Abstract

Background: Aseptic loosening of prosthesis (ALP) is one of the most common long-term complications of knee and hip arthroplasty. Wear particle-induced osteoclastogenesis and subsequent periprosthetic osteolysis account for the morbidity of ALP. Here, we investigate the potential of cimifugin (CIM), a natural extract from Cimicifuga racemosa and Saposhnikovia divaricata, as a bone-protective drug in the treatment of ALP. Method: First, we performed cell viability and osteoclast formation assays to assess the effect of noncytotoxic CIM on osteoclast differentiation in vitro. Bone slice resorption and F-actin ring immunofluorescence assays were adopted to assess the effects of CIM on bone-resorption function. Then, quantitative real-time polymerase chain reaction (qRT–PCR) analysis was performed to further assess the repressive effects of CIM on osteoclastogenesis at the gene expression level. To elucidate the mechanisms underlying the above findings, Western blot and luciferase reporter gene assays were used to assess the regulatory effects of CIM on the NF-κB and MAPK signaling pathways. Moreover, a Ti particle-induced murine calvarial osteolysis model and subsequent histomorphometric analysis via micro-CT and immunohistochemical staining were used to elucidate the effect of CIM on periprosthetic osteolysis in vivo. Result: CIM dose-dependently inhibited both bone marrow-derived macrophage (BMM)- and RAW264.7 cell-derived osteoclastogenesis and bone resorption pit formation in vitro, which was further supported by the reduced expression of F-actin and osteoclast-specific genes. According to the Western blot analysis, inhibition of IκBα phosphorylation in the NF-κB signaling pathway, not the phosphorylation of MAPKs, was responsible for the suppressive effect of CIM on osteoclastogenesis. Animal experiments demonstrated that CIM alleviated Ti particle-induced bone erosion and osteoclast accumulation in murine calvaria. Conclusion: The current study suggested for the first time that CIM can inhibit RANKL-induced osetoclastogenesis by suppressing the NF-κB signaling pathway in vitro and prevent periprosthetic osteolysis in vivo. These findings suggest the potential of CIM as a therapeutic in ALP.

Highlights

  • With the development of prosthesis design and minimally invasive procedures, arthroplasty has become one of the most reliable surgical procedures to treat stubborn diseases, such as severe osteoarthritis, developmental hip dysplasia, femoral neck fractures, rheumatoid arthropathy, and ankylosing spondylitis

  • Excessive RANKL triggers the formation of osteoclasts by binding to the receptor activator of nuclear factor κ B (RANK) located on the surface of the cell membrane and produces an initial signal to recruit TNF receptorassociated factor 6 (TRAF6) (Walsh et al, 2015)

  • The results suggested that CIM at concentrations greater than 640 μM significantly reduced the number of osteoclast precursors, while CIM at concentrations below 320 μM did not, indicating a noncytotoxic threshold of 320 μM for the subsequent osteoclast formation assays (Figure 1B)

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Summary

Introduction

With the development of prosthesis design and minimally invasive procedures, arthroplasty has become one of the most reliable surgical procedures to treat stubborn diseases, such as severe osteoarthritis, developmental hip dysplasia, femoral neck fractures, rheumatoid arthropathy, and ankylosing spondylitis. Research suggests that approximately 5% of patients develop aseptic loosening of prosthesis (ALP) after undergoing arthroplasty and require complicated revision surgeries (Goodman and Gallo, 2019). Excessive RANKL triggers the formation of osteoclasts by binding to the receptor activator of nuclear factor κ B (RANK) located on the surface of the cell membrane and produces an initial signal to recruit TNF receptorassociated factor 6 (TRAF6) (Walsh et al, 2015). The wear debris-induced inflammatory response and pathological formation of osteoclasts in periprosthetic tissues play pivotal roles in the occurrence of ALP. Aseptic loosening of prosthesis (ALP) is one of the most common long-term complications of knee and hip arthroplasty. We investigate the potential of cimifugin (CIM), a natural extract from Cimicifuga racemosa and Saposhnikovia divaricata, as a bone-protective drug in the treatment of ALP

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