Heberden Oration 1980: aspects of the cell biology of the rheumatoid synovial lesion

Elevation of carboxyl methylation activity on GTP-binding protein gamma-subunit in synovial tissues from rheumatoid arthritis: how does elevation of the methylation relate to the signal transduction system of rheumatoid arthritis?

We examined guanosine triphosphate (GTP)-binding proteins (G-proteins) in synovial tissues obtained from patients with rheumatoid arthritis or osteoarthritis. The results of immunoblot analysis with anti-bovine G-protein betagamma-subunit antibody in the rheumatoid synovial tissue were similar to those in the osteoarthritis synovial tissue. On the other hand, the carboxyl methylation activity on G-protein gamma-subunit in the rheumatoid synovial tissue was enhanced compared with that in the osteoarthritis synovial tissues: Km and Vm values were 2.6 microM and 10 pmol/mg x min, respectively, for the rheumatoid arthritis, and 4.8 microM and 5.6 pmol/mg x min, respectively, for the osteoarthritis. These results suggest that G-protein-linked signal transduction, in reference to carboxyl methylation of the gamma-subunit, is affected in rheumatoid tissues.

Prostaglandin E2 elicits a morphological change in cultured orbital fibroblasts from patients with Graves ophthalmopathy

Fibroblasts derived from distinct anatomical regions appear to differ in regard to their behavior in culture. These differences may reflect functions of these cells in vivo that are tissue specific. Moreover, intrinsic differences in fibroblasts may underlie the site-specific connective tissue manifestations associated with systemic disease. We have demonstrated previously that orbital fibroblasts exhibit different cytokine response domains and protein synthetic programs when compared to those emanating from the skin. In the present communication, we demonstrate that prostaglandin E2 (PGE2) elicits in cultured human orbital fibroblasts from patients with Graves ophthalmopathy a rapid and dramatic change in cell morphology in vitro as assessed by phase-contrast and scanning electron microscopy. The central areas of the cells become elevated with respect to the plane of the substratum and are stellate, with long processes that touch neighboring cells. These changes occur within 6 hr of prostanoid addition to culture medium at an apparent concentration threshold of approximately 10 nM. Shape changes are accompanied by marked alterations in monolayer impedance as assessed by electric cell-substrate impedance sensing as described previously. Both morphologic and impedance changes elicited by PGE2 revert over 24 hr toward those found in untreated cells despite the continued presence of the prostanoid in the culture medium. In contrast, dermal fibroblasts fail to respond to PGE2. These observations define a previously unrecognized phenotypic attribute of orbital fibroblasts. Intrinsic differences in these cells may account for the anatomic site-selective vulnerability of the orbit in Graves ophthalmopathy. The culture system described here may be useful for studying the morphogenic actions of prostanoids.

Differential modulation of degradative and repair responses of interleukin-1-treated chondrocytes by platelet-derived growth factor

Interleukin 1 (IL-1) plays a dual role in cartilage matrix degeneration by promoting extracellular proteinase action such as the matrix metalloproteinases (increased degradation) and by suppressing the synthesis of extracellular matrix molecules (inhibition of repair). Platelet-derived growth factor (PDGF) is a wound-healing hormone which is released along with IL-1 during the inflammatory response. Since previous studies have shown that PDGF enhances IL-1 alpha effects on metalloproteinase activity, in this report, we have examined whether PDGF modifies IL-1 beta effects on cartilage proteoglycan synthesis. Initially, we confirmed that rabbit articular chondrocytes treated with IL-1 beta + PDGF induced higher proteinase activity, in comparison with IL-1-treated cells. We further observed that the increased proteinase activity correlated with an increase in the synthesis of collagenase/stromelysin proteins and a corresponding increase in the steady-state mRNA levels for both the enzymes. Studies on IL-1 receptor expression suggested that PDGF caused an increase in IL-1 receptor expression which, by augmenting the IL-1 response, may have led to the increase in proteinase induction. Analysis of proteoglycan synthesis confirmed that IL-1 reduced the incorporation of sulphated proteoglycan, aggrecan, into the extracellular matrix of chondrocytes, whereas PDGF stimulated it. However, cells treated with IL-1 + PDGF synthesized normal levels of aggrecan. This is in contrast with cells treated with IL-1 + fibroblast growth factor, in which case only proteinase activity was potentiated. The results allow us to conclude that (a) the two effector functions that play a role in matrix remodelling, namely matrix lysis (proteinase induction) and matrix repair (proteoglycan synthesis), occur via distinct pathways and (b) PDGF may play a crucial role in cartilage repair by initially causing matrix degradation followed by promoting new matrix synthesis.

Uptake of acetylated low density lipoprotein (ac-LDL) by synovial cells

Acetylated low density lipoprotein (ac-LDL) is known to be incorporated into monocyte/macrophages. We examined the uptake of fluorescence-labeled ac-LDL as well as the surface expression of CD14 using flow cytometry, in order to identify macrophage-like type A synoviocytes in the synovium of patients with rheumatoid arthritis (RA) (n = 15) and osteoarthritis (OA) (n = 5). The mean (+/- SD) percentage of ac-LDL uptake cells in RA synoviocytes (38.3 +/- 19.9%) was relatively higher than that in OA synoviocytes (16.6 +/- 8.7%) (p < 0.05). Also the proportion of ac-LDL incorporating cells paralleled, but was higher than, that of CD14 positive cells (r = 0.91, p < 0.001). This method is helpful in determining macrophage-like type A synoviocytes, and the presence of CD14-negative macrophage-like synoviocytes has been revealed.

Expression of vascular cell adhesion molecule-1 in fibroblastlike synoviocytes after stimulation with tumor necrosis factor

Rapid expression of mRNA encoding vascular cell adhesion molecule-1 (VCAM-1) was induced by tumor necrosis factor (TNF) in fibroblast-like cells obtained from synovial tissue. Both alternatively spliced forms of VCAM-1 mRNA were detected by polymerase chain reaction in TNF-stimulated fibroblast-like synoviocytes. Western blotting analysis showed that two distinct proteins, reactive with an anti-VCAM-1 anti-sera, were expressed by 2 hours of TNF stimulation in both synoviocytes and human umbilical cord vein endothelial cells (HUVEC). The majority of HUVEC and synoviocytes displayed VCAM-1 surface expression after several hours of TNF stimulation. In contrast, dermal fibroblasts upregulated intercellular adhesion molecule-1 (ICAM-1) but not VCAM-1 expression in response to TNF. These results indicate that VCAM-1 and ICAM-1 expression can be differentially regulated and suggest tissue specific regulation of VCAM-1 expression. Furthermore, these findings may provide an explanation for the chronic retention and activation of long-lived lymphocytes and monocytes, which express VLA-4 (the receptor for VCAM-1), in the synovium in rheumatoid arthritis.

Intra-articular administration of interleukin-1 causes prolonged suppression of cartilage proteoglycan synthesis in rats

The effect of IL-1 on proteoglycan synthesis was studied after intraarticular injection of IL-1 into the knee joints of rats. IL-1 reduced the sulfated glycosaminoglycan synthesis in the articular cartilage of rats in a dose-dependent fashion. Analysis of the sulfated molecules by chondroitinase ABC digestion followed by composite agarose/acrylamide gel electrophoresis confirmed the proteoglycan nature of the molecules. Immunoprecipitation of the methionine-labeled extracts with a polyclonal antibody against the core protein indicated that the reduction in glycosaminoglycan synthesis was due to an inhibition of the core protein synthesis after IL-1 treatment. IL-1 induced inhibition occurred in both young and old rats and was independent of the prostaglandin pathway, as non-steroidal anti-inflammatory drugs failed to block the inhibition of proteoglycan synthesis by IL-1. The cartilage of rats injected with IL-1 was able to recover with time and synthesize normal amounts of total proteoglycan. However, administration of successive doses resulted in a much delayed return to normal synthesis. These results suggest that IL-1, if available locally in a cyclical fashion, could significantly interfere with the ability of cartilage to repair by causing a prolonged suppression of proteoglycan synthesis.

Pathways of destruction in metacarpal and metatarsal joints of patients with rheumatoid arthritis

219 metatarsal (MTP) and 69 metacarpal (MCP) capitulae obtained during surgery from patients with definite rheumatoid arthritis (RA) were histologically evaluated. This evaluation, focussing on primary pathways of joint destruction by tumor-like proliferated synovial cell masses revealed 3 pathways of aggression: Pathway A: In 15% aggression onto the articular cartilage only. Pathway B: In 49% direct invasion exclusively into the cortical bone. Pathway C: In 36% a "forceps-like" aggression, a combination of A and B in which the joint is attacked from both sides. In contrast to the hitherto conventional concepts, the findings of this study reveal a clear preference of the synovial aggression for the cortical bone rather than for the articular cartilage. The different concepts of joint destruction in RA are being discussed in the light of our findings. Thus, future pathogenetic considerations with regard to joint destruction in RA should take this fact into consideration.

Modulation of synovial fibroblast plasminogen activator and plasminogen activator inhibitor production by protein kinase C

Phorbol myristate acetate (PMA) added to human synovial fibroblast cultures caused a dose-dependent increase in the production of plasminogen activator inhibitor-type 1 (PAI-1). In addition, PMA inhibited endogenous and interleukin-1 (IL-1) induced plasminogen activator (PA) activity, while increasing mRNA PAI-1 levels. Other protein kinase C (PKC) activators, mezerein and teleocidin B4, caused similar effects. The simultaneous addition of the PKC antagonists, H-7 or staurosporine, prevented the inhibition of PA activity by PMA. This study shows that activation of PKC inhibits PA and stimulates PAI production in human synovial fibroblasts. These results suggest that activation of PKC may play an important role in regulating increased PA production associated with joint destruction in rheumatoid arthritis (RA).

Arthritis induced by interleukin-1 is dependent on the site and frequency of intraarticular injection

Intraarticular injection of recombinant human interleukin-1 (IL-1) in rats resulted in varying degrees of inflammatory changes depending on the site and frequency of injections. (i) Much lower amounts of IL-1 were required to elicit an inflammatory response in the ankle joints (15-3000 ng) than the knee joints (90-150 micrograms). (ii) The inflammatory response was much greater if IL-1 was administered in multiple doses as compared to a single dose injection. One day after a single injection of IL-1 (90-150 micrograms), knee joints exhibited a mild increase in volume as a consequence of edema, but at the end of 1 week, no discernible change in volume was observed. However, when the same total amount of IL-1 was injected in three doses, there was a dramatic increase in joint volume at the end of 1 week that persisted for at least 3 weeks. The increase was dose dependent. (iii) The inflammatory response was dependent on the age/weight of the rats: the older the animals the greater the response. (iv) Under conditions where IL-1 induced inflammatory changes in knee joints, recombinant tumor necrosis factor failed to induce any significant response. (v) Histological examination of the knee joints revealed distinct differences in the pathological response to the two different protocols of IL-1 administration in the knee joints. The animals injected with a single dose of IL-1 showed a mild and transient inflammation that was resolved by 2 weeks postinjection, but exhibited degenerative changes associated with focal loss of chondrocytes and proteoglycan of the knee joint cartilage, which became progressively severe. The knee joints of animals given three injections of IL-1 showed evidence of marked acute synovitis, fibroplasia, loss of proteoglycan and chondrocytes, resorption of subchondral bone, and transition of hematopoeitic marrow cells into cells of mesenchymal morphology. (vi) Examination of proteoglycan synthesis by cartilage of IL-1-injected rats revealed that within 1 day after injection, a dramatic reduction in synthesis occurred which persisted for at least 2 weeks. These studies suggest that intraarticular injection of IL-1 provides a useful rodent model for the investigation of pathological changes occurring within a localized joint as a result of acute and chronic inflammatory stimuli. Relevant aspects of the pathology of joint erosion can be demonstrated depending on the frequency of IL-1 injection.

Abnormal osteocalcin binding in rheumatoid arthritis

Studies of osteocalcin in the serum and synovial fluid of patients with rheumatoid arthritis (RA) and osteoarthritis (OA) showed the presence of significant amounts of osteocalcin in synovial fluid and that the values in RA synovial fluid were significantly lower than in OA synovial fluid. In addition, the osteocalcin in OA synovial fluid bound almost completely to hydroxyapatite, whereas a significant proportion of the osteocalcin in RA synovial fluid did not. These studies suggest that patients with severe RA produce low amounts of active osteocalcin and higher than expected amounts of inactive osteocalcin in the synovial fluid. They provide some evidence that osteoblast function may be abnormal in the osteoporosis of RA.

Mechanisms of matrix degradation in rheumatoid arthritis

In the inflammatory synovium production of collagenase is probably responsible for the degradation of collagen in the extracellular matrix and distortion of the architecture and function of the joints. Major collagenase-producing cells are mesenchymal cells such as fibroblasts and chondrocytes, which synthesize and secrete the enzyme influenced by the action of cytokines produced by adjacent mononuclear cells. The cytokines act primarily through cell-surface receptors, whose signal is probably then mediated by complexes of nuclear oncoproteins, to activate transcription of the procollagenase gene. The increased production of collagenase ultimately is the result of a cascade of cellular effects involving complex interactions of different ligands in a system characterized by amplification and feedback loops.

Potential mechanisms for coordinate gene activation in the rheumatoid synoviocyte: implications and hypotheses

Evidence is reviewed to support the concept that synovial cells in rheumatoid arthritis have undergone distinctive alterations at the cellular and subcellular level that result in their taking on some of the characteristics that are also manifest by transformed cells. These phenotypic modulations could be indirectly driven by cytokines in a paracrine or autocrine fashion. Specific regional patterns of cell phenotype modulation were used to argue against a simple widely diffusing direct inductive effect to cytokines and in favor of microenvironmental determinants. It is hypothesized that these extracellular factors induce novel activation in a coordinate manner by acting through master regulatory genes operating in cells with specific microenvironmental interactions. Two of these regulatory genes, fos and jun, are discussed in detail because of their induction by growth factors and their central role in the transactivation of genes which have been implicated in rheumatoid synovitis. A model for gene activation in the rheumatoid synovium is proposed based on the premise that fos and jun are an important link in the intracellular transduction pathways used by cytokines to induce cellular phenotypic changes.

Cellular basis and oncogene expression of rheumatoid joint destruction

A new animal model for human rheumatoid arthritis is described, and the unsolved questions regarding the mechanism of primary joint destruction are discussed. Following an analysis of the types of cells and antibodies found in joints affected by rheumatoid arthritis, it is concluded that both expression of oncogenes and the presence of retroviral sequences detectable by monoclonal antibodies to HTLV I p19 and p24 sequences are associated with early abnormal proliferation of apparently transformed cells at the site of initial cartilage and/or bone destruction.

Activation of macrophages in an experimental rat model of arthritis induced by Erysipelothrix rhusiopathiae infection

Infection of Lewis rats with Erysipelothrix rhusiopathiae represents an experimental model system of acute and chronic arthritis. We studied here the acute inflammatory phase with respect to stimulation of macrophages and lymphocytes. Intragluteal injection of viable E. rhusiopathiae (10(2) to 10(4) bacteria) rapidly induced generalized inflammation, loss of body weight, hind leg arthritis, and systemic macrophage activation within 2 to 3 days. The same symptoms could also be evoked by injection of dead E. rhusiopathiae. Ex vivo, peritoneal macrophages released large amounts of tumor necrosis factor alpha on day 2 and interleukin-1 on day 3, whereas production of prostaglandin E2 was delayed to days 5 to 7 and appeared to counteract tumor necrosis factor alpha synthesis. The inflammatory response and development of arthritis were strongly dependent on T lymphocytes, as evidenced by the following findings: (i) lymphocytes released lymphokines that activated macrophages to enhanced mediator release; (ii) treatment of rats with cyclosporin A reduced infection-induced macrophage activation; (iii) mitogen-stimulated thymocyte proliferation was enhanced, indicating an infection-induced maturation-differentiation process in the thymus; and (iv) in T-cell-deficient nude rats, a higher dose of bacteria was required for infection, the inflammatory response was less severe, and only mild, but not chronic, arthritis developed. Thus, an E. rhusiopathiae-induced inflammation in rats provides a useful tool to characterize activated macrophages and T lymphocytes during the development of acute arthritis and its transition into the chronic form.

The metabolism and immunology of bone

Many cells and their cytokines produce a significant effect on bone metabolism. Bone matrix synthesis is a function of the osteoblast (Fig 1), influenced directly by numerous local and systemic factors (Tables 1 and 2). Locally synthesized factors such as SGF, BMP, and BDGF may be particularly important in stimulating new bone formation at sites of bone resorption or following bony injury. Of the systemic factors, GH; somatomedin C (IGF-1); high concentrations of insulin, testosterone, PDGF and TGF beta; and low concentrations of PGE2 and IL-1 appear to stimulate bone formation in vitro. These latter factors may be more important in maintaining skeletal growth and bone mass. Bone resorption by osteoclasts (Figs 2 and 3) is also controlled by the osteoblast, as this cell produces a leukotriene-dependent polypeptide that stimulates osteoclastic bone resorption. Osteoblasts cover the periosteal and endosteal bone-surfaces and limit exposure of the underlying bone to osteoclasts. PTH, vitamin D, PGE2, and other systemic factors interact directly with the osteoblast, not the osteoclast. Surface receptor binding of PTH increases intracellular cAMP and calcium and results in release of the factor that stimulates osteoclastic bone resorption. PGE2 induces osteoblasts to activate osteoclasts and is a major controlling factor in bone metabolism; the osteoblast produces PGE2, which can then modify osteoblastic function by positive feedback. Although low concentrations of PGE2 stimulate bone formation, higher concentrations promote osteoblast-mediated bone resorption. Furthermore, many of the systemic factors stimulate bone resorption via a PGE2-associated mechanism. Immune cytokines also appear to exert a profound influence on bone metabolism. INF-gamma inhibits osteoclastic resorption, whereas IL-1, TNF, and LT strongly stimulate bone resorption. However, low concentrations of IL-1 paradoxically result in stimulation of bone formation. These cytokines, particularly in various combinations, may prove extremely important in understanding and treating the bone loss associated with malignancies, osteoporosis, and rheumatoid arthritis.

Induction of interleukin-1 receptors on chondrocytes by fibroblast growth factor: a possible mechanism for modulation of interleukin-1 activity

Interleukin-1 is a polypeptide factor with profound effects on several cell types, such as chondrocytes, fibroblasts, and T-cells. The ability of interleukin-1 to induce the synthesis of matrix-degradative enzymes, as well as prostaglandin E2, suggests a pivotal role for this mediator in chronic inflammation. Previous studies have shown that the effect of human monocyte interleukin-1 on the synthesis of collagenase and neutral proteases by chondrocytes was enhanced by basic fibroblast growth factor. Using recombinant human interleukin-1B, we have examined whether the potentiation of interleukin-1 effects by fibroblast growth factor is related to changes in the number or affinity of interleukin-1 receptors. Our studies confirm that rabbit articular chondrocytes in culture contain a single class of high-affinity receptors for interleukin-1 with a Ka of 0.9-1.1 x 10(-13) M-1. While the untreated chondrocytes contain approximately 1,620 receptors per cell, fibroblast growth factor-treated cells exhibit a higher number of receptors (approximately 2,960 per cell) with no apparent change in the affinity. The increase in receptor number can be abolished by inhibitors of lysosomal function, indicating a requirement for intracellular processing of the fibroblast growth factor. Our results suggest that the potentiation of interleukin-1 catabolic effects by fibroblast growth factor may be related to its ability to induce additional interleukin-1 receptors on the chondrocyte cell surface.

Synovial microenvironment-T cell interactions. Human T cells bind to fibroblast-like synovial cells in vitro

Synovitis in rheumatoid arthritis is characterized by infiltration of the synovium by T and B lymphocytes and monocytes, as well as by the proliferation of synovial lining cells, fibroblasts, and endothelial cells. To study synovial cell-T cell interactions in vitro, we established cultures of fibroblast-like synovial cells, and used these cells in a synovial cell-T cell binding assay. Using T cells at various stages of differentiation and activation, we found that human thymocytes and mitogen-activated peripheral blood T cells bound to fibroblast-like synovial cells, whereas fresh peripheral blood T cells did not. Moreover, activated T cells from inflammatory synovial tissue or from synovial fluid also bound to fibroblast-like synovial cells cultured in vivo. Antibodies against certain epitopes of the T cell CD2 (35.1) and synovial cell lymphocyte function-associated antigen-3 (LFA-3) (TS2/9) molecules inhibited synovial cell-thymocyte binding. However, these same anti-CD2 and anti-LFA-3 antibodies only partially inhibited synovial cell binding to activated normal peripheral blood T cells. Moreover, T cells from inflammatory synovium from rheumatoid arthritis and psoriatic arthritis patients also bound to synovial cells in vitro. These findings demonstrate that fibroblast-like synovial cells are capable of binding to human T cells in vitro, and suggest that during the course of inflammatory synovitis, synovial fibroblast-T cell interactions may occur in vivo.

Activated monocytes induce arthritis-associated changes in mitochondria of cultured synovial fibroblasts

We have recently shown that synovial fibroblasts cultured from patients with reactive or rheumatoid arthritis exhibit increased autofluorescence when compared with controls. Morphological studies suggested that this increase was related to the anomalous structure of mitochondria in cells cultured from rheumatoid or non-rheumatoid inflammatory synovial tissue. The present study describes attempts to find an explanation for these observations. The effects of conditioned media of cultured mononuclear cells were tested on normal synovial fibroblasts. Conditioned media of monocytes stimulated with lipopolysaccharide or poly-IC induced an increase in the cellular autofluorescence and changes in the morphology of mitochondria in normal fibroblasts. These changes were indistinguishable from those seen in synovial fibroblasts cultured from various arthritides. Indomethacin or gold salts did not abolish the effects of monocyte-conditioned media. Abnormal mitochondria could not be induced in the presence of cycloheximide. This study describes a new aspect of monocyte-fibroblast interactions during rheumatoid and non-rheumatoid inflammation of synovial tissue.

Spontaneous production of an interleukin 1-like factor by cloned rheumatoid synovial cells in long-term culture

We have cloned adherent synovial cells from rheumatoid synovitis. These can be generally divided into three types, including cells that have the characteristic features of dendritic cells (DCs), macrophagelike cells (MCs) and fibroblastlike cells (FCs), as classified by morphology and immunofluorescent staining. The cloned cells were able to divide and were cultured for up to 11 mo without any significant morphological changes. All the cloned cells were HLA-DR+ after gamma-interferon treatment. Spontaneous production of a factor with interleukin 1 activity by the cloned cells was detected even after long-term culture (the ability, on a per cell basis, being in the following order: DC greater than MC greater than FC). These synovial cells may be important for bony destruction in rheumatoid joints.

Histamine H1 receptors on adherent rheumatoid synovial cells in culture: demonstration by radioligand binding and inhibition of histamine-stimulated prostaglandin E production by histamine H1 antagonists

Histamine H1 receptors have been demonstrated on adherent rheumatoid synovial cells using biochemical and radioligand binding assays in vitro. The addition of histamine (17.8 mumol/l) to nine primary cultures of adherent rheumatoid synovial cells resulted in a two- to 21-fold increase in the production of prostaglandin E (PGE). This increase was inhibited by three H1 receptor antagonists (mepyramine, tripelennamine, and chlorpheniramine) in a dose related manner at concentrations below 10(-6) mol/l. Competitive binding assays with [3H]mepyramine gave ED50 values of approximately 10(-5) mol/l for the three H1 antagonists. H2 receptor antagonists (cimetidine and ranitidine) did not inhibit the histamine induced increase in PGE and did not compete effectively with the binding of H1 antagonists.

Porcine heart valves produce a protein that induces cell-mediated connective tissue degradation: II. Biochemical properties of the partially purified protein

A cardiac catabolic factor (CCF) has been partially purified from serum-free medium conditioned by minced porcine heart valves. CCF was prepared by a series of chromatographic techniques and compared directly with porcine synovial catabolin purified by the same protocol. CCF displayed a somewhat higher molecular weight (Mr 21,000) and isoelectric point (pI 5.2) than did synovial catabolin (Mr 18,000 and pI 4.8), but the two factors clearly resemble one another closely. CCF stimulated the release of glycosaminoglycans from cultured cartilage and mitral valve and provoked porcine valves to degrade their own collagen extracellular matrix. The release of hydroxyproline was inhibited by corticosteroids, whereas proteoglycan breakdown was not. Partially pure preparations of CCF and synovial catabolin stimulated murine thymocyte proliferation; moreover, that activity was almost totally abolished by an antibody raised against pure porcine interleukin-1. These observations suggest that CCF may represent a catabolic factor that belongs to the interleukin-1 family and that it could potentially regulate the composition of valvular connective tissue.

The effects of synovial fluid macrophages and interleukin-1 on hyaluronic acid synthesis by normal synovial fibroblasts

The effects of peripheral blood monocyte and rheumatoid synovial fluid macrophage conditioned media were studied on hyaluronic acid (HA) metabolism of normal synovial fibroblasts. Both media stimulated HA synthesis about two-fold compared to controls (1% fetal calf serum). The activated mononuclear phagocyte conditioned media did not contain HA-degrading activity in these experiments. The effects of various concentrations of interleukin-1 (IL-1) on HA synthesis and proliferation of synovial fibroblasts were studied. Even at very low concentrations (0.1 IU IL-1/ml) HA synthesis was stimulated. With increasing concentrations HA synthesis did not increase but proliferation was stimulated. Stimulated fibroblasts synthesized mainly high molecular weight HA. Thus with IL-1-activation, normal synovial fibroblasts could not produce increased amounts of abnormal HA with decreased molecular weight.

Inhibition of mammalian collagenases by thiol-containing peptides

The following thiol-containing peptide analogues of the carboxyl side of the collagenase-sensitive bond of collagen were synthesized and tested as inhibitors of collagenases partially purified from homogenates of rabbit V-2 tumor and culture medium of pig synovium: HSCH2CH(CH3)CO-Ala-OEt (I), HSCH2CH(CH2Ph)CO-Ala-OEt (II), HSCH2CH[CH2CH(CH3)2]CO-Ala-OEt (III); HSCH2 CH-[CH2CH(CH3)2]CO-Ala-Gly-OEt (IV); HSCH2CH[CH2CH(CH3)2]CO-Ala-Gly-Gln (V). The compounds are listed in order of their inhibitory potency when assayed with nonfibrillar-acid-soluble calf skin collagen at pH 7.6, 35 degrees C. The best inhibitor (III) gave 50% inhibition between 1 and 4 microM. II was a competitive inhibitor with a Ki value of 75 microM. The enzymes preferred an isobutyl side chain at the 2-carbon position, and, where tested (III, IV), did not discriminate strongly between stereoisomers at the chiral 2-carbon. Increasing the length of the inhibitor did not markedly increase potency.

The effect of interleukin-1 on connective tissue metabolism and its relevance to arthritis

Interleukin-1 (IL-1) is the name given to a family of related proteins showing a variety of activities. It was originally shown to be produced by monocytes and macrophages but is now known to be produced by numerous cell types, including synovial cells. From the point of view of arthritis, its most interesting activities are those on connective tissue cells in vitro. These include stimulation of production of prostaglandins, plasminogen activator and metalloproteinases such as collagenase and proteoglycanase. IL-1 is also mitogenic for synoviocytes and bone cells, and can alter rates of production of extracellular matrix constituents. The presence of IL-1 in synovial fluids from rheumatoid and osteoarthritic joints and its actions on connective tissues in vitro suggest that IL-1 may play an important role in the pathogenesis of arthritis. There are several potential cellular sources of IL-1 in the inflamed rheumatoid joint and interactions between these cells, T lymphocytes and plasma cells may continually induce IL-1 so contributing to the chronicity of the disease. The mechanism of action of IL-1 on connective tissue cells is at present uncertain though preliminary studies suggest that IL-1 may induce cellular responses by stimulating phosphoinositide turnover and possibly protein kinase C activity.

Effects of 1-hydroxyethylidene-1,1 bisphosphonate and (chloro-4 phenyl) thiomethylene bisphosphonic acid (SR 41319) on the mononuclear cell factor-mediated release of neutral proteinases by articular chondrocytes and synovial cells

Articular chondrocytes and synovial cells were stimulated to produce collagenase, neutral casein and proteoglycan-degrading proteinases by conditioned medium from human peripheral blood mononuclear cells. Collagenase, neutral casein and proteoglycan-degrading proteinase secretion was inhibited by SR 41319, a new bisphosphonate, in a concentration-dependent manner. Complete inhibition was achieved at about 0.3 mM. EHDP exhibited the same general profile but was about 10-fold less active and never completely inhibited the enzyme secretion. When added before MCF, SR 41319 had a protective effect against subsequent activation of the cells by MCF. SR 41319 also inhibited the increase of enzyme secretion by cells previously stimulated with MCF. The results suggest that the ability of SR 41319 to inhibit the MCF-mediated secretion of neutral enzymes involved in cartilage destruction could be valuable in the management of connective tissue damage in rheumatoid arthritis.

Cyclic adenosine 3'5' monophosphate stimulates prostaglandin E production by human adherent synovial cells

Production of prostaglandin E (PGE) by rheumatoid synovium appears important to regulation of the pathologic process in rheumatoid arthritis. Cells derived from human synovium by proteolytic digestion produce large amounts of PGE which in turn can elevate synovial cell cAMP levels and inhibit cell proliferation. Data presented here indicate that cAMP can further increase production of PGE from adherent synovial cells (ASC). PGE production occurs over 12-72 hr and is not due to the ability of cAMP to inhibit cell proliferation. Exposure of cells to cAMP results in increased release of 3H arachidonic acid from precursors but not in activation of the cyclooxygenase enzyme. This phenomenon suggests the presence in adherent synovial cells of a mechanism for amplifying PGE production.

Mast-cell products and heparin stimulate the production of mononuclear-cell factor by cultured human monocyte/macrophages

Purified mast cells derived from rat peritoneal fluids and dog mastocytomas were extracted with 1 M-NaCl and sonication techniques. The mast-cell products increased the production of mononuclear cell factor from human peripheral blood mononuclear cells in culture, as judged by the enhanced stimulation of prostaglandin E (2-5 fold) and collagenase (3-11-fold) production by cultured adherent synovial cells. Heparin alone (1-10 micrograms/ml) induced a similar stimulation of mononuclear-cell-factor production by monocyte cultures, whereas histamine (1-10 micrograms/ml) had no effect. The stimulatory effect of mast-cell products and heparin represented a direct effect on mononuclear cells; they did not potentiate the effect of monokine on the synovial cells. These results suggest that mast-cell-macrophage interactions may play a significant role in the pathogenesis of inflammation and connective-tissue degradation.

Mononuclear cell-conditioned medium containing mononuclear cell factor (MCF), homologous with interleukin 1, stimulates collagen and fibronectin synthesis by adherent rheumatoid synovial cells: effects of prostaglandin E2 and indomethacin

Adherent rheumatoid synovial cells produce and release into supernatant culture medium latent collagenase and PGE2. The levels of collagenase and PGE2 can be increased by a soluble factor present in mononuclear cell-conditioned medium, partially purified by gel-filtration, which has homologies with interleukin 1, and is produced by monocyte/macrophages. The synovial cell cultures produce collagens (procollagens) and fibronectin as well. The factor(s) present in the mononuclear cell conditioned medium which increases medium levels of collagenase PGE2 also stimulates synthesis of total protein as well as types I and III procollagen by the synovial cells. This stimulation by the monocyte factor is augmented in the presence of indomethacin, which blocks endogenous PGE2 production. Medium levels of fibronectin parallel those of procollagen. The addition of exogenous PGE2 abolishes the effect of indomethacin on collagen and fibronectin synthesis. These observations of mononuclear cell-mediated increases in fibronectin synthesis may account for the high levels of fibronectin found by others in rheumatoid synovium and synovial fluids as the increases in collagen synthesis might also explain the fibrosis observed in some rheumatoid joints.

The pathobiology of the osteoclast

This article reviews recent information concerning the origin of osteoclasts and the local and systemic regulation of their activity. It appears that much of the environmental responsiveness of osteoclasts is mediated by cells of the osteoblastic lineage, which exert a major influence on the localisation, induction, stimulation, and inhibition of osteoclastic bone resorption. Some of the mechanisms by which osteoclast function may be disturbed by inflammatory and neoplastic diseases are discussed, and it is suggested that many pathological disturbances of osteoclastic bone resorption may be explicable as mimicry of physiological regulatory mechanisms by local hormones introduced into bone as the local regulators of the diseased tissue.

Peripheral blood mononuclear cells stimulate N-acetyl-beta-glucosaminidase levels of human synovial fibroblast-like cells

Fibroblast-like synovial cells isolated from intact joints of non-arthritic human donors released up to nine-times higher activity of the lysosomal acid hydrolase N-acetyl-beta-glucosaminidase (NAG) than controls when incubated in conditioned medium from homologous peripheral blood mononuclear cells (MCCM). This increase occurred without decrease in cell numbers or other evidence of cytotoxicity. An increase in cell-associated NAG activity was also suggested, but this was not statistically significant. Indomethacin present during production of MCCM or added with MCCM to fibroblast cultures did not alter the response to MCCM, indicating that the effect of MCCM was not due to the presence of products from the cyclo-oxygenase pathway. At a concentration known to block protein synthesis in most cells (10(-5) M), cycloheximide markedly suppressed the NAG releasing response to MCCM. The secretion of NAG due to MCCM was not affected by all-trans retinoic acid (10(-6) M) but was suppressed by the corticosteroid, dexamethasone.

Enhanced breakdown in vitro of bovine articular cartilage proteoglycans by conditioned synovial medium. The effect of phenylglyoxal

Addition of conditioned medium derived from fragment cultures of synovial tissue dissected from bovine knee joints (SM) to cultures of articular cartilage derived from the same animal resulted in enhanced breakdown of cartilage proteoglycans, measured as the release of [35S]sulphate from pieces of prelabelled cartilage. Addition of conditioned medium from synovial tissue that had been cultured with 50 micrograms/ml dextran sulphate (DS-SM) to the cartilage cultures greatly enhanced cartilage degradation. Phenylglyoxal is an arginine-specific reagent which has been shown to destroy the activity of interleukin 1 (former called LAF, lymphocyte-activating factor). The addition of phenylglyoxal (0.01, 0.1 or 1.0 mM) to the cartilage cultures did not affect cartilage degradation, whereas the addition of 2.5 mM phenylglyoxal seemed to inhibit cartilage breakdown. However, the cartilage degradation induced by SM was inhibited in a dose-dependent manner by the addition of phenylglyoxal (0.1, 1.0 and 10.0 mM). Also culturing the synovial tissue with phenylglyoxal (1.0 mM) inhibited the synovial-enhanced cartilage degradation. The addition of phenylglyoxal (1.0 mM) together with DS-SM to the cartilage cultures reduced cartilage degradation to that exerted by SM. Culturing the synovial tissue with both dextran sulphate (50 micrograms/ml) and phenylglyoxal (0.1, 1.0 and 10.0 mM) also dose-dependently reduced cartilage degradation to that exerted by SM. It is therefore suggested that the cytokines produced by synovial tissue in culture may be related to interleukin 1. However, the role of other proteins, such as degradative enzymes, cannot be completely ruled out.

The effects of monocyte-conditioned medium and interleukin 1 on the synthesis of collagenous and non-collagenous proteins by mouse bone and human bone cells in vitro

Cultured adherent human mononuclear cells produce factor(s) which stimulate the release of calcium from new-born mouse calvaria in organ culture. This stimulation of bone resorption is accompanied by an inhibition of the incorporation of [3H]proline into collagen which is independent of increased prostaglandin production by the bone. When human osteoblast-like cells are treated with conditioned medium from human mononuclear cells, collagen accounts for a decreased proportion of the protein synthesised. This effect on matrix synthesis is not accompanied by an inhibitory action of the monocyte-conditioned medium preparations on net cell proliferation. In human osteoblast-like cell cultures, partially purified human interleukin 1 also inhibits the production of the bone-specific protein osteocalcin in a dose-dependent fashion. These observations are consistent with the hypothesis that products of human monocytes similar to, or identical with, human interleukin 1 may be important regulators of bone metabolism and may contribute to the bone loss seen in diseases such as chronic rheumatoid arthritis.

Histopathology of the rheumatoid lesion. Identification of cell types at sites of cartilage erosion

Histochemical and ultrastructural techniques were used to examine the cartilage-pannus junction of 49 rheumatoid joints. Whereas 24 showed relatively acellular, fibrous pannus tissue, 25 demonstrated "cellular" junctions with different cell types at sites of erosion. Macrophages and fibroblasts were commonly observed as majority cell types in most specimens, but others showed mast cells, polymorphonuclear leukocytes, dendritic, or plasma cells as the predominant cell type. Some showed local accumulations of different cell types at sites along each junction. Our findings show that the cellular composition at sites of cartilage erosion varies greatly and suggest that cells are subject to turnover and interchange.

Stimulation of prostaglandin synthesis in cultured rat synovial cells by a factor derived from polymorphonuclear leukocytes

Stimulation of synovial cell prostaglandin production by a factor obtained from casein-induced peritoneal polymorphonuclear (PMN) cells has been investigated. Both the extract and short time cultured medium of rat peritoneal PMN cells stimulate prostaglandin (PG)E2 production as well as collagenase production in the culture of rat synovial cells. PGE2 production by the cells in the presence of the PMN factor is much faster (5 to 24 hr) than collagenase production (24 hr or later, Biomedical Res. 3, 506-516, 1982). This stimulating factor is confirmed to be derived from PMN cells, based on the purification of the cells from peritoneal exudate cells by the Ficoll-Urographin method. Elution profile of the factor on gel filtration has indicated that both PGE2 and collagenase productions by synovial cells are stimulated by the same effluent fractions corresponding to molecular weights of 15,000 - 20,000 daltons and 30,000 - 40,000 daltons. These results suggest that PMN cells are involved in PG production as well as collagenase production in the inflamed tissue by stimulating connective tissue cells such as synovial cells.

Studies on the release of proteolytic enzymes during synovium-induced cartilage breakdown in vitro and the actions of anti-inflammatory drugs

Pig articular cartilage, overlaid with a minced preparation of synovium from the same joint, underwent extensive matrix degradation during a two-week culture period. This degradation was associated with de novo synthesis by the synovium of specific neutral proteoglycan- and collagen-degrading enzymes. Both enzymes exhibited neutral pH optima, and were inhibited by serum and the metal ion chelators EGTA and 1,10-phenanthroline. The neutral proteoglycanase cleaved the core protein of isolated proteoglycan. The effects of some anti-inflammatory drugs on synovial enzyme production and cartilage metabolism were investigated. The steroids, dexamethasone and prednisolone, inhibited production of both enzymes whereas the non-steroidal anti-inflammatory drugs (NSAID's), flurbiprofen and indomethacin, slightly increased medium enzyme levels. Flurbiprofen and indomethacin had no effect on the extent of synovium-mediated cartilage degradation as assessed histologically. Inhibition by the steroids of synovial collagenase production correlated with inhibition of cartilage collagen breakdown, whereas inhibition of synovial proteoglycanase production did not prevent extensive proteoglycan breakdown. Experiments using radiotracer techniques indicated that dexamethasone, whilst partially inhibiting synovium-mediated proteoglycan degradation, severely inhibited cartilage proteoglycan synthesis thus resulting in net proteoglycan loss.

Immunohistologic characterization of synovial membrane lymphocytes in rheumatoid arthritis

Synovial membrane biopsy specimens from 15 rheumatoid arthritis patients were examined using routine histologic stains and monoclonal antibodies directed against cell surface antigens. Three patterns of lymphoid cell infiltrates were recognized: 1) diffuse infiltration of T cells that surrounded clusters of germinal center B cells (3 patients); 2) diffuse T cell infiltration, lacking germinal centers (8 patients); and 3) proliferation of subsynovial fibroblasts, with relatively few lymphoid cells (4 patients). The synovial, subsynovial, and perivascular tissues in each of the patterns exhibited a high frequency of HLA-DR antigen, HLA-DS antigen, transferrin receptor, and/or epidermal growth factor receptor. In contrast, normal or osteoarthritic synovial tissues did not display a marked increase of these antigens or receptors. Cells bearing natural killer antigen were infrequent in each of these patterns. Active synovitis, synovial effusions, anemia, and elevated sedimentation rate were present in rheumatoid arthritis patients with each of the three histologic patterns. Immunohistologic characterization of synovial membrane infiltrates by these monoclonal antibodies provides additional information about pathogenesis of rheumatoid arthritis and may help in predicting responses to different therapeutic modalities.

An interleukin 1 like factor stimulates bone resorption in vitro

Many activities are now ascribed to the monokine interleukin 1 including enhancement of immune responses, stimulation of thymocyte proliferation, activation of B cells, stimulation of proteinase and prostaglandin production by connective tissue cells, stimulation of the production of acute phase proteins, induction of fever and the induction of neutrophilia. These activities were thought to be due to various different factors, but are now considered probably due to very similar, if not identical, molecules. The term interleukin 1 (IL-1) was coined to describe the factor released by monocyte/macrophages which acts on T and B lymphocytes. Only after this definition had been accepted was it shown that target cells other than lymphocytes were affected by IL-1. Products of human blood monocytes (mononuclear cell factor, MCF) have been implicated in the pathogenesis of inflammatory diseases such as rheumatoid arthritis and periodontal disease. Bone resorption is often a feature of such diseases, and monocytes are frequently found at sites of localized bone resorption. Preliminary experiments with monocyte-conditioned medium indicated that MCF could stimulate bone resorption. We therefore undertook this study to verify these observations and to determine whether purified IL-1 could stimulate connective tissue breakdown in vitro.

A serum antibody in patients with rheumatoid arthritis stimulates cathepsin B activity in peritoneal mouse macrophages

Mouse peritoneal macrophages were stimulated by sera from patients with active rheumatoid arthritis (RA) to increased intracellular cathepsin B activity. By gel filtration of three RA sera, the stimulatory activity was found in the IgG and to a lesser extent in the IgM containing fraction. The DEAE-cellulose purified IgG preparations of five additional RA patients stimulated intracellular cathepsin B activity significantly above IgG from healthy controls. IgG and IgM antibodies to macrophages were detected in sera from RA patients but not from controls by indirect immunofluorescence (IIF) technique. Pepsin F (ab')2 fragments of IgG from the RA patients also gave clearcut membrane fluorescent staining of the macrophages which demonstrated the antibody nature of the binding. A good correlation between the cathepsin B assay and the IIF was found when serial dilutions of serum were compared.

Stimulation of bone resorption in vitro by a non-prostanoid factor released by human monocytes in culture

Cultured human monocytes produce a non-prostanoid factor which stimulates bone resorption in vitro. Production of the factor is not dependent on prostaglandin synthesis, but stimulation of resorption by the factor does involve prostaglandin production by bone. Salmon calcitonin inhibits the stimulatory activity by up to 80%. Production of the factor is not increased by the presence of lymphocytes in the monocyte cultures. Partial purification of the bone-resorbing activity by Ultrogel ACA 54 chromatography shows that it has an apparent molecular weight between 12 000 and 20 000. We suggest that the resorptive activity is due to an interleukin 1-like factor rather than an osteoclast activating factor.