Effect of acetaminophen and nonsteroidal anti-inflammatory drugs on gene expression of human mesenchymal stem cells

A major drawback of cartilage tissue engineering is that human mesenchymalStem cells (MSCs) from patients with osteoarthritis (OA) express high levels of type X collagen. Type X collagen is a marker of late stage chondrocyte hypertrophy, linked with endochondral ossification. Also, MSCs from OA patients express osteogenic marker genes such as alkaline phosphatase (ALK), bone sialoprotein (BSP), and osteocalcin (OC) as well as aggrecan (ACAN), a marker of chondrogenesis, but not type II collagen. OA patients, in an attempt to relieve pain and other symptoms, often take NSAIDs and pain relievers like acetaminophen. The aim of this present study was to determine how these drugs influence human MSC gene expression of different chondrogenic and osteogenic markers. MSCs isolated from the bone marrow of osteoarthritic patients or from normal donors were cultured in Dulbecco's Modified Eagle Medium (DMEM) supplemented with 10% fetal bovine serum (FBS) without or with Acetaminophen (Acet) or non-steroidal anti-inflammatory drugs (NSAIDs), Ibuprofen (Ibu), Diclofenac (Dic), Naproxen (Npx) and Celecoxib (Cele). After 3 days of culture, the cells were collected and gene expression was measured using quantitative PCR for type X collagen (COL10A1), aggrecan (ACAN) and type 1 collagen，as well as osteogenic marker genes such as alkaline phosphatase (ALP), bone sialoprotein (BSP), osteocalcin (OC) and Runt-related transcription factor 2 (RUNX2). Acet and Npx supplementation led to a significant increase in COL10A1 & RUNX2 expression when compared to control. Furthermore, with Ibu, Acet and Npx supplementation, aggrecan message levels were decreased. In contrast, addition of Cele significantly increased aggrecan gene expression. Finally, Ibu, Acet and Npx decreased type I collagen expression while Cele had a tendency to increase type I collagen expression. The present study showed that NSAIDs and Acet could affect Osteogenic and chondrogenic differentiation of human MSCs. These are features that could interfere with intervertebral disc (IVD) or cartilage repair. Thus, caution must be exercised when using MSCs from OA patients in biological repair of articular cartilage or disc.Un des principaux problèmes de l'ingénierie tissulaire du cartilage réside dans le fait que les cellules souches mésenchymateuses humaines (hCSMs) de patients osteoarthritiques (OA) expriment fortement le collagène de type X (Col X) qui est un marqueur de l'hypertrophie des chondrocvytes, hypertrophie qui est associée à l'ossification. Les hCSMs de patients OA expriment également des marqueurs de l'ostéogénèse tels que la phosphatase alcaline (ALK), une sialoprotéine de l'os (BSP) et l'ostéocalcine (OC), ainsi que l'aggrécane (AGG), un marqueur de la chondrogenèse. Dans le but de diminuer la douleur et autres symptômes reliés à leur maladie, les patients OA consomment des drogues anti-inflammatoires non-stéroïdiennes (NSAIDs). Le but de la présente étude était de déterminer si ces drogues pouvaient influencer l'expression de gènes associés à la chondrogenèse ou à l'ostéogénèse dans les hCSMs. Les CSMs isolées de la moelle osseuse de patients OA ou de donneurs normaux ont été cultivées dans du milieu Eagle modifié selon Dulbecco (DMEM) supplémenté avec 10% de sérum de veau fétal (SVF), sans ou avec Acétominophène (Acét), Ibuprofène (Ibu), Dichlorofenac (Dic), Naproxen (Npx) et Célécoxib (célé). L'expression des marqueurs ostéogéniques et du Col X a été mesurée par PCR quantitatif après 3 jours en culture. Les résultats montrent que l'Acét et le Npx induisaient significativement l'expression du Col X et diminuaient, tout comme l'Ibu, l'expression de l'AGG et du Col de type I (Col I). Cependant, Célé stimulait de façon significative l'expression de l'AGG et inhibait, mais de façon non significative, l'expression du Col I. En résumé, la présente étude montre que les NSAIDs peuvent moduler l'expression de gènes associés à l'ostéogénèse et à la chondrogenèse dans les hCSMs, indiquant qu'ils pourraient interférer dans la réparation du cartilage. L'utilisation de hCSMs de patients OA devrait donc être faite avec prudence pour la réparation biologique du cartilage articulaire et même du disque intervertébral

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population