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Sci Transl Med. 2019 Feb 27;11(481). pii: eaav4319. doi: 10.1126/scitranslmed.aav4319.

Targeting the NF-κB signaling pathway in chronic tendon disease.

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Department of Orthopedic Surgery, Columbia University, 650 W 168th St, New York, NY 10032, USA.
Department of Biomedical Engineering, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130, USA.
Department of Biomedical Engineering, Columbia University, 1210 Amsterdam Ave, New York, NY 10027, USA.
Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Ave., Glasgow, Scotland G12 8TA, UK.
Departments of Orthopedic Surgery and Cell Biology and Physiology, Washington University in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
Shriners Hospital for Children, 4400 Clayton Ave, St. Louis, MO 63110, USA.
Department of Orthopedic Surgery, Mount Sinai, 5 E 98th St., New York, NY 10029, USA.
Department of Orthopedic Surgery, Columbia University, 650 W 168th St, New York, NY 10032, USA.


Tendon disorders represent the most common musculoskeletal complaint for which patients seek medical attention; inflammation drives tendon degeneration before tearing and impairs healing after repair. Clinical evidence has implicated the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway as a correlate of pain-free return to function after surgical repair. However, it is currently unknown whether this response is a reaction to or a driver of pathology. Therefore, we aimed to understand the clinically relevant involvement of the NF-κB pathway in tendinopathy, to determine its potential causative roles in tendon degeneration, and to test its potential as a therapeutic candidate. Transcriptional profiling of early rotator cuff tendinopathy identified increases in NF-κB signaling, including increased expression of the regulatory serine kinase subunit IKKβ, which plays an essential role in inflammation. Using cre-mediated overexpression of IKKβ in tendon fibroblasts, we observed degeneration of mouse rotator cuff tendons and the adjacent humeral head. These changes were associated with increases in proinflammatory cytokines and innate immune cells within the joint. Conversely, genetic deletion of IKKβ in tendon fibroblasts partially protected mice from chronic overuse-induced tendinopathy. Furthermore, conditional knockout of IKKβ improved outcomes after surgical repair, whereas overexpression impaired tendon healing. Accordingly, targeting of the IKKβ/NF-κB pathway in tendon stromal cells may offer previously unidentified therapeutic approaches in the management of human tendon disorders.

[Available on 2020-02-27]

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