Forward and reverse degradomics defines the proteolytic landscape of human knee osteoarthritic cartilage and the role of the serine protease HtrA1

OBJECTIVES

Proteolytic destruction of articular cartilage, a major pathogenic mechanism in osteoarthritis (OA), was not previously investigated by terminomics strategies. We defined the degradome of human knee OA cartilage and the contribution therein of the protease HtrA1 using Terminal Amine Isotopic Labeling of Substrates (TAILS).

DESIGN

Proteins from OA cartilage taken at knee arthroplasty (n = 6) or separately, from healthy cartilage incubated in triplicate with/without active HtrA1, were labeled at natural and proteolytically cleaved N-termini by reductive dimethylation, followed by trypsin digestion, enrichment of N-terminally labeled/blocked peptides, tandem mass spectrometry and positional peptide annotation to identify cleavage sites. Biglycan proteolysis by HtrA1 was validated biochemically and Amino-Terminal Oriented Mass Spectrometry of Substrates (ATOMS) was used to define the HtrA1 cleavage sites.

RESULTS

We identified 10,155 unique internal peptides from 2,162 proteins, suggesting at least 10,797 cleavage sites in OA cartilage. 7,635 internal peptides originated in 371 extracellular matrix/secreted components, many undergoing extensive proteolysis. Rampant ragging of protein termini suggested pervasive exopeptidase activity. HtrA1, the most abundant protease in OA cartilage, experimentally generated 323 cleavages in 109 cartilage proteins, accounting for 171 observed cleavages in the OA degradome. ATOMS identified HtrA1 cleavage sites in a selected substrate, biglycan, whose direct cleavage by HtrA1 was thus orthogonally validated.

CONCLUSIONS

OA cartilage demonstrates widespread proteolysis by endo- and exopeptidases. HtrA1 contributes broadly to cartilage proteolysis. Forward degradomics of OA cartilage together with reverse degradomics of proteases active in OA, e.g., HtrA1, can potentially fully annotate OA proteolytic pathways and provide new biomarkers.

Phase II trial of liposomal doxorubicin (Doxil) in advanced soft tissue sarcomas

PURPOSE

To assess the objective response rate, toxicity experienced, progression-free survival, and overall survival of patients with previously untreated advanced soft tissue sarcomas treated with a liposomal doxorubicin formulation (Doxil).

METHODS

Patients with metastatic or recurrent soft tissue sarcoma who had received no prior chemotherapy for advanced disease were treated with liposomal doxorubicin (Doxil) according to a two stage accrual design. Doxil was administered at 50 mg/m2 every 4 weeks. A total of 15 patients were treated and are evaluable for response and toxicity.

RESULTS

The male/female ratio was 7/8, the median age was 60 years (34-75) and the ECOG performance status was 0-1 in >90% of patients. Leiomyosarcoma (7/15) and malignant fibrous histiocytoma (2/15) were the most common histologic diagnoses. No objective responses were observed in the 15 evaluable patients. No lethal toxicity occurred. Grade 3-4 leukopenia or neutropenia were reported in 3/15 (20%) patients. Grade 3 mucositis or hand-foot syndrome occurred in 2/15 (13%) and 1/15 (7%) patients respectively and seemed more severe in older patients. The median time to progression was 1.9 months (range 0.9-6.2). Twelve patients have now died. The Kaplan-Meier estimate of median overall survival is 12.3 months. As called for in the study design, accrual was terminated because no responses were obtained in the first 15 patients.

CONCLUSION

Though well-tolerated, Doxil given according to this dose and schedule to patients with advanced soft tissue sarcoma had no significant therapeutic activity. A correlation between older age and skin/mucosal toxicity of Doxil is suggested in this study but needs confirmation. Future investigations of Doxil in soft tissue sarcomas should use a different schedule and dose.

Bone transport using intramedullary fixation and a single flexible traction cable

The transfixing wires used in the limb-lengthening and bone-transport procedures described by Ilizarov are the primary source of complications, including infection, restricted joint motion, and pain. In an attempt to eliminate the need for external fixation, a traction cable device was devised to perform a 3-cm bone transport in the canine femur using an interlocking intramedullary rod for fixation. Twelve dogs were divided into 2 groups. Transport began 7 days after osteotomy and continued at either 1 mm per day (n = 6) or 2 mm per day (n = 6). The in vivo peak force, resting force, and stiffness of the transport segment increased throughout distraction to a mean of 150 Newtons, 58 N, and 58 N per millimeter, respectively, at the time of docking. The regenerate and docking sites united in 10 of 12 dogs. Failure of the regenerate associated with deep infection around the rod occurred in 2 animals (17%). Modifications of this technique to reduce the risk of infection are discussed. This study confirms that intramedullary fixation is compatible with distraction osteogenesis and shows that a single traction cable can provide the force necessary for bone transport without transfixing wires in this setting.

Three-dimensional MR imaging of the knee using surface coils

The selective three-dimensional magnetic resonance imaging acquisition method is used to obtain thin (0.8 mm), contiguous slices of the knee. When combined with the improved signal-to-noise ratio of surface coils, this method produces excellent anatomical definition of the knee. Two fresh cadaver specimens were imaged and dissected. Normal anatomy was defined on three normal volunteers. Four patients with knee injuries were imaged. This method may be useful in the routine imaging of patients with certain traumatic knee injuries.

MR imaging of iliopsoas bursitis and concurrent avascular necrosis of the femoral head

The magnetic resonance (MR) features of iliopsoas bursitis secondary to an inflammatory arthropathy of the hip are described in a patient with concurrent avascular necrosis of the femoral heads. The MR findings of avascular necrosis were demonstrated on one side where radiography, bone scan, and CT were negative.

Morphogenesis of the mitochondrial alterations in muscle diseases

In this paper we present sequential morphologic changes produced in rat muscle mitochondria. Respiratory toxins such as crotoxin (rattle-snake venom) and 2,4-dinitrophenol (DNP-an uncoupler of oxidative phosphorylation) were injected in rat quadriceps muscle and the mitochondrial alterations were studied at various time intervals. The series of mitochondrial changes consisted of rounding and swelling of mitochondria, unfolding of the cristae as straight lines, formation of the concentric rings, appearance of paracrystalline inclusions, formation of multiple vesicles and finally vacuole formation. These changes were comparable to the range of mitochondrial alterations seen in the human material examined. Similarity of the time-related mitochondrial changes in the rat to the spectrum of changes observed in human muscle biopsies suggests that the mitochondrial alteration in the human muscle disorders is a stepwise process in which respiratory alterations and calcium ion may play a role.