The Related Gene Expression In Bone Tissue Of Necrotic Area In Terminal Alcoholic Femoral Head Necrosis

Background and Purpose:Since Axhausen reported alcohol poisoning patients was susceptible toosteonecrosis in1922, people began to study the relationship between osteonecrosisof the femoral head(ONFH) with alcohol. Jones has found that alcohol poisoning cancause osteonecrosis of femoral head under the cartilage in1968, possessing all thefeatures of osteonecrosis. In recent years, along with the improvement of people’sliving standard, people is drinking more and more, increasing the consumption ofalcohol and the number of patients with alcoholic femoral head necrosis year by year.Now it has been proved that alcohol is one of the definite causes of femoral headnecrosis.There are a variety of theory about the pathogenesis of femoral headnecrosis,such as fat embolism theory, adipose differentiation theory,low coagulationhigh fibrinolysis theory,high pressure in bone theory, intravascular coagulation theory,etc. Formerly people investigated the pathologic changes of the alcoholic femoralhead necrosis, found that fat accumulating within the femoral head,lipid metabolicdisorder, proliferation of adipose cell hypertrophy,which oppresses capillaries andblood sinus,making high pressure in bone and venous reflux obtacle in early stage,further studies found that genes regulating cells adipogenesis differentiationincreasingly and osteogenesis differentiation decreasingly, which was induced byalcohol.Pluripotent stem cells was also induced into adipogenic differentiation insteadof osteogenic differentiation.They aggravated the pathological process of fataccumulation within the femoral head and bone-repairs insufficience resulting infemoral head necrosis at last.Terminal femoral head necrosis（ARCOⅢ-Ⅳstage）hastypical pathological performance:subchondral fracture,bone loss,particularly largenecrotic area,repair sclerosis band surrounding and deformation and collapse offemoral head,but its exact acreage of necrotic area and related gene experssion ofbone cells in it is still unclear.We research gene expression of bone cells in necrosisarea in late alcoholic necrosis of femoral head necrosis about Bone morphogeneticprotein-2(BMP-2),Osteogenesis transcription factors-2(Runx-2), Peroxisomeproliferator activated receptor-γ(ppar-γ), Bone protection element (osteoprotegerin,OPG) and Receptor activator of NF. KB ligand（RANKL)in order to further explorethe changes of related gene expression of bone tissue bells.There is certain referencevalue to select next treatment of terminal alcoholic ONFH.Material and Methods:Between January2013to June2013,bone tissues of femoral head were gatheredfrom10patients suffering terminal alcoholic femoral head necrosis in stage ofARCOⅢ-Ⅳ(3cases in ARCOⅢ-B,3cases in ARCOⅢ-C,4cases in ARCOⅣ)asthe experimental group and from10patients suffering fracture of femoral neck in stage ofGardenⅢ-Ⅳ(5cases in GardenⅢ,5cases in GardenⅣ)as the control group.Inexperimental group there are8male and2female,33~60years old, average age is45, patients who suffer alcoholic ONFH, there is no hormoneapplication,infection,trauma and other medical history. In control group there aremale6cases, female4cases,44~70years old, the average age is52, preoperativeduration is1-3days, an average of2days, there is no history of drinking, hormoneapplication history and other medical history.Finally the expression levels of BMP-2、Runx-2、PPAR-γ、OPG、RANKL in necrotic area will be measured by real-time quantitative PCR(RT-qPCR) for each sample.Results:Real-time fluorescent quantitative PCR (RT-qPCR) detectes Ct value of purposegene (Ct value means cycle number which reaction in each tube fluorescent signalreach to threshold value), and finally we ues the2-Ctmethod obtain multiple of thepurpose gene expression in the experimental group comparing to control group.Theresults of RT-qPCR show that the expression levels of BMP-2、PPAR-γ、Runx2、OPG、RANKLmRNA in the experimental group are significantly lower than that inthe control group:2-Ctis0.51±0.04,0.46±0.09,0.59±0.07,0.31±0.04,0.51±0.06and0.58±0.03respectively,both of the differences observed are statisticallysignificant (P＜0.01).Conclusions:1. The size of necrotic area is particularly large in the terminal alcoholic ONFH,there is few of surviving bone cells.2. The gene expression of osteogenesis and adipogenesis are both reduced.