Skip to main content
Top
Published in: Arthritis Research & Therapy 1/2018

Open Access 01-12-2018 | Research article

Short Link N promotes disc repair in a rabbit model of disc degeneration

Authors: Fackson Mwale, Koichi Masuda, Michael P. Grant, Laura M. Epure, Kenji Kato, Shingo Miyazaki, Kevin Cheng, Junichi Yamada, Won C. Bae, Carol Muehleman, Peter J. Roughley, John Antoniou

Published in: Arthritis Research & Therapy | Issue 1/2018

Login to get access

Abstract

Background

The degeneration of the intervertebral disc (IVD) is characterized by proteolytic degradation of the extracellular matrix, and its repair requires the production of an extracellular matrix with a high proteoglycan-to-collagen ratio characteristic of a nucleus pulposus (NP)-like phenotype in vivo. At the moment, there is no medical treatment to reverse or even retard disc degeneration. The purpose of the present study was to determine if a low dose of short link N (sLN), a recently discovered fragment of the link N peptide, could behave in a manner similar to that of link N in restoring the proteoglycan content and proteoglycan-to-collagen ratio of the disc in a rabbit model of IVD degeneration, as an indication of its potential therapeutic benefit in reversing disc degeneration.

Methods

Adolescent New Zealand white rabbits received an annular puncture with an 18-gauge needle into two noncontiguous discs to induce disc degeneration. Two weeks later, either saline (10 μL) or sLN (25 μg in 10 μL saline) was injected into the center of the NP. The sLN concentration was empirically chosen at a lower molar concentration equivalent to half that of link N (100 μg in 10 μL). The effect on radiographic, biochemical and histologic changes were evaluated.

Results

Following needle puncture, disc height decreased by about 25–30% within 2 weeks and maintained this loss for the duration of the 12-week study; a single 25-μg sLN injection at 2 weeks partially restored this loss in disc height. sLN injection led to an increase in glycosaminoglycans (GAG) content 12 weeks post-injection in both the NP and annulus fibrosus (AF). There was a trend towards maintaining control disc collagen-content with sLN supplementation and the GAG-to-collagen ratio in the NP was increased when compared to the saline group.

Conclusions

When administered to the degenerative disc in vivo, sLN injection leads to an increase in proteoglycan content and a trend towards maintaining control disc collagen content in both the NP and AF. This is similar to link N when it is administered to the degenerative disc. Thus, pharmacologically, sLN supplementation could be a novel therapeutic approach for treating disc degeneration.
Literature
2.
go back to reference Mwale F. Collagen and other proteins of the nucleus pulposus, annulus fibrosus, and cartilage endplates. IM Shapiro, MV Risbud (eds). The Intervertebral discs. 2013;5:79–92. Mwale F. Collagen and other proteins of the nucleus pulposus, annulus fibrosus, and cartilage endplates. IM Shapiro, MV Risbud (eds). The Intervertebral discs. 2013;5:79–92.
3.
go back to reference Roughley PJ. Biology of intervertebral disc aging and degeneration: involvement of the extracellular matrix. Spine (Phila Pa 1976). 2004;29(23):2691–9.CrossRef Roughley PJ. Biology of intervertebral disc aging and degeneration: involvement of the extracellular matrix. Spine (Phila Pa 1976). 2004;29(23):2691–9.CrossRef
4.
go back to reference Oegema TR Jr. Biochemistry of the intervertebral disc. Clin Sports Med. 1993;12(3):419–39.PubMed Oegema TR Jr. Biochemistry of the intervertebral disc. Clin Sports Med. 1993;12(3):419–39.PubMed
5.
go back to reference Watanabe H, Yamada Y, Kimata K. Roles of aggrecan, a large chondroitin sulfate proteoglycan, in cartilage structure and function. J Biochem. 1998;124(4):687–93.CrossRefPubMed Watanabe H, Yamada Y, Kimata K. Roles of aggrecan, a large chondroitin sulfate proteoglycan, in cartilage structure and function. J Biochem. 1998;124(4):687–93.CrossRefPubMed
6.
go back to reference Urban JP, Smith S, Fairbank JC. Nutrition of the intervertebral disc. Spine (Phila Pa 1976). 2004;29(23):2700–9.CrossRef Urban JP, Smith S, Fairbank JC. Nutrition of the intervertebral disc. Spine (Phila Pa 1976). 2004;29(23):2700–9.CrossRef
7.
go back to reference Grant M, Epure LM, Salem O, AlGarni N, Ciobanu O, Alaqeel M, Antoniou J, Mwale F. Development of a large animal long-term intervertebral disc organ culture model that includes the bony vertebrae for ex vivo studies. Tissue Eng Part C Methods. 2016;22(7):636–43.CrossRefPubMed Grant M, Epure LM, Salem O, AlGarni N, Ciobanu O, Alaqeel M, Antoniou J, Mwale F. Development of a large animal long-term intervertebral disc organ culture model that includes the bony vertebrae for ex vivo studies. Tissue Eng Part C Methods. 2016;22(7):636–43.CrossRefPubMed
8.
go back to reference Antoniou J, Steffen T, Nelson F, Winterbottom N, Hollander AP, Poole RA, Aebi M, Alini M. The human lumbar intervertebral disc: evidence for changes in the biosynthesis and denaturation of the extracellular matrix with growth, maturation, ageing, and degeneration. J Clin Invest. 1996;98(4):996–1003.CrossRefPubMedPubMedCentral Antoniou J, Steffen T, Nelson F, Winterbottom N, Hollander AP, Poole RA, Aebi M, Alini M. The human lumbar intervertebral disc: evidence for changes in the biosynthesis and denaturation of the extracellular matrix with growth, maturation, ageing, and degeneration. J Clin Invest. 1996;98(4):996–1003.CrossRefPubMedPubMedCentral
9.
go back to reference Mwale F, Roughley P, Antoniou J. Distinction between the extracellular matrix of the nucleus pulposus and hyaline cartilage: a requisite for tissue engineering of intervertebral disc. Eur Cell Mater. 2004;8:58–63. discussion -4CrossRefPubMed Mwale F, Roughley P, Antoniou J. Distinction between the extracellular matrix of the nucleus pulposus and hyaline cartilage: a requisite for tissue engineering of intervertebral disc. Eur Cell Mater. 2004;8:58–63. discussion -4CrossRefPubMed
10.
go back to reference An HS, Anderson PA, Haughton VM, Iatridis JC, Kang JD, Lotz JC, Natarajan RN, Oegema TR Jr, Roughley P, Setton LA, et al. Introduction: disc degeneration: summary. Spine (Phila Pa 1976). 2004;29(23):2677–8.CrossRef An HS, Anderson PA, Haughton VM, Iatridis JC, Kang JD, Lotz JC, Natarajan RN, Oegema TR Jr, Roughley P, Setton LA, et al. Introduction: disc degeneration: summary. Spine (Phila Pa 1976). 2004;29(23):2677–8.CrossRef
11.
go back to reference Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968–74.CrossRefPubMed Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968–74.CrossRefPubMed
12.
go back to reference Kang JD, Stefanovic-Racic M, McIntyre LA, Georgescu HI, Evans CH. Toward a biochemical understanding of human intervertebral disc degeneration and herniation. Contributions of nitric oxide, interleukins, prostaglandin E2, and matrix metalloproteinases. Spine (Phila Pa 1976). 1997;22(10):1065–73.CrossRef Kang JD, Stefanovic-Racic M, McIntyre LA, Georgescu HI, Evans CH. Toward a biochemical understanding of human intervertebral disc degeneration and herniation. Contributions of nitric oxide, interleukins, prostaglandin E2, and matrix metalloproteinases. Spine (Phila Pa 1976). 1997;22(10):1065–73.CrossRef
13.
go back to reference Goupille P, Jayson MI, Valat JP, Freemont AJ. Matrix metalloproteinases: the clue to intervertebral disc degeneration? Spine (Phila Pa 1976). 1998;23(14):1612–26.CrossRef Goupille P, Jayson MI, Valat JP, Freemont AJ. Matrix metalloproteinases: the clue to intervertebral disc degeneration? Spine (Phila Pa 1976). 1998;23(14):1612–26.CrossRef
14.
go back to reference Oegema TR Jr, Johnson SL, Aguiar DJ, Ogilvie JW. Fibronectin and its fragments increase with degeneration in the human intervertebral disc. Spine. 2000;25(21):2742–7.CrossRefPubMed Oegema TR Jr, Johnson SL, Aguiar DJ, Ogilvie JW. Fibronectin and its fragments increase with degeneration in the human intervertebral disc. Spine. 2000;25(21):2742–7.CrossRefPubMed
15.
go back to reference Roberts S, Caterson B, Menage J, Evans EH, Jaffray DC, Eisenstein SM. Matrix metalloproteinases and aggrecanase: their role in disorders of the human intervertebral disc. Spine (Phila Pa 1976). 2000;25(23):3005–13.CrossRef Roberts S, Caterson B, Menage J, Evans EH, Jaffray DC, Eisenstein SM. Matrix metalloproteinases and aggrecanase: their role in disorders of the human intervertebral disc. Spine (Phila Pa 1976). 2000;25(23):3005–13.CrossRef
16.
go back to reference Akhatib B, Onnerfjord P, Gawri R, Ouellet J, Jarzem P, Heinegard D, Mort J, Roughley P, Haglund L. Chondroadherin fragmentation mediated by the protease HTRA1 distinguishes human intervertebral disc degeneration from normal aging. J Biol Chem. 2013;288(26):19280–7.CrossRefPubMedPubMedCentral Akhatib B, Onnerfjord P, Gawri R, Ouellet J, Jarzem P, Heinegard D, Mort J, Roughley P, Haglund L. Chondroadherin fragmentation mediated by the protease HTRA1 distinguishes human intervertebral disc degeneration from normal aging. J Biol Chem. 2013;288(26):19280–7.CrossRefPubMedPubMedCentral
17.
go back to reference Ishihara H, McNally DS, Urban JP, Hall AC. Effects of hydrostatic pressure on matrix synthesis in different regions of the intervertebral disk. J Appl Physiol (1985). 1996;80(3):839–46.CrossRef Ishihara H, McNally DS, Urban JP, Hall AC. Effects of hydrostatic pressure on matrix synthesis in different regions of the intervertebral disk. J Appl Physiol (1985). 1996;80(3):839–46.CrossRef
18.
go back to reference Handa T, Ishihara H, Ohshima H, Osada R, Tsuji H, Obata K. Effects of hydrostatic pressure on matrix synthesis and matrix metalloproteinase production in the human lumbar intervertebral disc. Spine (Phila Pa 1976). 1997;22(10):1085–91.CrossRef Handa T, Ishihara H, Ohshima H, Osada R, Tsuji H, Obata K. Effects of hydrostatic pressure on matrix synthesis and matrix metalloproteinase production in the human lumbar intervertebral disc. Spine (Phila Pa 1976). 1997;22(10):1085–91.CrossRef
19.
go back to reference Hutton WC, Elmer WA, Boden SD, Hyon S, Toribatake Y, Tomita K, Hair GA. The effect of hydrostatic pressure on intervertebral disc metabolism. Spine (Phila Pa 1976). 1999;24(15):1507–15.CrossRef Hutton WC, Elmer WA, Boden SD, Hyon S, Toribatake Y, Tomita K, Hair GA. The effect of hydrostatic pressure on intervertebral disc metabolism. Spine (Phila Pa 1976). 1999;24(15):1507–15.CrossRef
20.
go back to reference Hsieh AH, Lotz JC. Prolonged spinal loading induces matrix metalloproteinase-2 activation in intervertebral discs. Spine (Phila Pa 1976). 2003;28(16):1781–8.CrossRef Hsieh AH, Lotz JC. Prolonged spinal loading induces matrix metalloproteinase-2 activation in intervertebral discs. Spine (Phila Pa 1976). 2003;28(16):1781–8.CrossRef
21.
go back to reference Annunen S, Paassilta P, Lohiniva J, Perala M, Pihlajamaa T, Karppinen J, Tervonen O, Kroger H, Lahde S, Vanharanta H, et al. An allele of COL9A2 associated with intervertebral disc disease. Science. 1999;285(5426):409–12.CrossRefPubMed Annunen S, Paassilta P, Lohiniva J, Perala M, Pihlajamaa T, Karppinen J, Tervonen O, Kroger H, Lahde S, Vanharanta H, et al. An allele of COL9A2 associated with intervertebral disc disease. Science. 1999;285(5426):409–12.CrossRefPubMed
22.
go back to reference Kawaguchi Y, Osada R, Kanamori M, Ishihara H, Ohmori K, Matsui H, Kimura T. Association between an aggrecan gene polymorphism and lumbar disc degeneration. Spine. 1999;24(23):2456–60.CrossRefPubMed Kawaguchi Y, Osada R, Kanamori M, Ishihara H, Ohmori K, Matsui H, Kimura T. Association between an aggrecan gene polymorphism and lumbar disc degeneration. Spine. 1999;24(23):2456–60.CrossRefPubMed
24.
go back to reference Roughley P, Martens D, Rantakokko J, Alini M, Mwale F, Antoniou J. The involvement of aggrecan polymorphism in degeneration of human intervertebral disc and articular cartilage. Eur Cell Mater. 2006;11:1–7.CrossRefPubMed Roughley P, Martens D, Rantakokko J, Alini M, Mwale F, Antoniou J. The involvement of aggrecan polymorphism in degeneration of human intervertebral disc and articular cartilage. Eur Cell Mater. 2006;11:1–7.CrossRefPubMed
25.
go back to reference Battie MC, Videman T, Kaprio J, Gibbons LE, Gill K, Manninen H, Saarela J, Peltonen L. The Twin Spine Study: contributions to a changing view of disc degeneration. Spine J. 2009;9(1):47–59.CrossRefPubMed Battie MC, Videman T, Kaprio J, Gibbons LE, Gill K, Manninen H, Saarela J, Peltonen L. The Twin Spine Study: contributions to a changing view of disc degeneration. Spine J. 2009;9(1):47–59.CrossRefPubMed
26.
go back to reference Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine (Phila Pa 1976). 2012;37(1):67–76.CrossRef Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine (Phila Pa 1976). 2012;37(1):67–76.CrossRef
27.
go back to reference Levin DA, Hale JJ, Bendo JA. Adjacent segment degeneration following spinal fusion for degenerative disc disease. Bull NYU Hosp Jt Dis. 2007;65(1):29–36.PubMed Levin DA, Hale JJ, Bendo JA. Adjacent segment degeneration following spinal fusion for degenerative disc disease. Bull NYU Hosp Jt Dis. 2007;65(1):29–36.PubMed
28.
go back to reference Melching LI, Roughley PJ. The role of link protein in mediating the interaction between hyaluronic acid and newly secreted proteoglycan subunits from adult human articular cartilage. J Biol Chem. 1985;260(30):16279–85.PubMed Melching LI, Roughley PJ. The role of link protein in mediating the interaction between hyaluronic acid and newly secreted proteoglycan subunits from adult human articular cartilage. J Biol Chem. 1985;260(30):16279–85.PubMed
29.
go back to reference Donohue PJ, Jahnke MR, Blaha JD, Caterson B. Characterization of link protein(s) from human intervertebral-disc tissues. The Biochemical journal. 1988;251(3):739–47.CrossRefPubMedPubMedCentral Donohue PJ, Jahnke MR, Blaha JD, Caterson B. Characterization of link protein(s) from human intervertebral-disc tissues. The Biochemical journal. 1988;251(3):739–47.CrossRefPubMedPubMedCentral
30.
go back to reference Mwale F, Masuda K, Pichika R, Epure LM, Yoshikawa T, Hemmad A, Roughley PJ, Antoniou J. The efficacy of Link N as a mediator of repair in a rabbit model of intervertebral disc degeneration. Arthritis Res Ther. 2011;13(4):R120.CrossRefPubMedPubMedCentral Mwale F, Masuda K, Pichika R, Epure LM, Yoshikawa T, Hemmad A, Roughley PJ, Antoniou J. The efficacy of Link N as a mediator of repair in a rabbit model of intervertebral disc degeneration. Arthritis Res Ther. 2011;13(4):R120.CrossRefPubMedPubMedCentral
31.
go back to reference Wang Z, Weitzmann MN, Sangadala S, Hutton WC, Yoon ST. Link protein N-terminal peptide binds to bone morphogenetic protein (BMP) type II receptor and drives matrix protein expression in rabbit intervertebral disc cells. J Biol Chem. 2013;288(39):28243–53.CrossRefPubMedPubMedCentral Wang Z, Weitzmann MN, Sangadala S, Hutton WC, Yoon ST. Link protein N-terminal peptide binds to bone morphogenetic protein (BMP) type II receptor and drives matrix protein expression in rabbit intervertebral disc cells. J Biol Chem. 2013;288(39):28243–53.CrossRefPubMedPubMedCentral
32.
go back to reference Gawri R, Ouellet J, Onnerfjord P, Alkhatib B, Steffen T, Heinegard D, Roughley P, Antoniou J, Mwale F, Haglund L. Link N is cleaved by human annulus fibrosus cells generating a fragment with retained biological activity. J Orthop Res. 2014;32(9):1189–97.CrossRefPubMed Gawri R, Ouellet J, Onnerfjord P, Alkhatib B, Steffen T, Heinegard D, Roughley P, Antoniou J, Mwale F, Haglund L. Link N is cleaved by human annulus fibrosus cells generating a fragment with retained biological activity. J Orthop Res. 2014;32(9):1189–97.CrossRefPubMed
33.
go back to reference Masuda K, Aota Y, Muehleman C, Imai Y, Okuma M, Thonar EJ, Andersson GB, An HS. A novel rabbit model of mild, reproducible disc degeneration by an anulus needle puncture: correlation between the degree of disc injury and radiological and histological appearances of disc degeneration. Spine (Phila Pa 1976). 2005;30(1):5–14.CrossRef Masuda K, Aota Y, Muehleman C, Imai Y, Okuma M, Thonar EJ, Andersson GB, An HS. A novel rabbit model of mild, reproducible disc degeneration by an anulus needle puncture: correlation between the degree of disc injury and radiological and histological appearances of disc degeneration. Spine (Phila Pa 1976). 2005;30(1):5–14.CrossRef
34.
go back to reference Barbosa I, Garcia S, Barbier-Chassefiere V, Caruelle JP, Martelly I, Papy-Garcia D. Improved and simple micro assay for sulfated glycosaminoglycans quantification in biological extracts and its use in skin and muscle tissue studies. Glycobiology. 2003;13(9):647–53.CrossRefPubMed Barbosa I, Garcia S, Barbier-Chassefiere V, Caruelle JP, Martelly I, Papy-Garcia D. Improved and simple micro assay for sulfated glycosaminoglycans quantification in biological extracts and its use in skin and muscle tissue studies. Glycobiology. 2003;13(9):647–53.CrossRefPubMed
35.
go back to reference Mort JS, Roughley PJ. Measurement of glycosaminoglycan release from cartilage explants. Methods Mol Med. 2007;135:201–9.CrossRefPubMed Mort JS, Roughley PJ. Measurement of glycosaminoglycan release from cartilage explants. Methods Mol Med. 2007;135:201–9.CrossRefPubMed
37.
go back to reference Nimni ME. Collagen: structure, function, and metabolism in normal and fibrotic tissues. Semin Arthritis Rheum. 1983;13(1):1–86.CrossRefPubMed Nimni ME. Collagen: structure, function, and metabolism in normal and fibrotic tissues. Semin Arthritis Rheum. 1983;13(1):1–86.CrossRefPubMed
38.
go back to reference Urban JP, Roberts S. Development and degeneration of the intervertebral discs. Mol Med Today. 1995;1(7):329–35.CrossRefPubMed Urban JP, Roberts S. Development and degeneration of the intervertebral discs. Mol Med Today. 1995;1(7):329–35.CrossRefPubMed
39.
go back to reference Masuda K, Imai Y, Okuma M, Muehleman C, Nakagawa K, Akeda K, Thonar E, Andersson G, An HS. Osteogenic protein-1 injection into a degenerated disc induces the restoration of disc height and structural changes in the rabbit anular puncture model. Spine (Phila Pa 1976). 2006;31(7):742–54.CrossRef Masuda K, Imai Y, Okuma M, Muehleman C, Nakagawa K, Akeda K, Thonar E, Andersson G, An HS. Osteogenic protein-1 injection into a degenerated disc induces the restoration of disc height and structural changes in the rabbit anular puncture model. Spine (Phila Pa 1976). 2006;31(7):742–54.CrossRef
40.
41.
go back to reference Walsh AJ, Bradford DS, Lotz JC. In vivo growth factor treatment of degenerated intervertebral discs. Spine (Phila Pa 1976). 2004;29(2):156–63.CrossRef Walsh AJ, Bradford DS, Lotz JC. In vivo growth factor treatment of degenerated intervertebral discs. Spine (Phila Pa 1976). 2004;29(2):156–63.CrossRef
42.
go back to reference An HS, Takegami K, Kamada H, Nguyen CM, Thonar EJ, Singh K, Andersson GB, Masuda K. Intradiscal administration of osteogenic protein-1 increases intervertebral disc height and proteoglycan content in the nucleus pulposus in normal adolescent rabbits. Spine (Phila Pa 1976). 2005;30(1):25–31. discussion -2CrossRef An HS, Takegami K, Kamada H, Nguyen CM, Thonar EJ, Singh K, Andersson GB, Masuda K. Intradiscal administration of osteogenic protein-1 increases intervertebral disc height and proteoglycan content in the nucleus pulposus in normal adolescent rabbits. Spine (Phila Pa 1976). 2005;30(1):25–31. discussion -2CrossRef
43.
go back to reference Willems N, Bach FC, Plomp SG, van Rijen MH, Wolfswinkel J, Grinwis GC, Bos C, Strijkers GJ, Dhert WJ, Meij BP, et al. Intradiscal application of rhBMP-7 does not induce regeneration in a canine model of spontaneous intervertebral disc degeneration. Arthritis Res Ther. 2015;17:137.CrossRefPubMedPubMedCentral Willems N, Bach FC, Plomp SG, van Rijen MH, Wolfswinkel J, Grinwis GC, Bos C, Strijkers GJ, Dhert WJ, Meij BP, et al. Intradiscal application of rhBMP-7 does not induce regeneration in a canine model of spontaneous intervertebral disc degeneration. Arthritis Res Ther. 2015;17:137.CrossRefPubMedPubMedCentral
44.
go back to reference Mwale F, Wang HT, Roughley P, Antoniou J, Haglund L. Link N and mesenchymal stem cells can induce regeneration of the early degenerate intervertebral disc. Tissue Eng Part A. 2014;20(21–22):2942–9.CrossRefPubMedPubMedCentral Mwale F, Wang HT, Roughley P, Antoniou J, Haglund L. Link N and mesenchymal stem cells can induce regeneration of the early degenerate intervertebral disc. Tissue Eng Part A. 2014;20(21–22):2942–9.CrossRefPubMedPubMedCentral
45.
go back to reference Antoniou J, Epure LM, Michalek AJ, Grant MP, Iatridis JC, Mwale F. Analysis of quantitative magnetic resonance imaging and biomechanical parameters on human discs with different grades of degeneration. J Magn Reson Imaging. 2013;38(6):1402–14.CrossRefPubMed Antoniou J, Epure LM, Michalek AJ, Grant MP, Iatridis JC, Mwale F. Analysis of quantitative magnetic resonance imaging and biomechanical parameters on human discs with different grades of degeneration. J Magn Reson Imaging. 2013;38(6):1402–14.CrossRefPubMed
Metadata
Title
Short Link N promotes disc repair in a rabbit model of disc degeneration
Authors
Fackson Mwale
Koichi Masuda
Michael P. Grant
Laura M. Epure
Kenji Kato
Shingo Miyazaki
Kevin Cheng
Junichi Yamada
Won C. Bae
Carol Muehleman
Peter J. Roughley
John Antoniou
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Arthritis Research & Therapy / Issue 1/2018
Electronic ISSN: 1478-6362
DOI
https://doi.org/10.1186/s13075-018-1625-9

Other articles of this Issue 1/2018

Arthritis Research & Therapy 1/2018 Go to the issue