Abstract
The pathomechanism of the ligamentumflavum (LF) hypertrophy in diabetic patients with lumbar spinal canal stenosis (LSCS) remains unclear.A cross-sectional study was undertaken to investigate the mechanism of LF hypertrophy in thesepatients. Twenty-four diabetic and 20normoglycemic patients with LSCS were enrolled in the study. The structure of the LF in the study subjects was evaluated using histological and immunohistochemicalmethods, and thelevels of sorbitol, pro-inflammatory cytokines, and the fibrogenicfactor, TGF-β1,in the LF were analyzed.In vitro experiments were performed using NIH3T3 fibroblasts to evaluate the effect of high-glucoseconditions and an aldose reductase inhibitoron the cellular production ofsorbitol, pro-inflammatory factors, and TGF-β1. We found that the LF of diabetic patients exhibited significantly higher levels of sorbitol and pro-inflammatory cytokines, TGF-β1and of CD68-positive staining than that of the normoglycemic subjects. The diabetic LF was significantly thickerthan that of the controls, and showed evidence of degeneration. The high glucose-cultured fibroblasts exhibited significantly higher levels of sorbitol, pro-inflammatory factors, and TGF-β1compared to the low glucose-cultured cells, and these levels were dose-dependently reduced by treatment with the aldose reductase inhibitor.Taken together, our data suggests that increased sorbitol levels in the LF of diabetic patientsresults in increased production of pro-inflammatory and fibrogenicfactor, which contribute to LF hypertrophy, and could increase the susceptibility of diabetic patients to LSCS. Furthermore, aldose reductase inhibition effectively reduced the levels of sorbitol and sorbitol-induced pro-inflammatory factor expression in high glucose-cultured fibroblasts. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
บทคัดย่อThe pathomechanism of the ligamentumflavum (LF) hypertrophy in diabetic patients with lumbar spinal canal stenosis (LSCS) remains unclear.A cross-sectional study was undertaken to investigate the mechanism of LF hypertrophy in thesepatients. Twenty-four diabetic and 20normoglycemic patients with LSCS were enrolled in the study. The structure of the LF in the study subjects was evaluated using histological and immunohistochemicalmethods, and thelevels of sorbitol, pro-inflammatory cytokines, and the fibrogenicfactor, TGF-β1,in the LF were analyzed.In vitro experiments were performed using NIH3T3 fibroblasts to evaluate the effect of high-glucoseconditions and an aldose reductase inhibitoron the cellular production ofsorbitol, pro-inflammatory factors, and TGF-β1. We found that the LF of diabetic patients exhibited significantly higher levels of sorbitol and pro-inflammatory cytokines, TGF-β1and of CD68-positive staining than that of the normoglycemic subjects. The diabetic LF was significantly thickerthan that of the controls, and showed evidence of degeneration. The high glucose-cultured fibroblasts exhibited significantly higher levels of sorbitol, pro-inflammatory factors, and TGF-β1compared to the low glucose-cultured cells, and these levels were dose-dependently reduced by treatment with the aldose reductase inhibitor.Taken together, our data suggests that increased sorbitol levels in the LF of diabetic patientsresults in increased production of pro-inflammatory and fibrogenicfactor, which contribute to LF hypertrophy, and could increase the susceptibility of diabetic patients to LSCS. Furthermore, aldose reductase inhibition effectively reduced the levels of sorbitol and sorbitol-induced pro-inflammatory factor expression in high glucose-cultured fibroblasts. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.
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