Decrease of Markers Related to Bone Erosion in Serum of Patients with Musculoskeletal Disorders after Serial Low-Dose Radon Spa Therapy

Abstract

Musculoskeletal disorders (MSDs) are the most frequent cause of disability in Europe. Reduced mobility and quality of life of the patients are often associated with pain due to chronic inflammation. The inflammatory process, accompanied by a destruction of the cartilage and bone tissue, is discussed as a result of (A) the infiltration of immune cells into the joints, (B) an altered homeostasis of the joint cavity (synovium) with a critical role of bone remodeling cells, and (C) release of inflammatory factors including adipokines in the arthritic joint. In addition to the classical medication, low-dose radiation therapy using photons or radon spa treatments has shown to reduce pain and improve the mobility of the patients. However, the cellular and molecular mechanisms of anti-inflammatory effects of radon are yet poorly understood. We analyzed blood and serum samples from 32 patients, suffering from MSDs, who had been treated in the radon spa in Bad Steben (Germany). Before and after therapy, we measured the levels of markers related to bone metabolism (collagen fragments type-1, cartilage oligomeric matrix protein, receptor activator of NFκB ligand, and osteoprotegerin) in the serum of patients. In addition, adipokines related to inflammation (visfatin, leptin, resistin, and adiponectin) were analyzed. Some of these factors are known to correlate with disease activity. Since T cells play an important role in the progression of the disease, we further analyzed in blood samples the frequency of pro- and anti-inflammatory T cell subpopulations (CD4+IL17+ T cells and CD4+FoxP3+ regulatory T cells). Overall, we found a decrease of collagen fragments (CTX-I), indicating decreased bone resorption, presumably by osteoclasts, in the serum of MSD patients. We also observed reduced levels of visfatin and a consistent trend toward an increase of regulatory T cells in the peripheral blood, both indicating attenuation of inflammation. However, key proteins of bone metabolism were unchanged on a systemic level, suggesting that these factors act locally after radon spa therapy of patients with MSDs.

P144 Effect of low-dose ionizing radiation on the inflammatory phenotype of adipocytes and differentiation of osteoclasts (in vitro)

“…1 Objectives In our previous work, we observed a decrease of visfatin levels in serum of patients treated with low-dose ionizing radiation during exposure to the alpha-emitter radon. 2 In the same study, a decrease of markers for bone resorption after radon exposure was detected. Based on this, we next compared the response of human adipocytes derived from subcutaneous and infrapatellar adipose tissue to ionizing radiation with respect to release of adipokines and other inflammatory factors (IL-6, IL-8).…”

Balneotherapy and human immune function in the era of COVID-19

“…A fine balance between Th17 and Treg CD4+ lymphocytes has emerged as a crucial point in the inflammation associated with autoimmune and immune-mediated diseases. Sulphur balneotherapy seems to have a role in the activation of both polarization pathways (Vitale 2018), while in patients who followed bath applications over 3 weeks with low dose radon, only Treg cells were increased after the treatment and Th17 cells were unchanged (Cucu et al 2017).…”

Die Bedeutung der niedrig dosierten Radon-Speläo- und Balneotherapie in der Behandlung von rheumatischen Erkrankungen

“…Eine weiterführende Studie (RAD-ON02; Eu-draCT Nr. 2016-002085-31) läuft derzeit noch Cucu et al (2017). untersuchten bei einer Subgruppe von 32 Patienten des RAD-ON01 Studienkollektivs eine Reihe von Markern des Knochen-und Knorpelmetabolismus sowie entzündungsrelevante Adipokine und außerdem pro-und anti-inflammatorische T-Zell-Subpopulationen[74].…”

“…2016-002085-31) läuft derzeit noch Cucu et al (2017). untersuchten bei einer Subgruppe von 32 Patienten des RAD-ON01 Studienkollektivs eine Reihe von Markern des Knochen-und Knorpelmetabolismus sowie entzündungsrelevante Adipokine und außerdem pro-und anti-inflammatorische T-Zell-Subpopulationen[74]. Es zeigte sich eine Abnahme des Spiegels an Serum-Kollagenfragment-I (CTX-I) und des Hormons Kalzitonin, was auf eine verminderte Knochenresorption hinweist.…”

“…Der Knorpelumsatzwert Cartilage Oligomeric Matrix Protein (COMP) zeigte ebenfalls einen leichten Anstieg und der Knochenstoffwechselparameter Osteoprotegerin (OPG) eine leichte Abnahme. Die Veränderungen am Knochen scheinen sich eher lokal abzuspielen, denn das entscheidende Verhältnis des knochenanabolen OPG zum knochenkatabolen Faktor Receptor Activator of NF kappa-B Ligand (RANKL), blieb in dieser Studie unverändert[74].Ineiner Studie an 83 SpA-Patienten untersuchten Shehata et al die Wirkung der Gasteiner Heilstollenbehandlung auf Schmerz und das anti-inflammatorische Zytokin TGF-β1. Als Kontrollgruppen wurden einerseits SpA-Patienten in die Untersuchungen mit eingeschlossen, die eine konventionelle Therapie ohne Heilstollen-Exposition erhielten und andererseits 10 Patienten mit nichtentzündlichem Rückenschmerz (lower back pain, LBP).…”