Lumican is upregulated in osteoarthritis and contributes to TLR4-induced pro-inflammatory activation of cartilage degradation and macrophage polarization

OBJECTIVE

Lumican (LUM) is a major extracellular matrix glycoprotein in adult articular cartilage and its expression is known to be upregulated upon cartilage degeneration. LUM is associated with the pathogen-associated molecular pattern (PAMP) activation of the TLR4 signalling cascade, with TLR4 being highly associated with inflammation in rheumatic diseases. However, the main role of the LUM structural molecule in osteoarthritis (OA) remains elusive. The aim of this study was, therefore, to understand the role of LUM during TLR4-mediated activation in OA.

METHODS

After measuring LUM levels in synovial fluid (SF) of OA patients and lipopolysaccharide (LPS)-induced TLR4 activation, the role of LUM in the expression of pro-inflammatory molecules and cartilage degradation was assessed in vitro and ex vivo in a cartilage explant model. Primary macrophage activation and polarization were studied upon LUM co-stimulation with LPS.

RESULTS

We demonstrate that LUM is not only significantly upregulated in SF from OA patients compared to healthy controls, but also that LUM increases lipopolysaccharide (LPS)-induced TLR4 activation. Furthermore, we show that a pathophysiological level of LUM augments the LPS-induced TLR4 activation and expression of downstream pro-inflammatory molecules, resulting in extensive cartilage degradation. LUM co-stimulation with LPS also provided a pro-inflammatory stimulus, upregulating primary macrophage activation and polarization towards the M1-like phenotype.

CONCLUSIONS

These findings strongly support the role of LUM as a mediator of PAMP-induced TLR4 activation of inflammation, cartilage degradation, and macrophage polarization in the OA joint and potentially other rheumatic diseases.

Comparison of pregnancy outcomes in different localizations of uterine fibroids

OBJECTIVE

The basic aim of this study is to compare the pregnancy outcomes in cases with uterine fibroids located at the anterior and posterior uterine walls.

MATERIALS AND METHODS

A total of 84 pregnant women with a diagnosis of uterine myoma larger than 30 millimeter (mm) in diameter were included in the study to determine the obstetric outcomes. In 64 (76.20%) patients, myomas were detected at the anterior uterine wall (group 1), while 20 (23.80%) were detected at the posterior uterine wall (group 2). All patients were followed monthly until the end of pregnancy. Demographic and obstetric characteristics were compared between the two groups.

RESULTS

There were no significant differences in age, gravida, parity, and myoma size between the two groups. A significant difference existed between the groups with regard to pelvic pain. Posterior located fibroids were associated with more pelvic pain (p = 0.001). No difference was observed between the two groups with regard to the rates of preterm delivery, bleeding in early pregnancy, infants with small for gestational age, and hospitalization period during pregnancy. Women with posterior located myomas had significantly higher miscarriage rates.

CONCLUSION

Our findings suggest that pregnancies with uterine fibroids are at increased risk for complications. Posterior located fibroids larger than 30 mm in diameter are associated with severe pelvic pain compared to anterior located fibroids.

Predictive value of urinary interleukin-8 cutoff point for recurrences after transurethral resection plus induction bacillus Calmette-Guérin treatment in non-muscle-invasive bladder tumors

BACKGROUND

This study was designed to investigate whether there is a correlation between interleukin (IL)-8 secretion rate and recurrences in induction bacillus Calmette-Guérin (BCG) immunotherapy following transurethral resection (TUR) in cases of primary non-muscle-invasive bladder cancer (NMIBC).

PATIENTS AND METHODS

A total of 41 patients with NMIBC were randomized to receive a 6-week course with a standard dose of 81 mg intravesical BCG. Voided urine samples were collected immediately before and after (at 2 and 4 hours) BCG instillation. IL-8 was measured using enzyme-linked immunosorbent assay. Patients were monitored according to European Association of Urology Guidelines.

RESULTS

Patients were monitored for a mean duration of 21.0 +/- 13.86 months. The mean time to recurrence for the 15 patients who had recurrences was 11.2 months. After adjusting for risk factors, the change in IL-8 levels at 2 hours after the first BCG compared with the levels before BCG instillation was found to be significantly predictive of recurrence (P = .047), and the best cutoff point was estimated as 112 pg/mL. The sensitivity of this measure for prediction of recurrences was 53.3%, specificity was 88.5%, positive predictive value was 72.7%, and negative predictive value was 76.7%. Comparison of patients who had values below and above this cutoff point revealed that the recurrence-free survival rate was 76.7% versus 27.3%, and the expected recurrence-free survival time was 34.9 months versus 18.8 months (P = .006).

CONCLUSION

Besides numerous other prognostic factors that have been suggested so far, a cutoff point of 112 pg/mL for IL-8 levels measured 2 hours after the first BCG instillation appears to be a good predictive factor for successful outcome in BCG treatment following TUR.