osteoarthritis

Cartilage targeting exosomes for OA gene therapy and pain treatment

Project Summary Gene therapy has the potential to facilitate targeted expression of therapeutic proteins to promote cartilage regeneration in osteoarthritis (OA). The dense, avascular, aggrecan-glycosaminoglycan rich negatively charged cartilage, however, hinders their transport to reach chondrocytes in effective doses. While viral vector mediated gene delivery has shown promise, concerns over immunogenicity and tumorigenic side-effects persist. To address this, we have developed surface-modified cartilage-targeting MSC exosomes as non-viral carriers for gene therapy. MSC derived exosomes have intrinsic therapeutic potential as they can induce cartilage repair and are non-immunogenic, making them desirable for gene delivery. We have engineered charge-reversed cationic exosomes by anchoring cartilage targeting optimally charged arginine-rich cationic peptide (CPC) motifs into the anionic exosome bilayer (Exo-CPC) by using buffer pH as a charge-reversal switch. Exo-CPC use charge interactions to penetrate through the full thickness of arthritic cartilage (close to tidemark) and deliver the packaged genetic material cargo to chondrocytes residing in the deep tissue layers while native anionic exosomes cannot. They can also bind within the synovial joint, making them effective for OA pain relief gene therapy. Here we will engineer charge-reversed Exo-CPC for delivery of IL-1RA (receptor antagonist of interleukin-1) mRNA and NaV1.8 (voltage gated sodium channel 1.8) inhibitor siRNA to stimulate both disease modifying response and long-term pain relief with a one-time intra-articular dose. IL-1RA mRNA targets are in the chondrocytes and synovium cells; Nav1.8 expressing nerves innervate into synovium and subchondral bone in OA – sites that Exo-CPC can readily target. Aim 1 will engineer cartilage targeting Exo-CPC for delivery of IL- 1RA mRNA and Nav1.8 inhibitor siRNA. Their ability to deliver IL-1RA mRNA to chondrocytes and IL-1RA protein translation efficiency will be evaluated in-vitro. Exo-CPC-Na v1.8’s ability to reduce NaV1.8 bioactivity of sensory nerves will also be evaluated. In Aim 2, their distribution intra-articular (proximity to NaV1.8-positive nerves), extra-articular, and DRG and spinal cord using partial meniscectomy NaV1.8-tdTomato reporter mice OA models will be evaluated. Additionally, their dose dependent reduction on MMP activity, neuronal excitability and pain- related behaviors, and any immunogenicity will be assessed. Aim 3 will use the determined functional doses to study the long-term disease modifying and pain-relief effects of mono and combination therapy with Exo-CPC- IL-1RA and Exo-CPC-Nav1.8 in rescuing injury induced tissue structural damage as well as in reducing pain (weight bearing asymmetry) for up to one month following IA administration in early vs. late stages (intervention at 2 vs 6 weeks) of MMT (medial meniscectomy) induced OA rats. The project paves way for utilizing the intrinsic therapeutic potential of MSC Exosomes as viral-free, non-immunogenic carriers for OA gene therapy by employing cartilage as a drug depot. Cationic exosomes can be used to deliver other OA gene targets, and can be widely used for targeting other negatively charged tissues like meniscus, ligaments, discs, fracture callus etc.

Biostatistics, Ethics, Data Management, Research Design and Community Engagement(BEDRoC) Core

Biostatistics, Ethics, Data Management, Research Design and Community Engagement (BEDRoC) Core Abstract The Biostatistics, Ethics, Data Management, Research Design and Community Engagement (BEDRoC) Core will promote and support aging with serious illness science for the Center for Aging with Serious Illness (CASI). BEDRoC will provide expertise in statistical design and analysis, research ethics, and community engagement for all components of CASI. The Core's services will support the Research Project Leaders (RPLs) and Pilot Project Leaders (PPLs) and build capacity for the broader Dartmouth Health aging research community to conduct rigorous, impactful research to inform and improve care delivery for older adults with serious illness. BEDRoC includes expertise in mixed methods approaches that feature both quantitative and qualitative research methods to provide a comprehensive understanding of the complex issues related to aging with serious illness, ethical approaches to consent in research trials, multidimensional quality of life measurement, and innovative modeling approaches to studying clinical decision making. BEDRoC faculty have actively collaborated in study planning with each RPL, serving as both mentors and experienced collaborators on the three different projects involving decision aids for patients considering carotid revascularization, a patient-reported outcome-directed referral intervention to improve referral rates to palliative care services, and a pilot trial for a virtual/home-based exercise and a weight management osteoarthritis treatment program in older patients with osteoarthritis and multimorbidity. The BEDRoC Core will further support CASI by establishing an innovative training curriculum with workshops, tutorials, resources, and services, offered locally to RPLs and PPLs and extended to regional and national investigators in the IDeA network. In addition to their primary individual project mentors, each RPL will receive training and guidance from BEDRoC leaders through co-mentoring and RPL-focused works-in-progress sessions. BEDRoC will also provide access to a comprehensive inventory of patient-reported outcomes instruments, which are crucial in geriatric research to provide validated measures of health status, quality of life and functional ability outcomes. BEDRoC will coordinate with the Administrative and Mentoring Core to integrate community advisors in guiding their activities in support of the RPLs. BEDRoC will also enable research collaboration with and within the larger Dartmouth and IDeA investigator communities. The BEDRoC Core will build capacity for aging research and disseminate new resources to RPLs and PPLs, including innovative solutions created through robust community engagement. These services, resources, and solutions will ensure all projects operate in a cohesive, complementary, and collaborative manner to study approaches to improving the health of older patients with serious illness.

Temporomandibular Joint Disc Replacement: Biomechanical Characterization and Novel Implant Assessment

Project Summary/Abstract Temporomandibular joint (TMJ) disorders inflict approximately 5% to 12% of the population. For advanced disorders of the articular TMJ disc, which typically do not respond to conservative treatments, disc resection is the most common surgical intervention. However, the TMJ disc plays a critical role in distributing mechanical stress and preventing wear to the articular surfaces of the joint. Thus, removing the disc can further disrupt joint homeostasis, driving degeneration and the development of osteoarthritis, which can lead to highly invasive and challenging surgical interventions such as joint reconstructions and total joint replacement. Therefore, there is a critical need for disc replacements that can restore the homeostasis of the joint when disc resection is required. Prior attempts at replacing the disc with alloplastic implants have led to deleterious pathological changes related to wear debris, implant fragmentation, and adverse inflammatory responses. Therefore, it is crucial to consider wear, mechanical strength, and biocompatibility of disc replacement materials in the context of long-term cyclic loading in the TMJ. Accordingly, the objective of this proposal is to create an artificial TMJ disc that replaces the mechanical function of the native disc and prevents subsequent degeneration of the joint. Towards this goal, the proposed research will characterize the mechanical loading environment of the TMJ in order to determine the mechanical criteria of a TMJ disc replacement needed to minimize internal stress in the joint (Specific Aim 1). Further, non-resorbable composite hydrogels will be fabricated using biocompatible materials, refined to exhibit biomimetic properties, and molded into a TMJ disc implant. Rigorous mechanical evaluations will determine material durability and suitability as a TMJ disc replacement (Specific Aim 2). Finally, a large animal study will be utilized to evaluate the safety and efficacy of the developed TMJ disc replacement (Specific Aim 3). Successful completion of the proposed work would represent a paradigm shift in the treatment of TMJ disc disorders that can mitigate further joint degeneration and prevent more invasive and complicated surgeries.

Mechanisms of age-related inflammatory dysregulation in the pathogenesis of periodontal disease

Periodontal disease is a chronic inflammatory condition that affects the supporting tissues of the dentition. Similar to other chronic inflammatory conditions, the prevalence of periodontal disease increases with age. Dysregulation of the host inflammatory response is central to the pathogenesis of periodontal disease and other age-related diseases. Therefore, an improved understanding of the pathologic mechanisms that contribute to age-related inflammatory dysregulation is needed to better manage periodontal disease in older adults. Towards understanding a mechanism of age-related inflammatory dysregulation in periodontal disease, we will investigate the role of triggering receptor expressed on myeloid cells 2 (TREM2). TREM2 is a potent immunoregulator expressed on macrophages. Signaling through TREM2 downregulates inflammation, in part, through inhibition of inflammatory cytokine expression. Dysregulation of TREM2 has been implicated in chronic inflammatory disease and age-related conditions, such as Alzheimer’s disease, liver disease, and osteoarthritis. However, the role of TREM2 in periodontal disease is understudied. Therefore, we propose to study TREM2 in the pathogenesis of periodontal disease and age-related inflammatory dysregulation. Our preliminary work has demonstrated that TREM2 is critical in macrophage immunoregulatory processes in the periodontium and TREM2 dysregulation contributes to periodontal disease in mice. We have shown that Trem2 is expressed in macrophages isolated form the periodontium in mice. We demonstrated that old mice expressed less Trem2 in the periodontium compared to young, which was associated with local inflammatory dysregulation and increased periodontal disease severity. Interestingly, Trem2 depletion in young mice resulted in increased inflammatory dysregulation and periodontal disease severity, similar to what is observed in old mice. From the preliminary data, we hypothesize that TREM2 modulates macrophage activity in the periodontium and age-related dysregulation of TREM2 drives a pathologic inflammatory response in periodontal disease. In Aim 1, we will demonstrate the extent to which TREM2 modulates inflammation and periodontal disease severity using old, young, and Trem2-/- mouse models of periodontal disease. In Aim 2, we will develop tissue-specific, single cell map of the immune cells in the periodontium and understand the effect of age and Trem2 on immune cell phenotypes and subpopulations. Findings from this proposal will elucidate a novel mechanism in age-related inflammatory dysregulation in the pathogenesis of periodontal disease and further advance our understanding of the role of TREM2 within oral tissues. This proposal was designed to generate a novel body of work that will be used to develop the independent research program of an early stage investigator and to support an R01 proposal to be submitted at the completion of this project period.

Bedside to bench and back again, a path to translational pain research?

Pain has both a sensory and emotional component and is driven by activation of sensory neurones called nociceptors that are tuned to detect noxious stimuli in a process called nociception. Although nociception functions as a detect and protect mechanism. and is found in many organisms, this system becomes dysregulated in a number of conditions where chronic pain presents as a key symptom, for example osteoarthritis. Nociceptors do not innervate empty space though and do not act alone. Going beyond the neurone, other cell types, such as fibroblast-like synoviocytes interact with and modify the function of nociceptors, which is likely a key contributor to the chronification of pain. In this talk, I will look at how combining pre-clinical mouse work with human tissue and genetics might provide a way to accelerate new analgesics from bench to bedside, giving examples from our work in joint pain, bowel pain and labour pain.

Evaluation of TACAN as a new target for treating osteoarthritis pain