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Pulles AE, van Vulpen LFD, Coeleveld K, Mastbergen SC, Schutgens REG, Lafeber FPJG. On-demand treatment with the iron chelator deferasirox is ineffective in preventing blood-induced joint damage in haemophilic mice. Haemophilia 2021; 27:648-656. [PMID: 34043875 PMCID: PMC8361985 DOI: 10.1111/hae.14328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/01/2021] [Accepted: 04/16/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Early intervention in the devastating process of haemophilic arthropathy (HA) is highly desirable, but no disease-modifying therapy is currently available. Considering the pivotal role of iron in the development of HA, iron chelation is considered a promising therapeutic approach. A previous study in haemophilic mice demonstrated that treatment with the iron chelator deferasirox (DFX) 8 weeks before joint bleed induction, attenuated cartilage damage upon blood exposure. However, in haemophilia patients this approach is not opportune given the unpredictable occurrence of hemarthroses. AIM To evaluate the effectiveness of on-demand DFX treatment, initiated immediately after joint bleed induction. METHODS A joint bleed was induced in 66 factor VIII-deficient mice by infra-patellar needle puncture. Mice were randomly assigned to treatment with either placebo (drinking water) or DFX (dissolved in drinking water) throughout the study. Five weeks after joint bleed induction, inflammation and cartilage damage were assessed histologically. Joints of ten bleed naive haemophilic mice served as controls. RESULTS A joint bleed resulted in significant inflammation and cartilage damage in the blood-exposed joint compared with those of control animals, in both the placebo and DFX group (all p = <.05). No differences in tibiofemoral or patellar inflammation (p = .305 and p = .787, respectively) nor cartilage damage (p = .265 and p = .802, respectively) were found between the blood-exposed joints of both treatment groups. CONCLUSION On-demand treatment with DFX does not prevent joint damage following blood exposure in haemophilic mice. DFX seems unable to reach the joint in time to exert its effect before the irreversible harmful process is initiated.
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Affiliation(s)
- Astrid E. Pulles
- Department of Rheumatology & Clinical ImmunologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
- Van CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Lize F. D. van Vulpen
- Van CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Katja Coeleveld
- Department of Rheumatology & Clinical ImmunologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Simon C. Mastbergen
- Department of Rheumatology & Clinical ImmunologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Roger E. G. Schutgens
- Van CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Floris P. J. G. Lafeber
- Department of Rheumatology & Clinical ImmunologyUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
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2
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Vøls KK, Kjelgaard-Hansen M, Ley CD, Hansen AK, Petersen M. Bleed volume of experimental knee haemarthrosis correlates with the subsequent degree of haemophilic arthropathy. Haemophilia 2019; 25:324-333. [PMID: 30648774 DOI: 10.1111/hae.13672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Haemophilic arthropathy is the main morbidity of haemophilia. The individual pathological response to the same number of clinically evident joint bleeds is highly variable; thus, it remains unknown if certain joint bleeding characteristics are critical for the development of arthropathy. AIM To study the relation between bleed volume and subsequent development of arthropathy, we aimed to develop quantitative in vivo imaging of active joint bleeds in a mouse model of haemophilia. METHODS Haemophilia A (F8-KO) and wild-type (WT) mice were IV-dosed with a micro-CT blood pool contrast agent prior to an induced knee haemarthrosis or sham procedure. The mice were micro-CT scanned five times the following 2 days to characterise and quantify the induced haemarthrosis in vivo. On Day 14, the mice were euthanized and pathological changes evaluated by histology and micro-CT. Additionally, bleeding characteristics in vehicle-treated F8-KO mice were compared with those of recombinant FVIII (rFVIII)-treated F8-KO mice. RESULTS F8-KO mice had a significantly larger bleed volume than WT mice at all scan time points. The bleed volume 12 hours after induction of haemarthrosis correlated with the subsequent degree of arthropathy. Presence of µCT-detectable bone pathology was associated with a significantly increased bleed volume among F8-KO mice. rFVIII treatment significantly reduced bleed volume in F8-KO mice. CONCLUSION Quantitative in vivo contrast-enhanced micro-CT imaging can be used to characterize and quantify joint bleeds in a mouse model of haemophilic arthropathy. The bleed volume correlates with the subsequent degree of arthropathy.
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Affiliation(s)
- Kåre Kryger Vøls
- Global Drug Discovery, Novo Nordisk A/S, Maaloev, Denmark.,Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | | | | | - Axel Kornerup Hansen
- Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Maj Petersen
- Global Drug Discovery, Novo Nordisk A/S, Maaloev, Denmark
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3
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Haxaire C, Hakobyan N, Pannellini T, Carballo C, McIlwain D, Mak TW, Rodeo S, Acharya S, Li D, Szymonifka J, Song X, Monette S, Srivastava A, Salmon JE, Blobel CP. Blood-induced bone loss in murine hemophilic arthropathy is prevented by blocking the iRhom2/ADAM17/TNF-α pathway. Blood 2018; 132:1064-1074. [PMID: 29776906 PMCID: PMC6128089 DOI: 10.1182/blood-2017-12-820571] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/14/2018] [Indexed: 12/14/2022] Open
Abstract
Hemophilic arthropathy (HA) is a debilitating degenerative joint disease that is a major manifestation of the bleeding disorder hemophilia A. HA typically begins with hemophilic synovitis that resembles inflammatory arthritides, such as rheumatoid arthritis, and frequently results in bone loss in patients. A major cause of rheumatoid arthritis is inappropriate release of the proinflammatory cytokine tumor necrosis factor-α (TNF-α) by the TNF-α convertase (TACE; also referred to as ADAM17) and its regulator, iRhom2. Therefore, we hypothesized that iRhom2/ADAM17-dependent shedding of TNF-α also has a pivotal role in mediating HA. Here, we show that addition of blood or its components to macrophages activates iRhom2/ADAM17-dependent TNF-α shedding, providing the premise to study the activation of this pathway by blood in the joint in vivo. For this, we turned to hemophilic FVIII-deficient mice (F8-/- mice), which develop a hemarthrosis following needle puncture injury with synovial inflammation and significant osteopenia adjacent to the affected joint. We found that needle puncture-induced bleeding leads to increased TNF-α levels in the affected joint of F8-/- mice. Moreover, inactivation of TNF-α or iRhom2 in F8-/- mice reduced the osteopenia and synovial inflammation that develops in this mouse model for HA. Taken together, our results suggest that blood entering the joint activates the iRhom2/ADAM17/TNF-α pathway, thereby contributing to osteopenia and synovitis in mice. Therefore, this proinflammatory signaling pathway could emerge as an attractive new target to prevent osteoporosis and joint damage in HA patients.
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Affiliation(s)
- Coline Haxaire
- Arthritis and Tissue Degeneration Program and
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY
| | - Narine Hakobyan
- Pediatric Hematology/Oncology, Rush University Medical Center, Chicago, IL
| | | | - Camila Carballo
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY
| | - David McIlwain
- Baxter Laboratory in Stem Cell Biology, Department of Microbiology and Immunology, Stanford University, Stanford, CA
| | - Tak W Mak
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Scott Rodeo
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY
| | - Suchitra Acharya
- Pediatric Hematology/Oncology, Northwell Health, New Hyde Park, NY
| | - Daniel Li
- Arthritis and Tissue Degeneration Program and
| | - Jackie Szymonifka
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY
| | - Xiangqian Song
- Pediatric Hematology/Oncology, Rush University Medical Center, Chicago, IL
| | - Sébastien Monette
- Laboratory of Comparative Pathology, Memorial Sloan Kettering Cancer Center, The Rockefeller University, Weill Cornell Medicine, New York, NY
| | - Alok Srivastava
- Department of Hematology, Christian Medical College, Vellore, India
| | - Jane E Salmon
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY
- Department of Medicine and
| | - Carl P Blobel
- Arthritis and Tissue Degeneration Program and
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
- Department of Medicine and
- Department of Biophysics, Physiology, and Systems Biology, Weill Cornell Medicine, New York, NY; and
- Institute for Advanced Studies, Technical University Munich, Garching, Germany
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Prince R, Bologna L, Manetti M, Melchiorre D, Rosa I, Dewarrat N, Suardi S, Amini P, Fernández JA, Burnier L, Quarroz C, Reina Caro MD, Matsumura Y, Kremer Hovinga JA, Griffin JH, Simon HU, Ibba-Manneschi L, Saller F, Calzavarini S, Angelillo-Scherrer A. Targeting anticoagulant protein S to improve hemostasis in hemophilia. Blood 2018; 131:1360-1371. [PMID: 29317453 PMCID: PMC5865230 DOI: 10.1182/blood-2017-09-800326] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 01/03/2018] [Indexed: 01/13/2023] Open
Abstract
Improved treatments are needed for hemophilia A and B, bleeding disorders affecting 400 000 people worldwide. We investigated whether targeting protein S could promote hemostasis in hemophilia by rebalancing coagulation. Protein S (PS) is an anticoagulant acting as cofactor for activated protein C and tissue factor pathway inhibitor (TFPI). This dual role makes PS a key regulator of thrombin generation. Here, we report that targeting PS rebalances coagulation in hemophilia. PS gene targeting in hemophilic mice protected them against bleeding, especially when intra-articular. Mechanistically, these mice displayed increased thrombin generation, resistance to activated protein C and TFPI, and improved fibrin network. Blocking PS in plasma of hemophilia patients normalized in vitro thrombin generation. Both PS and TFPIα were detected in hemophilic mice joints. PS and TFPI expression was stronger in the joints of hemophilia A patients than in those of hemophilia B patients when receiving on-demand therapy, for example, during a bleeding episode. In contrast, PS and TFPI expression was decreased in hemophilia A patients receiving prophylaxis with coagulation factor concentrates, comparable to osteoarthritis patients. These results establish PS inhibition as both controller of coagulation and potential therapeutic target in hemophilia. The murine PS silencing RNA approach that we successfully used in hemophilic mice might constitute a new therapeutic concept for hemophilic patients.
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Affiliation(s)
- Raja Prince
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Luca Bologna
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Mirko Manetti
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, and
| | - Daniela Melchiorre
- Department of Experimental and Clinical Medicine, Section of Internal Medicine, Rheumatology Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Irene Rosa
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, and
| | - Natacha Dewarrat
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Silvia Suardi
- Vetsuisse, Institute of Animal Pathology, Comparative Pathology Platform, and
| | - Poorya Amini
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - José A Fernández
- Department of Molecular and Experimental Medicine, Scripps Research Institute, La Jolla, CA
| | - Laurent Burnier
- Department of Molecular and Experimental Medicine, Scripps Research Institute, La Jolla, CA
| | - Claudia Quarroz
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Maria Desiré Reina Caro
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Yasuhiro Matsumura
- Division of Developmental Therapeutics, Research Centre for Innovative Oncology, National Cancer Centre Hospital East, Chiba, Japan; and
| | - Johanna A Kremer Hovinga
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - John H Griffin
- Department of Molecular and Experimental Medicine, Scripps Research Institute, La Jolla, CA
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - Lidia Ibba-Manneschi
- Department of Experimental and Clinical Medicine, Section of Anatomy and Histology, and
| | - François Saller
- INSERM UMR-S 1176, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Sara Calzavarini
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Anne Angelillo-Scherrer
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and
- Department of Clinical Research, University of Bern, Bern, Switzerland
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van Vulpen LFD, Popov-Celeketic J, van Meegeren MER, Coeleveld K, van Laar JM, Hack CE, Schutgens REG, Mastbergen SC, Lafeber FPJG. A fusion protein of interleukin-4 and interleukin-10 protects against blood-induced cartilage damage in vitro and in vivo. J Thromb Haemost 2017; 15:1788-1798. [PMID: 28696534 DOI: 10.1111/jth.13778] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Indexed: 12/30/2022]
Abstract
Essentials Targeted treatment for hemophilic arthropathy, still causing significant morbidity, is lacking. This study evaluates the efficacy of a fusion of protein of interleukin(IL)-4 and IL-10. In vitro the fusion protein prevents blood-induced cartilage damage in a dose-dependent manner. In hemophilic mice, the IL4-10 fusion protein ameliorates cartilage damage upon joint bleeding. SUMMARY Background Joint damage still causes significant morbidity in hemophilia. It results from synovial inflammation and direct cartilage-degenerating properties of blood components. Interleukin (IL)-4 and IL-10 have been shown to protect cartilage from blood-induced damage. Recently an IL4-10 fusion protein has been developed to combine the function of IL-4 and IL-10 and increase their bioavailability. Objectives In this study we evaluate whether this IL4-10 fusion protein protects against blood-induced joint damage. Methods In vitro, human cartilage explants were exposed to whole blood and simultaneously to a broad concentration range of the IL4-10 fusion protein. Effects on cartilage matrix turnover were compared with the individual cytokines. Moreover, the influence of the fusion protein and its individual components on IL-1β and IL-6 production was investigated. In hemophilia A mice, the effect of intra-articular treatment on synovitis and cartilage damage resulting from joint bleeding was evaluated by histochemistry. Results In vitro, the fusion protein prevented blood-induced cartilage damage in a dose-dependent manner, with equal effectiveness to the combination of the separate cytokines. In whole blood cultures 10 ng mL-1 fusion protein completely blocked the production of IL-1β and IL-6 by monocytes/macrophages. In hemophilic mice, intra-articular injection of IL-4 and IL-10 did not influence synovitis or cartilage degeneration. In contrast, equimolar amounts of the fusion protein attenuated cartilage damage upon repeated joint bleeding, although synovial inflammation was hardly affected. Conclusions Overall, this study shows that the IL4-10 fusion protein prevents blood-induced cartilage damage in vitro and ameliorates cartilage degeneration upon joint bleeding in hemophilic mice.
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Affiliation(s)
- L F D van Vulpen
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J Popov-Celeketic
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M E R van Meegeren
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - K Coeleveld
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - C E Hack
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R E G Schutgens
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands
| | - S C Mastbergen
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - F P J G Lafeber
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
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