Skip to main content


We’d like to understand how you use our websites in order to improve them. Register your interest.

Comment to Ruiyu Liu et al.: Comparative analysis of gene expression profiles in normal hip human cartilage and cartilage from patients with necrosis of the femoral head

It was with great interest that we read the study entitled “Comparative analysis of gene expression profiles in normal hip human cartilage and cartilage from patients with necrosis of the femoral head (NFH)” by Ruiyu Liu and colleagues published in Arthritis Research & Therapy in May 2016 [1].

The authors identified a set of differentially expressed genes which may contribute to the destruction of articular cartilage in patients with necrosis of the femoral head (NFH). Specimens were collected from 18 patients with non-traumatic NFH, classified by the Ficat system as grade III, and 18 healthy control subjects. However, the paper did not provide sufficient information about the main causes of NFH. Thus, the conclusion that the cartilage damage in NFH is related to the differential expression of these genes is debatable. The causes of non-traumatic NFH are complicated. A nationally representative survey of 30,030 people demonstrated that blood levels of triglycerides, total cholesterol, LDL-cholesterol, non-HDL-cholesterol, male gender, urban residence, family history of osteonecrosis of the femoral head, heavy smoking, alcohol abuse and glucocorticoid intake, overweight, and obesity were all significantly associated with an increased risk of non-traumatic NFH [2]. Some of these factors may also result in differential gene expression in articular cartilage. A study by Sniekers et al. [3] showed that estradiol affects the expression of anabolic and catabolic genes (e.g., those encoding aggrecan (AGC)1, matrix metalloproteinase (MMP)2, MMP14, and tissue inhibitor of metalloproteinase (TIMP)2, transforming growth factor (TGF)B2, and TGFB3) in bovine cartilage explants. Another study showed that leptin, a hormone associated with obesity, induces ADAMTS-4, ADAMTS-5, and ADAMTS-9 gene expression through mitogen-activated protein kinase and NF-ĸB signaling pathways in human chondrocytes [4]. Considering these issues might help to avoid irrelevant variables. The control group should be in accord with the NFH group and the established causes of NFH, such as estrogen in-take history, alcohol abuse, obesity, and so on. In addition, it would be better to provide basic information like height, habits, or history of drug use.

Another concern is that the methods for both selecting genes for quantitative RT-PCR validation and the immunohistochemical analysis might not been explained clearly. The nine genes were not the most significantly differentially expressed according to the gene expression ratios in Table 2 showing the significance analysis of microarrays (SAM) results of the patients with NFH. We would suggest selecting the genes with extreme gene expression ratio values from the nine functional groups mentioned in Table 2. Moreover, the microarray analysis may be more convincing if the sample size could be increased.

In this study, it remains unclear whether the changes in gene expression lead to the cartilage damage in NFH. To clarify their role, we suggest an additional animal experiment to study the dynamic change in gene expression and loss of cartilage in models at different stages of NFH, which may help to clarify the mechanisms by which the identified genes affect the development of NFH.

Authors’ response

AuthorGroup Author AuthorName Ruiyu Liu Author AuthorName Qi Liu Author AuthorName Kunzheng Wang Author AuthorName Xiaoqian Dang Author AuthorName Feng Zhang

We thank Long and colleagues for their interest in our recent publication [1]. We would like to respond to their comments.

First, we totally agree with the comment that non-traumatic necrosis of the femoral head (NFH) is a complex disease, mainly caused by excessive steroid use, alcohol drinking, as well as idiopathic NFH without certain etiological factors [5]. Additionally, heavy smoking, overweight, and hyperlipemia were reported to contribute to the development of NFH. To control the potential impacts of steroids, alcohol, and other confounding factors on our study results, all case samples were idiopathic NFH patients without histories of steroid and alcohol abuse, heavy smoking, hyperlipemia, and obesity. The healthy control samples were matched to case samples for age and sex and also did not have histories of steroid and alcohol abuse, heavy smoking, hyperlipemia, and obesity.

Second, Long and colleagues suggest selecting the genes with extreme expression ratios for quantitative real-time PCR (qRT-PCR) validation. We think that it was better to select genes by considering both expression ratios and biological relevance to NFH. The selected nine qRT-PCR validation genes were not only significantly differentially expressed between NFH and controls but also generally had evidence supporting their roles in the normal growth, homeostatic maintenance, or damage of cartilage. Additionally, we agree with their comment that using more cartilage samples could increase the accuracy of the microarray studies. However, it is usually difficult to collect suitable cartilage samples in practice, especially healthy cartilage samples. The same sampling design has been widely used in previous microarray studies of cartilage [6].

Third, Long and colleagues advise us to conduct animal experiments to clarify the differences between gene expression patterns at different stages of NFH. This is a good suggestion and will be performed in our future studies.



necrosis of the femoral head


quantitative real-time PCR


  1. 1.

    Ruiyu L, Qi L, Kunzheng W, et al. Comparative analysis of gene expression profiles in normal hip human cartilage from patients with necrosis of the femoral head. Arthritis Res Ther. 2016;18:98.

  2. 2.

    Zhao DW, Yu M, Hu K, et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population: results from a nationally representative survey. Chin Med J. 2015;128(21):2843–50.

  3. 3.

    Sniekers YH, van Osch GJ, Jahr H, et al. Estrogen modulates iodoacetate-induced gene expression in bovine cartilage explants. J Orthop Res. 2010;28(5):607–15.

  4. 4.

    Yaykasli KO, Hatipoglu OF, Yaykasli E, et al. Leptin induces ADAMTS-4, ADAMTS-5, and ADAMTS-9 genes expression by mitogen-activated protein kinases and NF-ĸB signaling pathways in human chondrocytes. Cell Biol Int. 2015;39(1):104–12.

  5. 5.

    Duan C, Guo X, Zhang XD, et al. Comparative analysis of gene expression profiles between primary knee osteoarthritis and an osteoarthritis endemic to Northwestern China, Kashin-Beck disease. Arthritis Rheum. 2010;62(3):771–80.

  6. 6.

    Wang WZ, Guo X, Duan C, et al. Comparative analysis of gene expression profiles between the normal human cartilage and the one with endemic osteoarthritis. Osteoarthritis Cartilage. 2009;17(1):83–90.

Download references

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

ZL carried out the sequence alignment and the drafted the manuscript, TH participated in the design of the letter and performed the statistical analysis. WW participated in its design and coordination. All authors read and approved the final manuscript.

Author information



Corresponding author

Correspondence to Wanchun Wang.

Additional information

See related research by Liu et al.,

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Long, Z., Huang, T. & Wang, W. Comment to Ruiyu Liu et al.: Comparative analysis of gene expression profiles in normal hip human cartilage and cartilage from patients with necrosis of the femoral head. Arthritis Res Ther 18, 238 (2016).

Download citation


  • Femoral Head
  • Articular Cartilage
  • Alcohol Abuse
  • Heavy Smoking
  • Cartilage Damage