Abstract
Athletic performance relies on tendons, which enable movement by transferring forces from muscles to the skeleton. Yet, how load-bearing structures in tendons sense and adapt to physical demands is not understood. Here, by performing calcium (Ca2+) imaging in mechanically loaded tendon explants from rats and in primary tendon cells from rats and humans, we show that tenocytes detect mechanical forces through the mechanosensitive ion channel PIEZO1, which senses shear stresses induced by collagen-fibre sliding. Through tenocyte-targeted loss-of-function and gain-of-function experiments in rodents, we show that reduced PIEZO1 activity decreased tendon stiffness and that elevated PIEZO1 mechanosignalling increased tendon stiffness and strength, seemingly through upregulated collagen cross-linking. We also show that humans carrying the PIEZO1 E756del gain-of-function mutation display a 13.2% average increase in normalized jumping height, presumably due to a higher rate of force generation or to the release of a larger amount of stored elastic energy. Further understanding of the PIEZO1-mediated mechanoregulation of tendon stiffness should aid research on musculoskeletal medicine and on sports performance.
This is a preview of subscription content, access via your institution
Relevant articles
Open Access articles citing this article.
-
Longitudinal Evidence for High-Level Patellar Tendon Strain as a Risk Factor for Tendinopathy in Adolescent Athletes
Sports Medicine - Open Open Access 07 September 2023
-
Quantification of patellar tendon strain and opportunities for personalized tendon loading during back squats
Scientific Reports Open Access 29 May 2023
-
Piezo channels in the urinary system
Experimental & Molecular Medicine Open Access 14 June 2022
Access options
Access Nature and 54 other Nature Portfolio journals
Get Nature+, our best-value online-access subscription
$29.99 / 30 days
cancel any time
Subscribe to this journal
Receive 12 digital issues and online access to articles
$99.00 per year
only $8.25 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout








Data availability
The main data supporting the findings of this study are available within the paper and its Supplementary Information. The raw and analysed datasets generated during the study are too large to be publicly shared, yet they are available from the corresponding author on reasonable request.
Code availability
The software of the stretching device, as well as MATLAB, ImageJ and R codes, are all available from the corresponding author on request. The toolbox CHIPS is freely available65.
References
Magnusson, S. P., Langberg, H. & Kjaer, M. The pathogenesis of tendinopathy: balancing the response to loading. Nat. Rev. Rheumatol. 6, 262–268 (2010).
Dickinson, M. H. et al. How animals move: an integrative view. Science 288, 100–106 (2000).
Roberts, T. J., Marsh, R. L., Weyand, P. G. & Taylor, C. R. Muscular force in running turkeys: the economy of minimizing work. Science 275, 1113–1115 (1997).
Wilson, A. M., Watson, J. C. & Lichtwark, G. A. Biomechanics: a catapult action for rapid limb protraction. Nature 421, 35–36 (2003).
Arampatzis, A., Karamanidis, K. & Albracht, K. Adaptational responses of the human Achilles tendon by modulation of the applied cyclic strain magnitude. J. Exp. Biol. 210, 2743–2753 (2007).
Heinemeier, K. M. et al. Uphill running improves rat Achilles tendon tissue mechanical properties and alters gene expression without inducing pathological changes. J. Appl Physiol. 113, 827–836 (2012).
Arampatzis, A., Karamanidis, K., Morey-Klapsing, G., De Monte, G. & Stafilidis, S. Mechanical properties of the triceps surae tendon and aponeurosis in relation to intensity of sport activity. J. Biomech. 40, 1946–1952 (2007).
Riley, G. Tendinopathy–from basic science to treatment. Nat. Clin. Pract. Rheumatol. 4, 82–89 (2008).
Nourissat, G., Berenbaum, F. & Duprez, D. Tendon injury: from biology to tendon repair. Nat. Rev. Rheumatol. 11, 223–233 (2015).
Pan, B. et al. TMC1 forms the pore of mechanosensory transduction channels in vertebrate inner ear hair cells. Neuron 99, 736–753 e736 (2018).
Ranade, S. S. et al. Piezo2 is the major transducer of mechanical forces for touch sensation in mice. Nature 516, 121–125 (2014).
Li, J. et al. Piezo1 integration of vascular architecture with physiological force. Nature 515, 279–282 (2014).
Wang, S. et al. Endothelial cation channel PIEZO1 controls blood pressure by mediating flow-induced ATP release. J. Clin. Invest. 126, 4527–4536 (2016).
Woo, S. H. et al. Piezo2 is the principal mechanotransduction channel for proprioception. Nat. Neurosci. 18, 1756–1762 (2015).
Nonomura, K. et al. Piezo2 senses airway stretch and mediates lung inflation-induced apnoea. Nature 541, 176–181 (2017).
Coste, B. et al. Piezo1 and Piezo2 are essential components of distinct mechanically activated cation channels. Science 330, 55–60 (2010).
Kang, L., Gao, J., Schafer, W. R., Xie, Z. & Xu, X. S. C. elegans TRP family protein TRP-4 is a pore-forming subunit of a native mechanotransduction channel. Neuron 67, 381–391 (2010).
Servin-Vences, M. R., Moroni, M., Lewin, G. R. & Poole, K. Direct measurement of TRPV4 and PIEZO1 activity reveals multiple mechanotransduction pathways in chondrocytes. eLife 6, e21074 (2017).
Patel, A. J. et al. A mammalian two pore domain mechano-gated S-like K+ channel. EMBO J. 17, 4283–4290 (1998).
Maingret, F., Fosset, M., Lesage, F., Lazdunski, M. & Honoré, E. TRAAK is a mammalian neuronal mechano-gated K+ channel. J. Biol. Chem. 274, 1381–1387 (1999).
Xu, J. et al. GPR68 senses flow and is essential for vascular physiology. Cell 173, 762–775 e716 (2018).
O’Hagan, R., Chalfie, M. & Goodman, M. B. The MEC-4 DEG/ENaC channel of Caenorhabditis elegans touch receptor neurons transduces mechanical signals. Nat. Neurosci. 8, 43–50 (2005).
Zhang, M. et al. Structure of the mechanosensitive OSCA channels. Nat. Struct. Mol. Biol. 25, 850–858 (2018).
Murthy, S. E. et al. OSCA/TMEM63 are an evolutionarily conserved family of mechanically activated ion channels. eLife 7, e41844 (2018).
Lukacs, V. et al. Impaired PIEZO1 function in patients with a novel autosomal recessive congenital lymphatic dysplasia. Nat. Commun. 6, 8329 (2015).
Fotiou, E. et al. Novel mutations in PIEZO1 cause an autosomal recessive generalized lymphatic dysplasia with non-immune hydrops fetalis. Nat. Commun. 6, 8085 (2015).
Retailleau, K. et al. Piezo1 in smooth muscle cells is involved in hypertension-dependent arterial remodeling. Cell Rep. 13, 1161–1171 (2015).
Peyronnet, R. et al. Piezo1-dependent stretch-activated channels are inhibited by polycystin-2 in renal tubular epithelial cells. EMBO Rep. 14, 1143–1148 (2013).
Cahalan, S. M. et al. Piezo1 links mechanical forces to red blood cell volume. eLife 4, e07370 (2015).
Sun, W. et al. The mechanosensitive Piezo1 channel is required for bone formation. eLife 8, e47454 (2019).
Ma, S. et al. Common PIEZO1 allele in African populations causes RBC dehydration and attenuates Plasmodium infection. Cell 173, 443–455 (2018).
Stauber, T., Blache, U. & Snedeker, J. G. Tendon tissue microdamage and the limits of intrinsic repair. Matrix Biol. 85-86, 68–79 (2020).
Snedeker, J. G., Ben Arav, A., Zilberman, Y., Pelled, G. & Gazit, D. Functional fibered confocal microscopy: a promising tool for assessing tendon regeneration. Tissue Eng. C 15, 485–491 (2009).
Zheng, K. et al. Time-resolved imaging reveals heterogeneous landscapes of nanomolar Ca2+ in neurons and astroglia. Neuron 88, 277–288 (2015).
Screen, H. R., Lee, D. A., Bader, D. L. & Shelton, J. C. An investigation into the effects of the hierarchical structure of tendon fascicles on micromechanical properties. Proc. Inst. Mech. Eng. H 218, 109–119 (2004).
Murthy, S. E., Dubin, A. E. & Patapoutian, A. Piezos thrive under pressure: mechanically activated ion channels in health and disease. Nat. Rev. Mol. Cell Biol. 18, 771–783 (2017).
Wunderli, S. L. et al. Tendon response to matrix unloading is determined by the patho-physiological niche. Matrix Biol. 89, 11–26 (2020).
Peffers, M. J. et al. Transcriptome analysis of ageing in uninjured human Achilles tendon. Arthritis Res. Ther. 17, 33 (2015).
Ranade, S. S. et al. Piezo1, a mechanically activated ion channel, is required for vascular development in mice. Proc. Natl Acad. Sci. USA 111, 10347–10352 (2014).
Howell, K. et al. Novel model of tendon regeneration reveals distinct cell mechanisms underlying regenerative and fibrotic tendon healing. Sci. Rep. 7, 45238 (2017).
Syeda, R. et al. Chemical activation of the mechanotransduction channel Piezo1. eLife 4, e07369 (2015).
Wunderli, S. L. et al. Minimal mechanical load and tissue culture conditions preserve native cell phenotype and morphology in tendon-a novel ex vivo mouse explant model. J. Orthop. Res. 36, 1383–1390 (2018).
Couppé, C. et al. Life-long endurance running is associated with reduced glycation and mechanical stress in connective tissue. Age 36, 9665 (2014).
Thorpe, C. T., Stark, R. J., Goodship, A. E. & Birch, H. L. Mechanical properties of the equine superficial digital flexor tendon relate to specific collagen cross-link levels. Equine Vet. J. Suppl. 42, 538–543 (2010).
Zeeman, R. et al. Successive epoxy and carbodiimide cross-linking of dermal sheep collagen. Biomaterials 20, 921–931 (1999).
Marturano, J. E., Xylas, J. F., Sridharan, G. V., Georgakoudi, I. & Kuo, C. K. Lysyl oxidase-mediated collagen crosslinks may be assessed as markers of functional properties of tendon tissue formation. Acta Biomater. 10, 1370–1379 (2014).
Mersha, T. B. & Abebe, T. Self-reported race/ethnicity in the age of genomic research: its potential impact on understanding health disparities. Hum. Genomics 9, 1 (2015).
Yancy, C. W. & McNally E. Reporting genetic markers and the social determinants of health in clinical cardiovascular research—it is time to recalibrate the use of race. JAMA Cardiol. https://doi.org/10.1001/jamacardio.2020.6576 (2020).
Athletics—100m men. Olympic Games www.olympic.org/athletics/100m-men (accessed May 2020).
100 meters men. World Athletics www.worldathletics.org/records/all-time-toplists/sprints/100-metres/outdoor/men/senior (accessed May 2020).
Long jump men. World Athletics www.worldathletics.org/records/all-time-toplists/jumps/long-jump/outdoor/men/senior (accessed May 2020).
Ishikawa, M., Niemela, E. & Komi, P. V. Interaction between fascicle and tendinous tissues in short-contact stretch-shortening cycle exercise with varying eccentric intensities. J. Appl Physiol. 99, 217–223 (2005).
Earp, J. E. et al. Influence of muscle-tendon unit structure on rate of force development during the squat, countermovement, and drop jumps. J. Strength Cond. Res. 25, 340–347 (2011).
Lavagnino, M. et al. Tendon mechanobiology: current knowledge and future research opportunities. J. Orthop. Res. 33, 813–822 (2015).
Arnoczky, S. P., Lavagnino, M. & Egerbacher, M. The response of tendon cells to changing loads: implications in the etiopathogenesis of tendinopathy. Tendinopathy Athl. 1, 46–59 (2007).
Wall, M. E. & Banes, A. J. Early responses to mechanical load in tendon: role for calcium signaling, gap junctions and intercellular communication. J. Musculoskelet. Neuronal Interact. 5, 70–84 (2005).
Maeda, E., Hagiwara, Y., Wang, J. H. & Ohashi, T. A new experimental system for simultaneous application of cyclic tensile strain and fluid shear stress to tenocytes in vitro. Biomed. Microdevices 15, 1067–1075 (2013).
Kongsgaard, M. et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand. J. Med. Sci. Sports 19, 790–802 (2009).
Beyer, R. et al. Heavy slow resistance versus eccentric training as treatment for achilles tendinopathy: a randomized controlled trial. Am. J. Sports Med. 43, 1704–1711 (2015).
Frost, H. M. Bone “mass” and the “mechanostat”: a proposal. Anat. Rec. 219, 1–9 (1987).
Heinemeier, K. M., Schjerling, P., Heinemeier, J., Magnusson, S. P. & Kjaer, M. Lack of tissue renewal in human adult Achilles tendon is revealed by nuclear bomb 14C. FASEB J. 27, 2074–2079 (2013).
Forde, M. S., Punnett, L. & Wegman, D. H. Prevalence of musculoskeletal disorders in union ironworkers. J. Occup. Environ. Hyg. 2, 203–212 (2005).
Sebbag, E. et al. The world-wide burden of musculoskeletal diseases: a systematic analysis of the World Health Organization Burden of Diseases Database. Ann. Rheum. Dis. 78, 844–848 (2019).
Gautieri, A. et al. Advanced glycation end-products: mechanics of aged collagen from molecule to tissue. Matrix Biol. 59, 95–108 (2017).
Barrett, M. J. P., Ferrari, K. D., Stobart, J. L., Holub, M. & Weber, B. CHIPS: an extensible toolbox for cellular and hemodynamic two-photon image analysis. Neuroinformatics 16, 145–147 (2018).
Li, Y., Fessel, G., Georgiadis, M. & Snedeker, J. G. Advanced glycation end-products diminish tendon collagen fiber sliding. Matrix Biol. 32, 169–177 (2013).
Tinevez, J.-Y. et al. TrackMate: an open and extensible platform for single-particle tracking. Methods 115, 80–90 (2017).
McNeilly, C. M., Banes, A. J., Benjamin, M. & Ralphs, J. R. Tendon cells in vivo form a three dimensional network of cell processes linked by gap junctions. J. Anat. 189, 593–600 (1996).
Song, M. J. et al. Mapping the mechanome of live stem cells using a novel method to measure local strain fields in situ at the fluid-cell interface. PLoS ONE 7, e43601 (2012).
Razafiarison, T., Silvan, U., Meier, D. & Snedeker, J. G. Surface-driven collagen self-assembly affects early osteogenic stem cell signaling. Adv. Healthc. Mater. 5, 1481–1492 (2016).
Cornish, R. Flow in a pipe of rectangular cross-section. Proc. R. Soc. A 120, 691–700 (1928).
Naito, Y., Hino, K., Bono, H. & Ui-Tei, K. CRISPRdirect: software for designing CRISPR/Cas guide RNA with reduced off-target sites. Bioinformatics 31, 1120–1123 (2015).
Morgens, D. W. et al. Genome-scale measurement of off-target activity using Cas9 toxicity in high-throughput screens. Nat. Commun. 8, 15178 (2017).
Sanjana, N. E., Shalem, O. & Zhang, F. Improved vectors and genome-wide libraries for CRISPR screening. Nat. Methods 11, 783–784 (2014).
Stewart, S. A. et al. Lentivirus-delivered stable gene silencing by RNAi in primary cells. RNA 9, 493–501 (2003).
Arganda-Carreras, I. et al. Trainable Weka segmentation: a machine learning tool for microscopy pixel classification. Bioinformatics 33, 2424–2426 (2017).
Robinson, J. M. et al. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br. J. Sports Med. 35, 335–341 (2001).
Grimby, G. Physical activity and muscle training in the elderly. Acta Med. Scand. Suppl. 711, 233–237 (1986).
Silbernagel, K. G., Shelley, K., Powell, S. & Varrecchia, S. Extended field of view ultrasound imaging to evaluate Achilles tendon length and thickness: a reliability and validity study. Muscles Ligaments Tendons J. 6, 104–110 (2016).
Silbernagel, K. G., Gustavsson, A., Thomee, R. & Karlsson, J. Evaluation of lower leg function in patients with Achilles tendinopathy. Knee Surg. Sports Traumatol. Arthrosc. 14, 1207–1217 (2006).
Acknowledgements
We thank A. Ziegler for software assistance; N. Wili for support in chemistry; B. Rutishauser and E. Bachmann for engineering assistance; L. Gasser (Statistical Consulting Group, ETH Zurich) for statistical support; members of the Snedeker group for constructive discussions; A. Huang and R. Schweitzer for providing Scx-creERT2 mice; A. Patapoutian for providing Piezo1GOF mice and feedback; U. Lüthi and A. Käch from the Center for Microscopy and Image Analysis (University of Zurich) for help with transmission electron microscopy; R. Mezzenga and Y. Yao (ETH Zurich) for access to the differential scanning calorimeter and assistance during the experiments; and P. Aagaard for insights on the human jumping performance data. Funding was provided by the Swiss National Science Foundation (grant numbers 165670 and 185095).
Author information
Authors and Affiliations
Contributions
F.S.P., P.K.J., A.S.S. and J.G.S. designed experiments and wrote the manuscript. F.S.P. performed the Ca2+-imaging experiments with tendon explants. F.S.P., K.D.F., D.H., S.C., A.N.H., U.S. and B.W. designed and analysed the Ca2+-imaging experiments. P.K.J. and F.S.P. carried out and analysed the shear-stress experiments. M.J.A., F.S.P., M.B. and B.P.-T. generated and analysed the knockout cells. S.F.F., M.B. and U.B. helped with human tendon tissues and isolation of primary cells. F.S.P. and S.M. performed mouse experiments. S.H., K.G.S., F.S.P. and J.G.S. designed and performed the human study. F.S.P. and B.P.-T. carried out human genotyping. F.S.P., S.H. and T.G. analysed the human data. All of the authors provided feedback on the manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Peer review information Nature Biomedical Engineering thanks Michael Lavagnino and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Peer reviewer reports are available.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Supplementary Information
Supplementary Figs. 1–7 and Tables 1 and 2, and captions for Supplementary Videos 1–5.
Supplementary Video 1
A tendon fascicle at baseline (unstretched condition), showing sparse spontaneous Ca2+ signals in tenocytes.
Supplementary Video 2
A tendon fascicle during tissue stretching from 0–10% strain, showing a tissue-wide Ca2+ response in tenocytes.
Supplementary Video 3
Propagation of Ca2+ signals to neighbouring cells, potentially through cell–cell communication.
Supplementary Video 4
Isolated human tenocytes showing Ca2+ signals on stimulation with 5 Pa shear stress.
Supplementary Video 5
A tendon fascicle stimulated with the PIEZO1-agonist Yoda1, showing a prompt Ca2+ response in tenocytes.
Rights and permissions
About this article
Cite this article
Passini, F.S., Jaeger, P.K., Saab, A.S. et al. Shear-stress sensing by PIEZO1 regulates tendon stiffness in rodents and influences jumping performance in humans. Nat Biomed Eng 5, 1457–1471 (2021). https://doi.org/10.1038/s41551-021-00716-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41551-021-00716-x
This article is cited by
-
Longitudinal Evidence for High-Level Patellar Tendon Strain as a Risk Factor for Tendinopathy in Adolescent Athletes
Sports Medicine - Open (2023)
-
Quantification of patellar tendon strain and opportunities for personalized tendon loading during back squats
Scientific Reports (2023)
-
Acoustic and Magnetic Stimuli-Based Three-Dimensional Cell Culture Platform for Tissue Engineering
Tissue Engineering and Regenerative Medicine (2023)
-
Piezo channels in the urinary system
Experimental & Molecular Medicine (2022)
-
Shear mechanosensing drives tendon adaptation
Nature Biomedical Engineering (2021)