Biologic Treatments for Shoulder Pain
Advances in the elucidation of potential targets for abrogating subacromial bursitis and the promotion of soft-tissue healing after rotator cuff repair have generated emerging therapeutics in the treatment of shoulder pain. While oral and injectable medications typically offer temporary relief, much of the promise associated with biologic therapies centers around their ability to provide a more durable solution while minimizing adverse effects.
Shoulder motion pain, and the underlying synovitis of the subacromial bursa, has an unclear pathophysiology. One source gaining traction is synovial proliferation, and a number of molecules have been implicated in driving this process. Vascular endothelial growth factor (VEGF), a known angiogenic factor, plays a central role in inflammatory angiogenesis. Yanagisawa et al. were able to show a robust association between shoulder motion pain, synovial proliferation, and VEGF expression. These observations were confirmed in another study on diabetic patients with rotator cuff disease. Subacromial bursitis also is characterized by upregulation in inflammatory cytokines and matrix metalloproteinases. More recently, the inflammatory cytokines IL-1β and IL-6 were shown to directly stimulate the expression of stromal cell-derived factor 1 (SDF-1α) in bursal synoviocytes. Although clinical evaluation of biologics in the treatment of subacromial bursitis have yet to be performed, these studies provide potential targets in the subacromial bursa for localized inhibition.
Cytokines
Advances in the elucidation of potential targets for abrogating subacromial bursitis and the promotion of soft-tissue healing after rotator cuff repair have generated emerging therapeutics in the treatment of shoulder pain. While oral and injectable medications typically offer temporary relief, much of the promise associated with biologic therapies centers around their ability to provide a more durable solution while minimizing adverse effects.
Shoulder motion pain, and the underlying synovitis of the subacromial bursa, has an unclear pathophysiology. One source gaining traction is synovial proliferation, and a number of molecules have been implicated in driving this process. Vascular endothelial growth factor (VEGF), a known angiogenic factor, plays a central role in inflammatory angiogenesis. Yanagisawa et al. were able to show a robust association between shoulder motion pain, synovial proliferation, and VEGF expression. These observations were confirmed in another study on diabetic patients with rotator cuff disease. Subacromial bursitis also is characterized by upregulation in inflammatory cytokines and matrix metalloproteinases. More recently, the inflammatory cytokines IL-1β and IL-6 were shown to directly stimulate the expression of stromal cell-derived factor 1 (SDF-1α) in bursal synoviocytes. Although clinical evaluation of biologics in the treatment of subacromial bursitis have yet to be performed, these studies provide potential targets in the subacromial bursa for localized inhibition.