The Role of Wnt/Β-Catenin Antagonists - Sclerostin and DKK1 - in Bone Homeostasis and Mechanotransduction
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The role of Wnt/β-catenin antagonists - sclerostin and DKK1 - in bone homeostasis and mechanotransduction Alyson Ruth Morse B Biotech (Hons) A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy Supervisor: Prof David G Little Co-supervisors: A/Prof Aaron Schindeler Dr Michelle M McDonald 2017 The University of Sydney Sydney Medical School Statement of Originality This is to certify that to the best of my knowledge, the content of this thesis is my own work. This thesis has not been submitted for any degree or other purposes. I certify that the intellectual content of this thesis is the product of my own work and that all the assistance received in preparing this thesis and sources have been acknowledged. Alyson Morse ii Acknowledgments It has been a long, long journey with many people to thank. My husband, James: he is my number one supporter and inspiration. He has a drive and desire for achievement that I see unmatched. My little girl, Lyndsey: who has been the motivating force every day over the past two years to get this thesis finished! My parents and family: they have always believed in my abilities and maintained interest in my achievements - thank you for all that you have given for me. My supervisor, David: he has shown more confidence in me than I ever did in myself. I’m sure he is unaware of the full influence and ambition that he has instilled. My associate supervisors, Michelle and Aaron: each have provided invaluable guidance, experience and knowledge during different stages of my candidature - thank you! The additional experts that have helped me along the way: Prof Marjolein van der Meulen, Dr Wendy Gold, and Dr Ciara Murphy - you have been invaluable. iii Abstract Promising avenues for improving bone mass and fracture resistance include loading-based exercise and agents modulating Wnt/β-catenin signalling. This thesis examines the intersection between these. Murine models of tibial loading and unloading, genetic knockout (KO) models of Wnt antagonists sclerostin and dickkopf-1/DKK1 (encoded by Sost and Dkk1 genes), and neutralising antibodies for sclerostin (Scl-Ab) were applied. Sost KO mice underwent unloading and compressive loading of the tibiae. Sclerostin was vital for the bone response to unloading yet not for loading. Rather, loading-induced anabolism was synergistically augmented in Sost KO mice. It was hypothesised that other Wnt antagonists, such as DKK1, may up-regulate following long-term sclerostin deficiency. Similarly, Dkk1 KO mice exhibited a synergistically augmented anabolic bone response to loading compared to wild type. However, compensation by sclerostin was doubtful as the primary cause for the augmented response with similar sclerostin expression seen in non-loaded tibiae of Dkk1 KO and wild type mice, and similar down-regulation following loading. Dkk1 KO mice treated with Scl-Ab resulted in additive increases in bone volume above either individual DKK1 or sclerostin deficiency. Prominent and synergistic effects were within cancellous bone. Immunohistochemical staining did not support the hypothesis that sclerostin up- regulates to compensate for long-term DKK1 deficiency. Finally, Scl-Ab was co-administered to mice undergoing tibial compressive loading, with additional anabolic increases seen above either monotherapy. RNA sequencing provided insight into mechanisms involved in the augmented response to loading with Scl-Ab use. This thesis supports future clinical use of antibodies targeting Wnt antagonists, whereby load/resistance exercise or dual-agents may increase the efficacy of Scl-Ab or DKK1-Ab therapy. This may have a critical impact for treatment of osteoporosis and other conditions of bone-loss. iv Original Publications Over the course of this candidature, several studies have been published as articles within peer- reviewed scientific journals. Publications related to this thesis Original published articles related to the submission of this thesis: Morse A, McDonald MM, Kelly NH, Melville KM, Schindeler A, Kramer I, Kneissel M, van der Meulen MC, Little DG. Mechanical load increases in bone formation via a sclerostin-independent pathway. J Bone Miner Res, 2014;29(11):2456-67. Chapter 2 p68. Morse A, Cheng TL, Schindeler A, McDonald MM, Mohanty S, Kneissel M, Kramer I, Little DG. Dkk1 KO mice treated with sclerostin antibody have additional increases in bone volume. Calcif Tissue Int. 2018 May 29; [Epub ahead of print]. Chapter 4 p113. Morse A, Schindeler A, McDonald MM, Kneissel M, Kramer I, Little DG. Sclerostin antibody augments the anabolic bone formation response in a mouse model of mechanical tibial loading. J Bone Miner Res. 2017 Nov 1; [Epub ahead of print]. Chapter 5 p146. Publications not related to this thesis Original articles published not related to the submission of this thesis: Liu R, Birke O, Morse A, Peacock L, Mikulec K, Little DG, Schindeler A. Myogenic progenitors contribute to open but not closed fracture repair. BMC Musculoskelet Disord, 2011;22(12):288. v Yang N, Schindeler A, McDonald MM, Seto JT, Houweling PJ, Lek M, Hogarth M, Morse AR, Raftery JM, Balasuriya D, MacArthur DG, Berman Y, Quinlan KG, Eisman JA, Nguyen TV, Center JR, Prince RL, Wilson SG, Zhu K, Little DG, North KN (2011). α-Actinin-3 deficiency is associated with reduced bone mass in human and mouse. Bone. 2011;49(4):790-8. McDonald MM, Morse A, Peacock L, Mikulec K, Schindeler A, Little DG. Characterization of the bone phenotype and fracture repair in osteopetrotic incisors absent rats. J Orthop Res. 2011;29(5):726-33. McDonald MM, Morse A, Mikulec K, Peacock L, Yu N, Baldock PA, Birke O, Liu M, Ke HZ, Little DG. Inhibition of sclerostin by systemic treatment with sclerostin antibody enhances healing of proximal tibial defects in ovariectomized rats. J Orthop Res. 2012;30(10):1541-8. McDonald MM, Morse A, Mikulec K, Peacock L, Baldock PA, Kostenuik PJ, Little DG. Matrix metalloproteinase-driven endochondral fracture union proceeds independently of osteoclast activity. J Bone Miner Res. 2013;28(7):1550-60. Morse A, Yu NY, Peacock L, Mikulec K, Kramer I, Kneissel M, McDonald MM, Little DG. Endochondral fracture healing with external fixation in the Sost knockout mouse results in earlier fibrocartilage callus removal and increased bone volume fraction and strength. Bone. 2015;71:155- 63. Morse A, Cheng TL, Peacock L, Mikulec K, Little DG, Schindeler A. RAP-011 augments callus formation in closed fractures in rats. J Orthop Res. 2016;34(2):320-30 McDonald MM, Reagan MR, Youlten SE, Mohanty ST, Seckinger A, Terry RL, Pettitt JA, Simic MK, Cheng TL, Morse A, Le LMT, Abi-Hanna D, Kramer I, Falank C, Fairfield H, Ghobrial IM, Baldock PA, Little DG, Kneissel M, Vanderkerken K, Bassett JHD, Williams GR, Oyajobi BO, Hose D, Phan TG, Croucher PI. Inhibiting the osteocyte specific protein sclerostin increases bone mass and fracture resistance in multiple myeloma. Blood. 2017;129(26):3452-3464 vi Morse A, McDonald MM, Schindeler A, Peacock L, Mikulec K, Cheng TL, Liu M, Ke HZ, Little DG. Sclerostin Antibody Increases Callus Size and Strength but does not Improve Fracture Union in a Challenged Open Rat Fracture Model. Calcif Tissue Int. 2017;101(2):217-228 McDonald MM, Morse A*, Birke O, Yu NYC, Mikulec K, Peacock L, Schindeler A, Liu M, Ke HZ, Little DG. Sclerostin antibody enhances bone formation in a rat model of distraction osteogenesis. J Orthop Res. 2017; [Epub ahead of print] *equal first author McDonald MM, Morse A, Schindeler A, Mikulec K, Peacock L, Liu M, Ke HZ, Little DG. Homozygous Dkk1 knockout mice exhibit high bone mass phenotype due to increased bone formation. Calcif Tissue Int. 2017; [Epub ahead of print] vii Authorship attribution statement The work presented in this thesis was conducted during my full time candidature to fulfil the requirements of Doctor of Philosophy through the Sydney Medical School, The University of Sydney. Unless otherwise stated, all experiments were conducted, and data collected and analysed, by myself at the Orthopaedic Research and Biotechnology Unit at The Children’s Hospital at Westmead. Animal ethics was approved by the South Western Area Health Service (SWAHS) Animal Ethics Committee and/or CMRI/CHW animal ethics. Experimental conception, and manuscript and thesis editing, was conducted in conjunction with my supervisors Prof David G Little, A/Prof Aaron Schindeler and Dr Michelle M McDonald. Chapter 2 of this thesis is published as: Morse A, McDonald MM, Kelly NH, Melville KM, Schindeler A, Kramer I, Kneissel M, van der Meulen MC, Little DG. Mechanical load increases in bone formation via a sclerostin- independent pathway. J Bone Miner Res. 2014;29(11):2456-67. KNH and KMM performed strain gauging experiments. IK, MK and MCVDM were involved with experimental design and the review of the manuscript and data. Guy Smith assisted with some DXA data collection. Chapter 3 of this thesis is drafted for submission for review with Bone. Morse A, Ko F, McDonald MM, Schindeler A, van der Meulen MC, Lee L, Little DG. A Dkk1 KO mouse shows an increased anabolic bone response following compressive tibial loading. FK assisted in strain gauging experiments. MCVDM was involved in experimental design and review of manuscript and data. LL, Kathy Mikulec-Langton and Matthew Summers assisted with some specimen collection/homogenisation and/or RNA extractions. Kathy Mikulec-Langton and Lauren Peacock assisted with some mechanical loading and DXA scans. viii Chapter 4 of this thesis is published as: Morse A, Cheng TL, Schindeler A, McDonald MM, Mohanty S, Kneissel M, Kramer I, Little DG. Dkk1 KO mice treated with sclerostin antibody have additional increases in bone volume. Calcif Tissue Int. 2018 May 29 [Epub ahead of print]. With my assistance, TLC performed and analysed mechanical testing experiments. SM performed immunohistochemistry. IK and MK were involved with experimental design and the review of the manuscript and data.