Abstract
Chronic and acute tendinopathies are difficult to treat and tendon healing is generally a very slow and incomplete process and our general understanding of tendon biology and regeneration lags behind that of muscle or bone. Although still largely unexplored, several studies suggest a positive effect of nutritional interventions on tendon health and repair. With this study, we aim to reveal effects of a high-glucose diet on tendon neoformation in a non-diabetic rat model of Achilles tenotomy. After surgery animals received either a high-glucose diet or a control diet for 2 and 4 weeks, respectively. Compared to the control group, tendon repair tissue thickness and stiffness were increased in the high-glucose group after 2 weeks and gait pattern was altered after 1 and 2 weeks. Cell proliferation was up to 3-fold higher and the expression of the chondrogenic marker genes Sox9, Col2a1, Acan and Comp was significantly increased 2 and 4 weeks post-surgery. Further, a moderate increase in cartilage-like areas within the repair tissue was evident after 4 weeks of a high-glucose diet regimen. In summary, we propose that a high-glucose diet significantly affects tendon healing after injury in non-diabetic rats, potentially driving chondrogenic degeneration.
Highlights
Tendon injuries are caused by a variety of intrinsic and extrinsic factors such as insufficient loading, local inflammation and individual factors like age[1, 2]
It is well known that appropriate nutrition is important for physiological wound healing to occur in various tissues and adequate amounts of glucose are mandatory for providing energy for angiogenesis and deposition of new tissue[20, 21]
With this study we show for the first time that nutritional glucose significantly affects tendon healing in a non-diabetic rat model
Summary
Tendon injuries are caused by a variety of intrinsic and extrinsic factors such as insufficient loading, local inflammation and individual factors like age[1, 2]. Hyperosmolar dextrose solutions together with an anaesthetic are often injected into or alongside tendons and ligaments aiming at reducing chronic pain and to stimulate cell proliferation and extracellular matrix (ECM) deposition by inducing an inflammatory response[14]. This increasingly popular treatment for a wide range of musculoskeletal pathologies is deemed safe, evidence to support the effectiveness of this so-called prolotherapy is limited as only few randomised controlled clinical trials have been conducted[15]. Our findings reveal that a high-glucose diet has a favourable effect on cell proliferation and ECM deposition within the newly formed tissue, potentially increases the risk of chondroid degeneration in injured tendons
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