The role of the adaptive immune system in burn-induced heterotopic ossification and mesenchymal cell osteogenic differentiation

Kavitha Ranganathan, Shailesh Agarwal, David Cholok, Shawn Loder, Jonathan Li, Hsiao Hsin Sung Hsieh, Stewart C. Wang, Steven R. Buchman, Benjamin Levi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background Heterotopic ossification (HO) is the pathologic process of extraskeletal bone formation. Although the exact etiology remains unknown, inflammation appears to catalyze disease progression. The goal of this study is to determine the impact of the adaptive immune system on HO. Methods HO was induced in 8-wk-old control C57BL/6 and immunocompromised Rag1tm1Mom (Rag1 KO) male mice deficient in B- and T-lymphocytes via combined Achilles tenotomy and burn injury. Microcomputed tomography quantified the extent of HO formation at the tenotomy site. Adipose-derived mesenchymal stem cells were harvested to evaluate osteogenic differentiation potential. Results Areas of developing HO demonstrated substantial enrichment of CD45 + leukocytes at 3 wk after injury. HO from Rag1 KO mice was substantially less mature with foci of cartilage and disorganized trabecular bone present 12 wk after injury. Rag1 KO mice formed 60% less bone compared to immunocompetent controls (4.67 ± 1.5 mm versus 7.76 ± 0.65 mm; P = 0.001). Tartrate-resistant acid phosphatase staining and immunofluorescent analysis of osteoprotegerin and nuclear factor kappa-light-chain-enhancer of activated B cells demonstrated no appreciable difference in osteoclast number or activation. Alizarin red staining in vitro demonstrated a significant decrease in osteogenic potential in immunocompromised mice compared to controls (29.1 ± 0.54 mm versus 12.1 ± 0.14 mm; P < 0.001). Conclusions We demonstrate a prominent role for the adaptive immune system in the development of HO. In the absence of mature B- and T-lymphocytes, HO growth and development are attenuated. Furthermore, we demonstrate that mesenchymal populations from B- and T-cell deficient mice are inherently less osteogenic. This study identifies a potential therapeutic role for modulation of the adaptive immune system in the treatment of HO.

Original languageEnglish
Pages (from-to)53-61
Number of pages9
JournalJournal of Surgical Research
Issue number1
StatePublished - 1 Nov 2016
Externally publishedYes


  • Adaptive immune system
  • Bone biology
  • Ectopic bone
  • Heterotopic ossification
  • Trauma


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