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Background Rotator cuff tears (RCTs) are among the most common musculoskeletal disorders that affect quality of life. This study aimed to investigate the efficacy of ginsenoside Rb1 in RCTs and the mechanisms involved. Methods First, a fibrotic model of FAPs was induced, and FAPs were cultured in media supplemented with different concentrations of ginsenoside Rb1. Next, a rat model of RCTs was constructed and treated with ginsenoside Rb1. Molecular docking was subsequently utilized to detect the binding of ginsenoside Rb1 and SFRP1. Finally, SFRP1 was knocked down and overexpressed in vivo and in vitro to investigate the mechanism of ginsenoside Rb1 and SFRP1 in RCTs. Results Compared with the Normal group, FAP viability was decreased, but Collagen II, FN and α-SMA levels were increased in the Control group. After treatment with different concentrations of ginsenoside Rb1, FAP viability increased, but Collagen II, FN and α-SMA levels decreased. Among them, 60 µM ginsenoside Rb1 had the best effect. In vivo experiments revealed that ginsenoside Rb1 improved RCTs in rats. Molecular docking revealed the binding of ginsenoside Rb1 to SFRP1. Additionally, SFRP1 levels were lower in the Control group than in the Normal group. After treatment with ginsenoside Rb1, SFRP1 levels increased. In vivo, overexpressing SFRP1 along with ginsenoside Rb1 treatment further alleviated tendon tissue fibroblast infiltration and fat accumulation and further reduced the expression of Collagen II, FN, and α-SMA. In vitro, overexpressing SFRP1 along with ginsenoside Rb1 treatment further decreased the expression of CaMKII, PLC, PKC, Wnt, and β-catenin, further decreased the Ca2+ fluorescence intensity and mitochondrial length, increased the red/green intensity, and decreased the MitoSOX fluorescence intensity. Additionally, overexpressing SFRP1 along with ginsenoside Rb1 treatment further increased cell proliferation, decreased apoptosis, reduced the protein expression of Collagen II, FN, and α-SMA in muscle tissue, and further reduced the levels of TNF-α, IL-1β, and IL-6 in the cell supernatant. Conclusions Ginsenoside Rb1 inhibited the activation of the Wnt signaling pathway by promoting SFRP1 expression, thereby inhibiting mitochondrial function and Ca2+ absorption to treat fat infiltration and muscle fibrosis caused by RCTs.
Background Rotator cuff tears (RCTs) are among the most common musculoskeletal disorders that affect quality of life. This study aimed to investigate the efficacy of ginsenoside Rb1 in RCTs and the mechanisms involved. Methods First, a fibrotic model of FAPs was induced, and FAPs were cultured in media supplemented with different concentrations of ginsenoside Rb1. Next, a rat model of RCTs was constructed and treated with ginsenoside Rb1. Molecular docking was subsequently utilized to detect the binding of ginsenoside Rb1 and SFRP1. Finally, SFRP1 was knocked down and overexpressed in vivo and in vitro to investigate the mechanism of ginsenoside Rb1 and SFRP1 in RCTs. Results Compared with the Normal group, FAP viability was decreased, but Collagen II, FN and α-SMA levels were increased in the Control group. After treatment with different concentrations of ginsenoside Rb1, FAP viability increased, but Collagen II, FN and α-SMA levels decreased. Among them, 60 µM ginsenoside Rb1 had the best effect. In vivo experiments revealed that ginsenoside Rb1 improved RCTs in rats. Molecular docking revealed the binding of ginsenoside Rb1 to SFRP1. Additionally, SFRP1 levels were lower in the Control group than in the Normal group. After treatment with ginsenoside Rb1, SFRP1 levels increased. In vivo, overexpressing SFRP1 along with ginsenoside Rb1 treatment further alleviated tendon tissue fibroblast infiltration and fat accumulation and further reduced the expression of Collagen II, FN, and α-SMA. In vitro, overexpressing SFRP1 along with ginsenoside Rb1 treatment further decreased the expression of CaMKII, PLC, PKC, Wnt, and β-catenin, further decreased the Ca2+ fluorescence intensity and mitochondrial length, increased the red/green intensity, and decreased the MitoSOX fluorescence intensity. Additionally, overexpressing SFRP1 along with ginsenoside Rb1 treatment further increased cell proliferation, decreased apoptosis, reduced the protein expression of Collagen II, FN, and α-SMA in muscle tissue, and further reduced the levels of TNF-α, IL-1β, and IL-6 in the cell supernatant. Conclusions Ginsenoside Rb1 inhibited the activation of the Wnt signaling pathway by promoting SFRP1 expression, thereby inhibiting mitochondrial function and Ca2+ absorption to treat fat infiltration and muscle fibrosis caused by RCTs.
The aim of this Guest Editorial is to highlight recent advancements in the study and practice of shoulder and elbow surgery for the practicing orthopaedic surgeon. Rotator Cuff Nonoperative ManagementNonoperative management remains a primary method of treatment for rotator cuff tears, with platelet-rich plasma (PRP) and corticosteroid injections as components of this treatment option. A recent systematic review and meta-analysis reviewed 9 studies with 537 patients. The authors found no difference in pain, function, complications, or retear rates when repair with and without PRP was analyzed 1 . Another systematic review and meta-analysis examined 9 randomized controlled trials (RCTs) that compared PRP with corticosteroids to treat rotator cuff disease in 469 patients 2 . The Constant score, Simple Shoulder Test, and American Shoulder and Elbow Surgeons score were reviewed at short-term, intermediate-term, and long-term follow-ups. Corticosteroids were superior in the short term, and PRP was demonstrated to be more beneficial in the long term.Perioperative management during rotator cuff repair continues to evolve. Nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors have been a mainstay, but their utilization in the immediate postoperative period following rotator cuff repair remains controversial. A recent systematic review and meta-analysis examined whether NSAIDs or COX-2 inhibitors influenced healing rates, functional outcomes, or patient satisfaction after rotator cuff repair 3 . The authors included 7 RCTs with 507 patients. NSAIDs did not affect the cuff healing rate, but NSAID use significantly improved postoperative pain and functional outcomes. Postoperative pain and functional outcomes were not different with COX-2 inhibitors. Zoledronic acid has also been the subject of recent investigation. A recent prospective, single-blinded randomized study enrolled 138 female patients with postmenopausal osteoporosis undergoing rotator cuff repair. Tendon healing was evaluated with ultrasound at 6 weeks and 24 months. The results demonstrated that zoledronic acid reduced the retear rate but did not significantly influence the clinical standardized outcomes 4 .Finally, the use of a brace compared with a simple sling was examined with a systematic review and meta-analysis 5 . The authors reviewed 275 articles, but only 4 articles (302 patients) met inclusion criteria. There was no advantage in brace compared with sling use in standardized outcome scores, a visual analog scale (VAS) for pain, and shoulder range of motion. The authors suggested that a simple sling may be a superior choice because of the potential cost savings. Surgical Technique and Biologic AugmentationImproving the biologic environment for rotator cuff repairs may improve healing rates and outcomes. A recent RCT compared 60 patients treated with arthroscopic rotator cuff repair with and without bone marrow stimulation. Fifty of the patients were available at the 2-year follow-up. Clinical outcomes and retear rates w...
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