Carboxymethyl chitosan reduces inflammation and promotes osteogenesis in a rabbit knee replacement model
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RESEARCH ARTICLE
Open Access
Carboxymethyl chitosan reduces inflammation and promotes osteogenesis in a rabbit knee replacement model Feng Liu1,2, Hai-Yan Li1, Zhen Wang1,3, Hai-Ning Zhang1, Ying-Zhen Wang1* and Hao Xu1*
Abstract Background: The major causes of failure after total knee arthroplasty (TKA) include prosthesis loosening and infection. This study aimed to investigate the role of carboxymethyl chitosan (CMC) in knee arthroplasty. Methods: A total of 20 New Zealand white rabbits that were divided into two groups (10 in the control group and 10 in the chitosan group) were included in the study. They underwent TKA surgery, and all were implanted with titanium rod prostheses; the prosthesis in the chitosan group was coated with CMC. After 12 weeks, all rabbits were euthanized, and the following analyses of some specific surface membrane tissues around the prosthesis were performed: X-ray analysis; micro-computed tomography scan; haematoxylin and eosin, Van Gieson, and Von Kossa staining; reverse transcription polymerase chain reaction; and Western Blotting. Results: The result of CCK8 test showed CMC can promote cell proliferation and increase cell viability. Radiological result showed better amount of bone deposits and more bone formation in the chitosan group. HE staining result showed CMC reduces inflammation around the prosthesis. The VG and Von Kossa staining results showed CMC can promote bone deposition around prosthesis. And according to the results of PCR and WB, the OCN content was higher in the chitosan group, while the MMPs content was lower. The chitosan group has an increased OPG/RANKL ratio than the control group. Conclusion: CMC can effectively inhibit the inflammatory response around the prosthesis and osteoclast activation and promote osteogenesis by interfering with the osteoprotegerin/receptor activator of nuclear factor kappa-Β ligand/receptor activator of nuclear factor kappa-Β signalling pathway. Keywords: Carboxymethyl chitosan, Knee arthroplasty, Inflammatory, Osteogenesis, Rabbit model
Background Artificial knee arthroplasty is an effective method for treating end-stage knee joint disease. Annually, millions of patients undergo this operation worldwide. Most patients have reconstructed joint function, which improves their quality of life [1]. The number of patients undergoing total knee arthroplasty (TKA) is increasing, * Correspondence: [email protected]; [email protected] 1 Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China Full list of author information is available at the end of the article
and revision surgeries are also consistently developing [2]. However, complications including pain and dysfunction are inevitable. Revision surgery is relatively expensive, increasing the patients’ medical burden. Moreover, revision surgery has less satisfactory results than the first TKA [3]. Therefore, decreasing the revision rate after the first TKA has become one of the most interesting topics in the field of joint surgery
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