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Subudhi I, Konieczny P, Prystupa A, Castillo RL, Sze-Tu E, Xing Y, Rosenblum D, Reznikov I, Sidhu I, Loomis C, Lu CP, Anandasabapathy N, Suárez-Fariñas M, Gudjonsson JE, Tsirigos A, Scher JU, Naik S. Metabolic coordination between skin epithelium and type 17 immunity sustains chronic skin inflammation. Immunity 2024; 57:1665-1680.e7. [PMID: 38772365 PMCID: PMC11236527 DOI: 10.1016/j.immuni.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 03/11/2024] [Accepted: 04/24/2024] [Indexed: 05/23/2024]
Abstract
Inflammatory epithelial diseases are spurred by the concomitant dysregulation of immune and epithelial cells. How these two dysregulated cellular compartments simultaneously sustain their heightened metabolic demands is unclear. Single-cell and spatial transcriptomics (ST), along with immunofluorescence, revealed that hypoxia-inducible factor 1α (HIF1α), downstream of IL-17 signaling, drove psoriatic epithelial remodeling. Blocking HIF1α in human psoriatic lesions ex vivo impaired glycolysis and phenocopied anti-IL-17 therapy. In a murine model of skin inflammation, epidermal-specific loss of HIF1α or its target gene, glucose transporter 1, ameliorated epidermal, immune, vascular, and neuronal pathology. Mechanistically, glycolysis autonomously fueled epithelial pathology and enhanced lactate production, which augmented the γδ T17 cell response. RORγt-driven genetic deletion or pharmacological inhibition of either lactate-producing enzymes or lactate transporters attenuated epithelial pathology and IL-17A expression in vivo. Our findings identify a metabolic hierarchy between epithelial and immune compartments and the consequent coordination of metabolic processes that sustain inflammatory disease.
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Affiliation(s)
- Ipsita Subudhi
- Department of Pathology, NYU Langone Health, New York, NY 10016, USA
| | - Piotr Konieczny
- Department of Pathology, NYU Langone Health, New York, NY 10016, USA.
| | - Aleksandr Prystupa
- Department of Pathology, NYU Langone Health, New York, NY 10016, USA; Applied Bioinformatics Laboratories, NYU Langone Health, New York, NY 10016, USA
| | - Rochelle L Castillo
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY 10016, USA; Psoriatic Arthritis Center, NYU Langone Health, New York, NY 10016, USA
| | - Erica Sze-Tu
- Department of Pathology, NYU Langone Health, New York, NY 10016, USA
| | - Yue Xing
- Department of Pathology, NYU Langone Health, New York, NY 10016, USA
| | - Daniel Rosenblum
- Department of Pathology, NYU Langone Health, New York, NY 10016, USA
| | - Ilana Reznikov
- Department of Pathology, NYU Langone Health, New York, NY 10016, USA
| | - Ikjot Sidhu
- Department of Pathology, NYU Langone Health, New York, NY 10016, USA; Applied Bioinformatics Laboratories, NYU Langone Health, New York, NY 10016, USA
| | - Cynthia Loomis
- Department of Pathology, NYU Langone Health, New York, NY 10016, USA
| | - Catherine P Lu
- The Hansjörg Wyss Department of Plastic Surgery and Department of Cell Biology, NYU Langone Health, New York, NY 10016, USA
| | | | - Mayte Suárez-Fariñas
- Department of Genetics and Genomic Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Aristotelis Tsirigos
- Applied Bioinformatics Laboratories, NYU Langone Health, New York, NY 10016, USA; Precision Medicine Institute, Department of Medicine, NYU Langone Health, New York, NY 10016, USA
| | - Jose U Scher
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY 10016, USA; NYU Colton Center for Autoimmunity, Department of Medicine, NYU Langone Health, New York, NY 10016, USA
| | - Shruti Naik
- Department of Pathology, NYU Langone Health, New York, NY 10016, USA; NYU Colton Center for Autoimmunity, Department of Medicine, NYU Langone Health, New York, NY 10016, USA; Ronald O. Perelman Department of Dermatology, Department of Medicine, Perlmutter Cancer Center, NYU Langone Health, New York, NY 10016, USA.
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2
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Kapnick SM, Martin CA, Jewell CM. Engineering metabolism to modulate immunity. Adv Drug Deliv Rev 2024; 204:115122. [PMID: 37935318 PMCID: PMC10843796 DOI: 10.1016/j.addr.2023.115122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 07/19/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
Metabolic programming and reprogramming have emerged as pivotal mechanisms for altering immune cell function. Thus, immunometabolism has become an attractive target area for treatment of immune-mediated disorders. Nonetheless, many hurdles to delivering metabolic cues persist. In this review, we consider how biomaterials are poised to transform manipulation of immune cell metabolism through integrated control of metabolic configurations to affect outcomes in autoimmunity, regeneration, transplant, and cancer. We emphasize the features of nanoparticles and other biomaterials that permit delivery of metabolic cues to the intracellular compartment of immune cells, or strategies for altering signals in the extracellular space. We then provide perspectives on the potential for reciprocal regulation of immunometabolism by the physical properties of materials themselves. Lastly, opportunities for clinical translation are highlighted. This discussion contributes to our understanding of immunometabolism, biomaterials-based strategies for altering metabolic configurations in immune cells, and emerging concepts in this evolving field.
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Affiliation(s)
- Senta M Kapnick
- Fischell Department of Bioengineering, University of Maryland, 8278 Paint Branch Drive, College Park, MD, USA; Department of Veterans Affairs, VA Maryland Health Care System, 10 N Green Street, Baltimore, MD, USA
| | - Corinne A Martin
- Fischell Department of Bioengineering, University of Maryland, 8278 Paint Branch Drive, College Park, MD, USA
| | - Christopher M Jewell
- Fischell Department of Bioengineering, University of Maryland, 8278 Paint Branch Drive, College Park, MD, USA; Department of Veterans Affairs, VA Maryland Health Care System, 10 N Green Street, Baltimore, MD, USA; Robert E. Fischell Institute for Biomedical Devices, 8278 Paint Branch Drive, College Park, MD, USA; Marlene and Stewart Greenebaum Comprehensive Cancer Center, 22 S Greene Street, Suite N9E17, Baltimore, MD, USA.
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3
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Caslin HL, Abebayehu D, Pinette JA, Ryan JJ. Lactate Is a Metabolic Mediator That Shapes Immune Cell Fate and Function. Front Physiol 2021; 12:688485. [PMID: 34733170 PMCID: PMC8558259 DOI: 10.3389/fphys.2021.688485] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022] Open
Abstract
Lactate and the associated H+ ions are still introduced in many biochemistry and general biology textbooks and courses as a metabolic by-product within fast or oxygen-independent glycolysis. However, the role of lactate as a fuel source has been well-appreciated in the field of physiology, and the role of lactate as a metabolic feedback regulator and distinct signaling molecule is beginning to gain traction in the field of immunology. We now know that while lactate and the associated H+ ions are generally immunosuppressive negative regulators, there are cell, receptor, mediator, and microenvironment-specific effects that augment T helper (Th)17, macrophage (M)2, tumor-associated macrophage, and neutrophil functions. Moreover, we are beginning to uncover how lactate and H+ utilize different transporters and signaling cascades in various immune cell types. These immunomodulatory effects may have a substantial impact in cancer, sepsis, autoimmunity, wound healing, and other immunomodulatory conditions with elevated lactate levels. In this article, we summarize the known effects of lactate and H+ on immune cells to hypothesize potential explanations for the divergent inflammatory vs. anti-inflammatory effects.
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Affiliation(s)
- Heather L Caslin
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, United States.,Department of Biology, Virginia Commonwealth University, Richmond, VA, United States
| | - Daniel Abebayehu
- Department of Biology, Virginia Commonwealth University, Richmond, VA, United States.,Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Julia A Pinette
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, United States
| | - John J Ryan
- Department of Biology, Virginia Commonwealth University, Richmond, VA, United States
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4
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He YF, Mai CT, Pan HD, Liu L, Zhou H, Xie Y. Targeting immunometabolism by active ingredients derived from traditional Chinese medicines for treatment of rheumatoid arthritis. CHINESE HERBAL MEDICINES 2021; 13:451-460. [PMID: 36119361 PMCID: PMC9476673 DOI: 10.1016/j.chmed.2021.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/06/2021] [Accepted: 09/15/2021] [Indexed: 01/19/2023] Open
Abstract
Rheumatoid arthritis (RA), the most common inflammatory arthropathy word wild, is a systemic autoimmune disease that mainly affects the synovium of joints with a high disability rate. Metabolic mis-regulation has emerged as a fundamental pathogenesis of RA linked to immune cell dysfunction, while targeting immunometabolism provides a new and effective approach to regulate the immune responses and thus alleviate the symptom of RA. Recently, natural active compounds from traditional Chinese medicines (TCMs) have potential therapeutic effects on RA and regulating immunometabolism. In this review, in addition to updating the connection between cellular metabolism and cell function in immune cells of RA, we summarized that the anti-inflammatory mechanisms of the potential natural compounds from TCM by targeting metabolic reprogramming of immune cells, and discusses them as a rich resource for providing the new potential paradigm for the treatment of RA.
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Affiliation(s)
| | | | - Hu-dan Pan
- State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Macau (SAR), China
| | - Liang Liu
- State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Macau (SAR), China
| | - Hua Zhou
- State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Macau (SAR), China
| | - Ying Xie
- State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Macau (SAR), China
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5
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Weiss HJ, Angiari S. Metabolite Transporters as Regulators of Immunity. Metabolites 2020; 10:E418. [PMID: 33086598 PMCID: PMC7603148 DOI: 10.3390/metabo10100418] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 12/22/2022] Open
Abstract
In the past decade, the rise of immunometabolism has fundamentally reshaped the face of immunology. As the functions and properties of many (immuno)metabolites have now been well described, their exchange among cells and their environment have only recently sparked the interest of immunologists. While many metabolites bind specific receptors to induce signaling cascades, some are actively exchanged between cells to communicate, or induce metabolic reprograming. In this review, we give an overview about how active metabolite transport impacts immune cell function and shapes immunological responses. We present some examples of how specific transporters feed into metabolic pathways and initiate intracellular signaling events in immune cells. In particular, we focus on the role of metabolite transporters in the activation and effector functions of T cells and macrophages, as prototype adaptive and innate immune cell populations.
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Affiliation(s)
- Hauke J. Weiss
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland;
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6
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Metabolic reprogramming as a key regulator in the pathogenesis of rheumatoid arthritis. Inflamm Res 2020; 69:1087-1101. [DOI: 10.1007/s00011-020-01391-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/02/2020] [Accepted: 08/05/2020] [Indexed: 02/07/2023] Open
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7
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Pucino V, Certo M, Varricchi G, Marone G, Ursini F, Rossi FW, De Paulis A, Mauro C, Raza K, Buckley CD. Metabolic Checkpoints in Rheumatoid Arthritis. Front Physiol 2020; 11:347. [PMID: 32362840 PMCID: PMC7180190 DOI: 10.3389/fphys.2020.00347] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/26/2020] [Indexed: 12/11/2022] Open
Abstract
Several studies have highlighted the interplay between metabolism, immunity and inflammation. Both tissue resident and infiltrating immune cells play a major role in the inflammatory process of rheumatoid arthritis (RA) via the production of cytokines, adipo-cytokines and metabolic intermediates. These functions are metabolically demanding and require the most efficient use of bioenergetic pathways. The synovial membrane is the primary site of inflammation in RA and exhibits distinctive histological patterns characterized by different metabolism, prognosis and response to treatment. In the RA synovium, the high energy demand by stromal and infiltrating immune cells, causes the accumulation of metabolites, and adipo-cytokines, which carry out signaling functions, as well as activating transcription factors which act as metabolic sensors. These events drive immune and joint-resident cells to acquire pro-inflammatory effector functions which in turn perpetuate chronic inflammation. Whether metabolic changes are a consequence of the disease or one of the causes of RA pathogenesis is still under investigation. This review covers our current knowledge of cell metabolism in RA. Understanding the intricate interactions between metabolic pathways and the inflammatory and immune responses will provide more awareness of the mechanisms underlying RA pathogenesis and will identify novel therapeutic options to treat this disease.
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Affiliation(s)
- Valentina Pucino
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Michelangelo Certo
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Gilda Varricchi
- Department of Translational Medical Sciences (DiSMeT) and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | - Giancarlo Marone
- Department of Public Health, University of Naples Federico II, Naples, Italy
- Ospedale dei Colli, Hospital Pharmacy, Naples, Italy
| | - Francesco Ursini
- Section of Rheumatology, Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Wanda Rossi
- Department of Translational Medical Sciences (DiSMeT) and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | - Amato De Paulis
- Department of Translational Medical Sciences (DiSMeT) and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy
| | - Claudio Mauro
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Karim Raza
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Research into Inflammatory Arthritis Centre Versus Arthritis, College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
- MRC and Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), College of Medical and Dental Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Christopher Dominic Buckley
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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8
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Pucino V, Certo M, Bulusu V, Cucchi D, Goldmann K, Pontarini E, Haas R, Smith J, Headland SE, Blighe K, Ruscica M, Humby F, Lewis MJ, Kamphorst JJ, Bombardieri M, Pitzalis C, Mauro C. Lactate Buildup at the Site of Chronic Inflammation Promotes Disease by Inducing CD4 + T Cell Metabolic Rewiring. Cell Metab 2019; 30:1055-1074.e8. [PMID: 31708446 PMCID: PMC6899510 DOI: 10.1016/j.cmet.2019.10.004] [Citation(s) in RCA: 269] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 06/21/2019] [Accepted: 10/12/2019] [Indexed: 02/06/2023]
Abstract
Accumulation of lactate in the tissue microenvironment is a feature of both inflammatory disease and cancer. Here, we assess the response of immune cells to lactate in the context of chronic inflammation. We report that lactate accumulation in the inflamed tissue contributes to the upregulation of the lactate transporter SLC5A12 by human CD4+ T cells. SLC5A12-mediated lactate uptake into CD4+ T cells induces a reshaping of their effector phenotype, resulting in increased IL17 production via nuclear PKM2/STAT3 and enhanced fatty acid synthesis. It also leads to CD4+ T cell retention in the inflamed tissue as a consequence of reduced glycolysis and enhanced fatty acid synthesis. Furthermore, antibody-mediated blockade of SLC5A12 ameliorates the disease severity in a murine model of arthritis. Finally, we propose that lactate/SLC5A12-induced metabolic reprogramming is a distinctive feature of lymphoid synovitis in rheumatoid arthritis patients and a potential therapeutic target in chronic inflammatory disorders.
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Affiliation(s)
- Valentina Pucino
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Michelangelo Certo
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vinay Bulusu
- Cancer Research UK Beatson Institute, Glasgow, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Danilo Cucchi
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Katriona Goldmann
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Elena Pontarini
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Robert Haas
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Joanne Smith
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sarah E Headland
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kevin Blighe
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Frances Humby
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Myles J Lewis
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jurre J Kamphorst
- Cancer Research UK Beatson Institute, Glasgow, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Michele Bombardieri
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Costantino Pitzalis
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Claudio Mauro
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Weyand CM, Zeisbrich M, Goronzy JJ. Metabolic signatures of T-cells and macrophages in rheumatoid arthritis. Curr Opin Immunol 2017; 46:112-120. [PMID: 28538163 DOI: 10.1016/j.coi.2017.04.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 04/10/2017] [Accepted: 04/11/2017] [Indexed: 12/17/2022]
Abstract
In most autoimmune diseases, a decade-long defect in self-tolerance eventually leads to clinically relevant, tissue-destructive inflammatory disease. The pathogenic potential of chronic persistent immune responses during the pre-clinical and clinical phase is ultimately linked to the bioenergetic fitness of innate and adaptive immune cells. Chronic immune cell stimulation, high cellular turn-over, structural damage to the host tissue and maladaptive wound healing, all require a reliable supply of nutrients, oxygen, and biosynthetic precursors. Here, we use the model system of rheumatoid arthritis (RA) to discuss immunometabolism from the vantage point of T-cells and macrophages that encounter fundamentally different metabolic stress scenarios in the RA host. We outline the general principle that both insufficient nutrient supply, as well as nutrient excess generate cellular stress responses and guide immune function. ATPlow, NADPHhigh, ROSlow T-cells hyperproliferate and are forced into premature senescence. ATPhigh, ROShigh macrophages dimerize the glycolytic enzyme pyruvate kinase to amplify STAT3-dependent inflammatory effector functions. A corollary of this model is that simple nutraceutical interventions will be insufficient to re-educate the immune system in RA. Instead, interference with cell-type-exclusive and differentiation-stage-dependent metabolic setpoints will be needed to reprogram arthritogenic pathways.
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Affiliation(s)
- Cornelia M Weyand
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA , United States.
| | - Markus Zeisbrich
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA , United States
| | - Jörg J Goronzy
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA , United States
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10
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Abstract
One of the fundamental traits of immune cells in rheumatoid arthritis (RA) is their ability to proliferate, a property shared with the joint-resident cells that form the synovial pannus. The building of biomass imposes high demands for energy and biosynthetic precursors, implicating metabolic control as a basic disease mechanism. During preclinical RA, when autoreactive T cells expand and immunological tolerance is broken, the main sites of disease are the secondary lymphoid tissues. Naive CD4+ T cells from patients with RA have a distinct metabolic signature, characterized by dampened glycolysis, low ATP levels and enhanced shunting of glucose into the pentose phosphate pathway. Equipped with high levels of NADPH and depleted of intracellular reactive oxygen species, such T cells hyperproliferate and acquire proinflammatory effector functions. During clinical RA, immune cells coexist with stromal cells in the acidic milieu of the inflamed joint. This microenvironment is rich in metabolic intermediates that are released into the extracellular space to shape cell-cell communication and the functional activity of tissue-resident cells. Increasing awareness of how metabolites regulate signalling pathways, guide post-translational modifications and condition the tissue microenvironment will help to connect environmental factors with the pathogenic behaviour of T cells in RA.
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11
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Fujii W, Kawahito Y, Nagahara H, Kukida Y, Seno T, Yamamoto A, Kohno M, Oda R, Taniguchi D, Fujiwara H, Ejima A, Kishida T, Mazda O, Ashihara E. Monocarboxylate Transporter 4, Associated With the Acidification of Synovial Fluid, Is a Novel Therapeutic Target for Inflammatory Arthritis. Arthritis Rheumatol 2015. [DOI: 10.1002/art.39270] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Wataru Fujii
- Kyoto Prefectural University of Medicine; Kyoto Japan
| | | | | | - Yuji Kukida
- Kyoto Prefectural University of Medicine; Kyoto Japan
| | - Takahiro Seno
- Kyoto Prefectural University of Medicine; Kyoto Japan
| | | | | | - Ryo Oda
- Kyoto Prefectural University of Medicine; Kyoto Japan
| | | | | | - Akika Ejima
- Kyoto Prefectural University of Medicine; Kyoto Japan
| | | | - Osam Mazda
- Kyoto Prefectural University of Medicine; Kyoto Japan
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12
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Simkin PA. The human knee: A window on the microvasculature. Tissue Barriers 2015; 3:e970465. [PMID: 25838977 DOI: 10.4161/21688362.2014.970465] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 09/24/2014] [Indexed: 11/19/2022] Open
Abstract
In synovial joints, the lining cells do not have tight junctions with their neighboring cells and they have no underlying basement membrane. Therefore, the synovial fluid within the articular cavity is continuous with the interstitial fluid of the synovial intima. These features, combined with ready access to the space via arthrocentesis, permit quantitative studies of microvascular function in the knees of unanesthetized, volunteer, human subjects both with and without chronic arthritis. This brief article reviews the principal findings of such work over ∼40 years at the University of Washington. Examined variables include bidirectional fenestral diffusion of small solutes, effective blood flow, lymphatic drainage, and endothelial pore size and permeability. The latter work introduced a new method using gel filtration chromatography of paired synovial fluid (SF) and serum (S) to obtain essentially continuous SF/S ratios over a range of radii between 1 and 12 nanometers.
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Key Words
- BCP, Basic Calcium Phosphate
- C, Concentration
- Cl, Clearance
- IF, Interstitial Fluid
- NSAID, Non-steroidal Anti-inflammatory Drugs
- OA, Osteoarthritis
- P, Plasma
- RA, Rheumatoid Arthritis
- S, Serum
- SF, Synovial Fluid
- blood flow
- capillary
- fenestration
- glycocalyx
- lymph flow
- nm, nanometer
- permeability
- pore size
- rheumatoid
- synovium
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Affiliation(s)
- Peter A Simkin
- Division of Rheumatology; University of Washington ; Seattle, WA USA
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13
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Lasker JM, Fong CJ, Ginat DT, Dwyer E, Hielscher AH. Dynamic optical imaging of vascular and metabolic reactivity in rheumatoid joints. JOURNAL OF BIOMEDICAL OPTICS 2007; 12:052001. [PMID: 17994887 DOI: 10.1117/1.2798757] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Dynamic optical imaging is increasingly applied to clinically relevant areas such as brain and cancer imaging. In this approach, some external stimulus is applied and changes in relevant physiological parameters (e.g., oxy- or deoxyhemoglobin concentrations) are determined. The advantage of this approach is that the prestimulus state can be used as a reference or baseline against which the changes can be calibrated. Here we present the first application of this method to the problem of characterizing joint diseases, especially effects of rheumatoid arthritis (RA) in the proximal interphalangeal finger joints. Using a dual-wavelength tomographic imaging system together with previously implemented model-based iterative image reconstruction schemes, we have performed initial dynamic imaging case studies on a limited number of healthy volunteers and patients diagnosed with RA. Focusing on three cases studies, we illustrated our major finds. These studies support our hypothesis that differences in the vascular reactivity exist between affected and unaffected joints.
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Affiliation(s)
- Joseph M Lasker
- Columbia University, Department of Biomedical Engineering, 500 West 120th Street, ET351 Mudd Building, MC8904, New York, New York 10027, USA
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14
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Swelling of synovial joints - An anatomical, physiological and energy metabolical approach. PATHOPHYSIOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR PATHOPHYSIOLOGY 2000; 7:1-19. [PMID: 10825680 DOI: 10.1016/s0928-4680(00)00044-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The direction and part of the rate of fluid filtration between synovial capillary (subscript capill) plasma and joint (subscript j) cavity fluid depends on the hydrostatic (P(capill)-P(j)) and colloid osmotic (COP(plasma)-COP(j)) pressure differences and on the osmotic efficiency (coefficient sigma) of 'colloids' across the barrier between plasma and synovial fluid. The rate of filtration also depends on capillary endothelial hydraulic conductance (L(p)) and surface area (A). Synovial fluid protein is removed by lymphatics, or split to be resorbed or used up by cells. Physiologists put together as equations the above, as well as other terms, all of these influenced by numerous factors. The equations offer a frame for a multifactorial approach to diseases associated with joint swelling and suggest, among others, that in the presence of weak generalized exsudation, synovial joints are loci minores resistentiae to swelling. The influence of joint cartilage energy demands on synovial blood flow may have been underrated. There are many accepted clinical, laboratory and morphological findings that fit this physiological frame that merits further clinical research.
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van Dijke CF, Peterfy CG, Brasch RC, Lang P, Roberts TP, Shames D, Kneeland JB, Lu Y, Mann JS, Kapila SD, Genant HK. MR imaging of the arthritic rabbit knee joint using albumin-(Gd-DTPA)30 with correlation to histopathology. Magn Reson Imaging 1999; 17:237-45. [PMID: 10215479 DOI: 10.1016/s0730-725x(98)00167-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to demonstrate a technique, in a pilot study, for measuring abnormal capillary permeability in synovial tissue of rabbit arthritic knees using dynamic MRI with a gadolinium-based blood pool agent. Arthritis, simulating rheumatoid arthritis, was induced in knees of 8 rabbits by intra-articular injection of carrageenan (n = 4) or ovalbumin (n = 4). Sequential fat presaturated T1-weighted Spoiled Grass images were obtained before and up to 30 min after intravenous administration of albumin-(Gd-DTPA)30. Estimates of synovial tissue plasma-volume (PV), fractional-leak-rate (FLR), and permeability-surface-area-product (PS) were computed. Histologic correlation was obtained in the corresponding regions. Dynamic MRI showed extravasation of albumin-(Gd-DTPA)30 into hypertrophic synovium in six of the eight arthritic knees. Histologic examination of these six knees showed markedly inflamed synovium. The two knees that did not show abnormal vascular permeability contained non-hypertrophic synovium. None of the rabbits showed abnormal permeability in muscle. MRI derived microvascular characteristics (PV, FLR and PS) correlated positively (r2 = 0.51, 0.97 and 0.86) with the histology. Factors involving the structural and functional microvascular characteristics of synovial tissue can be estimated non-invasively using albumin-(Gd-DTPA)30. This technique may be useful for monitoring disease progression and treatment response in rheumatoid arthritis.
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Affiliation(s)
- C F van Dijke
- Department of Radiology, University of California, San Francisco 94143-0628, USA
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16
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Walsh DA, Wade M, Mapp PI, Blake DR. Focally regulated endothelial proliferation and cell death in human synovium. THE AMERICAN JOURNAL OF PATHOLOGY 1998; 152:691-702. [PMID: 9502411 PMCID: PMC1858385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Angiogenesis and vascular insufficiency each may support the chronic synovial inflammation of rheumatoid arthritis. We have shown by quantitative immunohistochemistry and terminal uridyl deoxynucleotide nick end labeling that endothelial proliferation and cell death indices were each increased in synovia from patients with rheumatoid arthritis compared with osteoarthritic and noninflamed controls, whereas endothelial fractional areas did not differ significantly among disease groups. Markers of proliferation were associated with foci immunoreactive for vascular endothelial growth factor and integrin alpha(v)beta3, whereas cell death was observed in foci in which immunoreactivities for these factors were weak or absent. No association was found with thrombospondin immunoreactivity. The balance between angiogenesis and vascular regression in rheumatoid synovitis may be determined by the focal expression of angiogenic and endothelial survival factors. Increased endothelial cell turnover may contribute to microvascular dysfunction and thereby facilitate persistent synovitis.
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Affiliation(s)
- D A Walsh
- Inflammation Group, Queen Mary and Westfield College, London, United Kingdom.
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17
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Gaffney K, Cookson J, Blades S, Coumbe A, Blake D. Quantitative assessment of the rheumatoid synovial microvascular bed by gadolinium-DTPA enhanced magnetic resonance imaging. Ann Rheum Dis 1998; 57:152-7. [PMID: 9640130 PMCID: PMC1752541 DOI: 10.1136/ard.57.3.152] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the relation between rate of synovial membrane enhancement, intra-articular pressure (IAP), and histologically determined synovial vascularity in rheumatoid arthritis, using gadolinium-DTPA enhanced magnetic resonance imaging (MRI). METHODS Dynamic gadolinium-DTPA enhanced MRI was performed in 31 patients with knee synovitis (10 patients IAP study, 21 patients vascular morphometry study). Rate of synovial membrane enhancement was quantified by line profile analysis using the image processing package ANALYZE. IAP was measured using an intra-compartmental pressure monitor system. Multiple synovial biopsy specimens were obtained by a blind biopsy technique. Blood vessels were identified immunohistochemically using the endothelial cell marker QBend30 and quantified (blood vessel numerical density and fractional area). RESULTS Median blood vessel numerical density and fractional area were 77.5/mm2 (IQR; 69.3-110.7) and 5.6% (IQR; 3.4-8.5) respectively. The rate of synovial membrane enhancement (median 2.74 signal intensity units/s, IQR 2.0-3.8) correlated with both blood vessel numerical density (r = 0.46, p < 0.05) and blood vessel fractional area (r = 0.55, p < 0.02). IAP did not influence the rate of enhancement. CONCLUSIONS Gadolinium-DTPA enhanced MRI may prove to be a valuable technique for evaluating drugs that influence angiogenesis.
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Affiliation(s)
- K Gaffney
- Bone and Joint Research Unit, St Bartholomew's, London
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18
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Abstract
Synovial perfusion was quantified in milliliters per minute per knee by two quite different clearance methods based on (1) counting tritiated water in serial aspirates of intraarticular saline, and (2) external counting of joints injected with free radioiodide. In each case, the serial counting data determine a rate constant that is multiplied by a distribution volume to provide the clearance in flow terms of milliliters per minute. This report updates and summarizes these data and compares the two methods to each other and to alternative assessments of synovial blood flow. Available methods such as laser Doppler flowmetry (with data output measured in volts) and solute clearance constant determinations (in min-1) are useful for selected purposes but cannot be used to quantify the articular flux (in milligrams per minute) of any solute. Radiolabeled microspheres provide data (in milliliters per minute per g of tissue) but are unsuitable for human use. The two clearance methods provide comparable results, but the free iodide technique seems most suitable for physiologic investigations. The latter potentially includes critical evaluations of synovial blood flow in relation to issues such as palpable warmth, visible erythema, articular ischemia, the permeability of synovial vessels, the genesis of effusions, the delivery and removal of therapeutic agents, and the concentration of every synovial fluid solute from micronutrients through cytokines, plasma proteins, and molecular markers of cartilagenous injury.
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Affiliation(s)
- P A Simkin
- Department of Medicine, University of Washington, Seattle 98195, USA
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Affiliation(s)
- P A Simkin
- Department of Medicine, University of Washington, Seattle 98195, USA
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Edmonds SE, Ellis G, Gaffney K, Archer J, Blake DR. Hypoxia and the rheumatoid joint: immunological and therapeutic implications. Scand J Rheumatol Suppl 1995; 101:163-8. [PMID: 7747120 DOI: 10.3109/03009749509100921] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- S E Edmonds
- ARC Bone and Joint Research Unit, London Hospital Medical College, England
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21
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Davis AJ, Hawkes GE, Haycock PR, O'Brien P, Kidd BL, Mapp PI, Naughton D, Grootveld M. Generation of substance P carbamate in neutral aqueous solution. Relevance to inflammatory joint diseases. FEBS Lett 1993; 329:249-52. [PMID: 7689976 DOI: 10.1016/0014-5793(93)80231-i] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
High-field proton (1H) nuclear magnetic resonance (NMR) spectroscopy has been employed to evaluate the formation of substance P carbamate in aqueous solution. Equilibration of substance P with physiologically relevant concentrations of bicarbonate (2.50 x 10(-2) mol.dm-3) at pH 7.00 generated a new multiplet signal centred at 4.13 ppm in its NMR spectrum, characteristic of the alpha-proton of peptide carbamate species. High-field 1H NMR spectroscopy also demonstrated that the model dipeptide, Arg-Gly, formed a carbamate in neutral aqueous solutions containing 2.50 x 10(-2) mol.dm-3 HCO3-. The physiological significance of these results is discussed in view of the central roles of vasoactive neuropeptides in human joint diseases and the hypercapnic environment of the inflamed rheumatoid joint.
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Affiliation(s)
- A J Davis
- Department of Chemistry, Queen Mary and Westfield College, University of London, UK
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22
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Naughton D, Whelan M, Smith EC, Williams R, Blake DR, Grootveld M. An investigation of the abnormal metabolic status of synovial fluid from patients with rheumatoid arthritis by high field proton nuclear magnetic resonance spectroscopy. FEBS Lett 1993; 317:135-8. [PMID: 8381364 DOI: 10.1016/0014-5793(93)81508-w] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The 1H Hahn spin-echo NMR profiles of rheumatoid synovial fluids have been investigated and compared with those of matched serum samples. In addition to markedly elevated lactate and diminished glucose concentrations, inflammatory synovial fluids contained (i) substantially lower levels of NMR-detectable chylomicron-and very-low-density-lipoprotein-associated triacylglycerols which appear to have a shortened mean chain-length, and (ii) high concentrations of ketone bodies (predominantly 3-D-hydroxybutyrate), relative to those of corresponding paired serum samples. These observations confirm the abnormal metabolic status of the inflamed rheumatoid joint and provide evidence for an increased utilisation of lipids for fuel therein.
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Affiliation(s)
- D Naughton
- Inflammation Research Group, London Hospital Medical College, UK
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23
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Farrell AJ, Williams RB, Stevens CR, Lawrie AS, Cox NL, Blake DR. Exercise induced release of von Willebrand factor: evidence for hypoxic reperfusion microvascular injury in rheumatoid arthritis. Ann Rheum Dis 1992; 51:1117-22. [PMID: 1444624 PMCID: PMC1012415 DOI: 10.1136/ard.51.10.1117] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Experimental evidence suggests that rheumatoid synovitis may be perpetuated by the generation of reactive oxygen species during hypoxic reperfusion injury. The latter occurs because increased intra-articular pressure during exercise exceeds synovial capillary perfusion pressure, impairing blood flow. The object of this study was to establish a marker for and the mechanism of synovial hypoxic reperfusion injury. Von Willebrand factor (vWF) is only released from endothelial cells and platelets and is an in vivo and in vitro marker of endothelial injury. In vivo exercise induced changes in plasma vWF were therefore investigated in patients with rheumatoid arthritis (RA) compared with controls and in vitro vWF release by human umbilical vein endothelial cells subjected to hypoxia reperfusion. Pre-exercise plasma vWF levels were 1001 and 817 IU/l, increasing after exercise to 1658 and 845 IU/l in patients with RA and controls respectively. Von Willebrand factor release from human umbilical vein endothelial cells followed a biphasic pattern, occurring during both hypoxia and reperfusion. Hypoxia reperfusion induced vWF release by human umbilical vein endothelial cells in vitro suggests that exercise induced vWF release in patients with RA is best explained by synovial hypoxic reperfusion injury. This study supports evidence that generation of reactive oxygen species plays a principal part in synovial hypoxic reperfusion injury and suggests vWF as a useful marker of this phenomenon.
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Affiliation(s)
- A J Farrell
- Inflammation Research Group, London Hospital Medical College, Whitechapel, United Kingdom
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24
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Ferrell WR, Najafipour H. Changes in synovial PO2 and blood flow in the rabbit knee joint due to stimulation of the posterior articular nerve. J Physiol 1992; 449:607-17. [PMID: 1522525 PMCID: PMC1176097 DOI: 10.1113/jphysiol.1992.sp019104] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
1. Experiments were performed to measure the partial pressure of oxygen in the synovial fluid (Ps,O2) of the normal rabbit knee joint and assess the extent to which this varied with changes in knee joint blood flow. 2. With the hypodermic needle oxygen electrode sited just within the synovial cavity, Ps,O2 values ranged from 25 to 72 mmHg with a mean of 48.2 +/- 3.1 (S.E.M.; n = 18). 3. Ps,O2 was found to decrease with increasing depth of penetration of the oxygen electrode. Lowest values were observed close to the articular cartilage. 4. Electrical stimulation of the posterior articular nerve (PAN) of the knee resulted in vasoconstriction of knee joint blood vessels which was accompanied by a decrease in Ps,O2. The frequency-response and voltage-response profiles to electrical stimulation of PAN, although differing in magnitude, showed a high degree of correlation between blood flow and Ps,O2. 5. As judged by the conduction velocity, the vasoconstrictor response to nerve stimulation was mediated by unmyelinated nerve fibres, presumed to be sympathetic postganglionic fibres. 6. In view of the low Ps,O2 values occurring deep within the joint, avascular structures such as cartilage could be subject to injury if sustained reduction in synovial blood flow occurred. This could be a contributory factor in the pathogenesis of degenerative and inflammatory joint diseases.
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Affiliation(s)
- W R Ferrell
- Institute of Physiology, University of Glasgow
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25
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Stevens CR, Blake DR, Merry P, Revell PA, Levick JR. A comparative study by morphometry of the microvasculature in normal and rheumatoid synovium. ARTHRITIS AND RHEUMATISM 1991; 34:1508-13. [PMID: 1747135 DOI: 10.1002/art.1780341206] [Citation(s) in RCA: 128] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Vascularity is said to be increased (subjectively) in rheumatoid arthritis, yet synovial fluid is hypoxic and acidotic. Morphometry by image analysis was used to quantify vascularity in normal and rheumatoid synovium from the knee joint. Capillaries were distributed more deeply in the rheumatoid synovium (93.3 microns, compared with 32.5 microns in normal synovium) and were significantly less densely arranged (80.2/mm2 rheumatoid, 241.5/mm2 normal). The blood volume fraction fell from 2.9% in normal knee synovium to 1.2% in rheumatoid synovium. These results imply that there is impairment of O2 transfer, which contributes to the intraarticular hypoxia, in rheumatoid arthritis.
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Affiliation(s)
- C R Stevens
- Bone and Joint Research Unit, London Hospital Medical College, Whitechapel, United Kingdom
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26
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Hutadilok N, Smith MM, Ghosh P. Effects of hydrogen peroxide on the metabolism of human rheumatoid and osteoarthritic synovial fibroblasts in vitro. Ann Rheum Dis 1991; 50:219-26. [PMID: 2029203 PMCID: PMC1004390 DOI: 10.1136/ard.50.4.219] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The effects of hydrogen peroxide (H2O2) on the metabolism of cultured human synovial fibroblasts derived from joints of four patients with rheumatoid arthritis and three with osteoarthritis have been investigated. The exposure of rheumatoid cell cultures to this oxygen derived species at sublethal concentrations (1-100 mumol/l) induced a dose related inhibition of both hyaluronic acid (HA) and DNA synthesis. In contrast, in osteoarthritic cell lines a biphasic response was shown. At low concentrations of H2O2 (less than 10 mumol/l) a stimulatory effect on HA synthesis was noted, whereas in the presence of higher concentrations (greater than 10 mumol/l) a significant inhibition of synthesis occurred. These deleterious effects of H2O2 were partially reduced by the addition of catalase to the culture media. The finding that both HA and DNA synthesis were inhibited at concentrations of H2O2 less than those which caused loss of cell integrity (greater than 200 mumol/l) suggests oxidation of intracellular components, such as glyceraldehyde-3-phosphate dehydrogenase, and subsequent depletion of ATP concentrations.
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Affiliation(s)
- N Hutadilok
- Raymond Purves Research Laboratories, (University of Sydney), Royal North Shore Hospital of Sydney, St Leonards, NSW, Australia
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27
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Stevens CR, Williams RB, Farrell AJ, Blake DR. Hypoxia and inflammatory synovitis: observations and speculation. Ann Rheum Dis 1991; 50:124-32. [PMID: 1705416 PMCID: PMC1004353 DOI: 10.1136/ard.50.2.124] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- C R Stevens
- ARC Bone and Joint Research Unit, London Hospital Medical College
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28
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Conditions Associated with Impaired Oxygen Extraction. UPDATE IN INTENSIVE CARE AND EMERGENCY MEDICINE 1991. [DOI: 10.1007/978-3-642-84169-9_28] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Geborek P, Forslind K, Wollheim FA. Direct assessment of synovial blood flow and its relation to induced hydrostatic pressure changes. Ann Rheum Dis 1989; 48:281-6. [PMID: 2653243 PMCID: PMC1003742 DOI: 10.1136/ard.48.4.281] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A method for measuring synovial blood flow changes using the laser Doppler technique is described. Mean blood flow and mean pulse amplitude decreased by 50-70% in relation to the reference level when the intra-articular hydrostatic pressure in effusive knee joints of patients with rheumatoid arthritis was increased. As an increase of intra-articular pressure of as little as 20 mmHg decreased synovial blood flow significantly it is suggested that hypoxia may occur in vivo during joint use in the presence of an effusion. This may be of aetiopathogenetic importance for tissue destruction and the persistence of chronic synovitis.
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Affiliation(s)
- P Geborek
- Department of Rheumatology, University Hospital of Lund, Sweden
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30
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Tegelberg A, Kopp S. Skin surface temperature over the temporomandibular and metacarpophalangeal joints in individuals with rheumatoid arthritis. Acta Odontol Scand 1987; 45:329-36. [PMID: 3478938 DOI: 10.3109/00016358709096355] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Temperature measurements were made on the skin surface over the temporomandibular joint (TMJ) and metacarpophalangeal (MCP) joint in 71 individuals with rheumatoid arthritis (RA) and 52 individuals without general joint disease or symptoms. The recordings were performed with thermistors in contact with the skin. Symptoms in the stomatognathic system and general joint symptoms were investigated by a questionnaire. A clinical examination was performed of the stomatognathic system. In addition, a medical examination including clinical articular indices and laboratory tests was made. The skin surface temperature over the TMJ was generally lower for the individuals with RA than for the individuals without joint disease, whereas the opposite was found for the MCP joint. The most important determinants of skin surface temperature over the TMJ in RA were duration of TMJ symptoms, room temperature, tenderness to palpation of the masseter muscle, and rheumatoid factor. The results of this study indicate that there is a correlation between both symptoms and signs of disorder in the stomatognathic system and temperature of the skin surface overlying the TMJ and MCP joint in individuals with RA.
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Affiliation(s)
- A Tegelberg
- Public Dental Clinic and Rheumatism Hospital, Strängnäs, Sweden
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31
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Svalastoga E, Grønlund J. Experimental osteoarthritis in the rabbit. III. Acute osteoarthritis: subchondral P02 and oxygen consumption and diffusion capacity in the synovial membrane. Acta Vet Scand 1986. [PMID: 4096321 DOI: 10.1186/bf03546534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wallis WJ, Simkin PA, Nelp WB. Low synovial clearance of iodide provides evidence of hypoperfusion in chronic rheumatoid synovitis. ARTHRITIS AND RHEUMATISM 1985; 28:1096-1104. [PMID: 4052121 DOI: 10.1002/art.1780281004] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Iodide clearance was measured in the chronic knee effusions of 11 patients with rheumatoid arthritis and 9 patients with osteoarthritis. The mean (+/- SE) iodide clearance of 1.92 +/- 0.30 ml/minute in rheumatoid arthritis effusions did not differ significantly from the 2.19 +/- 0.52 ml/minute found in osteoarthritis effusions. Clearance values in rheumatoid arthritis patients ranged widely (0.79-3.22 ml/minute). Iodide clearance in these patients correlated directly with synovial fluid (SF) pH (r = 0.731, P = 0.005), SF glucose:serum glucose ratio (r = 0.746, P = 0.004), and SF temperature (r = 0.878, P = 0.001), and directly with SF lactate (r = -0.782, P = 0.002) and percentage of SF neutrophils (r = -0.581, P = 0.03). These relationships support the hypothesis that rheumatoid synovitis is often marked by tissue hypoperfusion, and that the "sickest" rheumatoid joints (as defined by physiologic indices) are the most ischemic.
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Ahlqvist J. Multifactorial pathogenesis: ought we to classify disease or treat the individual's causes of disease? Med Hypotheses 1985; 16:289-302. [PMID: 3889563 DOI: 10.1016/0306-9877(85)90012-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Added to the uniqueness of most of us imparted by HLA, our individual differences in the expression of other genetic traits, foetal period steroid imprints on brain and other functions, and regulators shared by body and mind indicate that each one of us (except most monozygotic twins) is born as a unique individual whole (I). Mechanisms suspected to be contributing ones in classified synovitides appear to correspond to individually exaggerated or depressed modes of response by physiological mechanisms linked to our unique individual wholes (II). If we upgrade the importance of influences of combinations of 'contributing' mechanisms, the importance of the alleged unknown fundamental causes of these diseases diminishes (III). This broad interpretation of 'multifactorial pathogenesis' can probably be applied to many common types of disease (IV), implying that disease classifications may poorly reflect the individual's causes of disease (V). There is reason to challenge modern concepts about disease (VI).
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Experimental osteoarthritis in the rabbit. II. A new method to estimate the oxygen consumption and diffusion capacity in the synovial membrane of the knee. Acta Vet Scand 1985. [PMID: 4096320 DOI: 10.1186/bf03546533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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35
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Svalastoga E, Grønlund J. Experimental osteoarthritis in the rabbit. II. A new method to estimate the oxygen consumption and diffusion capacity in the synovial membrane of the knee. Acta Vet Scand 1985; 26:326-39. [PMID: 4096320 PMCID: PMC8202703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The oxygen supply to the joint cartilage depends on the oxygen transport from the capsular arteries to the capillaries, the oxygen diffusion across the synovial membrane and the oxygen transport through the synovia. In osteoarthritis the resistance to transport across all 3 barriers may be increased because of the joint effusion, the elevated intraarticular pressure and the inflammatory changes of the synovial membrane. In the present study we describe a method to determine 2 important parameters affecting the oxygen transport through the synovial membrane: the oxygen consumption and diffusion capacity of the membrane. The principle of the method is to perfuse the joint cavity of the knee by saline saturated with air and to record the relationship between the oxygen partial pressure in the outflowing perfusate and the perfusion rate. The values found for the diffusion capacity and oxygen consumption were 0.039 ± 0.013 μl O2/min/Torr and 0.93 ± 0.90 μl O2/min (mean ± s).
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36
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Svalastoga E, Grønlund J. Experimental osteoarthritis in the rabbit. III. Acute osteoarthritis: subchondral P02 and oxygen consumption and diffusion capacity in the synovial membrane. Acta Vet Scand 1985; 26:340-51. [PMID: 4096321 PMCID: PMC8202704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The earliest sign of osteoarthritis is acute synovitis with joint effusion and elevated intraarticular pressure, which causes compression of the intracapsular vein segments draining the epiphyseal bone compartment. The increased outflow resistance may cause a fall in the regional blood flow and thereby lead to a state of tissue hypoxia. The acute osteoarthritis may also affect the transfer of oxygen to the cartilage across synovial membrane because of the extensive inflammation with hypercellularity and edema. In the present study we have investigated the subchondral P02 and Pc02 in acute osteoarthritis. There was no significant difference between these gas tensions in the normal and osteoarthritic bone. We have also investigated the oxygen consumption and diffusion capacity in the synovial membrane. The latter was decreased by a factor of 4 in the osteoarthritic joints whilst the oxygen consumption was increased by a factor of 3.
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Ahlqvist J. A hypothesis on the pathogenesis of rheumatoid and other non-specific synovitides. IV A. The possible intermediate role of local hypoxia and metabolic alterations. Med Hypotheses 1984; 13:257-302. [PMID: 6371458 DOI: 10.1016/0306-9877(84)90162-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
According to the original hypothesis, synovial tissue (ST) oedema and synovial fluid (SF) volume increase contribute to local hypoxia and metabolic alterations and to inflammation (A 1). Studies on biochemical mechanisms (A 2) in synovitides show that the SF volume correlates to SF hypoxia that correlates to lactate increase, acidosis and to some decrease in glucose. Normal ST produces lactate by glycolytic and pentose phosphate pathway activity, both, as well as the normally low oxygen utilization, being increased in synovitides . In ST very little carbohydrate seems to pass directly into the citric acid cycle and oxidation of fat may be involved, but it is not known if the fat is carried to ST by the blood or if it is synthetized locally (B). ST oedema and effusions may be most important as causes of local hypoxia (C). Acidosis alters physico-chemical properties of proteins, possibly changing their chemotactic and antigenic qualities, etc. Hypoxia and fuel supply might be related to fibroblast, macrophage and neutrophil reactions, and, in view of the high metabolic demands of villi, they may contribute to, e.g., ST necroses, and to erosions (D). I shall summarize some essentials of my present views on the pathogenesis (E 1 a) and causes in single cases (E 3 b) of synovitis, and comment on two other new hypotheses on rheumatoid arthritis (E 2) and on therapeutic (E 4) and other implications of this concept (E).
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Wallis WJ, Simkin PA. Antirheumatic drug concentrations in human synovial fluid and synovial tissue. Observations on extravascular pharmacokinetics. Clin Pharmacokinet 1983; 8:496-522. [PMID: 6360465 DOI: 10.2165/00003088-198308060-00002] [Citation(s) in RCA: 93] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Antirheumatic drug concentrations have been measured in human synovial fluid and synovial tissue, and provide insights on: (1) extravascular pharmacokinetics; (2) articular pathophysiology; and (3) the factors which modify drug levels in inflamed tissues. Concentrations of free drug in synovial fluid and plasma are the same in all conditions except rheumatoid and infectious arthritis, where the most severely afflicted joints may contain lower synovial fluid drug concentrations. This finding may be relevant to the chronicity and intractability of chronic arthritis. After single-dose therapy and a characteristic 'equilibration time', higher concentrations are found in synovial fluid than in plasma - a phenomenon which results from relative drug sequestration across the trans-synovial diffusion barrier away from the organs of elimination. Studies of oral, parenteral, topical and intra-articular antirheumatic drug therapy are reviewed, and recommendations are made for the conduct of future studies.
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Kopp S, Wenneberg B, Clemensson E. Clinical, microscopical and biochemical investigation of synovial fluid from temporomandibular joints. SCANDINAVIAN JOURNAL OF DENTAL RESEARCH 1983; 91:33-41. [PMID: 6573758 DOI: 10.1111/j.1600-0722.1983.tb00772.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The aim of this study was to investigate the relationship between pain and tenderness to palpation of the temporomandibular joint (TMJ), radiographic changes of the joint and signs of inflammation in the synovial fluid. Saline was injected into and aspirated from the TMJ of 29 patients with painful and tender TM joints and from five individuals with healthy joints. In another two patients synovial fluid could be aspirated without saline. The aspirated fluid was analyzed for inflammatory cells and for plasma proteins. A clinical examination of the stomatognathic system and a radiographic examination of the TMJ were performed before the aspiration. Besides tenderness to palpation of the TMJ, pain on mandibular movement and tenderness to palpation of the masticatory muscles were common. Erosion of the cortical outline of the joint surfaces was the most common radiographic finding. Inflammatory cells were present in the fluid of three patients but in none of the healthy individuals. Plasma proteins of inflammatory type could be detected in the fluid from seven of the patients. The results show that radiographic, cellular or biochemical signs of inflammation can frequently be found in the TMJ of patients with longstanding pain and tenderness of this joint.
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Banford JC, Brown DH, Hazelton RA, McNeil CJ, Sturrock RD, Smith WE. Serum copper and erythrocyte superoxide dismutase in rheumatoid arthritis. Ann Rheum Dis 1982; 41:458-62. [PMID: 7125714 PMCID: PMC1001022 DOI: 10.1136/ard.41.5.458] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Serum copper and thiol levels an caeruloplasmin activity were determined and compared with measurements of articular index, erythrocyte sedimentation rate, and zinc and haemoglobin levels in patients with rheumatoid arthritis. Superoxide dismutase activity, thiol, zinc, and copper levels of haemolysate were measured and compared with each other and to the above parameters. In serum, caeruloplasmin activity increased and thiol levels decreased, whereas in the haemolysate superoxide dismutase activity decreased and thiol levels increased. It is suggested that the changes in copper levels and in the activities of process which may be copper-dependent between plasma and cytosol in patients with rheumatoid arthritis reflect a change in oxidative status of the blood which may have implications in the pathogenesis of the disease.
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Abstract
Past research into the pathogenesis of RA has generally concerned itself with established inflammation. The present review summarizes alterations in microvascular anatomy and function which occur during the hypoxic state, in various experimental and disease conditions. It further shows that tissue hypoxia is a common finding in RA and that the microvascular alterations of RA are similar to those produced by experimental hypoxia. The available data suggest that microcirculatory compromise, concomitant with an increase in metabolic needs of synovial tissue, may initiate tissue injury via anoxia and acidosis, resulting in hydrolytic enzyme release, increased vascular permeability and acceleration of inflammatory processes. It is further believed that the microcirculatory abnormality may be generalized, accounting for the systemic manifestations often seen in RA. Factors effecting arteriolar blood flow obstruction are reviewed to identify areas for future investigation in RA and other disorders involving microvasculopathy. The multitude of longknown and newly recognized factors predisposing to vasospasm and vasodilatation have been outlined as a guide to possible mechanisms which may be operative in RA. An attempt has been made to gather and synthesize the available data in the hope that it may stimulate other investigators to pursue more definitive research into specific areas which may show early microvascular abnormalities in the pathophysiology of RA. Identification of factors operative early in the pathogenesis of RA, before it becomes self-perpetuating, may well be a step in the direction of preventing the ravages of this disease, or providing insight to more effective control.
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Richman AI, Su EY, Ho G. Reciprocal relationship of synovial fluid volume and oxygen tension. ARTHRITIS AND RHEUMATISM 1981; 24:701-5. [PMID: 6786298 DOI: 10.1002/art.1780240512] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
To investigate the impact of synovial fluid volume on oxygen tension (PO2) and other metabolic correlates, 24 specimens of synovial fluid from the knees of 22 patients were analyzed for volume, number of leukocytes (WBC), pH, PO2, PCO2, glucose, protein, and complement (CH50) levels. Concurrent arterial blood samples were obtained in 21 instances. Synovial fluid PO2 values varied inversely with volumes of synovial fluid (r = -0.54, P less than 0.01), but when patients with rheumatoid arthritis were excluded, the correlation was more significant (r = -0.76, P less than 0.001). When synovial fluid PO2 dropped below 45 mm Hg, intraarticular acidosis resulted. The decrease in pH (r = 0.93, P less than 0.001), the lowering of glucose values (r = 0.89, P less than 0.001), and the rise in PCO2 (r = -0.79, P less than 0.01) can be explained by a shift toward anaerobic metabolism coupled with the impaired elimination of its products. Systemic acidosis and hypoxia were not found. Intraarticular hypoxia most likely represents circulatory imbalance at the level of the synovial membrane, although an inverse relationship of synovial fluid PO2 and WBC was also noted. Complement and protein levels had no correlation with volume, pH, or respiratory gas tensions of synovial fluids. Our data support the importance of the effective blood flow to the joint in maintaining homeostasis. The volume of synovial effusion and the compliance of the joint capsule appear to be important determinants of the articular blood supply.
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Abstract
In patients with rheumatoid arthritis, as well as in persons with other kinds of synovitis, proteins enter the knee joint more rapidly than in normal individuals (P less than 0.001). The rheumatoid synovium, however, is less permeable to small molecules (tritiated water, P less than 0.02; urate, P less than 0.05; and glucose, P less than 0.002) than is the normal joint lining. This difference is explained if rheumatoid microvascular changes enhance synovial permeability to proteins while coexisting interstitial changes diminish synovial permeability to smaller molecules.
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Abstract
The effect of hyperoxia on pig articular tissue has been studied in organ culture. Hyperoxia (55% O2) causes an increased release of hydroxyproline and collagenolytic activity from synovial tissue as compared with control explants in 20% O2, but neither 55% nor 95% O2 has any effect on the breakdown of isolated cartilage during 10 days in culture. When synovium and cartilage are cultured in contact, the breakdown of cartilage collagen is greater in the hyperoxic (55% O2) group than in the controls (20% O2), but the breakdown of proteoglycan is not increased. The enhanced collagenolytic action is due to an increase in the direct effect of the synovial tissue on the cartilage matrix. In 20% O2 the synovium causes the chondrocytes to degrade the cartilage matrix, but this effect is inhibited by 55% O2.
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Rosenthall L, Hawkins D. Radionuclide joint imaging in the diagnosis of synovial disease. Semin Arthritis Rheum 1977; 7:49-61. [PMID: 333587 DOI: 10.1016/s0049-0172(77)80004-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Niinikoski J, Einola S. Postoperative synovial fluid. Metabolic response to meniscectomy or synovectomy. ACTA ORTHOPAEDICA SCANDINAVICA 1977; 48:129-37. [PMID: 17262 DOI: 10.3109/17453677708985123] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The metabolic response of synovial tissue to surgery was investigated by synovial fluid analysis after two types of operations, medial meniscectomy and synovectomy. Analyses of intra-articular fluid were also performed in non-operated patients with traumatic effusion or chronic synovitis in the knee. It was found that the knee joint metabolism in chronic synovitis is shifted towards anaerobic glycolysis in both operated and non-operated patients whereas meniscectomized and traumatized knees are more capable of maintaining oxidative metabolism. The data also demonstrate that one of the main reasons for decreased oxygen supply on the articular surface after meniscectomies or synovectomies is excessive intra-articular effusion which, according to earlier investigations, produces pressure in the joint cavity and inhibits local capillary circulation.
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Camerlain M, McCarty DJ, Silcox DC, Jung A. Inorganic pyrophosphate pool size and turnover rate in arthritic joints. J Clin Invest 1975; 55:1373-81. [PMID: 166095 PMCID: PMC301892 DOI: 10.1172/jci108056] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Recent studies have shown elevated inorganic pyrophosphate (PPi) levels in most knee joint fluid supernates from patients with pseudogout (PG) or osteoarthritis (OA) and more modestly elevated levels in some supernates from patients with gout or rheumatoid arthritis (RA) relative to PPi levels found in the venous blood plasma of normal or arthritic subjects. We measured the intraarticular PPi pool and its rate of turnover to better understand the significance of the joint fluid-plasma PPi gradient. Preliminary studies in rabbits showed that (32-P)PPi passed from joint space to blood and vice versa without detectable hydrolysis. Incubation of natural or synthetic calcium pyrophosphate dihydrate (CPPD) microcrystals with synovial fluid in vitro in the presence of (32P)PPi tracer showed no change in PPi specific activity in the supernate over a 19-h period so that exchange of PPi in solution with that in CPPD microcrystals could be ignored. Clearance rates of (32P)PPi and of (33P)Pi, as determined by serially sampling the catheterized knee joints of volunteers with various types of arthritis over a 3-h period, were nearly identical. The (32P)PPi/(32P)Pi was determined in each sample. A mixture of a large excess of cold PPi did not influence the clearance rate of either nuclide. The quantity of PPi turned over per hous was calculated from the pool size as determined by isotope dilution and the turnover rate. The residual joint fluid nuclide was shown to be (32P)PPi. The PPi pool was generally smaller and the rate of turnover was greater in clinically inflamed joints. The mean plus or minus SEM pool size (mu-moles) and turnover rate (percent/hour) in PG knees was 0.23 plus or minus 0.07 and 117 plus or minus 11.9, hydrolysis rate (%/h) to Pi was 27.7 plus or minus 13.2; in OA knees: 0.45 plus or minus 0.26 and 72 plus or minus 9.2, hydrolysis 6.9 plus or minus 0.9; in gouty knees: 0.8 plus or minus 0.41 and 50 plus or minus 11.6, hydrolysis 9.8 plus or minus 2.8; and in RA knees: 0.14 plus or minus 0.14 and 114 plus or minus 35.8, hydrolysis 236 plus or minus 116. PPi turnover (mumoles/hour) correlated with the degree of OA change present in the joint as graded by radiologic criteria irrespective of the clinical diagnosis. Mean PPi turnover in joints with advanced OA was greater than in those with mild or moderate changes (P smaller than 0.001), but the mild and moderate groups showed no significant difference. We conclude that synovial PPi turnover and elevated PPi fluid concentrations are not specific for PG patients, and that these factors alone cannot be the only determinants of CPPD crystal deposition.
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Goetzi EJ, Rynes RI, Stillman JS. Abnormalities of respiratory gases in synovial fluid of patients with juvenile rheumatoid arthritis. ARTHRITIS AND RHEUMATISM 1974; 17:450-4. [PMID: 4850367 DOI: 10.1002/art.1780170416] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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