Growth Factor Expression During Healing in 3 Distinct Tendons.

Purpose: We investigated unique tendon growth-factor expression profiles over time in response to simultaneous, similar injuries. Characterizing these genetic differences lays the foundation for creating targeted, tendon-specific therapies and provides insight into why current growth-factor treatments have success in some applications but not others.

Methods: The left fourth digital flexor, triceps, and supraspinatus tendons in 24 rats were cut to 50% of their transverse width at the midbelly under anesthesia. On postoperative days 1, 3, 5, 7, and 14, randomly selected rats were sacrificed, and the damaged tendons were excised and flash-frozen in liquid nitrogen. The expressional fibroblast growth factor 1, bone morphogenic protein 13, and transforming growth factor β-1 were measured at each time point and compared to their respective, uninjured levels with real-time polymerase chain reaction.

Results: The digital flexor tendon showed exponentially elevated expression of all 3 factors over the preinjury baseline values. Expression in the triceps and supraspinatus had more variation over time. The triceps tendon showed a considerable decrease of transforming growth factor β-1 and bone morphogenic protein 13 expression. The supraspinatus tendon had statistically significant increases of both transforming growth factor β-1 and bone morphogenic protein 13 expression relative to preoperative, uninjured levels, with a nonstatistically significant decrease of fibroblast growth factor 1.

Conclusions: Our study suggests different tendons express their own unique growth-factor profiles after similar, simultaneous injuries. The digital flexor showed particularly high, sustained levels of growth-factor expression in comparison to the supraspinatus and triceps, suggesting that variable dosing may be necessary for growth-factor therapies aimed at supplementing innate responses in these different tendon types.

Clinical Relevance: These data show different tendons express unique trends of growth-factor expression over time in response to injury, suggesting each unique tendon may require specific dosing or knockdown therapies. These observations serve as a foundation for more tendon-specific questioning, experimentation, and therapeutic design.