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Single-cell sequencing studies have suggested that although clustered chondrocytes highly express autophagy-related proteins ULK1, Beclin-1, and LC3II, mitophagic flux is blocked, making it impossible to effectively clear ROS-damaged mitochondria, leading to continuous ROS accumulation and forming a vicious cycle of mitochondrial damage-ROS outburst-abnormal proliferation-autophagic disorder. (46, 47) More importantly, such clustered cells have undergone phenotypic malignant transformation, highly expressing hypertrophy markers such as Runx2, alkaline phosphatase (ALP), and type X collagen (COL10A1), while excessively secreting FGF2 and MMP-13

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Our observations are further supported by a study in APPswe/PS1dE9 mice [78]

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