BCCMA: Targeting Osteoarthritis Pain and Progression: Defining biologic and inflammatory markers associated with rapid progression

1膝关节骨关节炎(OA)是世界范围内导致残疾的主要原因。中国的疾病发展 退伍军人的发病年龄要比#年的人口年轻得多，人数也比#年高得多。 3一般。目前还没有治疗骨关节炎的药物(DMOAD) 4将历史重点放在识别和跟踪放射学OA结果上，而不是 5放射学前骨性关节炎的细胞和分子疾病途径。TOPP协作优势 6综述将检验这一中心假设，即骨性关节炎疼痛和结构进展的异质性 7与骨性关节炎的“免疫病程类型”有关，这种“免疫病程类型”是由细胞和 8骨、软骨和滑膜对炎症和关节力学的分子反应 9环境。主要的具体目标是：目标1：提高对 10骨关节炎(OA)的发病机制，使制定有针对性的早期治疗 11种方法；目标2：为新的治疗靶点建立临床前和临床数据 12减轻疼痛，防止骨性关节炎进展。实现这些目标需要相互补充 13和我们的协作优势--聘用早期和晚期骨性关节炎临床队列 14在VAHCS和关节损伤动物模型中流行以确定OA的免疫病理类型 15并测试新的治疗方法。这个特殊的项目将建立一个队列 16例无明显X线征象的退行性骨性关节炎 17个半月板撕裂(DMT)以确定关节镜下部分切除术后疼痛和进展的预测因素 半月板切除术(APM)18例。退行性半月板撕裂(DMT)从中年开始很常见。 19岁，可发生在没有明显的膝关节骨关节炎的情况下。越来越多的证据也 20提示DMT可能是膝关节向OA表型转变的信号。类似于办公自动化 据报道，DMT患者的临床结果具有很高的变异性。 22无论治疗是物理治疗、APM还是假手术。我们 23假设DMT的APM治疗后的可变结果与是否 24关节生物学已转为OA表型。该项目旨在通过以下方式验证这一假设 25确定退伍军人2年后膝关节疼痛和结构进展的生物学预测因素 26例症状性DMT合并APM治疗。这项研究的目标1将测试术前滑膜 27由我们的初步数据和以前的工作支持的OA生物标志物的液体水平(C2C，C12C， 28 COMP和CS846)预测DMT患者2年内的膝关节疼痛和结构进展 29在APM之后。AIM 2将测试手术前血清生物标记物是否与骨性关节炎疼痛有关 30我们的初步数据(IL-4、IL-13和IL-17E)可以预测膝关节疼痛和结构进展2 在APM之后的31年。AIM 3将测试术前尿uCTXII和uCTXIIa水平是否能预测膝关节 32在APM后2年，我们的DMT队列中有疼痛和结构进展。实现这一目标 33提案将贡献新的信息，对定义免疫病理类型和 34个早期人类骨性关节炎的生物标志物。完成这个项目还将有助于确定DMT是否 具有骨性关节炎生物学特征的35名患者包括一个新的早期骨性关节炎队列，该队列流行于 36种VAHC适合临床试验，评估新的治疗策略以预防或延迟 37起致残性骨性关节炎。这些结果支持最重要的假设和目标 38 TOPP协作功绩审查，具有改善大型护理的高潜力 39患有膝骨性关节炎的退伍军人和普通公众人数。

1 Knee osteoarthritis (OA) is a leading cause of disability worldwide. Disease development in 2 Veterans occurs at significantly younger ages and at higher numbers than the population in 3 general. Currently there are no disease modifying anti-osteoarthritis drugs (DMOAD) due in part 4 to a historical focus on identification and tracking of radiographic OA outcomes rather than 5 cellular and molecular disease pathways in pre-radiographic OA. The TOPP Collaborative Merit 6 Review will test the central hypothesis that heterogeneity in OA pain and structural progression 7 is related to the “immune pathotype” of OA, which arises from the variability in the cellular and 8 molecular responses of bone, cartilage, and synovium to inflammation and joint mechanical 9 environment. The overarching Specific Aims are: Aim 1: To improve understanding of 10 osteoarthritis (OA) pathogenesis to enable development of targeted early treatment 11 approaches; and Aim 2: To establish preclinical and clinical data for new therapeutic targets to 12 reduce pain and prevent OA progression. Achieving these Aims requires the complementary 13 and synergistic expertise of our Collaborative Merit to employ early and late OA clinical cohorts 14 prevalent in the VAHCS and joint injury animal models to define the immune pathotypes of OA 15 and to test novel therapeutic approaches. This particular project will establish a cohort of 16 patients without significant signs of radiographic OA who suffer from symptomatic degenerative 17 meniscus tears (DMT) to identify predictors of pain and progression after arthroscopic partial 18 meniscectomy (APM). Degenerative meniscus tears (DMT) are prevalent starting in middle age 19 and can occur in the absence of significant radiographic knee OA. Growing evidence also 20 suggests that the DMT may signal transition of the knee to an OA phenotype. Similar to OA 21 treatment, clinical outcomes for DMT patients have been reported to be highly variable 22 irrespective of whether treatment is with physical therapy, APM, or sham surgery. We 23 hypothesize that the variable results following APM treatment of DMT are related to whether 24 joint biology has switched to an OA phenotype. This project aims to test this hypothesis by 25 identifying biological predictors of knee pain and structural progression in Veterans 2 years after 26 treatment of symptomatic DMT with APM. Aim 1 of this study will test if preoperative synovial 27 fluid levels of OA biomarkers supported by our preliminary data and prior work (C2C, C1,2C, 28 COMP and CS846) predict knee pain and structural progression in DMT patients 2 years 29 following APM. Aim 2 will test if preoperative serum biological markers implicated in OA pain by 30 our preliminary data (IL-4, IL-13, and IL-17E) predict knee pain and structural progression 2 31 years after APM. Aim 3 will test if preoperative levels of urine uCTXII and uCTXIIa predict knee 32 pain and structural progression in our DMT cohort 2 years after APM. Achieving the Aims of this 33 proposal will contribute new information important to defining immune pathotypes and 34 biomarkers of early human OA. Completing this project will also help determine whether DMT 35 patients with biological signatures of OA comprise a novel early OA cohort prevalent within the 36 VAHCS suitable for clinical trials evaluating new treatment strategies to prevent or delay the 37 onset of disabling OA. These outcomes support the overarching hypothesis and Aims of the 38 TOPP Collaborative Merit Review and have high potential to improve the care of the large 39 number of Veterans and members of the general public who suffer from knee OA.