[Superoxide-dismutase and superoxide-radical-release in rheumatoid arthritis (author's transl)]

The interrelation of glutathione reductase, catalase, glutathione peroxidase, superoxide dismutase, and glucose-6-phosphate in the pathogenesis of rheumatoid arthritis

Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis, a systemic autoimmune disease characterized by chronic inflammation of the synovial joints, ultimately leading to joint destruction and permanent disability, affecting 1% of the world population. Oxidative stress in rheumatoid inflammation, due to the fact that antioxidant systems are impaired in RA and caused by fee radicals, might have an essential role in etiology of RA. This review includes the interrelation of antioxidants against free radicals in RA patients. There is much evidence that antioxidant team that covers glutathione reductase, catalase, glutathione peroxidase, superoxide dismutase, and glucose-6-phopshate destroy reactive oxygen species and other free radicals through enzymatic as well as nonenzymatic means. The change in relative levels of antioxidants vis-à-vis free radical formation and level could be used as indicators for effective and earlier diagnosis of RA.

Comparison of malondialdehyde and hydrogen peroxide modified CuZnSOD by EPR spectroscopy

CuZn superoxide dismutase (CuZnSOD) contributes to the regulation of the steady-state concentration of reactive oxygen species in cells and minimizes pathological consequences induced by these reactive oxygen species. During the exaggerated formation of reactive oxygen species, often resulting from an activation of phagocytotic cells, CuZnSOD is administered with a therapeutic purpose. But inhibition of the endogeneous or administered CuZnSOD by products generated during the process of formation of reactive oxygen species (H2O2, HOCl, .OH, products of lipid peroxidation) might intensify cell damage. In this study, we compared the influence of malondialdehyde (MDA, high reactive molecule formed in lipid peroxidation) and H2O2 (known to inhibit the CuZnSOD) on bovine CuZnSOD. MDA reacted with CuZnSOD. The reaction was found to be both time- and concentration-dependent, which was demonstrated by the formation of fluorophors. EPR spectroscopy revealed that this reaction had no influence on the activity of CuZnSOD since the catalytic centre of the CuZnSOD was not effected by MDA. In contrast, H2O2 modified the catalytic centre which caused an activity decrease.

Decreased plasma superoxide scavenging activity in immunological disorders--carboxyethylgermanium sesquioxide (Ge-132) as a promoter of prednisolone

We investigated so-called superoxide scavenging activity (SSA) of plasma in patients with several immunological disorders, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), polymyo-dermatomyositis (PM), progressive systemic sclerosis (PSS), myasthenia gravis (MG) and autoimmune thyroid disease (AT), using the electron paramagnetic resonance/spin trapping technique. Since carboxyethylgermanium sesquioxide, Ge-132, has been reported to modulate both the immune response and leukocyte functions, we have studied in vivo effect of Ge-132 on plasma SSA and other laboratory parameters in these disorders. The plasma SSA was significantly lower in RA, SLE, PM and PSS, but not in MG and AT, as compared with that in healthy controls. An inverse correlation was observed between plasma SSA and parameters such as erythrocytes sedimentation rates, absolute number of leukocytes, C-reactive protein and serum globulin levels. Furthermore, plasma SSA was significantly decreased in rheumatoid factor-positive patients as compared to negative patients. No correlation was observed between plasma SSA and factors such as ages, sex of patients or the other laboratory parameters, such as serum albumin, triglyceride, cholesterol, hemoglobin and serum iron levels. Patients treated with prednisolone, especially ones with RA, showed an increase of plasma SSA. It appears that Ge-132 promotes prednisolone effects. Our results indicate that a decrease in plasma SSA is not disease specific, but inversely correlates with the severity and activity of inflammation. The methodology to measure plasma SSA presented in this work provides a helpful tool for determining the actual activity of the diseases as well as in vivo studies of antiinflammatory agents.

Active oxygen species, articular inflammation and cartilage damage

Rheumatoid arthritis and osteoarthritis are age-related diseases, in which degenerative changes (arthrosis) and superimposed inflammatory reactions (arthritis) lead to progressive destruction of the joints. Active oxygen species derived from various sources play a role in this process, which may be influenced by appropriate treatment with antioxidants and free radical scavengers.

Oxygen radicals, inflammation, and arthritis: pathophysiological considerations and implications for treatment

A vast amount of circumstantial evidence implicates oxygen-derived free radicals, especially superoxide and hydroxyl radical (and to lesser extent, hydrogen peroxide), as mediators of inflammation and/or tissue destruction in inflammatory and arthritic disorders. The substrates for radical generation, namely properly stimulated phagocytic cells, transition metal catalysts, and (to a limited extent) ischemia, are all amply present, although there is no particular rheumatic disease in which a consistent abnormality of radical generation has been identified. These radical species can clearly degrade hyaluronic acid, modify collagen and perhaps proteoglycan structure and/or synthesis, alter and interact with immunoglobulins, activate enzymes and inactivate their inhibitors, and possibly participate in chemotaxis. In most situations, however, there is ample scavenging ability to detoxify these radicals before they hit their target, and many rheumatic disease drugs can decrease their production and/or effects. Despite the apparent sufficiency of natural scavengers and the lack of direct evidence that oxygen radicals are pathogenetically important, substantial pharmaceutical effort is still being made to develop free radical scavengers as therapeutic agents. Although individual free radicals die out quickly, rheumatologic interest in them has been sustained for nearly two decades.

Superoxide anion production by circulating polymorphonuclear leucocytes in rheumatoid arthritis

In twelve rheumatoid arthritis (RA) patients, receiving only nonsteroid anti-inflammatory therapy, superoxide anion (02-) generation by polymorphonuclear leucocytes (PMNs) was assessed by Cytochrome C reduction. The 02- production by non-activated PMNs in RA patients was significantly higher than in healthy controls. The 02- production by PMNs activated by zymosan and phorbol myristate acetate was significantly lower than in controls. PMNs from controls preincubated with rheumatoid sera generated higher 02- levels than the same PMNs incubated in normal sera.

A comparison of the antioxidant requirements of proteins with those of synthetic polymers suggests an antioxidant function for clusters of aromatic and bivalent sulphur-containing amino acid residues

Many proteins which function in extracellular environments potentially rich in oxygen-derived free radicals contain clustered tyrosine and cysteine residues which, by analogy with the chemistry of antioxidants used with synthetic polymers, may provide an appreciable antioxidant and redox stabilization activity. Such proteins may function as antioxidants, and as ligand binding sites for free radicals and other active molecules employed in normal biochemical processes.

Superoxide dependent iron release from ferritin in inflammatory diseases

Convincing evidence is presented that oxygen free radicals are involved in the pathogenesis of rheumatoid arthritis (RA). Superoxide is produced by polymorphonuclear leucocytes (PMN) in synovial fluid and by macrophages in the synovial membrane. Tissue damage typical for free radical attack is detected in RA. No absolute deficiency of protective factors is found in RA compared to controls, but the available protection is insufficient to cope with all radicals formed. The toxicity of superoxide is increased by iron. It is doubtful whether a low molecular weight iron pool is present. Superoxide is able to release iron from ferritin, providing a suitable source of iron, for the formation of hydroxyl radicals. This new pathogenetic mechanism stimulates to the application of iron chelators in the treatment of RA. Preliminary results with desferrioxamine were disappointing because of serious side-effects. Hopefully in the future intra-articular injection of iron chelators with better pharmacodynamics will be possible. The interaction of free radicals and ferritin is probably also involved in the pathogenesis of other inflammatory diseases such as systemic lupus erythematosus, hepatitis, and haemochromatosus.

Aspects of the structure, function, and applications of superoxide dismutase

The current status of superoxide dismutase (SOD) is that it is an enzyme with diverse ramifications. This review attempts an understanding of SOD as a structural, functional, and biological entity. Accordingly, the review is in three parts. The first part discusses SOD in terms of protein structure, proceeding from primary to secondary and three-dimensional structure for the three forms of SOD: copper/zinc SOD, manganese SOD, and iron SOD. This is the order of structural knowledge of the enzyme. Iron SOD is an enzyme of prokaryotes and some higher plants. Manganese SOD is an enzyme of prokaryotes and eukaryotes. Copper/zinc SOD is an enzyme of eukaryotes and certain prokaryotes. The evolutionary relationships of the three forms of SOD, the status of the copper/zinc SOD gene in prokaryotes, and the cloning and sequencing of SOD genes are discussed. The second part of the review deals with the catalytic mechanism of SOD in the three forms of the enzyme. Structural and mechanistic conclusions from various spectroscopic studies are critically considered. A detailed picture is given of the active site of copper/zinc SOD. The third part is a review of SOD in the general context of oxygen toxicity. After consideration of the question of superoxide toxicity and superoxide pathology, several areas in which SOD has been investigated or used as a tool in a biochemical, pharmacological, or clinical context are discussed, including population genetics; trisomy 21; development and senescence; the nutritional copper, zinc, and manganese status; hemolysis and anemia; oxygen toxicity in the lung and nervous system; inflammation, autoimmune disease and chromosome breakage, ischemia and degenerative changes; radiation damage; and malignancy. A comprehensive picture is given of measurements of SOD activity in disease states, and the question of superoxide-related disease is considered at several points.

Superoxide production by polymorphonuclear leucocytes in rheumatoid arthritis and osteoarthritis: in vivo inhibition by the antirheumatic drug piroxicam due to interference with the activation of the NADPH-oxidase

The superoxide (O2-) production of stimulated polymorphonuclear leucocytes is increased in patients with rheumatoid arthritis and osteoarthritis compared with controls. Treatment of these different groups with pharmacological amounts of the non-steroidal anti-inflammatory drug piroxicam in vivo resulted in a decrease of about 25% in O2- secretion by isolated granulocytes. In vitro experiments showed that piroxicam inhibits O2- production of granulocytes by interference with the stimulation of the NADPH-oxidase. Piroxicam caused diminished O2- production of membrane fragments if it was present during the stimulation of the NADPH-oxidase of the intact cells. During the actual O2- production of the stimulated membrane fragments piroxicam had no effect. It is concluded that piroxicam is able to inhibit granulocyte O2- production by blocking the activation of NADPH-oxidase, which results in diminished tissue destruction by oxygen free radicals in inflammatory diseases.

Inhibition of proteoglycan synthesis by hydrogen peroxide in cultured bovine articular cartilage

Oxygen-derived reactive species, generated enzymatically by the action of xanthine oxidase upon hypoxanthine, significantly inhibit proteoglycan synthesis by cultured bovine articular cartilage (Bates, E.J., Lowther, D.A. and Handley, C.J. (1984) Ann. Rheum. Dis. 43, 462-469). Here we extend these investigations and show, through the use of catalase and the specific iron chelator diethylenetriaminepentaacetic acid, that the active species involved is H2O2 and not the hydroxyl radical. Incubations of cartilage with H2O2 at concentrations of 1 X 10(-4) M and above are also inhibitory to proteoglycan synthesis. Subsequent recovery of the tissue is dependent upon the initial dose of xanthine oxidase or H2O2. Xanthine oxidase at 84 mU per incubation results in a prolonged inhibition of proteoglycan synthesis which is still apparent after 14 days in culture. Lower concentrations of xanthine oxidase (21-66 mU) are inhibitory to proteoglycan synthesis, but the tissue is able to synthesise proteoglycans at near normal rates after 3 days in culture. The inhibition of proteoglycan synthesis by 1 X 10(-4) M H2O2 is completely reversed after 5 days in culture, whereas 1 X 10(-3) M H2O2 results in a more prolonged inhibition. The synthesis of the proteoglycan core protein is inhibited, but the ability of the newly formed proteoglycans to aggregate with hyaluronic acid is unimpaired.

Oxygen free-radicals mediate an inhibition of proteoglycan synthesis in cultured articular cartilage

Superoxide radical, generated enzymatically by the action of xanthine oxidase on hypoxanthine, significantly inhibited proteoglycan synthesis by cultured bovine articular cartilage. This inhibition was not due to the generation of uric acid or to the generation of superoxide per se. It was immediate in onset and still evident after six days in culture. The inhibition was similar for both 35S-sulphate and 3H-acetate incorporation into glycosaminoglycans and could not be reversed by addition of beta-D-benzyl xyloside. Protein synthesis was also inhibited.

Effect of intra-articular orgotein versus a corticosteroid on rheumatoid arthritis of the knees

The effects of intra-articular injections of orgotein (4 mg a week for six weeks) and of methylprednisolone acetate (4 mg a week for six weeks) on the knee joints were compared in a random long-term trial. Twenty-eight patients with active, definitive rheumatoid arthritis were studied by double-blind comparison. The first control examination made after six weeks of therapy showed no differences between the joints treated with orgotein or with steroid. However, at the final control examination after 24 weeks, a disparity between both drug regimens became apparent. Clinical response was evaluated in the knees in terms of cumulative rheumatoid activity index based on morning stiffness, range of flexion, pain scores, and 25-foot walking time. After 24 weeks, orgotein was found to be superior to steroid in the major points of the clinical assessment index but equipotent in marked improvement of the rheumatoid activity index after six weeks of treatment. After intrasynovial orgotein injections, synovial fluid enzyme activity fell significantly, concurrently with reduced prostaglandin E2 formation. Synovial fluid leukocyte counts also decreased, but the percentage of polymorphonuclear cells increased simultaneously only in the orgotein-treated group. The results suggest that patients with rheumatoid arthritis of the knee joints who show good response to orgotein during a short course of treatment are likely to continue their positive response and possibly attain increased relief of symptoms over longer periods of treatment, in contrast to those patients receiving steroids.