Ultrastructural changes produced in rheumatoid synovial membrane by chrysotherapy

Thiol-reactive metal compounds inhibit NF-kappa B activation by blocking I kappa B kinase

Gold compounds are used in the treatment of rheumatoid arthritis. NF-kappa B is a transcription factor implicated in the expression of many inflammatory genes. NF-kappa B is activated by signal-induced phosphorylation and subsequent degradation of inhibitory I kappa B (inhibitory protein that dissociates from NF-kappa B) proteins, and a multisubunit I kappa B kinase (IKK) has been identified previously. We tested the effect of various gold compounds on the activation of NF-kappa B and IKK in LPS-stimulated RAW 264.7 mouse macrophages. A lipophilic gold compound, auranofin, suppressed the LPS-induced increase of nuclear kappa B-binding activity, degradation of I kappa B proteins, and IKK activation. Auranofin also blocked IKK activation induced by TNF and PMA/ionomycin, suggesting that the target of auranofin action is common among these diverse signal pathways. In vitro IKK activity was suppressed by addition of hydrophilic gold compounds, such as aurothiomalate, aurothioglucose, and AuCl3. Other thiol-reactive metal ions such as zinc and copper also inhibited IKK activity in vitro, and induction of IKK in LPS-stimulated macrophages. In vitro IKK activity required the presence of reducing agent and was blocked by addition of thiol group-reactive agents. Two catalytic subunits of IKK complex, IKK alpha and IKK beta, were both inhibited by these thiol-modifying agents, suggesting the presence of a cysteine sulfhydryl group in these subunits, which is critical for enzyme activity. The antiinflammatory activity of gold compounds in the treatment of rheumatoid arthritis may depend on modification of this thiol group by gold.

Inhibition of IL-6 and IL-8 induction from cultured rheumatoid synovial fibroblasts by treatment with aurothioglucose

Gold compounds have long been used in the treatment of rheumatoid arthritis (RA). However, their actions in RA have not been clarified. In this study, we examined the effect of one of the monovalent gold compounds, aurothioglucose (AuTG), on the IL-1-induced production of IL-6, IL-8 and granulocyte macrophage colony stimulating factor (GM-CSF) from rheumatoid synovial fibroblasts (RSF) isolated from three RA patients. IL-6 and IL-8 induction but not GM-CSF induction was inhibited in most of the RSF after pretreatment with AuTG. Since gene expression of these cytokines is known to be under the control of a common transcription factor, NF-kappaB, the effect of AuTG on the cellular localization of NF-kappaB (p65 subunit) and on NF-kappaB-DNA binding was examined. Although AuTG treatment did not prevent NF-kappaB nuclear translocation, AuTG blocked the DNA-binding activity of NF-kappaB when examined in vitro. Morphologically, both metal-specific cell staining using p-dimethylaminobenzylidene rhodamine and transmission electron microscopic examinations demonstrated the accumulation of metal gold in the cytoplama and some organella (mitochondria and lysosomes) of the AuTG-treated RSF. These results indicate that one of the anti-rheumatic actions of AuTG might be through its inhibitory action on NF-kappaB.

Artefacts in electron microscopy: ultrastructural features of chrysiasis

Eleven cases of chrysiasis have been studied ultrastructurally and by electron probe microanalysis. Tissue samples were examined both with and without osmium and uranyl acetate staining. There was a significant morphological difference in the appearance of the gold deposits within aurosomes between the two groups. The untreated group showed finely granular deposits, often arranged in a linear fashion. Aurosomes from samples treated with osmium and uranyl acetate showed more electron-dense deposits and star-like formations. We propose that treatment of the tissue with osmium and uranyl acetate causes a change in the electron microscopic appearance of aurosomes, including the formation of the characteristic star-like aurosomes.

Melanoses of the gastrointestinal tract

Electronmicroscopy and electron probe energy dispersive X-ray analysis studies have substantially contributed to our understanding of the various gastrointestinal tract melanoses. The nature of the pigment granules which occur in the various melanoses is discussed; their pattern of distribution in melanosis coli, melanosis ilei, melanosis duodeni and melanosis oesophagi is summarized and current knowledge of the aetiology and pathogenesis of these conditions is reviewed. Brief mention is also made of other examples of lipofuscin pigmentation, and a case of haemosiderosis ilei is described.

15N NMR studies of the binding of C15N- with gold(I) drugs

15N NMR studies of the interaction of 15N cyanide ion with gold(I)-thiomalate (Autm) and gold(I)-thioglucose (Autg) have been carried out at pH* 7.40. The chemical shifts of the two 15N ions containing species Au(C15N)2- and RS-Au-C15N- (where RS- = tm- or tg-) were identified at 265.94 and 260.30 ppm, respectively. From the broadened 15N NMR signals, approximate life times of the RS-Au-CN- species were calculated.

Interleukin-8 in inflammatory rheumatic diseases: synovial fluid levels, relation to rheumatoid factors, production by mononuclear cells, and effects of gold sodium thiomalate and methotrexate

The content of interleukin-8 (IL-8) in the synovial fluid and its production by blood and synovial fluid mononuclear cells (PBMC and SFMC) was compared in rheumatoid arthritis (RA) and various other inflammatory rheumatic disorders. The study included 125 patients and 20 healthy individuals. The highest concentrations of IL-8 were found in the synovial fluids and culture supernatants of PBMC and SFMC from patients with seropositive RA. Only PBMC from seropositive patients, and not from other rheumatic diseases, exhibited significant spontaneous release of IL-8 that correlated with serum IgM rheumatoid factor titers. Gold sodium thiomalate (GST) and methotrexate (MTX) inhibited the spontaneous and stimulated IL-8 production by PBMC by 55-86% at 50 and 10 micrograms/ml, respectively. Two main conclusions were drawn: (1) rheumatoid factors appeared to be a major cause of enhanced IL-8 production in seropositive RA, and (2) inhibition of IL-8-mediated neutrophil migration and activation could be part of the mechanism of action of GST and MTX.

Influence of an intravenous dose of aurothiomalate on the status of low-molecular-mass endogenous metabolites in blood plasma: a proton nuclear magnetic resonance (NMR) study

The effect of aurothiomalate on the status of a wide range of low-molecular-mass endogenous metabolites in blood plasma obtained from animals treated with an intravenous dose of this second-line agent (150 mg/kg) has been assessed by high field proton Hahn spin-echo NMR spectroscopy. As well as modulating the effective concentrations of NMR-detectable biomolecules, aurothiomalate induces a time-dependent decrease in plasma levels of triacylglycerols with a corresponding elevation in the concentration of the ketone body 3-D-hydroxybutyrate, indicating an increased utilisation of fats for energy in rats treated with this 1:1 gold(I)-thiolate complex. These observations may reflect the toxic side-effects that are associated with aurothiomalate treatment.

Crystalline and amorphous gold in chrysiasis

Skin biopsy specimens from five patients (three females and two males) treated parenterally with gold were investigated using transmission electron microscopy. X-ray microanalysis and electron diffraction were used to determine the dermal heavy metal content. Additional sections were stained for light microscopic examination. The amount of elemental gold administered to the patients over a period of years to alleviate rheumatoid arthritis lay between a minimum of 4.0 g and a maximum of 10.0 g. In one and the same patient dermal histiocytic gold aggregations in sun-exposed areas of skin displayed a different pattern and divergent physiochemical states from the gold deposits in non-UV-exposed skin, where aurosome-like amorphous formations are found in the cells of the upper dermis. Additional spherical particles are associated predominantly with phagolysosomes in melanophages beneath solar-irradiated epidermis. Convergent beam electron diffraction proves the crystalline nature of the spherical auriferous deposits. The occurrence of skin rash was not related to different physicochemical states of the precious metal.

Control of oxidative damage in rheumatoid arthritis by gold(I)-thiolate drugs

The roles of anti-arthritic gold(I)-thiolate drugs such as disodium aurothiomalate ('Myocrisin') in the modulation or promotion of oxygen radical-mediated oxidative damage in vivo are reviewed. In particular, the precise molecular mechanisms by which these novel second-line agents exert their therapeutic effects are discussed in terms of (i) the direct and indirect control of enzymes involved in the generation or scavenging of reactive oxygen species (ROS) such as superoxide ion, hydrogen peroxide and hydroxyl radical, (ii) the protection of proteins and relevant enzyme systems against attack by ROS and (iii) their direct involvement in the production (at appropriate 'target' sites) or scavenging of ROS in vivo. In addition, the role of the orally-effective gold(I)-phosphine complex auranofin in the control of oxidative damage in rheumatoid arthritis is also discussed.

Effect of gold salt treatment on the receptor binding activity of monocytes and macrophages isolated from rats with adjuvant arthritis

We investigated the effect of chrysotherapy on the Fc and complement receptor binding activity of peripheral blood (PB) monocytes and peritoneal (PE) macrophages isolated from normal rats and rats with adjuvant induced arthritis. The adjuvant induced severe disease in Dark Agouti (DA) rats and less marked disease in J. C. Lewis (JC) rats. Gold treatment reduced the disease in DA rats but exacerbated the disease in JC rats. PB monocytes generally exhibited increased receptor activity after adjuvant injection. Gold treatment resulted in a simultaneous reduction of the PB monocyte receptor activity and increased the PE macrophage receptor activity. This was considered to be due to a direct effect of gold, since the Fc receptor activity of PE macrophages increased after in vitro gold treatment.

Effect of two gold compounds on lysosomes

The effect of two gold(I) compounds on stability of lysosomes in vitro was studied. Lysosomes from homogenates of rat kidney cortex were isolated by differential centrifugation. These lysosomes were incubated at 37 degrees C with widely varied concentrations of sodium aurothiomalate and sodium aurothiosulphate for 5, 35, and 65 minutes. Acid phosphatase activities were measured and used as an indication of lysosomal membrane stability in the presence and absence of drugs. The enhanced release of acid phosphatase from lysosomes by aurothiomalate and aurothiosulphate was related to dose, but the drugs differed substantially in their potencies. The disruptive effect on lysosomes was more marked for aurothiosulphate than for aurothiomalate. In addition, both drugs inhibited acid phosphatase activities at relatively high gold concentrations. Aurothiomalate had a moderate and aurothiosulphate a weaker inhibitory effect on the enzyme. Our results indicate that aurothiomalate and aurothiosulphate exert their beneficial effect in the treatment of rheumatoid arthritis through mechanism(s) other than lysosomal membrane stabilisation.

Three kinds of foamy cells in the spleen: comparative histochemical and ultrastructural studies

By light and electron microscopy, we observed foamy cells in the spleens from a patient with hemolytic anemia due to red cell adenosine deaminase (ADA) overproduction, a patient with rheumatoid arthritis (RA) treated with gold, and patients with idiopathic thrombocytopenic purpura (ITP). The foamy cells associated with red cell ADA overproduction were essentially similar to Gaucher-like cells described in patients with thalassemia, and it was suggested that the accelerated destruction of red cells was one of the factors responsible for the development of foamy cells. Foamy cells in ITP and RA were closely associated with an increased destruction of platelets in the spleen. Morphologic transitions between phagocytosed platelets and myelin-like materials were traced in these disorders. In RA, however, foamy cells were heterogeneous from an ultrastructural standpoint, with different cytoplasmic inclusions. In addition to myelin-like materials, dense bodies, vacuoles with flocculent materials, and gold were noted in most of foamy cells. As gold compounds are known to inhibit lysosomal enzymes, we surmise that an acquired disturbance in lysosomal digestion is partially responsible for the accumulation of intermediate metabolites. In the pathogenesis of foamy cells associated with blood cell dyscrasia, the accelerated destruction of blood cells and/or acquired disorders in catabolic pathways within the macrophages are suggested to be the underlying mechanism of an intralysosomal accumulation of incompletely degraded cellular debris.

Effects of gold salts on experimental periodontitis. III. Ultrastructural observations

Previous studies showed that the systemic administration of soluble gold salts resulted in significantly less periodontal destruction after 2 weeks of experimentally induced periodontitis. The present study compared the ultrastructural characteristics of the inflammatory lesion in animals receiving gold salts (experimental) with those in animals that had not received gold salts (control). Maxillary gingival biopsy specimens were obtained from the buccal aspect of ligatured teeth after 2 weeks of experimental periodontitis. A cellular and extracellular ultrastructural characterization was done in an "epithelial and superficial connective-tissue zone," and a "deep connective-tissue zone." Experimental (gold-receiving) specimens had an intact sulcular epithelium with narrow intercellular spaces overlying a collagen dense connective tissue. Control specimens had a degenerating disrupted epithelium overlying a collagen-poor connective tissue in which polymorphonuclear leucocytes predominated and often were closely apposed to morphologically altered fibroblasts. The cellular distribution of electron-dense deposits of gold salts was demonstrated, and their possible role in modulating mechanisms of cell cytotoxicity and collagen turnover is discussed.

The effect of cyanide on the uptake of gold by red blood cells

Cyanide markedly increased the rate of uptake of gold by red blood cells when incubated with sodium aurothiomalate, a polymeric gold complex. Thiocyanate had no significant effect on gold uptake. The effect of cyanide was demonstrated to be due to the conversion of aurothiomalate to the complexion, aurocyanide, which is rapidly taken up by red blood cells. At a low ratio (1:20) of cyanide to aurothiomalate, cyanide appeared to act as a shuttle to carry gold into red blood cells. Tobacco smoking is known to increase the concentrations of gold in red blood cells in patients treated with aurothiomalate. The present data indicate that this effect of smoking is most likely due to cyanide inhaled in tobacco smoke and not to thiocyanate, a circulating metabolite of cyanide. An effect of cyanide on the uptake of polymeric gold complexes to target cells such as polymorphonuclear leukocytes and monocytes is suggested.

Remission-inducing therapy in rheumatoid arthritis

Rheumatoid arthritis is characterized by immunologically mediated chronic inflammation of synovial structures. Remission-inducing drugs, such as gold compounds, antimalarials, and D-penicillamine, have been shown to suppress disease activity in rheumatoid arthritis while having minimal nonspecific anti-inflammatory properties. The possibility that these agents are effective because they modulate the underlying immunologic reactivity prompted an examination of the immunosuppressive properties of these drugs. The evidence indicates that immunosuppression is an action that is shared by these agents and thus supports the view that remission induction may result from suppression of the immunologic activity that underlies rheumatoid inflammation. Despite the fact that these agents can function as immunosuppressives, each appears to have a unique site of action, specifically inhibiting the function of only one of the populations of cells likely to be involved in chronic immunologically mediated inflammation. Gold compounds and anti-malarials appear to be active by virtue of their capacity to depress various functions of mononuclear phagocytes, while D-penicillamine acts by inhibiting a number of the activities of T lymphocytes. These results imply that the means by which these drugs suppress rheumatoid inflammation are fundamentally different. This suggests the conclusion that the remission-inducing drugs may be classified as T cell-active and mononuclear phagocyte-active agents. A better understanding of the pathophysiology of rheumatoid arthritis should thus be helpful in deciding which of these classes of drugs is appropriate in individual cases.

Mechanisms of action of gold

Since the successful introduction of injectable gold compounds for the treatment of rheumatoid arthritis over 50 years ago, numerous studies on the possible mechanism of action have been performed. This heavy metal has been show to possess a bewildering array of biological effects. Studies using gold performed both in vitro and in vivo can be grouped into anti-microbial, anti-immunologic, anti-inflammatory, anti-enzymatic and other effects. In this survey, we have analyzed these multiple approaches to the study of the mechanism of action of injectable gold preparations and apply the findings to rheumatoid arthritis.

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.

Gold-induced changes in the morphology and functional capabilities of human monocytes

The capacity of gold compounds to induce morphologic changes and alterations in the functional activity of human mononuclear phagocytes (M phi) in vitro was examined. Human peripheral blood mononuclear cells were incubated with gold sodium thiomalate (25 microgram/ml) for 96 hours. As a result, M phi developed electron dense precipitates within phagolysosomes, as well as marked dilatation of these organelles. Gold incubation also altered a number of M phi functions. While viability and adherence were unaffected, the capacity to spread on surfaces was diminished. Pinocytosis of soluble proteins and phagocytosis of opsonized sheep erythrocytes were impaired, but Fc mediated particle binding was not. These data indicate that gold can alter certain functional activities of M phi and support the idea that the major action of gold in rheumatoid arthritis results from its capacity to alter M phi function.

Ultrastructural localization and in situ analysis of iron, bismuth, and gold inclusions

The purpose of this article is to review ultrastructural and electron probe X-ray analytical studies on metallic deposits in cells. The metals that will be dealt with are iron, bismuth, and gold, mainly because they have been extensively studied in recent years. The nature and chemical composition of endogenously (e.g., from breakdown of autologous blood) and exogenously (e.g., after a transfusion or injection of iron compounds) produced hemosiderin (i.e., iron deposits) has been the subject of time-hallowed controversies. Quite a few of these have now been resolved by ultrastructural studies and the atomic composition of such deposits has been determined by electron probe X-ray analysis. The interest in bismuth centers around the fact that this is one of the two metals (the other being lead) that produces quite large intranuclear inclusions. Here again much has been learned by ultrastructural and X-ray analytical studies. The interest in gold stems from the fact that soluble salts of this metal are used for the treatment of rheumatoid arthritis and current studies with the above-mentioned techniques indicates how gold produces its beneficial and toxic effects.

A tissue culture model of cartilage breakdown in rheumatoid arthritis. III. Effects of antirheumatic drugs

The effects of hydrocortisone, indomethacin, and gold thiomalate on proteoglycan release were assessed in bovine nasal cartilage-rheumatoid synovium cocultures. Of the three agents, only hydrocortisone consistently inhibited both basal and synovium-stimulated cartilage breakdown. Hydrocortisone responsivity was a direct function of the degradative capacity of synovial specimens, and this was equally well demonstrated both in patients receiving long-term therapy and those given perioperative glucocorticoid therapy. The data are consistent with significant hydrocortisone inhibition of lysosomal enzyme-mediated degradation of cartilage.

Long-term effects of myochrysine on the synovial membrane and aurosomes

Mysochrysine injected into the rabbit knee joint produced regressive and destructive changes in the synovial membrane, ultimately leading to fibrosis. Aurosomes, containing characteristic electron-dense deposits indicating the presence of gold, formed in the synovial intimal cells and subsynovial macrophages. The number of aurosomes decreased with the passage of time but some were found even 2 yr after the injection of Myochrysine. Electron-probe X-ray analysis showed that the aurosomes contain gold, sulphur and phosphorus. A comparison was made between the atomic ratios of these elements in 3-day and 18-mth-old aurosomes but no significant difference was detected.

Long term effects of myochrysine in articular cartilage

Intra-articularly administered sodium aurothiomalate (Myochrysine) produced aurosomes containing characteristic electron dense contents (indicating the presence of gold), in the chondrocytes of rabbit articular cartilage. At first the aurosomes were bounded by a membrane but later the electron dense contents were seen lying free in the cytoplasmic matrix. Such deposits were detectable up to 14 months after injection of Myochrysine but none were found at later time intervals (18 months and 2 years). There was a reduction in the population of superficial chondrocytes (Zone I) while those in deeper zones (Zones II and III) showed an increased content of intracytoplasmic filaments. It is thought that these are regressive or degenerative changes produced by gold.

Ocular chrysiasis correlated with gold concentrations in the crystalline lens during chrysotherapy

The eyes of 11 patients with rheumatoid arthritis (RA) who received extended chrysotherapy (mean cumulative dose greater than 7 grams during a mean 6-year period) were examined biomicroscopically. Minute reddish-purple particles were seen in the cornea (corneal chrysiasis) in 5 and in the lens (lens chrysiasis) in 4 patients. Particulate deposits were absent in 11 other RA patients who had not received gold treatment. Seven crystalline lenses from 5 gold-treated patients were removed surgically because of incidental cataract formation and analyzed for gold content using neutron activation analysis. Although the mean lens gold concentration was higher in these patients than in non-gold-treated controls without RA (0.0073 microgram/grams versus 0.001 microgram/grams), the absolute gold level was markedly lower than that found in 25 diverse tissue analyzed previously. This finding is compatible with the absence of clinical gold-related lens disease or visual impairment.

Ultrastructure of the skin of patients treated with sodium aurothiomalate

Skin biopsies from cases of rheumatoid arthritis treated with sodium aurothiomalate were examined with the electron microscope. Intralysosomal gold deposits were found in the macrophages of both normal-looking skin and from areas of erythematous rash that had developed as a toxic manifestation of gold therapy. The main difference between affected and normal-looking skin was the presence of numerous mast cells in the former. It is hence suggested that the dermatologic side-effects of gold are probably mediated by the release of vasoactive substances from mast cells and that vigorous administration of antihistamines to neutralise the liberated products of mast cells or an agent that interferes with degranulation of mast cells might have a palliative effect on the skin rash that sometimes develops during chrysotherapy.

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.

Comparative ultrastructural morphology of aurosomes produced by colloidal gold and soluble gold salts

Intra-articular administration of colloidal gold produced aurosomes which contained spherical electron-dense granules and also often some very fine electron-dense particles. Intra-articular administration of aurothioglucose produced aurosomes of a morphology similar to that reported to occur after administration of sodium aurothiomalate. These aurosomes produced by soluble gold salts are characterised by particle and granule-studded membranous formations which present in profile as rod-like and curled filamentous structures. On the basis of morphological differences two types of aurosomes should be recognised, the "Type I or granular aurosome" and the "Type II or membranous aurosome".

Gold nephropathy

Nephropathy with proteinuria is an occasional complication of gold therapy for rheumatoid arthritis and is considered to be due to an immune hypersensitivity reaction. Three patients are described in whom the structural changes typical of gold nephropathy were demonstrated by electron microscopy of renal biopsies. There was early membranous glomerular nephropathy with multiple sub-epithelial deposits of immune complexes. In one case these were shown by immunofluorescence to contain IgG and complement. Proximal tubules contained characteristic dense granular intracytoplasmic gold inclusions, best demonstrated by electron microscopy of unstained sections.

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.