Ultrasound-targeted Simvastatin-loaded Microbubble Destruction Promotes OA Cartilage Repair by Modulating Cholesterol Efflux Pathway Mediated by PPARγ in Rabbits

Objective: To evaluate ultrasound-targeted simvastatin-loaded microbubble destruction (UTMDSV) attenuation of osteoarthritis (OA) progression in rabbits through modulation of the peroxisome proliferator-activated receptor (PPARγ)-mediated cholesterol efflux pathway.Methods: In vitro, chondrocytes were treated with ultrasound (US), US-targeted microbubble destruction (UTMD), simvastatin (SV) and UTMDsv on alternate days for 4 weeks. Chondrocytes were also treated with PPARγ inhibitor, PPARγ inhibitor+UTMDsv and UTMDsv. The cholesterol efflux rate and triglyceride were measured respectively by assay kit and oil red O staining. In vivo, the OA rabbits were treated with a single intra-articular injection of UTMD, SV and UTMDSV every 7 days for 4 weeks. Cartilage histopathology was assessed by safranin-O staining and the Mankin score. Total cholesterol (TC) and high-density lipoprotein-cholesterol (HDL-C) in rabbit knee synovial fluid were detected by enzyme-marker assay. Aggrecan, collagen II and PPARγ expression levels were analyzed western blotting (WB).Results: OA models exhibited primarily by a loss of aggrecan and collagen II, changes to subchondral bone architecture and cartilage degradation. In vitro, UTMDSV significantly increased the cholesterol efflux rate and aggrecan, collagen II and PPARγ levels in OA chondrocytes; these effects were blocked by the PPARγ inhibitor. In vivo, UTMDSV significantly increased aggrecan, collagen II, PPARγ and HDL-C levels, while TC levels and Mankin scores were decreased compared with the UTMD, SV, OA and control groups (95% CI: 0.069 to 6.671).Conclusion: UTMDSV promotes the expression of aggrecan and collagen II and relieve cartilage degradation by modulating the PPARγ-mediated cholesterol efflux pathway in rabbits.