# Diabetes-related Tendon Changes: Integrating Ex Vivo and In Vivo Approaches

> **NIH NIH F32** · WASHINGTON UNIVERSITY · 2020 · $65,310

## Abstract

PROJECT SUMMARY. Diabetes has been identified as an epidemic in the United States and its deleterious
effects have broad implications for the musculoskeletal system. Individuals with diabetes are at increased risk
of tendon injury as well as tendon-limited joint mobility, which has been suggested to be an inciting factor in the
development of plantar ulcers and lower limb loss. Despite the potentially severe sequelae of diabetes-related
tendon complications, there is a lack of non-invasive tools to assess tendon in vivo particularly at smaller levels
of tendon architecture. Magnetic resonance-based diffusion tensor imaging (DTI) has the potential of being
applied to tendon to non-invasively assess tendon microstructure. DTI uses the direction and freedom of water
molecule mobility in fiber tracts to characterize tissue microstructure. Tendon has traditionally been very
difficult to image with DTI, however, a newly-improved DTI pulse sequence has allowed for the application of
this technique to tendon tissue.
 The long-term goal of this fellowship application is to optimize tendon healing from injury and metabolic
disease by bridging basic science and clinical research approaches. As a step toward that goal, this proposal
compares DTI to direct testing of human tendon tissue and applies DTI to a clinical population of individuals
with and without diabetes to improve our understanding of diabetes-related changes to tendon health. This
objective will be accomplished using a combination of ex vivo and in vivo approaches. Aim 1 uses Achilles
tendon specimens collected from individuals undergoing lower extremity amputation. DTI indices are compared
to direct measurement of tendon microstructural properties to improve our ability to interpret DTI indices. The
tendon is imaged ex vivo with DTI and then analyzed using quantitative polarized light imaging to measure
collagen alignment, biochemical analysis to quantify accumulation of advanced glycation endproducts, and
tensile mechanical testing. Aim 2 leverages DTI to quantify in vivo microstructural properties of the Achilles
tendon to identify diabetes-related changes to tendon health. DTI indices will be compared in a group of
individuals with compared to individuals without diabetes.
 The outcome of the proposed study will bridge basic science approaches of tendon assessment with
emerging non-invasive imaging methods of assessing tendon microstructure as well as improve our
understanding of diabetes-related alterations in tendon microstructure. This innovative approach will help
identify parameters that could serve as imaging biomarkers of tendon injury and disease for future clinical,
interventional studies.

## Key facts

- **NIH application ID:** 10025170
- **Project number:** 5F32DK123916-02
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Jennifer Zellers
- **Activity code:** F32 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $65,310
- **Award type:** 5
- **Project period:** 2019-09-16 → 2021-09-15

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10025170

## Citation

> US National Institutes of Health, RePORTER application 10025170, Diabetes-related Tendon Changes: Integrating Ex Vivo and In Vivo Approaches (5F32DK123916-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10025170. Licensed CC0.

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