Diacerein Versus Chondroitin Sulfate in Treatment of Adult Kashin-Beck Disease: An Intervention Trial in Heilongjiang Province, China

Background: Kashin-Beck disease (KBD) is a special type of osteoarthritis and has disabled and stunted the growth of hundreds of people in China. It also can affect patients' ability to work and live. So, how to conduct effective treatment for adult KBD patients has become a major public health problem in current KBD endemic areas. In this trial, therapeutic effects of diacerein and chondroitin sulfate on adult KBD was to evaluate and compare so that we can screen out more suitable drug. Methods: 308 KBD patients were divided into two groups and received chondroitin sulphate (Group A) and diacerein (Group B) for 24 weeks, respectively. Data were collected at 0 week (baseline), 12 weeks (primary end point) and 24 weeks (secondary end point) to calculate the proportion of patients with effective therapeutic effect and overall improvement rate (primary efficacy parameters), WOMAC pain and stiffness scores (secondary efficacy parameters). Blood sample was collected to measure liver and renal function indexes. All indexes and parameters were analysed with SPSS software and intent-to-treat (ITT) analysis was applied. Results: Two primary efficacy parameters in group B at primary end point were significantly higher than those in group A (P=0.021, P=0.007), but no statistical differences were seen in these two primary efficacy parameters between two groups at secondary end point or between primary and secondary end points in same group (all P>0.05). In both groups, with the prolongation of treatment time, WOMAC pain and stiffness scores decreased significantly (all P<0.001), but no significant differences were seen between primary and secondary end points (all P>0.05). In addition, in both groups, the occurrences of total adverse events were relatively low and no side effect on liver function was seen. Diacerein also had no side effect on renal function. Conclusion: For treatment of adult KBD, both diacerein and chondroitin sulfate were effective, and diacerein might work stronger than chondroitin sulfate. Taking into account both efficacy and safety, the optimal intervention time of diacerein was 12 weeks. Trial registration: The trial was registered complementally on 31/10/2020, and the registration number in the Chinese Clinical Trial Registry is ChiCTR2000039600 (http://www.chictr.org.cn).

Polymorphism of MMP-3 gene and imbalance expression of MMP-3 / TIMP-1 in articular cartilage are associated with an endemic osteochondropathy, Kashin- Beck disease

Background The etiology of Kashin-Beck disease (KBD), an endemic osteochondropathy, is largely unknown. Matrix metalloproteinase-3 (MMP-3) plays a central role in the initiation and progression of cartilage destruction, however, no study has reported on the relationship between KBD and MMP-3. The objective of this study was to explore the polymorphism of MMP-3 gene and expression of MMP-3 / TIMP-1(Tissue inhibitors of matrixmetalloproteinases-1) in the pathogenesis of KBD. Methods Single nucleotide polymorphism (SNP) genotyping was conducted in 274 KBD cases and 248 healthy controls for eight SNPs in MMP-3 using the Sequenom MassARRAY system. Additionally, the expression of MMP-3、TIMP-1 in different layers of the articular cartilage was analyzed by immunohistochemistry for 22 KBD patients, 15 osteoarthritis (OA) patients and 21 controls. Results The results showed that six SNPs (rs520540、rs591058、rs679620、rs602128、rs639752 and rs678815) in MMP-3 were associated with the increased risk of KBD, however, after Bonferroni correction, only the SNP rs679620 in the recessive model remained significant difference (OR = 2.31, 95%CI = 1.29–4.14, P = 0.0039), homozygous for “T” allele have a risk for KBD than “C” allele carriers. Moreover, the percentages of cells expressing MMP-3 in articular cartilage were significantly higher in the KBD and OA groups than in the controls (t = 5.37 and 4.19, P<0.01). While the KBD and OA groups had lower levels of TIMP-1 positive staining compared with the controls (t = 5.23and 5.06, P<0.01). And there was no significant different between KBD and OA for the levels of MMP-3 and TIMP-1 positive staining (t = 0.05and 0.28, P>0.05). Conclusions MMP-3 is associated with the susceptibility of KBD, and the imbalance expression of MMPs / TIMPs leading to cartilage degradation may play an important role in cartilage degradation and osteoarthritis formation in OA and KBD.

Comprehensive expression profiles of mRNAs, lncRNAs and miRNAs in Kashin-Beck disease identified by RNA-sequencing

Kashin-Beck disease (KBD) is a chronic, endemic and deforming osteochondropathy, whose basic pathological alterations include apoptosis and necrosis of chondrocytes in articular cartilage and growth plates and imbalanced extracellular matrix metabolism.

GLRX5 as a Differential Diagnosis Marker for Kashin-Beck Disease and Osteoarthritis and Its Clinical Significance

Background: Kashin-Beck disease (KBD) is currently an endemic form of osteoarthritis. In this study, we explored novel KBD diagnostic biomarkers.Methods: The GSE59446 dataset was used to conduct Weighted Gene Co-expression Network Analysis (WGCNA) and differentially expressed genes (DEGs) analysis with peripheral blood samples of 100 healthy individuals and 100 KBD patients. As part of the gene ontology pathway enrichment analysis, genes related to SONFH and DEGs were selected from the extraction module. Then, central DEGs were selected for LASSO analysis, and, based on SVM-RFE and DEG results, overlapping genes were identified as key KBD genes. Next, we analyzed the correlations between the selected genes and age, gender, and other factors to eliminate their influences on gene expression. Finally, we evaluated the diagnostic value of key KBD genes using case information collected by us.Results: Seven gene co-expression modules were created using WGCNA. The turquoise module was identified as a KBD key module since it showed the highest correlation to KBD. The functional enrichment analysis revealed that the genes associated with this key module were mainly involved in mitochondrial reactions, protein heterooligomerization, and negatively regulating cysteine-type endopeptidase-dependent apoptotic processes. Additionally, 12 key genes were identified using the LASSO analysis, 5 major genes using SVM-RFE analysis, and 36 DEGs were screened through the "limma" R package. The GLRX5 gene - pivotal in DEGs, LASSO, and SVM-RFE - was further aggregated as the key KBD gene. Correlation analyses confirmed the GLRX5 diagnostic value for KBD and that it was not related to age, gender, and other factors. Finally, data from our patients demonstrated that GLRX5 can be a KBD diagnostic biomarker.Conclusions: We demonstrated that the target gene GLRX5 can be a KBD non-invasive diagnosis biomarker.

Evaluation of health-related quality of life in patients with Kashin-Beck disease using a new questionnaire：A cross-sectional study

Objective: Kashin-Beck disease (KBD) is an endemic deformable bone and joint disease, which seriously affects the quality of life (QOL) of patients. We tried to conduct a cross-sectional study of the QOL of KBD patients by a new KBD quality of life (KBDQOL) questionnaire.Methods: 252 KBD patients came from Northwest China, and 260 healthy people living in the same area as KBD patients served as the control group. KBDQOL questionnaire was used to evaluate the QOL of all objects.Results: The average score of physical functions, activity limitations, support of society, mental health and general health of KBD patients was significantly lower than that in control group. There was no statistical difference in economics between KBD patients and control group. The univariate analysis showed that age, height, weight status, education level and grade of KBD had a statistically significant effect on KBDQOL score. The results of multivariate analysis showed that grade of KBD was the influencing factor of physical function score; sex, age, height, grade of KBD and duration of symptoms were the influencing factors of activity restriction score; grade of KBD was the influencing factor of economic score, age and grade of KBD were influencing factors of general health.Conclusions: The QOL of patients with KBD was significantly lower than that of healthy people living in the same place. The KBDQOL questionnaire may be a promising tool for assessing the QOL of KBD patients.

Hydrochemical Characteristics of Surface Waters and Their Relationships to the Kashin–Beck Disease in Longzi County, Tibet

Although previous studies have been reported between the Kashin–Beck Disease (KBD) epidemic and the hydrochemical characteristics of surface waters, the etiology of the disease remains unclear. In the present study, we investigated the relationship between the KBD and the environment by comprehensively examining the hydrochemical characteristics of surface waters in Longzi County, Tibet, and the spatial incidence of the disease. Results show that, the pH (mean = 7.27±0.30), TH (mean = 57.08±45.74 mg L–1), and TDS (mean = 67.56±44.00 mg L–1) of surface waters in KBD endemic areas are lower than for those in the non-KBD endemic areas (means of pH = 7.49±0.30; TH = 262.06±123.29 mg L–1; TDS = 253.25±100.39 mg L–1). These results suggest that long-term consumption of low TDS, essential trace elements (e.g., nickel, cobalt, iron, selenium, zinc, molybdenum, and iodine) deficient, and potential toxic elements (such as arsenic) enriched waters by humans likely causes the KBD. Environmental factors such as the geology and geomorphology may produce biogeochemical imbalance, geomorphic, vegetation types and local climatic conditions may have significant impact on food fungi toxin poisoning and water organic compound poisoning, and these are also important in the KBD occurrence.

Alterations in the gut microbiota and metabolite profiles of patients with Kashin-Beck disease, an endemic osteoarthritis in China

Kashin-Beck disease (KBD) is a severe osteochondral disorder that may be driven by the interaction between genetic and environmental factors. We aimed to improve our understanding of the gut microbiota structure in KBD patients of different grades and the relationship between the gut microbiota and serum metabolites. Fecal and serum samples collected from KBD patients and normal controls (NCs) were used to characterize the gut microbiota using 16S rDNA gene and metabolomic sequencing via liquid chromatography-mass spectrometry (LC/MS). To identify whether gut microbial changes at the species level are associated with the genes or functions of the gut bacteria in the KBD patients, metagenomic sequencing of fecal samples from grade I KBD, grade II KBD and NC subjects was performed. The KBD group was characterized by elevated levels of Fusobacteria and Bacteroidetes. A total of 56 genera were identified to be significantly differentially abundant between the two groups. The genera Alloprevotella, Robinsoniella, Megamonas, and Escherichia_Shigella were more abundant in the KBD group. Consistent with the 16S rDNA analysis at the genus level, most of the differentially abundant species in KBD subjects belonged to the genus Prevotella according to metagenomic sequencing. Serum metabolomic analysis identified some differentially abundant metabolites among the grade I and II KBD and NC groups that were involved in lipid metabolism metabolic networks, such as that for unsaturated fatty acids and glycerophospholipids. Furthermore, we found that these differences in metabolite levels were associated with altered abundances of specific species. Our study provides a comprehensive landscape of the gut microbiota and metabolites in KBD patients and provides substantial evidence of a novel interplay between the gut microbiome and metabolome in KBD pathogenesis.