Why Tendon Problems Behave Differently: A Glimpse Into Proteomics' Future

While genomics studies the full set of genes, proteomics studies the proteins those genes produce, which can more directly reflect a cell’s physiologic state. 

In this study, using proteomics, authors asked: Why do treatment responses differ between traditional tenopathy and tenopathy associated with diabetes?

The study

Researchers analyzed Achilles tendon tissue using mass spectrometry to quantify thousands of proteins, comparing patterns from three groups:

• Tendinopathy (n=8)

• Diabetes (n=5)

• Controls (n=5)

Key findings

Tendinopathy showed major changes: 

• 311 proteins altered

• Marked increases in inflammatory proteins and enzymes that break down tendon structure (e.g., MMPs, TIMPs)

• Degeneration scores much higher than controls

Diabetes caused smaller shifts: 

• 66 proteins changed

• Patterns suggested reduced Type I collagen and signs of metabolic/fibrotic stress

• Importantly, diabetic tendons did not show the structural damage typical of tendinopathy

What it means

• Tendinopathy: Represents active tissue breakdown and inflammation, which likely makes treatments targeting remodeling and inflammatory pathways.

• Diabetes produces subtler changes that may weaken tendon integrity but don’t generate classic tendinopathic degeneration, which likely increases injury risk rather than directly causing tendinopathy.

Clinical relevance

Proteomics is not yet clinic-ready, but these findings highlight distinctive biological “signatures” that could eventually: 

• Enable earlier diagnose

• Predict treatment response 

• Guide personalized therapy based on an individual patient’s tendon biology

In other words, this research points toward true precision medicine for tendon disorders.