<?xml version='1.0'?>
<!DOCTYPE art SYSTEM 'http://www.biomedcentral.com/xml/article.dtd'>
<art>
   <ui>ar2468</ui>
   <ji>ARJ</ji>
   <fm>
      <dochead>Research article</dochead>
      <bibl>
         <title>
            <p>Caveolin-1 expression and stress-induced premature senescence in human intervertebral disc degeneration</p>
         </title>
         <aug>
            <au id="A1">
               <snm>Heathfield</snm>
               <mnm>Kathleen</mnm>
               <fnm>Sarah</fnm>
               <insr iid="I1"/>
               <email>Sarah.Heathfield@manchester.ac.uk</email>
            </au>
            <au id="A2">
               <snm>Le Maitre</snm>
               <mnm>Lyn</mnm>
               <fnm>Christine</fnm>
               <insr iid="I2"/>
               <email>C.Lemaitre@shu.ac.uk</email>
            </au>
            <au id="A3" ca="yes">
               <snm>Hoyland</snm>
               <mnm>Alison</mnm>
               <fnm>Judith</fnm>
               <insr iid="I1"/>
               <email>judith.a.hoyland@manchester.ac.uk</email>
            </au>
         </aug>
         <insg>
            <ins id="I1">
               <p>Tissue Injury and Repair Group, Research School of Clinical and Laboratory Sciences, Faculty of Medical and Human Sciences, Stopford Building, The University of Manchester, Oxford Road, Manchester, M13 9PT, UK</p>
            </ins>
            <ins id="I2">
               <p>Biomedical Research Centre, Biosciences, Faculty of Health and Wellbeing, Sheffield Hallam University, City Campus, Howard Street, Sheffield, S1 1WB, UK</p>
            </ins>
         </insg>
         <source>Arthritis Research &amp; Therapy</source>
         <issn>1478-6354</issn>
         <pubdate>2008</pubdate>
         <volume>10</volume>
         <issue>4</issue>
         <fpage>R87</fpage>
         <url>http://arthritis-research.com/content/10/4/R87</url>
         <xrefbib>
            <pubidlist>
               <pubid idtype="pmpid">18681962</pubid>
               <pubid idtype="doi">10.1186/ar2468</pubid>
            </pubidlist>
         </xrefbib>
      </bibl>
      <history>
         <rec>
            <date>
               <day>20</day>
               <month>5</month>
               <year>2008</year>
            </date>
         </rec>
         <revreq>
            <date>
               <day>12</day>
               <month>6</month>
               <year>2008</year>
            </date>
         </revreq>
         <revrec>
            <date>
               <day>9</day>
               <month>7</month>
               <year>2008</year>
            </date>
         </revrec>
         <acc>
            <date>
               <day>5</day>
               <month>8</month>
               <year>2008</year>
            </date>
         </acc>
         <pub>
            <date>
               <day>5</day>
               <month>8</month>
               <year>2008</year>
            </date>
         </pub>
      </history>
      <cpyrt>
         <year>2008</year>
         <collab>Heathfield et al.; licensee BioMed Central Ltd.</collab>
         <note>This is an open access article distributed under the terms of the Creative Commons Attribution License (<url>http://creativecommons.org/licenses/by/2.0</url>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</note>
      </cpyrt>
      <abs>
         <sec>
            <st>
               <p>Abstract</p>
            </st>
            <sec>
               <st>
                  <p>Introduction</p>
               </st>
               <p>Chronic and debilitating low back pain is a common condition and a huge economic burden. Many cases are attributed to age-related degeneration of the intervertebral disc (IVD); however, age-related degeneration appears to occur at an accelerated rate in some individuals. We have previously demonstrated biomarkers of cellular senescence within the human IVD and suggested a role for senescence in IVD degeneration. Senescence occurs with ageing but can also occur prematurely in response to stress. We hypothesised that stress-induced premature senescence (SIPS) occurs within the IVD and here we have investigated the expression and production of caveolin-1, a protein that has been shown previously to be upregulated in SIPS.</p>
            </sec>
            <sec>
               <st>
                  <p>Methods</p>
               </st>
               <p>Caveolin-1 gene expression in human nucleus pulposus (NP) cells was assessed by conventional and quantitative real-time polymerase chain reaction (PCR), and caveolin-1 protein expression was examined within human IVDs using immunohistochemistry. The correlation between caveolin-1 and p16<sup>INK4a </sup>(biomarker of cellular senescence) gene expression was investigated using quantitative real-time PCR.</p>
            </sec>
            <sec>
               <st>
                  <p>Results</p>
               </st>
               <p>Caveolin-1 gene expression and protein expression were demonstrated within the human IVD for the first time. NP cells from degenerate discs exhibited elevated levels of caveolin-1 which did not relate to increasing chronological age. A negative correlation was observed between gene expression for caveolin-1 and donor age, and no correlation was found between caveolin-1 protein expression and age. A positive correlation was identified between gene expression of caveolin-1 and p16<sup>INK4a</sup>.</p>
            </sec>
            <sec>
               <st>
                  <p>Conclusion</p>
               </st>
               <p>Our findings are consistent with a role for caveolin-1 in degenerative rather than age-induced changes in the NP. Its expression in IVD tissue and its association with the senescent phenotype suggest that caveolin-1 and SIPS may play a prominent role in the pathogenesis of IVD degeneration.</p>
            </sec>
         </sec>
      </abs>
   </fm>
   <meta>
      <classifications>
         <classification type="bmc" subtype="user_supplied_xml" id="endnote"/>
      </classifications>
   </meta>
   <bdy>
      <sec>
         <st>
            <p>Introduction</p>
         </st>
         <p>Low back pain (LBP) is a condition that affects a significant proportion of the population, with a lifetime incidence rate in excess of 70% in industrialised nations <abbrgrp><abbr bid="B1">1</abbr></abbrgrp>. It not only impacts on quality of life, but also places a substantial financial burden on the National Health Service and the economy in general due to loss of working days <abbrgrp><abbr bid="B1">1</abbr><abbr bid="B2">2</abbr></abbrgrp>. Many cases of LBP are attributed to degeneration of the intervertebral disc (IVD) and imaging studies have indicated a link between IVD degeneration and LBP <abbrgrp><abbr bid="B3">3</abbr><abbr bid="B4">4</abbr></abbrgrp>.</p>
         <p>To date, no clear mechanism for IVD degeneration has been identified, although the involvement of both environmental and genetic factors has been proposed <abbrgrp><abbr bid="B5">5</abbr><abbr bid="B6">6</abbr><abbr bid="B7">7</abbr><abbr bid="B8">8</abbr></abbrgrp>. The occurrence of IVD degeneration increases with age <abbrgrp><abbr bid="B9">9</abbr><abbr bid="B10">10</abbr></abbrgrp>; however, a subset of individuals appear to exhibit accelerated degeneration that is independent of age <abbrgrp><abbr bid="B5">5</abbr><abbr bid="B6">6</abbr></abbrgrp>. This has led to speculation that additional factors could play a key role in the development of degeneration in some individuals.</p>
         <p>There is increasing evidence that many features of IVD degeneration, including altered matrix synthesis and enhanced matrix degradation, originate at a cellular level <abbrgrp><abbr bid="B6">6</abbr><abbr bid="B11">11</abbr><abbr bid="B12">12</abbr></abbrgrp>. Cellular senescence is a strong candidate for the prolonged alteration in cellular activity observed during degeneration. Senescence and accompanying alterations in cell function have been implicated in ageing-related, degenerative, and pathological changes in a variety of tissues, including atherosclerotic plaque development within blood vessels and osteoarthritic alterations to cartilage <abbrgrp><abbr bid="B13">13</abbr><abbr bid="B14">14</abbr><abbr bid="B15">15</abbr></abbrgrp>. Two groups have shown increased staining for senescence-associated &#946;-galactosidase (SA-&#946;-gal) in cells from prolapsed and degenerate IVD cells, respectively, when compared with non-degenerate discs <abbrgrp><abbr bid="B16">16</abbr><abbr bid="B17">17</abbr></abbrgrp>. More recently, our group has presented more comprehensive evidence of senescence biomarkers in human IVD samples, demonstrating increased cellular senescence during IVD degeneration <abbrgrp><abbr bid="B18">18</abbr></abbrgrp>. In particular, cells from degenerate discs exhibited increased SA-&#946;-gal activity, elevated expression of the cell cycle inhibitor p16<sup>INK4a</sup>, telomere erosion, and a decrease in replicative potential. Furthermore, a correlation was observed between p16<sup>INK4a </sup>expression and the expression of matrix-degrading enzymes matrix metalloproteinase (MMP)-13 and a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-5, suggesting a role for cell senescence in the molecular processes observed during IVD degeneration <abbrgrp><abbr bid="B18">18</abbr></abbrgrp>.</p>
         <p>Senescence occurs naturally with ageing but can also occur prematurely in response to stresses (such as exposure to cytokines or oxidative stress) in a number of cell types <abbrgrp><abbr bid="B19">19</abbr><abbr bid="B20">20</abbr><abbr bid="B21">21</abbr><abbr bid="B22">22</abbr><abbr bid="B23">23</abbr><abbr bid="B24">24</abbr></abbrgrp>. Since telomeric erosion and p16<sup>INK4a </sup>protein expression are increased in degenerate discs compared to non-degenerate age-matched samples <abbrgrp><abbr bid="B18">18</abbr></abbrgrp>, we hypothesised that stress-induced premature senescence (SIPS) occurs within the IVD and may be responsible for the accelerated degeneration observed in some individuals.</p>
         <p>Caveolae are plasma membrane compartments found abundantly in terminally differentiated cells such as fibroblasts and endothelial and muscle cells <abbrgrp><abbr bid="B25">25</abbr></abbrgrp>. The mammalian caveolin gene family codes for three 21 to 25 kDa caveolin proteins, which are integral membrane proteins essential for the structural integrity and function of caveolae <abbrgrp><abbr bid="B26">26</abbr></abbrgrp>. Expression of caveolin-3 is muscle-specific, whereas caveolin-1 and caveolin-2 are coexpressed in many cell types <abbrgrp><abbr bid="B26">26</abbr></abbrgrp>. Proposed functions include lipid transport, membrane trafficking, and a role in intracellular signalling pathways which stems from the colocalisation of caveolins with a variety of signal transduction molecules <abbrgrp><abbr bid="B25">25</abbr><abbr bid="B26">26</abbr><abbr bid="B27">27</abbr><abbr bid="B28">28</abbr></abbrgrp>. Interestingly, caveolin-1 has been implicated in the senescent phenotype of several cell types, including human fibroblasts, lung adenocarcinoma cells, endothelial cells, and articular chondrocytes <abbrgrp><abbr bid="B19">19</abbr><abbr bid="B29">29</abbr><abbr bid="B30">30</abbr><abbr bid="B31">31</abbr><abbr bid="B32">32</abbr><abbr bid="B33">33</abbr></abbrgrp>. Moreover, caveolin-1 has been proposed to mediate SIPS in murine fibroblasts and human articular chondrocytes in response to oxidative stress and the inflammatory cytokine interleukin-1&#946; (IL-1&#946;) (both of which are known to be increased during IVD degeneration) <abbrgrp><abbr bid="B19">19</abbr><abbr bid="B31">31</abbr><abbr bid="B34">34</abbr><abbr bid="B35">35</abbr><abbr bid="B36">36</abbr><abbr bid="B37">37</abbr><abbr bid="B38">38</abbr></abbrgrp>. Here, we have investigated the expression of caveolin-1 in human IVDs and correlated its expression with the cell cycle inhibitor and the biomarker of senescence p16<sup>INK4a</sup>, focusing on the nucleus pulposus (NP) as this area shows the most evidence of cell senescence in human IVDs <abbrgrp><abbr bid="B18">18</abbr></abbrgrp>.</p>
      </sec>
      <sec>
         <st>
            <p>Materials and methods</p>
         </st>
         <sec>
            <st>
               <p>Tissue samples</p>
            </st>
            <p>Human IVD tissue was obtained either at post mortem (PM) examination or from patients undergoing surgery, where patients were selected on the basis of magnetic resonance imaging-diagnosed degeneration and progression to anterior resection either for spinal fusion or disc replacement surgery for chronic LBP. Local research ethics committee approval was obtained together with informed consent from the patient or relatives. Disc tissue was removed as detailed previously <abbrgrp><abbr bid="B37">37</abbr></abbrgrp>.</p>
            <sec>
               <st>
                  <p>General procedure for tissue specimens</p>
               </st>
               <p>A block of tissue (incorporating annulus fibrosus [AF] and NP in continuity) was fixed in 10% vol/vol neutral buffered formalin and embedded in paraffin wax. Four micron sections were stained with haematoxylin and eosin to grade the degree of morphological degeneration according to previously published criteria that assess the demarcation between NP and AF, proteoglycan content of the NP, presence and extent of structural fissures, and cell cluster formation <abbrgrp><abbr bid="B39">39</abbr></abbrgrp>. Potential grades range between 0 and 12. A grade of 0 to 3 indicates a histologically non-degenerate IVD, 4 to 7 indicates evidence of intermediate (or moderate) degeneration, and 8 to 12 indicates severe degeneration. Further tissue sections were taken for immunohistochemical analysis of caveolin-1.</p>
            </sec>
         </sec>
         <sec>
            <st>
               <p>Isolation of nucleus pulposus cells</p>
            </st>
            <p>To obtain NP cells from human IVD tissue, NP tissue was identified and dissected from AF. NP tissue was finely chopped and digested in a solution of 2 U/mL protease (Sigma-Aldrich, Gillingham, UK) in Dulbecco's modified Eagle's medium plus Ham's F-12 nutrient medium (DMEM + F-12) (Gibco BRL, now part of Invitrogen, Paisley, UK) for 30 minutes at 37&#176;C. NP cells were washed twice with DMEM + F-12 prior to cell isolation with collagenase type I treatment (0.4 mg/mL; Invitrogen).</p>
         </sec>
         <sec>
            <st>
               <p>Conventional reverse transcription-polymerase chain reaction</p>
            </st>
            <p>To investigate gene expression of caveolin-1 in human NP cells, RNA was extracted from isolated cells following the standard procedure for TRIzol<sup>&#174; </sup>reagent (Invitrogen). cDNA was then synthesised using Superscript II in accordance with the instructions of the manufacturer (Invitrogen). A standard Platinum Taq (Invitrogen) method was used for conventional polymerase chain reaction (PCR), using a concentration of 1.5 mM MgCl<sub>2</sub>. Primers specific for caveolin-1 <abbrgrp><abbr bid="B19">19</abbr></abbrgrp> and the housekeeping gene <it>18S </it>(Invitrogen) are detailed in Table <tblr tid="T1">1</tblr>. All primers were confirmed for gene specificity using BLAST (Basic Local Alignment Search Tool) (Genbank database sequences). Reactions, including non-template controls, were conducted for 35 cycles, including the annealing temperature of 58&#176;C on a thermal cycler (MJ Research, now part of Bio-Rad Laboratories, Hercules, CA, USA), and products were analysed alongside a 100-base pair DNA ladder (Hyperladder IV; Bioline, London, UK) by electrophoresis on a 1.5% wt/vol agarose gel containing 0.2 &#956;g/mL ethidium bromide (Sigma-Aldrich). Product bands were visualised by UV transillumination and images were captured using Gene Snap software (Syngene, Cambridge, UK).</p>
            <tbl id="T1" hint_layout="double">
               <title>
                  <p>Table 1</p>
               </title>
               <caption>
                  <p>Details of polymerase chain reaction (PCR) primers, probes, and amplicon sizes</p>
               </caption>
               <tblbdy cols="4">
                  <r>
                     <c cspan="4" ca="left">
                        <p>Conventional PCR conditions</p>
                     </c>
                  </r>
                  <r>
                     <c cspan="4">
                        <hr/>
                     </c>
                  </r>
                  <r>
                     <c ca="left">
                        <p>Target</p>
                     </c>
                     <c ca="left">
                        <p>Forward primer 5' to 3'</p>
                     </c>
                     <c ca="left">
                        <p>Reverse primer 5' to 3'</p>
                     </c>
                     <c ca="left">
                        <p>Amplicon size, base pairs (bp)</p>
                     </c>
                  </r>
                  <r>
                     <c ca="left">
                        <p>
                           <it>18S</it>
                        </p>
                     </c>
                     <c ca="left">
                        <p>GCC ATG CAT GTC TAA GTA CG</p>
                     </c>
                     <c ca="left">
                        <p>GCT GGC ACC AGA CTT GCC</p>
                     </c>
                     <c ca="left">
                        <p>574 bp</p>
                     </c>
                  </r>
                  <r>
                     <c ca="left">
                        <p>Caveolin-1</p>
                     </c>
                     <c ca="left">
                        <p>AAG GAG ATC GAC CTG G</p>
                     </c>
                     <c ca="left">
                        <p>GGA ATA GAC ACG GCT G</p>
                     </c>
                     <c ca="left">
                        <p>309 bp</p>
                     </c>
                  </r>
                  <r>
                     <c cspan="4">
                        <hr/>
                     </c>
                  </r>
                  <r>
                     <c cspan="4" ca="left">
                        <p>Real-time PCR primers and probes</p>
                     </c>
                  </r>
                  <r>
                     <c cspan="4">
                        <hr/>
                     </c>
                  </r>
                  <r>
                     <c ca="left">
                        <p>Target</p>
                     </c>
                     <c ca="left">
                        <p>Forward primer 5' to 3'</p>
                     </c>
                     <c ca="left">
                        <p>Probe 5' to 3'</p>
                     </c>
                     <c ca="left">
                        <p>Reverse primer 5' to 3'</p>
                     </c>
                  </r>
                  <r>
                     <c ca="left">
                        <p>
                           <it>18S</it>
                        </p>
                     </c>
                     <c ca="left">
                        <p>PDAR</p>
                     </c>
                     <c ca="left">
                        <p>PDAR (VIC-TAMRA)</p>
                     </c>
                     <c ca="left">
                        <p>PDAR</p>
                     </c>
                  </r>
                  <r>
                     <c ca="left">
                        <p>Caveolin-1</p>
                     </c>
                     <c ca="left">
                        <p>ACT TGC AAC CGT CTG TTA TGC T</p>
                     </c>
                     <c ca="left">
                        <p>FAM &#8211; ACA TGG CCC CTC CCC &#8211; MGB</p>
                     </c>
                     <c ca="left">
                        <p>GCA AAG GGA TGC TTG GAT TAG GT</p>
                     </c>
                  </r>
                  <r>
                     <c ca="left">
                        <p>p16<sup>INK4a</sup></p>
                     </c>
                     <c ca="left">
                        <p>GGC TCT ACA CAA GCT TCC TTT CC</p>
                     </c>
                     <c ca="left">
                        <p>FAM &#8211; ACC CTG GCT CTG ACC A &#8211; MGB</p>
                     </c>
                     <c ca="left">
                        <p>TCA TGA CCT GCC AGA GAG AAC A</p>
                     </c>
                  </r>
               </tblbdy>
               <tblfn>
                  <p>PDAR, pre-developed assay reagent.</p>
               </tblfn>
            </tbl>
         </sec>
         <sec>
            <st>
               <p>Quantitative real-time polymerase chain reaction</p>
            </st>
            <p>Quantitative real-time reverse transcription-PCR (qRT-PCR) was performed to further examine caveolin-1 gene expression in human NP cells and to investigate any correlation between caveolin-1 and p16<sup>INK4a </sup>gene expression in isolated NP cells using the standard curve method of analysis as described previously <abbrgrp><abbr bid="B18">18</abbr></abbrgrp>.</p>
            <sec>
               <st>
                  <p>Primers and probe design</p>
               </st>
               <p>Primers and FAM-MGB probe specific for human caveolin-1 were designed by Applied Biosystems (ABI) (Warrington, UK) upon provision of caveolin-1-specific exon sequence (Gene expression assays) (Table <tblr tid="T1">1</tblr>). p16<sup>INK4a </sup>primers and probe were as described previously <abbrgrp><abbr bid="B18">18</abbr></abbrgrp>, and <it>18S </it>primer/VIC-TAMRA probe set was a pre-developed assay reagent (PDAR) purchased from ABI.</p>
            </sec>
            <sec>
               <st>
                  <p>Genomic curve standards</p>
               </st>
               <p>Genomic DNA (gDNA) was used to create standard curves for absolute quantification of copy number per reaction. gDNA (Promega Corporation, Southampton, UK) was homogenised, diluted to 100 ng/&#956;L, and sonicated on ice. Serial dilutions of gDNA were prepared to generate standards with gene copy numbers of 75,000, 7,500, 750, 75, and 0 copies per 25 &#956;L reaction.</p>
            </sec>
            <sec>
               <st>
                  <p>Quantitative real-time reverse transcription-polymerase chain reaction amplification</p>
               </st>
               <p>qRT-PCRs were carried out in triplicate in a 96-well plate. Reactions contained 12.5 &#956;L of mastermix (Taqman<sup>&#174; </sup>Universal PCR mastermix; ABI) and 2.5 &#956;L of template cDNA or gDNA. Primers were added to a final concentration of 900 nM and probe to a concentration of 250 nM, and molecular-grade water was added to a total reaction volume of 25 &#956;L. A gDNA standard curve for each gene was included on each plate. Real-time PCR was performed using an ABI Prism 7000 sequence detection system (ABI). Reactions consisted of an initial Taq activation step of 95&#176;C for 10 minutes to denature DNA and activate Taq polymerase followed by 40 cycles of 95&#176;C for 15 seconds and 60&#176;C for 1 minute.</p>
            </sec>
            <sec>
               <st>
                  <p>Quantitative real-time reverse transcription-polymerase chain reaction analysis</p>
               </st>
               <p>Following amplification, an auto-baseline was set using the ABI 7000 sequence detection software and a threshold was set for each gene, above background levels and within the exponential phase. From these, a cycle threshold (Ct) was obtained for each well and data exported into Microsoft Excel (Microsoft Corporation, Redmond, WA, USA), where the three Ct values for each sample were averaged. Data were analysed as described previously <abbrgrp><abbr bid="B18">18</abbr></abbrgrp> and results were expressed as copy number of target gene per 100 ng cDNA normalised to <it>18S</it>.</p>
            </sec>
         </sec>
         <sec>
            <st>
               <p>Immunohistochemistry</p>
            </st>
            <p>Immunohistochemistry (IHC) was used to determine the expression and localisation of caveolin-1 protein in the NP of 28 paraffin-embedded disc samples (Table <tblr tid="T2">2</tblr>). Normal human skin tissue was used as a positive control. The protocol was based upon previously published IHC <abbrgrp><abbr bid="B40">40</abbr></abbrgrp>. Briefly, following deparaffination, blocking of endogenous peroxidase activity, and enzyme retrieval in 0.01% wt/vol chymotrypsin (Sigma-Aldrich) solution at 37&#176;C for 20 minutes, sections were washed and incubated with 25% rabbit serum (Sigma-Aldrich) to block non-specific binding sites. Sections were then incubated at 4&#176;C overnight with mouse monoclonal antibody against human caveolin-1 (BD Transduction Laboratories catalogue number 610406, clone 2297; BD Biosciences, Oxford, UK) (1:10 dilution in 25% rabbit serum in 0.1% bovine serum albumin; Sigma-Aldrich). Negative control sections were incubated with an equivalent concentration of mouse IgG1 (Dako UK Ltd., Ely, UK). Following washes in Tris-buffered saline (TBS), sections were incubated with biotinylated rabbit anti-mouse antiserum (1:400; Dako UK Ltd.) for 30 minutes at room temperature. After further washes in TBS, immunoreactivity was visualised using the streptavidin-biotin complex (Dako UK Ltd.) technique with 3,3'-diaminobenzidine tetrahydrochloride solution (Sigma-Aldrich). Sections were subsequently rinsed in water, counterstained with Mayer's haematoxylin, dehydrated, and mounted with Pertex (HistoLab, Gothenburg, Sweden).</p>
            <tbl id="T2" hint_layout="double">
               <title>
                  <p>Table 2</p>
               </title>
               <caption>
                  <p>Details of human nucleus pulposus samples used to study caveolin-1 protein expression by immunohistochemistry</p>
               </caption>
               <tblbdy cols="4">
                  <r>
                     <c ca="center">
                        <p>Laboratory number</p>
                     </c>
                     <c ca="center">
                        <p>Histological grade</p>
                     </c>
                     <c ca="center">
                        <p>Age, years</p>
                     </c>
                     <c ca="center">
                        <p>Source</p>
                     </c>
                  </r>
                  <r>
                     <c cspan="4">
                        <hr/>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>1</p>
                     </c>
                     <c ca="center">
                        <p>1</p>
                     </c>
                     <c ca="center">
                        <p>25</p>
                     </c>
                     <c ca="center">
                        <p>Surgery</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>2</p>
                     </c>
                     <c ca="center">
                        <p>1</p>
                     </c>
                     <c ca="center">
                        <p>30</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>3</p>
                     </c>
                     <c ca="center">
                        <p>1</p>
                     </c>
                     <c ca="center">
                        <p>47</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>4</p>
                     </c>
                     <c ca="center">
                        <p>2</p>
                     </c>
                     <c ca="center">
                        <p>47</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>5</p>
                     </c>
                     <c ca="center">
                        <p>2</p>
                     </c>
                     <c ca="center">
                        <p>75</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>6</p>
                     </c>
                     <c ca="center">
                        <p>2</p>
                     </c>
                     <c ca="center">
                        <p>Unknown</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>7</p>
                     </c>
                     <c ca="center">
                        <p>3</p>
                     </c>
                     <c ca="center">
                        <p>30</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>8</p>
                     </c>
                     <c ca="center">
                        <p>3</p>
                     </c>
                     <c ca="center">
                        <p>30</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>9</p>
                     </c>
                     <c ca="center">
                        <p>3</p>
                     </c>
                     <c ca="center">
                        <p>37</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>10</p>
                     </c>
                     <c ca="center">
                        <p>3</p>
                     </c>
                     <c ca="center">
                        <p>74</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>11</p>
                     </c>
                     <c ca="center">
                        <p>4</p>
                     </c>
                     <c ca="center">
                        <p>30</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>12</p>
                     </c>
                     <c ca="center">
                        <p>4</p>
                     </c>
                     <c ca="center">
                        <p>37</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>13</p>
                     </c>
                     <c ca="center">
                        <p>5</p>
                     </c>
                     <c ca="center">
                        <p>30</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>14</p>
                     </c>
                     <c ca="center">
                        <p>5</p>
                     </c>
                     <c ca="center">
                        <p>74</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>15</p>
                     </c>
                     <c ca="center">
                        <p>5</p>
                     </c>
                     <c ca="center">
                        <p>Unknown</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>16</p>
                     </c>
                     <c ca="center">
                        <p>5</p>
                     </c>
                     <c ca="center">
                        <p>Unknown</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>17</p>
                     </c>
                     <c ca="center">
                        <p>6</p>
                     </c>
                     <c ca="center">
                        <p>74</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>18</p>
                     </c>
                     <c ca="center">
                        <p>6</p>
                     </c>
                     <c ca="center">
                        <p>75</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>19</p>
                     </c>
                     <c ca="center">
                        <p>7</p>
                     </c>
                     <c ca="center">
                        <p>75</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>20</p>
                     </c>
                     <c ca="center">
                        <p>7</p>
                     </c>
                     <c ca="center">
                        <p>78</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>21</p>
                     </c>
                     <c ca="center">
                        <p>8</p>
                     </c>
                     <c ca="center">
                        <p>58</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>22</p>
                     </c>
                     <c ca="center">
                        <p>8</p>
                     </c>
                     <c ca="center">
                        <p>75</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>23</p>
                     </c>
                     <c ca="center">
                        <p>9</p>
                     </c>
                     <c ca="center">
                        <p>58</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>24</p>
                     </c>
                     <c ca="center">
                        <p>9</p>
                     </c>
                     <c ca="center">
                        <p>74</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>25</p>
                     </c>
                     <c ca="center">
                        <p>9</p>
                     </c>
                     <c ca="center">
                        <p>74</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>26</p>
                     </c>
                     <c ca="center">
                        <p>10</p>
                     </c>
                     <c ca="center">
                        <p>58</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>27</p>
                     </c>
                     <c ca="center">
                        <p>11</p>
                     </c>
                     <c ca="center">
                        <p>46</p>
                     </c>
                     <c ca="center">
                        <p>Surgery</p>
                     </c>
                  </r>
                  <r>
                     <c ca="center">
                        <p>28</p>
                     </c>
                     <c ca="center">
                        <p>12</p>
                     </c>
                     <c ca="center">
                        <p>Unknown</p>
                     </c>
                     <c ca="center">
                        <p>PM</p>
                     </c>
                  </r>
               </tblbdy>
               <tblfn>
                  <p>PM, post mortem tissue.</p>
               </tblfn>
            </tbl>
            <p>Sections were visualised using a Leica RMDB microscope (Leica Camera Limited, Knowlhill, Milton Keynes, UK), and images were captured using a digital camera and Bioquant Nova image analysis system (Bioquant Image Analysis Corporation, Nashville, TN, USA). For analysis, the NP was identified morphologically within each disc section. Within each section, a minimum of 200 NP cells were analysed from at least five different fields of view and immunopositivity was calculated as a percentage of the total cell population.</p>
         </sec>
         <sec>
            <st>
               <p>Statistical analysis</p>
            </st>
            <p>Data were non-parametric and thus Mann-Whitney <it>U </it>tests were conducted to compare gene copy number and numbers of caveolin-1-immunopositive cells in non-degenerate NP (grades 0 to 3) and degenerate NP (grades 4 to 7 and 8 to 12). Non-parametric linear regression analysis was performed to analyse the correlation between copy numbers of different genes and between gene copy numbers and subject age or number of caveolin-1-immunopositive cells and subject age.</p>
         </sec>
      </sec>
      <sec>
         <st>
            <p>Results</p>
         </st>
         <sec>
            <st>
               <p>Caveolin-1 gene expression in human nucleus pulposus cells</p>
            </st>
            <p>cDNAs derived from cells directly extracted from the NP of 19 different IVDs, from both PM and surgical sources, were analysed for expression of the caveolin-1 gene. Eight samples were taken from non-degenerate IVD (grades 0 to 3; mean age &#177; standard deviation [SD] 45.4 &#177; 18.7 years) and 11 samples from degenerate IVD (grades 4 to 9; 51.7 &#177; 24.3 years). Gene expression for caveolin-1 was detected in the NP tissue of every sample analysed (qRT-PCR analysis). Comparison of caveolin-1 gene expression by non-degenerate and degenerate samples demonstrated higher gene expression in degenerate samples (conventional RT-PCR analysis, Figure <figr fid="F1">1</figr>). This was supported by qRT-PCR analysis (Figure <figr fid="F2">2a</figr>) in that non-degenerate samples demonstrated a median caveolin-1 gene copy number of 35,220 with a range of 6,740 to 70,9222 copies per 100 ng cDNA compared with the elevated degenerate median caveolin-1 gene copy number of 45,695 with a range of 7,589 to 105,626 copies per 100 ng cDNA (Figure <figr fid="F2">2a</figr>). A negative correlation was observed between gene expression for caveolin-1 and age of the donor (<it>P </it>= 0.0472) (Figure <figr fid="F2">2b</figr>).</p>
            <fig id="F1">
               <title>
                  <p>Figure 1</p>
               </title>
               <caption>
                  <p>Conventional reverse transcription-polymerase chain reaction (RT-PCR) for caveolin-1 and housekeeping gene <it>18S</it></p>
               </caption>
               <text>
                  <p>Conventional reverse transcription-polymerase chain reaction (RT-PCR) for caveolin-1 and housekeeping gene <it>18S</it>. Representative photographs following agarose gel electrophoresis of products from conventional RT-PCR for caveolin-1 and <it>18S</it>. cDNA samples displayed are non-degenerate samples from a post mortem (PM) source (respective grades [G] and ages of subjects: G3, 30 years; G1, 30 years; and G2, 75 years) and degenerate samples from surgical and PM sources (G5, 29 years; G6, 34 years; and G9, 74 years). Photographs are inverted to improve visualisation of product bands. Cav-1, caveolin-1.</p>
               </text>
               <graphic file="ar2468-1"/>
            </fig>
            <fig id="F2">
               <title>
                  <p>Figure 2</p>
               </title>
               <caption>
                  <p>Quantitative real-time reverse transcription-polymerase chain reaction analysis of caveolin-1 gene expression levels in nucleus pulposus (NP) cells from human intervertebral disc</p>
               </caption>
               <text>
                  <p>Quantitative real-time reverse transcription-polymerase chain reaction analysis of caveolin-1 gene expression levels in nucleus pulposus (NP) cells from human intervertebral disc. <b>(a) </b>Caveolin-1 gene expression per 100 ng cDNA normalised to <it>18S </it>in non-degenerate and degenerate NP presented as box-and-whisker plot (5&#8211;95 percentile). <b>(b) </b>Correlation of caveolin-1 gene expression with age of subject. Non-parametric linear regression analysis (<it>P </it>= 0.0472; <it>R</it><sup>2 </sup>= 0.2122).</p>
               </text>
               <graphic file="ar2468-2"/>
            </fig>
         </sec>
         <sec>
            <st>
               <p>Immunohistochemical detection of caveolin-1 protein in human nucleus pulposus</p>
            </st>
            <p>Caveolin-1 protein expression was investigated in 28 IVD samples (for sample details, see Table <tblr tid="T2">2</tblr>). Immunohistochemical analysis for caveolin-1 demonstrated cytoplasmic/membrane staining within the chondrocyte-like cells of the NP (Figure <figr fid="F3">3</figr>). The percentage of immunopositive cells for caveolin-1 increased from 2.59% &#177; 1.01% (mean &#177; standard error of the mean [SEM]) in non-degenerate discs to 13.62% &#177; 6.51% in severely degenerate samples (Figure <figr fid="F4">4a</figr>). All IgG1 controls were negative. It must be noted that the majority of patients with severely degenerate discs were above 50 years of age; however, in the 24 samples of all grades for which the chronological age of individuals was known, no correlation was observed between caveolin-1 immunopositivity and age of the donors (<it>P </it>= 0.6609) (Figure <figr fid="F4">4b</figr>).</p>
            <fig id="F3">
               <title>
                  <p>Figure 3</p>
               </title>
               <caption>
                  <p>Caveolin-1 immunohistochemistry</p>
               </caption>
               <text>
                  <p>Caveolin-1 immunohistochemistry. <b>(a) </b>Photomicrograph demonstrating staining for caveolin-1 protein in degenerate human nucleus pulposus (sample 28). <b>(b) </b>Immunoglobulin G controls were negative.</p>
               </text>
               <graphic file="ar2468-3"/>
            </fig>
            <fig id="F4">
               <title>
                  <p>Figure 4</p>
               </title>
               <caption>
                  <p>Analysis of caveolin-1 immunohistochemistry</p>
               </caption>
               <text>
                  <p>Analysis of caveolin-1 immunohistochemistry. <b>(a) </b>Percentage of cells immunopositive for caveolin-1 protein in non-degenerate, moderately degenerate, and severely degenerate intervertebral discs. Data are shown as mean &#177; SEM. <b>(b) </b>Correlation of caveolin-1 protein expression with age of subject. Non-parametric linear regression analysis (<it>P </it>= 0.6609; <it>R</it><sup>2 </sup>= 0.0089).</p>
               </text>
               <graphic file="ar2468-4"/>
            </fig>
         </sec>
         <sec>
            <st>
               <p>Correlation between caveolin-1 gene expression and gene expression of the senescence biomarker p16<sup>INK4a</sup></p>
            </st>
            <p>Seventeen NP samples were analysed for both caveolin-1 and p16<sup>INK4a </sup>gene expression using qRT-PCR. Analysis of p16<sup>INK4a </sup>expression agreed with our previous study <abbrgrp><abbr bid="B18">18</abbr></abbrgrp> in that a higher proportion of degenerate than non-degenerate discs expressed p16<sup>INK4a</sup>. Of the five non-degenerate samples (from PM source, mean age &#177; SD 45.8 &#177; 18.4 years), only two samples expressed p16<sup>INK4a </sup>at copy numbers of 1.4 and 55.8 copies per 100 ng cDNA from individuals of 30 and 75 years of age, respectively. Eleven of the 12 degenerate samples (from both PM and surgical sources, 35.4 &#177; 12.7 years) expressed p16<sup>INK4a </sup>with median and maximum copy numbers of 32.5 and 17,075 copies per 100 ng cDNA, respectively. qRT-PCR analysis demonstrated a significant correlation between caveolin-1 and p16<sup>INK4a </sup>gene expression in the degenerate NP samples (<it>P </it>= 0.02) (Figure <figr fid="F5">5</figr>).</p>
            <fig id="F5">
               <title>
                  <p>Figure 5</p>
               </title>
               <caption>
                  <p>Correlation between caveolin-1 and p16<sup>INK4a </sup>gene expression in degenerate nucleus pulposus samples</p>
               </caption>
               <text>
                  <p>Correlation between caveolin-1 and p16<sup>INK4a </sup>gene expression in degenerate nucleus pulposus samples. Caveolin-1 and p16<sup>INK4a </sup>gene expression (copy number per 100 ng cDNA normalised to <it>18S</it>) analysed by quantitative real-time reverse transcription-polymerase chain reaction. Non-parametric linear regression analysis (<it>P </it>= 0.02; <it>R</it><sup>2 </sup>= 0.4725).</p>
               </text>
               <graphic file="ar2468-5"/>
            </fig>
         </sec>
      </sec>
      <sec>
         <st>
            <p>Discussion</p>
         </st>
         <p>This study has demonstrated for the first time that cells from the NP of human IVDs express caveolin-1 and furthermore that caveolin-1 gene expression and protein expression are elevated in degenerate IVDs, but that this rise in caveolin-1 expression does not correlate with increasing age. This is consistent with a role for caveolin-1 in degenerative rather than age-induced changes in the NP.</p>
         <p>Changes associated with tissue ageing and degeneration have been postulated to involve cellular senescence <abbrgrp><abbr bid="B41">41</abbr><abbr bid="B42">42</abbr><abbr bid="B43">43</abbr></abbrgrp>. Two major categories of senescence are generally described in the literature as replicative senescence (RS) and SIPS. RS was first described by Hayflick in 1965 <abbrgrp><abbr bid="B44">44</abbr></abbrgrp> and is widely regarded as one of the main mechanisms underlying the normal ageing process via reduction of telomere length to critical levels following cumulative population doublings. In addition, there are a number of reports describing premature induction of senescence as a result of cellular exposure to stress. Factors linked to the induction of SIPS vary widely, from DNA damage &#8211; for example, radiation (bovine aortic endothelial cells <abbrgrp><abbr bid="B45">45</abbr></abbrgrp>), UV light (human fibroblasts <abbrgrp><abbr bid="B46">46</abbr></abbrgrp> and human melanocytes <abbrgrp><abbr bid="B47">47</abbr></abbrgrp>), chemical treatment (nasopharyngeal carcinoma cells <abbrgrp><abbr bid="B48">48</abbr></abbrgrp> and human fibroblasts <abbrgrp><abbr bid="B49">49</abbr><abbr bid="B50">50</abbr></abbrgrp>), and oxidative stress (human fibroblasts <abbrgrp><abbr bid="B20">20</abbr><abbr bid="B22">22</abbr><abbr bid="B24">24</abbr></abbrgrp> and human articular chondrocytes <abbrgrp><abbr bid="B19">19</abbr></abbrgrp>) &#8211; to oncogenic protein overexpression (for example, ras in human fibroblasts <abbrgrp><abbr bid="B51">51</abbr></abbrgrp>) and exposure to inflammatory cytokines such as IL-1 and tumour necrosis factor-&#945; (human chondrocytes and fibroblasts <abbrgrp><abbr bid="B19">19</abbr><abbr bid="B21">21</abbr><abbr bid="B23">23</abbr></abbrgrp>). Previous data from our laboratory described accelerated senescence (characterised by a variety of biomarkers, including reduced cell replication potential, elevated levels of the cell cycle inhibitor p16<sup>INK4a</sup>, increased SA-&#946;-gal activity, and telomere erosion) in degenerate human IVDs compared with age-matched non-degenerate discs <abbrgrp><abbr bid="B18">18</abbr></abbrgrp>, suggesting that SIPS may be involved in IVD degeneration.</p>
         <p>Caveolin-1 forms homodimers, or heterodimers with its family member caveolin-2, that insert into the plasma membrane of terminally differentiated cells <abbrgrp><abbr bid="B25">25</abbr></abbrgrp>. The caveolin-1-rich areas termed caveolae and the caveolin proteins themselves are proposed to regulate cellular processes, including membrane traffic, signal transduction, and cellular senescence <abbrgrp><abbr bid="B25">25</abbr><abbr bid="B26">26</abbr><abbr bid="B27">27</abbr><abbr bid="B28">28</abbr><abbr bid="B52">52</abbr></abbrgrp>. Caveolin-1 was investigated here due to its possible role in cellular senescence, in particular SIPS <abbrgrp><abbr bid="B19">19</abbr><abbr bid="B31">31</abbr><abbr bid="B52">52</abbr></abbrgrp>. Here, we show that caveolin-1 gene expression and protein expression are increased during IVD degeneration, but not in a manner that is associated with increasing chronological age.</p>
         <p>Moreover, we demonstrate a correlation between caveolin-1 and p16<sup>INK4a </sup>gene expression. p16<sup>INK4a </sup>is a cyclin-dependent kinase inhibitor that prevents retinoblastoma phosphorylation and arrests the cell cycle in the G<sub>0</sub>/G<sub>1 </sub>phase prior to entry into the synthesis phase <abbrgrp><abbr bid="B53">53</abbr><abbr bid="B54">54</abbr></abbrgrp>. Many studies have shown increased levels of p16<sup>INK4a </sup>alongside the occurrence and maintenance of permanent growth arrest and senescence, including a rodent model of ageing <abbrgrp><abbr bid="B55">55</abbr><abbr bid="B56">56</abbr><abbr bid="B57">57</abbr></abbrgrp>. Previous studies by our group and others strongly suggest a role for p16<sup>INK4a </sup>in cellular senescence within degenerate tissue when compared with age-matched controls <abbrgrp><abbr bid="B18">18</abbr><abbr bid="B58">58</abbr></abbrgrp>. Furthermore, elevated p16<sup>INK4a </sup>expression has been described in the premature senescence of human fibroblasts and leukaemic cells exposed to oncogenic ras and DNA double-strand breaks <abbrgrp><abbr bid="B51">51</abbr><abbr bid="B59">59</abbr><abbr bid="B60">60</abbr></abbrgrp>, strengthening the reports that p16<sup>INK4a </sup>is a biological marker for senescence. The present study demonstrated that the increased expression of caveolin-1 seen in the degenerate NP positively correlated with gene expression for p16<sup>INK4a</sup>, suggesting that caveolin-1 expression is linked to the senescent phenotype observed in these cells.</p>
         <p>The literature describes evidence linking cell exposure to stressful stimuli to both caveolin-1 expression and cellular senescence. In mouse NIH 3T3 fibroblasts, administration of subcytotoxic levels of H<sub>2</sub>O<sub>2 </sub>to experimentally mimic oxidative stress induced cellular senescence and increased caveolin-1 expression. Treatment with H<sub>2</sub>O<sub>2 </sub>in the presence of caveolin-1 antisense oligonucleotides reduced expression of senescence biomarkers, whereas transgenic overexpression of caveolin-1 induced SIPS <abbrgrp><abbr bid="B31">31</abbr></abbrgrp>. In human endothelial cells, isolated from atherosclerotic patients and induced to senesce, caveolin-1 expression was correlated with senescence biomarkers and with expression of 4-hydroxynonenal expression (a marker of lipid peroxidation and thus oxidative stress) independently of an effect on telomere length <abbrgrp><abbr bid="B31">31</abbr></abbrgrp>. These studies strongly support a role for caveolin-1 in SIPS induced by oxidative stress and this is further strengthened by work conducted on osteoarthritic articular chondrocytes. Administration of H<sub>2</sub>O<sub>2 </sub>to these chondrocytes induced cellular senescence via expression of the caveolin-1 protein, a mechanism reversed by antisense oligonucleotide-mediated downregulation of the caveolin-1 gene <abbrgrp><abbr bid="B19">19</abbr></abbrgrp>. The same study demonstrated an identical role for the inflammatory cytokine IL-1&#946;.</p>
         <p>Articular chondrocytes and the degenerative process observed during osteoarthritis share many characteristics with IVD cells and IVD degeneration <abbrgrp><abbr bid="B12">12</abbr><abbr bid="B43">43</abbr></abbrgrp>. Interestingly, IVD cells are subjected to both oxidative stress and catabolic cytokines, which have been implicated in the induction of SIPS <abbrgrp><abbr bid="B19">19</abbr><abbr bid="B20">20</abbr><abbr bid="B21">21</abbr><abbr bid="B22">22</abbr><abbr bid="B24">24</abbr></abbrgrp>. Work published by our group suggests that IL-1&#946; not only is increased in degenerate discs but is an important factor involved in catabolic events during IVD degeneration, including decreased matrix production and increased MMP and ADAMTS expression <abbrgrp><abbr bid="B37">37</abbr><abbr bid="B38">38</abbr><abbr bid="B61">61</abbr><abbr bid="B62">62</abbr></abbrgrp>. Moreover, advanced glycation endproducts (AGEs) such as carboxymethyl-lysine (CML) and the receptor for AGEs (RAGE) have been localised to the NP of degenerate IVD <abbrgrp><abbr bid="B34">34</abbr><abbr bid="B35">35</abbr><abbr bid="B36">36</abbr></abbrgrp>. CML is a tissue marker for accumulated oxidative stress <abbrgrp><abbr bid="B35">35</abbr></abbrgrp>; therefore, its presence and that of its receptor RAGE are highly significant for both mechanisms underlying IVD degeneration and the likelihood that they could cause SIPS in human NP cells. Furthermore, RAGE has been localised to caveolin-1-rich membranes in endothelial cells <abbrgrp><abbr bid="B63">63</abbr></abbrgrp>. This gives evidence, together with studies involving IL-1, that there are factors in the degenerate disc that may induce caveolin-1 expression and thus lead to the senescent phenotype described in IVD cells <abbrgrp><abbr bid="B16">16</abbr><abbr bid="B17">17</abbr><abbr bid="B18">18</abbr></abbrgrp>.</p>
         <p>Caveolin-1-rich regions of the plasma membrane have been associated with several receptors and signalling molecules, predominantly through isolation of caveolae and colocalisation studies. These studies have highlighted a subset of proteins that are relevant to IVD degeneration and to SIPS. First, RAGE, described above, is known to regulate several intracellular signalling pathways, including the nuclear factor-kappa-B pathway, which is essential for the expression of MMPs present in the degenerate IVD <abbrgrp><abbr bid="B34">34</abbr><abbr bid="B64">64</abbr></abbrgrp>. Second, there is evidence suggesting that caveolin-1, &#946;1 integrin, and urokinase plasminogen activator receptor (uPAR) colocalise in human articular chodrocytes <abbrgrp><abbr bid="B65">65</abbr></abbrgrp>. uPAR has an integral role in plasmin activation and thereby promotes catabolic events through initiation of a proteolytic cascade through which matrix-degrading enzymes described in IVD degeneration such as MMPs are activated <abbrgrp><abbr bid="B66">66</abbr></abbrgrp>. Both could conceivably be pathways via which elevated caveolin-1 levels exert aspects of the senescent cellular phenotype observed in IVD degeneration.</p>
      </sec>
      <sec>
         <st>
            <p>Conclusion</p>
         </st>
         <p>This study has shown that caveolin-1 expression in human NP cells is linked to IVD degeneration and is associated with the senescent phenotype as depicted by increased expression of p16<sup>INK4a</sup>. Caveolin-1 expression was not linked to increasing chronological age, suggesting a role in accelerated degeneration which could be due to SIPS, rather than RS. Further work will elucidate the role of caveolin-1 in these related areas.</p>
      </sec>
      <sec>
         <st>
            <p>Abbreviations</p>
         </st>
         <p>ABI = Applied Biosystems (Warrington, UK); ADAMTS = a disintegrin and metalloprotease with thrombospondin motifs; AF = annulus fibrosus; AGE = advanced glycation endproduct; CML = carboxymethyl-lysine; Ct = cycle threshold; DMEM + F-12 = Dulbecco's modified Eagle's medium and Ham's F-12 nutrient medium; gDNA = genomic DNA; IHC = immunohistochemistry; IL = interleukin; IVD = intervertebral disc; LBP = low back pain; MMP = matrix metalloproteinase; NP = nucleus pulposus; PCR = polymerase chain reaction; PDAR = pre-developed assay reagent; PM = post mortem; qRT-PCR = quantitative real-time reverse transcription-polymerase chain reaction; RAGE = receptor for advanced glycation endproducts; RS = replicative senescence; SA-&#946;-gal = senescence-associated &#946;-galactosidase; SD = standard deviation; SEM = standard error of the mean; SIPS = stress-induced premature senescence; TBS = Tris-buffered saline; uPAR = urokinase plasminogen activator receptor.</p>
      </sec>
      <sec>
         <st>
            <p>Competing interests</p>
         </st>
         <p>The authors declare that they have no competing interests.</p>
      </sec>
      <sec>
         <st>
            <p>Authors' contributions</p>
         </st>
         <p>SKH participated in the design of the study, performed the majority of the laboratory work and analysis, and drafted the manuscript. CLM helped to secure funding, participated in the design of the study and the interpretation of data, and assisted in the preparation of the final manuscript. JAH conceived the study, secured funding, contributed to the design and coordination of the study, and participated in the interpretation of data and extensive preparation of the final manuscript. All authors read and approved the final manuscript.</p>
      </sec>
   </bdy>
   <bm>
      <ack>
         <sec>
            <st>
               <p>Acknowledgements</p>
            </st>
            <p>This work was funded by a grant from DISCS (Diagnostic Investigation of Spinal Conditions and Sciatica) and was undertaken in the Human Tissue Profiling Laboratories of the Tissue Injury and Repair research group.</p>
         </sec>
      </ack>
      <refgrp>
         <bibl id="B1">
            <title>
               <p>Chapter 2. European guidelines for prevention in low back pain: November 2004</p>
            </title>
            <aug>
               <au>
                  <snm>Burton</snm>
                  <fnm>AK</fnm>
               </au>
               <au>
                  <snm>Balague</snm>
                  <fnm>F</fnm>
               </au>
               <au>
                  <snm>Cardon</snm>
                  <fnm>G</fnm>
               </au>
               <au>
                  <snm>Eriksen</snm>
                  <fnm>HR</fnm>
               </au>
               <au>
                  <snm>Henrotin</snm>
                  <fnm>Y</fnm>
               </au>
               <au>
                  <snm>Lahad</snm>
                  <fnm>A</fnm>
               </au>
               <au>
                  <snm>Leclerc</snm>
                  <fnm>A</fnm>
               </au>
               <au>
                  <snm>Muller</snm>
                  <fnm>G</fnm>
               </au>
               <au>
                  <snm>Beek</snm>
                  <mnm>van der</mnm>
                  <fnm>AJ</fnm>
               </au>
            </aug>
            <source>Eur Spine J</source>
            <pubdate>2006</pubdate>
            <volume>15</volume>
            <issue>Suppl 2</issue>
            <fpage>S136</fpage>
            <lpage>168</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1007/s00586-006-1070-3</pubid>
                  <pubid idtype="pmpid" link="fulltext">16550446</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B2">
            <title>
               <p>The economic burden of back pain in the UK</p>
            </title>
            <aug>
               <au>
                  <snm>Maniadakis</snm>
                  <fnm>N</fnm>
               </au>
               <au>
                  <snm>Gray</snm>
                  <fnm>A</fnm>
               </au>
            </aug>
            <source>Pain</source>
            <pubdate>2000</pubdate>
            <volume>84</volume>
            <fpage>95</fpage>
            <lpage>103</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1016/S0304-3959(99)00187-6</pubid>
                  <pubid idtype="pmpid" link="fulltext">10601677</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B3">
            <title>
               <p>A cross-sectional study correlating lumbar spine degeneration with disability and pain</p>
            </title>
            <aug>
               <au>
                  <snm>Peterson</snm>
                  <fnm>CK</fnm>
               </au>
               <au>
                  <snm>Bolton</snm>
                  <fnm>JE</fnm>
               </au>
               <au>
                  <snm>Wood</snm>
                  <fnm>AR</fnm>
               </au>
            </aug>
            <source>Spine</source>
            <pubdate>2000</pubdate>
            <volume>25</volume>
            <fpage>218</fpage>
            <lpage>223</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1097/00007632-200001150-00013</pubid>
                  <pubid idtype="pmpid" link="fulltext">10685487</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B4">
            <title>
               <p>Low back pain in relation to lumbar disc degeneration</p>
            </title>
            <aug>
               <au>
                  <snm>Luoma</snm>
                  <fnm>K</fnm>
               </au>
               <au>
                  <snm>Riihimaki</snm>
                  <fnm>H</fnm>
               </au>
               <au>
                  <snm>Luukkonen</snm>
                  <fnm>R</fnm>
               </au>
               <au>
                  <snm>Raininko</snm>
                  <fnm>R</fnm>
               </au>
               <au>
                  <snm>Viikari-Juntura</snm>
                  <fnm>E</fnm>
               </au>
               <au>
                  <snm>Lamminen</snm>
                  <fnm>A</fnm>
               </au>
            </aug>
            <source>Spine</source>
            <pubdate>2000</pubdate>
            <volume>25</volume>
            <fpage>487</fpage>
            <lpage>492</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1097/00007632-200002150-00016</pubid>
                  <pubid idtype="pmpid" link="fulltext">10707396</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B5">
            <title>
               <p>Biology of intervertebral disc aging and degeneration: involvement of the extracellular matrix</p>
            </title>
            <aug>
               <au>
                  <snm>Roughley</snm>
                  <fnm>PJ</fnm>
               </au>
            </aug>
            <source>Spine</source>
            <pubdate>2004</pubdate>
            <volume>29</volume>
            <fpage>2691</fpage>
            <lpage>2699</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1097/01.brs.0000146101.53784.b1</pubid>
                  <pubid idtype="pmpid" link="fulltext">15564918</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B6">
            <title>
               <p>What is intervertebral disc degeneration, and what causes it?</p>
            </title>
            <aug>
               <au>
                  <snm>Adams</snm>
                  <fnm>MA</fnm>
               </au>
               <au>
                  <snm>Roughley</snm>
                  <fnm>PJ</fnm>
               </au>
            </aug>
            <source>Spine</source>
            <pubdate>2006</pubdate>
            <volume>31</volume>
            <fpage>2151</fpage>
            <lpage>2161</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1097/01.brs.0000231761.73859.2c</pubid>
                  <pubid idtype="pmpid" link="fulltext">16915105</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B7">
            <title>
               <p>Genetic influences on cervical and lumbar disc degeneration: a magnetic resonance imaging study in twins</p>
            </title>
            <aug>
               <au>
                  <snm>Sambrook</snm>
                  <fnm>PN</fnm>
               </au>
               <au>
                  <snm>MacGregor</snm>
                  <fnm>AJ</fnm>
               </au>
               <au>
                  <snm>Spector</snm>
                  <fnm>TD</fnm>
               </au>
            </aug>
            <source>Arthritis Rheum</source>
            <pubdate>1999</pubdate>
            <volume>42</volume>
            <fpage>366</fpage>
            <lpage>372</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1002/1529-0131(199902)42:2&lt;366::AID-ANR20>3.0.CO;2-6</pubid>
                  <pubid idtype="pmpid" link="fulltext">10025932</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B8">
            <title>
               <p>Structural, psychological, and genetic influences on low back and neck pain: a study of adult female twins</p>
            </title>
            <aug>
               <au>
                  <snm>MacGregor</snm>
                  <fnm>AJ</fnm>
               </au>
               <au>
                  <snm>Andrew</snm>
                  <fnm>T</fnm>
               </au>
               <au>
                  <snm>Sambrook</snm>
                  <fnm>PN</fnm>
               </au>
               <au>
                  <snm>Spector</snm>
                  <fnm>TD</fnm>
               </au>
            </aug>
            <source>Arthritis Rheum</source>
            <pubdate>2004</pubdate>
            <volume>51</volume>
            <fpage>160</fpage>
            <lpage>167</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1002/art.20236</pubid>
                  <pubid idtype="pmpid" link="fulltext">15077255</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B9">
            <title>
               <p>Lumbar disc degeneration: correlation with age, sex, and spine level in 600 autopsy specimens</p>
            </title>
            <aug>
               <au>
                  <snm>Miller</snm>
                  <fnm>JA</fnm>
               </au>
               <au>
                  <snm>Schmatz</snm>
                  <fnm>C</fnm>
               </au>
               <au>
                  <snm>Schultz</snm>
                  <fnm>AB</fnm>
               </au>
            </aug>
            <source>Spine</source>
            <pubdate>1988</pubdate>
            <volume>13</volume>
            <fpage>173</fpage>
            <lpage>178</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1097/00007632-198802000-00008</pubid>
                  <pubid idtype="pmpid">3406837</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B10">
            <title>
               <p>Classification of age-related changes in lumbar intervertebral discs: 2002 Volvo Award in basic science</p>
            </title>
            <aug>
               <au>
                  <snm>Boos</snm>
                  <fnm>N</fnm>
               </au>
               <au>
                  <snm>Weissbach</snm>
                  <fnm>S</fnm>
               </au>
               <au>
                  <snm>Rohrbach</snm>
                  <fnm>H</fnm>
               </au>
               <au>
                  <snm>Weiler</snm>
                  <fnm>C</fnm>
               </au>
               <au>
                  <snm>Spratt</snm>
                  <fnm>KF</fnm>
               </au>
               <au>
                  <snm>Nerlich</snm>
                  <fnm>AG</fnm>
               </au>
            </aug>
            <source>Spine</source>
            <pubdate>2002</pubdate>
            <volume>27</volume>
            <fpage>2631</fpage>
            <lpage>2644</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1097/00007632-200212010-00002</pubid>
                  <pubid idtype="pmpid" link="fulltext">12461389</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B11">
            <title>
               <p>Molecular pathogenic factors in symptomatic disc degeneration</p>
            </title>
            <aug>
               <au>
                  <snm>Anderson</snm>
                  <fnm>DG</fnm>
               </au>
               <au>
                  <snm>Tannoury</snm>
                  <fnm>C</fnm>
               </au>
            </aug>
            <source>Spine J</source>
            <pubdate>2005</pubdate>
            <volume>5</volume>
            <issue>Suppl 6</issue>
            <fpage>260S</fpage>
            <lpage>266S</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmpid" link="fulltext">16291122</pubid>
                  <pubid idtype="doi">10.1016/j.spinee.2005.02.010</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B12">
            <title>
               <p>Current understanding of cellular and molecular events in intervertebral disc degeneration: implications for therapy</p>
            </title>
            <aug>
               <au>
                  <snm>Freemont</snm>
                  <fnm>AJ</fnm>
               </au>
               <au>
                  <snm>Watkins</snm>
                  <fnm>A</fnm>
               </au>
               <au>
                  <snm>Le Maitre</snm>
                  <fnm>C</fnm>
               </au>
               <au>
                  <snm>Jeziorska</snm>
                  <fnm>M</fnm>
               </au>
               <au>
                  <snm>Hoyland</snm>
                  <fnm>JA</fnm>
               </au>
            </aug>
            <source>J Pathol</source>
            <pubdate>2002</pubdate>
            <volume>196</volume>
            <fpage>374</fpage>
            <lpage>379</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1002/path.1050</pubid>
                  <pubid idtype="pmpid" link="fulltext">11920731</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B13">
            <title>
               <p>Vascular cell senescence: contribution to atherosclerosis</p>
            </title>
            <aug>
               <au>
                  <snm>Minamino</snm>
                  <fnm>T</fnm>
               </au>
               <au>
                  <snm>Komuro</snm>
                  <fnm>I</fnm>
               </au>
            </aug>
            <source>Circ Res</source>
            <pubdate>2007</pubdate>
            <volume>100</volume>
            <fpage>15</fpage>
            <lpage>26</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1161/01.RES.0000256837.40544.4a</pubid>
                  <pubid idtype="pmpid" link="fulltext">17204661</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B14">
            <title>
               <p>The role of chondrocyte senescence in osteoarthritis</p>
            </title>
            <aug>
               <au>
                  <snm>Price</snm>
                  <fnm>JS</fnm>
               </au>
               <au>
                  <snm>Waters</snm>
                  <fnm>JG</fnm>
               </au>
               <au>
                  <snm>Darrah</snm>
                  <fnm>C</fnm>
               </au>
               <au>
                  <snm>Pennington</snm>
                  <fnm>C</fnm>
               </au>
               <au>
                  <snm>Edwards</snm>
                  <fnm>DR</fnm>
               </au>
               <au>
                  <snm>Donell</snm>
                  <fnm>ST</fnm>
               </au>
               <au>
                  <snm>Clark</snm>
                  <fnm>IM</fnm>
               </au>
            </aug>
            <source>Aging Cell</source>
            <pubdate>2002</pubdate>
            <volume>1</volume>
            <fpage>57</fpage>
            <lpage>65</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1046/j.1474-9728.2002.00008.x</pubid>
                  <pubid idtype="pmpid" link="fulltext">12882354</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B15">
            <title>
               <p>Roles of articular cartilage aging and chondrocyte senescence in the pathogenesis of osteoarthritis</p>
            </title>
            <aug>
               <au>
                  <snm>Martin</snm>
                  <fnm>JA</fnm>
               </au>
               <au>
                  <snm>Buckwalter</snm>
                  <fnm>JA</fnm>
               </au>
            </aug>
            <source>Iowa Orthop J</source>
            <pubdate>2001</pubdate>
            <volume>21</volume>
            <fpage>1</fpage>
            <lpage>7</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmcid">1888191</pubid>
                  <pubid idtype="pmpid">11813939</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B16">
            <title>
               <p>Senescence in human intervertebral discs</p>
            </title>
            <aug>
               <au>
                  <snm>Roberts</snm>
                  <fnm>S</fnm>
               </au>
               <au>
                  <snm>Evans</snm>
                  <fnm>EH</fnm>
               </au>
               <au>
                  <snm>Kletsas</snm>
                  <fnm>D</fnm>
               </au>
               <au>
                  <snm>Jaffray</snm>
                  <fnm>DC</fnm>
               </au>
               <au>
                  <snm>Eisenstein</snm>
                  <fnm>SM</fnm>
               </au>
            </aug>
            <source>Eur Spine J</source>
            <pubdate>2006</pubdate>
            <volume>15</volume>
            <issue>Suppl 15</issue>
            <fpage>312</fpage>
            <lpage>316</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmpid" link="fulltext">16773379</pubid>
                  <pubid idtype="doi">10.1007/s00586-006-0126-8</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B17">
            <title>
               <p>Senescence in cells of the aging and degenerating intervertebral disc: immunolocalization of senescence-associated beta-galactosidase in human and sand rat discs</p>
            </title>
            <aug>
               <au>
                  <snm>Gruber</snm>
                  <fnm>HE</fnm>
               </au>
               <au>
                  <snm>Ingram</snm>
                  <fnm>JA</fnm>
               </au>
               <au>
                  <snm>Norton</snm>
                  <fnm>HJ</fnm>
               </au>
               <au>
                  <snm>Hanley</snm>
                  <fnm>EN</fnm>
                  <suf>Jr</suf>
               </au>
            </aug>
            <source>Spine</source>
            <pubdate>2007</pubdate>
            <volume>32</volume>
            <fpage>321</fpage>
            <lpage>327</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1097/01.brs.0000253960.57051.de</pubid>
                  <pubid idtype="pmpid" link="fulltext">17268263</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B18">
            <title>
               <p>Accelerated cellular senescence in degenerate intervertebral discs: a possible role in the pathogenesis of intervertebral disc degeneration</p>
            </title>
            <aug>
               <au>
                  <snm>Le Maitre</snm>
                  <fnm>CL</fnm>
               </au>
               <au>
                  <snm>Freemont</snm>
                  <fnm>AJ</fnm>
               </au>
               <au>
                  <snm>Hoyland</snm>
                  <fnm>JA</fnm>
               </au>
            </aug>
            <source>Arthritis Res Ther</source>
            <pubdate>2007</pubdate>
            <volume>9</volume>
            <fpage>R45</fpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmcid">2206356</pubid>
                  <pubid idtype="pmpid" link="fulltext">17498290</pubid>
                  <pubid idtype="doi">10.1186/ar2198</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B19">
            <title>
               <p>Catabolic stress induces features of chondrocyte senescence through overexpression of caveolin 1: possible involvement of caveolin 1-induced down-regulation of articular chondrocytes in the pathogenesis of osteoarthritis</p>
            </title>
            <aug>
               <au>
                  <snm>Dai</snm>
                  <fnm>SM</fnm>
               </au>
               <au>
                  <snm>Shan</snm>
                  <fnm>ZZ</fnm>
               </au>
               <au>
                  <snm>Nakamura</snm>
                  <fnm>H</fnm>
               </au>
               <au>
                  <snm>Masuko-Hongo</snm>
                  <fnm>K</fnm>
               </au>
               <au>
                  <snm>Kato</snm>
                  <fnm>T</fnm>
               </au>
               <au>
                  <snm>Nishioka</snm>
                  <fnm>K</fnm>
               </au>
               <au>
                  <snm>Yudoh</snm>
                  <fnm>K</fnm>
               </au>
            </aug>
            <source>Arthritis Rheum</source>
            <pubdate>2006</pubdate>
            <volume>54</volume>
            <fpage>818</fpage>
            <lpage>831</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1002/art.21639</pubid>
                  <pubid idtype="pmpid" link="fulltext">16508959</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B20">
            <title>
               <p>Subcytotoxic H2O2 stress triggers a release of transforming growth factor-beta 1, which induces biomarkers of cellular senescence of human diploid fibroblasts</p>
            </title>
            <aug>
               <au>
                  <snm>Frippiat</snm>
                  <fnm>C</fnm>
               </au>
               <au>
                  <snm>Chen</snm>
                  <fnm>QM</fnm>
               </au>
               <au>
                  <snm>Zdanov</snm>
                  <fnm>S</fnm>
               </au>
               <au>
                  <snm>Magalhaes</snm>
                  <fnm>JP</fnm>
               </au>
               <au>
                  <snm>Remacle</snm>
                  <fnm>J</fnm>
               </au>
               <au>
                  <snm>Toussaint</snm>
                  <fnm>O</fnm>
               </au>
            </aug>
            <source>J Biol Chem</source>
            <pubdate>2001</pubdate>
            <volume>276</volume>
            <fpage>2531</fpage>
            <lpage>2537</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1074/jbc.M006809200</pubid>
                  <pubid idtype="pmpid" link="fulltext">11060295</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B21">
            <title>
               <p>Appearance of biomarkers of <it>in vitro </it>ageing after successive stimulation of WI-38 fibroblasts with IL-1alpha and TNF-alpha: senescence associated beta-galactosidase activity and morphotype transition</p>
            </title>
            <aug>
               <au>
                  <snm>Dumont</snm>
                  <fnm>P</fnm>
               </au>
               <au>
                  <snm>Balbeur</snm>
                  <fnm>L</fnm>
               </au>
               <au>
                  <snm>Remacle</snm>
                  <fnm>J</fnm>
               </au>
               <au>
                  <snm>Toussaint</snm>
                  <fnm>O</fnm>
               </au>
            </aug>
            <source>J Anat</source>
            <pubdate>2000</pubdate>
            <volume>197</volume>
            <issue>Pt 4</issue>
            <fpage>529</fpage>
            <lpage>537</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmcid">1468167</pubid>
                  <pubid idtype="pmpid" link="fulltext">11197525</pubid>
                  <pubid idtype="doi">10.1046/j.1469-7580.2000.19740529.x</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B22">
            <title>
               <p>Induction of replicative senescence biomarkers by sublethal oxidative stresses in normal human fibroblast</p>
            </title>
            <aug>
               <au>
                  <snm>Dumont</snm>
                  <fnm>P</fnm>
               </au>
               <au>
                  <snm>Burton</snm>
                  <fnm>M</fnm>
               </au>
               <au>
                  <snm>Chen</snm>
                  <fnm>QM</fnm>
               </au>
               <au>
                  <snm>Gonos</snm>
                  <fnm>ES</fnm>
               </au>
               <au>
                  <snm>Frippiat</snm>
                  <fnm>C</fnm>
               </au>
               <au>
                  <snm>Mazarati</snm>
                  <fnm>JB</fnm>
               </au>
               <au>
                  <snm>Eliaers</snm>
                  <fnm>F</fnm>
               </au>
               <au>
                  <snm>Remacle</snm>
                  <fnm>J</fnm>
               </au>
               <au>
                  <snm>Toussaint</snm>
                  <fnm>O</fnm>
               </au>
            </aug>
            <source>Free Radic Biol Med</source>
            <pubdate>2000</pubdate>
            <volume>28</volume>
            <fpage>361</fpage>
            <lpage>373</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1016/S0891-5849(99)00249-X</pubid>
                  <pubid idtype="pmpid" link="fulltext">10699747</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B23">
            <title>
               <p>The proliferative capacity of neonatal skin fibroblasts is reduced after exposure to venous ulcer wound fluid: a potential mechanism for senescence in venous ulcers</p>
            </title>
            <aug>
               <au>
                  <snm>Mendez</snm>
                  <fnm>MV</fnm>
               </au>
               <au>
                  <snm>Raffetto</snm>
                  <fnm>JD</fnm>
               </au>
               <au>
                  <snm>Phillips</snm>
                  <fnm>T</fnm>
               </au>
               <au>
                  <snm>Menzoian</snm>
                  <fnm>JO</fnm>
               </au>
               <au>
                  <snm>Park</snm>
                  <fnm>HY</fnm>
               </au>
            </aug>
            <source>J Vasc Surg</source>
            <pubdate>1999</pubdate>
            <volume>30</volume>
            <fpage>734</fpage>
            <lpage>743</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1016/S0741-5214(99)70113-8</pubid>
                  <pubid idtype="pmpid" link="fulltext">10514213</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B24">
            <title>
               <p>Senescence-like growth arrest induced by hydrogen peroxide in human diploid fibroblast F65 cells</p>
            </title>
            <aug>
               <au>
                  <snm>Chen</snm>
                  <fnm>Q</fnm>
               </au>
               <au>
                  <snm>Ames</snm>
                  <fnm>BN</fnm>
               </au>
            </aug>
            <source>Proc Natl Acad Sci USA</source>
            <pubdate>1994</pubdate>
            <volume>91</volume>
            <fpage>4130</fpage>
            <lpage>4134</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmcid">43738</pubid>
                  <pubid idtype="pmpid" link="fulltext">8183882</pubid>
                  <pubid idtype="doi">10.1073/pnas.91.10.4130</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B25">
            <title>
               <p>The multiple faces of caveolae</p>
            </title>
            <aug>
               <au>
                  <snm>Parton</snm>
                  <fnm>RG</fnm>
               </au>
               <au>
                  <snm>Simons</snm>
                  <fnm>K</fnm>
               </au>
            </aug>
            <source>Nat Rev Mol Cell Biol</source>
            <pubdate>2007</pubdate>
            <volume>8</volume>
            <fpage>185</fpage>
            <lpage>194</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1038/nrm2122</pubid>
                  <pubid idtype="pmpid" link="fulltext">17318224</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B26">
            <title>
               <p>Caveolins, liquid-ordered domains, and signal transduction</p>
            </title>
            <aug>
               <au>
                  <snm>Smart</snm>
                  <fnm>EJ</fnm>
               </au>
               <au>
                  <snm>Graf</snm>
                  <fnm>GA</fnm>
               </au>
               <au>
                  <snm>McNiven</snm>
                  <fnm>MA</fnm>
               </au>
               <au>
                  <snm>Sessa</snm>
                  <fnm>WC</fnm>
               </au>
               <au>
                  <snm>Engelman</snm>
                  <fnm>JA</fnm>
               </au>
               <au>
                  <snm>Scherer</snm>
                  <fnm>PE</fnm>
               </au>
               <au>
                  <snm>Okamoto</snm>
                  <fnm>T</fnm>
               </au>
               <au>
                  <snm>Lisanti</snm>
                  <fnm>MP</fnm>
               </au>
            </aug>
            <source>Mol Cell Biol</source>
            <pubdate>1999</pubdate>
            <volume>19</volume>
            <fpage>7289</fpage>
            <lpage>7304</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmcid">84723</pubid>
                  <pubid idtype="pmpid" link="fulltext">10523618</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B27">
            <title>
               <p>Multiple functions of caveolin-1</p>
            </title>
            <aug>
               <au>
                  <snm>Liu</snm>
                  <fnm>P</fnm>
               </au>
               <au>
                  <snm>Rudick</snm>
                  <fnm>M</fnm>
               </au>
               <au>
                  <snm>Anderson</snm>
                  <fnm>RG</fnm>
               </au>
            </aug>
            <source>J Biol Chem</source>
            <pubdate>2002</pubdate>
            <volume>277</volume>
            <fpage>41295</fpage>
            <lpage>41298</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1074/jbc.R200020200</pubid>
                  <pubid idtype="pmpid" link="fulltext">12189159</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B28">
            <title>
               <p>Caveolins, a family of scaffolding proteins for organizing "preassembled signaling complexes" at the plasma membrane</p>
            </title>
            <aug>
               <au>
                  <snm>Okamoto</snm>
                  <fnm>T</fnm>
               </au>
               <au>
                  <snm>Schlegel</snm>
                  <fnm>A</fnm>
               </au>
               <au>
                  <snm>Scherer</snm>
                  <fnm>PE</fnm>
               </au>
               <au>
                  <snm>Lisanti</snm>
                  <fnm>MP</fnm>
               </au>
            </aug>
            <source>J Biol Chem</source>
            <pubdate>1998</pubdate>
            <volume>273</volume>
            <fpage>5419</fpage>
            <lpage>5422</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1074/jbc.273.10.5419</pubid>
                  <pubid idtype="pmpid" link="fulltext">9488658</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B29">
            <title>
               <p>Up-regulation of caveolin attenuates epidermal growth factor signaling in senescent cells</p>
            </title>
            <aug>
               <au>
                  <snm>Park</snm>
                  <fnm>WY</fnm>
               </au>
               <au>
                  <snm>Park</snm>
                  <fnm>JS</fnm>
               </au>
               <au>
                  <snm>Cho</snm>
                  <fnm>KA</fnm>
               </au>
               <au>
                  <snm>Kim</snm>
                  <fnm>DI</fnm>
               </au>
               <au>
                  <snm>Ko</snm>
                  <fnm>YG</fnm>
               </au>
               <au>
                  <snm>Seo</snm>
                  <fnm>JS</fnm>
               </au>
               <au>
                  <snm>Park</snm>
                  <fnm>SC</fnm>
               </au>
            </aug>
            <source>J Biol Chem</source>
            <pubdate>2000</pubdate>
            <volume>275</volume>
            <fpage>20847</fpage>
            <lpage>20852</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1074/jbc.M908162199</pubid>
                  <pubid idtype="pmpid" link="fulltext">10781609</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B30">
            <title>
               <p>Loss of functional caveolae during senescence of human fibroblasts</p>
            </title>
            <aug>
               <au>
                  <snm>Wheaton</snm>
                  <fnm>K</fnm>
               </au>
               <au>
                  <snm>Sampsel</snm>
                  <fnm>K</fnm>
               </au>
               <au>
                  <snm>Boisvert</snm>
                  <fnm>FM</fnm>
               </au>
               <au>
                  <snm>Davy</snm>
                  <fnm>A</fnm>
               </au>
               <au>
                  <snm>Robbins</snm>
                  <fnm>S</fnm>
               </au>
               <au>
                  <snm>Riabowol</snm>
                  <fnm>K</fnm>
               </au>
            </aug>
            <source>J Cell Physiol</source>
            <pubdate>2001</pubdate>
            <volume>187</volume>
            <fpage>226</fpage>
            <lpage>235</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1002/jcp.1071</pubid>
                  <pubid idtype="pmpid" link="fulltext">11268002</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B31">
            <title>
               <p>Expression of caveolin-1 induces premature cellular senescence in primary cultures of murine fibroblasts</p>
            </title>
            <aug>
               <au>
                  <snm>Volonte</snm>
                  <fnm>D</fnm>
               </au>
               <au>
                  <snm>Zhang</snm>
                  <fnm>K</fnm>
               </au>
               <au>
                  <snm>Lisanti</snm>
                  <fnm>MP</fnm>
               </au>
               <au>
                  <snm>Galbiati</snm>
                  <fnm>F</fnm>
               </au>
            </aug>
            <source>Mol Biol Cell</source>
            <pubdate>2002</pubdate>
            <volume>13</volume>
            <fpage>2502</fpage>
            <lpage>2517</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmcid">117330</pubid>
                  <pubid idtype="pmpid" link="fulltext">12134086</pubid>
                  <pubid idtype="doi">10.1091/mbc.01-11-0529</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B32">
            <title>
               <p>Downregulation of caveolin-1 affects bleomycin-induced growth arrest and cellular senescence in A549 cells</p>
            </title>
            <aug>
               <au>
                  <snm>Linge</snm>
                  <fnm>A</fnm>
               </au>
               <au>
                  <snm>Weinhold</snm>
                  <fnm>K</fnm>
               </au>
               <au>
                  <snm>Blasche</snm>
                  <fnm>R</fnm>
               </au>
               <au>
                  <snm>Kasper</snm>
                  <fnm>M</fnm>
               </au>
               <au>
                  <snm>Barth</snm>
                  <fnm>K</fnm>
               </au>
            </aug>
            <source>Int J Biochem Cell Biol</source>
            <pubdate>2007</pubdate>
            <volume>39</volume>
            <fpage>1964</fpage>
            <lpage>1974</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1016/j.biocel.2007.05.018</pubid>
                  <pubid idtype="pmpid" link="fulltext">17662641</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B33">
            <title>
               <p>Cellular senescence in endothelial cells from atherosclerotic patients is accelerated by oxidative stress associated with cardiovascular risk factors</p>
            </title>
            <aug>
               <au>
                  <snm>Voghel</snm>
                  <fnm>G</fnm>
               </au>
               <au>
                  <snm>Thorin-Trescases</snm>
                  <fnm>N</fnm>
               </au>
               <au>
                  <snm>Farhat</snm>
                  <fnm>N</fnm>
               </au>
               <au>
                  <snm>Nguyen</snm>
                  <fnm>A</fnm>
               </au>
               <au>
                  <snm>Villeneuve</snm>
                  <fnm>L</fnm>
               </au>
               <au>
                  <snm>Mamarbachi</snm>
                  <fnm>AM</fnm>
               </au>
               <au>
                  <snm>Fortier</snm>
                  <fnm>A</fnm>
               </au>
               <au>
                  <snm>Perrault</snm>
                  <fnm>LP</fnm>
               </au>
               <au>
                  <snm>Carrier</snm>
                  <fnm>M</fnm>
               </au>
               <au>
                  <snm>Thorin</snm>
                  <fnm>E</fnm>
               </au>
            </aug>
            <source>Mech Ageing Dev</source>
            <pubdate>2007</pubdate>
            <volume>128</volume>
            <fpage>662</fpage>
            <lpage>671</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1016/j.mad.2007.09.006</pubid>
                  <pubid idtype="pmpid" link="fulltext">18022214</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B34">
            <title>
               <p>Immunomorphological analysis of RAGE receptor expression and NF-kappaB activation in tissue samples from normal and degenerated intervertebral discs of various ages</p>
            </title>
            <aug>
               <au>
                  <snm>Nerlich</snm>
                  <fnm>AG</fnm>
               </au>
               <au>
                  <snm>Bachmeier</snm>
                  <fnm>BE</fnm>
               </au>
               <au>
                  <snm>Schleicher</snm>
                  <fnm>E</fnm>
               </au>
               <au>
                  <snm>Rohrbach</snm>
                  <fnm>H</fnm>
               </au>
               <au>
                  <snm>Paesold</snm>
                  <fnm>G</fnm>
               </au>
               <au>
                  <snm>Boos</snm>
                  <fnm>N</fnm>
               </au>
            </aug>
            <source>Ann N Y Acad Sci</source>
            <pubdate>2007</pubdate>
            <volume>1096</volume>
            <fpage>239</fpage>
            <lpage>248</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1196/annals.1397.090</pubid>
                  <pubid idtype="pmpid" link="fulltext">17405935</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B35">
            <title>
               <p>1997 Volvo Award winner in basic science studies. Immunohistologic markers for age-related changes of human lumbar intervertebral discs</p>
            </title>
            <aug>
               <au>
                  <snm>Nerlich</snm>
                  <fnm>AG</fnm>
               </au>
               <au>
                  <snm>Schleicher</snm>
                  <fnm>ED</fnm>
               </au>
               <au>
                  <snm>Boos</snm>
                  <fnm>N</fnm>
               </au>
            </aug>
            <source>Spine</source>
            <pubdate>1997</pubdate>
            <volume>22</volume>
            <fpage>2781</fpage>
            <lpage>2795</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1097/00007632-199712150-00001</pubid>
                  <pubid idtype="pmpid" link="fulltext">9431614</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B36">
            <title>
               <p>Increased accumulation of the glycoxidation product N(epsilon)-(carboxymethyl)lysine in human tissues in diabetes and aging</p>
            </title>
            <aug>
               <au>
                  <snm>Schleicher</snm>
                  <fnm>ED</fnm>
               </au>
               <au>
                  <snm>Wagner</snm>
                  <fnm>E</fnm>
               </au>
               <au>
                  <snm>Nerlich</snm>
                  <fnm>AG</fnm>
               </au>
            </aug>
            <source>J Clin Invest</source>
            <pubdate>1997</pubdate>
            <volume>99</volume>
            <fpage>457</fpage>
            <lpage>468</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmcid">507819</pubid>
                  <pubid idtype="pmpid" link="fulltext">9022079</pubid>
                  <pubid idtype="doi">10.1172/JCI119180</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B37">
            <title>
               <p>The role of interleukin-1 in the pathogenesis of human intervertebral disc degeneration</p>
            </title>
            <aug>
               <au>
                  <snm>Le Maitre</snm>
                  <fnm>CL</fnm>
               </au>
               <au>
                  <snm>Freemont</snm>
                  <fnm>AJ</fnm>
               </au>
               <au>
                  <snm>Hoyland</snm>
                  <fnm>JA</fnm>
               </au>
            </aug>
            <source>Arthritis Res Ther</source>
            <pubdate>2005</pubdate>
            <volume>7</volume>
            <fpage>R732</fpage>
            <lpage>745</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmcid">1175026</pubid>
                  <pubid idtype="pmpid" link="fulltext">15987475</pubid>
                  <pubid idtype="doi">10.1186/ar1732</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B38">
            <title>
               <p>Catabolic cytokine expression in degenerate and herniated human intervertebral discs: IL-1beta and TNFalpha expression profile</p>
            </title>
            <aug>
               <au>
                  <snm>Le Maitre</snm>
                  <fnm>CL</fnm>
               </au>
               <au>
                  <snm>Hoyland</snm>
                  <fnm>JA</fnm>
               </au>
               <au>
                  <snm>Freemont</snm>
                  <fnm>AJ</fnm>
               </au>
            </aug>
            <source>Arthritis Res Ther</source>
            <pubdate>2007</pubdate>
            <volume>9</volume>
            <fpage>R77</fpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmcid">2206382</pubid>
                  <pubid idtype="pmpid" link="fulltext">17688691</pubid>
                  <pubid idtype="doi">10.1186/ar2275</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B39">
            <title>
               <p>Expression of chondrocyte markers by cells of normal and degenerate intervertebral discs</p>
            </title>
            <aug>
               <au>
                  <snm>Sive</snm>
                  <fnm>JI</fnm>
               </au>
               <au>
                  <snm>Baird</snm>
                  <fnm>P</fnm>
               </au>
               <au>
                  <snm>Jeziorsk</snm>
                  <fnm>M</fnm>
               </au>
               <au>
                  <snm>Watkins</snm>
                  <fnm>A</fnm>
               </au>
               <au>
                  <snm>Hoyland</snm>
                  <fnm>JA</fnm>
               </au>
               <au>
                  <snm>Freemont</snm>
                  <fnm>AJ</fnm>
               </au>
            </aug>
            <source>Mol Pathol</source>
            <pubdate>2002</pubdate>
            <volume>55</volume>
            <fpage>91</fpage>
            <lpage>97</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmcid">1187156</pubid>
                  <pubid idtype="pmpid" link="fulltext">11950957</pubid>
                  <pubid idtype="doi">10.1136/mp.55.2.91</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B40">
            <title>
               <p>Localization of degradative enzymes and their inhibitors in the degenerate human intervertebral disc</p>
            </title>
            <aug>
               <au>
                  <snm>Le Maitre</snm>
                  <fnm>CL</fnm>
               </au>
               <au>
                  <snm>Freemont</snm>
                  <fnm>AJ</fnm>
               </au>
               <au>
                  <snm>Hoyland</snm>
                  <fnm>JA</fnm>
               </au>
            </aug>
            <source>J Pathol</source>
            <pubdate>2004</pubdate>
            <volume>204</volume>
            <fpage>47</fpage>
            <lpage>54</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1002/path.1608</pubid>
                  <pubid idtype="pmpid" link="fulltext">15307137</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B41">
            <title>
               <p>Stress-induced premature senescence. Essence of life, evolution, stress, and aging</p>
            </title>
            <aug>
               <au>
                  <snm>Toussaint</snm>
                  <fnm>O</fnm>
               </au>
               <au>
                  <snm>Dumont</snm>
                  <fnm>P</fnm>
               </au>
               <au>
                  <snm>Dierick</snm>
                  <fnm>JF</fnm>
               </au>
               <au>
                  <snm>Pascal</snm>
                  <fnm>T</fnm>
               </au>
               <au>
                  <snm>Frippiat</snm>
                  <fnm>C</fnm>
               </au>
               <au>
                  <snm>Chainiaux</snm>
                  <fnm>F</fnm>
               </au>
               <au>
                  <snm>Sluse</snm>
                  <fnm>F</fnm>
               </au>
               <au>
                  <snm>Eliaers</snm>
                  <fnm>F</fnm>
               </au>
               <au>
                  <snm>Remacle</snm>
                  <fnm>J</fnm>
               </au>
            </aug>
            <source>Ann N Y Acad Sci</source>
            <pubdate>2000</pubdate>
            <volume>908</volume>
            <fpage>85</fpage>
            <lpage>98</lpage>
            <xrefbib>
               <pubid idtype="pmpid" link="fulltext">10911950</pubid>
            </xrefbib>
         </bibl>
         <bibl id="B42">
            <title>
               <p>Cellular senescence, cancer and aging: the telomere connection</p>
            </title>
            <aug>
               <au>
                  <snm>Campisi</snm>
                  <fnm>J</fnm>
               </au>
               <au>
                  <snm>Kim</snm>
                  <fnm>SH</fnm>
               </au>
               <au>
                  <snm>Lim</snm>
                  <fnm>CS</fnm>
               </au>
               <au>
                  <snm>Rubio</snm>
                  <fnm>M</fnm>
               </au>
            </aug>
            <source>Exp Gerontol</source>
            <pubdate>2001</pubdate>
            <volume>36</volume>
            <fpage>1619</fpage>
            <lpage>1637</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1016/S0531-5565(01)00160-7</pubid>
                  <pubid idtype="pmpid" link="fulltext">11672984</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B43">
            <title>
               <p>Aging, articular cartilage chondrocyte senescence and osteoarthritis</p>
            </title>
            <aug>
               <au>
                  <snm>Martin</snm>
                  <fnm>JA</fnm>
               </au>
               <au>
                  <snm>Buckwalter</snm>
                  <fnm>JA</fnm>
               </au>
            </aug>
            <source>Biogerontology</source>
            <pubdate>2002</pubdate>
            <volume>3</volume>
            <fpage>257</fpage>
            <lpage>264</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1023/A:1020185404126</pubid>
                  <pubid idtype="pmpid" link="fulltext">12237562</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B44">
            <title>
               <p>The limited <it>in vitro </it>lifetime of human diploid cell strains</p>
            </title>
            <aug>
               <au>
                  <snm>Hayflick</snm>
                  <fnm>L</fnm>
               </au>
            </aug>
            <source>Exp Cell Res</source>
            <pubdate>1965</pubdate>
            <volume>37</volume>
            <fpage>614</fpage>
            <lpage>636</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1016/0014-4827(65)90211-9</pubid>
                  <pubid idtype="pmpid">14315085</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B45">
            <title>
               <p>Induction of a senescence-like phenotype in bovine aortic endothelial cells by ionizing radiation</p>
            </title>
            <aug>
               <au>
                  <snm>Oh</snm>
                  <fnm>CW</fnm>
               </au>
               <au>
                  <snm>Bump</snm>
                  <fnm>EA</fnm>
               </au>
               <au>
                  <snm>Kim</snm>
                  <fnm>JS</fnm>
               </au>
               <au>
                  <snm>Janigro</snm>
                  <fnm>D</fnm>
               </au>
               <au>
                  <snm>Mayberg</snm>
                  <fnm>MR</fnm>
               </au>
            </aug>
            <source>Radiat Res</source>
            <pubdate>2001</pubdate>
            <volume>156</volume>
            <fpage>232</fpage>
            <lpage>240</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1667/0033-7587(2001)156[0232:IOASLP]2.0.CO;2</pubid>
                  <pubid idtype="pmpid">11500132</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B46">
            <title>
               <p>UVB-induced premature senescence of human diploid skin fibroblasts</p>
            </title>
            <aug>
               <au>
                  <snm>Chainiaux</snm>
                  <fnm>F</fnm>
               </au>
               <au>
                  <snm>Magalhaes</snm>
                  <fnm>JP</fnm>
               </au>
               <au>
                  <snm>Eliaers</snm>
                  <fnm>F</fnm>
               </au>
               <au>
                  <snm>Remacle</snm>
                  <fnm>J</fnm>
               </au>
               <au>
                  <snm>Toussaint</snm>
                  <fnm>O</fnm>
               </au>
            </aug>
            <source>Int J Biochem Cell Biol</source>
            <pubdate>2002</pubdate>
            <volume>34</volume>
            <fpage>1331</fpage>
            <lpage>1339</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1016/S1357-2725(02)00022-5</pubid>
                  <pubid idtype="pmpid" link="fulltext">12200029</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B47">
            <title>
               <p>Ultraviolet B light induces G1 arrest in human melanocytes by prolonged inhibition of retinoblastoma protein phosphorylation associated with long-term expression of the p21Waf-1/SDI-1/Cip-1 protein</p>
            </title>
            <aug>
               <au>
                  <snm>Medrano</snm>
                  <fnm>EE</fnm>
               </au>
               <au>
                  <snm>Im</snm>
                  <fnm>S</fnm>
               </au>
               <au>
                  <snm>Yang</snm>
                  <fnm>F</fnm>
               </au>
               <au>
                  <snm>Abdel-Malek</snm>
                  <fnm>ZA</fnm>
               </au>
            </aug>
            <source>Cancer Res</source>
            <pubdate>1995</pubdate>
            <volume>55</volume>
            <fpage>4047</fpage>
            <lpage>4052</lpage>
            <xrefbib>
               <pubid idtype="pmpid" link="fulltext">7664278</pubid>
            </xrefbib>
         </bibl>
         <bibl id="B48">
            <title>
               <p>Evidence of cisplatin-induced senescent-like growth arrest in nasopharyngeal carcinoma cells</p>
            </title>
            <aug>
               <au>
                  <snm>Wang</snm>
                  <fnm>X</fnm>
               </au>
               <au>
                  <snm>Wong</snm>
                  <fnm>SC</fnm>
               </au>
               <au>
                  <snm>Pan</snm>
                  <fnm>J</fnm>
               </au>
               <au>
                  <snm>Tsao</snm>
                  <fnm>SW</fnm>
               </au>
               <au>
                  <snm>Fung</snm>
                  <fnm>KH</fnm>
               </au>
               <au>
                  <snm>Kwong</snm>
                  <fnm>DL</fnm>
               </au>
               <au>
                  <snm>Sham</snm>
                  <fnm>JS</fnm>
               </au>
               <au>
                  <snm>Nicholls</snm>
                  <fnm>JM</fnm>
               </au>
            </aug>
            <source>Cancer Res</source>
            <pubdate>1998</pubdate>
            <volume>58</volume>
            <fpage>5019</fpage>
            <lpage>5022</lpage>
            <xrefbib>
               <pubid idtype="pmpid" link="fulltext">9823301</pubid>
            </xrefbib>
         </bibl>
         <bibl id="B49">
            <title>
               <p>Differential degradation of intracellular proteins in human skin fibroblasts of mitotic and mitomycin-C (MMC)-induced postmitotic differentiation states <it>in vitro</it></p>
            </title>
            <aug>
               <au>
                  <snm>Rodemann</snm>
                  <fnm>HP</fnm>
               </au>
            </aug>
            <source>Differentiation</source>
            <pubdate>1989</pubdate>
            <volume>42</volume>
            <fpage>37</fpage>
            <lpage>43</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1111/j.1432-0436.1989.tb00605.x</pubid>
                  <pubid idtype="pmpid">2620784</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B50">
            <title>
               <p>Permanent cell cycle arrest in asynchronously proliferating normal human fibroblasts treated with doxorubicin or etoposide but not camptothecin</p>
            </title>
            <aug>
               <au>
                  <snm>Robles</snm>
                  <fnm>SJ</fnm>
               </au>
               <au>
                  <snm>Buehler</snm>
                  <fnm>PW</fnm>
               </au>
               <au>
                  <snm>Negrusz</snm>
                  <fnm>A</fnm>
               </au>
               <au>
                  <snm>Adami</snm>
                  <fnm>GR</fnm>
               </au>
            </aug>
            <source>Biochem Pharmacol</source>
            <pubdate>1999</pubdate>
            <volume>58</volume>
            <fpage>675</fpage>
            <lpage>685</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1016/S0006-2952(99)00127-6</pubid>
                  <pubid idtype="pmpid" link="fulltext">10413306</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B51">
            <title>
               <p>Oncogenic ras provokes premature cell senescence associated with accumulation of p53 and p16INK4a</p>
            </title>
            <aug>
               <au>
                  <snm>Serrano</snm>
                  <fnm>M</fnm>
               </au>
               <au>
                  <snm>Lin</snm>
                  <fnm>AW</fnm>
               </au>
               <au>
                  <snm>McCurrach</snm>
                  <fnm>ME</fnm>
               </au>
               <au>
                  <snm>Beach</snm>
                  <fnm>D</fnm>
               </au>
               <au>
                  <snm>Lowe</snm>
                  <fnm>SW</fnm>
               </au>
            </aug>
            <source>Cell</source>
            <pubdate>1997</pubdate>
            <volume>88</volume>
            <fpage>593</fpage>
            <lpage>602</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1016/S0092-8674(00)81902-9</pubid>
                  <pubid idtype="pmpid" link="fulltext">9054499</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B52">
            <title>
               <p>Caveolin-1 as a prime modulator of aging: a new modality for phenotypic restoration?</p>
            </title>
            <aug>
               <au>
                  <snm>Cho</snm>
                  <fnm>KA</fnm>
               </au>
               <au>
                  <snm>Park</snm>
                  <fnm>SC</fnm>
               </au>
            </aug>
            <source>Mech Ageing Dev</source>
            <pubdate>2005</pubdate>
            <volume>126</volume>
            <fpage>105</fpage>
            <lpage>110</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1016/j.mad.2004.09.029</pubid>
                  <pubid idtype="pmpid" link="fulltext">15610768</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B53">
            <title>
               <p>CDK inhibitors: positive and negative regulators of G1-phase progression</p>
            </title>
            <aug>
               <au>
                  <snm>Sherr</snm>
                  <fnm>CJ</fnm>
               </au>
               <au>
                  <snm>Roberts</snm>
                  <fnm>JM</fnm>
               </au>
            </aug>
            <source>Genes Dev</source>
            <pubdate>1999</pubdate>
            <volume>13</volume>
            <fpage>1501</fpage>
            <lpage>1512</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1101/gad.13.12.1501</pubid>
                  <pubid idtype="pmpid" link="fulltext">10385618</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B54">
            <title>
               <p>p16(INK4a) and the control of cellular proliferative life span</p>
            </title>
            <aug>
               <au>
                  <snm>Huschtscha</snm>
                  <fnm>LI</fnm>
               </au>
               <au>
                  <snm>Reddel</snm>
                  <fnm>RR</fnm>
               </au>
            </aug>
            <source>Carcinogenesis</source>
            <pubdate>1999</pubdate>
            <volume>20</volume>
            <fpage>921</fpage>
            <lpage>926</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1093/carcin/20.6.921</pubid>
                  <pubid idtype="pmpid" link="fulltext">10357768</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B55">
            <title>
               <p>p16 and ARF: activation of teenage proteins in old age</p>
            </title>
            <aug>
               <au>
                  <snm>Satyanarayana</snm>
                  <fnm>A</fnm>
               </au>
               <au>
                  <snm>Rudolph</snm>
                  <fnm>KL</fnm>
               </au>
            </aug>
            <source>J Clin Invest</source>
            <pubdate>2004</pubdate>
            <volume>114</volume>
            <fpage>1237</fpage>
            <lpage>1240</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmcid">524239</pubid>
                  <pubid idtype="pmpid" link="fulltext">15520854</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B56">
            <title>
               <p>Reversal of human cellular senescence: roles of the p53 and p16 pathways</p>
            </title>
            <aug>
               <au>
                  <snm>Beausejour</snm>
                  <fnm>CM</fnm>
               </au>
               <au>
                  <snm>Krtolica</snm>
                  <fnm>A</fnm>
               </au>
               <au>
                  <snm>Galimi</snm>
                  <fnm>F</fnm>
               </au>
               <au>
                  <snm>Narita</snm>
                  <fnm>M</fnm>
               </au>
               <au>
                  <snm>Lowe</snm>
                  <fnm>SW</fnm>
               </au>
               <au>
                  <snm>Yaswen</snm>
                  <fnm>P</fnm>
               </au>
               <au>
                  <snm>Campisi</snm>
                  <fnm>J</fnm>
               </au>
            </aug>
            <source>Embo J</source>
            <pubdate>2003</pubdate>
            <volume>22</volume>
            <fpage>4212</fpage>
            <lpage>4222</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmcid">175806</pubid>
                  <pubid idtype="pmpid" link="fulltext">12912919</pubid>
                  <pubid idtype="doi">10.1093/emboj/cdg417</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B57">
            <title>
               <p>Ink4a/Arf expression is a biomarker of aging</p>
            </title>
            <aug>
               <au>
                  <snm>Krishnamurthy</snm>
                  <fnm>J</fnm>
               </au>
               <au>
                  <snm>Torrice</snm>
                  <fnm>C</fnm>
               </au>
               <au>
                  <snm>Ramsey</snm>
                  <fnm>MR</fnm>
               </au>
               <au>
                  <snm>Kovalev</snm>
                  <fnm>GI</fnm>
               </au>
               <au>
                  <snm>Al-Regaiey</snm>
                  <fnm>K</fnm>
               </au>
               <au>
                  <snm>Su</snm>
                  <fnm>L</fnm>
               </au>
               <au>
                  <snm>Sharpless</snm>
                  <fnm>NE</fnm>
               </au>
            </aug>
            <source>J Clin Invest</source>
            <pubdate>2004</pubdate>
            <volume>114</volume>
            <fpage>1299</fpage>
            <lpage>1307</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmcid">524230</pubid>
                  <pubid idtype="pmpid" link="fulltext">15520862</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B58">
            <title>
               <p>Recovery of function in osteoarthritic chondrocytes induced by p16INK4a-specific siRNA <it>in vitro</it></p>
            </title>
            <aug>
               <au>
                  <snm>Zhou</snm>
                  <fnm>HW</fnm>
               </au>
               <au>
                  <snm>Lou</snm>
                  <fnm>SQ</fnm>
               </au>
               <au>
                  <snm>Zhang</snm>
                  <fnm>K</fnm>
               </au>
            </aug>
            <source>Rheumatology (Oxford)</source>
            <pubdate>2004</pubdate>
            <volume>43</volume>
            <fpage>555</fpage>
            <lpage>568</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1093/rheumatology/keh127</pubid>
                  <pubid idtype="pmpid" link="fulltext">15026580</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B59">
            <title>
               <p>Agents that cause DNA double strand breaks lead to p16INK4a enrichment and the premature senescence of normal fibroblasts</p>
            </title>
            <aug>
               <au>
                  <snm>Robles</snm>
                  <fnm>SJ</fnm>
               </au>
               <au>
                  <snm>Adami</snm>
                  <fnm>GR</fnm>
               </au>
            </aug>
            <source>Oncogene</source>
            <pubdate>1998</pubdate>
            <volume>16</volume>
            <fpage>1113</fpage>
            <lpage>1123</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1038/sj.onc.1201862</pubid>
                  <pubid idtype="pmpid" link="fulltext">9528853</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B60">
            <title>
               <p>Hydroxyurea induces a senescence-like change of K562 human erythroleukemia cell</p>
            </title>
            <aug>
               <au>
                  <snm>Park</snm>
                  <fnm>JI</fnm>
               </au>
               <au>
                  <snm>Jeong</snm>
                  <fnm>JS</fnm>
               </au>
               <au>
                  <snm>Han</snm>
                  <fnm>JY</fnm>
               </au>
               <au>
                  <snm>Kim</snm>
                  <fnm>DI</fnm>
               </au>
               <au>
                  <snm>Gao</snm>
                  <fnm>YH</fnm>
               </au>
               <au>
                  <snm>Park</snm>
                  <fnm>SC</fnm>
               </au>
               <au>
                  <snm>Rodgers</snm>
                  <fnm>GP</fnm>
               </au>
               <au>
                  <snm>Kim</snm>
                  <fnm>IH</fnm>
               </au>
            </aug>
            <source>J Cancer Res Clin Oncol</source>
            <pubdate>2000</pubdate>
            <volume>126</volume>
            <fpage>455</fpage>
            <lpage>460</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1007/s004320050013</pubid>
                  <pubid idtype="pmpid" link="fulltext">10961388</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B61">
            <title>
               <p>Interleukin-1 receptor antagonist delivered directly and by gene therapy inhibits matrix degradation in the intact degenerate human intervertebral disc: an <it>in situ </it>zymographic and gene therapy study</p>
            </title>
            <aug>
               <au>
                  <snm>Le Maitre</snm>
                  <fnm>CL</fnm>
               </au>
               <au>
                  <snm>Hoyland</snm>
                  <fnm>JA</fnm>
               </au>
               <au>
                  <snm>Freemont</snm>
                  <fnm>AJ</fnm>
               </au>
            </aug>
            <source>Arthritis Res Ther</source>
            <pubdate>2007</pubdate>
            <volume>9</volume>
            <fpage>R83</fpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmcid">2206387</pubid>
                  <pubid idtype="pmpid" link="fulltext">17760968</pubid>
                  <pubid idtype="doi">10.1186/ar2282</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B62">
            <title>
               <p>Matrix synthesis and degradation in human intervertebral disc degeneration</p>
            </title>
            <aug>
               <au>
                  <snm>Le Maitre</snm>
                  <fnm>CL</fnm>
               </au>
               <au>
                  <snm>Pockert</snm>
                  <fnm>A</fnm>
               </au>
               <au>
                  <snm>Buttle</snm>
                  <fnm>DJ</fnm>
               </au>
               <au>
                  <snm>Freemont</snm>
                  <fnm>AJ</fnm>
               </au>
               <au>
                  <snm>Hoyland</snm>
                  <fnm>JA</fnm>
               </au>
            </aug>
            <source>Biochem Soc Trans</source>
            <pubdate>2007</pubdate>
            <volume>35</volume>
            <fpage>652</fpage>
            <lpage>655</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1042/BST0350652</pubid>
                  <pubid idtype="pmpid" link="fulltext">17635113</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B63">
            <title>
               <p>Characterization of caveolin-rich membrane domains isolated from an endothelial-rich source: implications for human disease</p>
            </title>
            <aug>
               <au>
                  <snm>Lisanti</snm>
                  <fnm>MP</fnm>
               </au>
               <au>
                  <snm>Scherer</snm>
                  <fnm>PE</fnm>
               </au>
               <au>
                  <snm>Vidugiriene</snm>
                  <fnm>J</fnm>
               </au>
               <au>
                  <snm>Tang</snm>
                  <fnm>Z</fnm>
               </au>
               <au>
                  <snm>Hermanowski-Vosatka</snm>
                  <fnm>A</fnm>
               </au>
               <au>
                  <snm>Tu</snm>
                  <fnm>YH</fnm>
               </au>
               <au>
                  <snm>Cook</snm>
                  <fnm>RF</fnm>
               </au>
               <au>
                  <snm>Sargiacomo</snm>
                  <fnm>M</fnm>
               </au>
            </aug>
            <source>J Cell Biol</source>
            <pubdate>1994</pubdate>
            <volume>126</volume>
            <fpage>111</fpage>
            <lpage>126</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="pmcid">2120102</pubid>
                  <pubid idtype="pmpid" link="fulltext">7517942</pubid>
                  <pubid idtype="doi">10.1083/jcb.126.1.111</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B64">
            <title>
               <p>N(epsilon)-(carboxymethyl)lysine adducts of proteins are ligands for receptor for advanced glycation end products that activate cell signaling pathways and modulate gene expression</p>
            </title>
            <aug>
               <au>
                  <snm>Kislinger</snm>
                  <fnm>T</fnm>
               </au>
               <au>
                  <snm>Fu</snm>
                  <fnm>C</fnm>
               </au>
               <au>
                  <snm>Huber</snm>
                  <fnm>B</fnm>
               </au>
               <au>
                  <snm>Qu</snm>
                  <fnm>W</fnm>
               </au>
               <au>
                  <snm>Taguchi</snm>
                  <fnm>A</fnm>
               </au>
               <au>
                  <snm>Du Yan</snm>
                  <fnm>S</fnm>
               </au>
               <au>
                  <snm>Hofmann</snm>
                  <fnm>M</fnm>
               </au>
               <au>
                  <snm>Yan</snm>
                  <fnm>SF</fnm>
               </au>
               <au>
                  <snm>Pischetsrieder</snm>
                  <fnm>M</fnm>
               </au>
               <au>
                  <snm>Stern</snm>
                  <fnm>D</fnm>
               </au>
               <au>
                  <snm>Schmidt</snm>
                  <fnm>AM</fnm>
               </au>
            </aug>
            <source>J Biol Chem</source>
            <pubdate>1999</pubdate>
            <volume>274</volume>
            <fpage>31740</fpage>
            <lpage>31749</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.1074/jbc.274.44.31740</pubid>
                  <pubid idtype="pmpid" link="fulltext">10531386</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
         <bibl id="B65">
            <title>
               <p>Expression of the urokinase-type plasminogen activator receptor in human articular chondrocytes: association with caveolin and beta 1-integrin</p>
            </title>
            <aug>
               <au>
                  <snm>Schwab</snm>
                  <fnm>W</fnm>
               </au>
               <au>
                  <snm>Gavlik</snm>
                  <fnm>JM</fnm>
               </au>
               <au>
                  <snm>Beichler</snm>
                  <fnm>T</fnm>
               </au>
               <au>
                  <snm>Funk</snm>
                  <fnm>RH</fnm>
               </au>
               <au>
                  <snm>Albrecht</snm>
                  <fnm>S</fnm>
               </au>
               <au>
                  <snm>Magdolen</snm>
                  <fnm>V</fnm>
               </au>
               <au>
                  <snm>Luther</snm>
                  <fnm>T</fnm>
               </au>
               <au>
                  <snm>Kasper</snm>
                  <fnm>M</fnm>
               </au>
               <au>
                  <snm>Shakibaei</snm>
                  <fnm>M</fnm>
               </au>
            </aug>
            <source>Histochem Cell Biol</source>
            <pubdate>2001</pubdate>
            <volume>115</volume>
            <fpage>317</fpage>
            <lpage>323</lpage>
            <xrefbib>
               <pubid idtype="pmpid" link="fulltext">11405060</pubid>
            </xrefbib>
         </bibl>
         <bibl id="B66">
            <title>
               <p>Plasminogen activator system and vascular disease</p>
            </title>
            <aug>
               <au>
                  <snm>Nicholl</snm>
                  <fnm>SM</fnm>
               </au>
               <au>
                  <snm>Roztocil</snm>
                  <fnm>E</fnm>
               </au>
               <au>
                  <snm>Davies</snm>
                  <fnm>MG</fnm>
               </au>
            </aug>
            <source>Curr Vasc Pharmacol</source>
            <pubdate>2006</pubdate>
            <volume>4</volume>
            <fpage>101</fpage>
            <lpage>116</lpage>
            <xrefbib>
               <pubidlist>
                  <pubid idtype="doi">10.2174/157016106776359880</pubid>
                  <pubid idtype="pmpid" link="fulltext">16611153</pubid>
               </pubidlist>
            </xrefbib>
         </bibl>
      </refgrp>
   </bm>
</art>
