ReviewBiomedicines2026
Aging Biology of Bone-to-Tendon Healing and the Epigenetic Clock: A Biological-Age Readout of Rotator Cuff Healing Capacity.
Review in Biomedicines, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
The "unexplained failure" of rotator cuff repair is multifactorial, but its structural endpoint is anatomically consistent, i.e., the failure of the tendon-to-bone interface (enthesis) to heal. The native enthesis is a four-zone fibrocartilaginous gradient that does not regenerate but heals as a mechanically inferior fibrovascular scar, so the outcome of repair hinges on the interface's healing capacity-which chronological age predicts poorly. This review organizes the aging biology governing bone-to-tendon healing capacity into eight domains: progenitor competence, cellular senescence and the SASP, immune aging, extracellular-matrix and collagen aging via advanced glycation end-product cross-linking, footprint angiogenesis, morphogen signaling, mechanotransduction, and bone quality. We then precisely define the DNA-methylation epigenetic clock-a continuous value produced by weighted CpG methylation, with defined units, reproducibility, and effect sizes-and propose it as a candidate quantitative readout of these domains; whether or not it truly integrates them into a single biologically meaningful measure at the enthesis is a hypothesis of this review, not an established mechanism. In 1087 twins, epigenetic age acceleration predicted fracture and osteoporosis risk, with hazard ratios of 1.29-3.17 per standard deviation; moreover, aging is tissue-specific, so the enthesis may run ahead of blood. Critically, the clock provides a single axis on which current regenerative-medicine strategies-stem cells, exosomes, immunomodulation, biomimetic gradient scaffolds, growth factors, senolytics, and epigenetic reprogramming-can be systematically categorized by how far each shifts biological age toward a healing-competent state; partial reprogramming, which rewinds the clock directly, shows that the clock is simultaneously the readout and the therapeutic target. We integrate this into a "hidden biological age of bone-to-tendon healing", explicitly stating that this remains an unvalidated hypothesis requiring prospective validation.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.