Changes in the expression of matrix extracellular genes and TGFB family members in rotator cuff tears
Paulo Santoro BelangeroEduardo Antônio de FigueiredoCarina CohenFelipe de Seixas AlvesWânia Hiromi YanaguizawaMarı́lia de Arruda Cardoso SmithCarlos Vicente AndreoliAlberto de Castro PochiniMaria Teresa de Seixas AlvesBenno EjnismanMoisés CohenMariana Ferreira Leal
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ABSTRACT Lack of synthesis of extracellular matrix compounds may contribute to degeneration of the tendons. Thus, we aimed to evaluate the expression of extracellular matrix and TGFB family members in ruptured and non‐ruptured tendons of the rotator cuff, as well as the effect of clinical factors on gene expression in tendon samples, and the relationship between histological findings and altered gene expression. Injured and non‐injured supraspinatus tendon samples and subscapular non‐injured tendon samples were collected from 38 patients with rotator cuff tears. Non‐injured supraspinatus tendons were obtained from eight controls. Specimens were used for histological evaluation, quantification of collagen fibers, and mRNA and protein expression analyses. Increased COL1A1 , COL1A2 , COL3A1 , COL5A1 , FN1 , TNC , and TGFBR1 mRNA expression was observed in the tear samples ( p < 0.05). Duration of symptoms was correlated with the levels of collagen type I/III fibers ( p = 0.032; ρ = 0.0447) and FN1 immunostaining ( p = 0.031; ρ = 0.417). Smoking was associated with increased frequency of microcysts, myxoid degeneration, and COL5A1 , FN1 , TNC , and TGFB1 mRNA expression ( p < 0.05). FN1 immunostaining was correlated with the number of years of smoking ( p = 0.048; ρ = 0.384). Lower levels of collagen type I/III fibers were detected in samples with fissures (0 = 0.046). High frequency of microcysts was associated with increased COL5A1 , FN1 , and TNC expression ( p < 0.05, for all comparisons). Neovascularization was associated with reduced FN1 ( p = 0.035) and TGFBR1 expression ( p = 0.034). Our findings show differential expression of matrix extracellular genes and TGFB family members in the degeneration process involved in rotator cuff tears. These molecular alterations are influenced by clinical factors. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2542–2553, 2018.Keywords:
Immunostaining
Matrix (chemical analysis)
Rotator cuff tears are a frequent phenomenon with an increasing incidence when the patient gets older. A considerable number of tears remain asymptomatic during a lifetime. However, still, a substantial number of asymptomatic tears become symptomatic. There is, at present evolving evidence that surgical treatment of small to medium-sized tears does better than conservative treatment, even after a long term follow-up. A treatment algorithm is suggested to help the clinician in decision making, where tear size and age are important factors in the prognosis of surgical treatment. Keywords: Rotator cuff; Ruptures; Natural historyf tears; Partial rotator cuff tears; Subscapularis tears; Geometric Classification; Arthroscopic Classification; Rotator cuff retraction; Rotator cuff tendon quality; Prognosis for Rotator Cuff tears.
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