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Tendon-derived cathepsin K–expressing progenitor cells activate Hedgehog signaling to drive heterotopic ossification
Heng Feng, Wenhui Xing, Yujiao Han, Jun Sun, Mingxiang Kong, Bo Gao, Yang Yang, Zi Yin, Xiao Chen, Yun Zhao, Qing Bi, Weiguo Zou
Heng Feng, Wenhui Xing, Yujiao Han, Jun Sun, Mingxiang Kong, Bo Gao, Yang Yang, Zi Yin, Xiao Chen, Yun Zhao, Qing Bi, Weiguo Zou
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Research Article

Tendon-derived cathepsin K–expressing progenitor cells activate Hedgehog signaling to drive heterotopic ossification

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Abstract

Heterotopic ossification (HO) is pathological bone formation characterized by ossification within muscle, tendons, or other soft tissues. However, the cells of origin and mechanisms involved in the pathogenesis of HO remain elusive. Here we show that deletion of suppressor of fused (Sufu) in cathepsin K–Cre–expressing (Ctsk-Cre–expressing) cells resulted in spontaneous and progressive ligament, tendon, and periarticular ossification. Lineage tracing studies and cell functional analysis demonstrated that Ctsk-Cre could label a subpopulation of tendon-derived progenitor cells (TDPCs) marked by the tendon marker Scleraxis (Scx). Ctsk+Scx+ TDPCs are enriched for tendon stem cell markers and show the highest self-renewal capacity and differentiation potential. Sufu deficiency caused enhanced chondrogenic and osteogenic differentiation of Ctsk-Cre–expressing tendon-derived cells via upregulation of Hedgehog (Hh) signaling. Furthermore, pharmacological intervention in Hh signaling using JQ1 suppressed the development of HO. Thus, our results show that Ctsk-Cre labels a subpopulation of TDPCs contributing to HO and that their cell-fate changes are driven by activation of Hh signaling.

Authors

Heng Feng, Wenhui Xing, Yujiao Han, Jun Sun, Mingxiang Kong, Bo Gao, Yang Yang, Zi Yin, Xiao Chen, Yun Zhao, Qing Bi, Weiguo Zou

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Figure 1

Sufu deletion in Ctsk-Cre–expressing cells induces spontaneous HO in the ligament and tendon.

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Sufu deletion in Ctsk-Cre–expressing cells induces spontaneous HO in th...
(A) X-ray images and μCT scans reveal that spontaneous ossification (red arrows) of the tibiotalar ligament and Achilles tendon progresses gradually in Ctsk-CKO mice at 4, 9, and 20 weeks. Images are representative of 3 different sets of experiments. n = 3 per group. (B) H&E staining, Safranin O/fast green (SOFG) staining, and immunofluorescence staining of the chondrogenic marker type II collagen (COLII) and the osteogenic marker osteopontin (OPN) of the Achilles tendon from 20-week-old Ctsk-Ctrl and Ctsk-CKO mice. Images are representative of 3 different sets of experiments. Scale bars: 100 μm (2 left panels); 20 μm (8 right panels).

Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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