Potent Inhibition of Heterotopic Ossification by Nuclear Retinoic Acid Receptor γ Agonists

Heterotopic ossification (HO) consists of ectopic bone formation within soft tissues following surgery or trauma and can have debilitating consequences, but no definitive cure is available. Here we show that HO was essentially prevented in mice receiving nuclear retinoic acid receptor γ (RARγ) agonists. Side effects were minimal, and there was no significant rebound effect. To uncover mechanisms, mesenchymal stem cells were treated with RARγ agonist and transplanted into nude mice. Whereas control cells formed ectopic bone masses, the RARγ agonist-pretreated cells did not, suggesting that they had lost their skeletogenic potentials. Indeed, the cells became unresponsive to rBMP-2 and exhibited reduction of Smad1/5/8 phosphorylation and overall Smad levels. As importantly, the RARγ agonists blocked HO in transgenic mice expressing constitutive-active ALK2(Q207D) mutant that is related to ALK2(R206H) found in Fibrodysplasia Ossificans Progressiva patients. The data indicate that the RARγ agonists are potent inhibitors of HO and could also be as effective against congenital HO.