THE UPTAKE OF IRON IN RABBIT SYNOVIAL TISSUE FOLLOWING INTRA-ARTICULAR INJECTION OF IRON DEXTRAN. A LIGHT AND ELECTRON MICROSCOPE STUDY

Which part of the blood in the knee joint is responsible for its detrimental effects? (An experimental study on the knee joint in rabbits)

AIM

This study aims to determine the potential causative elements which are responsible for the cartilage damage in case of frequent intra-articular bleeding and to evaluate the effects of intra-articular free iron and chelation of iron in the knee joint.

METHODS

Thirty-five New Zealand rabbits were randomly divided into five groups according to substances injected into their knee joints. Plasma (group I) and cellular components (group II) of the blood harvested from the rabbits, iron (ferric hydroxide sucrose) (group III), iron&chelator (group IV) and only chelator (deferoxamine mesylate) (group V) were injected into their right knees three times a week for 12 weeks. The joint surface was examined histologically according to the classification system modified from Colombo et al. The changes in the synovial tissue were evaluated according to the scoring system modified from Madhok et al.

RESULTS

Cartilage and synovial abnormality scores were significantly higher in all study groups when compared to their own controls (p < 0.0001). Cartilage scores of groups I and V were significantly lower when compared to groups III and IV (p = 0.002 for group I and p = 0.003 for group V). Synovial abnormality score of group I was significantly lower than scores of groups III and IV (p = 0.001); and of group V lower than groups III and IV (p = 0.003 and p = 0.001, respectively).

CONCLUSIONS

All substances tested in this study caused a certain amount of damage in the cartilage tissue and led to synovial abnormalities. Both iron and iron&chelator caused more damage in the cartilage and led to more advanced synovial changes when compared to the plasma component of blood and chelator itself. Influence of iron and iron&chelators were found to be similar showing that chelation was inadequate in antagonizing the detrimental effects of iron.

Iron homeostasis in arthropathies: From pathogenesis to therapeutic potential

Iron is an essential element for proper functioning of cells within mammalian organ systems; in particular, iron homeostasis is critical for joint health. Excess iron can induce oxidative stress damage, associated with the pathogenesis of iron-storage and ageing-related diseases. Therefore, iron levels in body tissues and cells must be tightly regulated. In the past decades, excess iron content within joints has been found in some patients with joint diseases including hemophilic arthropathy, hemochromatosis arthropathy, and osteoarthritis (OA). Currently, increased evidence has shown that iron accumulation is closely associated with multiple pathological changes of these arthropathies. This review summarizes system-level and intracellular regulation of iron homeostasis, and emphasizes the role of iron in synovial alterations, cartilage degeneration, and subchondral bone of several arthropathies. Of note, we discuss the potential link between iron homeostasis and OA pathogenesis. Finally, we discuss the therapeutic potential of maintaining iron homeostasis in these arthropathies.

Ultrastructural localization of hyaluronic acid in the synovium of the goat knee joint

In the Japanese miniature (Shiba) goat, the synovial membrane contains synoviocytes referred to as type A (macrophage-like cells) and type B cells (fibroblast-like cells) in the intimal layer. Small capillaries and blood vessels of varying sizes were located in the extracellular matrix in the synovial subintima. The type A cells in the synovium possessed numerous vesicles, vacuoles and lysosomes as well as pinocytotic vesicles. These ultrastructural features indicating phagocytosis showed distinct positive reactions following hyaluronan staining. On the other hand, in the type B cells, hyaluronic acids were present in the surface coat of the plasma membrane and its periphery. Additionally, perivascular connective tissue of the small capillaries and blood vessels and interfibrous matrix contained hyaluronan. The results suggest that hyaluronic acid, in the synovial tissue, is synthesized on the plasma membrane of type B cells, and taken up by type A cells. Moreover, hyaluronan is involved in cellular functions in the synovial connective tissue.

Immunohistochemical study of the proliferation modality of synovium in rat adjuvant arthritis

To investigate the proliferative potencies of the two types of synovial lining cells (types A and B), we used immunohistochemical techniques under light and electron microscopy to survey the complete process of arthritis in a rat model system. Complete Freund's adjuvant (0.1 ml) containing 5 mg of heat-inactivated Mycobacterium butyricum was administered intradermally into the right hind paws of 25 male Sprague-Dawley rats. Five animals were killed at weeks 1, 2, 3, and 4 after the immunological challenge, respectively, and the infrapatellar adipose synovium was removed from each animal. Using proliferative cell nuclear antigen (PCNA) as a cell proliferation marker, we quantified the locations of proliferative cells under light microscopy and then identified the cell type with immunoelectron microscopy. The number of PCNA-positive cells was high in the deep layer at week 2, and most of them were determined to be B cells. At week 3, the number of PCNA-positive cells increased in the superficial layer, and most were identified as A cells. Our results support the idea that cells of the synovial lining proliferate in situ during the course of arthritis.

Radiation synovectomy with holmium-166 ferric hydroxide macroaggregate in equine metacarpophalangeal and metatarsophalangeal joints

OBJECTIVES

To evaluate the effects of radiation synovectomy (RSYN) with holmium-166 ferric hydroxide macroaggregate (Ho-166 FHMA) on synovium and synovial fluid in normal metacarpo- and metatarsophalangeal joints of horses and to determine intraarticular distribution of radioactivity after Ho-166 FHMA treatment.

STUDY DESIGN

Either Ho-166 FHMA or nonradioactive Ho-165 FHMA was injected into metacarpo- or metatarsophalangeal joints.

ANIMALS

Six adult mixed-breed horses without any clinical evidence of metacarpo- or metatarsophalangeal joint disease.

METHODS

Joints were injected with a single high dose of Ho-166 FHMA (mean, 1,000 MBq/joint) or a nonradioactive Ho-165 FHMA preparation (controls). Clinical examination, arthroscopy, synovial fluid analyses, and histologic studies were performed to detect effects of RSYN. Scintigraphy was used to localize intraarticular distribution of Ho-166 FHMA.

RESULTS

Ho-166 FHMA treatment induced joint inflammation leading to regional edema, effusion, and scar tissue formation. Scintigraphy revealed the highest intensity of radioactivity in the proximal plantar joint pouch, at which the Ho-166 FHMA treatment caused multifocal necrosis. In the dorsal joint pouch, however, arthroscopic study and histologic analysis showed very little effect of RSYN. There was no regeneration of synovium evident within 2 months. Synovial fluid protein concentration was significantly (P <.01) elevated, and some residual radioactivity remained for 5 days after Ho-166 FHMA injection.

CONCLUSIONS

Injection of a single high dose of Ho-166 FHMA caused multifocal necrosis of synovium and deep, soft-tissue injury in equine fetlock joints.

CLINICAL RELEVANCE

Inflamed equine joints with synovial lining hyperplasia could benefit from Ho-166 FHMA-induced radiation synovectomy if excessive scar tissue formation can be avoided.

Experimental radiation synovectomy in rabbit knee with holmium-166 ferric hydroxide macroaggregate

Holmium-166 ferric hydroxide macroaggregate (Ho-166 FHMA) particles possess two important properties for radiosynovectomy; relatively short half-life of the radioisotope and appropriate carrier size. Both these minimize radioactive leakage from the treated joint. This study was conducted to assess the effects of Ho-166 FHMA on synovium and synovial fluid in rabbit knee joints. Whole-knee autoradiography was utilized to determine distribution of radioactivity after intra-articular Ho-166 FHMA injection. Intra-articular injection of Ho-166 FHMA resulted in focal acute radiation necrosis in synovial lining but no hyperplasia of synoviocytes. Later, subsynovial fibrosis became evident. White blood cell and total protein levels in the joint fluid were elevated because of intra-articular inflammation due to the acute effects of radiation. Whole knee autoradiograms showed uneven distribution of the radionuclide along the synovium and extraarticular leakage on the third day after treatment.

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.

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.

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.

The ultrastructure of vesicle-containing cells and ER-cells of human peritoneum

In 16 human specimens the mesothelial cells of the diaphragmatic peritoneum and the pelvic parietal peritoneum were observed by transmission electron microscopy and freeze fracture replica. There were two types of cells i.e. the vesicle-containing cells and ER-cells. The former were found only in the diaphragmatic peritoneum and contained numerous cytoplasmic vesicles. These vesicles could be alone or in clusters. The clustered vesicles were often fused to form large vacuoles which opened on the free surface of the cell, into the intercellular space, or through the basement membrane, or sometimes became secretory particles on the free surface of the cells. Some vesicles were also observed in the microvilli. The latter were only found in the pelvic parietal peritoneum and contained abundant endoplasmic reticulum. The vesicle-containing cells seemed to absorb the material from the peritoneal cavity. The ER-cells contained abundant endoplasmic reticulum and Golgi apparatus, and showed high synthetic activity, possibly related to the production of peritoneal fluid.

Gene transfer to synovial cells by intra-articular administration of plasmid DNA

We studied reporter gene expression in synovial tissue after intra-articular administration of an expression plasmid into the knees of rabbits and rats. In both species, administration of a plasmid encoding beta-galactosidase led to gene expression in the synovial cells lining the joint. Expression correlated with the presence of plasmid DNA in synovial tissue extracts. Studies with a plasmid encoding chloramphenicol acetyltransferase demonstrated that gene expression persists for 2-5 days after administration. Southern blotting demonstrated that the administered plasmid was taken up rapidly by synovial tissue and degraded. By 24 hr after administration, no intact plasmid could be detected by Southern blotting, although small amounts of plasmid could be amplified by PCR up to 7 days. Administration of a plasmid encoding human growth hormone demonstrated that this product could be expressed from synovial cells and secreted into the synovial fluid. The histological distribution of gene expression in synovium resembles the known distribution of particulate materials injected into the joint and suggests that plasmid DNA is taken up by nonspecific endocytosis like other particulate materials during the remodeling of synovial fluid.

Aging of the human synovium: an in vivo and ex vivo morphological study

Age-associated changes of the human synovium have been investigated by microarthroscopy, optical and electron microscopy, immunohistochemistry, and cytochemistry. The knee joints of nineteen 15- to 56-year-old subjects, classified as normal by inspection, were carefully examined by microarthroscopy; small synovial tissue biopsy specimens from both the suprapatellar pouch and the medial tibiofemoral gutter were taken. Microarthroscopy showed that the villi were more numerous and the vascular network and cell distribution and profiles less regular in aged individuals. These data were confirmed by scanning electron microscopy, which also showed large areas of the synovial surface devoid of cells and collagen bundles in contact with the joint cavity in aged subjects. Light and transmission electron microscopy confirmed these data and allowed evaluation of the number, distribution, shape, and internal organization of cells as well as the distribution of vessels and the organization of the extracellular matrix in the full thickness of the synovium (down to 2 mm). Particular attention was paid to synovial lining cells, among which three main phenotypes could be recognized: synthetic type (present at all ages and hypertrophied in aged subjects), macrophagelike (increasing with age), and fibroblastlike. Collagen increased with age. Further studies are needed for comprehensive understanding of age-associated changes in the human synovium.

Effect of iron complexes on adjuvant arthritis in rats

When a total dose infusion of iron dextran is given to anaemic rheumatoid patients an exacerbation of inflammatory synovitis in previously affected joints is observed. The adjuvant arthritis model of inflammation in rats has been used to investigate the mechanism of iron promoted synovitis. Either iron dextran (5 mg injected intravenously) with a dextran C control, or iron sorbitol (7.5 mg injected intramuscularly) with a sorbitol citrate complex control was given at the onset of clinical joint inflammation. Iron dextran significantly increased joint inflammation (assessed by joint scoring) at days 12, 13, 14, and 16 after injection. Similarly, iron sorbitol produced a significant increase in the joint score at days 17, 18, 19, and 21. In addition, extensive osteoporosis was observed in the rats treated with iron sorbitol. These pro-inflammatory effects of iron coincide with the presence of positive results for synovial iron (III) using Perl's test and neutrophil infiltration. The results of this study suggest that the iron induced increase in synovitis in adjuvant arthritis is a result of iron promoted oxidative damage and is not likely to be due to the dextran C or the sorbitol citric acid components. It is suggested that a similar mechanism may occur in rheumatoid patients given iron supplements.

Immunocytochemical analysis of human synovial lining cells: phenotypic relation to other marrow derived cells

The antigenic phenotype of human synovial lining cells in normal and hyperplastic synovium intima was determined with a panel of monoclonal antibodies directed against a large number of well defined myeloid (macrophage/granulocyte associated) antigens. Synovial lining cells express numerous macrophage associated antigens, including CD11b (CR3), CD13, CD14, CD16 (FcRIII), CD18, CD32 (FcRII), CD45 (leucocyte common antigen), CD54 (ICAM-1), CD64 (FcRI), CD68, and CD71 (transferrin receptor). Few synovial lining cells expressed CD11a (LFA-1) and CD11c (p150,95). Subintimal macrophages expressed all the macrophage associated antigens which were present on synovial lining cells and, in addition, expressed CD15a, CD25 (interleukin-2 receptor), CD34, and CD35 (C3b receptor), none of which was present on synovial lining cells. Synovial lining cell expression of a wide range of macrophage antigens argues in favour of their marrow origin and membership of the mononuclear phagocyte system.

Modulation of exudate inflammation parameters in rat carrageenan-induced granuloma by modification of exudate iron levels

We have used the carrageenan-induced pouch-granuloma in rats to investigate how changes in low-molecular-mass iron chelate levels in the exudate, induced by iron loading (iron-dextran) or chelation (desferrioxamine) influence cellular and systemic inflammatory parameters. In the iron-treated group we observed a rapid decrease in the number of leukocytes and exudate volume; there was also an increase in ferritin iron and low-molecular-mass iron chelates, and on the eighth day a systemic response. In the desferrioxamine-treated group we detected a decrease in low-molecular-mass iron chelates, ferritin iron, and an increase in the number of leukocytes. We describe the protective effects of desferrioxamine against the deleterious effects of ferrous iron and relate this to its chelating and scavenging activity. The results suggest that the levels of low-molecular-mass iron chelates modulate the inflammatory response, possibly through their contribution to the oxygen free radical generation, which is responsible for the cell membrane damage and subsequently its death. The modulatory action of iron-dextran and desferrioxamine support our hypothesis.

In vivo stability of ferric hydroxide macroaggregates (FHMA). Is it a suitable carrier for radionuclides used in synovectomy?

Ferric hydroxide macroaggregates (FHMA) have been widely used as a carrier for several radionuclides used in radiation synovectomy. Different rates of extra-articular leakage of radioactivity have been observed with 90Y and 165Dy. In order to understand the mechanism(s) involved in the extra-articular leakage of radioactivity, the in vivo stability of FHMA carrier was studied. Following an injection of [59Fe]Fe-FHMA into the knees of normal rabbits, the cumulative leakage of [59Fe]Fe-FHMA was 2.9% at 5 days and 12.3% at 14 days. More than 60% of this activity was in the blood. But when FHMA was double labeled with 59Fe and 166Ho, the 59Fe leakage significantly increased to 18.5% at 5 days and 27% by 14 days. The instability of FHMA is accelerated when it is complexed with 166Ho and may be due to the "mass effect" of 166Ho or due to radiolysis induced by high energy beta particles from 166Ho. These results suggest that FHMA is a suitable carrier only for the short lived radionuclides used in synovectomy.

Mechanisms of joint damage in an experimental model of hemophilic arthritis

Autologous whole blood was injected into the knee joints of rabbits 3 times each week for 12 weeks. The resulting destructive arthritis showed macroscopic and microscopic changes similar to those described in hemophilic arthritis in humans. Immunofluorescence studies indicated that a specific immune response is probably not involved in the pathogenesis of hemophilic arthritis. Detailed histopathologic examinations of knee joints in both the early and the late phase of arthritis revealed an obvious synovial and cartilage iron load, in the absence of inflammatory changes. The implications of these findings in the pathogenesis of destructive cartilage changes are discussed.

Mechanism of exacerbation of rheumatoid synovitis by total-dose iron-dextran infusion: in-vivo demonstration of iron-promoted oxidant stress

The mechanism by which a synovial flare occurred in a patient with rheumatoid arthritis after intravenous infusion of iron-dextran was investigated. After the infusion, serum and synovial-fluid iron-binding capacity became saturated, giving rise to low-molecular-mass iron chelates with the capacity to cause oxidative damage ("bleomycin-iron"). At the same time lipid peroxidation and the concentration of oxidised ascorbic acid (dehydroascorbate) increased in both serum and synovial fluid, and red-cell glutathione fell. These changes corresponded closely to an exacerbation of rheumatoid synovitis. Hepatic function was transiently disturbed 7 days after the infusion, reflecting hepatic oxidant stress within the iron-loaded liver. Such changes provide clear evidence that iron-catalysed oxidative reactions influence the inflammatory process in human beings.

Effects of osmium tetroxide on the rabbit knee joint normal synovial membrane

The effect of osmium tetroxide, which is used in treatment of rheumatoid arthritis, was histologically and electronmicroscopically examined in the normal synovial membrane of the rabbit. The animals were albino rabbits, and they were 20 altogether. 0.3 ml. of 1% OsO(4) solution was injected, i.a., in the right knee. The left knee joint served as a control. One minute after the injection, black reduced osmium was observed in the synovial membrane. The endothelial layer of the synovial membrane coagulated and disappeared within some days. Deep in the synovial membrane, a foreign body granuloma and a connective tissue scar appeared in five weeks. The result was a strong thickening of the synovial membrane.

Relationship between iron deposits and tissue damage in the synovium: an ultrastructural study

A detailed ultrastructural study was made of the synovial iron deposits in cases of haemophilic synovitis (HS), pigmented villonodular synovitis (PVNS), rheumatoid arthritis (RA), osteoarthritis (OA), seronegative inflammatory arthritis (SNA), and in controls, to investigate the relationship between iron deposits and tissue damage. Iron was seen by electron microscopy in about 75% of synovial lining cells in HS and PVNS but only in about 25% of synovial cells from cases of RA and SNA. In cases of OA and in controls iron deposits were scarce. The iron was usually deposited within pleomorphic siderosomes and in HS was most common in type A synovial cells. In contrast, deposits in all other cases were more common in type B cells, which were frequently the predominant cell type, and siderosomes were smaller, more homogeneous, and were more common in deeper synovial tissue. Considerable tissue damage was noted in the vicinity of iron rich siderosomes in synovial A cells from cases of HS, but such deposits in B cells in the synovium from the other cases had relatively little effect. We discuss the possibility that such differences directly reflect the differing functions of type A and B synovial cells, and particularly their relative ability to produce metabolically active oxygen metabolites with tissue destructive potential in the presence of iron.

Absorption of intraarticularly injected horseradish peroxidase in synoviocytes of rat synovial membrane: an ultrastructural-cytochemical study

The ability of type A and type S synoviocytes to absorb horseradish peroxidase (HRP) and the intracellular fate of this tracer were studied by electron microscopic cytochemistry. Different concentrations of HRP (0.1-5 mg/ml) were injected into the left knee joint of rats and at intervals ranging from 1 min to 24 hr after injection the synovial membrane was fixed and incubated for HRP. Type A synoviocytes showed a striking ability to absorb HRP at low concentrations. At 1 and 5 min after injection reaction product was localized in coated pits and coated vesicles (110 nm) as well as in smooth-walled vesicles, vacuoles, and tubules. At 15 min to 4 hr postinjection the lysosomal system became increasingly loaded with reaction product. At 24 hr after injection reaction product had disappeared. At higher concentrations of HRP similar observations were made in the A cells, but reaction product was still apparent in lysosomes at 24 hr postinjection. With respect to type S synoviocytes no reaction product was detected within these cells at any time interval after injection of low concentrations of HRP. However, at 5 min after injection of higher concentrations of HRP reaction product was localized in smooth vesicles and vacuoles mainly restricted to the large cytoplasmic processes facing the joint cavity. At 30 min to 4 hr postinjection the lysosomal system became progressively more loaded with HRP reaction product. At 24 hr after injection reaction product still remained in the lysosomal system. The present findings that type A and type S synoviocytes showed major differences with respect to endocytic capacity and cellular structures involved in absorption of HRP support the interpretation that the A and S cells represent two distinct types of cells and further suggest that endocytosis in these two types of cells serve different functions.

Fine structure of the lysosomes in the two types of synoviocytes of normal rat synovial membrane. A cytochemical study

The lysosomal system of the two types of synoviocytes (A and S) from the knee joint of normal rat synovial membrane was studied by electron-microscopic acid phosphatase cytochemistry. In random sections of the synovial intima lysosomes were more often encountered in the A-cell profiles than in the S-cell profiles. Characteristically, type-A synoviocytes showed many large and medium-sized lysosomes the cytochemical appearance of which varied considerably. No acid phosphatase activity was detectable in the cisternae of the Golgi apparatus or in the Golgi vesicles. In type-S synoviocytes the lysosomes were smaller, and more uniform in cytochemical appearance. Heavy deposits of acid phosphatase reaction product were constantly demonstrated in cisternae of the Golgi apparatus as well as in smooth-walled Golgi vesicles in type-S cells. The findings that type-A and type-S synoviocytes show distinctly different organization of the lysosomal system indicate that the roles of the lysosomes in these two types of cells may be different.

The nature of iron deposits in haemophilic synovitis. An immunohistochemical, ultrastructural and X-ray microanalytical study

Using a computerized electron-probe X-ray microanalytical technique to measure phosphorus/iron ratios we have defined the iron saturation of ferritin in vitro from prepared ferritin standards of known iron loading. This technique has been applied to the study of 5 haemophilic synovial membranes. At light microscope level the distribution and relationship of iron/ferritin were defined using Perls' reaction and an immunoperoxidase technique respectively. The synovia from all cases contained intra and extra-cellular deposits of Perls' positive material which were granular in nature in the most superficial synovial cells. There were increasing numbers of pheomorphic (1-12 micron diameter ovate bodies in the deeper synovial layers. Immunoperoxidase ferritin staining produced a strongly positive reaction in the granular material but the ovate bodies were negative with the exception of some peripheral staining. X-ray microanalysis showed the granular material to be highly iron saturated ferritin and the ovate bodies to be almost pure iron. We suggest that iron saturated ferritin in the synovial membrane could increase/perpetuate inflammation by promoting lipid peroxidation.

Contributions of the lymphatic and microvascular systems to fluid absorption from the synovial cavity of the rabbit knee

1. The trans-synovial flow (Qs) of Ringer solution from the cavity of immobile knee (stifle) joints was determined in anaesthetized rabbits when intra-articular hydrostatic pressure (PJ) was elevated in steps from 2 to 25 cm H2O. 2. It has been demonstrated previously (Levick, 1978) that slope DQs/dPJ shows an abrupt sixfold increase at a 'breaking point' (PB) around 9 . 5 cm H2O, rising from a mean of 0 . 49 microliter.min-1 cm H2O-1 (PJ less than PB) to 2 . 81 microliter.min-1 cm H2O-1 (PJ greater than PB). 3. Perforation of the synovial intima by an intra-articular cannula increased dQs/dPJ below breaking pressure and thus largely abolished the breaking point phenomenon, indicating that the phenomenon might be simulated by a break-down in synovial resistance to flow. 4. Ligation of the femoral lymph trunks draining the joint did not significantly alter the relationship between Qs and PJ. The slope dQs/dPJ was 0 . 60 +/- 0 . 17 microliter.min-1 cm H2O-1 (mean +/- S.E.) below a breaking pressure of 8 . 8--10.5 cm H2O, and 2 . 90 +/- 0 . 64 microliter.min-1 cm H2O-1 above breaking pressure. Thus changes in synovial lymph flow did not explain the breaking point phenomenon. 5. Interruption of synovial blood flow by vascular clamps or by killing the animal reduced, but did not abolish fluid absorption; nor was the breaking point phenomenon abolished. Slope dQs/dPJ increased from 0 . 37 +/- 0 . 06 microliter.min-1 cm H2O-1 below breaking point (10 . 5 +/- 1 . 0 cm H2O) to between 1 . 82 and 0 . 96 +/- 0 . 15 microliter.min-1 cm H2O-1 above breaking pressure. Fluid accumulated in extra-synovial interstitial spaces. 6. When the synovial intima was divested of its surrounding tissues, lymphatic and vascular supplies by extensive dissection, the denuded synovium still showed a marked increase in hydraulic conductivity at normal breaking pressures. The breaking point phenomenon was therefore not caused by changes in extra-synovial interstitial pressure or compliance. 7. It is concluded that fluid absorption from the joint cavity occurs by two parallel pathways viz. the synovial capillary bed and the extra-synovial interstitial spaces. A simple analysis of the system indicates that the breaking point phenomenon cannot be explained by an abrupt increase in synovial conductivity (cf. Edlund, 1949) but is explicable if synovial conductivity (and possibly interstitial conductivity) becomes a continuous function of PJ above breaking pressure. This hypothesis reconciles the non-linear pressure-flow relationship with Starling's hypothesis for fluid absorption from connective tissue spaces (1896).

Overview article: the articular territory of the reticuloendothelial system

It has long been recognized that synovial intimal cells are phagocytic and that they are capable of picking up colloidal or particulate material injected into the circulation. Hence they have been described as the "articular territory of the reticuloendothelial system." Ultrastructural studies have added a wealth new knowledge and details about the remarkable endocytotic powers of synovial cells. It has been shown that they can endocytose not only small particulate substances like colloidal iron, colloidal gold, and thorotrast but also relatively large objects like masses of fibrin and entire erythrocytes. Controversy has arisen as to whether it is the Type A or Type B cell that is the main scavenger of the joint. Evidence will be presented to show that this is a somewhat fictitious controversy and that these are not distinct and different races of cells with different functions but merely cells whose differences in morphology reflects the function they are performing at a given moment.

Liposome-incorporated corticosteroids: I. The interaction of liposomal cortisol palmitate with inflammatory synovial membrane

Cortisol palmitate-containing liposomes were stable in rheumatoid synovial fluid at 37 degrees. Two hours after the intra-articular injection of such liposomes into experimentally arthritic rabbits relatively high proportions of the steroid and lecithin components were recovered from the synovialis. The level of cortisol in the tissue at this time was inversely related to the chronicity of the inflammation. It was found also that the degree and duration of the anti-inflammatory activity of the liposomes was greatest in the initial acute phases of the inflammation.

B-cells of the synovial membrane. II. Differentiation during development of the synovial cavity in the mouse

Study of pre- and postnatal development of the metatarsophalangeal joint of the mouse shows that the synovial cavity (SC) forms before any differentiation of the synovial mesenchyme. The primitive cleft results from degradation of a thin vascular mesenchymal layer in direct contact with the chondrogenic layers. Differentiation of the synovial membrane coincides with clarification of the SC (3rd to 6th day of postnatal life). When dilatation of the SC occurs (6th to 8th day), the two intimal cells types (A- and B-cells) are well identified. The B-cells already show typical features at day 6; their content of typical dense secretory vesicles is comparable to that of the adult B-cells at day 13. The specific secretory function of B-cells could be correlated with the particular structure of the intimal interstitial tissue and could account for the origin of some protein(s) of the synovial fluid.

Fate of antigen after intravenous and intraarticular injection into rabbits

To determine the manner in which small protein antigens enter the synovium and are localized, horseradish peroxidase (molecular weight 40,000) was injected by intravenous and intraarticular routes. Passage of antigen from capillary lumen to joint space and vice versa occurred primarily across fenestrated vessels. Antigen localized to collagen fibers and lining cells. At low concentrations of antigen, antigen was taken up predominantly by marcophages, whereas at higher concentrations both macrophages and fibroblast-like lining cells accumulated antigen.

B-cells of the synovial membrane. I. A comparative ultrastructural study in some mammals

Comparative ultrastructural study of the B-cells in the intimal layer of the synovial membrane in mouse, rat, rabbit, guinea-pig and man clearly distinguishes these cells from both the histiocytic A-cells (macrophage-like cells) and the fibroblasts. In addition to the marked development of the rough endoplasmic reticulum and Golgi apparatus, typical dense secretory vesicles apparently of Golgi origin are always found in mouse B-cells and frequently in those of the rat. These secretory characteristics clearly relate these cells to glandular cells engaged in polypeptidic secretion. The variations in the other species studied concern only the figuration of secretory material. Thus, the B-cells appear to constitute a category of secretory cells specific to the synovial membrane, but the function of which has yet to be determined.

Aurosomes produced in the synovial membrane by the oral administration of a gold compound SK & F 36914

Chlorotriethylphosphine gold (SK & F 36914) administered orally to rabbits produced aurosomes in the synovial membrane. These aurosomes were similar to aurosomes produced by parenteral or intra-articular injections of soluble gold salts such as sodium aurothiomalate and aurothioglucose. This study shows, (1) that an orally administered gold compound is capable of producing gold deposits in the synovial membrane, and (2) that such compounds may have a future in the treatment of rheumatoid arthritis.

The biology of the rheumatoid synovial cell

Over the past 15 years, many of the elaborate research techniques of cell biology and biochemistry have been applied toward discovering the cause of rheumatoid arthritis. Consequently, it is valuable to review the morphological, physiological and biochemical alterations that have been observed in rheumatoid synovial cells. All of the changes observed suggest that a viral agent may form the basis for these alterations. However, studies to date have failed to isolate or identify the putative causative virus and the search continues.

Experimental radiation synovectomy by 165Dy ferric hydroxide macroaggregate

The short half-life beta emitter 165Dy coprecipitated as a macroaggregate with ferric hydroxide (FHMA) has been shown to destroy knee synovium in the antigen-induced arthritic rabbit. Using 153Gd as a gamma tracer for leakage studies revealed that the leakage of this system from rabbit knee joints never exceeded 1.2% over 24 hours. This is such less than the leakage rates reported from any human studies or our rabbit studies using 198Au.

Localization of gold in synovial membrane of rheumatoid arthritis treated with sodium aurothiomalate. Studies by electron microscope and electron probe x-ray microanalysis

The localization of gold in the synovial membrane of rheumatoid arthritis patients treated with sodium aurothiomalate was examined and quantitative analysis of epon-embedded sections was carried out with a wavelength dispersive x-ray microanalyser. Gold was only detected in the lysosomes of synovial lining type A cells and subsynovial mononuclear cells in the form of filamentous deposits and highly electron-dense granules, the latter being few in number. The concentration of gold within the lysosomes containing the characteristic deposits and granules was equivalent to that in epon-embedded standard specimens of freeze-dried albumin in which 2-0-87-4 mg/ml of gold was included. In addition, sulphur was detected in the lysosomes containing the filamentous deposits, but the S/Au x-ray signal ratio was not equal to that detected in sodium aurothiomalate. The significance of the coexistence of gold with sulphur in lysosomes is discussed.

Primary lesion in osteoarthrosis

The primary disturbance in osteoarthrosis is generally regarded as occurring in the articular cartilage and as resulting from a combination of ageing and mechanical factors. An alternative hypothesis is that the primary disturbance is located in the synovial lining cells. It is suggested that proteolytic enzymes which normally leak from the phagocytic (A type) lining cells are in the healthy joint neutralised by inhibitors synthesised by the B-type lining cells. Osteoarthrosis is the result of an imbalance between leakage of enzymes and provision of inhibitors.

Epithelioid sarcoma: ultrastructural similarity to nodular synovitis

The ultrastructure of nodular synovitis of the knee and epithelioid sarcoma of the hand are compared. Both lesions show a similar pattern of light and dark cells having filopodia and microvilli, an outer coat of finely granular matrix without well defined basal laminae, maculae adherentes and attachment sites, pinocytotic vesicles, cytoplasmic filaments and complex nuclear invaginations. These similarities suggest a common histogenesis and support the concept that the epithelioid sarcoma is derived from synovioblastic mesenchyme.

Light and electron microscopic investigation of equine synovial membrane. A comparison between healthy joints and joints with intraarticular fractures and osteochondrosis dissecans

Light and electron microscopic examination was made on equine synovial membrane from 23 healthy joints, nine joints with synovitis caused by intraarticular fracture and 10 joints with synovitis caused by osteochondrosis dissecans. Histologically as well as ultrastructurally the equine synovial membrane from healthy joints was of principally the same character as described in other species. Three types of synovial membrane — areolar, fibrous and adipose — and two types of lining cell were distinguished histologically. Ultrastructurally three types of lining cells were distinguished: A and Β type and an intermediate cell type. In healthy joints they were loosely arranged, parallel to the joint surface in an intercellular matrix, which was in direct continuity with the joint space. In joints with intraarticular fracture there was mild inflammation of the synovial membrane. There was elongation and hyperplasia of the lining cells with a relative increase in type A cells. The cell surface of lining cells was increased through filopodia. There was also an increase in cytoplasmic organelles i.e. hyperplasia of rough endoplasmic reticulum and Golgi complexes in Β type cells and an increase in lysosomes, and increased numbers of vesicles of varying types in A cells. In joints with osteochondrosis dissecans the lining cell hyperplasia and the inflammation in the synovial membrane were more prominent. Ultrastructurally the same alterations as in the previous group were seen including a relative increase in the number of A cells but degenerative changes were common in the lining cells. These changes were dilatation and vesiculation of rough endoplasmic reticulum, mitochondrial condensation, dilatation of the nuclear envelope and loss of plasma membranes, leading to disintegration of cells.