced relative to 2D culture. In alginate, RhoA activation with CN03 increased the amount of actin, phosphorylated myosin light chain, and actomyosin gene expression, yet also promoted a more compact, circular morphology and increased NP markers, including ACAN and KRT19 with repeated dosing. Across culture conditions, increased cell roundness was consistently associated with increased ACAN expression, indicating strong coupling between cytoskeletal state, morphology, and NP matrix programs. Together, these findings demonstrate that RhoA pathway perturbation can promote NP phenotypic gene expression in both 2D and 3D culture, but the direction of optimal modulation depends on the microenvironment, supporting RhoA signaling as a context-dependent therapeutic target for disc regeneration.

ObjectiveTo validate SERPINB2 and SERPINA9 as chondrogenic biomarker candidates across independent transcriptomic platforms and cell sources, to characterise the complete SERPIN expression landscape during kartogenin (KGN)-induced chondrogenic differentiation of human mesenchymal stem cells (hMSCs), and to identify novel SERPIN biomarker candidates and their signalling context during cartilage lineage commitment. DesignMulti-platform transcriptomic analysis across three independent datasets: (i) Affymetrix HGU133+2 microarray of KGN-induced chondrocytes versus undifferentiated hMSCs (ATCC source); (ii) Affymetrix Clariom D whole-transcriptome array of KGN-treated versus control hMSCs from an independent Mexican source (SINREG Laboratories); and (iii) previously published qPCR validation. Differential expression was computed using limma with Benjamini,Hochberg correction. SERPIN-focused cross-platform correlation and targeted pathway analysis were performed. ResultsThe Clariom D dataset yielded 1,869 differentially expressed genes (925 upregulated, 944 downregulated; FDR < 0.05) from 29,124 transcripts tested. SERPINB2 was concordantly upregulated across all three platforms (Clariom D: fold-change [FC] +3.54, FDR = 0.006; HGU133+2: log2FC = +3.29, nominal P = 0.027; qPCR confirmed), establishing it as one of the most reproducible transcriptomic signals in chondrogenic differentiation. In the direct Bone versus Cart comparison, SERPINB2 showed [~]45-fold chondrogenic enrichment (log2FC = -5.45, adjusted P < 0.0001). Cross-platform SERPIN correlation was significant (Pearson r = 0.54, P = 0.0025; n = 29 shared genes). Four additional SERPINs reached genome-wide significance on Clariom D: SERPINE2 (FC +2.57), SERPING1, SERPIND1, and SERPINE1. SERPINA9 was not replicated in the independent SINREG source, identifying it as a context-dependent marker. ConclusionsSERPINB2 is a robust, cross-platform chondrogenic biomarker with translational potential for osteoarthritis (OA) monitoring. The coordinated SERPIN programme activates a multi-layered proteolytic and signalling network during cartilage lineage commitment, positioning SERPINB2 as a functional regulator of the chondro-osteogenic lineage decision.

BackgroundCranioplasty following decompressive craniectomy can be performed using various implant materials, with titanium and polyetheretherketone (PEEK) being the most commonly used synthetic options. However, their comparative safety and clinical performance remain debated. This systematic review and meta-analysis aimed to compare titanium-based cranioplasty with PEEK and other synthetic or autologous materials regarding implant survival, complications, functional outcomes, cosmetic results, and operative metrics. MethodsThis systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and registered in PROSPERO (CRD). A comprehensive search was performed in PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews (CDSR) without language or date restrictions. A total of 1,026 records were identified (Embase n = 263, Web of Science n = 272, Scopus n = 293, PubMed n = 193). After removal of 550 duplicates, 78 articles underwent full-text review, and 38 comparative studies met the eligibility criteria for qualitative synthesis. Three studies directly comparing titanium and PEEK with extractable infection data were included in the meta-analysis. Risk of bias was assessed using Joanna Briggs Institute (JBI) tools. ResultsForty-one studies encompassing heterogeneous patient populations and study designs were included, predominantly retrospective cohort studies. Titanium demonstrated shorter operative times and lower intraoperative blood loss compared with autologous bone and, in most studies, compared with PEEK and PMMA. Implant survival outcomes were heterogeneous: PEEK frequently showed lower exposure rates but higher rates of subgaleal fluid collection. Compared with autologous bone, titanium had higher exposure rates but avoided resorption-related failures. Infection outcomes varied across materials; however, pooled meta-analysis demonstrated a significantly lower odds of postoperative infection with titanium compared with PEEK (random-effects model), with moderate heterogeneity. Functional and neurological outcomes were largely comparable across materials, and cosmetic satisfaction was generally high regardless of implant type. ConclusionsTitanium cranioplasty provides favorable operative efficiency and competitive complication rates compared with alternative materials. While exposure risk may be higher than PEEK, pooled evidence suggests a lower infection risk with titanium. Overall, implant material selection should consider patient-specific risk factors, defect characteristics, and surgeon expertise. Further high-quality prospective studies are warranted to strengthen comparative evidence.

BackgroundAnterior knee pain (AKP) is common in adolescent athletes and encompasses heterogeneous osseous and soft tissue pathologies, yet its developmental mechanisms remain poorly integrated. HypothesisPain-generating tissues within the knee extensor mechanism are redistributed from osseous to soft tissue structures with skeletal maturation. Study DesignRetrospective observational cohort study. Level of EvidenceLevel 3. MethodsA total of 1,595 patients with sports-related knee injuries (2017-2025) were included. Skeletal maturity was determined by proximal tibial physeal status on radiographs, classifying participants into open-physes (n = 707) and closed-physes (n = 888) groups. AKP was classified into bony and non-bony subtypes based on maximal tenderness. Prevalence was compared using odds ratios (ORs) with 95% confidence intervals (CIs). ResultsOverall, 575 patients (36.1%) had AKP. AKP was more prevalent in the open-physes group than in the closed-physes group (60.1% vs 16.9%; OR, 7.4; 95% CI, 5.9-9.3; p < 0.001). Bony AKP showed a marked difference (42.4% vs 3.7%; OR, 19.1; 95% CI, 12.8-28.6; p < 0.001), whereas non-bony AKP showed only a modest difference (17.7% vs 13.2%; OR, 1.4; 95% CI, 1.1-1.9; p = 0.013). ConclusionThe association between AKP and skeletal maturity was primarily driven by bony AKP, supporting structural redistribution of pain-generating tissues during growth. Clinical RelevanceTenderness-based classification may aid identification of tissue-specific vulnerability and inform growth-stage-specific load management.

ObjectiveInvestigate how Ca2+/calmodulin dependent protein kinase kinase 2 (CaMKK2) orchestrates a catabolic shift in chondrocytes during early osteoarthritis (OA). MethodsCartilage, osteochondral plugs and chondrocytes were collected from patients undergoing total hip arthroplasty or non-OA donors. SOX9 levels were assessed via immunoblotting or immunohistochemistry (IHC). Sox9 levels were also assessed by IHC in knee joints from wild-type (WT) and Camkk2-/- mice that underwent sham or destabilization of medial meniscus (DMM), with or without STO-609 (0.033 mg/kg) treatment. Co-immunoprecipitation followed by mass spectrometry was performed to identify CaMKK2 interacting proteins in chondrocytes. Kinase assays were analyzed by immunoblotting and phosphosites identified by mass spectrometry. Proteasome function was assessed in murine and human chondrocytes lacking or expressing kinase-active or kinase-inactive CaMKK2. ResultsInhibition or loss of CaMKK2 increased SOX9, whereas the expression of kinase-active, not inactive, CaMKK2 reduced Sox9 in human and mouse OA cartilage. Proteomic analysis of CaMKK2 immunoprecipitates revealed the presence of ubiquitin E3 ligase Ubr4 and the 19S proteasome regulatory particle (RP). CaMKK2 kinase activity was dispensable for its interactions with Ubr4, 19S RP, and Sox9-ubiquitin conjugates, and kinase-inactive CaMKK2 attenuated Sox9 degradation in chondrocytes. Further, CaMKK2 phosphorylated the 19S RP ATPase Psmc5 on Ser136, and an intact kinase increased proteasome activity in chondrocytes. ConclusionsOur findings identify CaMKK2 as a dual-function regulator of chondrocyte UPS with a scaffolding role to assemble UPSUbr4-19S RP around polyubiquitinated proteins such as Sox9, and a catalytic role to enhance proteasome function, potentially through Psmc5 phosphorylation, thereby linking chondrocyte inflammatory signaling to Sox9 degradation and cartilage degeneration.

Social isolation is a known modifiable risk factor for many chronic diseases including cardiovascular, metabolic, and brain disorders. Recent research has demonstrated that social isolation is similarly detrimental to skeletal health, but these effects may be sexually dimorphic. In rodents, isolation negatively affects bone in adult male mice, but not in females. However, these sex differences have not been systematically investigated, and it is unknown if they persist with long-term social isolation. The goal of our study was to investigate if isolation-induced bone loss may occur on different timescales between female and male mice, as well as investigate the potential roles of estrogen and testosterone. We examined bone changes in grouped (4 mice/cage) or isolated (1 mouse/cage) female and male 16-week-old C57BL/6J mice after 2, 4, or 8 weeks of treatment. We found that social isolation through single housing significantly reduced bone parameters across treatment lengths in male mice (20% reduction in Tb.BV/TV; 8% reduction in Ct.Th.) but not in females even with prolonged isolation. Isolation also decreased biomechanical properties in the femur of male but not female mice. While the females overall bone phenotype was unaffected, isolated females did show an increase in bone turnover markers with as little as 2 weeks of isolation. Isolation also altered estrogen-related gene expression in male mice isolated for 4 or 8 weeks. Overall, our results demonstrate that short- and long-term social isolation has sexually dimorphic effects on murine bone. These findings have important clinical implications for individuals at risk for social isolation, as well as for pre-clinical rodent models utilizing single housing.