Influence of gait analysis on decision-marketing for lower extremity surgery

Tendon collagen turnover-related genes in cerebral palsy

N PORTINARO A, N GAGLIANO B, F PELILLO A, V GASPARRONI C,
O PICCOLINI D, M GIOIA A

  1. 1. Department of Pediatric Orthopaedic Surgery, Istituto Clinico Humanitas, Rozzano;
  2. 2. Department of Human Morphology, University of Milan;
  3. 3. Department of Physical Medicine and Rehabilitation, Istituto Clinico Humanitas, Rozzano;
  4. 4. Neonatal Intensive Care Unit, Department of Neonatology, Fondazione IRCCS Policlinico, Mangiagalli e Regina Elena, Milan, Italy

Background: In cerebral palsy (CP), spasticity alters the magnitude and frequency of mechanical loads on tendons. The tendon connective tissue responds to mechanical loading by modifying some of its metabolic, morphological, and biomechanical properties. We investigated the relationship between spasticity and tendon collagen turnover in CP tendon samples, collagen being the major tendon extracellular matrix component.

Objective: To analyze the effect of spasticity on tendon homeostasis.

Participants: Participants were divided into three experimental groups: healthy control (CT; n=2; one male, one female; mean age 18y6mo [SD 8mo]; non-walking quadriplegic (n=7; three males four females, mean age 15y 11mo [SD 3y 5mo]); and ambulant patients with diplegia (n=3; two males and one female; mean age 16y [SD 3y 5mo]).

Method: Tendon fragments were obtained during tendon lengthening procedures. In each group the ipsilateral gracilis and semitendinosus muscle tendons were processed. Gene expression for collagen type I (COL-I); matrix metalloproteinase 1 (MMP-1); long lysyl hydroxylase 2 (LH2b); and secreted protein acidic and rich in cysteine (SPARC) were analyzed by real-time polymerase chain reaction.

Results: COL-I was highly up-regulated in both quadriplegic and diplegic tendons, compared with CT tendons. MMP-I was expressed 4 to 8-fold in quadriplegic tendons, compared with diplegic and normal samples. LH2b mRNA levels tended to be higher in quadriplegic tendons. SPARC tended to be up-regulated in CP samples, compared with CT, and at higher extent in semitendinosus compared with GR tendons.

Conclusions: Tendon collagen turnover depends on adaptation  to mechanical loading, and is determined by the finely tuned dynamic balance between collagen synthesis and degradation by MMPs, playing a key role also in determining tendon strength. Our results suggest that gene expression profiles are quite different in normal from CP quadriplegic and diplegic tendons. In particular, CP tendons seem to experience a higher collagen turnover and extracellular matrix remodeling.

Acknowledgements: The authors would like to thank the Ariel Foundation for their financial support.

 
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