Fibrinolysis is essential for fracture repair and prevention of heterotopic ossification

被引:75
作者
Yuasa, Masato [1 ,2 ]
Mignemi, Nicholas A. [1 ,3 ]
Nyman, Jeffry S. [1 ,4 ,5 ,6 ]
Duvall, Craig L. [4 ]
Schwartz, Herbert S. [1 ,3 ]
Okawa, Atsushi [2 ]
Yoshii, Toshitaka [2 ]
Bhattacharjee, Gourab [7 ]
Zhao, Chenguang [7 ]
Bible, Jesse E. [1 ]
Obremskey, William T. [1 ]
Flick, Matthew J. [8 ]
Degen, Jay L. [8 ]
Barnett, Joey V. [9 ]
Cates, Justin M. M. [3 ]
Schoenecker, Jonathan G. [1 ,3 ,5 ,9 ,10 ]
机构
[1] Vanderbilt Univ, Med Ctr, Dept Orthopaed, Nashville, TN USA
[2] Tokyo Med & Dent Univ, Dept Orthopaed Surg, Tokyo, Japan
[3] Vanderbilt Univ, Med Ctr, Dept Pathol, Nashville, TN 37232 USA
[4] Vanderbilt Univ, Med Ctr, Dept Biomed Engn, Nashville, TN USA
[5] Vanderbilt Univ, Med Ctr, Ctr Bone Biol, Nashville, TN USA
[6] Tennessee Valley Healthcare Syst, Dept Vet Affairs, Nashville, TN USA
[7] ISIS Pharmaceut Inc, Carlsbad, CA USA
[8] Cincinnati Childrens Hosp Med Ctr, Div Expt Hematol & Canc Biol, Cincinnati, OH 45229 USA
[9] Vanderbilt Univ, Med Ctr, Dept Pharmacol, Nashville, TN 37232 USA
[10] Vanderbilt Univ, Med Ctr, Dept Pediat, Nashville, TN 37232 USA
关键词
TRAUMATIC BRAIN-INJURY; SPINAL-CORD-INJURY; PLASMINOGEN DEFICIENCY; CARDIOVASCULAR-DISEASE; IN-VIVO; CIGARETTE-SMOKING; BONE-FORMATION; MICE; FIBRINOGEN; ANGIOGENESIS;
D O I
10.1172/JCI80313
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Bone formation during fracture repair inevitably initiates within or around extravascular deposits of a fibrin-rich matrix. In addition to a central role in hemostasis, fibrin is thought to enhance bone repair by supporting inflammatory and mesenchymal progenitor egress into the zone of injury. However, given that a failure of efficient fibrin clearance can impede normal wound repair, the precise contribution of fibrin to bone fracture repair, whether supportive or detrimental, is unknown. Here, we employed mice with genetically and pharmacologically imposed deficits in the fibrin precursor fibrinogen and fibrin-degrading plasminogen to explore the hypothesis that fibrin is vital to the initiation of fracture repair, but impaired fibrin clearance results in derangements in bone fracture repair. In contrast to our hypothesis, fibrin was entirely dispensable for long-bone fracture repair, as healing fractures in fibrinogen-deficient mice were indistinguishable from those in control animals. However, failure to clear fibrin from the fracture site in plasminogen-deficient mice severely impaired fracture vascularization, precluded bone union, and resulted in robust heterotopic ossification. Pharmacological fibrinogen depletion in plasminogen-deficient animals restored a normal pattern of fracture repair and substantially limited heterotopic ossification. Fibrin is therefore not essential for fracture repair, but inefficient fibrinolysis decreases endochondral angiogenesis and ossification, thereby inhibiting fracture repair.
引用
收藏
页码:3117 / 3131
页数:15
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