Mechanotransduction impairment in adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal curvature that affects up to 4% of children. As a complex disorder, the cause of AIS is still poorly understood. However, multiple categories of biological factors have been found to be associated with its etiology. The role of biomechanics has been acknowledged by clinicians both in the description of deformity and in relation to bracing treatments. Bone responses to routinely applied forces are an important part in a tightly regulated network that is necessary for the optimal function of the skeletal system. However, little is known about the mechanotransduction of musculoskeletal tissues in AIS.  The main goal of this dissertation was to investigate the contribution of mechanotransduction in the etiology of AIS from a cellular-molecular aspect. We studied primary osteoblasts obtained intraoperatively from AIS patients and compared them to samples from trauma cases as controls. Fluid flow application was used for mechanical induction. Immunofluorescence staining, and confocal microscopy was used to assess cilia, actin and cellular tests. Molecular changes were followed using RT-PCR or ELISA. We also performed whole exome sequencing (WES) to test the hypothesis that rare variants accumulation in genes involved in cellular mechanotransduction could contribute to AIS etiology.   We found an abnormal cilia elongation among AIS osteoblasts, which grew significantly longer than controls. AIS cells after fluid flow application failed to adjust their cilia length in proportion to the applied force. Under both short- and long-term flow applications, their cilia length adjustment was significantly different from controls. Notably, the elevation in the expression of osteogenic factors, that was normally observed with control osteoblasts, was significantly reduced in AIS osteoblasts, suggesting a decrease in their mechanosensitivity. Moreover, transcriptomic analysis following the applied forces revealed an altered expression of genes involved in the Wnt canonical pathway. Strain induced increase in secreted VEGF-A in control osteoblasts was not detected in AIS flow-conditioned media. At the genomic level, our SKAT-O analysis of the WES data also supported the involvement of heterogenous defects in genes pertaining to the cellular mechanotransduction machinery. We tested the consequence of these mechanotransduction abnormalities in a series of functional cellular studies. As expected and unlike controls, AIS osteoblasts failed to position or elongate themselves in proportion to the bidirectional applied flow. The strain-induced rearrangement of actin filaments was compromised in AIS osteoblasts. Finally, fluid flow showed to have an inhibitory effect on their migration contrasting with control cells that migrated significantly faster under flow.  In summary, our data strongly suggest an impaired mechanotransduction in AIS osteoblasts that affect cilia, downstream signaling molecular pathways, cytoskeleton and finally the behaviour of the whole cell in response to flow. Fluid flow is one of the main mechanical forces applied physiologically to the bone cells. Cellular responses to these stimulations play a critical role in the structure, strength, shape and optimal performance of the skeletal system. Mapping the impaired profile response of scoliotic bone cells can help in designing more efficient therapeutic approaches or explaining the mechanisms behind less than optimal bracing outcomes.

Keyphrases: Wnt, VEGF, Adolescent idiopathic scoliosis, Osteoblasts, Mechanotransduction, Cilia