Diabetes mellitus (DM) involves metabolic changes that can impair bone repair, including a prolonged inflammatory response. A salicylic acid-based poly(anhydride-ester) (SA-PAE) provides controlled and sustained release of salicylic acid (SA) that locally resolves inflammation. This study investigates the effect of polymer-controlled SA release on bone regeneration in diabetic rats where enhanced inflammation is expected. Fifty-six Sprague-Dawley rats were randomly assigned to two groups: diabetic group induced by streptozotocin (STZ) injection or normoglycemic controls injected with citrate buffer alone. Three weeks after hyperglycemia development or vehicle injection, 5 mm critical sized defects were created at the rat mandibular angle and treated with SA-PAE/bone graft mixture or bone graft alone. Rats were euthanized 4 and 12 weeks after surgery, then bone fill percentage in the defect region was assessed by micro-computed tomography (CT) and histomorphometry. It was observed that bone fill increased significantly at 4 and 12 weeks in SA-PAE/bone graft-treated diabetic rats compared to diabetic rats receiving bone graft alone. Accelerated bone formation in normoglycemic rats caused by SA-PAE/bone graft treatment was observed at 4 weeks but not at 12 weeks. This study shows that treatment with SA-PAE enhances bone regeneration in diabetic rats and accelerates bone regeneration in normoglycemic animals.

We have previously shown that the transcription factor FOXO1 is elevated in conditions with high levels of bone resorption. To investigate the role of FOXO1 in the formation of osteoclasts we examined mice with lineage specific deletion of FOXO1 in osteoclast precursors and by knockdown of FOXO1 with siRNA. The receptor activator of NF-kappa B ligand (RANKL), a principal bone resorbing factor, induced FOXO1 expression and nuclear localization two days after stimulation in bone marrow macrophages (BMMs) and RAW264.7 osteoclast precursors. RANKL- induced osteoclast formation and osteoclast activity was reduced in half in vivo and in vitro with lineage specific FOXO1 deletion (LyzM.Cre+FOXO1L/L) compared to matched controls (LyzM.Cre−FOXO1L/L). Similar results were obtained by knockdown of FOXO1 in RAW264.7 cells. Moreover, FOXO1-mediated osteoclast formation was linked to regulation of NFATc1 nuclear localization and expression as well as a number of downstream factors including dendritic cell-specific transmembrane protein (DC-STAMP), ATP6vod2, cathepsin K and integrin αν Lastly, FOXO1 deletion reduced M-CSF induced RANK expression and migration of osteoclast precursors. Studies presented here provide the evidence that FOXO1 plays a direct role in osteoclast formation by mediating the effect of RANKL on NFATc1 and several downstream effectors. This is likely to be significant since FOXO1 and RANKL are elevated in osteolytic conditions.

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