Induction of chondrocyte apoptosis following impact load

Inhibition of caspase-9 reduces chondrocyte apoptosis and proteoglycan loss following mechanical trauma

OBJECTIVE

Chondrocyte death, a notable feature of osteoarthritis, may play a role in the initiation of cartilage degeneration. The present study was aimed at uncovering the nature and involvement of cell death in the initiation of cartilage degeneration induced by mechanical trauma.

METHODS

Articular cartilage discs obtained from healthy skeletally mature horses were subjected to a single-impact load (500 g from 50 mm) using a simple drop-tower device and cultured in vitro for 48 h. Chondrocyte death was examined using two independent methods: transmission electron microscopy and caspase-3 activity assay. To elucidate the signalling mechanisms involved in impact-induced cell death measured by terminal deoxynucleotidyl transferase-deoxyuridine triphosphate (dUTP) nick-end labelling (TUNEL), cartilage discs were incubated with specific caspase-3, -8 and -9 inhibitors prior to impact. Additionally, weight gain and glycosaminoglycan (GAG) release, markers of cartilage degeneration were monitored.

RESULTS

After 48 h, ultrastructural evidence of apoptosis was observed. Caspase-3 was activated after 12h of culture post-impact. When quantified by TUNEL, impact trauma induced death in 52.6% of superficial chondrocytes after 48 h in culture, compared to 4.2% in unimpacted controls. Specific caspases-3 and -9 inhibitors significantly reduced impact-induced apoptosis to 24.3% and 14.7%, respectively. Caspase-8 inhibition had no effect on chondrocyte death (60.3%). Impact-induced GAG release into the medium was significantly reduced by inhibition of cell death, but weight gain remained unaffected by caspase inhibition.

CONCLUSION

These results suggest that impact trauma-induced chondrocyte death is predominantly due to caspase-9-dependent apoptosis and is linked to cartilage degeneration.

Agonistic monoclonal antibody against CD40 receptor decreases lymphocyte apoptosis and improves survival in sepsis

Sepsis causes a marked apoptosis-induced depletion of lymphocytes. The degree of lymphocyte apoptosis during sepsis strongly correlates with survival. CD40, a member of the TNFR family, is expressed on APCs and has potent antiapoptotic activity. In this study we determined whether an agonistic Ab against CD40 could protect lymphocytes from sepsis-induced apoptosis. Secondly, we examined potential antiapoptotic mechanisms of the putative protection. Lastly, we aimed to determine whether anti-CD40 treatment could improve survival in sepsis. CD1 mice were made septic by the cecal ligation and puncture method and treated postoperatively with anti-CD40 Ab. Treatment with anti-CD40 completely abrogated sepsis-induced splenic B cell death and, surprisingly, decreased splenic and thymic T cell death as well (p < 0.001). To investigate the mechanism of protection of anti-CD40 therapy on T cells, CD40 receptor expression was examined. As anticipated, the CD40 receptor was constitutively expressed on B cells, but, unexpectedly, splenic and thymic T cells were found to express CD40 receptor during sepsis. Furthermore, CD4+CD8- T cells were the predominant subtype of T cells expressing CD40 receptor during sepsis. Additionally, the antiapoptotic protein Bcl-x(L) was found to be markedly increased in splenic B and T cells as well as in thymic T cells after treatment with anti-CD40 Ab (p < 0.0025). Lastly, mice that were made septic in a double injury model of sepsis had improved survival after treatment with anti-CD40 as compared with controls (p = 0.05). In conclusion, anti-CD40 treatment increases Bcl-x(L), provides nearly complete protection against sepsis-induced lymphocyte apoptosis, and improves survival in sepsis.

Upregulation of apoptotic and matrix-related gene expression during fresh osteochondral allograft storage

We identified changes in proapoptotic and extracellular matrix-related gene expression with prolonged storage of fresh osteochondral allografts using gene array analysis to better understand the process of graft degradation during storage. Six human distal femurs were obtained according to standard organ harvesting protocol and stored in serum-free allograft media. Each was examined at baseline (within 72 hours postmortem), 21 days (average time of implantation), and 35 days (maximum time to implantation) for proapoptotic and extracellular matrix-related gene expression using two 100-gene microarrays, cell viability using confocal microscopy, and proteoglycan synthesis via SO4 incorporation. We found numerous genes showing upregulation associated with increased storage time, including CD30, CD30 ligand, Fas, Fas ligand, tumor necrosis factor-alpha, and several caspases. Cell viability and proteoglycan synthesis also were significantly decreased with increased storage. Loss of chondrocytes via apoptosis is likely a key determinant of osteochondral allograft viability during storage, whereas extracellular matrix degeneration may occur at a later stage. These findings provide targets for future media modulation. Improved graft viability and the potential for lengthened storage periods through improved storage conditions may improve clinical outcomes and availability of fresh osteochondral allografts.

Pathomechanisms of cartilage destruction by mechanical injury

Mechanical injury is considered to be a major inductor of articular cartilage destruction and therefore a risk factor for the development of secondary osteoarthritis. Mechanical injury induces damage to the tissue matrix directly or mediated by chondrocytes via expression of matrix-degrading enzymes and reduction of biosynthetic activity. As a consequence the mechanical properties of cartilage change. Some of the pathomechanisms of mechanical injury have already been uncovered by the use of a broad range of in vitro-models. They demonstrate that mechanical injury induces tissue swelling and decrease in both the compressive and shear stiffness of articular cartilage, probably due to disruption of the collagen network. Injurious compression induces chondrocyte death by necrosis and apoptosis and the remaining cells decrease their biosynthetic activity. The tissue content of proteoglycans also decreases with time in injured cartilage, and the tissue loses its ability to respond to physiological levels of mechanical stimulation with an increase in biosynthesis. Immature cartilage seems to be more vulnerable to injurious compression than more mature tissue. The expression of several matrix-degrading enzymes like ADAM-TS5 and matrix-metalloproteinases (MMP-1, MMP-2, MMP-3, MMP-9, MMP-13) is increased after injury and may in part be regulated by an autocrine vascular endothelial growth factor (VEGF)-dependent signalling pathway. Apoptosis seems to be mediated by caspase activity and reactive oxygen species. For that reason activation of antioxidative defense mechanisms as well as the inhibition of angiogenetic factors and MMPs might be key regulators in the mechanically induced destruction of cartilage and might be suggested as potential therapeutic interventions. This review summarizes some of the most important data from in vitro injury studies dealing with the pathomechanisms of cartilage destruction.

Pathomechanic determinants of posttraumatic arthritis

The etiology of posttraumatic arthritis is poorly understood. One possible mechanism involves a mechanical insult to the cartilage matrix that affects chondrocyte function. To better understand the etiology of posttraumatic arthritis, pathomechanic changes in articular contact mechanics resulting from injury during physiologic motion and loading need to be determined. Previous studies of injury-associated changes in articular contact mechanics, using static testing methods, have measured relatively modest increases in contact stresses. Static testing cannot measure transient loads associated with motion or loading rates. This testing method poorly simulates normal viscoelastic cartilage properties, and accounts for contact stress changes in a single or limited number of joint positions. In this study, time-variant contact stresses in two ankles with an anterolateral stepoff were measured during quasiphysiologic motion and loading. Contact stresses were integrated over the entire range of motion to estimate pathomechanic loads that accumulate over the entire motion cycle. Numerical techniques were applied to time-variant contact stress data to calculate contact stress directional gradients and contact stress rates of change. Contact stress directional gradients and rates of change were integrated over the complete motion cycle to estimate whole-cycle accumulation of these potential pathomechanic parameters.

Cartilage tolerates single impact loads of as much as half the joint fracture threshold

We hypothesized that one mechanical insult could affect cellular proliferation, matrix turnover, and the structural integrity of cartilage, and that these effects would be dose dependent and time dependent. One impact load of low impact (14.4 MPa +/- 2.1 MPa), medium impact (22.8 MPa +/- 5.8 MPa), or high impact (55.5 MPa +/- 12.6 MPa) was administered to the posterior aspect of the medial femoral condyle of New Zealand White rabbits using a previously validated pendulum device. Animals were euthanized at 2, 6, and 12 weeks after impact, and the impacted and sham (contralateral limb) cartilage were harvested. Each specimen was assessed by light microscopy and by immunohistochemical methods. Although impacted specimens had greater loss of proteoglycan staining than sham cartilage, these changes were neither dose dependent nor time dependent. No structural damage, enzymatic proteoglycan or collagen breakdown, or cellular proliferation was identified in the different impact groups. Articular cartilage is a resilient tissue, particularly in situ, and can tolerate single impact loads of as much as 45% of the joint fracture threshold without considerable disruption or degradation.

Acute effects of cartilage impact

Posttraumatic arthrosis after joint injury occurs as a result of the disruption of the matrix components and chondrocyte death. Matrix components can be disrupted by mechanical and enzymatic means, and proteoglycan loss also has been shown to occur after cartilage injury. Until recently, chondrocyte death has been thought to occur primarily as a result of necrosis. However, new evidence shows that chondrocyte apoptosis can be stimulated to occur as a result of mechanical injury. The role chondrocyte death plays in the development of posttraumatic arthrosis currently is unknown. The development of in vitro cartilage injury models has made it possible to investigate some of the effects of impact load (acute injury) on cartilage. In vivo models of cartilage injury have made it possible to investigate changes in the integrity of the matrix components and of the chondrocytes in response to injury with time. However, considerably more information regarding this process is necessary before improvements in the prevention and treatment of posttraumatic arthrosis can be developed.