Kosuke Murata,1 Kentaro Uchida,1 Shotaro Takano,1 Shintaro Shoji,1 Dai Iwase,1 Gen Inoue,1 Jun Aikawa,1 Yuji Yokozeki,1 Hiroyuki Sekiguchi,2 Masashi Takaso11Department of Orthopedic Surgery, Kitasato University School of Medicine, Sagamihara City, Kanagawa 252-0374, Japan; 2Shonan University of Medical Sciences Research Institute, Chigasaki City, Kanagawa 253-0083, JapanPurpose: While research has identified diabetes mellitus (DM) as a risk factor for knee osteoarthritis (KOA), the underlying mechanisms are not fully understood. Studies suggest that Toll-like receptor 4 (TLR4) expression is elevated in osteoarthritic lesions of OA patients and in target tissues of insulin resistance such as adipose tissue and skeletal muscle in patients with DM. TLR4 is associated with inflammation and catabolic response via regulation of matrix metalloproteases (MMPs). We hypothesized that TLR4 and MMP expression may be increased in the synovial tissue (SYN) of KOA patients with diabetic pathology. We therefore investigated TLR and MMP expression in the SYN of KOA patients with and without high haemoglobin A1c concentrations.Patients and methods: A total of 171 patients radiographically diagnosed with KOA were grouped based on their HbA1c concentration (HbA1c ≥6.5 and HbA1c
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