Inhibition of cartilage breakdown by hydrocortisone in a tissue culture model of rheumatoid arthritis

Emerging MRI methods in rheumatoid arthritis

New MRI techniques have been developed to assess not only the static anatomy of synovial hyperplasia, bone changes and cartilage degradation in patients with rheumatoid arthritis (RA), but also the activity of the physiological events that cause these changes. This enables an estimation of the rate of change in the synovium, bone and cartilage as a result of disease activity or in response to therapy. Typical MRI signs of RA in the pre-erosive phase include synovitis, bone marrow edema and subchondral cyst formation. Synovitis can be assessed by T2-weighted imaging, dynamic contrast-enhanced MRI or diffusion tensor imaging. Bone marrow edema can be detected on fluid-sensitive sequences such as short-tau inversion recovery or T2-weighted fast-spin echo sequences. Detection of small bone erosions in the early erosive phase using T1-weighted MRI has sensitivity comparable to CT. Numerous MRI techniques have been developed for quantitative assessment of potentially pathologic changes in cartilage composition that occur before frank morphologic changes. In this Review, we summarize the advances and new directions in the field of MRI, with an emphasis on their current state of development and application in RA.

Human nasal cartilage responds to oncostatin M in combination with interleukin 1 or tumour necrosis factor alpha by the release of collagen fragments via collagenases

BACKGROUND

The synergistic degradation of cartilage by oncostatin M (OSM) in combination with either interleukin 1 (IL1) or tumour necrosis factor alpha (TNFalpha) has been previously demonstrated using bovine nasal cartilage (BNC).

OBJECTIVES

(a) To investigate if human nasal cartilage (HNC) responds in the same way as BNC to these cytokine combinations, particularly in collagen degradation. (b) To compare the response of human nasal and articular cartilages.

METHODS

Collagen release was assessed by measuring the hydroxyproline content of culture supernatants and proteoglycan release by the dimethylmethylene blue assay. Matrix metalloproteinase (MMP)-1, MMP-13, and tissue inhibitor of metalloproteinase 1 release were measured by specific enzyme linked immunosorbent assays (ELISAs), and collagenolytic activity was measured by a bioassay using radiolabelled collagen.

RESULTS

OSM in combination with either IL1 or TNFalpha acted synergistically to induce collagenolysis from HNC, with a maximum of 79% collagen release. This degradation strongly correlated with MMP-1 and MMP-13 levels and collagenolytic activity.

CONCLUSION

Collagen release from human cartilage is marked and implicates both MMP-1 and MMP-13 in the synergistic degradation of human cartilage by OSM in combination with either IL1 or TNFalpha. HNC responds in the same way as BNC, thus validating the bovine cartilage degradation assay as a model relevant to human disease.

Methylprednisolone acetate induced release of cartilage proteoglycans: determination by high performance liquid chromatography

A high performance liquid chromatography (HPLC) procedure suitable for the simultaneous determination of the molecular size and concentration of macromolecular hyaluronate and proteoglycans in synovial fluid has been developed. Irrigation of the equine tarsocrural joint with 20 ml physiological saline (PSS) caused a mild inflammation with an increase of proteoglycans in the synovial fluid over the baseline arthrocentesis control sample. Proteoglycan and hyaluronate in the synovial fluid did not interact to form hyaluronate-proteoglycan aggregates, but separated as distinct chromatographic peaks. This suggests that the cartilage derived proteoglycans in synovial fluid in the inflamed joint have been proteolytically cleaved from the non-covalent aggregates containing link protein and hyaluronate. Hyaluronidase digestion completely abolished the hyaluronate peak without affecting the proteoglycans. This seems to indicate that proteoglycan in synovial fluid is unable to interact with hyaluronate in synovial fluid to form cartilage type aggregates. Proteolytic degradation and the time dependent release into the synovial fluid of such digested proteoglycan also resulted from the intra-articular injection of methylprednisolone acetate into normal tarsocrural joints and joints irrigated with PSS. These proteoglycans were insensitive to hyaluronidase but may consist of a protein moiety with attached glycosaminoglycans, as suggested by their sensitivity to proteinase and keratanase/chondroitinase digestion. These observations with cartilage treated with methylprednisolone acetate and mildly stimulated articular cartilage are inconsistent with earlier work on osteoarthritic and rheumatoid articular cartilage and have interesting implications for the pathogenesis and for the therapeutic action of intraarticular corticosteroids. A rapid HPLC procedure applicable to unprocessed small volume samples of synovial fluid gives information simultaneously on hyaluronate and proteoglycan in synovial fluid which is not attainable with immunoradiometric or isotope tracer techniques. It therefore appears to be useful for the analysis of cartilage turnover and destruction in health and disease.

Some recombinant human cytokines stimulate glycosaminoglycan synthesis in human synovial fibroblast cultures and inhibit it in human articular cartilage cultures

Recombinant human cytokines were compared for their effects on glycosaminoglycan (GAG) synthesis in human synovial fibroblast cultures and human articular cartilage explant cultures. In fibroblast cultures, recombinant human interleukin-1 alpha (rHuIL-1 alpha), rHuIL-1 beta, and recombinant human tumor necrosis factor alpha (rHuTNF alpha) stimulated hyaluronic acid (HA) production and, to a lesser extent, sulfated GAG production, while recombinant human gamma-interferon did not have a significant effect. Half-maximal stimulation of HA by rHuIL-1 beta was 0.14 pM, while stimulation for rHuIL-1 alpha and rHuTNF alpha was 1.6 pM and 32 pM, respectively. Indomethacin (10 micrograms/ml) had no influence on HA stimulation by cytokines, while hydrocortisone (2-10 micrograms/ml) caused a significant reduction. In articular cartilage cultures, the cytokines inhibited production of sulfated GAGs. The activity of rHuIL-1 beta was greater than that of rHuIL-1 alpha (half-maximal inhibition at 0.71 pM and 4.7 pM, respectively) and both were considerably more active than rHuTNF alpha; gamma-interferon again had no significant effect. Neither indomethacin nor hydrocortisone influenced cytokine-induced inhibition by either rHuIL-1 preparation. These studies indicate that cytokines released during an inflammatory process may affect GAG synthesis in human joint tissues and may have opposite effects on GAG synthesis in different types of connective tissues.

Production of catabolin by synovium from an experimental model of osteoarthritis

Catabolic factors from synovium, or catabolins, may be important in the pathogenesis of osteoarthritis. The synovial production of catabolin in osteoarthritis was studied using the experimental model of osteoarthritis induced by section of the anterior cruciate ligament. At 1, 4, and 32 weeks after operation, the synovium was harvested, cultured, and the synovial conditioned medium assayed for catabolic activity. The synovial conditioned medium from the operated joints was significantly more capable of inducing cartilage destruction (p less than 0.05) than was the synovial conditioned medium from the unoperated knees. However, when the results were expressed relative to the weight of synovium, the differences were not significant. These results suggest that the increased production of catabolic synovial factors in early experimental osteoarthritis is probably a result of the synovial hypertrophy.

Anti-rheumatic drugs and cartilage

In this chapter an attempt has been made to draw together the known biology of cartilage and some of the mechanisms thought to be responsible for its failure in arthritis. The picture is far from complete but we are now in a good position to use this information to help appraise the pros and cons of the wide range of drugs now available to treat articular disorders. For convenience, these drugs were classified as NSAIDs, corticosteroids and chondroprotective agents. The influence of each of these classes on the metabolism of cartilage was examined in the light of published laboratory and clinical studies. It has been clearly shown that not all NSAIDs are the same. While many of the older drugs provided no benefit to cartilage metabolism, and in some instances suppressed it, the more recently discovered molecules appear to be free of these undesirable effects. Tiaprofenic acid, diclofenac and piroxicam emerged as drugs with little or no harmful effects on cartilage metabolism when used at concentrations within the human therapeutic range. For all NSAIDs, their potential effects on cartilage must be weighed against their respective anti-inflammatory potency, half-life, and effects on the gastric mucosa and other tissues. Other chapters in this book have addressed these important problems. The long-acting corticosteroids, betamethasone and triamcinolone hexacetonide, also appear to offer some benefit in the management of OA; however, as in RA, their use should be restricted to short-term applications. In terms of cartilage metabolism the chondroprotective agents pentosan polysulphate, Arteparon and Rumalon have been the most extensively studied class of drugs. While the laboratory studies have provided convincing evidence of their chondroprotective efficacy, it has been difficult to prove this clinically. This dichotomy of opinion (laboratory versus clinical) stems largely from the inadequacy of the methodologies currently available for the objective clinical assessment of patient response to anti-rheumatic drug therapy. With the advent of nuclear magnetic resonance imaging techniques and monoclonal antibodies to detect specific proteoglycan breakdown fragments in synovial fluid and plasma, the prospects for a unified research approach for the evaluation of these agents may now be possible.

Effect of steroid hormones on endotoxin-mediated cartilage degradation

Cartilage degradation is a characteristic feature of various types of human arthritis, notably rheumatoid arthritis and osteoarthritis. The influence of glucocorticoid and other steroid hormones on cartilage proteoglycan breakdown was examined in a model system in which breakdown is readily quantified by the release of proteoglycan from cultured bovine nasal cartilage discs. Endotoxin (bacterial lipopolysaccharides) treatment enhanced the depletion of cartilage proteoglycan by 2-3 fold. This was inhibited in a concentration-dependent manner by hydrocortisone (10(-9) to 10(-5) M) or other glucocorticoid hormones (dexamethasone, prednisolone, cortisone). Inhibition required the continued presence of the steroid. Removal of hydrocortisone (3 x 10(-7) M) after 4 days from endotoxin-treated cultures resulted in the rapid restoration of an endotoxin response, so that proteoglycan release approached maximum levels during a second 4-day culture period. Other C-21 steroid hormones (progesterone, aldosterone) were also inhibitory at 10(-5) M, but testosterone and beta-estradiol showed little influence on endotoxin action. Proteoglycan products of smaller average mol wt (Sepharose CL-2B chromatography), consistent with core protein cleavages, were released from endotoxin-treated cartilage. Cleavage was unaffected by beta-estradiol, partially blocked by aldosterone and largely prevented by hydrocortisone administration.

Effects of interleukin-1 and anti-inflammatory drugs on the degradation of human articular cartilage

It has been suggested that metalloproteases produced by chondrocytes play an important role in cartilage breakdown in joint diseases. The aim of this study was to investigate changes in enzyme activities in human rheumatoid and osteoarthritic articular cartilage. Cartilage fragments were incubated with various drugs for 48 hours. The concentrated culture media were used as enzyme solutions. Collagenase was assayed using FITC-collagen as the substrate. Proteoglycanase (PGase) was measured either by the release of 35S-labelled proteoglycans from cartilage into the medium, or by enzyme assay using proteoglycan monomer bound to fluorescein-conjugated hyaluronic acid as the substrate. Collagenase and proteoglycanase were found only in trace amounts in the concentrated media of healthy cartilage. Interleukin-1 (IL-1) enhanced the enzyme activities significantly. Marked increases of enzyme activities were observed in the concentrated media of rheumatoid (RA) and osteoarthritic (OA) cartilage. The sensitivity to interleukin-1 was also higher in OA and RA cartilage compared with healthy cartilage. Dexamethasone (10(-6) mol/L) markedly depressed enzyme activity. Tiaprofenic acid (4 x 10(-5) mol/L) also decreased enzyme activity, whereas indomethacin (4 x 10(-6) mol/L) and naproxen (3 x 10(-4) mol/L) had no effect.

Effect of purified human interleukin-1 on cartilage degradation

The effects of highly purified human monocyte-derived interleukin-1 (IL-1) on bovine nasal cartilage breakdown were investigated. Cartilage degradation was determined by quantifying the fraction of total proteoglycan released from cartilage during 8 days of culture. The response appeared to be chondrocyte-dependent, for IL-1 stimulated proteoglycan (PG) release from living but not from dead (frozen-thawed) cartilage. IL-1 action on living cartilage was heat labile and concentration dependent, with significant effect at 5 U/ml and maximal effect at 10-20 U/ml. Kinetic studies showed significant stimulation of PG release by 3 days of incubation with 10 U/ml IL-1. Studies in which IL-1 was removed on day 1 or day 4 showed that the cartilage-degrading effect of this monokine was reversible. Although IL-1 caused little change in the Sepharose CL-2B chromatographic profile of released PGs using an associative elution buffer, a significant shift to lower mol wt was observed under dissociative conditions. To probe the mechanism of IL-1 action, cartilage samples were incubated with IL-1 in the presence of the protein synthesis inhibitor, cycloheximide, or the lysosomal membrane-stabilizing steroid, hydrocortisone. Cycloheximide at 5-10 micrograms/ml completely blocked IL-1-induced breakdown. One the other hand, 3 x 10(-7) M hydrocortisone had little or no effect on IL-1 action. IL-1 was also shown to stimulate the degradation of human articular cartilage.

What's happened to catabolin?

Unlike other areas of research into arthritis, it is pleasing to record independent work leading to convergence of ideas instead of divergence and increasing complexity. Catabolin is now identified with interleukin-1, although there is case for the retention of the original name to describe its chondrocyte-stimulating function with subsequent matrix degradation. In 10 years, catabolin/interleukin-1 research has yielded much information about cellular interactions within the arthritic joint and has provided a probe with which the intricacies of matrix metabolism are being unravelled. In future, there are prospects of characterizing the naturally occurring inhibitors and developing new compounds which influence the actions of catabolin/IL-1 to the benefit of the patient with arthritis.

Studies of pharmacokinetics and therapeutic effects of glucocorticoids entrapped in liposomes after intraarticular application in healthy rabbits and in rabbits with antigen-induced arthritis

Dexamethasone palmitate (DMP) entrapped in liposomes of defined sizes was administered intraarticularly in healthy rabbits and in rabbits with antigen-induced arthritis. The pharmacokinetics and therapeutic effect of liposomal DMP were measured and compared with corresponding experiments using microcrystalline triamcinolone acetonide (TAC). The small DMP liposomes (diameter 160 nm) showed a greater decrease in joint circumference than the 3-times-higher dose of microcrystalline TAC. Moreover, about 98% of administered TAC had already disappeared from the joint 6 h after injection, whereas about 36% of liposomal DMP was still measured in synovial fluid and synovium at the same time. Increasing the vesicle diameter from 160 to 750 nm (large liposomes) improved the retention of DMP by a factor of 2.6 within 48 h after injection in healthy rabbits. In addition, none of the liposomal glucocorticoid preparations ever suppressed the endogenous plasma cortisol level, which is in contrast to the suppression measured after administration of the microcrystalline preparation.

Porcine heart valves produce a protein that induces cell-mediated connective tissue degradation: I. Biological properties

Cultured porcine heart valves secrete a factor that induces cells to degrade their extracellular matrix. This activity was routinely monitored by measuring the release of glycosaminoglycans from proteoglycan in cultured bovine nasal cartilage. It was observed that factor-mediated matrix degradation was dose dependent and required live target cells, while factor production by valves was inhibited by cycloheximide and declined with reduced cell viability. The effect of various steroidal and nonsteroidal anti-inflammatory drugs on the production and activity of the factor is discussed with reference to similar cytokines. It is concluded that there is a close similarity between the cardiac catabolic factor described here and catabolin, a protein isolated from porcine synovia and leukocytes, as shown by the neutralization of biological activity with antisera raised to porcine catabolin (interleukin-1).

Therapeutic effects on cartilage metabolism in arthritis as measured by release of proteoglycan structures into the synovial fluid

Proteoglycans are molecules that are degraded and released from the articular cartilage into the synovial fluid early in an arthritic process. Such released proteoglycans were quantified by an enzyme linked immunosorbent assay (ELISA). The proteoglycan content in synovial fluid from patients with various knee joint arthritides was constant in two samples withdrawn five days apart. To determine if therapeutic measures were paralleled by effects directly on the articular cartilage the patients were treated with local injections of glucocorticoids. In all patients the glucocorticoids induced a reduction of the proteoglycan content in the synovial fluid, reflecting their effects on the cartilage. In two patients with spontaneous remission of their arthritis a reduction in the proteoglycan content in the synovial fluid was also noted. The quantification of proteoglycans in synovial fluid appears to have potential as a useful tool for monitoring the effects of therapy on cartilage metabolism.

Dose related effects of dexamethasone treatment on the ultrastructure of articular cartilage in rats

Corticosteroid administration is known to cause degenerative changes in articular cartilage interfering with the cell metabolism of chondrocytes. The present study analyzes the ultrastructural changes in chondrocytes after systemic dexamethasone acetate treatment in relation to dosage, using a standardized morphometrical method. Five male Wistar rats of 300 g body weight in each experimental group were subjected to 3, 4 and 5 mg dexamethasone acetate by intramuscular injections of 1 mg per week. 1000 electron micrographs of single chondrocytes in the middle zone of hyaline cartilage from the knee joints were evaluated with standardized morphometry and nonparametric statistics. With increasing dexamethasone dosage the amount of rough endoplasmic reticulum and Golgi apparatus decreased. Considerably increased glycogen granula and clusters indicated a severe change in glycolytic pathways. Lysosomes duplicated in number. Degenerative changes were also manifested in lipid droplets and myeloid bodies, which, like the amount of microfilaments, exhibited a clear dosage-dependent increase under dexamethasone treatment. The ratio of dead versus living chondrocytes increased in relation to dosage up to 25% cell mortality.

Hereditary joint disorder in progressive ankylosis (ank/ank) mice. II. Effect of high-dose hydrocortisone treatment on inflammation and intraarticular calcium hydroxyapatite deposits

Mice homozygous for the progressive ankylosis trait develop an inflammatory joint disorder associated with the intraarticular deposition of calcium hydroxyapatite. When affected (ank/ank) mice were treated with high doses of hydrocortisone, synovitis receded, development of cartilaginous and bony osteophytes halted, and calcium hydroxyapatite accumulated in and distended the synovial spaces. No changes, however, occurred in the joint morphology of hydrocortisone-treated normal (ank/+) mice. Since inhibition of inflammation by hydrocortisone treatment did not block apatite accumulation, intraarticular deposition of hydroxyapatite occurs independent of inflammation in progressive ankylosis.

Human rheumatoid arthritic cartilage and its neutral proteoglycan-degrading proteases. The effects of antirheumatic drugs

Measurements were made of the neutral proteoglycan-digesting protease activity in the cartilage matrix breakdown observed in the rheumatoid arthritic process. Normal knee (tibial plateau) cartilage specimens were obtained from 7 fresh cadavers and 29 cartilage specimens were obtained from 23 patients diagnosed as having rheumatoid arthritis (RA). The total neutral metalloproteoglycan-degrading enzyme (NMPE) activity in RA cartilages exhibited roughly an eightfold elevation over that of control subjects. The active form of the NMPE for diseased cartilage was higher than that observed for normal cartilage, but was not statistically different. A very low level of activity was detected for serine proteases and no variation was observed between normal and diseased cartilages. Data obtained from RA cartilages were also analyzed with respect to the relationship between enzyme activities and the patients' medications. Four groups of patients were then selected according to their drug treatments: S + G patients received steroid and gold therapy; S patients received steroids only; NS + NG patients did not receive steroid or gold therapy; G patients received gold therapy alone. The total NMPE activity for each of these groups remained at a very high level. The active enzyme activity measured in S + G and S patients was decreased to a level not different from that of normal controls. Specimens from NS + NG patients presented a significantly higher level of the active form of the enzyme (P less than 0.05) when compared with either normal controls, S + G, or S patients. No significant difference was noted in the level of serine protease activity between the RA cartilage and normal cartilage.(ABSTRACT TRUNCATED AT 250 WORDS)