When nutrition meets bone: modulation of inflammatory signals for skeletal homeostasis and repair Restricted; Files Only

Roberts, Joseph (Spring 2020)

Permanent URL: https://etd.library.emory.edu/concern/etds/1z40kt88d?locale=fr
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Abstract

Metabolic bone diseases characterized by low bone mass are highly prevalent. Many factors contribute to the development of these diseases, including poor nutrition, gut microbiota, and inflammation. Inflammatory effectors can tip the balance between bone formation and resorption to favor osteoclastic bone resorption. As bone mass declines, the risk of experiencing a fracture increases. While most fractures heal naturally, excessive inflammation can disrupt the well- orchestrated series of cellular and molecular events that would normally heal the broken bone. However, the contributors to this excessive inflammatory response to bone fractures remains poorly understood. The overarching goal of this dissertation is to investigate the inflammatory and nutritional contributors to bone homeostasis and repair.

Using highly informative pre-clinical murine models we sought to address the following three aims: 1) establish the role of the inflammatory modulator Wnt5a in osteoblast and osteoclast coupling; 2) examine the influence of aging on the inflammatory response to fracture; and 3) determine whether probiotics regulate inflammation during fracture healing. In Aim 1 and 2, murine genetic models to conditionally delete Wnt5a in osteoclasts and IL-17ra in periosteal mesenchymal cells were employed. In Aims 2 and 3, the murine mid-diaphyseal femoral fracture model was used to assess fracture healing.

The findings from this dissertation identify inflammatory effectors as important components of bone homeostasis and repair. Aim 1 redefined the role of Wnt5a in controlling bone homeostasis by identifying a unique phosphorylated Wnt5a that is secreted by mature osteoclasts to control bone formation. Results from Aim 2 revealed that increased aged results in a unique systemic cytokine profile after fracture that includes higher levels of the anti-osteogenic proinflammatory cytokine IL-17a. Lastly, Aim 3 demonstrates that influencing the gut microbiome through supplementation with the probiotic species B. adolescentis can dampen systemic inflammation to accelerate healing and protect the intact skeleton against bone loss. The collective results of this dissertation bring novel insight to the growing body of literature which indicate that inflammation is a key negative contributor to bone maintenance and repair. Additionally, we identify probiotic supplements as a therapeutic approach to dampen the negative consequence of systemic inflammation after traumatic bone injuries. 

Table of Contents

TABLE OF CONTENTS

INTRODUCTION 1

Societal and Economic Burden of Musculoskeletal Diseases 1

Bone biology 2

The Basic Multicellular Unit 3

Non-canonical Wnt5a control of bone remodeling 4

Mechanisms of fracture healing 5

Patient-specific factors that influence fracture healing 6

Role of inflammation in bone homeostasis and repair 7

Role of IL-17a in bone remodeling and repair 9

Role of the gut microbiota in bone health 10

PURPOSE OF RESEARCH 11

REFERENCES 14

CHAPTER 2: ADVANCES AND PROMISES OF NUTRITIONAL INFLUENCES ON NATURAL BONE REPAIR 19

ABSTRACT 20

INTRODUCTION 21

MECHANISMS OF BONE FRACTURE HEALING 22

METABOLIC RESPONSE TO FRACTURE 23

IMPACT OF NUTRITIONAL DEFICIENCIES ON BONE HEALING 25

INFLUENCE OF NUTRITIONAL SUPPLEMENTS ON NATURAL BONE HEALING 28

NUTRITIONAL INFLUENCES ON PATIENT OUTCOMES 32

EMERGING AREAS AND FUTURE PERSPECTIVES 33

Nontraditional Dietary Supplements 33

Precision Nutrition through Integrated Omics 34

CONCLUSION 35

REFERENCES 37

CHAPTER 3: GENERATION AND EXPERIMENTAL OUTCOMES OF CLOSED FEMORAL FRACTURE IN MICE 55

ABSTRACT 56

1. INTRODUCTION 57

2. MATERIALS 58

3. METHODS 62

4. NOTES 74

REFERENCES 78

CHAPTER 4: DELETION OF WNT5A IN OSTEOCLASTS RESULTS IN BONE LOSS THROUGH DECREASED BONE FORMATION 84

ABSTRACT 85

INTRODUCTION 86

METHODS 87

Animals 87

Lentivirus-mediated deletion of Wnt5a 88

Bone marrow macrophage (BMM) osteoclast formation assay 89

Isolation of periosteal cells 89

Periosteal cell osteogenesis assay 90

Gene expression 90

Micro-computed tomography 91

Histology and static histomorphometry 92

Dynamic Histomorphometry 92

Measurement of bone turnover markers 93

Post-translational modification (PTM) and phosphorylation detection assays for WNT5A 93

Statistics 95

RESULTS 95

Deletion of Wnt5a decreases osteoclast formation and function in vitro 95

Generation of mice with conditional deletion of Wnt5a in mature osteoclasts 95

Conditional deletion of Wnt5a in mature osteoclasts results in an unexpected decrease in bone mass 96

Decreased bone formation contributes to the low-bone-mass phenotype in Wnt5a cKO mice 98

Non-specific deletion of Wnt5a in periosteal mesenchymal cells does not affect osteogenic differentiation potential 98

Osteoclast-derived WNT5A is distinct from osteoblast-derived WNT5A 99

DISCUSSION 100

REFERENCES 106

CHAPTER 5: AGED MICE HAVE A UNIQUE SYSTEMIC CYTOKINE PROFILE DURING FRACTURE HEALING CHARACTERIZED BY HIGH LEVELS OF ANTI-OSTEOGENIC IL-17A 121

ABSTRACT 122

INTRODUCTION 123

METHODS 124

Animal husbandry 124

Fracture model 124

Micro-computed tomography 125

Histology and static histomorphometry 126

Immunohistochemistry 126

Measurement of serum cytokines 127

Periosteal cell isolation 128

Periosteal cell osteogenic differentiation 128

Gene expression 129

Statistics 129

RESULTS 129

Aged mice are more impacted by femoral fracture 129

Fracture healing is delayed in aged mice 130

The inflammatory response to fracture is exacerbated in aged mice 130

Deletion of IL-17ra in the periosteum increases callus bone volume 131

IL-17a inhibits osteogenic differentiation of fracture activated periosteal cells 131

DISCUSSION 132

REFERENCES 137

CHAPTER 6: CONTROL OF FRACTURE-INDUCED GUT LEAKINESS BY BIFIDOBACTERIUM ADOLESCENTIS 149

ABSTRACT 150

INTRODUCTION 151

METHODS 152

Animal husbandry 152

Assessment of gut permeability after fracture 153

Probiotic manipulation of gut microbiota 153

Fracture model 154

Bacterial culture 154

Micro-computed tomography 155

Histology and static histomorphometry 156

Gene expression 157

Measurement of serum inflammatory and bone turnover markers 157

Measurement of serum endotoxin/lipopolysaccharide 158

16s rRNA Sequencing 158

Statistical & Bioinformatic analysis 159

RESULTS 159

Fracture induces gut permeability 159

Probiotic supplementation accelerates callus cartilage remodeling 160

B. adolescentis dampens the systemic inflammatory response to fracture 161

Probiotic supplementation increases expression of intestinal tight junction proteins after fracture 162

B. adolescentis supplementation influences the diversity of the gut microbiome during fracture healing 163

Probiotic supplementation protects against post-traumatic bone loss 164

DISCUSSION 165

REFERENCES 172

CHAPTER 7: DISCUSSION AND CONCLUSIONS 192

KEY FINDINGS 193

STRENGTHS, INNOVATIONS, AND LIMITATIONS 194

FUTURE DIRECTIONS 195

CONCLUSIONS 198

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