Synovial tissue and synovial fluid

Synovial tissue is a highly specialized tissue that keeps the articular joint well lubricated, and at the same time provides nutrients to the articular surface. A joint needs a small amount of synovial fluid to work. Although the tissue structure is simple, its function is highly sophisticated. Because synovial tissue is the target of most autoimmune diseases, joints need to be understood in their entirety to create new treatments for such immunological disorders.

Evidence for a role of hyaluronan in the spacing of fibrils within collagen bundles in rabbit synovium

Synovial hydraulic resistance is vital for the retention of intra-articular fluid, and originates within the matrix of biopolymers in the intercellular gaps. Specific digestion of hyaluronan resulted in a increase in synovial hydraulic permeability from 0.478+/-0.24 microl min(-1) cm H(2)O(-1) in control tissue to 4.561+/-0.40 microl min(-1) cm H(2)O(-1) (mean+/-S.D., n=6 rabbits, P<0.001 t test). To investigate whether hyaluronidase also altered the interstitial ultrastructure, morphometry of hyaluronidase treated synovium was carried out. The most striking novel finding was that hyaluronidase treatment reduced extrafibrillar volume fraction within the synovial collagen bundles from 50.5+/-11.1% to 36.8+/-15.5% (mean+/-S.D., n=6 rabbits, P<0.001, two-way anova). This was accompanied by a reduction in interfibrillar centre to centre spacing from 101+/-11 (control) to 84+/-6 nm (mean+/-S.D.; n=6 rabbits, P<0.001) in enzyme-treated bundles. Individual fibrils showed a small but highly significant reduction in cross-sectional diameter from 76.9+/-6.3 to 72.5+/-6.3 nm (mean+/-S.E.; P<0.001) after hyaluronidase treatment. The findings indicate that hyaluronan chains have a major organisational role within the collagen bundle itself. The trans-synovial pathway comprises bundles and substantial areas of intervening, bundle-free matrix, and it is possible that bundle collapse contributes to a rise in overall permeability by increasing the inter-bundle space.

Synovial regeneration in the equine carpus after arthroscopic mechanical or carbon dioxide laser synovectomy

OBJECTIVE

To compare synovial regeneration in the equine carpus after mechanical or CO(2) laser synovectomy.

STUDY DESIGN

Arthroscopic partial synovectomy was performed in the radiocarpal and intercarpal joints.

SAMPLE POPULATION

Twelve horses, 3 to 6 years of age, were randomly divided into 3 groups.

METHODS

The antebrachiocarpal and intercarpal joints in each horse were randomly assigned a treatment such that each horse had one joint treated as a control (arthroscopic lavage), one in which a mechanical or CO(2) laser partial dorsal carpal synovectomy was performed, and one in which a combination of the mechanical and laser techniques was performed. The groups were euthanized for collection of specimens, respectively, at 1, 3, and 6 months postoperatively. The synovial membrane was evaluated grossly, histologically, and by transmission and scanning electron microscopes (TEM and SEM).

RESULTS

The synovial villi failed to regenerate in all groups. At 1 month, the intimal cell layer was incomplete and the surface was still granulating. At 3 months, intimal regeneration was complete but more mature in the CO(2) laser synovectomy groups than in the mechanical synovectomy groups. Intimal regeneration was complete in all groups at 6 months. The subintima was replaced with fibrous tissue that separated the original subintimal vascular bed from the regenerated synovial surface. The CO(2) laser required preliminary training to operate effectively, and the air environment altered the intraoperative evaluation of the synovectomy site.

CONCLUSIONS

Villous regeneration does not occur in horses after surgical synovectomy. All synovial membranes healed with a fibrous subintima and less populated intima. The CO(2) laser is capable of performing a more superficial synovectomy than that achieved with mechanical synovectomy using a motorized arthroscopic synovial resector.

CLINICAL RELEVANCE

Mechanical or CO(2) laser synovectomy may be performed in the horse; however, additional evaluation is needed to determine the physiological significance of the lack of villus regeneration in this species. A combination of the resection techniques is not advised because of the increased risk of full-thickness capsular defects.

Ultrastructural changes in the transitional zone between articular cartilage and synovial membrane during the development of experimental osteoarthrosis

We studied the ultrastructural changes that take place in the transitional zone between the articular cartilage and the synovial membrane during the development of experimental osteoarthrosis. We focused special attention on changes involving the proteoglycan complexes within the matrix of articular cartilage. We observed that changes in the transitional zone resemble those seen in articular cartilage during the development of osteoarthrosis. We also found transient cellular forms with fibroblast phenotype regulating the demands of both cartilage and synovial matrix. The transient nature of these elements determines the pronounced lability of this zone, and this may be related to the early development of osteoarthrosis.

Three-dimensional ultrastructure of synoviocytes in the knee joint of rabbits and morphological changes in osteoarthritis model

The synovial intima is composed of two types of synoviocytes: absorptive macrophages and secretory, fibroblast-like F cells. Many studies have tried to observe synoviocytes by scanning electron microscopy (SEM) but failed to reveal the entire shape of synoviocytes because they are deeply embedded in the interstitial matrix. The present study, primarily employing SEM observation of NaOH macerated samples, reveals the distribution and three-dimensional ultrastructure of the synoviocytes in the normal knee joint of rabbits, and the morphological changes of synoviocytes in an osteoarthritis model of this animal. F cells were broadly distributed throughout the synovial intima, while macrophages showed a restricted distribution on fatty tissues around the patella. F cells were classified into a flat type, which covered the surface of synovial membrane like an epithelium, and a dendritic type, which extended long processes to form a characteristic meshwork on the surface. The flat type predominated in regions adhering to the femur, while the dendritic type predominated in ambilateral parts of both the patella and tendon of the musculus quadriceps femoris, and on the peripatellar fatty tissue. Intermediate forms of flat and dendritic types appeared in middle regions between the patella and periphery of the joint capsule. In the synovial membrane of the osteoarthritis model, both types of synoviocytes increased in number and changed their morphology, indicating their elevated activities in absorption and secretion. It is suggested that the ultrastructural changes in synoviocytes reflect pathological conditions of the synovial membrane, and synoviocytes play important roles in the pathogenesis of osteoarthritis.

Evidence for synovitis in active polymyalgia rheumatica: sonographic study in a large series of patients

OBJECTIVE

To determine the frequency and localization of synovitis and enthesitis in patients with active, untreated polymyalgia rheumatica (PMR) by ultrasonography (US).

METHODS

Polyarticular sonographic evaluation was carried out in 50 consecutive patients with PMR at disease onset. Results were compared with 50 consecutive patients with seronegative spondyloarthropathies (SpA) and 50 with seronegative and seropositive rheumatoid arthritis (RA) at disease onset.

RESULTS

Synovitis and/or effusion was detected, in at least one joint, in 100% of patients with PMR. The most frequent alterations observed in patients with PMR were effusion in the subacromial-subdeltoid (SA-SD) bursa in 70% of patients, tenosynovitis of the long head of the biceps tendon (LHBT) in 68%, glenohumeral joint effusion in 66%, tenosynovitis of the flexor tendons in the carpal tunnel in 38%, radiocarpal effusion in 18%, wrist extensors tenosynovitis in 18%, coxofemoral joint effusion in 40%. knee effusion in 38%, and ankle effusion in 10%. Enthesitis and tendonitis of the anchoring tendons were relatively rare in all the articular sites. Comparison of the SpA and PMR patients showed that enthesitis (mostly in the elbow, knee, and heel) was significantly more frequent in SpA. There was a significant difference in glenohumeral and coxofemoral effusion between the PMR and SpA patients (66% vs 16% and 40% vs 14%, respectively). Comparison of PMR and RA patients showed no significant difference in the involvement of entheses, shoulder, hip, or wrist flexor tendons in the carpal tunnel. Synovitis of the elbow, knee, and wrist was significantly more frequent in the SpA and RA patients than in those with PMR.

CONCLUSION

Synovitis was detected in at least one site in 100% of patients with PMR. SA-SD bursitis, LHBT tenosynovitis, carpal tunnel syndrome, and glenohumeral, knee and hip synovitis were the most frequent alterations in PMR. Enthesitis was relatively rare at any articular site.

Infection of synovial fibroblasts in culture by Yersinia enterocolitica and Salmonella enterica serovar Enteritidis: ultrastructural investigation with respect to the pathogenesis of reactive arthritis

Synovial fibroblasts were infected with Yersinia enterocolitica or Salmonella enterica serovar Enteritidis and analyzed by electron microscopy and fluorescence in situ hybridization. Intracellular bacterial replication was followed by degradation leading to "ghosts" possessing lipopolysaccharides but not DNA. However, single bacteria survived for more than 2 weeks. Therefore, transient intra-articular infection might be the missing link between initial intestinal infection and late synovial inflammation in the pathogenesis of reactive arthritis.

[Experimental study on effect of xinfeng capsule in treating rats' adjuvant arthritis on ultrastructure of synoviocyte and splenic lymphocyte]

OBJECTIVE

To observe the effect of Xinfeng capsule (XFC) on the ultrastructure of synoviocyte and splenic lymphocyte in rat adjuvant arthritis (AA) model.

METHODS

Sixty rats were randomly divided into normal control group, model group, XFC group and Tripterygium wilfordii polycoside (TP) group, 15 in each. Complete adjuvant 0.1 ml was injected into right posterior metatarsus of rats subcutaneously to induce inflammation, except that in the normal control. The ultrastructural change including mitochondria swelling, vacuolation and ridge pathologic change of synoviocyte and splenic lymphocyte was observed by transmission electron microscopy (TEM). The mitochondria lesion rate (MLR) of each group was then calculated.

RESULTS

The swelling degree of right posterior metatarsus in XFC and TP group obviously lowered after treatment (P < 0.05). MLR of synoviocyte in the XFC group and the TP group after treatment was also obviously lower than that in the model group (P < 0.05). MLR of splenic lymphocyte in the XFC group reduced markedly (P < 0.05) after treatment, while in the TP group, the change was insignificant (P > 0.05). In comparison with TP group, the reduction of both MLR of synoviocyte and splenic lymphocyte after treatment in the XFC group was more significant (P < 0.05).

CONCLUSION

XFC could lower the degree of swelling in AA rats like TP did, but XFC could improve ultrastructural change of rat's synovicocyte and splenic lymphocyte better than that of TP, which was likely the morphological basis of XFC's therapeutical effect.

Methotrexate inhibits rheumatoid synovitis by inducing apoptosis

OBJECTIVE

To clarify the pharmacological action of methotrexate (MTX) on the synovium of patients with rheumatoid arthritis (RA) using severe combined immunodeficient (SCID) mice in which human RA synovial tissue had been grafted (SCID-HuRAg).

METHODS

One month after engraftment of human RA tissue into SCID mice, MTX (0.3 mg/kg) was administered orally, then the appearance of apoptosis in the grafted tissue was examined by TdT mediated dUTP nick end labeling (TUNEL) staining and electron microscopy at various time points after MTX administration. In cultured synovial cells, synovial apoptotic changes after MTX treatment were studied by agarose gel electrophoresis and flow cytometric analysis. To compare the histological changes induced by MTX with those induced by other disease modifying antirheumatic drugs (DMARD) and a nonsteroidal antiinflammatory drug, histological examination of the grafted synovial tissues from SCID-HuRAg mice was conducted after 4 weeks of oral administration of MTX (0.3 mg/kg/week), salazosulfapyridine (30 mg/kg/day), auranofin (0.2 mg/kg/day), bucillamine (10 mg/kg/day), or indomethacin (2 mg/kg/day).

RESULTS

A significant decrease in the number of inflammatory cells was observed in the grafted synovial tissue of MTX treated SCID-HuRAg. A similar antiinflammatory effect was not observed with the other DMARD. Induction of apoptosis was noted with MTX treatment but not with the others. The pro-apoptotic effect of MTX was also observed in synovial cell cultures.

CONCLUSION

MTX induces apoptosis in RA synovium that, in turn, may contribute to its antiinflammatory effect on RA synovitis.

Meniscus and synovial membrane: an electronmicroscopic study on rabbits

Seven healthy mature rabbits were used to study both the surface morphology of the meniscus using both transmission electronmicroscopy (TEM) and scanning electronmicroscopy (SEM) and articular cartilage of the femoral condyle using SEM. Results showed that the membrane covering the meniscus was structurally the extension of synovial membrane of the knee joint capsule. Additionally, the presence of canal-like openings over the membranes surface to the meniscus was noted, which were absent over the articular cartilage surface.

Osteoclast-like cells in an in vitro model of bone destruction by rheumatoid synovium

OBJECTIVE

Osteoclasts may be involved in the process of rheumatoid bone destruction. To test this hypothesis, we developed an in vitro model of bone destruction by osteoclast-like cells derived from cultured rheumatoid synovial tissue without using any inducers.

METHODS

Synovial tissues were obtained from rheumatoid arthritis and osteoarthritis patients and tissue pieces of about 2 mm(3) that contained synovial lining were cultured. Multinucleated cells derived from cultured synovial tissues were studied cytochemically and morphologically for osteoclast-specific markers.

RESULTS

Fibroblast-like and macrophage-like cells from the tissue pieces proliferated in the coexistence of lymphocytes. After 14 days of culture, multinucleated cells with tartrate-resistant acid phosphatase activity appeared. These cells expressed vacuolar H(+)-ATPase, the vitronectin receptor and cathepsin K. Although binding of (125)I-labelled salmon calcitonin was very low, the cells contained ringed structures of F-actin and showed strong bone-resorbing activity on ivory slices. Proliferation of macrophage-like cells and formation of multinucleated cells continued during 6 months of culture in the presence of fibroblast-like cells. The bone-resorbing activity of multinucleated cells derived from rheumatoid synovial tissue was much higher than that of cells from osteoarthritis synovial tissue, and was related to the disease activity of rheumatoid arthritis.

CONCLUSION

Our culture system reproduced in vitro the process of bone destruction by rheumatoid synovium, including the proliferation and fusion of precursor cells, polarization, activation and bone tissue resorption. This system may provide a tool for understanding the mechanisms of bone destruction in rheumatoid arthritis and for the development of new therapies to prevent bone destruction.

Ultracytochemistry of glycosaminoglycans in the canine knee synovium

The accurate localization and nature of glycosaminoglycans (GAGs) in the canine knee synovium were studied by ultracytochemical methods that involved high or low iron diamine-thiocarbohydrazide-silver proteinate (physical development) staining in combination with enzyme digestion control procedures. The results obtained indicated that heparan sulfates and hyaluronan were present mainly in the plasma membrane of the B (fibroblast-like) cells. In contrast, the plasma membrane of the A (macrophage-like) cells showed negative reactions after the histochemical examination. Dermatan sulfates, chondroitin sulfates (A and/or C) and hyaluronan were localized in the extracellular matrix of the synovial intima, whereby dermatan sulfates were confined to the fibrous component, whereas chondroitin sulfates and hyaluronan were found in the interfibrous matrix. Heparan sulfate was the only notable GAG molecular species localized in the basement membrane of the capillary wall. It is obvious that differences in the quality and localization of glycosaminoglycans in the canine synovial tissue are of specific interest in understanding normal functions as well as pathological alterations of the knee synovium in mammals.

The role of hyaluronic acid in protecting surface-active phospholipids from lysis by exogenous phospholipase A(2)

BACKGROUND

This in vitro study aimed to elucidate the extent and kind of involvement of hyaluronic acid (HA) in the currently accepted view of synovial joint lubrication, in which surface-active phospholipids (SAPL) constitute the main boundary lubricant. The integrity of SAPL is apparently threatened by the lysing activity of phospholipase A(2) (PLA(2)).

METHODS

The effects of increasing concentrations of HA degraded by free radicals and non-degraded HA on the lysing activity of PLA(2) were examined in vitro. Liposomes (lipid model membrane) containing phosphatidylcholine (PC) were used as the substrate, on the assumption that they are appropriate representatives of SAPL.

RESULTS

HA adhered to the phospholipid membrane (liposomes), inhibiting their lysis by PLA(2). However, in its degraded form, HA not only failed to inhibit PLA(2)-lysing activity, but accelerated it.

CONCLUSIONS

It is reasonable to assume that HA plays an important indirect role in the steady state of the boundary lubrication process of joints by protecting SAPL from being lysed by PLA(2). However, as excessive loading generates free radicals within the joint (among other effects), the HA that is degraded in this way is incapable of protecting SAPL from lysis by PLA(2). When the rate of degradation exceeds that of synthesis, there will be insufficient replacement of HA and/or SAPL, resulting in denudation of the articular surfaces. These are then exposed to increasing friction, and hence increased danger of degenerative joint changes.

Can the human intervertebral disc be compared to a diarthrodial joint?

The joint between human vertebral bodies is traditionally classified as a symphysis, a major cartilaginous synarthrosis. However, it has been suggested by some authors to compare the intervertebral disc (IVD) to a diarthrodial joint. The bases of this comparison are reviewed and discussed. In his description of 1895, Luschka saw the IVD as a diarthrodial joint containing articular cartilages and synovium in the annulus fibrosus. Subsequently, histologic and ultrastructural investigations into the cells and extracellular matrix of the nucleus pulposus (NP) supported the same hypothesis. More recently, the appearances of the IVD in magnetic resonance imaging (MRI) and discography, as well as clinical considerations were interpreted in the same way to simplify understanding of IVD pathology. However, a number of objections involving general, morphological, embryological, biochemical, histologic, radiological and clinical considerations demonstrate the limitations of this hypothesis. The general structural and mechanical principles of joint classification are mentioned to highlight the basic differences between the IVD and a synovial joint. An overview of the development of these joints, and a review of the literature dealing with ultrastructural aspects of the NP, with histopathological studies of the IVD, and with the normal appearance of the IVD on MRI and its age-related changes has led us to refute the hypothesis of this analogy. The IVD cannot be compared to a synovial joint, explaining why most of its pathologic features are quite different from those of a joint of the appendicular skeleton.

In vitro loading of human synovial membrane with 5-hydroxydopamine: evidence for dense core secretory granules in type B cells

Ultrastructural studies of the synovial membrane were performed on tissue samples obtained from the human lumbar facet joint. Ultrastructural changes in synoviocytes were studied after loading synovial samples with 5-hydroxydopamine (5-OHDA) in an oxygenated Krebs' solution, prior to fixation. Synoviocytes were set loosely in the intimal matrix and classified into type A (phagocytic) and type B (secretory) cells. In general, type A cells populated the surface of the synovial lining, whereas type B cells were located deeper in the tissue, extending a process into the synovial fluid. Type B cells in control samples contained sparse secretory granules. Free nerve endings were not found in the synovial intima. In response to incubation in 5-OHDA, a precursor of biogenic monoamines, synoviocytes clustered and established contact. The ultrastructure of type B cells in the loaded group clearly differed from controls. They possessed typical membrane-bound vesicles, containing an electron dense interior surrounded by a lucent space. The size of these dense core vesicles ranged from 100 to 260 nm (on average 180 nm). They were in relation to microtubules and located preferentially in the marginal area of the cytoplasm, close to the Golgi complex. The ultrastructure of type A cells was not significantly altered. The present observations provide morphological evidence for the amine-handling properties of type B cells, indicating that they might be added to the list of 'APUD' cells of the diffuse neuroendocrine system. A recepto-secretory function for type B cells is discussed.

Arrangement of D-periodic collagen fibrils and association of proteoglycans with fibrils in the synovium of the mouse temporomandibular joint

The present study was performed to examine changes in the arrangement of D-periodic collagen fibrils in the synovium of the growing temporomandibular joint in mice. At 1 week of age, the mandibular condyle was undeveloped, and only a few collagen fibrils were recognizable in the subintimal layer of the synovium. At 8 weeks, the mandibular condyle was structurally developed with an increase of collagen fibrils in the synovium; a fully mature condyle was observed at 6 months of age. The close association of proteoglycans with collagen fibrils in the synovium of the growing joint was examined by both conventional and energy-filtering transmission electron microscopy of cupromeronic blue-stained specimens. Proteoglycans were associated with D-periodic collagen fibrils in the short filamentous form in random fashion at 1 week of age, but in a regular pattern with D-periodicity at 6 months. These associations in the synovium could be correlated with the mechanical character of the temporomandibular joint.

The microanatomy of the rhesus monkey temporomandibular joint

PURPOSE

The objective of this study was to describe and compare the histology of the rhesus monkey temporomandibular joint (TMJ) with that of the human joint.

MATERIALS AND METHODS

Seventeen rhesus monkeys (Macaca mulatta) with an age range from 4 to 11 years were used. Both TMJs of the first animal and the left TMJs of the remaining 16 animals were used for this study. The joint specimens were sectioned sagittally and processed for light and electron microscopic studies.

RESULTS

The rhesus monkey TMJ consists of the condylar, glenoid fossa, and articular disc components. The histology of these components is described at the light and electron microscopic level.

CONCLUSIONS

The monkey TMJ was found to be anatomically similar to the human joint. It was concluded that the rhesus monkey is one of the most suitable animal models for studies involving the TMJ.

[Histological and ultrastructural characteristics of interface membrane around aseptically loosened prostheses]

OBJECTIVE

To investigate the effect of wear particles on prosthetic loosening by analyzing the histological and ultrastructural characteristics of interface membrane around aseptically loosened prostheses.

METHODS

Slices of interface membranes around aseptically loosened hip prostheses of 51 cases were stained with HE, Safranin O-Briliant green and CD68 Mab immunohistochemical technique respectively. The histological structure of the membranes and the kinds of wear particles and their distribution characters were observed. The size of particles and the number of CD68 positive cells were measured. Ultrastructure of cells in the membrane and the characters and size of the particles phagocytozed by M phi were also observed and measured.

RESULTS

Interface membrane consisted of fibromatrix, fibroblasts, M phi[CD68 positive, occupying (23 +/- 5)% (x +/- s)], and foreign body giant cells. In the membranes at the site of osteolysis, great amount of UHMWPE particles, PMMA particles and Ti alloy or CoCr alloy particles collected at the side attaching to the implant and caused chronic foreign body inflammatory reaction. Most of the particles outside M phi were less than 15 microns while that inside M phi were less than 1 micron. Different kinds of wear particles could exist in the lysosomes of one M phi. No particles but cartilage-like tisses appeared in the membranes at the site without osteolysis.

CONCLUSION

Wear particles in the interface membrane have relations with osteolysis and fibrous tissue proliferation at bone-implant interface, which plays an important role in aseptic loosening.

Morbidity and mortality associated with a new mycoplasma species from captive American alligators (Alligator mississippiensis)

Nine of 74 American alligators (Alligator mississippiensis) from a captive Florida herd of 3-4-m-long, 200-350-kg, adult males greater than 30 yr of age died within a 10-day period during 1995. Nonspecific clinical signs included anorexia, lethargy, muscle weakness, paraparesis, bilateral white ocular discharge, and various degrees of periocular, facial, cervical, and limb edema. Pneumonia, pericarditis, and arthritis were found on postmortem evaluation of the spontaneously dead and euthanatized alligators. Rapidly growing mycoplasmas were identified by culture, and mycoplasma nucleotide sequences were identified by polymerase chain reaction testing of fresh lung and synovial fluid from an affected alligator. Culture of banked frozen lung from necropsy specimens and fresh lung and fresh synovial fluid from newly affected alligators confirmed the presence of a new mycoplasma species in seven of eight individuals. Oxytetracycline was administered, but related deaths continued for 6 mo until only 14 of the initial alligators remained. An enzyme-linked immunosorbent assay to detect antibody was developed, and the organism was transmitted experimentally to naive juvenile alligators, although the source of the organism, Mycoplasma sp. (ATCC 700619), has not been identified. The alligator isolate is a novel species in the mycoplasma family because its nucleotide sequence does not match those of over 75 characterized mycoplasma species. Such factors as population density, animal age, and mycoplasmal virulence likely contributed to the course of disease.

Advances in the biology of zone II flexor tendon healing and adhesion formation

There has been dramatic improvement in the results of zone II tendon surgery in the last three decades. This improvement was brought, to a great extent, by the better understanding of the mechanisms of tendon healing. This article provides an overview of the mechanism of intrasynovial tendon healing, the role and origin of fibroblasts, and the effects of extracellular components and various growth factors on tendon healing. It also sheds light on the incidence and significance of tendon adhesions. An account of the ultrastructure of the synovial sheath is presented.

Gap junctions in human synovial cells and tissue

Our objective was to establish the existence of intercellular communication through gap junctions in synovial lining cells and in primary and passaged cultures of human synovial cells. Communication between cells was assessed using the nystatin perforated-patch method, fluorescent dye transfer, immunochemistry, transmission electron microscopy, and immunoblotting. Functional gap junctions were observed in primary and passaged cultures and were based on measurements of the transient current response to a step voltage. The average resistance between cells in small aggregates was 300 +/- 150 MOmega. Gap junctions were also observed between synovial lining cells in tissue explants; the size of the cell network in synovial tissue was estimated to be greater than 40 cells. Intercellular communication between cultured cells and between synovial lining cells was confirmed by dye injection. Punctate fluorescent regions were seen along intercellular contacts between cultured cells and in synovial membranes in cells and tissue immunostained for connexin43. The presence of the protein was verified in immunoblots. Regular 2-nm intermembrane gap separations characteristic of gap junctions were seen in transmission electron micrographs of synovial biopsies. The results showed that formation of gap-junction channels capable of mediating ionic and molecular communication was a regular feature of synovial cells, both in tissue and in cultured cells. The gap junctions contained connexin43 protein and perhaps other proteins. The physiological purpose of gap junctions in synovial cells is unknown, but it is reasonable to anticipate that intercellular communication serves some presently unrecognized function.

Carrageenan-induced arthritis in the rat

This study documents a model of carrageenan-induced chronic inflammatory arthritis in the rat, using quantitative histomorphometric assessment. Ten Sprague-Dawley female rats were randomly assigned to one of two groups. Arthritis was induced in the right tibiofemoral joint by 7 intra-articular injections of 0.02 mL of 1% carrageenan in the arthritic group over 24 days. The control (normal) group was injected with 0.02 mL of saline in the right tibiofemoral joint. Sagittal sections of the right knee joint (distal femur and proximal tibia) were assessed by histomorphometry using the LECO 2001 image analysis system. Articular cartilage thickness, epiphyseal plate thickness, subchondral bone plate thickness, trabecular bone volume and thickness of the synovial lining cell layer were measured. Differences between normal and arthritic groups were statistically significant for articular cartilage thickness of the femur, epiphyseal plate thickness of both the femur and tibia, subchondral bone plate thickness of the tibia and the thickness of the synovial lining cell layer. These findings demonstrate that carrageenan-induced arthritic changes are similar to other, established models of arthritis in the rat.

Ultrastructural localization of advanced glycation end products and beta2-microglobulin in dialysis amyloidosis

BACKGROUND

beta2-microglobulin (beta2m) is considered to be the amyloidogenic precursor in dialysis-related amyloidosis (DRA, Abeta2M amyloidosis). beta2m modified with advanced glycation end products (AGE) may be an important factor in the pathogenesis of DRA. The presence of AGE in beta2m-positive amyloid deposits and surrounding macrophages has been demonstrated by immunohistochemical techniques in light microscopy.

METHODS

In order to better define the localization of beta2m and AGE in amyloid deposits and in cells, carpal tunnel connective tissues obtained from surgical specimens in six patients with DRA were studied by immunohistochemistry and electron microscopy, using the avidine-biotine complex and immunogold staining procedures, respectively. A polyclonal rabbit anti-human beta2m and two monoclonal mouse anti-AGE antibodies [AG-1 anti-imidazolone and AG-10 anti-N(epsilon)-carboxymethyl-lysine] enabled us to label their respective antigens at the optical and ultrastructural level.

RESULTS

with both techniques, extracellular amyloid deposits strongly reacted with anti-beta2m and anti-AGE antibodies, although the immunoreactivity of beta2m was more intense. Macrophage-like synovial cells (CD-68 positive) surrounding amyloid deposits were also immunoreactive for beta2m and AGE, which were detected in lysosomes and in intracellular fibrillar material. Anti-AGE reactivity was also evident in collagenous structures in the absence of beta2m or amyloid deposits, supporting the proposal that AGE modification of collagen might have pathogenic relevance in the development of DRA.

CONCLUSIONS

The co-localization of AGE and beta2m, both intra- and extra-cellularly, in amyloid fibrils was confirmed by immunoelectron microscopy; however, the positivity of collagen to anti-AGE antibodies and a different pattern of intracellular localization suggest that molecules other than beta2m may also be modified by AGE and may be involved in the pathogenesis of DRA.

Morphology and functional roles of synoviocytes in the joint

The joint capsule exhibits a unique cellular lining in the luminal surface of the synovial membrane. The synovial intimal cells, termed synoviocytes, are believed to be responsible for the production of synovial fluid components, for absorption from the joint cavity, and for blood/synovial fluid exchanges, but their detailed structure and function as well as pathological changes remain unclear. Two types of synoviocytes, macrophagic cells (type A cells) and fibroblast-like cells (type B cells) have been identified. Type A synoviocytes are non-fixed cells that can phagocytose actively cell debris and wastes in the joint cavity, and possess an antigen-presenting ability. These type A cells, derived from blood-borne mononuclear cells, can be considered resident macrophages (tissue macrophages) like hepatic Kupffer cells. Type B synoviocytes are characterized by the rich existence of rough endoplasmic reticulum, and dendritic processes which form a regular network in the luminal surface of the synovial membrane. Their complex three-dimensional architecture was first revealed by our recent scanning electron microscopy of macerated samples. The type B cells, which are proper synoviocytes, are involved in production of specialized matrix constituents including hyaluronan, collagens and fibronectin for the intimal interstitium and synovial fluid. The proliferative potentials of type B cells in loco are much higher than type A cells, although the transformation of subintimal fibroblasts into type B cells can not be excluded. In some mammals, type B cells show features suggesting endocrine and sensory functions, but these are not recognized in other species. The synoviocytes, which form a discontinuous cell layer, develop both fragmented basement membranes around the cells and junctional apparatus such as desmosomes and gap junctions. For an exact understanding of the mechanism of arthritis, we need to establish the morphological background of synoviocytes as well as their functions under normal conditions.

Immunocytochemical demonstration of heat shock protein 25 in the rat temporomandibular joint

The expression of heat shock protein 25 (Hsp 25) was investigated in the rat temporomandibular joint by immunocytochemistry combined with confocal and electron microscopy. Immunostaining with an antibody to Hsp25 was able to demonstrate various cellular elements in the synovial membrane of the joint. Intense immunoreaction for Hsp25 was recognized in certain cells comprising the synovial lining layer. Confocal microscopic observation revealed two characteristic profiles of the Hsp25-positive cells with cytoplasmic processes: one extended thick and long processes towards the articular cavity, and the other prejected horizontally slender processes which covered the synovial membrane. Under the electron microscope, the immunoreactive synovial lining cells were characterized by a well-developed rough endoplasmic reticulum and secretory granules, suggesting that they can be categorized as fibroblastic type B cells. The covering by the cytoplasmic extensions was confirmed by immuno-electron microscopic observations. This cytoplasmic covering presumably performs a barrier function and expedites the effective secretion/resorption of synovial fluids. Since it has been proposed that Hsp 25 is associated with an estrogen receptor, the immunopositive synovial lining cells were considered estrogen-target cells. Immunoreactivity for Hsp25 was also observed in the chondrocytes of the maturative and hypertrophic cell layers as well as in the cells of the articular disk. A suggestion was made that Hsp25 might be involved in the inhibition of apoptosis of those cells.

Ultrastructural study of cells at the synovium-cartilage junction: response of synovial cells of the rat knee joint to intra-articularly injected latex particles

To study phagocytosis in synovial cells at the synovium-cartilage junction, we used polystyrene latex spheres which induced no infiltration of inflammatory cells into the synovial tissues and observed them for a long term period. The latex bead suspension was injected into the knee joint cavities of 60 day-old male Wistar rats. The animals were then sacrificed at 1, 4, 7, 14, 28 and 56 days after the injections and their synovial tissues including the patellar cartilage were resected for subsequent examination with the transmission electron microscope. On day 1, particles were phagocytised intensively by both type A (macrophage-like) and type B (fibroblast-like) cells. Particles were more numerous in the cytoplasm of type A rather than type B cells. The number of synovial cells containing particles and the number of particles present in these cells decreased remarkably on day 4. By day 7, particles were also observed in the tendon. On day 14, particles were observed in the cytoplasm of chondrocyte. It was noted that particle density within cells began to increase again after day 28. On day 56, numerous particles were observed in type A and type B cells and moreover within the intercellular matrix. Even tendon cells actively engulfed the particles. The results of the present study suggest that both type A and B synovial cells, chondrocytes and tendon cells possess the ability to phagocytise foreign materials. Moreover, the possibility is proposed that the synovium-cartilage junction is the point where the synovial fluid exits and particles drain via the blood circulation.

Three-dimensional ultrastructure of synoviocytes in the horse joint as revealed by the scanning electron microscope

The synovial membrane displays a superficial cellular lining composed of two types of synoviocytes: "absorptive" macrophages (type A cells) and "secretory" fibroblast-like cells (type B cells). The types are intermingled and extend a variety of processes, rendering the cellular architecture of the synovial membrane difficult to visualize. Previous electron microscopic and histochemical studies failed to demonstrate the entire shape of synoviocytes, except our immunohistochemical study for protein gene product 9.5 in the horse joint. The present SEM study is the first to demonstrate the three-dimensional ultrastructure of synoviocytes as well as their distribution in the synovial membrane, using macerated samples from the horse carpal joints. The equine synovial membrane was largely covered by conspicuously developed synovial villi. Type A synoviocytes were closely similar to macrophages in regard to surface structure, and showed uneven distribution with the densest occurrence around the tips of the synovial villi. In the basal half of villi, type B synoviocytes, which were situated in close proximity to the synovial cavity, projected thick processes horizontally and intertwined to form a regular network of processes on the synovial surface. Those in the upper half of the villi were located in the abluminal layers and protruded an antenna-like process into the joint cavity with tips covered with long microvilli, in addition to forming the superficial plexus of processes. Type B cells were also provided with fine, membranous extensions that tended to cover the surface of synovial intima. The meshwork of horizontal processes, the antenna-like processes, and the membranous processes imply advantages in not only secretion but also sensation and regulation of the barrier function in the synovial membrane.

Polyester fibre prosthetic anterior cruciate ligament implant rupture: necrosis of ingrown connective tissue

AIMS

To describe the histopathological and microanalytical features in seven cases of ruptured Apex(R) polyester (Terylene(R)) fibre anterior cruciate ligament prosthesis.

METHODS AND RESULTS

Transmitted and polarized light microscopy was performed in all cases; one case was investigated by immunohistochemistry, transmission electron microscopy and scanning electron microscopy, with backscatter and X-ray detectors for elemental microanalysis. For comparison we also studied synovial biopsy material and unused polyester fibres. In the excised ligaments there was much ingrowth of fibrous tissue accompanying a florid giant cell reaction to the individual intact polyester fibres throughout the ligaments. Phagocytosis of particles of prosthesis-derived material was demonstrated and a striking finding was of necrosis of the ingrown connective tissue in the central portions of the ligaments. Hyalinized areas and 'neoligament growth' were less striking. A consistent finding in the polyester fibres was of small particles containing antimony, used as a catalyst in the manufacturing process.

CONCLUSIONS

The pattern of reaction to the prosthetic material and the presence of necrosis differ from previous descriptions in animal and human explants of this and other prosthesis types. The mechanical effect of the necrosis is unlikely to be of significance with this ligament, which is load-bearing ab initio.

alpha-smooth muscle actin and contractile behavior of bovine meniscus cells seeded in type I and type II collagen-GAG matrices

Many types of injuries to the meniscus of the knee joint result in defects that do not heal, leading to pain and dysfunction. Several ongoing investigations are developing porous absorbable matrices to be used alone or seeded with cultured cells to facilitate regeneration of this tissue. The objective of this study was to evaluate in vitro the contractile behavior of meniscal cells seeded in type I and type II collagen matrices. In many connective tissues, fibroblasts that have assumed a contractile phenotype (myofibroblasts) have been found to play an important role in healing and in pathological conditions. This phenotype, if expressed by meniscal cells, could affect their behavior in cell-seeded matrices developed for tissue engineering. In this study, the presence of a contractile actin isoform, alpha-smooth muscle (alpha-SM) actin, was assessed by immunohistochemistry in normal calf meniscal tissue and in meniscal cells in 2- and 3-dimensional culture. Calf meniscus cells were seeded in type I and type II collagen-glycosaminoglycan (GAG) matrices. The diameter of the matrices was measured every 2-3 days. Immunohistochemical staining of the 2-dimensional cultures for alpha-SM actin was performed after 1, 3, and 7 days and the staining of the seeded matrices was at 1, 7, 14, and 21 days. Transmission electron microscopy (TEM) was performed on selected samples. After 3 weeks the seeded type I matrices displayed a significant shrinkage of almost 50% whereas the type II matrix and both types of unseeded controls showed almost no contraction over the same time period. Positive staining for the alpha-SM actin phenotype was seen in 10% of the cells of the normal tissue but was present in all cells seeded in monolayer and in both types of matrices. TEM of representative cell-seeded matrices showed microfilaments approximately 7 nm thick, consistent with the myofibroblast phenotype. This is the first report of alpha-SM actin containing cells in the knee meniscus. The finding that, under certain conditions, meniscal cells can express the myofibroblast phenotype warrants study of their role in meniscal healing and the tissue response to implants to facilitate tissue regeneration.

Immunocytochemical demonstration of laminin in the synovial lining layer of the rat temporomandibular joint

This immunocytochemical study describes the distribution of laminin in the synovial lining of the rat temporomandibular joint. Laminin immunostaining was present around some synovial lining cells and blood vessels. Ultrastructurally, immunoreactive products for laminin were deposited around cells with a well-developed rough endoplasmic reticulum and secretory granules, suggesting that they were type B synovial lining cells. The localization of laminin immunoreactivity was not uniform around the cell membrane, the most intense immunoreaction being present on the basal aspect membrane as is seen in the basement membrane of epithelia. In contrast, macrophage-like synovial lining type A cells did not show laminin immunoreactivity. This different immunostaining pattern suggests that laminin acts as an adhesion molecule for the type B cells in their epithelial-like arrangement.

Normal structure and morphological effects of a corticosteroid on the peripatellar synovial membrane of the rat

We observed the peripatellar synovial membranes of normal and betamethasone-treated rats with a scanning electron microscope (SEM), light microscope (LM) and transmission electron microscope (TEM). On the basis of SEM findings, the peripatellar synovial membrane is divided into two distinct regions; an upper, smaller, round, non-folded region which is covered with small excrescences, and a lower, larger, horseshoe-shaped region which has numerous folds consisting of cobblestone-like oval cells. These SEM findings were well confirmed by parallel LM and TEM observations of both regions. The synovial membrane of rats treated with intra-articular injections of betamethasone, an anti-inflammatory agent for rheumatoid arthritis, showed cell-sized excrescences on the surface of the non-folded regions. Under LM and TEM, the synovial membrane of treated rats showed an expansion of the intercellular spaces with collagen fibers, swelling of vacuoles in the cytoplasm in the type M synoviocytes, and increases in the number and elongation of microvilli of the type M synoviocytes. These observations suggest that repeated betamethasone injection therapy may result in unnecessary damage to the synovial membrane.

Activation of Sp1 and its functional co-operation with serum amyloid A-activating sequence binding factor in synoviocyte cells trigger synergistic action of interleukin-1 and interleukin-6 in serum amyloid A gene expression

The serum amyloid A (SAA) protein has been implicated in the progression and pathogenesis of rheumatoid arthritis through induction of collagenase activity in synovial fibroblast cells that line the joint tissues. We demonstrate that SAA is synergistically induced in synovial cells by interleukin (IL)-1 and IL-6 that are present at significantly high level in the synovial fluid of arthritis patients. These cytokines induced phenotypic changes in synovial cells, promoting protrusion and increased cellular contact. Induction of SAA under this condition is mediated by promoter elements located between -254 and -226, which contains binding sites for transcription factors Sp1 and SAA activating sequence binding factor (SAF). Mutation of these sequences abolishes SAA promoter response to IL-1 and IL-6. The role of Sp1 in SAA induction was demonstrated by increased DNA binding activity, phosphorylation, and increased protein content of Sp1 during cytokine treatment. Sp1 interacts with the SAA promoter in association with SAF as an SAF. Sp1 heteromeric complex. Furthermore, using a phosphatase inhibitor, we demonstrated increased transactivation potential of both Sp1 and SAF as a consequence of a phosphorylation event. These results provide first evidence for cytokine-mediated activation of Sp1 in synovial fibroblast cells and its participation in regulating SAA expression by acting in conjunction with SAF.

Ultrastructural study on adhesions in internal derangement of the temporomandibular joint

PURPOSE

This study examined the ultrastructural characteristics of adhesions in the upper joint compartment of temporomandibular joint (TMJ).

MATERIALS AND METHODS

Tissue biopsy specimens of adhesions were obtained during arthroscopic operation on 36 joints in 22 patients with internal derangement (ID). The biopsy specimens were examined by light and transmission electron microscopy.

RESULTS

Adhesions were grossly divided into two types based on arthroscopic observation: 1) a band-like type, which connected the articular fossa and TMJ disc, and 2) a pseudowall-like type, which faced the synovial fluid and was lined by articular tissue. Two types of collagen arrangement were observed at the electron microscopic level: orderly arranged collagen bundles and randomly arranged collagen bundles. Orderly arranged collagen bundles were prominent in the band-like adhesions. In pseudowall-like adhesions, mainly the randomly arranged collagen bundles were seen. However, in some dense fiber parts, orderly arranged collagen bundles also were observed. In other pseudowall-like adhesions, only orderly arranged collagen bundles were seen. Elastic fibers were abundant in some pseudowall-like adhesions with randomly arranged collagen bundles. There were no elastic fibers in the band-like adhesions, some dense fiber parts of the pseudowall-like adhesion, pseudowall-like adhesions consisting of only orderly arranged collagen bundles, and in the synovial membrane.

CONCLUSION

The different arrangement of collagen fibers and presence or absence of elastic fibers were observed in the two types of adhesions. These findings served to show that extracellular components correspond to a dysfunction involving an ID of TMJ.

Distribution and characteristics of synoviocytes in the rabbit knee joint: a scanning/transmission electron microscopic study

The distribution and the characteristics of A and B synoviocytes were investigated using scanning and transmission electron microscopy in the study of the three types of synovial membranes (fibrous, areolar, adipose) of the rabbit knee joint. The scanning electron microscope showed that the B-synoviocytes had dendritic processes and were separated by wide spaces in the fibrous synovium. The areolar synovium was covered by numerous B-synoviocytes of fibroblastoid-shape. The B-synoviocytes of the adipose synovium were characterized by short cytoplasmic processes. The transmission electron microscope revealed that the B-cells showed signs of intense synthetic activity such as the presence of an evident rough endoplasmic reticulum, the Golgi apparatus and many peripheric vesicles. Our study also revealed that cells with morphological and ultrastructural characteristics of macrophages, the so-called A-synoviocytes, were present in the areolar membrane. We concluded that B-synoviocytes can show variable shape under normal conditions: in particular, dendritic morphology seems to be a normal characteristic of the synoviocytes of the fibrous membrane. Moreover, our results demonstrate that A and B synoviocytes are ultrastructurally and morphologically distinct cells and that each type has different functions.

Immunocytochemical demonstration of the synovial membrane in experimentally induced arthritis of the rat temporomandibular joint

The present study is first to report an experimental model of adjuvant-induced arthritis in the rat temporomandibular joint (TMJ). Arthritis was induced by simultaneous intradermal administrations of Freund's complete adjuvant, one at the parietal scalp and the other at the base of the tail. In this model, we demonstrated responses of the synovial membrane by immunocytochemistry using antibodies to OX6 and ED1 which recognize Ia antigen in MHC class II antigen-expressing cells and the macrophage/monocyte lineage, respectively. Three weeks after administration, no remarkable signs of inflammation were macroscopically recognizable in the TMJ, but microscopically the synovial membrane in the TMJ revealed marked changes such as enhanced vascularization and hemostasis in the sublining layer and a thickening in the synovial lining cell layer. Intense OX6-immuno-reactivity was found in the synovial lining cells at lesions in the experimental group but not in the control group. Immunoelectron microscopy revealed that these OX6-immunopositive synovial lining cells developed dense cytoplasmic processes and numerous vacuoles and vesicles, resembling type A cells. Part of the type A cells also showed ED1-immunoreactivity. The expression of OX6 or ED1 immunoreactivity in the synovial lining cells might be involved in the initial immune responses in this arthritis model because the synovial membranes are exposed to the synovial fluids which have been believed to contain antigenic substances.

Regenerating synovial lining of the normal rabbit knee: a scanning electron microscopy study

Regeneration of the synovial lining in the synovectomized rabbit knee was studied using the scanning electron microscope. The resected synovia regenerated considerably 3 weeks after synovectomy. However, 44 weeks following excision, their surface morphology was still very different from that of the normal tissue of intact animals. The regenerated synovia were characterized by three main features: the large number of various patterns, the many fields harboring fibrillation and the almost total lack of a bubble layer (the latter was formerly shown to be predominant on normal, intact synovia). The surface morphology of the non-operated (contralateral) knee differed greatly from that of normal synovia. The surface of sham-operated synovia was totally covered by the bubble layer. The appearance of vast fields harboring fibrillations indicated deficient ultrastructural regeneration. The altered surface morphology of the contralateral synovia was a novel finding. We wonder whether it would be appropriate to propose that the systemic reaction induced by synovectomy of the experimental knee initiated the synovial appearances recorded on the contralateral knee. The data reported here rule out the possibility of using the contralateral leg as an intact control.

Effect of particulate bioactive glass on human synoviocyte cultures

Bioglass is a resorbable glass material that has been shown to induce osteoblast proliferation as well as bone matrix production in vitro. Its physico-chemical properties have been reported to be suitable for use as an implant coating for arthroplasty. However, Bioglass is a ceramic material that can fragment into particulate debris in vivo. The effect of particulate Bioglass on tissue cells has not been defined. In order to determine the biologic response to particulate Bioglass, we tested its effect on human synoviocytes in a cell culture model. At the concentrations of 1.0 and 10, micrograms/mL, particulate Bioglass (sizes ranging from approximately 0.5 to 80 microns) had a low cytotoxic effect. However, these concentrations induced secretion of TNF alpha. The observation that particulate Bioglass elicits release of inflammatory cytokines suggests that the development of this bioceramic implant coating should address techniques that would minimize the generation of particulates.

Effect of depletion of glycosaminoglycans and non-collagenous proteins on interstitial hydraulic permeability in rabbit synovium

1. The hydraulic resistance of synovial interstitium helps to retain a lubricating fluid within the joint cavity. The contributions of sulphated glycosaminoglycans to resistance were assessed by selective depletion by chondroitinase ABC, keratanase and heparinases I, II and III in vivo. Also, since glycosaminoglycans do not account fully for the resistance, the contribution of non-collagenous, structural proteins in interstitium was assessed by treatment with chymopapain, a collagen-sparing protease. 2. Ringer solution containing enzyme was injected into the synovial cavity of the knee in anaesthetized rabbits. After >= 30 min the intra-articular pressure was raised and the relation between pressure (Pj) and trans-synovial outflow (Qs) determined. The slope dQs/dPj at low pressures, i.e. below yield pressure, represents the hydraulic conductance of the lining, i.e. 1/resistance. The contralateral joint received Ringer solution without enzyme as a control. Action of enzymes on the tissue was confirmed by histochemical and immunohistochemical studies. 3. Treatment with chondroitinase ABC (5 joints) increased the hydraulic conductance of the lining by 2.3 times (control, 1.34 +/- 0.22 microliter l min-1 cmH2O-1; post-enzyme, 3.11 +/- 0.45 microliter l min-1 cmH2O-1). This was significantly less than the effects of leech, Streptomyces and testicular hyaluronidases, which caused an average 4.7 times increase (P < 0.001, ANOVA). Analogous findings were made above yield pressure. 4. Treatment with keratanase (3 joints) or heparinases I, II and III (3 joints) caused no significant increase in trans-synovial flows or conductance, even though the concentration of heparan sulphate in synovium is higher than that of chondroitin sulphates or hyaluronan. 5. Treatment with chymopapain (7 joints) caused the greatest increases in trans-synovial flow, which exceeded control flow by an order of magnitude in one case. After 0.1 U chymopapain the average conductance was 6.6 times the control conductance below yield pressure. Immunohistochemical studies confirmed that chymopapain treatment removed the synovial proteoglycans. 6. It is concluded that, despite their similar resistivities in vitro, the different glycosaminoglycans do not contribute equally, weight for weight, to interstitial resistance in vivo. Hyaluronan is the dominant glycosaminoglycan governing synovial interstitial resistance. In addition, non-collagenous structural proteins contribute significantly to interstitial resistance.

Synoviocytes from osteoarthritis and rheumatoid arthritis produce plasminogen activators and plasminogen activator inhibitor-1 and display u-PA receptors on their surface

The production of plasminogen activators and their inhibitors was studied in vitro in osteoarthritic (OA) and rheumatoid arthritic (RA) synovial fibroblasts (SF), obtained from RA and OA patients undergoing joint surgery. Subcultured SF were cultivated for 2, 4, 6, 8, 10 and 13 days and the medium assayed for the presence of both plasminogen activators (PAs) and plasminogen activator inhibitor-1 (PAI-1). The presence of urokinase-Plasminogen Activator (u-PA) receptors (u-PAR) on the surface of synovial cells was investigated by radio-ligand binding assay and cross-linking and by transmission electron microscopy (TEM) of a gold-u-PA complex. Our results showed a low production of tissue-type-Plasminogen Activator (t-PA) in both OA and RA SF, but relatively high levels of u-PA, until confluence, both in OA and in RA. SF were also able to produce plasminogen activator inhibitor in large amounts, in particular in RA since the very beginning of the culture. Receptors for u-PA were evident on both RA and OA SF. Our data show that SF in vitro produce mainly u-PA, the most important plasminogen activator involved in tissue modifications. The demonstration of u-PA receptors on the surface of OA and RA SF represents a step forward in the understanding of the possible role of fibrinolytic and tissue destructive proteinase cascade in joint inflammation.

Ultrastructural evaluation of microcirculatory vessels in rheumatoid synovial membrane

Since morphological lesions in microcirculatory vessels are often difficult to be found in the light microscope, the electron microscope investigations were performed on the synovial membrane biopsy specimens from 70 patients with rheumatoid arthritis (RA). Most common lesions referred to venules, capillaries and arterioles were swelling and proliferation of endothelial cells, adherence of lymphocytes, monocytes and neutrofiles to the endothelium, their margination and diapedesis. Also destructive changes in the endothelial cells, basement membrane thickening due to their multiplication and microthrombi were observed. Platelet aggregates, fibrin, fragments of desintegrated cells and deposits of granulofibrillary substance corresponding to fibrinoid necrosis were frequently seen. In 7 patients, lesions of this kind were found only in electronograms. It can be assumed that the evaluation of ultrastructural changes in the microcirculatory vessels may be of great significance as a complementary diagnostic examination in future determination of RA progression and further prognostication.

Time course of apoptosis in collagen-induced arthritis

Recently, apoptotic cells were discovered in the synovial cells of rheumatoid arthritis patients. Their role, however, is unknown. We thus examined the time course of apoptosis in the synovium using an animal model of rheumatoid arthritis, in which arthritis was induced by intracutaneous injection of collagen. No apoptotic cells were detected before the onset of synovitis, but they increased in parallel with the progress of arthritis in its initial period, and decreased in the later chronic stages. Apoptotic cells appear to maintain the homeostasis of a joint when synovial proliferation occurs.

Synovial metaplasia in lipoma

We present a unique case of a lipoma with widespread synovial metaplasia. A 52-year-old woman had a recurrence 1 year after excision of a subcutaneous lipoma of the neck. Histologically, the primary tumor was an ordinary lipoma. The recurrent tumor was a myxoid lipoma with synovial metaplasia. The synovial metaplastic process manifested as labyrinthlike clefts, which were lined by one or more synovial-like cell layers. Ultrastructurally, the synovial metaplastic cell had secretory, phagocytic, and fibroblastlike features.

The innervation of the synovium of the knee joint in the guinea pig: an immunohistochemical and ultrastructural study

The innervation of the knee joint synovial membrane of the guinea pig, i.e., the synoviocyte layer, the subjacent connective tissue and the connective tissue region beneath, was analyzed with immunohistofluorescence and electron microscopy. A screening of the innervation with antibodies against the general axon marker -- protein gene product (PGP) 9,5 -- revealed the presence of nerve fibers distributed in various regions of the knee joint synovial membrane. Confirming previous studies, some of these nerve fibers stained with antibodies to tyrosine hydroxylase (TH), neuropeptide Y (NPY), substance P (SP), calcitonin gene-related peptide (CGRP), and vasoactive intestinal polypeptide (VIP). In addition, dynorphin (DYN)-containing fibers were detected, which have not been reported previously in normal joints. In general, the immunoreactive fibers were observed close to the synoviocytes and at blood vessels. Fibers with colocalization of NPY- and TH-like immunoreactivities (LIs), as well as of DYN- and TH-LIs were demonstrated. In the electron microscope, bundles of unmyelinated fibers as well as single fibers were found in the connective tissue region below the synoviocytes. Varicose parts of the nerve fibers contained mainly small, clear vesicles. Small and large dense-cored vesicles were also seen, but less frequently. Denser portions of the plasma membranes of some axons were observed in these regions, facing the extracellular space. Myelinated fibers were also observed in some nerve bundles. These findings emphasize the complex innervation of the synovial membrane, with nerve fibers containing a host of neuroactive substances. Altogether, these fibers are probably involved in many functions such as vasoregulation and control of synovial secretion in addition to being a source of mediators in joint inflammation.

An immunocytochemical study of the distribution of proline-4-hydroxylase in normal, osteoarthritic and rheumatoid arthritic synovium at both the light and electron microscopic level

The monoclonal antibody 5B5 reacts with the beta subunit of proline-4-hydroxylase, the enzyme which catalyses the formation of 4-hydroxyl proline in collagen and other proteins with collagen-like amino acid sequences. This study aims to assess the production and tissue distribution of this enzyme in normal and diseased synovia from patients with various joint diseases, on the basis that it is a putative marker of collagen-producing cells and, therefore, in this context, of fibroblasts. Sections from five normal, 10 osteoarthritic (OA) and 26 rheumatoid arthritic (RA) synovia were labelled with a mouse monoclonal antibody to proline-4-hydroxylase. The enzyme was found to be expressed by a proportion of synovial intimal cells and by fibroblasts in the underlying connective tissue in normal, OA and RA synovia. Labelling was more pronounced in OA and RA cases. The intimal cells labelling positively showed type B synoviocyte morphology, which was confirmed by subsequent double immunolabelling with 5B5 and antibody against type IV collagen using immunocytochemistry and immunoelectron microscopy.

[Bioassay of TNF-alpha in synovial fluid and ultrastructural observation of synovium from patients with osteoarthritis]

OBJECTIVE

To better define the role of synovium in the pathogenesis of osteoarthritis (OA).

METHODS

We measured the bioactivity of tumor necrosis factor-alpha(TNF-alpha) in synovial fluid (SF) and examined the histologic and ultrastructural features of the synovium from patients with OA and from patients with acute and chronic traumatologic joint.

RESULTS

The results showed that the levels of TNF-alpha in SF from OA were significantly elevated. Marked fibrosis and thickened intima were found in OA synovium, with much dense collagen, which, in some cases, was banded, but no specific inflammatory changes were detected. Type B cells in OA synovium had the characteristics of organelles of cells active in synthesizing and secreting protein. Type A cells in OA synovium had the features of the macrophage.

CONCLUSION

Evident fibrosis in synovium may be either mediated by the cartilage degradation product or by the enhanced joint damage process in OA.

[Ultrastructure of the synovial membrane and the articular cartilage in the temporomandibular joint of the rabbits with occlusal trauma]

OBJECTIVE

To study the effect of occlusal trauma on the ultra structure of rabbits' temporomandibular joints (TMJ) synovial membrane and articular cartilage.

METHODS

TMJs from six rabbits with occlusal trauma and three control rabbits were studied by transmission electron microscopy.

RESULTS

Degenerative changes of TMJ tissues were found. The articular surface of the condyle was damaged, and the chondrocytes showed signs of degeneration. The synovial lining cell consisted of a number of vimentin intermediate filaments (IFs) which were especially prevalent in the processes as well as paranuclearly. Microvilli on the cell membrane were commonly seen. The vermiform body in the deeper interstitium was also found. Our finding of punctate adherens between synoviocytes was firstly reported in the study.

CONCLUSION

The occlusal trauma is really a factor inducing degenerative changes of the TMJ.

Ultrastructural characteristics of the synovial membrane in osteoarthritic temporomandibular joints

PURPOSE

This study analyzed the ultrastructural characteristics of the synovial membrane in various stages of osteoarthritis (OA) of the temporomandibular joint (TMJ), and developed a classification of this involvement based on these morphologic characteristics.

PATIENTS AND METHODS

Synovial membrane biopsies were performed during unilateral arthroscopy in 40 patients. Thirty-one TMJs constituted the OA group; nine TMJs that were not involved by OA constituted the control group. During light microscopic (LM) examination, various variables were recorded and related to the duration of clinical signs and symptoms. Ten synovial membranes from osteoarthritic joints showing histologically visible pathologic changes in various stages and one control synovial membrane were selected for electron microscopic examination.

RESULTS

The initial, early, and intermediate stages of synovial membrane involvement in TMJ OA were characterized by intima hyperplasia. In the initial and early stages, active and hypertrophic intimal cells are found. In the intermediate stage, an increased number of both intracytoplasmic and extracellular filaments was predominant. Fibrosis of the subintimal tissue was initiated by an increased number of active fibroblasts. The late stage of synovial membrane involvement in TMJ OA was characterized by a relatively normal synovial intima of normal thickness, whereas extensive fibrosis was seen in the subintimal tissues.

CONCLUSIONS

Synovial membrane involvement in TMJ OA is characterized by an early proliferative phase with probable growth factor-mediated increases in the cellular activity of the synovial intima cells (resulting in hyperplasia and hypertrophy), of fibroblasts (resulting in increased production of collagen fibrils and fibrosis), and of endothelial cells (resulting in blood vessel growth and hypervascularity). The late phase is characterized by extensive fibrosis of the subintimal tissue, whether caused by sustained production of growth factors or by chronic venous insufficiency, with normal or little cellular activity.