Pharmacological Mitigation of Fibrosis in a Porcine Model of Volumetric Muscle Loss Injury

Benjamin T. Corona, Jessica C. Rivera, Kyle A. Dalske, Joseph C. Wenke, Sarah M. Greising

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Volumetric muscle loss (VML) resulting from extremity trauma presents functional deficits and fibrosis, ultimately manifesting disability. The extensive fibrotic accumulation is expected to interfere with neural, trophic, vascular, and mechanical connectivity of any possible regenerative medicine approaches. Our objective was to quantify the muscle properties and stiffness following injury and investigate if the fibrotic deposition could be mitigated using an antifibrotic agent; we hypothesized that antifibrotic treatment would prevent the overwhelming fibrotic response. Yorkshire Cross pigs (n = 10) were randomized to sham or a nontreated ∼20% VML injury. Immediately following surgery, injured animals were further randomized to nintedanib (Ofev; 300 mg/day) or no treatment for 30 days. Longitudinal analysis of muscle function via peroneal nerve stimulation, compartment volume, and quantitative muscle stiffness using shearwave elastography were conducted. Terminally comprehensive histopathologic, biochemical, and genetic investigations were conducted on the skeletal muscle and fibrosis. Through 4 weeks post-VML, nontreated muscles presented a significant deficit (23%) in maximal torque compared to the sham operated (p < 0.01). The stiffness in the VML defect area increased significantly (7-fold) in the VML-nontreated leg than the VML antifibrotic-treated legs by 4 weeks postinjury, which was coupled with the nontreated muscle having ∼40% more hydroxyproline per mg of tissue than those receiving antifibrotic treatment (p = 0.01). This work indicates that VML injury progressively induces fibrosis and muscle stiffness. Antifibrotic treatment can mitigate the pathologic development of fibrosis. Future work should evaluate optimal timing and duration of treatments combined with regenerative medicine approaches in efforts to improve function. This work primarily evaluated the effect of a clinically available antifibrotic therapy (nintedanib) on the development of fibrosis after volumetric muscle loss (VML) injury in a large animal model. As a primary outcome measure of fibrosis, skeletal muscle stiffness was repeatedly measured in vivo and noninvasively using a quantitative ultrasound device with shearwave elastography capability. The most salient finding of the study is that the antifibrotic nintedanib significantly reduced the development of VML injury-induced fibrous tissue deposition and stiffness.

Original languageEnglish (US)
Pages (from-to)636-646
Number of pages11
JournalTissue Engineering - Part A
Volume26
Issue number11-12
DOIs
StatePublished - Jun 1 2020

Bibliographical note

Funding Information:
Studies were funded by the U.S. Army Medical Research and Material Command, Clinical and Rehabilitative Medical Research Program (Award #C_001_2018_USAISR to Sarah M. Greising).

Publisher Copyright:
© Copyright 2020, Mary Ann Liebert, Inc., publishers 2020.

Keywords

  • VML
  • muscle stiffness
  • neuromuscular strength
  • nintedanib
  • orthopedic trauma
  • ultrasound shearwave elastography

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't

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