Acupuncture Increases The Diameter And Reorganisation Of Collagen Fibrils During Rat Tendon Healing

Background: Our previous study showed that electroacupuncture (EA) increases the concentration and reorganisation of collagen in a rat model of tendon healing. However, the ultrastructure of collagen fibrils after acupuncture is unknown. Objectives: To assess the effect of acupuncture protocols on the ultrastructure of collagen fibrils during tendon healing. Methods: Sixty-four rats were divided into the following groups: non-tenotomised (normal group), tenotomised (teno group), tenotomised and subjected to manual acupuncture at ST36 (ST36 group), BL57 (BL57 group) and ST36+BL57 (SB group) and EA at ST36+BL57 (EA group). The mass-average diameter (MAD) and the reorganisation of collagen fibril diameters were determined during the three phases of tendon healing (at 7, 14 and 21 days). Results: The MAD increased during the three phases of healing in the SB group. In the EA group, MAD increased initially but was reduced at day 21. The reorganisation of collagen fibrils was improved in the EA and SB groups at days 14 and 21, respectively. EA at day 21 appeared to reduce the reorganisation. Conclusions: These results indicate that the use of EA up to day 14 and manual acupuncture at ST36+BL57 up to day 21 improve the ultrastructure of collagen fibrils, indicating strengthening of the tendon structure. These data suggest a potential role for acupuncture in rehabilitation protocols.3315157Wang, J., Mechanobiology of tendon (2006) J Biomech, 39, pp. 1563-1582Abate, M., Schiavone, C., Salini, V., Occurrence of tendon pathologies in metabolic disorders (2013) Rheumatology (Oxford), 52, pp. 599-608Järvinen, T.A., Kannus, P., Maffulli, N., Achilles tendon disorders: Etiology and epidemiology (2005) Foot Ankle Clin, 10, pp. 255-266Richardson, L.E., Dudhia, J., Clegg, P.D., Stem cells in veterinary medicine: Attempts at regenerating equine tendon after injury (2007) Trends Biotechnol, 25, pp. 409-416Abate, M., Karin, G.S.K., Siljeholm, C., Pathogenesis of tendinopathies: Inflammation or degeneration? (2009) Arthritis Res Ther, 11, p. 235Alaseirlis, D.A., Li, Y., Cilli, F., Decreasing inflammatory response of injured patellar tendons results in increased collagen fibril diameters (2005) Connect Tissue Res, 46, pp. 12-17Lee, G.J., Choi, S., Chon, J., Changes in collagen fibril pattern and adhesion force with collagenase-induced injury in Achilles rat tendon observed via AFM (2011) J Nanosci Nanotechnol, 11, pp. 773-777Spaas, J.H., Guest, D.J., Van De Walle, G.R., Tendon regeneration in human and equine athletes Ubi Sumus-Quo Vadimus (where are we and where are we going to) ? (2012) Sports Med, 42, pp. 871-890Christiansen, D.L., Huang, E.K., Silver, F.H., Assembly of type I collagen: Fusion of fibril subunits and the influence of fibril diameter on mechanical properties (2000) Matrix Biol, 19, pp. 409-420Watanabe, T., Imamura, Y., Suzuki, D., Concerted and adaptive alignment of decorin dermatan sulfate filaments in the graded organization of collagen fibrils in the equine superficial digital flexor tendon (2012) J Anat, 220, pp. 156-163Edwards, L.J., Goodship, A.E., Birch, H.L., Effect of exercise on age-related changes in collagen fibril diameter distributions in the common digital extensor tendons of young horses (2005) Am J Vet Res, 66, pp. 564-568Zhang, Y., Lao, L., Chen, H., Acupuncture use among American adults: What acupuncture practitioners can learn from National Health Interview Survey 2007? (2012) Evid Based Complement Alternat Med, 2012, p. 710750Kavoussi, B., Ross, B., The neuroimmune basis of anti-inflammatory acupuncture (2007) Integr Cancer Ther, 6, pp. 251-257Almeida, M.S., Aro, A.A., Guerra, F.D., Electroacupuncture increases the concentration and organization of collagen in a tendon healing model in rats (2012) Connect Tissue Res, 53, pp. 542-547Aro, A.A., Nishan, U., Perez, M.O., Structural and biochemical alterations during the healing process of tendons treated with Aloe vera (2012) Life Sci, 91, pp. 885-893Guerra Fda, R., Vieira, C.P., Almeida, M.S., LLLT improves tendon healing through increase of MMP activity and collagen synthesis (2013) Lasers Med Sci, 28, pp. 1281-1288Tomiosso, T.C., Nakagaki, W.R., Gomes, L., Organization of collagen bundles during tendon healing in rats treated with L-NAME (2009) Cell Tissue Res, 337, pp. 235-242Langevin, H.M., Bouffard, N.A., Churchill, D.L., Connective tissue fibroblast response to acupuncture: Dose-dependent effect of bidirectional needle rotation (2007) J Altern Complement Med, 13, pp. 355-360Lee, J.H., Jang, K.J., Lee, Y.T., Electroacupuncture inhibits inflammatory edema and hyperalgesia through regulation of cyclooxygenase synthesis in both peripheral and central nociceptive sites (2006) Am J Chin Med, 34, pp. 981-988Zhang, G., Ezura, Y., Chervoneva, I., Decorin regulates assembly of collagen fibrils and acquisition of biomechanical properties during tendon development (2006) J Cell Biochem, 98, pp. 1436-1449Flint, M.H., Craig, A.S., Reilly, H.C., Collagen fibril diameters and glycosaminoglycan content of skins.indices of tissue maturity and function (1984) Connect Tissue Res, 13, pp. 69-81Canty, E.G., Starborg, T., Lu, Y., Actin filaments are required for fibripositor-mediated collagen fibril alignment in tendon (2006) J Biol Chem, 281, pp. 38592-38598Zhang, G., Young, B.B., Ezura, Y., Development of tendon structure and function: Regulation of collagen fibrillogenesis (2005) J Musculoskelet Neuronal Interact, 5, pp. 5-21Patterson-Kane, J.C., Wilson, A.M., Firth, E.C., Comparison of collagen fibril populations in the superficial digital flexor tendons of exercised and nonexercised thoroughbreds (1997) Equine Vet J, 29, pp. 121-125Parry, D.A., Barnes, G.R., Craig, A.S., A comparison of the size distribution of collagen fibrils in connective tissues as a function of age and a possible relation between fibril size distribution and mechanical properties (1978) Proc R Soc Lond B Biol Sci, 203, pp. 305-321Strocchi, R., Pasquale, V., Guizzardi, S., Human Achilles tendon, morphological and morphometric variations as a function of age (1991) Foot Ankle, 12, pp. 100-104Lan, L., Tao, J., Chen, A., Electroacupuncture exerts anti-inflammatory effects in cerebral ischemia-reperfusion injured rats via suppression of the TLR/NF-κB pathway (2013) Int J Mol Med, 31, pp. 75-80Yim, Y.K., Lee, H., Hong, K.E., Electro-acupuncture at acupoint ST36 reduces inflammation and regulates immune activity in collagen-induced arthritic mice (2007) Evid Based Complement Alternat Med, 4, pp. 51-57Verrechia, F., Mauviel, A., TGF-β and TNF-α: Antagonistic cytokines controlling type I collagen gene expression (2004) Cell Signal, 16, pp. 873-880Shen, H., Yao, P., Lee, E., Interferon-gamma inhibits healing post scald burn injury (2012) Wound Repair Regen, 20, pp. 580-591Cilli, F., Khan, M., Fu, F., Prostaglandin E2 affects proliferation and collagen synthesis by human patellar tendon fibroblasts (2004) Clin J Sport Med, 14, pp. 232-236Casalechi, H.L., Nicolau, R.A., Casalechi, V.L., The effects of low-level light emitting diode on the repair process of Achilles tendon therapy in rats (2009) Lasers Med Sci, 24, pp. 659-665Yamamura, Y., (2001) Acupuntura Tradicional: A Arte de Inserir, , 2nd edn. Sao Paulo, SP: RocaLangevin, H.L., Churchill, D.L., Cipolla, M.J., Mechanical signaling through connective tissue: A mechanism for the therapeutic effect of acupuncture (2001) FASEB J, 15, pp. 2275-2282Wang, J.H.C., Guo, Q., Tendon biomechanics and mechanobiology.a minireview of basic concepts and recent advancements (2012) J Hand Ther, 25, pp. 133-141Vidal, B.C., Image analysis of tendon helical superstructure using interference and polarized light microscopy (2003) Micron, 34, pp. 423-432Almeida, M.S., Guerra, F.D., Oliveira, L.P., A hypothesis for the anti-inflammatory and mechanotransduction molecular mechanisms underlying acupuncture tendon healing (2014) Acupunct Med, 32, pp. 178-182Vacek, T.P., Metreveli, N., Tyagi, N., Electrical stimulation of cardiomyocytes activates mitochondrial matrix metalloproteinase causing electrical remodeling (2011) Biochem Biophys Res Commun, 404, pp. 762-766Biancalana, A., Veloso, L.A., Gomes, L., Obesity affects fibril diameter and mechanical properties of tendons in Zucker rats (2010) Connect Tissue Res, 51, pp. 171-178Neal, B.S., Longbottom, J., Is there a role for acupuncture in the treatment of tendinopathy? (2012) Acupunct Med, 30, pp. 346-34