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Smoking and impaired bone healing: will activation of cholinergic anti-inflammatory pathway be the bridge?

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Abstract

Purpose

This review was written to analyse the potential role of the cholinergic anti-inflammatory pathway in smoking-induced impairment of the bone healing process.

Methods

Literature in PubMed was reviewed by entering the following keywords “smoking AND bone healing”, “cholinergic anti-inflammatory pathway AND tumour necrosis factor”, “tumour necrosis factor AND bone healing”. All the related papers were recruited and carefully selected according to the content of this paper.

Results

Literature review indicated that tumour necrosis factor alpha (TNF-α) plays a pivotal role in the fracture healing process. In brief, TNF-α may accelerate the endochondral ossification process by increasing matrix metalloproteinases (MMPs) level, chondrocyte apoptosis, as well as osteoclast formation, therefore reducing the cartilaginous stage leading to the acceleration of fracture healing. Nicotine is the main effective ingredient of tobacco, which has been found to inhibit the secretion of TNF-α through activation of the cholinergic anti-inflammatory pathway.

Conclusions

It is reasonable to believe that the nicotine in tobacco at least partly contributes to the delayed fracture healing by inhibiting TNF-α secretion through the activation of the cholinergic anti-inflammatory pathway. An in-depth study of this issue will contribute to the clinical treatment of nonunion, as well as the development of new therapies to accelerate bone healing.

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Acknowledgement

This research was supported by the National Natural Science Foundation of China (support number: 81000786).

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Authors and Affiliations

  1. Centre for Translational Medicine Research and Development, Shen Zhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shen Zhen, GuangDong province, China

    Ling Qin & Peng Zhang

  2. Department of Trauma, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China

    Yonghua Chen & Qingshan Guo

  3. Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China

    Ling Qin

  4. The Department of Orthopedics, The Second Clinical Medical College, Ji Nan University, Shen Zhen, Guangdong, China

    Xiaohua Pan

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  1. Yonghua Chen
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  2. Qingshan Guo
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  3. Xiaohua Pan
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  4. Ling Qin
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  5. Peng Zhang
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Corresponding author

Correspondence to Peng Zhang.

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Chen, Y., Guo, Q., Pan, X. et al. Smoking and impaired bone healing: will activation of cholinergic anti-inflammatory pathway be the bridge?. International Orthopaedics (SICOT) 35, 1267–1270 (2011). https://doi.org/10.1007/s00264-011-1243-5

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  • DOI: https://doi.org/10.1007/s00264-011-1243-5

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