tuina intervention in a sodium monoiodoacetate injection-induced rat model of knee osteoarthritis

무릎 골관절염에 대한 Tuina 마사지의 치료 잠재력

Knee osteoarthritis (KOA) is a common degenerative osteoarthritis, characterized by chronic pain and disability, and relatively severe KOA will lead to irreversible structural damage to the joint1. The high global prevalence of KOA has become a major global public health challenge2,3, which seriously impairs the quality of life of patients4,5. Studies have shown that KOA affects more than 260 million people worldwide6. With the aging of the population, the total prevalence rate of KOA in China is as high as 17.0% over the age of 40, which puts a heavy burden on the families of those affected7,8.
According to Chinese medicine, KOA belongs to the category of &#34;paralysis&#34;9, and the Yellow Emperor&#39;s Classic of Internal Medicine associates tendons, bones, and flesh with paralysis. Hence, we need to pay attention to the connection between the cartilage, muscle, synovium, as well as other tissues around the knee joint in KOA. In modern medicine, both muscle and bone inflammation, which are major components of the immune homeostasis of arthritis, drive the progression of KOA pain. However, most studies focus on cartilage inflammation and synovial inflammation in bone joints, and there is a paucity of articles examining inflammatory phenomena in skeletal muscles. Therefore, more research on the role of skeletal muscle in inflammation is needed to gain a more comprehensive understanding of KOA and provide ideas for more effective treatment modalities. In a review of the literature, we found that inhibition of the immune-related factor programmed death ligand 1 (PD-L1) exacerbated the progression of KOA10,11 and that there was differential expression of IL-15 and FOXO1 in the skeletal muscle of patients with KOA12, as well as significant skeletal muscle inflammation in patients with end-stage KOA, which was also associated with changes in gait. It has been shown that the skeletal muscle can also secrete factors closely related to inflammatory immunity such as IL-6, and that TNF-&#945; is also closely related to the PD-L1 pathway and KOA13,14,15.
Currently, available treatments for KOA include weight control, exercise, medication, and surgery, which usually include intra-articular injections, analgesic medication, arthroscopic surgery, and periprosthetic osteotomy of the knee16. Currently, KOA disease progression cannot be completely stopped or reversed, and without a clear understanding of the complex mechanisms underlying KOA pain, KOA patients are at risk for overuse of analgesic medications and a high incidence of side effects8. Most treatment strategies are effective only for short periods and focus only on the temporary relief of symptoms rather than on the pathogenesis of the disease. Therefore, KOA pain remains a priority and a challenge for treatment, posing a serious clinical challenge. However, Tuina can directly stimulate the skeletal muscles around the affected joint in KOA treatment and can provide some benefits. Combined with the previous description, it is the ideal therapy to study the role of skeletal muscle tissue in KOA, and clarifying the role of skeletal muscle tissue in inflammation can also provide better theoretical support for Tuina of KOA.
Studies have shown that massage therapy, osteopathic manipulative therapy, and spinal manipulation can help relieve pain and restore body function17,18. These manipulations can act on local inflammation and relieve spasms and analgesia through external mechanical action. They can relieve pain after total knee arthroplasty, reduce the use of analgesic drugs, promote postoperative recovery, and improve biomechanical balance19. Swedish massage is feasible in the treatment of osteoarthritis and can reduce stress and improve quality of life20. The therapeutic effect of Tuina on KOA has been preceded by certain studies.
In this experiment, our team will explore whether the expression of PD-L1 and related inflammatory factors in skeletal muscle can induce KOA and promote its development based on the MIA-induced KOA model in rats. Tuina will also be implemented to see whether it can alleviate KOA symptoms caused by increased inflammatory factor expression. Tuina will be combined with PD-L1 inhibition to demonstrate the association between Tuina-mediated PD-1 pathway in skeletal muscle inflammation affecting KOA development and pain, laying the foundation for further multi-level studies on the therapeutic mechanisms of Tuina intervention in KOA.
In summary, this paper describes the investigation and elaboration of the mechanisms of skeletal muscle inflammation in the development of KOA and its pain, as well as the therapeutic effects of Tuina on KOA, from the perspective of immune-inflammatory factor expression, combined with behavioral related indicators, to provide modern research evidence for the &#34;imbalance of tendon and bone&#34; theory in traditional Chinese medicine.

저자 스포트라이트: Tuina와 함께 무릎 골관절염 치료 - 새로운 관점 

무릎 골관절염의 나트륨 모노요오드아세트산 주사 유도 쥐 모델에 대한 Tuina 개입

Watch this Scientific Journal Video about Tuina Intervention in a Sodium Monoiodoacetate Injection-Induced Rat Model of Knee Osteoarthritis at JoVE.com

Tuina Intervention in a Sodium Monoiodoacetate Injection-Induced Rat Model of Knee Osteoarthritis  

무릎 골관절염의 모노요오드아세트산 나트륨 주사 유도 쥐 모델에 대한 Tuina 개입

먼저, 1주일 동안 적응 먹이를 준 후 쥐를 무작위로 4개의 그룹으로 나누고, 각 그룹에는 8마리의 동물이 있습니다. 마취된 쥐의 오른쪽 뒷다리를 면도하고 소독한 후 슬개골 인대가 위쪽을 향하도록 무릎 굴곡을 90도의 정확한 각도로 조심스럽게 고정합니다. 그 후, 25 마이크로 리터의 모노 요오드 아세테이트 용액을 쥐의 오른쪽 무릎 관절 구멍에 주입합니다.실험적 침술을 사용하여 손가락 주무르기 대상으로 쥐의 경혈을 정확하게 찾습니다. 그런 다음 쥐 고정 장비를 사용하여 쥐를 엎드린 자세로 고정합니다. 쥐가 진정되고 하지가 이완되면 엄지와 검지로 영향을 받은 팔다리의 EX-LE4와 ST35를 동시에 4분 동안 반죽합니다.그런 다음 엄지와 검지로 영향을 받은 사지의 전방 및 내측 외측 근육을 3분 동안 주무릅니다. SP10, ST34 및 무릎 관절 근처 근육에 초점을 맞춥니다. 엄지, 검지, 중지를 사용하여 영향을 받은 사지의 종아리 뒤쪽 근육을 위에서 아래로 주무릅니다.시술 부위를 완전히 노출시키려면 약지와 새끼손가락으로 환부의 발목 관절을 잡고 팔다리를 부드럽게 잡아당깁니다. SP9, GB34 및 무릎 관절 근처 근육에 초점을 맞춥니다.

tuina-intervention-sodium-monoiodoacetate-injection-induced-rat-model

Research

JoVE Journal

Medicine

Tuina Intervention in a Sodium Monoiodoacetate Injection-Induced Rat Model of Knee Osteoarthritis

288 조회수. 먼저, 1주일 동안 적응 먹이를 준 후 쥐를 무작위로 4개의 그룹으로 나누고, 각 그룹에는 8마리의 동물이 있습니다. 마취된 쥐의 오른쪽 뒷다리를 면도하고 소독한 후 슬개골 인대가 위쪽을 향하도록 무릎 굴곡을 90도의 정확한 각도로 조심스럽게 고정합니다. 그 후, 25 마이크로 리터의 모노 요오드 아세테이트 용액을 쥐의 오른쪽 무릎 관절 구멍에 주입합니다.실험적 침?...

비디오: Tuina Intervention in a Sodium Monoiodoacetate Injection-Induced Rat Model of Knee Osteoarthritis  

Tuina Intervention in Sodium Monoiodoacetate Injection-Induced Rat Model of Knee Osteoarthritis

Knee osteoarthritis (KOA), a common degenerative joint disorder, is characterized by chronic pain and disability, which can progress to irreparable structural damage of the joint. Investigations into the link between articular cartilage, muscles, synovium, and other tissues surrounding the knee joint in KOA are of great importance. Currently, managing KOA includes lifestyle modifications, exercise, medication, and surgical interventions; however, the elucidation of the intricate mechanisms underlying KOA-related pain is still lacking. Consequently, KOA pain remains a key clinical challenge and a therapeutic priority. Tuina has been found to have a regulatory effect on the motor, immune, and endocrine systems, prompting the exploration of whether Tuina could alleviate KOA symptoms, caused by the upregulation of inflammatory factors, and further, if the inflammatory factors in skeletal muscle can augment the progression of KOA.
We randomized 32 male Sprague Dawley (SD) rats (180-220 g) into four groups of eight animals each: antiPD-L1+Tuina (group A), model (group B), Tuina (group C), and sham surgery (group D). For groups A, B, and C, we injected 25 &#181;L of sodium monoiodoacetate (MIA) solution (4 mg MIA diluted in 25 &#181;L of sterile saline solution) into the right knee joint cavity, and for group D, the same amount of sterile physiological saline was injected. All the groups were evaluated using the least to most stressful tests (paw mechanical withdrawal threshold, paw withdrawal thermal latency, swelling of the right knee joint, Lequesne MG score, skin temperature) before injection and 2, 9, and 16 days after injection.

This protocol describes the methods of Tuina intervention in sodium monoiodoacetate injection-induced rat model of knee osteoarthritis (KOA), which provides a reference for the application of Tuina in KOA animal models. This protocol also studies the effective mechanism of Tuina for KOA, and the results will help promote its application.

Knee osteoarthritis (KOA), a common degenerative joint disorder, is characterized by chronic pain and disability, which can progress to irreparable ...