Bone marrow changes in adjuvant-induced and collagen-induced arthritis. Interleukin-1 and interleukin-6 activity and abnormal myelopoiesis

Inflammatory Cell Migration in Rheumatoid Arthritis: A Comprehensive Review

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that primarily affects the joints. Self-reactive B and T lymphocytes cooperate to promote antibody responses against self proteins and are major drivers of disease. T lymphocytes also promote RA independently of B lymphocytes mainly through the production of key inflammatory cytokines, such as IL-17, that promote pathology. While the innate signals that initiate self-reactive adaptive immune responses are poorly understood, the disease is predominantly caused by inflammatory cellular infiltration and accumulation in articular tissues, and by bone erosions driven by bone-resorbing osteoclasts. Osteoclasts are giant multinucleated cells formed by the fusion of multiple myeloid cells that require short-range signals, such as the cytokines MCSF and RANKL, for undergoing differentiation. The recruitment and positioning of osteoclast precursors to sites of osteoclast differentiation by chemoattractants is an important point of control for osteoclastogenesis and bone resorption. Recently, the GPCR EBI2 and its oxysterol ligand 7a, 25 dihydroxycholesterol, were identified as important regulators of osteoclast precursor positioning in proximity to bone surfaces and of osteoclast differentiation under homeostasis. In chronic inflammatory diseases like RA, osteoclast differentiation is also driven by inflammatory cytokines such as TNFa and IL-1, and can occur independently of RANKL. Finally, there is growing evidence that the chemotactic signals guiding osteoclast precursors to inflamed articular sites contribute to disease and are of great interest. Furthering our understanding of the complex osteoimmune cell interactions should provide new avenues of therapeutic intervention for RA.

Surface-bound bovine serum albumin carrier protein as present in recombinant cytokine preparations amplifies T helper 17 cell polarization

Understanding of T helper 17 lineage (T_H17) polarization has been significantly promoted by cell culture experiments that reduce the complexity of the in vivo environment. We here investigated T_H17 amplification by coating of cytokine preparations. Cytokine preparations coated to the surface compared to the same amount given in solution significantly enhanced T_H17 polarization assessed by flow cytometry and interleukin (IL)-17A, IL-17F and RORγt mRNA expression. T cell proliferation and T_H1 polarization were similarly enhanced while T_REG polarization was impeded. T_H17 amplification was replicated by coating the plate with low amounts of FCS or albumin as used as carrier protein for cytokines (0.5 μl 0.1%). It was unaltered by filtration, protein digestion and arylhydrocarbon receptor blockade, not replicated by LPS and independent of integrin stimulation. T_H17 amplification required anti-CD3 stimulation and was T cell intrinsic. Supernatants of CD4⁺ cells polarized on coated cytokine preparations with carrier albumin conferred amplification to fresh splenocytes. Coating markedly elevated CD4⁺ IL-22 mRNA expression and IL-22 blockade significantly reduced T_H17 amplification. Our data show T_H17 amplification by coated albumin in the low amounts present in recombinant cytokine preparations. This unexpected adjuvant like effect underscores the need for controls also for temporal and spatial factors in cell culture.

Charcot stage 0: A review and consideratons for making the correct diagnosis early

Charcot neuropathic osteoarthropathy (CN) is a rare disease (NIDDK, NIH Summary Report Charcot Workshop, 2008) that causes significant morbidity and mortality for affected patients. The disease can result in severe deformities of the foot and ankle that contribute to the development of ulcerations and amputations. Medical advances have failed to find ways to stop the progression of the disease. However, it is known that early detection of the CN has a substantial impact on patient outcomes. CN in the earliest stage is very difficult to recognize and differentiate from other similar presenting diseases. We intend to outline clinical considerations practitioners can use when evaluating a patient with early stage suspected CN.

Oral administration of bovine milk derived extracellular vesicles attenuates arthritis in two mouse models

SCOPE

This study shows the effect of bovine milk derived extracellular vesicles (BMEVs) on spontaneous polyarthritis in IL-1Ra-deficient mice and collagen-induced arthritis.

METHODS AND RESULTS

BMEVs were isolated from semi-skimmed milk by ultracentrifugation and the particle size was around 100 nm by dynamic light scattering and electron microscopy. BMEVs expressed exosome marker CD63, immunoregulatory microRNA's (miR-30a, -223, -92a), and milk-specific beta-casein and beta-lactoglobulin mRNA. In vitro, PKH-67-labeled BMEVs were taken up by RAW264.7, splenocytes, and intestinal cells as determined by flow cytometry and confocal microscopy. IL-1Ra(-/-) mice received BMEVs by daily oral gavage starting at wk 5 till 15 after birth and collagen-induced arthritis mice via their drinking water starting 1 wk before immunization till day 40. Macroscopically, BMEV treatment delayed the onset of arthritis and histology showed diminished cartilage pathology and bone marrow inflammation in both models. BMEV treatment also reduced the serum levels of MCP-1 and IL-6 and their production by splenic cells. BMEV treatment diminished the anticollagen IgG2a levels, which was accompanied by reduced splenic Th1 (Tbet) and Th17 (RORγT) mRNA.

CONCLUSION

This is the first report that oral delivery of BMEVs ameliorates experimental arthritis and this warrants further research to determine whether this beneficial effect can be seen in rheumatoid arthritis patients.

Inflammatory lesions in the bone marrow of rheumatoid arthritis patients: a morphological perspective

The synovial tissue stands at the epicenter of joint pathology in rheumatoid arthritis (RA). As a primary target of the disease, studies on the synovium have provided invaluable insights into the mechanisms involved in disease pathogenesis. Recent work has, however, revealed the importance of a previously unseen anatomic compartment in direct contact with the joint space, namely the subchondral bone marrow. Bone marrow edema (BME) visible on magnetic resonance imaging (MRI) is clinically meaningful in both early and late RA as it associates with future development of bone erosions and poor functional outcomes. Although the histopathologic correlates of MRI-based BME in early RA remain obscure, studies in advanced disease are consistent in describing lymphocytic inflammatory infiltrates within the subchondral marrow cavity of affected joints. In this review, we discuss the nature of bone marrow lesions in patients with RA, analyze their relationship with synovitis, and explore their potential contribution to the pathological processes of the disease.

Combined labeled leukocyte and technetium 99m sulfur colloid bone marrow imaging for diagnosing musculoskeletal infection

The use of labeled leukocyte (white blood cell [WBC]) studies in the diagnosis of osteomyelitis can be problematic. A combined study consisting of WBC imaging and complementary bone marrow imaging performed with technetium 99m (99mTc) sulfur colloid is approximately 90% accurate and is especially useful for diagnosing osteomyelitis in situations involving altered marrow distribution. There are limitations and pitfalls associated with a combined study. If there is no labeled WBC activity in the region of interest, marrow imaging is not useful. The sulfur colloid image becomes photopenic within about 1 week after the onset of infection, so that the study should be interpreted cautiously in the acute setting. Labeled WBC accumulation in lymph nodes can also confound image interpretation, although nodal activity can usually be recognized because it is typically round, discrete, multifocal, linear in distribution, and often bilateral. Furthermore, 99mTc-sulfur colloid that is improperly prepared or is more than about 2 hours old degrades image quality, potentially causing erroneous conclusions. Nevertheless, WBC-marrow imaging is a very accurate technique for diagnosing osteomyelitis. Knowledge of the criteria for image interpretation and of the aforementioned limitations and pitfalls, combined with careful attention to imaging technique, will maximize the value of this study.

Hypercalcemia in rheumatoid arthritis: relationship with disease activity and bone metabolism

To investigate the relationship between ionized calcium and disease activity, parameters of bone metabolism and bone mineral density (BMD) at the lumbar spine (BMD-LS) and the femoral neck (BMD-FN) measured by dual X-ray absorptiometry in rheumatoid arthritis (RA). In 146 patients with RA, the following parameters were investigated: serum levels of ionized calcium, total calcium, vitamin D metabolites 25-hydroxyvitamin D3 (25D3) and 1,25-dihydroxyvitamin D3 (1,25D3), intact parathyroid hormone (iPTH), interleukin-6, osteocalcin, erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP); renal excretion of pyridinolin (PYD)- and desoxypyridinolin (DPD)-crosslinks. A total of 30.1% of the patients were hypercalcemic (ionized calcium >1.30 mmol/l). In comparison with normocalcemic patients, those with hypercalcemia had significantly higher ESR (P<0.01) and CRP values (P<0.05) and significantly lower serum levels of both iPTH (P<0.01) and 1,25D3 (P<0.05) and a significantly lower BMD-LS (P<0.05). The results indicate that a substantial part of RA patients is hypercalcemic. Hypercalcemia is associated with high disease activity and may contribute to suppression of PTH secretion and vitamin D hormone synthesis. High levels of ionized calcium may be a reflection of disease-activity-related systemic bone loss, and could be a predictor of BMD at the lumbar spine in RA.

Incadronate disodium inhibits joint destruction and periarticular bone loss only in the early phase of rat adjuvant-induced arthritis

Destruction of articular cartilage and subchondral bone loss in the affected joints of rat adjuvant arthritis have never been quantified histologically. This study aimed to evaluate the effect of incadronate disodium on joint destruction and periarticular bone loss, using histomorphometric measurements. Seven-week-old female Lewis rats were injected with 0.1 mg of heat-killed Mycobacterium butyricum into the tail base. Immediately after sensitization, vehicle, or incadronate at 10 or 100 microg/kg per day, was administered subcutaneously, three times per week. Hind-paw volume was measured weekly and the animals were killed at 2, 4, 6, and 10 weeks after sensitization. After taking X-rays, decalcified sagittal sections of the ankle joint were prepared and stained with toluidine blue and tartarate-resistant acid phosphatase. Articular cartilage destruction and subchondral bone loss were evaluated histomorphometrically. At 2 weeks after sensitization, no radiographic or histologic changes were observed. However, at 4 weeks, severe articular cartilage destruction and subchondral bone loss were found in the arthritic control group, while these changes were inhibited dose-dependently by incadronate treatment. At 6 and 10 weeks, both the destructive changes and the bone loss had further progressed, and they were not inhibited by incadronate treatment. Incadronate dose-dependently inhibited articular cartilage destruction and subchondral bone loss at 4 weeks after sensitization in this adjuvant arthritis model. However, the suppressive effects of incadronate did not continue until 6 and 10 weeks.

Bone response to mechanical loading in adult rats with collagen-induced arthritis

To elucidate the effects of inflammation on the response of bone to mechanical stress, we performed experiments using a rat with collagen-induced arthritis (CIA) model. Six-month-old female Wistar rats were used in the experiment. Bovine type II collagen sensitization and additional sensitization after 1 week were preformed in all CIA groups. Loads were applied using a four-point bending device. The right tibia was loaded in both CIA and control (CONT) groups at 35 N (low groups), 40 N (medium groups), or 47 N (high groups) for 36 cycles at 2 Hz three times per week for 3 weeks. Histomorphometrical data were collected from the periosteal and endosteal surfaces of the tibia in all rats. The tibia periosteal surface was subdivided into lateral and medial surfaces. Formation surface (FS), mineral apposition rate (MAR) and bone formation rate (BFR) were calculated. At lateral surface of periosteal surface, all three parameters showed significant differences between the loaded and nonloaded tibiae. All these parameters were significantly lower in CIA groups than in CONT groups, and interaction was seen between applied loading and CIA. There was a significant correlation between peak strain and the right-left difference of FS in the CONT groups. At medial surface of periosteal surface, there were force-related increase in FS, MAR, and BFR on the loaded side in both CIA and CONT groups, except MAR in the CONT group. All three parameters showed significant differences between the loaded and nonloaded tibiae. At endocortical surface, force-related increase was observed only in FS on the loaded side in CONT groups, and FS was significantly higher on the loaded side than the nonloaded side. CIA lowered all three parameters significantly. We examined the response to mechanical loading on the tibia in untreated CONT rats and rats with CIA by bone histomorphometry, and found that arthritis suppressed bone formation induced by mechanical loading.

Immunotherapy in Collagen-Induced Arthritis: Past, Present, and Future

Type II collagen-induced arthritis has played a critical role in the development of novel approaches to the treatment of rheumatoid arthritis. The model has provided insights into autoimmune mechanisms relevant to the pathogenesis of joint disease and permitted the identification of potential targets for arthritis therapy. Notably, the model excelled in the development of cytokine inhibition for rheumatoid arthritis, with investigations demonstrating that a complex network of cytokine interactions regulate the autoimmune response to collagen. Recent studies of collagen-induced arthritis provide indications of novel approaches to disease intervention. New directions include modulation of the recognition and presentation of autoantigens, inhibition of specific T cell subsets responding to autoantigens, blocking of stimulatory cosignals at the cell surface, decoys for cytoplasmic and nuclear activation signals, interference with lymphocyte migration to the synovial joint, and reduction of the mediators of joint destruction. These approaches can be implemented through gene therapy, biological response mediators, or classic pharmacological intervention.

Effect of minodronic acid (ONO-5920) on bone mineral density and arthritis in adult rats with collagen-induced arthritis

OBJECTIVE

To study the effect of minodronic acid (ONO-5920) on bone loss and arthritis in rats with collagen-induced arthritis (CIA) treated according to 2 different schedules.

METHODS

Four groups of female Sprague-Dawley rats (7 months old) were studied: rats without CIA treated with vehicle (controls), CIA rats treated with vehicle (CIA-V), CIA rats treated therapeutically with minodronic acid (CIA-T), and CIA rats treated prophylactically with minodronic acid (CIA-P). Minodronic acid was administered orally at 0.2 mg/kg 3 times a week, beginning 2 weeks after initial sensitization in the CIA-T rats and beginning the day after initial sensitization in the CIA-P rats. Bone mineral density (BMD) was measured by peripheral quantitative computed tomography in the proximal metaphysis and diaphysis of the tibia every 2 weeks until week 8, when the rats were killed. The BMD and bone microstructure of the excised femur were evaluated by dual x-ray absorptiometry and microfocal computed tomography, respectively. Histomorphometry of the proximal tibia was also performed.

RESULTS

In CIA-P rats, the incidence of arthritis and the severity of posterior limb swelling were reduced early after sensitization, and the decrease in BMD was prevented throughout the observation period. Bone and joint destruction evaluated by radiography of the foot was reduced in CIA-P rats. The eroded surface was reduced and the microstructure was maintained in CIA-P rats compared with CIA-V rats. The mineral apposition and bone formation rates were not reduced in the CIA-P rats. In CIA-T rats, however, the inflammation was not suppressed and the inhibitory effect on bone loss was smaller than that in CIA-P rats.

CONCLUSION

Minodronic acid suppressed the decrease in BMD and the deterioration of the bone microstructure caused by arthritis. Prophylactic administration of minodronic acid had a preventive effect on arthritis at the early stage, although not throughout the observation period.

Clonal analysis of B cells in the synovial membrane of patients with rheumatoid arthritis

OBJECTIVE

To investigate the clonal characteristics of B cells in the synovial membranes of rheumatoid arthritis (RA) patients.

METHODS

The clonality of B cells at separate sites of the synovial membrane and other tissues from RA patients were investigated by a reverse transcriptase-polymerase chain reaction with a VH framework 3 consensus primer and a subsequent single-strand conformation polymorphism analysis.

RESULTS

Several dominant bands were observed in all synovial membrane samples and some of the dominants bands were common among the 2 or 3 separate regions of each synovial sample. The persistent existence of clonal B cells was observed in metachronous synovial fluid samples.

CONCLUSION

Infiltrating B cells are oligoclonal and antigen-driven mechanisms may play a role in the generation of clonal B cells in RA synovium. The stable presence of B cell clones in synovial fluid suggests the involvement of these clones in the perpetuation of the chronic inflammation in RA.

Expression of proteinases and inflammatory cytokines in subchondral bone regions in the destructive joint of rheumatoid arthritis

OBJECTIVE

We previously described abnormalities in the bone marrow of patients with rheumatoid arthritis (RA), but were able to shed little light on the pathogenic roles of inflammatory cytokines and proteinases in joint destruction in the subchondral region in RA. This is the first report to describe the co-localization of cytokines and proteinases in this area.

METHODS

Decalcified paraffin-embedded sections from 10 patients with RA and five patients with osteoarthritis (OA) were examined for the immunolocalization of cathepsins B, K and L and the localization of messenger RNAs for interleukin 1beta (IL-1beta), tumour necrosis factor alpha (TNF-alpha) and matrix metalloproteinase 9 (MMP-9). The cells were double-stained with anti-CD68 or anti-prolyl 4-hydroxylase (PH) antibody.

RESULTS

An immunohistochemical study confirmed the expression of cathepsins B and L by CD68-positive mononuclear cells at the sites of significant cartilage and bone erosion from the subchondral region in all RA specimens. Osteoclast-like cells showed intense staining for cathepsin K and MMP-9. Osteoblast-like cells strongly expressed MMP-9. Analysis of serial sections revealed that expression of the IL-1beta and TNF-alpha genes occurred near that of the cathepsins and MMP-9 in the subchondral region.

CONCLUSION

We conclude that inflammatory cytokines and tissue-damaging proteinases play important roles in joint destruction in the subchondral region in RA.

Bone mass changes of tibial and vertebral bones in young and adult rats with collagen-induced arthritis

To study the effect of arthritis on bone mass, bone mineral density (BMD) of cancellous and cortical bone in the tibial metaphysis and diaphysis in 2- and 7-month-old rats with collagen-induced arthritis (CIA) was serially measured using peripheral quantitative computed tomography (pQCT). BMD in the fourth lumbar vertebra in 7-month-old CIA rats was also measured by pQCT. The fourth lumbar vertebral body, distal femur, and proximal tibia in 7-month-old CIA rats were analyzed histomorphometrically. Changes in BMD differed between 2-month-old (young) and 7-month-old (adult) CIA rats. Although the BMD for the proximal tibia (2 mm and 5 mm distal from the growth cartilage) in young CIA rats decreased compared with that in control rats, the values exceeded the initial value during the arthritis course. On the other hand, bone loss in adult CIA rats occurred predominantly in the cancellous bone of the periarticular region of the tibia (2 mm distal from the growth cartilage), in which the enhancement of bone resorption and reduced bone formation were observed histomorphometrically. No remarkable changes were demonstrated in BMD or histomorphometrical analysis for the lumbar vertebra during the experimental course. These results suggest that bone loss in adult CIA rats resembles the osteoporosis that develops during the early stage of human rheumatoid arthritis. We conclude that adult CIA rats are more appropriate than young CIA rats as an experimental model of secondary osteoporosis due to rheumatoid arthritis.

Establishment of nurse-like stromal cells from bone marrow of patients with rheumatoid arthritis: indication of characteristic bone marrow microenvironment in patients with rheumatoid arthritis

OBJECTIVE

To investigate the microenvironment of bone marrow (BM) of patients with rheumatoid arthritis (RA).

METHODS

Nurse cell-like BM stromal cell lines were established from BM mononuclear cells of patients with RA. We examined the various characteristics of these cell lines, including morphology, pseudoemperipolesis activity, cell surface markers, cytokine production and hyaluronan (HA) production.

RESULTS

These RA BM nurse cell-like lines (RA-BMNC) were of mesenchymal origin and positive for CD44, CD54 and HLA-DR. They were defined as nurse cells because of pseudoemperipolesis activity that allowed lymphocytes to migrate underneath. RA-BMNC lines produced HA and multiple cytokines including interleukin (IL)-6, IL-7, IL-8 and granulocyte-macrophage colony-stimulating factor (GM-CSF). HA production by BM stromal cells was correlated with pseudoemperipolesis activity. RA-BMNC produced significantly higher levels of IL-6, IL-8 and GM-CSF by co-culture with lymphocytes. The cells also produced IL-1beta, G-CSF and tumour necrosis factor only when co-cultured with lymphocytes. The RA-BMNC maintained the growth of CD14+ myeloid cells unique to severe RA.

CONCLUSION

The present results both indicate that RA-BMNC are nurse cells and suggest that they may play an important role in the pathogenesis of RA.

Estrogen's bone-protective effects may involve differential IL-1 receptor regulation in human osteoclast-like cells

Declining estrogen levels during the first postmenopausal decade lead to rapid bone loss and increased fracture risk that can be reversed by estrogen replacement therapy. The bone-protective effects of estrogen may involve suppression of inflammatory cytokines that promote osteoclastogenesis and bone resorption, such as IL-1, TNF-alpha, and IL-6. We investigated whether estrogen modulates IL-1 actions on human osteoclasts (OCs) and other bone cell types. Isolated human OCs and primary bone marrow-derived OC-like cells expressed both the signaling (IL-1RI) and decoy (IL-1RII) IL-1 receptors, whereas only IL-1RI was detected in osteoblasts. IL-1RII/IL-1RI mRNA ratios and release of soluble IL-1RII (sIL-1RII) were lower in OC-like cells derived from women in the late postmenopausal period compared with younger women, but were unrelated to male donor age, suggesting that estrogen might play a role in regulating IL-1 receptor levels in vivo. Estrogen directly reduced in vitro OC-like cell IL-1RI mRNA levels while increasing IL-1RII mRNA levels and sIL-1RII release. These estrogenic events were associated with inhibited IL-1-mediated cytokine (IL-8) mRNA induction and cell survival, i.e., increased apoptosis. In contrast, estrogen did not alter IL-1R levels or IL-1 responsiveness in primary human osteoblasts or bone marrow stromal cells. We conclude that one novel mechanism by which estrogen exerts bone-protective effects may include a selective modulation of IL-1R isoform levels in OC or OC-like cells, thereby reducing their IL-1 responsiveness and cell survival. Conversely, this restraint on IL-1 actions may be lost as estrogen levels decline in aging women, contributing to an enhanced OC-mediated postmenopausal bone loss.

Histomorphometric assessment of bone changes in rats with type II collagen-induced arthritis

Numerous studies have demonstrated bone loss in rats following immobilization by tenotomy or nerve sectioning and following ovariectomy. However, few experiments have focused on bone change in rats with arthritis. We investigated bone loss in the proximal tibia and lumbar vertebra in rats with type II collagen-induced arthritis, an experimental model of rheumatoid arthritis, using histomorphometry. Bone loss in the early phase after immunization reflected a significant increase in numbers of osteoclasts and temporarily decreased bone formation. In the proximal tibia, near an arthritic joint, osteoclast numbers associated with bone trabeculae were increased four times over control numbers 4 weeks after immunization. In the lumbar vertebra, where arthritis was not shown, recruitment of osteoclasts occurred later than in the proximal tibia. With time, in both the proximal tibia and lumbar vertebra bone resorption normalized, but bone formation rate and double-label surface by tetracycline, a parameter reflecting bone formation, were increased above control values. We conclude that differences between the proximal tibia and lumbar vertebra probably reflected resumption of function as well as distance from areas of inflammation. These findings indicate that collagen-induced arthritis in rats is a useful model not only of autoimmunity, but also of juxta-articular and generalized osteoporosis in rheumatoid arthritis.

Periarticular bone alterations in chronic antigen-induced arthritis: free and liposome-encapsulated clodronate prevent loss of bone mass in the secondary spongiosa

The long-term effects of acutely administered clodronate (free or liposome-encapsulated) on periarticular bone mass and bone turnover were investigated in chronic antigen-induced arthritis (AIA; day 28). Wistar rats were treated intraperitoneally at 3 h and on days 1, 2, and 7 of AIA, with phosphate-buffered saline (PBS; sham), PBS-containing liposomes, free clodronate, or liposome-encapsulated clodronate (cumulative dose, 3.64 mg/animal). In the primary spongiosa (</=1 mm from the growth plate) sham-treated AIA was associated with a significant decrease (-31%) of trabecular bone volume only; this change was not prevented by any treatment. In the secondary spongiosa (>1.25 mm from the growth plate), sham-treated AIA was associated with: (a) a marked significant decrease in trabecular bone volume (-56%); (b) a significant increase of osteoid-covered surface (+135%); and (c) a numerical increase of resorption surface with osteoclasts (+96%). In the secondary spongiosa, free clodronate completely prevented the loss of periarticular bone mass and selectively normalized the parameters of bone formation (i.e., osteoid-covered surface and osteoid-covered surface with osteoblasts). Clodronate liposomes, in addition to these effects, also significantly suppressed bone resorption (i.e., resorption surface covered with osteoclasts). The effects of clodronate liposomes coincided with in vivo targeting of osteoclasts in primary and secondary spongiosa. Thus, low-dose, acutely administered clodronate, both in free and encapsulated forms, exerts an excellent preventive effect on bone loss in the secondary spongiosa of chronic AIA.

Wax D of Mycobacterium tuberculosis induced osteomyelitis accompanied by reactive bone formation in Buffalo rats

A suspension of heat-killed Mycobacterium tuberculosis in liquid paraffin has been reported to induce foot swelling accompanied by new bone formation in Buffalo (BUF) rats, which are low responders to the induction of adjuvant arthritis. In the present study, we found that wax D, a mycobacterial cell wall peptidoglycan fragment-arabinogalactan-mycolic acid complex, was an effective component of this bacterium for the induction of osteomyelitis accompanied by reactive bone formation in BUF rats. Chronic inflammation was produced in BUF rats by a single subcutaneous injection of wax D suspended in liquid paraffin. Other Mycobacterium species and Gordona bronchialis were also capable of inducing this reaction. Other bacterial cells including the acid-fast bacteria Nocardia and Rhodococcus, purified cell walls and peptidoglycans from Lactobacillus plantarum, wax C, cord factor, arabinogalactan and mycolic acid prepared from M. tuberculosis were inactive in this respect. In addition, when wax D was administered as a water-in-oil emulsion (Freund's type adjuvant), bone formation scarcely occurred in BUF rats. In Fisher (F344) and Wistar rats, both of which are responder strains to adjuvant arthritis, wax D in liquid paraffin did not induce bone formation.

Cytokine and nitric oxide production in the acute phase of bacterial cell wall-induced arthritis

We have investigated the temporal relationship among proinflammatory cytokine expression, nitric oxide (NO) production and joint inflammation in the acute phase of bacterial cell wall-derived peptidoglycan polysaccharide (PG/PS)-induced arthritis. Acute joint inflammation was induced in female LEW/N rats by a single intraperitoneal injection of PG/PS. Arthritis index and paw volume were quantified and joint histopathology was evaluated during acute joint inflammation (0-10 days). Tumor necrosis factor (TNF), interleukin-1 (IL-1) and interleukin-6 (IL-6) were determined by bioassay whereas nitric oxide (NO) was quantified by measuring serum nitrate/nitrite levels via the Griess procedure. We found that serum levels of TNF and serum IL-1 preceded the increase in IL-6 and NO production. Furthermore, the production of these proinflammatory cytokines and NO preceded bone erosion and osteoclast activity. Erosion of subchondral bone preceded pannus formation and cellular synovitis in the acute phase of PG/PS-induced arthritis. The temporal expression of TNF, IL-1, IL-6 and NO suggest a cascade of inflammatory mediators in which monocytes and macrophages respond to PG/PS with enhanced synthesis of TNF and IL-1, which may in turn promote the synthesis of IL-6 and NO. We postulate that one or more of these inflammatory events are responsible for initiating the subchondral bone erosion observed in acute joint inflammation.

Immune ablation and hematopoietic stem cell rescue for severe autoimmune diseases (SADS)

In addition to our center (Northwestern University, Chicago), several institutions in the United States (Fred Hutchinson Cancer Center, University of California at Los Angeles, and Medical College of Wisconsin) and Europe are activating protocols to transplant patients with SADS. In this age of cost-effectiveness, it will be difficult to arrange third-party reimbursement for a hematopoietic stem cell transplant that may lead to medical charges of between $100,000 and $200,000. However, the cost of standard medical care for patients with SADS is not trivial. Dialysis for an SLE patient with renal failure costs $40,000 per year, while the medical resources required to care for a patient with progressive multiple sclerosis may exceed $35,000 per year. Unique BMT regimen-related toxicities may occur, including intracranial hemorrhage in the SLE or rheumatoid arthritis patient who has vasculitis; acute neurologic decompensation in patients with multiple sclerosis, especially if the conditioning regimen contains neurotoxic agents that cross a compromised blood-brain barrier; respiratory failure in patients with myasthenia gravis; and increased renal or pulmonary toxicity in patients with scleroderma and parenchymal fibrosis. Scleroderma-associated gastrointestinal dysmotility and bacterial overgrowth may also lead to greater fungal and bacterial infections [76]. BMT is currently considered appropriate therapy for patients with chronic-phase Chronic myelogenous leukemia (CML) and indolent lymphomas who otherwise have a relatively long life expectancy of 5 and 10 years, respectively. The roughly similar long survival but greater functional impairment of patients with SADS may justify consideration of immune ablation and hematopoietic stem cell rescue.

Changes in urinary deoxypyridinoline level and vertebral bone mass in the development of adjuvant-induced arthritis in rats

This study was designed to determine the effect of bone resorption on the development of generalized osteopenia in adjuvant-induced arthritic rats. Thirty of a total of sixty male SD rats, 6 weeks of age, were injected with killed mycobacterium butyricum suspended in mineral oil into the right hind paw and assigned to six groups of 5 animals each. The other thirty animals served as the age-matched noninjected controls. Animals were sacrificed at 4, 7, 10, 14, 21, and 28 days post-injection after measuring the bilateral hind-paw volumes. Twenty-four-hour urinary samples were obtained before sacrifice and the levels of deoxypyridinoline (D-Pyr) and creatinine (CR) were measured. Plasma intact osteocalcin levels were measured by a sandwich enzyme immunoassay at the start, 14 and 28 days after injection. Bone mineral measurement and histomorphometrical analyses were performed on specimens of the third lumbar vertebral body. On the seventh day after injection, arthritic rats showed significant decreases in the values of bone mineral content (BMC) and density (BMD) when compared to controls. Urinary D-Pyr/Cr ratios, however, did not increase on the seventh day, showing a significant increase on the tenth day after injection. The serum osteocalcin level was significantly reduced on the fourteenth day. The trabecular bone volume (BV/TV) in the arthritic rats showed a significant decrease from the seventh day. The trabecular thickness (Tb.Th) value significantly decreased on the seventh day after injection.(ABSTRACT TRUNCATED AT 250 WORDS)

Neonatal capsaicin pretreatment suppresses intramedullary inflammation in adjuvant-induced spondylitis

In order to investigate the proposed involvement of neuropeptides in musculoskeletal inflammation we pretreated rats, in an adjuvant spondylitis model, with capsaicin, a neurotoxin. Immunohistochemistry showed that administration of capsaicin to newborn rats depleted irreversibly the neuropeptide, substance P. Elimination of capsaicin-sensitive fibres by the neonatal injection of capsaicin did not suppress the peridiscitis of rats in which adjuvant spondylitis was induced at 7 weeks of age. However, elimination of capsaicin-sensitive fibres did suppress the inflammation usually seen in the bone marrow. We speculate that this intramedullary inflammation is normally induced or sustained by capsaicin-sensitive fibres.

Rheumatoid arthritis: opposing actions of haemopoietic growth factors and slow-acting anti-rheumatic drugs

The pathogenesis of rheumatoid arthritis and the mode of action of anti-rheumatic drugs are unknown. This hypothesis proposes that haemopoietic growth factors (colony stimulating factors [CSFs]) have an important role in rheumatoid arthritis as regulators of myelopoiesis and as activators of inflammatory leucocytes. It also suggests that slow-acting anti-rheumatic drugs may work by inhibiting myelopoiesis. This opposition to one of the actions of the CSFs would result in fewer inflammatory cells in the inflamed joints.

Bone morphometric changes in adjuvant-induced polyarthritic osteopenia in rats: evidence for an early bone formation defect

Adjuvant polyarthritis (AP) in rats is known to result in extensive bone loss. This study investigates the mechanisms responsible for the early trabecular osteopenia evaluated at a single point in time--2 weeks after adjuvant injection--in the hindpaw of female Lewis rats using biochemical and histomorphometric methods. At this early point in time, the inflammation was generalized (inflammatory score, 20; albumin/globulin, -80% versus control). Histomorphometric analysis of the noninjected femur showed that the trabecular bone volume was significantly decreased (-28% versus control) in both proximal and distal parts, and the femur growth rate was unaffected. The trabecular osteopenia was associated with a 90% decrease in osteoid surface and a concomitant thinning (-19%) of the trabeculae. Both the double-fluorescence-labeled surface and the osteoblast surface were also markedly decreased (-75%). In addition, the mineral apposition rate was reduced (-50%) and the bone formation rate was decreased by as much as 90%. The trabecular bone volume was decreased in relation with the extent of double-fluorescence labeling (r = 0.38, p = 0.03) and bone formation rate (r = 0.42, p = 0.01), suggesting that the generalized osteopenia resulted from the reduced bone formation. This was associated with a 26% reduction in plasma osteocalcin. Neither the osteoclast surface nor the number of osteoclasts was consistently affected. However, urinary hydroxyproline was increased by 100-200%, which likely reflected the cartilage and bone destruction at the site of injection. The present data show that the early extensive osteopenia observed 2 weeks after AP induction in rats results from defective bone formation with unchanged bone resorption. The role of cytokines in such an inhibitory effect on bone formation remains to be determined.