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Mechanobiology
From Molecular Sensing to Disease
Edited by
GLEN L. NIEBUR, PHD
Director
Bioengineering Graduate Program
University of Notre Dame, Notre Dame
Indiana
United States
Professor
Aerospace and Mechanical Engineering
University of Notre Dame
]
Mechanobiology ISBN: 978-0-12-817931-4
Copyright Ó 2020 Elsevier Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
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vii
viii LIST OF CONTRIBUTORS
HISTORY OF MECHANOBIOLOGY Roux. Wolff published his monograph “Das Gesetz der
Mechanobiology is, in some ways, a new field. The first Transformation der Knochen” (“The Law of Bone
reference to the term mechanobiology in the US govern- Remodeling”)5,6 in 1892, and Roux published “Der
ment’s PubMed database was by Marjolein van der Kampf Der Theile im Organismus” (“The Challenges to
Meulen in 1993.1 Indeed, the term mechanobiology was the Parts in the Organism”) in which he proposed the
coined specifically for this paper at a meeting of the idea of functional adaptation to external stimuli in
Stanford-Palo Alto Bone Remodeling club. The group 1881.4 In 1885, Roux published a second treatise on
had realized that biomechanical neither was the correct developmental mechanics (“Die Entwicklungsmecha-
description for the phenomenon they were describing nik; ein neuer Zweig der biologischen Wissenschaft” or
nor was it sufficient to use the adjective “mechanical” to “Developmental mechanics: a new branch of biological
modify biological terms.2 They noted science”).7,8
The term mechanobiological is used to emphasize Before the emergence of the term mechanobiology, a
that the mechanical effects we are modeling are also significant amount of research was described by the
dependent upon a biological response.1 ubiquitously applied misnomer “Wolff’s law for .”,
Within a few years, a number of papers from labo- which was used to describe the concept of tissue adap-
ratories at Stanford and the Palo Alto VA adopted the tation or healing under the influence of mechanical
term. It came into more widespread use throughout the loads in tendons, ligaments,9e11 and skin,12 among
1990s. One of the seminal definitions of the term other tissues.13
appeared in the article “Why Mechanobiology?” published “Wolff’s law” has certainly seen its share of criticism
in the Journal of Biomechanics in 2001.3 In this article the for its simplicity, conflation of differing processes, over-
authors laid out the central precept of mechanobiology reliance on mechanics relative to hormonal and nutri-
for the skeleton: tional factors, and incorrect understanding of
mechanics.14,15 Similarly, Roux’s writings intermixed
The premise of mechanobiology is that these biological pro- concepts of heredity and adaptation, using examples of
cesses are regulated by signals to cells generated by me- ducks and cows. However, one must remember that the
chanical loading, a concept dating back to Roux.4 The existence of cells had only been known for a few decades
relevant questions include how external and muscle loads are at the time, Charles Darwin was a contemporary, and the
transferred to the tissues, how the cells sense these loads, and discovery of DNA was far in the future. In this context,
how the signals are translated into the cascade of biochem- these researchers established concepts and asked ques-
ical reactions to produce cell expression or differentiation. tions that remain at the heart of mechanobiology today,
Ultimately, we want to predict growth and differentiation in even if their initial hypotheses have been superseded and
augmented with newly discovered biological structures
quantitative terms, based on a given force exerted on a given
and phenomena over time.
tissue matrix populated by cells.3
Much of the early work in mechanobiology focused
This definition has been readily adapted to other on the musculoskeletal system, formalizing the ideas
tissues by changing “muscle loading” to a variety of force and incorporating growing knowledge of cellular pro-
generators and “tissue matrix populated by cells” with cesses. Advanced mechanical analysis, made possible by
any number of tissues or even cells themselves. At the the finite element method, provided a means to calculate
same time that a new field was being defined, the authors the spatial distribution of the mechanical signal, which
noted that it was in some ways a very old field. The un- was correlated to locations of bone formation or
derlying principles of mechanobiology were outlined a resorption or to changes in the local density of the
century earlier in the work by Julius Wolff and Wilhelm bone.16e18 Similarly, cartilage19 and tendon20e22
xi
xii PREFACE: MECHANOBIOLOGY, WHY NOT?
adaptation and remodeling were simulated using algo- Mechanobiology is now studied as an inherently
rithms that incorporated mechanical cues. Cardiovas- multiscale phenomenon. Starting from the cell scale, the
cular mechanobiology research also grew, leveraging role of mechanotransduction in sensing the presence or
similar computational methods but applying differing localized motions of surrounding cells or ECM is the first
theories of cellular response and remodeling.23 As stage in the mechanobiological cascade. At this level, it is
computational power has grown, cell and molecular essential to understand how forces are transmitted to the
level knowledge has been incorporated into simulations physiologic structures that connect the cells to the ECM
to include the local cell density, the density of local or to other cellsdthe integrins and the adherens,
signaling molecules, and nutrient diffusion.24,25 respectivelydas well as the cytoskeleton and cell mem-
brane, and how they are transduced into biochemical
actions within the cell. Forces on these structures can
MECHANOBIOLOGY ACROSS LENGTH induce gene translation, post-translational modification
SCALES of proteins, or upregulation of secondary messengers
At the largest length scales, mechanobiology has been that drive protein translation and cell differentiation
used to explain how activities of daily living and envi- through both autocrine and paracrine signaling. This
ronment affect the composition, geometry, or healing of signaling may alter local cell phenotypes, cell signaling,
the tissue. For example, multiple mechanobiological further ECM production and degradation, or the orga-
models have attempted to predict the shape and scaling nization of ECM molecules.
of bones with respect to mechanical loading26,27 or to
investigate rehabilitation regimens that can best rees-
tablish normal function.28 WHY NOT MECHANOBIOLOGY?
At the tissue scale the focus is often on the changes in Most cells contain the machinery necessary to sense and
extracellular matrix (ECM) properties. In these models respond to loads, even if other factors may dominate
the cell populations can often aggregate as concentra- their function. While mechanical loading is obviously an
tions. The interactions of cells with the matrix are essential part of the function of musculoskeletal and
quantified by the local strain or fluid flow. The choice of cardiovascular tissues, almost all tissues are subjected to
constitutive model has proven to be important in many some mechanical forces and deformation. Both epithe-
instances, with fiber-reinforced or poroelastic de- lial and endothelial surfaces can be subjected to fluid
scriptions improving the fidelity of calculations of the flows and stretching. Even baseline respiration in
mechanical behavior. The mechanobiological processes mammals causes cyclic motion and pressure changes in
are hypothesized to alter the mechanical properties by the thoracic and abdominal cavities, which would
defining rate laws for any or all of the constitutive pa- induce mechanical stress in the organs. For example,
rameters that depend on the number and the state of the mechanobiology plays a role in liver regeneration30 and
various cells. Nutrients or signaling molecules can also normal kidney function.31,32 Interestingly, molecules
be described by concentrations. Their diffusion and involved in mechanosensing in the kidneyd
convection are typically governed by classical laws, but yes-associated protein (YAP) and transcriptional coac-
additional production and consumption laws must also tivator with PDZ-binding motif (TAZ)dalso play a role
be postulated based on the cell populations present. in bone mechanobiology33,34 and many other cell line-
In parallel with these macroscopic phenomenological ages.35 Identification of this and other molecular targets
models, novel methods were being developed to deter- may provide a link to mechanobiological functions in
mine whether cells actually sense and respond to me- other tissues and organ systems.
chanical cues. Flow chambers, stretched surfaces, Over the past 25 years, mechanobiology has grown
patterned surfaces, and materials of varying mechanical into a distinct field with research centers, journals, and
properties were all used to determine whether cells conferences dedicated to its study. It is a uniquely
altered gene or protein expression in response to me- interdisciplinary field that rests at an interface between
chanical cues. Lower and upper bounds of shearing engineering, biology, materials science, and physics. It
stresses, stretches, and pressures have since been estab- relies on many other new and growing fields such as
lished for mechanobiological response of a range of cell bioinformatics, gene editing, and high-resolution imag-
phenotypes. In a seminal paper, Engler and colleagues29 ing to achieve its aims. Mechanobiology is now firmly
showed that culturing stem cells on materials with established in the biology and bioengineering lexicon,
differing constitutive properties alters their differentia- and in 2018, 308 articles indexed in the PubMed data-
tion fate. base specifically used one of the terms mechanobiology
PREFACE: MECHANOBIOLOGY, WHY NOT? xiii
or mechanobiological in the abstract or title. There is an powerful experimental platforms for mechanobiology,
excellent textbook on mechanobiology,36 and courses especially when coupled with genetically engineered cell
are offered at many universities. A multisite National sources37 or small molecule activators or inhibitors of
Science Foundation is highly active, and there are other pathways of interest. Underlying biological mechanisms
institutes and centers at universities throughout the can be further probed by cell culture using reporter cells
world. to quantify the mechanics of individual cells.
New technologies, including animal models, organ-/ The final two chapters consider modeling of mecha-
tissue-on-a-chip, and engineered tissues, coupled with nobiology in development and tissue morphogenesis.
gene editing and cellular level probes, have opened Computational modeling can provide the best approach
endless possibilities for mechanobiology research. It is to develop and test hypotheses in mechanobiology.
now much easier to probe the mechanical response of Multiphysics modeling software allows researchers to
systems and to understand how they are coupled to both explore the interactions of mechanics, transport, and
health and disease. As such, we have entered the era of growth and to explore scenarios that lead to experi-
“why not mechanobiology.” mentally testable hypotheses. Development provides a
unique model with which to study mechanobiology
because the tissue and organ morphology can change
rapidly, and the effects of interventions are easily
OVERVIEW observed. Researchers have studied the mechanobiology
In the first five chapters of this book, mechanobiological of development using animal38,39 and even human
effects in different tissues are reviewed and discussed. As models.40,41
mechanobiology has taken root in various fields, the
theories and methods have evolved independently. It is Glen L. Niebur
often valuable to look across fields to understand new Tissue Mechanics Laboratory, Bioengineering Graduate
potential pathways and molecules that may play similar Program, Department of Aerospace and Mechanical
or differing roles in other systems. Across these chapters, Engineering, University of Notre Dame, IN, USA
we can see the recurring themes of understanding the
mechanical environment of the tissue and how that is
translated to the cells. Many themes are repeated across REFERENCES
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structures are involved in all tissues, but with varying 2. van der Meulen MC. Origins of the term mechanobiol-
effects. ogy. Personal Commun. 2019. June, 2019.
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20. Malaviya P, Butler DL, Korvick DL, Proch FS. In vivo 34. McDermott AM, Herberg S, Mason DE, Collins JM,
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tendon adaptation to compressive loading through mechanotransduction. Nature. 2011;474:179e183.
fibrocartilaginous metaplasia. J Rehabil Res Dev. 36. Jacobs CR, Huang H, Kwon RY. Introduction to Cell Me-
2000;37:135e143. chanics and Mechanobiology. Garland Science; 2012.
23. Taber LA, Humphrey JD. Stress-modulated growth, re- 37. Adkar SS, Wu CL, Willard VP, Dicks A, Ettyreddy A,
sidual stress, and vascular heterogeneity. J Biomech Eng. Steward N, Bhutani N, Gersbach CA, Guilak F. Step-wise
2001;123:528e535. chondrogenesis of human induced pluripotent stem cells
24. Checa S, Prendergast PJ. A mechanobiological model for and purification via a reporter allele generated by crispr-
tissue differentiation that includes angiogenesis: A cas9 genome editing. Stem Cells. 2019;37:65e76.
lattice-based modeling approach. Ann Biomed Eng. 38. Nowlan NC, Murphy P, Prendergast PJ. A dynamic
2009;37:129e145. pattern of mechanical stimulation promotes ossification
25. Khayyeri H, Checa S, Tagil M, O’Brien FJ, Prendergast PJ. in avian embryonic long bones. J Biomech. 2007.
Tissue differentiation in an in vivo bioreactor: In silico 39. Nowlan NC, Murphy P, Prendergast PJ. Mechanobiology
investigations of scaffold stiffness. J Mater Sci Mater Med. of embryonic limb development. Ann N Y Acad Sci.
2010;21:2331e2336. 2007b;1101:389e411.
PREFACE: MECHANOBIOLOGY, WHY NOT? xv
40. Verbruggen SW, Loo JH, Hayat TT, Hajnal JV, 41. Verbruggen SW, Kainz B, Shelmerdine SC, Arthurs OJ,
Rutherford MA, Phillips AT, Nowlan NC. Modeling the Hajnal JV, Rutherford MA, Phillips ATM, Nowlan NC.
biomechanics of fetal movements. Biomech Model Altered biomechanical stimulation of the developing hip
Mechanobiol. 2016;15:995e1004. joint in presence of hip dysplasia risk factors. J Biomech.
2018;78:1e9.
SECTION I MECHANOBIOLOGICAL BASIS OF DISEASES
CHAPTER 1.1
Mechanobiology. https://doi.org/10.1016/B978-0-12-817931-4.00001-7
Copyright © 2020 Elsevier Inc. All rights reserved. 1
2 SECTION I Mechanobiological Basis of Diseases
FIG. 1.1.1 (A) Depiction of osteocyte morphology, lacunocanalicular organization, and interaction with other
osteocytes, surface osteoblasts, bone marrow, and the vasculature. From S.L. Dallas, M. Prideaux, L.F.
Bonewald, The osteocyte: an endocrine cell . and more, Endocr. Rev., 34 (2013), pp. 658e690. (B) Scanning
electron microscopic image of an acid-etched resin embedded murine osteocyte demonstrating its numerous
and tortuous canalicular network. From Lynda F. Bonewald, Osteocyte Biology In Robert Marcus, David
Feldman,... Jane A. Cauley Eds. Osteoporosis (Fourth Edition), (2013), pp. 209e234. (C) Mechanisms whereby
osteocytes regulate remodeling within and throughout a bone. From Sakhr, A. Murshid, The role of osteocytes
during experimental orthodontic tooth movement: A review, Archives of Oral Biology, 73, (2017), pp. 25e33,
2017.
theoretic set point that must be surpassed or unmet skeletal response to externally applied load include the
before initiating structurally appropriate alterations to nature of the strain (dynamic vs. static) and the time
bone mass and architecture. In this model, strains below over which it is applied.9
a set point promote osteoclast formation and bone Mechanotransduction refers to the complex interac-
resorption in order to reduce bone mass, thereby mini- tions whereby tissue-level strains are converted to local-
mizing the metabolic cost of unnecessary mass, and ized biophysical signals that ultimately promote skeletal
strains above the set point increase bone mass and the adaptation; per Duncan and Turner, it consists of four
strength to prevent pathologic fractures. Feedbackdin unique stages12:
the form of increased bone cross section that reduces (1) Mechanocoupling: Conversion of tissue-level loads
bone straindthereby limits the adaptive response.11 into localized mechanical signals perceived by
Beyond strain magnitude, other critical determinants of mechanosensitive cells.
CHAPTER 1.1 Osteocyte Mechanobiology in Aging and Disease 3
(2) Biochemical coupling: Transduction of localized Because of their frequency and localization
mechanical signals into biochemical responses in throughout bone, osteocytes are currently considered
mechanosensitive cells. the primary mechanosensory cell within a bone. Based
(3) Signal transmission: From mechanosensory cell to on in vitro studies of osteoblast mechanosensitivity, os-
effector cell. teoblasts (and, by inference, osteocytes) require
(4) Effector cell response: Initiation of tissue-level >5000 mε in order to elicit second messenger activation
response. and gene transcription,18,19 the magnitude of which in-
Within this model, the strain induced by bone duces pathologic fracture. Therefore it has been pro-
bending during physical activity or exercise, approxi- posed that osteocytes possess an ability to amplify the
mately 400e3000 microstrain (mε), induces a plethora applied tissue-level strain into a localized strain suffi-
of biophysical signals within the bone tissue, consisting cient to elicit osteocyte activation.20 In this model, cana-
of interstitial fluid flow, direct mechanical strain, hydro- licular tethering elements, such as integrins and the
static pressure, and electrokinetic effects on bone hyaluronan-rich glycocalyx, connect the osteocyte cell
cells.13,14 Rapid responses (0 se1 min) to biophysical membrane to the extracellular matrix,21e24 which gen-
forces include the generation or liberation of second erates drag forces across the canalicular cell process to
messengers such as Ca2þ, cyclic AMP, diacylglycerol, amplify the tissue-level strain to a level sufficient to
and inositol triphosphate. Over the course of minutes induce an osteocytic response.
to hours, such messengers subsequently promote the Tremendous efforts have identified potential and
synthesis and secretion of autocrine/paracrine factors functional biochemical coupling mechanisms in bone.
(e.g., NO, prostaglandin [PG] E2, and ATP), kinase acti- Thus there are several mechanisms by which osteocytes
vation, cytoskeletal rearrangement, transcription factor may detect mechanical signals, and it is likely that most,
(nuclear factor [NF]-kB, b-catenin) activity, and gene if not all, of these mechanisms contribute to mechano-
transcription and translation. Concomitantly, gap junc- transduction in osteocytes.
tional intercellular communication (GJIC) and juxta- a) Integrins. Integrins are heteromeric membrane-
crine signaling amplifies the local signal among spanning proteins composed of a- and b-chains.
effector cells for initiation of appropriate tissue-level re- Integrins bind focal adhesion kinase (FAK) and
sponses (Fig. 1.1.2).15e17 transmit force to ERK, Src, and RhoA, leading to
stress fiber formation.25 Fluid-flow-induced shear
FIG. 1.1.2 (A) Mechanistic model for osteocyte mechanocoupling, wherein fluid shear stress and/or tissue
deformation promotes integrin engagement, ion channel activation and opening, and cytoskeletal alignment.
From M. Prideaux, D.M. Findlay, G.J. Atkins, Osteocytes: The master cells in bone remodeling, Curr Opin
Pharmacol 28 (2016), pp. 24-30. (B) Proposed influence of mechanical loading or disuse influences bone
modeling via sclerostin, osteoprotegerin, and Rankl. OPG, osteoprotegerin. T. Moriishi, R. Fukuyama, M. Ito, M.
Myazaki, Y. Kawai, H. Komori, T. Komori, Osteocyte Network: a Negative Regulatory System for Bone Mass
Augmented by the Induction of Rankl in Osteoblasts and Sost in Osteocytes at Unloading, PLoS ONE (2012).
4 SECTION I Mechanobiological Basis of Diseases
stress causes conformational changes in integrins mechanotransduction, but there has only been one
that likely activate downstream signaling.26 study describing their role in osteocyte mechano-
Furthermore, recent evidence suggests that pan- transduction: Miyauchi38 demonstrated that
nexin 1, which is implicated as an ATP-releasing gadolinium chloride blocked hypoosmotic stretch-
channel; the ATP-gated purinergic receptor P2RX7; induced increases in intracellular Ca2þ (Ca2þi) in
and the low-voltage transiently opened T-type cal- rat osteocytes, as well as inhibiting expression of the
cium channel Cav3.2 co-localize with b3 integrin pore-forming a1c subunit of the Cav1.2 calcium
attachment foci on osteocyte processes, suggesting a channel.
specialized mechanotransduction complex at these Similar to the case with gadolinium-sensitive
sites.27 Thus integrins are well positioned to stretch-activated channels, there are limited studies
contribute to osteocyte mechanotransduction not on the role of TRP channels in osteocyte mecha-
only through mechanocoupling of direct substrate notransduction. However, in a comprehensive
strain into an intracellular response but also as a study Lyons et al. demonstrated that TRPV4 was a
node that integrates multiple mechanocoupling critical component of the mechanism by which
mechanisms. fluid-flow-induced shear stress increases cytosolic
b) Cilia. Over the past several years, the role of cilia in Ca2þ levels, which then reduces sclerostin expres-
osteocyte mechanotransduction has begun to sion.39 As sclerostin inhibits bone formation, these
emerge. Cilia are long antennalike structures that results suggest that osteocytic TRPV is involved in
have been implicated in mechanotransduction in the bone anabolic effects of mechanical signals.
several cell types including osteocytes. It has been d) Gap junctions. Abundant in vitro data suggest that
demonstrated that lengthening primary cilia en- GJIC, largely through gap junction composed of
hances cellular mechanosensitivity. Osteocytic cells Cx43, plays a critical role in mechanotransduction
designed to have longer cilia displayed greater in bone. In vitro experiments, largely with osteo-
increased expression of COX-2 and osteopontin blasts, demonstrate that gap-junction-deficient cell
messenger RNA in response to fluid flow than did ensembles are less responsive to mechanical sig-
cells with normal length cilia.28 Furthermore, Lee nals40 and that mechanically induced signals travel
et al. demonstrated that the primary cilium function from bone cell to bone cell via gap junctions.41 This
as a mechanical and calcium signaling nexus in suggests that gap junctions sensitize bone to me-
osteocytes. Additionally, removal of polycystins chanical signals. However, in vivo studies do not
(Pkd1 and 2 in osteoblasts and osteocytes) or support the concept. For instance, bone from mice
ciliary proteins (Kif3a) impairs specifically deficient in osteoblast and osteocyte
mechanotransduction.29e31 However, while abun- Cx43 (Gja1) is actually more responsive to the
dant data suggest a role for cilia in osteocyte anabolic effects of mechanical loading42,43 and less
mechanotransduction, the biochemical coupling responsive to the catabolic effects of unloading.44,45
linking cilia movement to osteoanabolism remains The mechanism underlying these rather counterin-
elusive. Furthermore, cilia are located on cell bodies tuitive results is not known. However, a nonca-
rather than on dendritic processes, the more ideal nonical function of Cx43, that of a molecule that
location of mechanosensors in osteocytes. binds b-catenin, has been proposed.46,47
c) Membrane Channels. Osteocytic cells express Gap junction hemichannels may also play a role in
gadolinium-sensitive stretch-activated channels, bone mechanotransduction. Mechanical signals,
transient receptor potential (TRP) channels, and including fluid-flow-induced shear stress, increase
voltage-sensitive calcium channels.32e36 Brown the release of ATP48 and PGE249 via Cx43 hemi-
et al. elegantly demonstrated that Cav3.2 T-type channels and, in the case of PGE2 release, this may
voltage-sensitive calcium channels mediate shear- involve activated AKT kinase.50 However, one study
stress-induced cytosolic calcium in osteocytes has demonstrated that, at least in osteoblasts, fluid-
through a mechanism involving endoplasmic re- flow-induced PGE2 release occurs in Cx43-deficient
ticulum calcium dynamics,37 and Thompson et al. osteoblasts and is dependent on the expression of
found that the auxiliary a2d1 subunit of the Cav3.2 pannexin 1.51 Similarly, Genetos et al.48 found that
channel complex is involved in osteocytic stretch- osteocytes transfected with Cx43 small interfering
activated release of ATP. Regarding gadolinium- RNA were still capable of PGE2 release in response
sensitive stretch-activated channels, there is to purinoceptor activation, supporting a mecha-
considerable evidence for their role in osteoblast nism wherein ATP is released via Cx43 or
CHAPTER 1.1 Osteocyte Mechanobiology in Aging and Disease 5
pannexins, which subsequently binds to purino- Unloading of bones because of disuse, weight loss,
ceptors to induce PGE2 secretion. or exposure to microgravity during spaceflight causes
Initial consideration of bone mechanobiology focused relatively rapid decreases in bone mass and mineraliza-
on the effects of diverse biophysical forces on osteoblast tion. Humans in space suffer bone loss of 0.5%e1.5%
or osteoclast function, as these are the primary effectors of bone mineral density (BMD) per month from expo-
of bone adaptation. Furthermore, osteocyte isolation pro- sure to microgravity, even when using a light exercise
cedures were time-consuming, and the ignorance or un- program of 3e4 days per week.63,64 Unloading from
availability of osteocyte markers prevented procurement immobilization also causes similar amounts of bone
of pure populations. The development of fluorescent re- loss in human and animal studies on Earth.56,65e67
porter mice and improved primary osteocyte enrichment Bones exposed to extended periods of unloading have
approaches have overcome this burden, enabling investi- increased numbers of empty lacunae and lacunae size,
gators to directly assay the effects of biophysical forces on increased porosity, and increased endosteal resorption.
osteocytes. Although osteocytes recapitulate many of the These changes make bone more susceptible to fracture
biophysical load-induced responses as observed in osteo- and less sensitive to changes in mechanical loading.
blasts, for example, rapid and transient increases in Ca2þi; Noting variations in lacunar shape, Marotti68 pro-
release of PGs, nitric oxide, and ATP; and OPG/RANKL, posed that osteocytes secrete an inhibitory factor that
there exist fundamental differences between osteoblastic limits bone deposition by nearby osteoblasts; this hy-
and osteocytic responses to in vitro mechanical loading. pothesis was refined by Martin,69 whose model pre-
For example, fewer primary osteocytes than primary oste- dicted tonic suppression bone-lining cell activation by
oblasts responded to shear stresses of 1.2e2.4 Pa by the said inhibitory factor. Furthermore, the funda-
mobilizing Ca2þi.52 Similarly, the molecular mecha- mental necessity of osteocytes for mechanosensing is
nisms whereby localized biophysical signals are trans- observed in their absence: targeted deletion of osteo-
duced into intracellular responses can alter as a cytes increases porosity and microdamage and de-
function of osteolineage state, with osteoblasts reliant creases bone formation, strength, and
on Cav1.2 calcium channels, and osteocytes reliant on mechanosensitivity.70 Sclerostin (product of the Sost
Cav3.2 calcium channels, to mobilize Ca2þi.53 Further, gene), an inhibitor of Wnt signaling expressed primarily
osteocyte-specific responses to mechanical load are in osteocytes, represents such an osteocyte-expressed in-
observed in the context of osteocyte-specific or -enriched hibitor of bone formation. Nonsense mutations in Sost
proteins, which are mechanoregulated in osteocytes, but produce the sclerosing bone dysplasia sclerosteosis,71
not mechanoregulated in osteoblasts. and a related syndrome, van Buchem disease, results
from the deletion of a noncoding distal enhancer.72e74
Murine models of Sost or ECR5 deletion phenocopy the
3. EVIDENCE FOR OSTEOCYTE-DIRECTED high bone mass phenotype observed in humans,75,76
SKELETAL RESPONSES enabling thorough evaluation of the molecular mecha-
Exercise has many long-lasting benefits to bone, nisms of Sost transcriptional regulation. The mechanical
including increasing bone volume, bone strength, and environment reciprocally influences sclerostin expres-
bone tissue quality.54e57 Bones respond to dynamic, re- sion, which decreases in limbs of loaded animals and
petitive loading with increased periosteal bone forma- increases following disuse.77,78 Load-induced changes
tion, bone mineralization, and tissue quality. This in Sost expression are required for skeletal adaptation:
response strengthens the areas of bone tissue exposed transgenic mice that increase Sost expression in response
to the highest amounts of loading.58 Periosteal bone to loading, rather than the natural downregulation that
formation increases linearly with increasing applied occurs after load, are incapable of an osteoadaptive
strain,59 loading frequency, and daily loading cycles.9 response,79 and pharmacologic or genetic inhibition
However, bone becomes desensitized to prolonged of Sost function protects mice from disuse-induced
loading, after approximately 40 high-magnitude bone loss.80,81 Mechanoregulated Sost expression ap-
loading cycles per day.60 Effects of increasing loading pears independent of the ECR5 enhancer, as, despite be-
on bone are also dependent on age and skeletal devel- ing mechanosensitive in vitro, ECR5/ mice
opment. Exercising when young and still undergoing demonstrate equivalent bone formation or loss
skeletal development offers the greatest benefits to compared to wild-type mice in response to loading or
bone mass and bone strength.61 Benefits to bone mass unloading, respectively.82 In contrast, the inhibitory ef-
from exercise decrease throughout adulthood such fect of parathyroid hormone (PTH) (1-34) requires
that, in the elderly, exercise only helps to attenuate ECR5.83
bone loss from aging.62 Osteocytes also have the ability to regulate bone
resorption by secreting receptor activator of NF-kB
6 SECTION I Mechanobiological Basis of Diseases
ligand (RANKL). RANKL is also secreted by chondrocytes the transcription factor b-catenin. Mice lacking b-catenin
and osteoblastic cells and is required for differentiation in osteocytes do not fully develop bones and die prema-
of osteoclast progenitor cells into osteoclasts.84 Osteo- turely,86 and heterozygous b-catenin osteocyte cKO mice
cytes also secrete osteoprotegerin (OPG) that works as reveal decreased trabecular bone volume and fail to lose
a decoy receptor,85,86 binding to RANKL and preventing cortical bone in response to unloading.100 Furthermore,
its osteoclastogenic effects. RANKL and OPG are closely constitutively active b-catenin in osteocytes has an
regulated, and the RANKL/OPG ratio is used as an indi- osteoanabolic effect resulting from the increasing bone
cator of osteoclastogenic activity.87 Osteocyte apoptosis formation and osteoblast differentiation.101 Yet, other
induces RANKL and decreases OPG expression in neigh- factors that exert osteotropic effects, beyond Wnt
boring osteocytes, thereby promoting pro-resorptive signaling, are capable of activating b-catenin signaling
adaptation.88 Thus reciprocal modulation of OPG and and eliciting osteoanabolic effects: load-induced b-cate-
RANKL by osteocytes provides a means to target bone, nin signaling in osteocytes is also driven through auto-
damaged from overuse, for replacement and subse- crine PGE2 function102 and PTH independent of
quent reduction of fracture risk.89,90 Lrp5,103e105 as well as fibroblast growth factor
In addition to regulating bone tissue remodeling, os- signaling.106
teocytes possess the capacity to remodel the perilacunar Osteocytes release many factors that work together to
area in which they reside. Perilacunar remodeling al- regulate bone remodeling. Communication between
lows for more rapid mobilization or storage of minerals neighboring osteocytes and the extracellular environment
from bone, as the osteocytes’ perilacunar networks is crucial for osteocytes to release and propagate these sig-
contain far more surface area of mineralized tissue nals in response to changes in mechanical loading. For
than the periosteal and endosteal bone surfaces. example, skeletal response to increases in mechanical
Enlarged lacunae, indicative of perilacunar bone resorp- loading is independent of osteocyte density in areas of
tion, are observed in patients with mineral metabolism maximum loading, supporting the concept that signal
disorders,91 in rats exposed to unloading during space- propagation from a modest few mechanoactivated osteo-
flight,92 in hibernating animals,93 and in lactating ani- cytes is necessary to promote skeletal adaptation.
mals.94,95 Perilacunar remodeling is activated through Membrane-bound connexins help osteocytes to propa-
tumor growth factor (TGF)-b96 or PTH95,97 signaling gate signals released in response to mechanical loading.
and, thus, is sensitive to both changes in both the hu- Mechanical loading increases expression and activation
moral milieu (PTH) and factors released from bone ma- of connexin 43, allowing for greater release of signals
trix during resorption (TGF-b, PTH-related protein such as PGE2 that affect bone metabolism. Deletion of
[PTHrP]). Furthermore, changes in lacuna size from per- connexin 43 in osteocytes causes early onset osteopenia,
ilacunar remodeling affect fluid-flow-induced shear weak bones, and high porosity, properties usually seen in
stress forces sensed by osteocytes.98 Thus conditions older bones or following increased osteocyte
that change the lacuna size can also change the mecha- apoptosis.107,108 This change in phenotype is not seen
nosensitivity of the bone. in osteocytes with normal connexin 43 hemichannels
To limit osteocytic influence on bone remodeling to and defective connexin 43 gap junctions,109 suggesting
a few scant proteinsesclerostin, OPG, and RANKLeor hemichannels play a predominant role in the response
via perilacunar remodeling minimizes the tremendous to changes in mechanical loading. Connexin 43-
influence that osteocytes have on skeletal development deficient osteocytes are more responsive to increases in
and repair. Dickkopf-1 (Dkk1) functions similar to scle- mechanical loading, increasing production of PGE2 and
rostin to inhibit bone formation by inhibiting activation decreasing Sost expression to a greater extent than in
of the Wnt pathway. However, the absence of Dkk1 does wild-type osteocytes.110 Connexin 43-deficient osteocytes
not influence bone mass and strength to the extent are less responsive to unloading, although these bones
observed in SostKO mice: neither osteocytic Dkk1 cKO already have signs of bone loss seen after wild-type bones
mice nor mice in which Dkk1 is systemically neutralized are exposed to microgravity.44,45 Yet, while cell-cell
by an antibody reveal a robust skeletal response to these communication, or release of paracrine factors, is attrib-
interventions, in contrast to the dramatic skeletal pheno- uted to Cx43 function in bones, evidence indicates that
type in animals deprived of sclerostin expression or func- the Cx43 carboxy terminus, independent of gap junction
tion. Instead, absence of Dkk1 expression or function signaling, is obligate for normal skeletal development.47
increases sclerostin expression, indicating a compensa- Alternately, direct cell-cell interactions, rather than
tory mechanism between the two Wnt antagonists.99 secretion of soluble factors, reveal tremendous influ-
Osteoanabolic effects of Wnt signaling appear to require ence on skeletal form and function; this is observed,
CHAPTER 1.1 Osteocyte Mechanobiology in Aging and Disease 7
for example, in the context of Notch signaling, which is many studies designed to interrogate the effect of chro-
activated by direct interactions between a Notch ligand nologic age on osteoanabolic response to loading. Yet,
and a Notch receptor in neighboring cells. Notch rather than suggest failures in various models, the
signaling imparts osteolineage-specific effects on the inability to answer such a facile question may underlie
skeleton: in osteoprogenitors or immature osteoblasts, the complexity of organism aging viz. redundancy in
activation of Notch signaling through overexpression mechanoresponsive or mechanoadaptive mechanisms.
of the Notch1 intracellular domain (NICD) reduces Indeed, rather than posit a specific defective signaling
osteoblast differentiation, whereas in osteocytes the pathway in osteocytes as the cause for primary osteopo-
same model increases cancellous bone volume through rosis, it is necessary to consider osteoporosis as the
increased bone formation and reduced bone resorp- result of changes in the interaction of osteocytes with
tion.111 Notch activation in osteocytes promotes Wnt their matrix, osteocyte abundance, the hormonal
signaling through reductions in expression of the Wnt milieu, and cell-autonomous deficits in osteocyte func-
antagonists Sost and Dkk1; mice expressing constitu- tion (Fig. 1.1.3).
tively active b-catenin show increased Notch receptor
expression,101 and osteocytic Notch activation pro- 4.1. Osteocyte Number
motes Wnt signaling, creating a positive feedback be- The ability to perceive biophysical signals and transduce
tween Notch and Wnt signaling.112 them to tissue-level responses is predicated upon the
presence of an osteocyte, such that alterations in osteo-
cyte number may contribute to osteoporosis. Indeed, re-
4. OSTEOCYTES, ductions in osteocyte number and lacuna are observed
MECHANOTRANSDUCTION, AND AGING in human specimens and murine models, although
The existence of skeletal involution with increasing this highly depends on the anatomic location and
chronologic age is without dispute, but attributing type of bone (cortical vs. trabecular). For example, oste-
this tissue-level response to deficits in specific cells, or ocyte lacunar density decreases exponentially with
specific signaling mechanisms, is nigh impossible advancing chronologic age in human mid-diaphyseal
owing to the rich diversity of changes in, for example, cortical bone in specimens from both men and
the hormonal milieu, attenuation of cell function, and women,119 whereas lacunar number in iliac trabecular
increases in the inflammatory environment. Murine bone decreases linearly120; yet it was reported that in
models of inbred mice can identify quantitative trait the femoral head trabecular bone, there is no decrease
loci to map genes that influence BMD or other parame- in osteocyte density until 70 years of age, after which
ters113 or adaptation to mechanical loading,114 either a sharp decline in osteocyte lacunar density appears.121
confirming candidate genes or identifying novel genes Osteocyte density is also a function of distance from
for susceptibility to osteoporosis. Similarly, human ge- the bone/haversian surfacesdthat is, as a function of
netic diseases can reveal novel genes involved in causing bone agedwith superficial osteocytes (<25 mm from
osteoporosis (e.g., LRP5 or CYP17), but such variants surfaces) resistant to age-related decreases in osteocyte
that have a large effect are rare, whereas common allelic density, whereas osteocyte density in deep bones
variants have a small effect.115 Provided the evidence (>45 mm from surfaces) decreases with age in both
for skeletal adaptation to a changing mechanical envi- men and women.122 Osteocyte density in both superfi-
ronment, the question whether age influences the ca- cial and deep bones is reduced in vertebral iliac trabec-
pacity of an osteoanabolic response to age, seemingly ular bone from individuals with osteoporotic
a simple question to resolve with murine models, has fractures,119,123 and the endosteal cortex appears more
inconsistent results. For example, Rubin et al.116 re- sensitive to age-dependent osteocyte loss than the peri-
ported that greater strain was required for the initiation osteal cortex.124 As osteocytes are mechanosensory
of an osteoanabolic response in the ulna of aged (19- cells, their reduction secondary to aging removes a
month-old) turkeys versus younger (9-month-old) tur- means through which skeletal integrity may be interro-
keys, whereas Järvinen et al.117 found no overt effect of gated and improved.
age on the influence of treadmill-running on the
femoral neck, and Brodt and Silva118 reported 4.2. Changes in Osteocyte
enhanced endocortical response to axial tibial compres- Microenvironment
sion in aged mice. Stark differences in animal models, The mechanosensory role of osteocytes is grounded in
age ranges, experiment duration, and method of me- localized biophysical signals that are engendered during
chanical stimulus prevent direct comparison among locomotion or exercise. As described earlier, such signals
8 SECTION I Mechanobiological Basis of Diseases
FIG. 1.1.3 Age-related changes in osteocyte networks. (A) Scanning electron microscopic images of
acid-etched resin embedded human bone sections, revealing decreased osteonal width, osteocyte
frequency, and canaliculi in aged bone. From L.M. Tiede-Lewis, S.L. Dallas, Changes in the osteocyte
lacunocanalicular network with aging, Bone 122 (2019), pp. 101-113. (B) A model for osteocyte-mediated
effects of age on bone quality and fragility. From B. Busse, D. Djonic, P. Milanovic, M. Hahn, K. Püschel, R.O.
Ritchie, M. Djuric, M. Amling, Decrease in the osteocyte lacunar density accompanied by hypermineralized
lacunar occlusion reveals failure and delay of remodeling in aged human bone, Aging Cell 9 (2010), pp. 1065-
1075From B. Busse, D. Djonic, P. Milanovic, M. Hahn, K. Püschel, R.O. Ritchie, M. Djuric, M. Amling, Decrease
in the osteocyte lacunar density accompanied by hypermineralized lacunar occlusion reveals failure and delay of
remodeling in aged human bone, Aging Cell 9 (2010), pp. 1065-1075. (C) Alterations in osteocyte
microenvironment via perilacunar remodeling associated with pharmacotherapy, disease, and age. From L.F.
Bonewald. (2011) Osteocyte Mechanosensation and Transduction. In: Noda M. (eds) Mechanosensing Biology.
Springer, Tokyo, 2011, pp. 141-155.
include the shear stresses of interstitial fluid flow across canaliculi and thereby generating a “wall,” a “sink,” or
the plasma membrane of osteocyte dendrites and cell a “reservoir” to mitigate interstitial fluid flow and
body, microperturbations in osteocyte plasma mem- mass transport within bone.125 Thus microdamage
brane integrity, and tethering of osteocyte dendritic pro- effectively decreases the concentration of osteotropic
cesses to the canalicular wall.21,23 Thus it is axiomatic agents, from the vasculature or osteocytes within the
that age-related alterations to the microenvironment in LCN to osteocytes distal from the microdamage.
which an osteocyte resides would subsequently alter Furthermore, compromised transport and exchange of
the biophysical signals experienced by an osteocyte. nutrients in response to microdamage would decrease
The integrity of the lacunocanalicular network osteocyte viability, as is observed in vivo.126 Occlusion
(LCN) is diminished by microdamage, severing of the LCN can also occur with aging, a process termed
CHAPTER 1.1 Osteocyte Mechanobiology in Aging and Disease 9
micropetrosis by Frost, wherein osteocyte death promotes The osteocyte morphology appears to depend on the
occlusion of lacunae with hypermineralized calcium anatomic location, age, hormonal status, and mechani-
phosphate, which could further cause deteriorations cal loading environment. In humans and rodents, oste-
in canalicular fluid flow.124 Even in the absence of ocyte morphology changes from relatively flattened to
lacunar occlusion, microstructural changes in the LCN more spherical.135,136 Similarly, osteocytes within ro-
negatively impact fluid flow in response to loading. dents demonstrate an elongated morphology, whereas
Strain amplification within osteocyte lacunae is influ- calvarial osteocytes are more spherical.137 Differences
enced by pericellular lacunar tissue modulus, with pre- in osteocyte morphology may result from the mechan-
dicted maximum perilacunar strain increasing as the ical loading environment: the long axis of fibular osteo-
modulus of the perilacunar matrix decreases; cytes align parallel to the principal loading direction,
conversely, maximum perilacunar strain decreased as whereas calvarial osteocytes do not appear to align
perilacunar matrix modulus increased.127 Furthermore, with any loading direction. In human osteonal bone,
microstructural changes, such as increases in vascular osteocyte lacunae are aligned with collagen fiber
porosity, reductions in trabecular number, and in- orientation,138e140 suggesting that osteocyte orienta-
creases in trabecular separation, in response to ovariec- tion within a lacuna occurs during the osteoblast-to-
tomy fundamentally reduce load-induced interstitial osteocyte transition.141 Hormonal cues also influence
fluid flow,128 indicating that changes in micro- and osteocyte morphology: for instance, compared to virgin
nanostructural properties of bone can negatively mice, the lacunar volume of lactating mice is increased,
influence osteocyte mechanosensation. Estrogen defi- indicating perilacunar remodeling,133 and exercise-
ciency influences strain distribution across osteocytes induced changes in PTH secretion promote changes in
more than osteoblasts, exerting acute increases yet sus- lacunar volume.134
tained decreases on applied strain129 resulting from To date, that osteocyte morphology influences
changes in tissue stiffness and mineral content.130 mechanosensation and downstream effects on remod-
Thus localized changes in mineral density, tissue eling, bone strength, etc. is inferred from changes in
composition, and even LCN tortuosity immediately sur- bone material and structural properties. Direct demon-
rounding the osteocyte130,131 may serve as a means to stration of altered osteocyte morphology to a given me-
sensitize or diminish osteocyte mechanoresponsiveness chanical load is light, although Bacabac et al.142
via osteocytic perilacunar remodeling. Indeed, Hesse demonstrated that round, partially adherent MLO-Y4
et al.132 used synchrotron radiation phase-contrast osteocytes were more mechanosensitive than flat,
nanoecomputed tomography to reveal a gradient of adherent osteocytes. Nonetheless, with the possible
bone tissue mass density that decreases from the pore- exception of hormonal influence on osteocyte
matrix interface into the tissue. Hemmatian et al.133 morphology, whether changes in osteocyte morphology
used virgin or lactating mice to evaluate the influence are the cause, or the consequence, of changes in bone
of perilacunar remodeling on the activation of b-cate- health requires more careful and considerate
nin, as a marker of mechanotransduction, and found investigation.
that load-induced stabilization of b-catenin was greater
in the lactating mouse than in the virgin mouse, sug- 4.3. Cell-Autonomous Alteration of
gesting that increased lacunar volume enhances the Osteocyte Function
response to mechanical loading. Although lacunar vol- The reductions in bone mass, density, and microarchi-
ume was interrogated as a marker of perilacunar remod- tecture that are observed as a result of aging are pro-
eling, other aspects of the lacuna-matrix interface, such posed to result, in part, from decreased
as mineral-matrix ratio and carbon-phosphate ratio, mechanosensing. Although there is sufficient evidence
were not studied. Conversely, exercise induces perilacu- (detailed earlier) that applied strains or interstitial fluid
nar remodeling; Gardinier et al.134 reported that perila- flows can be reduced secondary to increases in vascular
cunar remodeling occurs during exercise, with porosity or lacunocanalicular tortuosity, there is little
alterations in mineral-matrix or carbonate-phosphate direct evidence regarding whether osteoblasts or osteo-
ratio observed within 0e5 mm from osteocyte lacunae cytes per se are less capable of perceiving a given load.
yet disappearing with greater radial distance from Donahue et al.143 observed a modest decrease in the
lacunae. Thus there appears to be a finely regulated percent of aged rat osteoblastic cells that responded to
interaction between lacunocanalicular properties as oscillatory fluid flow with an increase in cytosolic
both a predictor of osteocyte mechanosensation and Ca2þ levels. Sterck et al.144 evaluated the influence of
the result of osteocyte mechanoresponsiveness. donor cell age on mechanically induced responses,
10 SECTION I Mechanobiological Basis of Diseases
finding that PGE2 and PGI2 release increased with bone is not derived from bone cells, instead it results
donor cell age, and Bakker et al.145 reported that pulsa- from the clonal plasma cell malignant neoplasm, which
tile fluid flow is able to induce the synthesis and release subsequently causes osteolytic bone lesions in >80% of
of second messengers (nitric oxide, PGE2) from osteo- patients with myeloma.153 Osteolytic bone lesions are
porotic or osteoarthritic donors. Similarly, relative in- also observed in breast and lung cancers that have
creases in cytosolic Ca2þ levels and cfos transcription metastasized to the skeleton, and mixed osteoblastic/
in fluid flow across osteoblasts are no different in osteolytic lesions are most commonly observed in met-
response to loading in osteoblasts from young versus astatic prostate cancer (PCa). Complications of skeletal
senescent mice, whereas absolute changes are affected metastasis, termed skeletal related events (SREs),
as a function of age.146 include pathologic fracture, hypercalcemia, spinal cord
Thus rather than the decreased capacity of osteocytes compression, and chronic pain. Beyond the debilitating
to perceive a given stimulus, it is perhaps more likely impact on quality of life, the incidence of SREs nega-
that other age-related changes in cell function tively predicts survival: 5-year survival rates for PCa
contribute to loss of bone with age. For example, there are 56% after skeletal metastasis, but the survival rate
is a loss of osteoprogenitors with age as mesenchymal plummets to <1% with metastasis and an SRE.154 The
stem cells shift toward adipogenesis, increased osteo- events involved in cancer metastasis to the skeleton
blast apoptosis reduces the duration of bone-forming involve disseminated tumor cells (1) colonizing the
capacity, and increased marrow adiposity enhances sup- bone microenvironment and (2) adapting to the new
pression of bone formation through reductions in environment, avoiding immune surveillance, and
osteoblastogenesis and mineralization.147 entering a state of dormancy; (3) reactivating in
Alternately, senescence of osteoblasts or osteocytes response to as-yet-unknown cues, thereafter prolifer-
can contribute to tissue dysfunction.148 Markers of cell ating and forming micrometastases; and (4) growing
senescence, including gene transcripts (p16Ink4, uncontrollably, independent of the microenvironment
Cdkn1a/p21, and p53), telomere shortening, and (reviewed in Ref. 155) (Fig. 1.1.4).
senescence-associated secretory phenotype, are Provided that osteocytes are sentinels against remod-
observed in osteoblasts and osteocytes from older eling, and the proclivity and propensity for cancer to
(24 months) mice relative to young (6 months) mice, subvert normal homeostatic processes, it is logical to
with greater age-related increases observed in osteocytes suggest that tumor colonization, dormancy, and activa-
relative to osteoblasts.149 Senescence is no longer an un- tion involve, if not require, altered osteocyte function.
avoidable consequence of aging, as genetic150 and phar- The most direct way to alter osteocyte function is to pro-
macologic151,152 approaches to reduce or eliminate mote their death, and osteocyte death is implicated in
senescent cell populations revert age-related pathologic disseminated tumor cell colonization and adaptation:
conditions. Indeed, genetic or pharmacologic ablation increased frequency of apoptotic osteocytes is observed
of senescent cells in old mice increases bone mass and in individuals with MM156 and selective depletion of
strength resulting from decreased endocortical bone osteocytes supports MM colonization of bone and tu-
resorption and increased endocortical bone forma- mor growth.157 Whether the oppositedmaintaining
tion.148 That bone resorption was reduced after senes- osteocyte viability pharmacologically or through other
cent cell ablation without concomitantly reducing meansdreduces tumor burden is under active investi-
bone formation is in contrast to current antiresorptive gation. Bisphosphonates reduce osteoclast formation,
therapies (bisphosphonates, anti-RANKL antibody, or but also exert antiapoptotic effects on osteocytes
estrogen), which reduce both bone formation and in vitro158 and in animal models of osteoporosis159,160
resorption. Because the currently identified senolytic through a molecular mechanism involving Cx43 hemi-
agents are already FDA-approved, and a monthly channels and ERK1/2.161 Provided that bisphospho-
dosing of senolytics was sufficient to reverse changes nates differentially influence apoptosis in osteocytes
due to age, such approaches portend their use in the versus osteoclasts, an unresolved question is to what
treatment of age-related bone loss. extent the beneficial effects of bisphosphonates for indi-
viduals with MM is related to osteocyte survival rather
than reduced osteoclast activity. The discovery of
5. OSTEOCYTES AND DISEASE bisphosphonates, which maintain osteocyte viability
5.1. Cancer without influencing osteoclast activity,162e164 provides
The skeleton is a common site for metastasis of other an opportunity to evaluate such a scenario. Other
cancers: multiple myeloma (MM) also begins in the agents that promote osteocyte viability, such as the
CHAPTER 1.1 Osteocyte Mechanobiology in Aging and Disease 11
FIG. 1.1.4 Proposed model for osteocyte interaction with cancer cells. Red arrows indicate direct effects on
cancer cells, whereas green arrows indicate indirect effects mediated via osteoblasts or osteoclasts. From M.
Zhang, J. Dai, E.T. Keller, Multiple Roles of Osteocytes in Bone-Associated Cancers, Reference Module in
Biomedical Sciences 2019, 10.1016/B978-0-12-801238-3.11246-2
proteasome inhibitor bortezomib165 and PTH (1-34), in patients with MM and correlate with advanced dis-
are under investigation as a means of minimizing the ease172 and the Sost expression is increased in response
skeletal impact of MM or skeletal complications to to MM-osteocyte interactions,171 suggesting that
radiotherapy.166,167 manipulation of Sost expression or function may pro-
Communication between osteocytes and neigh- vide a means to reduce MM tumor burden and impact.
boring cells is also subverted during tumor metastasis Indeed, Sost deletion or pharmacologic inhibition of
to bone and growth therein, which has recently been sclerostin reduced MM-induced osteolysis and bone
elegantly reported in the context of MM signaling loss, although it did not decrease tumor volume,173
through Notch receptors and breast cancer communica- providing a promising opportunity to mitigate the skel-
tion through connexin 43 gap junctions. Compelling etal sequelae of MM.
evidence demonstrates that MM colonization of bone Osteocyte functiondor, minimally, markers of oste-
and adaptation therein involves reciprocal interactions ocyte functiondis also implicated in tumor burden and
between MM cells and osteocytes. Notch signaling is growth in PCa that has metastasized to the skeleton.
enhanced in MM cells,168e170 and direct coculture of Prostate carcinoma stimulates bone formation, both
MM cells with MLO-A5 osteocytes promotes osteocyte through the secretion of pro-osteogenic factors such as
apoptosis via Notch signaling.171 As in other studies, Wnts and through osteomimicry, wherein cancer tumor
osteocyte apoptosis increased osteoclastogenesis cells can secrete matrix, mineral, and osteotropic fac-
through enhanced Rankl expression and reductions in tors, as well as respond to osteotropic factors. For
Opg. Furthermore, MM cells increase Sost expression example, expression of the Wnt antagonist Dkk1 is
and decrease Wnt signaling in osteocytes, leading to re- observed in focal lesions of MM cells,174 sclerostin is
ductions in osteoblastogenesis. Reciprocally, Notch secreted by breast cancer cells,175 and increased b-cate-
activation in MM cells by osteocytes promotes MM nin levels are observed in individuals with PCa.176,177
cell proliferation. Serum sclerostin levels are increased Functionally, overexpressing Sost, but not Dkk1, in
12 SECTION I Mechanobiological Basis of Diseases
osteolytic PC3 cells reduces osteolysis in xenograft- (Gja1D130-136), which reduces both GJIC and hemichan-
derived tumor lesions,178 whereas increasing Wnt nel activity, relative to control animals. In contrast, tu-
signaling in mixed osteolytic/osteoblast C4-2B PCa mor growth in osteocytic Gja1R76W mice, which can
cells, through knockdown Dkk1, shifts tumor pheno- form hemichannels but not participate in GJIC, was
type toward osteolysis.179 Similarly, osteocyte-derived phenotypically similar to wild-type animals. Further-
GDF15, a member of the TGF-b superfamily, promotes more, the inhibitory effect of zolendronate on tumor
PCa metastasis to the skeleton.180 growth was absent in osteocytic Gja1 cKO or Gja1D130-
136
Disseminated tumor cell adaptation to the bone mice but not Gja1R76W animals, indicating a specific
microenvironment also subverts gap junctions. Con- inhibitory role of osteocytic Cx43 hemichannel-
nexins are considered antitumorigenic, as loss of con- mediated ATP release in tumor metastasis and growth
nexin 43 expression is a marker for breast tumors,181 in the skeleton.185
and connexin expression and intercellular communica-
tion are reduced during tumorigenesis, whereas trans- 5.2. Vascular Health
fection of cancer cells with connexins reduces cell A consequence of multicellular growth is the insuffi-
proliferation.182 Connexins exert multipronged influ- ciency of simple diffusion to provide sufficient oxygen
ences on tumor growth via GJIC, hemichannels, and for host respiration; oxygen delivery, as well as nutrient
channel-independent connexin function. Wang provision and waste removal, is provided by the
et al.183 found that Ca2þi-dependent transcription fac- vascular system. Bone development, homeostasis, and
tor activation of NFAT and MEF2 was enriched in breast repair are each exquisitely coupled to the vasculature
carcinomas that have metastasized to bones. Such ob- (reviewed in Ref. 186). Furthermore, blood vessels pro-
servations were recapitulated in both in vivo and vide the necessary conduit for calcium and phosphate,
ex vivo models of bone metastasis, such that inhibition liberated from the matrix, to reach target tissues for ho-
of calcium signaling with dominant-negative calci- meostatic function. A sufficient vasculature is funda-
neurin or calmodulin-dependent protein (CaM) kinase mental to osteogenesis, but vessel function is often
II function eliminated tumor colonization of bone. compromised by calcification as a consequence of aging
Cx43 expression was greater in skeletally metastatic and lifestyle. Calcification may occur throughout the
breast carcinomas, correlated with calcium-dependent vascular tree, with distinct molecular origins and path-
transcription factor enrichment, and established cal- ologic consequences. For example, calcification of
cium flux from osteogenic to tumor cells; reducing medial arteries increases vessel stiffness and decreases
Cx43 expression or inhibiting GJIC with carbenoxolone compliance, thereby impairing Windkessel physiology
reduced bone colonization and skeletal tumor burden. and increasing vessel pressure and cardiac work-
This association between connexins, GJIC, and calcium- load.187,188 Similarly, calcification of atherosclerotic
dependent transcription factor enrichment was not plaques reduces vessel lumen size and increases tissue
unique to breast carcinoma, as prostate carcinoma ischemia and thromboembolic events,188 whereas
and PCa cell lines demonstrated equivalent interactions aortic valve calcification reduces valve leaflet mobility
between calcium signaling, Cx43 expression, and tumor and impairs leaflet closing, promotes left ventricular hy-
burden. Notably, mesenchymal stem cells, but not oste- pertrophy, and results in aortic valve regurgitation.189
ocytes, were capable of altering calcium signaling in tu- Ectopic calcification within the vasculature and cardiac
mor cells, further suggesting that unique bone valves was long considered to be a passive, degenerative
microenvironments contribute to tumor cell coloniza- process. However, the biochemical and structural similar-
tion and survival. The influence of connexins on tumor ity of these ectopic calcifications to orthotopic bone
cell adaptation to the skeletal microenvironment is not hinted that an active process may be involved (Fig.
restricted to GJIC, as connexin hemichannels are also 1.1.5).190e192 This was initially confirmed in the study
implicated as mediators of tumor fate. Osteocytic hemi- by Boström et al.,193 wherein the potent osteogenic
channel opening in response to fluid shear stress48 or morphogen BMP-2 (then known as BMP-2a) immuno-
the bisphosphonate alendronate184 promotes the localized within human atherosclerotic lesions. Because
release of cytosolic ATP, which reduces the migratory ca- BMP-2 stimulates orthotopic calcification by increasing
pacity of breast cancer cells and reduces tumor growth. matrix synthesis, this finding suggested an active, cell-
The antitumor effect of osteocytic Cx43 appears mediated process for vessel calcification. Further studies
restricted to hemichannels: growth of mammary carci- revealed the presence of Wnts, osteoblast-related tran-
noma cells in the skeleton is greater in mice lacking scription factors Runx2194 and Msx2,195 and matrix ves-
osteocytic Gja1 or expressing dominant-negative Cx43 icles within arterial calcifications,196,197 suggesting that a
CHAPTER 1.1 Osteocyte Mechanobiology in Aging and Disease 13
FIG. 1.1.5 Osteogenic networks implicated in vessel wall calcification. A.S.A. Bardeesi, J. Gao, K. Zhang, S.
Yu, M. Wei, P. Liu, H. Huang, A novel role of cellular interactions in vascular calcification, J Transl Med
(2017) 15: 95. https://doi.org/10.1186/s12967-017-1190-z AGE, advanced glycation end product; BMP, bone
morphogenetic protein; DKK-1, dickkopf-1; DMP-1, dentin matrix protein 1; FGF23, fibroblast growth factor
23; IGF-1, insulinlike growth factor 1; M-CSF, macrophage colony-stimulating factor; MEPE, matrix
extracellular phosphoglycoprotein; OB, osteoblast; OC, osteoclast; OCy, osteocyte; OPG, osteoprotegerin;
PGE2, prostaglandin E2; RANKL, receptor activator of nuclear factor kB ligand; SFRP-1, secreted frizzled-
related protein 1.
subpopulation of cells within the vessel wall are capable heterogeneous group of valve interstitial cells contains
of active mineralization processes described in chondro- mesenchymal precursors with osteogenic and chondro-
cytes and osteoblasts.188,193 Altering Wnt signaling, genic potential.200,201
through the overexpression of the Wnt antagonist sclero-
stin or the addition of recombinant sclerostin, attenuates
angiotensin-II-induced atherosclerosis.198 A similar oste- 6. CONCLUSIONS AND FUTURE
ogenic mechanism is involved in cardiac valve calcifica- DIRECTIONS
tion, wherein the Wnt/Lrp5/b-catenin signaling Although clearly the most abundant cell in bone, osteo-
pathway actively promotes calcium deposition. Caira cytes have been understudied until the past decades,
et al.199 revealed increased Lrp5 and osteogenic marker owing largely to technical reasons. However, recent ad-
gene expression in calcified aortic valves compared vances in cell isolation, the characterization of specific
with control valves. These results may at least partially gene transcripts in osteocytes, and the use of novel mu-
explain the increased risk of cardiovascular disease in in- rine models of altered osteocyte gene expression have
dividuals receiving antisclerostin antibody to treat osteo- revealed the central role that osteocytes play in surpris-
porosis. However, serum sclerostin levels are higher in ingly diverse areas of bone, and possibly host, meta-
individuals with cardiovascular disease, emphasizing bolism. Osteocytes not only are the orchestrator of
the complicated nature of sclerostin function in nonbone osteoblast and osteoclast activity in response to mechan-
tissue. ical, hormonal, or cytokine signals but also clearly play a
For active ectopic calcification to occur, these ectopic central role in bone cancer, vascular disease, and age-
sites must contain osteoblast(-like) cells. Both the related bone loss. However, there remain clear gaps in
vasculature and cardiac valves contain resident progen- our understanding of osteocyte biology. For example,
itor cells capable of osteogenic differentiation. Boström osteocyte function in osteoimmunology is poorly under-
et al.193 isolated a subpopulation of aortic medial cells, stood, the interactions of osteocytes with the peripheral
termed calcifying vascular cells (CVCs), that express and central nervous systems have only been
osteoblastic markers and are capable of osteogenic dif- suggested, and the role of osteocytes in development,
ferentiation in vitro. A similar effector cell, the adventi- maintenance, and activation of stem cell niches under
tial myofibroblast (pericyte), has been implicated in health and disease is unresolved. Furthermore, the role
medial artery calcification, as occurs in diabetic patients. that genetic variability plays in osteocyte biology and
Both CVCs and adventitial myofibroblasts express the how osteocytes may be exploited to regenerate lost
smooth muscle cell markers SM22 and a-SMA, which bone tissue and mass after injury or aging have not
are routinely used as the basis for confirmation of the been explored. These are just some of the gaps in osteo-
SMC phenotype for ex vivo cultures. Similarly, the cyte biology whose questions we avidly await answers.
14 SECTION I Mechanobiological Basis of Diseases
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18 SECTION I Mechanobiological Basis of Diseases
T
his work, which has the high honour of being introduced to
the world by the author of Loehiel and Hohenlinden, is not
wholly unworthy of so distinguished a chaperon. It professes,
indeed, to be no more than a compilation; but it is an exceedingly
amusing compilation, and we shall be glad to have more of it. The
narrative comes down at present only to the commencement of the
Seven Years’ War, and therefore does not comprise the most
interesting portion of Frederic’s reign.
It may not be unacceptable to our readers that we should take
this opportunity of presenting them with a slight sketch of the life of
the greatest king that has, in modern times, succeeded by right of
birth to a throne. It may, we fear, be impossible to compress so long
and eventful a story within the limits which we must prescribe to
ourselves. Should we be compelled to break off, we may perhaps,
when the continuation of this work appears, return to the subject.
The Prussian monarchy, the youngest of the great European
states, but in population and revenue the fifth among them, and in
art, science, and civilisation entitled to the third, if not to the second
place, sprang