Osteoarthritis and Cartilage

ObjectiveThe Agc1CreERT2 mouse line is a powerful tamoxifen-inducible genetic tool used for conditional gene manipulation specifically in cartilage. The aim of this study was to investigate the effects of aggrecan hypomorphism on the progression of post-traumatic osteoarthritis (PT-OA) in Agc1CreERT2 mice. MethodsProteoglycan content in cartilage samples from the knees of E18.5 embryos extracts were quantified by sulfated glycosaminoglycan (sGAG) assay. Destabilization of the medial meniscus (DMM) surgery was performed to induce PT-OA in 12-week-old wild-type, heterozygous Agc1CreERT2/+ and homozygous Agc1CreERT2/CreERT2 mice. Progression of OA was assessed at 4-, 8-, and 12-weeks post-DMM by OARSI, synovitis and osteophyte maturation histopathology scores and micro-computed tomography ({micro}CT). Aggrecan deposition, cartilage matrix-degrading proteases, aggrecan and collagen II degradation neoepitopes were investigated by immunohistochemical staining, and serum C-terminal cross-linked telopeptide of type II collagen (CTX-II) levels by an enzyme-linked immunosorbent assay (ELISA). Chondrocyte apoptosis was analyzed with the terminal deoxynucleotidyl transferase (TdT) dUTP nick-end labeling (TUNEL) assay. The biomechanical properties of articular cartilage (AC) were investigated with indentation-type atomic force microscopy (IT-AFM). ResultsBefore DMM, homozygous Agc1CreERT2/CreERT2 mice had reduced sGAG and aggrecan levels and increased cartilage stiffness. After DMM, they exhibited increased cartilage degradation, synovitis, osteophyte formation and meniscus mineralization, chondrocyte apoptosis and cartilage stiffness compared to wild-type mice. Immunohistochemistry demonstrated increased expression of the aggrecanase ADAMTS-5, the metalloproteinase MMP-13, the aggrecan degradation neoepitope NITEGE and the collagen degradation neoepitope C1,2C in AC. ELISA also revealed elevated serum CTX-II levels. Heterozygous Agc1CreERT2/+ mice also exhibited accelerated PT-OA compared with wild-type mice, characterized by elevated CTX-II levels at 4-weeks, increased synovitis, osteophyte and soft tissue mineralization at 8-weeks, and more severe cartilage degeneration at 12-weeks post-DMM. ConclusionBoth homozygous and heterozygous Agc1CreERT2 mice exhibit increased susceptibility to PT-OA, underscoring the importance of physiological aggrecan expression in maintaining joint homeostasis and regulating joint pathophysiology. These findings indicate that Agc1CreERT2/+ mice are not phenotypically neutral in the DMM model and that this intrinsic susceptibility should be considered when interpreting studies employing inducible, cartilage-specific gene deletion.

BackgroundIn osteoarthritis (OA) TLR4 signaling leads to downstream activation of the phosphoinositide 3-kinases/ protein kinase B/ mammalian target of Rapamycin (PIK3/AKT/mTOR) pathway, a known modulator of autophagic mechanisms in chondrocytes. This paper focuses on creating a realistic ex vivo OA model that mimics elements of the pathophysiology of OA, allowing for further hypotheses-based investigations, and for use as a bench test for new therapeutic targets. ObjectiveTo study the downstream inflammatory and matrix changes in cartilage due to TLR4 signaling and the recovery achieved by a commonly used immunosuppressive drug, Rapamycin. MethodsIn an ex vivo 3D model based on healthy porcine cartilage explants, we mimicked the OA environment by LPS stimulation activating TLR4 signaling. Furthermore, we inhibited mTOR signaling via Rapamycin, which is accepted to attenuate the cartilage response to LPS-TLR4 activation. Histology and immunohistochemistry were used to evaluate the structural and biomolecular modifications driven by LPS and Rapamycin. ResultsThe explant model captured key features of OA, such as extracellular matrix degeneration and altered autophagy. The OA-like changes in the model were driven by TLR4 activation and mTOR signaling, well-known OA-related molecular pathways, and reversed by Rapamycin. ConclusionWe demonstrate that our explant model is responsive to LPS stimulation, leading to activation of OA-related biomolecular pathways, closely mimicking the native physiological processes. This evidence supports the potential of our model to act as a platform for OA studies, in particular related to the gut-joint axis in age-related OA, and for the screening of new disease-modifying molecules.

BackgroundPost-traumatic osteoarthritis (PT-OA) is a debilitating condition with significant unmet clinical need. Mesenchymal stem cells (MSCs) represent promising candidates for the treatment of cartilage conditions, owing to their immunomodulatory and regenerative capacities. However, the marked heterogeneity of MSC preparations remains a major challenge for product standardization and prediction of therapeutic efficacy. We previously identified integrin 10{beta}1 as a marker for the selection of a more homogenous MSC preparation, with cartilage repair potential in vivo. In this study, we evaluated the therapeutic efficacy of human MSCs selected for high integrin 10{beta}1 expression in a murine PT-OA model, and compared their effects with those of unselected MSCs. MethodsUnselected or integrin 10-selected human bone marrow MSCs were characterized by flow cytometry and differentiation potential into adipogenic, osteogenic and chondrogenic lineages. Cells encapsulated into fibrin gel were applied intra-articularly at the time of surgery in the destabilization of the medial meniscus (DMM) mouse model of PT-OA. Eight weeks after DMM induction, severity of cartilage damage was assessed on Safranin O-stained sections using the OARSI scoring system. Synovitis, periarticular chondrogenesis, and osteophyte formation were evaluated histologically. OA-associated proteases, extracellular matrix degradation markers, and apoptosis were analyzed by immunohistochemistry, ELISA, and TUNEL assay. Persistence of transplanted human cells was assessed by PCR. ResultsIntegrin 10{beta}1-selected MSCs showed the characteristic MSCs immunophenotype and trilineage differentiation capacity. In vivo, treatment with integrin 10-selected MSCs significantly attenuated PT-OA-induced articular cartilage degeneration compared with both unselected MSCs and vehicle-treated controls. Further histopathological analyses revealed tendency toward reduced synovitis and periarticular chondrogenesis. Moreover, integrin 10-selected MSC treatment was associated with modest reductions in apoptotic activity and decreased expression of OA-related proteases and extracellular matrix degradation markers. Lastly, human cells were not detectable in joint tissues at the study endpoint. ConclusionsIntegrin 10-selected MSCs demonstrated superior chondroprotective effects compared with unselected MSCs, highlighting their potential as a standardized and efficacious cell therapy for PT-OA. These findings further validate the feasibility and safety of selection and in vivo administration of MSCs with high expression of integrin 10.

ObjectiveThe repair response to focal osteochondral injuries frequently fails to truly restore native osteochondral tissue, predisposing the joint to the likelihood of progressive degeneration and post-traumatic osteoarthritis. The biological mechanisms governing the earliest stages of repair in these tissues remain poorly understood, limiting the development of effective regenerative therapies. We therefore aimed to define the early cellular and spatial organisation of repair in a reproducible murine osteochondral injury model by integrating single cell spatial transcriptomics across the whole joint with longitudinal structural imaging and histological analyses. DesignA reproducible, non-critical osteochondral injury was created in the trochlear groove of female C57BL/6 mice. Structural repair was assessed using a multimodal approaching comprising quantitative histology, immunophenotyping, longitudinal magnetic resonance imaging (MRI) and micro-computed tomography ({micro}CT), while whole-joint Xenium spatial transcriptomics at days 3 and 7 defined the cellular and molecular organisation of the early repair response. ResultsSpatial transcriptomics demonstrated that the first week after injury is characterised by the emergence of anatomically distinct immune, vascular and stromal microenvironments across the synovial joint. Resolution of the early inflammatory response was accompanied by regional organisation of repair-associated stromal populations by day 7 after injury. The synovium preferentially supported matrix-associated fibro-chondrocyte-like cells, whereas the osteochondral injury itself retained stress-responsive stromal states with comparatively limited representation of matrix-associated populations. These findings indicate that distinct anatomical niches within the joint are associated with transcriptionally distinct stromal cell phenotypes during early repair. Longitudinal MRI and {micro}CT and histological analysis, demonstrated that these early spatial differences in cell phenotype were associated with progressive restoration of osteochondral architecture, with more effective regeneration of subchondral bone and limited restoration of native articular cartilage. ConclusionsThis study provides, to our knowledge, the first spatially resolved transcriptomic analysis of the early osteochondral repair response to injury across the whole synovial joint. Our findings demonstrate that the first week after injury establishes spatially organised immune, vascular and stromal cell microenvironments. Furthermore, these data suggest that incomplete cartilage repair may reflect an initial failure to establish and sustain matrix-associated stromal cellular states within the injury niche. These findings identify the early repair microenvironment as a critical determinant of tissue regeneration and provide a rationale for regenerative strategies that target repair with spatial and temporal precision.

ObjectiveCellular senescence has been shown to underlie many age-related diseases, including osteoarthritis (OA). In addition to age, biological sex is an OA risk factor with females at greater risk of hand and knee OA. We profiled the senescence burden in OA human synovial fibroblasts while accounting for these factors to understand how senescence may contribute to the increased burden of OA in females. MethodsSynovial fibroblasts were isolated from tissue obtained at knee arthroplasty for OA from 10 male and 10 female donors. Single cell multiplexed immunofluorescence imaging was used to profile the senescence burden in samples age-matched to account for the differences in chronological age. Clustering was performed using stability and generalizability scoring. ResultsIndependent of chronological age, OA synovial fibroblasts from female donors showed higher levels of senescence associated proteins p16, p21, p53, phospho-p65, IL-6, and IL-8. Assessment of oxidative stress associated proteins NRF2, SEPP1, NQO1 and TXNIP indicated a lower capacity for female cells to respond to oxidative stress. Clustering analysis revealed male and female enriched clusters. The female-enriched clusters showed higher levels of senescence-associated proteins and an increased oxidative stress response. ConclusionsOA synovial fibroblasts from female donors demonstrated higher levels of senescence associated markers, lower ability to respond to oxidative stress, and increased senescence with increasing age. These findings indicate that female synovial fibroblasts are more likely to show markers of senescence and oxidative stress, suggesting senescence can contribute to the increased incidence of osteoarthritis in women.

BackgroundKnee osteoarthritis (KOA) is a prevalent degenerative joint disease in which synovial inflammation and fibrosis are closely linked to pain, stiffness, and functional limitation. Growing evidence suggests that metabolic dysregulation, particularly in lipid metabolism, is involved in KOA pathogenesis, but the underlying mechanisms remain incompletely defined. MethodsSprague Dawley rats underwent bilateral anterior cruciate ligament transection to establish a KOA model; sham-operated rats served as controls. RNA sequencing of synovial tissues was performed to identify differentially expressed genes (DEGs) and enriched pathways, followed by GO/KEGG and GSEA analyses. In vivo, adeno-associated virus vectors were used to overexpress or knock down PPAR-{gamma} and phosphoenolpyruvate carboxykinase 1 (PCK1) via intra-articular injection. Ex vivo, primary rat fibroblast-like synoviocytes (FLSs) were stimulated with IL-1{beta} and transfected with PPAR-{gamma} or PCK1 siRNA/overexpression plasmids. synovitis and fibrosis were evaluated by HE, Masson, and Sirius Red staining, immunofluorescence, ELISA, RT-qPCR, and Western blotting. ResultsRNA-seq revealed 621 up-regulated and 228 down-regulated genes in KOA synovium versus sham, with DEGs significantly enriched in PPAR signaling, adipocytokine, and AMPK pathways. Metabolism-related genes including Fabp5, Plin1, Adipoq, Lep, and Pck1 were up-regulated. GSEA indicated downregulation of PPAR-{gamma} signaling in KOA synovium. In vivo and ex vivo, PPAR-{gamma} expression was reduced in KOA, whereas PCK1, FABP5, and ADIPOQ were increased. PPAR-{gamma} overexpression alleviated synovial inflammation, collagen I deposition, and fibrosis, and suppressed FABP5, ADIPOQ, and PCK1 expression; PPAR-{gamma} knockdown produced the opposite effects. Functional studies showed that PCK1 overexpression aggravated synovial inflammatory cell infiltration and fibrosis, elevated IL-1{beta}, IL-18, and TGF-{beta}, and decreased TIMP1 levels in serum, synovial tissue, and FLSs supernatants, whereas PCK1 silencing reversed these changes. ConclusionsThe PPAR-{gamma}/PCK1 metabolic axis modulates synovitis and fibrosis in KOA. Downregulation of PPAR-{gamma} and consequent upregulation of PCK1 promote synovitis and fibrotic remodeling. These findings identify the PPAR-{gamma}/PCK1 pathway as a potential therapeutic target for KOA.

BackgroundOsteoarthritis cartilage contains heterogeneous chondrocyte states, but molecular programs linked to state transitions within human cartilage remain incompletely resolved using public single-cell data. MethodsA retrospective reanalysis was conducted of a public human knee cartilage single-cell RNA sequencing dataset (GSE255460) including 8 osteoarthritis donors and 3 non-osteoarthritis donors (19 samples). Cells underwent sample-wise quality control and doublet removal, followed by batch-corrected clustering, chondrocyte subclustering with marker-based annotation, and trajectory inference using Slingshot. Regulatory chondrocytes were prioritized for osteoarthritis versus control differential expression, with downstream Gene Ontology/KEGG enrichment (Benjamini-Hochberg false discovery rate <0.05) and protein-protein interaction network hub screening. ResultsAfter quality control, 27,036 cells were retained. Chondrocytes formed multiple transcriptional states with branching-like continuous relationships, and regulatory chondrocytes localized near the main manifold and adjacent to multiple inferred branches, consistent with a transition-adjacent state. In regulatory chondrocytes, osteoarthritis versus control differential expression was enriched for collagen-containing extracellular matrix and extracellular matrix organization, endoplasmic reticulum lumen-associated secretory/proteostasis processes, cell-matrix adhesion (including focal adhesion), and transforming growth factor beta/SMAD-related signaling. Protein-protein interaction analysis of regulatory-chondrocyte differential genes identified five high-connectivity hub genes: COL5A1, COL5A2, COL6A1, COL1A2, and COL3A1. ConclusionThis public-dataset reanalysis supports a transition-adjacent regulatory chondrocyte program in osteoarthritis characterized by coordinated extracellular matrix remodeling with concurrent secretory/proteostasis and adhesion-transforming growth factor beta signatures, nominating collagen-network hubs as candidates for downstream validation.

Objective We developed a patient- and joint-specific explant co-culture system to model active psoriatic arthritis (PsA) and capture donor-specific tissue responses to therapeutic interventions. Methods Based on convergent joint pathology between end-stage osteoarthritis (OA) and PsA, OA cartilage-bone and synovium tissues from arthroplasty patients were exposed to synovial fluid (SF) obtained from PsA and OA patients. Histological outcomes (synovitis, proteoglycan distribution), curated gene expression, soluble mediators, and proteinase activity were assessed over 7-21-days. Model responses to dexamethasone (DEX) and the anti-tumor necrosis factor antibody adalimumab (ADA) were evaluated. Results PsA SF induced distinct inflammatory and tissue remodeling responses compared to OA SF and control conditions, including altered cartilage proteoglycan distribution, increased synovitis, and tissue-specific transcriptional changes. Multivariate analyses identified distinct osteochondral and synovial transcriptional responses to PsA SF, characterized by reduced osteochondral COL2A1 expression and increased synovial expression of inflammatory and matrix-remodeling genes, including MMP1 and CXCL8. DEX and ADA elicited donor-specific responses across histological, transcriptional, and protein readouts. Among multivariable model outputs, histologic synovitis scores emerged as the most clinically aligned parameter, demonstrating associations with baseline PsA donor disease activity, active joint counts, pain, high-sensitivity C-reactive protein (hsCRP), and radiographic scores. Synovitis score changes to DEX and ADA treatments also aligned with corresponding PsA SF donor clinical improvements to corticosteroid and TNF-modifying therapies. Conclusion This osteochondral-synovial explant co-culture model captured donor-specific inflammatory and treatment-responsive features of PsA SF-induced pathology, thereby providing a clinically relevant ex vivo platform for studying patient-specific therapeutic responses in PsA.

Osteoarthritis (OA) is a major cause of chronic pain and disability worldwide, characterized by progressive degeneration of cartilage and subchondral bone. Post-traumatic OA (PTOA) develops in as many as 25-50% of individuals following major joint injury, making it a leading cause of OA in younger and otherwise healthy populations.1,2 Connexin 43 (Cx43), a gap junction protein involved in intercellular communication and cellular stress responses, has been linked to OA; however, its role in the progression of PTOA remains unclear. Here, we examined how cartilage-specific loss of Cx43 influences PTOA and chondrocyte metabolic function. Using a murine model of conditional Cx43 deletion in cartilage, we demonstrate that male knockout mice exhibited severe cartilage surface damage and matrix loss, whereas female knockout mice showed cartilage thinning accompanied by reduced chondrocyte hypertrophy, decreased subchondral bone density, and increased osteophyte formation. Thus, loss of Cx43 disrupts cartilage integrity and osteochondral remodeling in a sex-specific manner, predisposing joints to maladaptive bone changes and cartilage degeneration. Complementary mechanistic studies in human articular chondrocytes revealed that Cx43 deficiency impairs mitochondrial respiration, reduces spare respiratory capacity, and lowers ATP production, consistent with compromised cellular bioenergetics. Together, these findings identify Cx43 as an important coordinator of metabolic and structural responses to joint injury. These results position Cx43 as a context-dependent regulator of joint homeostasis and suggest that maintenance of Cx43 expression may support cartilage resilience following injury.

Osteoarthritis (OA) drug development remains constrained by preclinical models that fail to recapitulate the multicellular interactions that regulate human joint inflammation and extracellular matrix degeneration in response to investigational drugs. Tanezumab, a humanized anti-nerve growth factor monoclonal antibody developed for non-opioid pain relief, advanced to late-stage clinical trials but was discontinued due to unresolved joint-localized safety concerns, including rapidly progressive OA. This study evaluated whether a human microfluidic joint-on-a-chip co-culture system could detect early biomarker responses to tanezumab exposure that were not apparent in conventional chondrocyte monoculture. Tanezumab was first tested in human chondrocyte monoculture under untreated and disease-like (i.e., IL-1{beta}-treated) conditions. Across a 20-analyte panel of inflammatory and matrix-remodeling biomarkers, statistically significant monoculture responses to tanezumab were limited to decreased IL-1{beta} from 335 to 132 pg/mL ([~]0.39-fold) and increased IL-8 from 575 to 675 pg/mL ([~]1.17-fold). Major OA-associated matrix-remodeling markers, including MMP-1, MMP-3, and MMP-13, remained largely unchanged, indicating that monoculture conditions are insufficiently sensitive to detect clinically predictive drug-related molecular changes. Tanezumab was then evaluated in co-cultures containing chondrocytes, osteoblasts, fibroblast-like cells, and macrophages under low-inflammation (i.e., M0 macrophage-based) and high-inflammation (i.e., M1 macrophage-based) conditions. In the M0-based co-culture, tanezumab increased MMP-1 from [~]4.20 x 104 to [~]6.20 x 104 pg/mL ([~]1.48-fold), MMP-3 from [~]8.00 x 104 to [~]1.20 x 105 pg/mL ([~]1.50-fold), and MCP-1 from 2.85 x 103 to 4.31 x 103 pg/mL ([~]1.51-fold). In contrast, the M1-based co-culture showed decreases in MMP-13 from [~]1.66 x 104 to [~]1.17 x 104 pg/mL ([~]0.70-fold) and IFN-{gamma} from [~]1.95 x 104 to [~]1.56 x 104 pg/mL ([~]0.80-fold), changes that may appear beneficial despite the drugs known clinical risks. Collectively, these findings show that low-inflammation multicellular co-culture revealed coordinated matrix remodeling and inflammatory responses to NGF blockade that were missed in monoculture and were partly obscured in highly stimulated disease-like conditions. This platform may provide a useful, human-relevant approach for safety signal assessment and early evaluation of OA therapeutics within a defined context of use focused on joint-specific, tissue-level drug-response testing.

Osteoarthritis is a leading cause of chronic pain and disability, which lacks disease-modifying treatment. Given the complex multi-tissue and multifactorial drivers behind disease progression, effective treatments will require simultaneously targeting several mechanisms underlying joint degeneration and pain. Here, we developed and evaluated a combinatorial gene therapy, consisting of a high-capacity adenoviral vector carrying two therapeutic genes to target distinct pathological mechanisms: inflammation (IL-1Ra) and chondrocyte health (PRG4). Intra-articular delivery of this treatment improved functional, structural, and pain outcomes in murine and equine osteoarthritis models. In addition, treatment normalized inflammatory environments in joint tissues, as well as in the dorsal root ganglia (DRG) known to harbor joint-innervating sensory neurons. Moreover, gene therapy reversed OA-induced molecular signatures of neural hyperexcitability, suggesting amelioration of peripheral sensitization. Collectively, these findings support combinatorial gene therapy as a promising treatment for osteoarthritis, while identifying neuroinflammatory signatures for correction of disease progression and pain. One Sentence SummaryA single intra-articular injection of a combinatorial gene therapy slows OA progression and reduces pain in small and large animal models.

Introduction: Osteoarthritis (OA) is a degenerative joint condition characterized by chronic pain and the need for pain management. Locally targeting the endocytotic AP2 complex in nociceptors presents a potential strategy for providing sustained pain relief in individuals with OA. Objective: We investigated whether pain behavior associated with OA can be mitigated by genetically silencing the AP2alpha2 subunit of the AP2 complex in nociceptors and by pharmacologically inhibiting the AP2 complex through the intraarticular administration of a small lipidated decoy peptide. Method: Monoiodoacetate (MIA) was employed to induce knee joint OA in mice and rats. Pain behavior was assessed using dynamic weight-bearing and von Frey filaments. Upon confirmation of established OA pain behavior, in vivo AP2alpha2 genetic knockdown in mice was achieved through sciatic nerve transfection of a targeting AP2alpha2 short hairpin RNA (shRNA). To pharmacologically target endocytosis, a single intraarticular injection of peptide was administered into the arthritic knee of rats. The injection contained either the AP2 inhibitor peptide or a scrambled peptide control. Results: Pain behavior was significantly reduced after both genetic and pharmacological disruption of AP2-driven endocytosis. Animals treated with the Ap2 inhibitor peptide exhibited reduced pain behavior throughout the 28-day assay period. Following the completion of behavioral testing, arthritic knee joints and contralateral healthy knee joints were subsequently collected to assess the impact of the treatment on disease progression. Micro-computed tomography analysis revealed a preservation of bone volume in the arthritic joints that received the AP2 inhibitor peptide treatment, in contrast to the scrambled peptide group. Conclusion: These findings demonstrate that the inhibition of nociceptor endocytosis by a small lipidated peptide presents a promising approach to provide sustained relief from joint pain in individuals with arthritis.

We here determined therapeutic efficacy and mode-of-action of human induced pluripotent-derived therapeutic stem cells (hiMSCs) across in vivo mouse and ex vivo human osteoarthritis models. hiMSC treatment in DMM-mice significantly reduced OARSI damage scores, which was affirmed by a decrease in the catabolic marker Mmp13 and an increase in the anabolic marker Col2. These treatment effects appeared, irrespective of modifying factors such as xeno-free media or thermosensitive hydrogel carrier. Subsequently treatment of hiMSC+gel in human osteoarthritic cartilage explants showed a transcriptome-wide significant activation of the cholesterol and sterol synthesis pathways marked by genes such as MVD, DHCR7, MSMO1, FABP3. Additionally, we showed that these changes alleviated OA-associated imbalances of the cellular Zinc-ion homeostasis pathways, represented by genes such as MT1F, MT1G, MT1H and SLC30A1. Spatial transcriptomics then sensitively captured that hiMSC+gel treatment evoked, specifically at the superficial cartilage layer, a consistent upregulation of healthy chondrocyte markers such as CHAD, ACAN, FRZB, and SOX9, alongside a suppression of catabolic and inflammatory mediators such as SERPINE1, SPP1, MMP13, ADAMTS5. Our findings link therapeutic outcomes of hiMSC treatment to precise spatially resolved molecular changes in human tissue, that would otherwise be obscured by heterogeneous cell populations. Collectively our study highlighted that hiPSC-derived stem cell therapy (hiMSCs) could provide a scalable off-the-shelf solution to treat osteoarthritis, with strong prospects for clinical applications in the near future.

BackgroundCartilage tissue engineering requires scalable culture strategies to produce high-quality organoids. Human induced pluripotent stem cells (hiPSCs) provide a renewable source of chondrogenic cells. However, conventional static 3D culture limits tissue maturation, reproducibility, and scalability. Dynamic culture systems may help overcome these limitations, although their application for hiPSC-derived cartilage maturation remains poorly explored. MethodsIn this study, we established and validated a dynamic suspension bioreactor culture platform (CERO, OLS) for scalable maturation of hiPSC-derived chondroprogenitor cells (hiCPCs) into cartilage organoids populated by biomimetic human induced chondrocytes (hiCHOs). Key culture parameters, including aggregate preparation strategy, agitation speed, and maturation duration, were systematically evaluated. Cartilage maturation under dynamic and conventional static culture conditions was assessed by histology and immunohistochemistry, biochemical assays, organoid size measurements, and gene expression (RT-qPCR). In addition, the functional integration of optimized organoids was evaluated in a human osteochondral explant model. ResultsPre-formed manually picked hiCPC aggregates showed improved cartilage formation compared with single-cell seeding or pelleted aggregates in the bioreactor. Dynamic suspension culture promoted increased construct growth, enhanced ECM deposition, and a more favourable cartilage-associated molecular phenotype compared with static culture. HiCHO organoids matured under dynamic suspension conditions displayed increased sulphated glycosaminoglycan and proteoglycan deposition together with higher expression of cartilage-associated genes ACAN, COMP, MGP, and COL2A1. Although prolonged static maturation alone supported continued cartilage development, introducing dynamic suspension culture during later maturation stages further reinforced favourable molecular and matrix-associated features. Importantly, hiCHO organoids generated under optimized dynamic culture conditions successfully filled human cartilage defects and established matrix continuity with surrounding native tissue in a human osteochondral ex vivo explant model. ConclusionsThis study shows that dynamic suspension culture is an effective and scalable strategy for maturation of hiPSC-derived cartilage organoids. Consequently, this approach supports reproducible neo-cartilage production and allows functional testing in human tissue models. These findings support the use of dynamic culture systems for cartilage repair and in vitro/ex vivo cartilage research.

Osteoarthritis is the most common joint disease for which disease-modifying therapies remain unavailable. Intra-articular gene delivery of interleukin-1 receptor antagonist (IL-1Ra) using high-capacity adenovirus (HCAd) has shown therapeutic promise; however, the duration of therapeutic benefit and the feasibility of repeat dosing under anti-adenoviral immunity remain unresolved. Using the murine anterior cruciate ligament transection model of osteoarthritis, we show that a single intraarticular injection of HCAd5-NF{kappa}B-IL-1Ra provides structural preservation and functional improvement in early-stage osteoarthritis but fails to sustain cartilage protection as disease progresses. However, HCAd5 transduction following repeated treatment is limited due to pre-existing immunity against this serotype. Notably, exchanging serotypes for repeated treatments effectively restores vector transduction and transgene expression in both healthy and osteoarthritic joints. Leveraging this strategy, we demonstrate that sequential intra-articular HCAd-NF{kappa}B-IL-1Ra administration does not further improve pain or motor function compared to the initial treatment, but preserves cartilage as assessed by histopathology and phase-contrast CT, irrespective of serotype. These findings establish HCAd serotype switching as a feasible approach to overcome immune barriers to repeat intra-articular gene therapy. Importantly, sequential HCAd-NF{kappa}B-IL-1Ra administration enhances therapeutic durability in post-traumatic osteoarthritis, providing a translational framework for repeat intra-articular gene delivery strategies aimed at long-term disease modification in osteoarthritis.

ObjectiveThis study investigates joint injury-induced angiogenesis and the effects of genetic deficiency of thrombospondin-2 (TSP2), an anti-angiogenic factor, in joint homeostasis and post-traumatic osteoarthritis (PTOA). MethodWe utilized a murine non-invasive anterior cruciate ligament rupture (ACLR) model of PTOA and mined published synovial transcriptomics datasets to investigate injury-induced synovial angiogenesis. Spatial transcriptomics and flow cytometry of TSP2-GFP reporter mice were used to assess injury-induced thrombospondin-2 and its cellular origins in synovium. Global TSP2 knockout mice (TSP2-KO) were used to assess the effect of TSP2 deficiency on early and late stages of PTOA development via molecular imaging of inflammation and angiogenesis, histopathology, micro-computed tomography, Raman spectroscopy, and synovium bulk RNA-sequencing. ResultsIntra-articular angiogenesis peaked at 7d post-ACLR and declined but remained elevated above baseline at 28d post-ACLR. We identified synovial crosstalk between endothelial cells and sublining fibroblasts as a key driver of angiogenesis and source of thrombospondin-2 signaling, with TSP2 primarily upregulated in sublining fibroblasts. TSP2-KO mice exhibited increased peri-articular inflammation at 7d post-ACLR and inferior bone quality. Histopathology revealed greater PTOA severity but paradoxically lower synovitis in TSP2-KOs. Additionally, aberrant structural remodeling of the entire knee joint was observed in uninjured and ACLR TSP2-KO limbs. The uninjured TSP2-KO synovial transcriptome demonstrated elevated immune, fibrotic, and angiogenic activation; however, TSP2-KO and WT synovial transcriptomes partially converged upon injury. ConclusionTSP2 is essential for joint homeostasis and trauma response. Global TSP2 deficiency causes premature OA and worsened PTOA, suggesting that therapeutic targeting with TSP2 mimetic could be used to prevent OA.

Successful cartilage repair remains one of the most significant challenges in the musculoskeletal field. Microfracture (MFx), a form of marrow stimulation, remains the predominant repair technique, but it exhibits routine failure due to inadequate defect fill and inferior fibrotic tissue formation. Whereas current strategies focus on augmenting MFx with scaffolds and bioactive factors, the potential to target the MFx clot itself and use the capabilities of this dynamic environment to guide MFx repair remains largely unexplored. We verified that MFx contraction and fibrosis hinder repair success in minipigs and become evident as early as one week in multiple animal models. Therefore, our objective was to investigate and direct microenvironmental interactions in the MFx clot to promote volumetric maintenance and reprogram cells from a fibrotic to more chondrogenic phenotype. Extracellular control of cell-environment interactions, through fibrinogen augmentation or anti-fibrinolytic treatment, limited contraction but had no effect on or even exacerbated the fibrotic susceptibility of marrow-derived cells (MDCs). Intracellular control of microenvironmental interactions, through modulation of the Rho-ROCK pathway, drove TGF-{beta}3 activity of MDCs along a "chondro-fibro axis". In particular, treatment with the ROCK inhibitor Fasudil drove TGF-{beta}3-treated cells away from a myofibroblast phenotype and towards chondrogenesis. Short-term Fasudil treatment prevented TGF-{beta}3-driven macroscale clot contraction and enhanced cartilage-specific matrix deposition in vitro. In a pilot rat study, this combination treatment improved GAG deposition and better protected surrounding cartilage. These findings suggest that Rho-ROCK modulates TGF-{beta} signaling along this chondro-fibro axis and its precise control could be the key to promoting precise and volumetric cartilage repair through microenvironmental interactions.

Osteoarthritis (OA) disproportionately affects women, and estrogen has been implicated in cartilage and joint homeostasis, yet its effects on meniscal fibrochondrocytes (MFCs), and whether those effects differ by sex, remain poorly defined. We reanalyzed a publicly available RNA-sequencing dataset (Gene Expression Omnibus, GSE199087) comprising human MFCs from a male and a female donor treated with 17{beta}-estradiol (E2) or vehicle. Differential expression, Gene Set Enrichment Analysis, Enrichr, and iLINCS were integrated to identify the transcriptional programs modulated by E2 in each sex. In female MFCs, E2 upregulated pathways governing DNA replication, cell-cycle progression, and genomic maintenance (e.g., MCM8, BRCA1, RAD51), while downregulating inflammatory and extracellular matrix-degrading genes, including MMP1, IL12A, CXCL12, and MYD88. In male MFCs, E2 instead upregulated chromatin remodeling and developmental signaling programs, led by SRCAP, ERCC6, and NOTCH1, and downregulated antigen presentation and mitochondrial genes. These divergent responses indicate that E2 engages distinct, sex-specific transcriptional programs in MFCs, with the female profile favoring proliferation and matrix preservation. Although derived from a limited sample and therefore hypothesis-generating, these findings nominate candidate mechanisms underlying sex differences in meniscal biology and OA susceptibility, and warrant validation in larger, sex-balanced cohorts. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=200 SRC="FIGDIR/small/740612v1_ufig1.gif" ALT="Figure 1"> View larger version (33K): org.highwire.dtl.DTLVardef@16026fforg.highwire.dtl.DTLVardef@1a048acorg.highwire.dtl.DTLVardef@3246corg.highwire.dtl.DTLVardef@4c598b_HPS_FORMAT_FIGEXP M_FIG C_FIG

Background and purpose: Patellofemoral pain syndrome (PFPS) is a multifaceted condition where proximal, local, and distal factors may contribute to symptoms and limitations. How these factors collectively contribute to PFPS remains poorly understood. Therefore, this study compared proximal, local, and distal mechanical characteristics between individuals with and without PFPS and investigated their association with pain intensity and functional disability. Methods: Eighty participants were included: 40 individuals with unilateral or bilateral PFPS, 40 healthy controls. Isometric muscle strength of hip, trunk, and ankle was assessed using a handheld dynamometer. Joint alignment (Q-angle, rearfoot angle, pelvic tilt) and muscle flexibility (iliotibial band, hamstrings, quadriceps, gastrocnemius, and soleus) were measured using standard clinical techniques. Pain severity was assessed using a visual analog scale (VAS), and functional disability was evaluated using the Kujala score. Results: Individuals with PFPS showed reduced iliotibial band flexibility, decreased hamstring and soleus length, lower hip abductor strength, and greater anterior and lateral pelvic tilt (all p < 0.02). Multivariate analysis identified reduced iliotibial band flexibility (OR = 7.48) and greater anterior pelvic tilt (OR = 11.75) as independent associates of PFPS. Anterior pelvic tilt predicted pain severity, while anterior trunk muscle strength and Q-angle predicted disability. Discussion: Reduced iliotibial band flexibility and increased anterior pelvic tilt were independently associated with PFPS, while anterior pelvic tilt predicted pain severity and anterior trunk muscle strength and Q-angle predicted functional disability. Clinical assessment and rehabilitation of PFPS should therefore extend beyond the knee to include iliotibial band flexibility, pelvic alignment, and trunk muscle strength.

Sensory neuropeptides, particularly Substance P (SP) and -calcitonin gene-related peptide (CGRP), are implicated in osteoarthritis (OA) pathogenesis. This study elucidates their specific roles in spontaneous, age-related OA. Male and female mice deficient in SP (Tac1-/-), CGRP (CGRP-/-), or both (DKO) were evaluated at 6, 12, and 18 months of age. Assessments included histological OARSI scoring for articular cartilage matrix structure, Luminex arrays for systemic serum cytokines, and flow cytometry for local synovial immune cell profiling. Wild type (WT) mice developed early-stage, age-related cartilage degradation, predominantly in the lateral compartment. Conversely, all neuropeptide-deficient strains exhibited significant structural protection against this process. Systemically, SP deficiency distinctly altered cytokine profiles (e.g., decreased IL-23, increased IP-10), whereas CGRP deficiency caused minimal systemic shifts, highlighting a disconnect between circulating markers and local joint preservation. Locally, flow cytometry revealed profound, sexually dimorphic, and age-dependent neuroimmune alterations. In young males, neuropeptide deficiency significantly reduced synovial macrophage counts to levels comparable to those of aged WT mice. Furthermore, male CGRP-/- mice exhibited an age-related accumulation of CD8+ cytotoxic T cells. In contrast to males, young WT females demonstrated higher baseline CD8+ T cell counts that declined with age, whereas these subpopulations remained persistently low in KO mice. SP and CGRP act as critical modulators of age-related cartilage degradation. Their absence provides robust structural protection mediated through highly localized, sexually dimorphic neuroimmune pathways. These findings emphasize the necessity of targeting the local joint microenvironment for future personalized, sex-specific OA therapies.