A new model for rheumatoid arthritis?

Nitric oxide-driven hypoxia initiates synovial angiogenesis, hyperplasia and inflammatory lesions in mice

Background

Rheumatoid arthritis (RA) is an inflammatory articular disease with cartilage and bone damage due to hyperplasic synoviocyte invasion and subsequent matrix protease digestion. Although monoclonal antibodies against tumor necrosis factor alpha (TNFα) have been approved for clinical use in patients with RA, desired therapeutic regimens suitable for non-responders are still unavailable because etiological initiators leading to RA remain enigmatic and unidentified.

Methodology/Principal Findings

Bacteria-induced arthritis (BIA) that simulates collagen-induced arthritis (CIA) is developed in mice upon daily live bacterial feeding. The morphological lesions of paw erythema and edema together with the histological alterations of synovial hyperplasia and lymphocytic infiltration emerge as the early-phase manifestations of BIA and CIA. Bacteria- or collagen-mediated global upregulation of pro-inflammatory cytokines is accompanied by the burst of nitric oxide (NO). Elevation of the serum NO level is correlated with decline of the blood oxygen saturation percentage (SpO2), reflecting a hypoxic consequence during development towards arthritis. NO-driven hypoxia is further evident from a positive relationship between NO and lactic acid (LA), an end product from glycolysis. Upregulation of hypoxia inducible factor 1 alpha (HIF-1α) and vascular endothelial growth factor (VEGF) validates hypoxia-induced angiogenesis in the inflamed synovium of modeling mice. Administration of the NO donor compound sodium nitroprusside (SNP) causes articular inflammation by inducing synovial hypoxia. Anti-bacteria by the antibiotic cefotaxime and/or the immunosuppressant rapamycin or artesunate that also inhibits nitric oxide synthase (NOS) can abrogate NO production, mitigate hypoxia, and considerably ameliorate or even completely abort synovitis, hence highlighting that NO may serve as an initiator of inflammatory arthritis.

Conclusions/Significance

Like collagen, bacteria also enable synovial lesions via upregulating pro-inflammatory cytokines, triggering NO production, driving hypoxic responses, and inducing synovial angiogenesis and hyperplasia, suggesting that sustained infection might be, in part, responsible for the onset of synovitis and arthritis in mice.

From Dogs to Frogs: How Pets, Laboratory Animals, and Wildlife Aided in Elucidating Harmful Effects Arising from a Hazardous Dumpsite

The medical literature contains many examples of cases in which serendipitous observations have led to important findings. In the example described in this article, laboratory and field observations conducted at the Mohawk Nation Community of Akwesasne led to the important and unexpected finding that frogs once plentiful in the area were no longer observed. Laboratory tests comparing river sediments from Akwesasne to pristine sediment from Ithaca, NewYork, indicated multiple adverse health effects on developing frogs. Some of the behavioral changes observed in the laboratory were similar to those described by residents of Akwesasne before the onset of amphibian decline. The magnitude of changes paralleled frog body burden of polychlorinated biphenyls acquired from the Akwesasne sediment. The impact of these findings on the identification of a hazardous waste site and global amphibian decline are discussed.

Zinc-binding sites in the N terminus of Mycoplasma arthritidis-derived mitogen permit the dimer formation required for high affinity binding to HLA-DR and for T cell activation

Zinc-dependent superantigens can be divided into two subfamilies based on how they use zinc ions for interactions with major histocompatibility complex (MHC) class II molecules. Members of the first subfamily use zinc ions for interactions with histidine 81 on the beta-chain of MHC class II molecules, whereas members of the second subfamily use zinc ions for dimer formation. The zinc-binding motif is located in the C terminus of the molecule in both subfamilies. While our recent studies with Mycoplasma arthritidis-derived mitogen (MAM) have provided the first direct evidence demonstrating the binding to MHC class II molecules in a zinc-dependent manner, it still not known how zinc coordinates the interaction. Data presented here show that the zinc ion is mainly required to induce MAM/MAM dimer formation. Residues in the N terminus of MAM are involved in dimer formation and MHC class II binding, while histidine 14 and aspartic acid 31 of the MAM sequence are the major residues mediating MAM/MAM dimerization. Zinc-induced dimer formation is necessary for MAM binding, MHC class II-induced cell-cell adhesion, and efficient T cell activation. Together these results depict the unique mode of interaction of MAM in comparison with other superantigens.

Lessons from animal models of arthritis

There is increasing thought that autoantibodies to systemic self-antigens may provide a principal effector mechanism for the initiation and propagation of joint inflammation. The recent identification of arthritis transfer with antibodies to the self-antigen glucose-6-phosphate isomerase has boosted this interest. Fc receptor involvement in arthritis has been evaluated, identifying pro-inflammatory and inhibitory Fc gamma receptor subtypes, and demonstrating a link between Fc gamma receptor expression, cytokine production, cartilage destruction, and mouse strain susceptibility to immune complex arthritis. Further proof of a key role of interleukin (IL)-1 in arthritis was provided by the occurrence of spontaneous arthritis in IL-1 receptor antagonist knockout mice and elicitation of full-blown arthritis in tumor necrosis factor (TNF)-deficient mice. IL-18 (part of the IL-1 family) is a crucial upstream cytokine that, with IL-12, induces IL-1 and TNF and promotes arthritis and T-cell differentiation. IL-18 neutralization improved arthritis outcome, but its central role in host defense against bacterial infections may complicate therapeutic IL-18 targeting. T helper 1 (Th1) cells may aggravate arthritis and joint destruction through the production of IL-17, which shows joint destructive potential independent of IL-1. Studies have also focused on the control of receptor activator of nuclear factor kappaB ligand, modulation with IL-4, and regulation of downstream mediators in tissue destruction. Gene therapeutic approaches proved efficacious and will provide future ways to control arthritis.

21st European Workshop for Rheumatology Research, Vienna, Austria, 1-4 March 2001

Major advances in technology now drive how we approach questions in immunology, particularly in analyzing complex data sets commonly encountered in genomics and proteomics studies. Active areas of investigation include development of novel technologies, identification of elusive target antigens for RA and other diseases, dissection of signaling pathways connecting the lymphocyte cell surface with the nucleus, and exploration of new avenues for therapeutic interventions. The European Workshop for Rheumatology Research (EWRR) is a forum for many European and non-European scientists to present research findings of high quality. Arthritis researchers from around the globe should be strongly encouraged to attend future meetings, the next of which is the 22nd EWRR meeting in Leiden, the Netherlands, in 2002.