Expression and proinflammatory role of proteinase‐activated receptor 2 in rheumatoid synovium: Ex vivo studies using a novel proteinase‐activated receptor 2 antagonist

Objective

Serine proteinases activate the G protein–coupled receptor, proteinase‐activated receptor 2 (PAR‐2), via cleavage and exposure of a tethered ligand. PAR‐2 is known to exert proinflammatory actions in a murine model of arthritis, since PAR‐2–deficient mice exhibit strikingly reduced articular inflammation. This study was undertaken to examine synovial PAR‐2 expression and to determine the effect of a novel PAR‐2 antagonist on synovial cytokine production, in order to investigate the hypothesis that PAR‐2 plays a critical role in the pathogenesis of rheumatoid arthritis (RA).

Methods

Using a monoclonal antibody to human PAR‐2, expression in RA synovium and cultured synovial fibroblasts was characterized. The novel PAR‐2 antagonist, ENMD‐1068, was added to primary cultures of RA synovial tissue, from which spontaneous cytokine release was measured.

Results

PAR‐2 was substantially up‐regulated in RA synovium compared with control synovial tissue from patients with osteoarthritis or seronegative inflammatory arthritis, neither of which exhibited significant PAR‐2 expression. Importantly, spontaneous release of tumor necrosis factor α and interleukin‐1β from RA synovium was substantially inhibited by ENMD‐1068, in a dose‐dependent manner.

Conclusion

These findings identify PAR‐2 as a novel upstream regulator of proinflammatory cytokine production in RA and indicate its potential as a novel therapeutic target in inflammatory arthritis.

     

Divergent Effects of Endogenous and Exogenous Glucocorticoid‐Induced Leucine Zipper in Animal Models of Inflammation and Arthritis

Objective

Glucocorticoid‐induced leucine zipper (GILZ) has effects on inflammatory pathways that suggest it to be a key inhibitory regulator of the immune system, and its expression is exquisitely sensitive to induction by glucocorticoids. We undertook this study to test our hypothesis that GILZ deficiency would exacerbate experimental immune‐mediated inflammation and impair the effects of glucocorticoids on inflammation and, correspondingly, that exogenous GILZ would inhibit these events.

Methods

GILZ^−/− mice were generated using the Cre/loxP system, and responses were studied in delayed‐type hypersensitivity (DTH), antigen‐induced arthritis (AIA), K/BxN serum–transfer arthritis, and lipopolysaccharide (LPS)–induced cytokinemia. Therapeutic expression of GILZ via administration of recombinant adeno‐associated virus expressing the GILZ gene (GILZ‐rAAV) was compared to the effects of glucocorticoid in collagen‐induced arthritis (CIA).

Results

Increased T cell proliferation and DTH were observed in GILZ^−/− mice, but neither AIA nor K/BxN serum–transfer arthritis was affected, and GILZ deficiency did not affect LPS‐induced cytokinemia. Deletion of GILZ did not impair the effects of exogenous glucocorticoids on CIA or cytokinemia. In contrast, overexpression of GILZ in joints significantly inhibited CIA, with an effect similar to that of dexamethasone.

Conclusion

Despite effects on T cell activation, GILZ deficiency had no effect on effector pathways of arthritis and was unexpectedly redundant with effects of glucocorticoids. These findings do not support the hypothesis that GILZ is central to the actions of glucocorticoids, but the efficacy of exogenous GILZ in CIA suggests that further evaluation of GILZ in inflammatory disease is required.

     

Protective role of systemic furin in immune response–induced arthritis

Objective

Rheumatoid arthritis (RA) is an autoimmune joint disease associated with chronic inflammation of the synovium that causes profound damage of joints. Inflammation results in part from the influx of immune cells secreting inflammatory cytokines and the reduction in the number of Treg cells. We undertook this study to assess the effect of furin, a proteinase implicated in the proteolytic activity of various precursor proteins and involved in the regulation of both proteinase maturation and immune cells, in an experimental model of RA.

Methods

The effect of furin and its inhibitor α1‐PDX was tested in mice with collagen‐induced arthritis (CIA). Joints were processed for histology and protein expression. Levels of cytokines were measured in joint tissue, and Treg cell numbers were measured in spleens.

Results

Furin expression and activity were high in the synovial pannus in RA patients and mice with CIA. Systemic administration of furin prevented increases in the arthritis score, joint destruction, and bone loss, in contrast to systemic administration of the furin inhibitor α1‐PDX, which enhanced these parameters. By preventing the development of synovial pannus, furin reduced the expression of metalloproteinases in the joints. In contrast, α1‐PDX enhanced synovial proliferation and the expression and activity of matrix metalloproteinases. Furthermore, furin reversed the local Th1/Th2 balance and restored the number of Treg cells in the spleen, indicating mediation by immune cells.

Conclusion

These findings show the protective role of exogenous furin against RA, mediated by an immune response. The data suggest the potential therapeutic use of furin or its derivatives in autoimmune diseases including RA.

     

Inhibition of interleukin‐33 signaling attenuates the severity of experimental arthritis

Objective

Interleukin‐33 (IL‐33; or, IL‐1F11) was recently identified as the ligand of the IL‐1 family receptor T1/ST2. The aim of this study was to examine IL‐33 production in human and mouse joints and to investigate the role of IL‐33 and T1/ST2 in experimental arthritis.

Methods

IL‐33 expression was examined in human synovial tissue, rheumatoid arthritis (RA) synovial fibroblasts, and arthritic mouse joints. Mice with collagen‐induced arthritis (CIA) were treated with blocking anti‐ST2 antibody or control antibody beginning at the onset of disease. Arthritis severity was assessed by clinical and histologic scoring. Draining lymph node (LN) cell responses were examined ex vivo, and joint messenger RNA (mRNA) was used for expression profiling.

Results

IL‐33 was highly expressed in human RA synovium. In cultured synovial fibroblasts, IL‐33 expression was strongly induced by IL‐1β and/or tumor necrosis factor α. Furthermore, IL‐33 mRNA was detected in the joints of mice with CIA and increased during the early phase of the disease. Administration of a blocking anti‐ST2 antibody at the onset of disease attenuated the severity of CIA and reduced joint destruction. Anti‐ST2 antibody treatment was associated with a marked decrease in interferon‐γ production as well as with a more limited reduction in IL‐17 production by ex vivo–stimulated draining LN cells. Finally, RANKL mRNA levels in the joint were reduced by anti‐ST2 treatment.

Conclusion

IL‐33 is produced locally in inflamed joints, and neutralization of IL‐33 signaling has a therapeutic effect on the course of arthritis. These observations suggest that locally produced IL‐33 may contribute to the pathogenesis of joint inflammation and destruction.

     

Function of interleukin‐20 as a proinflammatory molecule in rheumatoid and experimental arthritis

Objective

The pathogenesis of rheumatoid arthritis (RA) reflects an ongoing imbalance between proinflammatory and antiinflammatory cytokines. Interleukin‐20 (IL‐20) has proinflammatory properties for keratinocytes. In this study, we sought to determine whether IL‐20 is involved in RA.

Methods

We analyzed IL‐20 levels in synovial fluid from RA patients. IL‐20 and its receptors were detected in RA synovial fibroblasts (RASFs), using immunohistochemical staining. The effect of IL‐20 on endothelial cells, neutrophils, and RASFs was investigated using MTT and migration assays. The expression of IL‐20 and its receptors in healthy rats and in rats with collagen‐induced arthritis (CIA) was also analyzed. Soluble IL‐20 receptor type I (sIL‐20RI) or sIL‐20RII was administered to rats with CIA by intramuscular electroporation, and the severity of arthritis was monitored.

Results

RA patients expressed significantly higher levels of synovial fluid IL‐20 than did the rheumatic disease controls. IL‐20 and its receptors were expressed in the synovial membranes and RASFs. IL‐20 induced RASFs to secrete monocyte chemoattractant protein 1, IL‐6, and IL‐8, and it promoted neutrophil chemotaxis, RASF migration, and endothelial cell proliferation. Both IL‐20 and IL‐20RI were up‐regulated in the rat CIA model. In vivo, electroporated sIL‐20RI plasmid DNA decreased the severity of arthritis in the rats with CIA.

Conclusion

IL‐20 was up‐regulated in the synovial fluid of RA patients and acted as a chemokine that attracted the migration of neutrophils and RASFs in vitro. The rat CIA model demonstrated that IL‐20 was involved in the pathogenesis of arthritis, because sIL‐20RI significantly reduced arthritis in rats with CIA. Thus, IL‐20 may modulate the incidence and severity of arthritis and play important roles at local sites of inflammation.

     

The programmed death 1/programmed death ligand 1 inhibitory pathway is up‐regulated in rheumatoid synovium and regulates peripheral T cell responses in human and murine arthritis

Objective

T cells play a major role in the pathogenesis of rheumatoid arthritis (RA). The programmed death 1 (PD‐1)/programmed death ligand 1 (PDL‐1) pathway is involved in peripheral tolerance through inhibition of T cells at the level of synovial tissue. The aim of this study was to examine the role of PD‐1/PDL‐1 in the regulation of human and murine RA.

Methods

In synovial tissue and synovial fluid (SF) mononuclear cells from patients with RA, expression of PD‐1/PDL‐1 was examined by immunohistochemistry and flow cytometry, while PD‐1 function was assessed in RA peripheral blood (PB) T cells after stimulation of the cells with anti‐CD3 and PDL‐1.Fc to crosslink PD‐1. Collagen‐induced arthritis (CIA) was induced in PD‐1^−/− C57BL/6 mice, and recombinant PDL‐1.Fc was injected intraperitoneally to activate PD‐1 in vivo.

Results

RA synovium and RA SF were enriched with PD‐1+ T cells (mean ± SEM 24 ± 5% versus 4 ± 1% in osteoarthritis samples; P = 0.003) and enriched with PDL‐1+ monocyte/macrophages. PD‐1 crosslinking inhibited both T cell proliferation and production of interferon‐γ (IFNγ) in RA patients; PB T cells incubated with RA SF, as well as SF T cells from patients with active RA, exhibited reduced PD‐1–mediated inhibition of T cell proliferation at suboptimal, but not optimal, concentrations of PDL‐1.Fc. PD‐1^−/− mice demonstrated increased incidence of CIA (73% versus 36% in wild‐type mice; P < 0.05) and greater severity of CIA (mean maximum arthritis score 5.0 versus 2.3 in wild‐type mice; P = 0.040), and this was associated with enhanced T cell proliferation and increased production of cytokines (IFNγ and interleukin‐17) in response to type II collagen. PDL‐1.Fc treatment ameliorated the severity of CIA and reduced T cell responses.

Conclusion

The negative costimulatory PD‐1/PDL‐1 pathway regulates peripheral T cell responses in both human and murine RA. PD‐1/PDL‐1 in rheumatoid synovium may represent an additional target for immunomodulatory therapy in RA.

     

Interleukin‐17–positive mast cells contribute to synovial inflammation in spondylarthritis

Objective

Studies comparing spondylarthritis (SpA) to rheumatoid arthritis (RA) synovitis suggest that innate immune cells may play a predominant role in the pathogenesis of SpA. Recent observations have indicated a marked synovial mast cell infiltration in psoriatic SpA. We therefore undertook the present study to investigate the potential contribution of mast cells to synovial inflammation in SpA.

Methods

Synovial tissue and fluid were obtained from patients with either nonpsoriatic or psoriatic SpA (n = 82) and patients with RA (n = 50). Synovial biopsy tissue was analyzed by immunostaining and used in ex vivo cultures. Synovial fluid was analyzed by enzyme‐linked immunosorbent assay.

Results

We observed a strong and specific increase of c‐Kit–positive mast cells in the synovium from patients with SpA compared to the synovium from patients with RA synovitis, which was independent of disease subtype (nonpsoriatic versus psoriatic), disease duration, and treatment. Staining of mast cell granules, analysis of synovial fluid, and results in ex vivo tissue culture did not indicate increased degranulation in SpA synovitis. However, mast cells expressed significantly more interleukin‐17 (IL‐17) in SpA than in RA synovitis, and mast cells constituted the major IL‐17–expressing cell population in the SpA synovium. Ex vivo targeting of synovial mast cells with the c‐Kit inhibitor imatinib mesylate significantly decreased the production of IL‐17 as well as other proinflammatory cytokines in synovial tissue cultures. Analysis of paired pre‐ and posttreatment synovial tissue samples indicated that the mast cell/IL‐17 axis in SpA was not modulated by effective tumor necrosis factor (TNF) blockade.

Conclusion

The specific and TNF‐independent increase in IL‐17–expressing mast cells may contribute to the progression of synovial inflammation in peripheral SpA.

     

Macrophage subpopulations in rheumatoid synovium: Reduced CD163 expression in CD4+ T lymphocyte–rich microenvironments

Objective

The cell surface glycoprotein CD163 is a member of the cysteine‐rich scavenger receptor family, highly specific for leukocytes of the mononuclear phagocyte lineage. In vitro, it is induced by glucocorticoids, interleukin‐6 (IL‐6), and IL‐10 and down‐regulated by interferon‐γ (IFNγ), indicating that it has a role in antiinflammatory or other immunomodulatory pathways. We assessed CD163 expression in microenvironments within rheumatoid arthritis (RA) synovium to clarify the relationships among CD4+ T lymphocytes, IFNγ, and macrophage function in RA.

Methods

Double immunofluorescence and serial immunoenzymatic studies were performed on normal, osteoarthritic, and RA synovium and tonsil with antibodies to CD163, CD45, CD68, CD14, CD3, CD4, CD8, CD19, and IFNγ.

Results

CD163 was observed on all CD14+ cells in synovium and tonsil with the exception of cells within larger T lymphocyte clusters in synovium and within tonsillar follicles. All brightly CD14+ cells in or around vessel walls (interpreted as immigrant monocytes) were CD163+. CD163 labeled fewer cells than did CD68 in synovial intima, but all CD45+ intimal cells were CD163+. CD4+,IFNγ+ T lymphocytes in RA synovium were chiefly localized within clusters containing CD68+, CD163− cells.

Conclusion

Within RA synovium, CD163 has major advantages as a macrophage marker and does not appear to be restricted to “mature” macrophages. CD163 discriminates between synovial macrophages and synovial intimal fibroblasts, which also stain positively for CD68 in diseased tissue.

     

Expression of hypoxia‐inducible factor 1α by macrophages in the rheumatoid synovium: Implications for targeting of therapeutic genes to the inflamed joint

Objective

To determine if the rheumatoid synovium is a suitable target for hypoxia‐regulated gene therapy.

Methods

Sequential sections of wax‐embedded synovial membrane samples were obtained from 10 patients with rheumatoid arthritis (RA), 10 with primary osteoarthritis (OA), and from 6 healthy controls. Membrane sections from each patient were immunostained for hypoxia‐inducible factor 1α (HIF‐1α) and CD68 (a pan–macrophage marker).

Results

HIF‐1α was expressed abundantly by macrophages in most rheumatoid synovia, predominantly close to the intimal layer but also in the subintimal zone. There was markedly lower expression of HIF‐1α in OA synovia, and it was absent from all of the healthy synovia.

Conclusion

These observations indicate that macrophages transduced with a therapeutic gene under the control of a hypoxia‐inducible promoter could be administered to RA patients systemically. Migration of these cells to synovial tissue would result in the transgene being switched on in diseased joints but not in healthy tissues.

     

Fluoxetine and citalopram exhibit potent antiinflammatory activity in human and murine models of rheumatoid arthritis and inhibit toll‐like receptors

Objective

Selective serotonin reuptake inhibitors (SSRIs), in addition to their antidepressant effects, have been reported to have antiinflammatory effects. The aim of this study was to assess the antiarthritic potential of 2 SSRIs, fluoxetine and citalopram, in murine collagen‐induced arthritis (CIA) and in a human ex vivo disease model of rheumatoid arthritis (RA).

Methods

Following therapeutic administration of SSRIs, paw swelling was assessed and clinical scores were determined daily in DBA/1 mice with CIA. Joint architecture was examined histologically at the end of the treatment period. Cultures of human RA synovial membranes were treated with SSRIs, and cytokine production was measured. Toll‐like receptor (TLR) function was examined in murine and human macrophages, human B cells, and human fibroblast‐like synovial cells treated with SSRIs.

Results

Both SSRIs significantly inhibited disease progression in mice with CIA, with fluoxetine showing the greatest degree of efficacy at the clinical and histologic levels. In addition, both drugs significantly inhibited the spontaneous production of tumor necrosis factor, interleukin‐6, and interferon‐γ–inducible protein 10 in human RA synovial membrane cultures. Fluoxetine and citalopram treatment also inhibited the signaling of TLRs 3, 7, 8, and 9, providing a potential mechanism for their antiinflammatory action.

Conclusion

Fluoxetine and citalopram treatment selectively inhibit endosomal TLR signaling, ameliorate disease in CIA, and suppress inflammatory cytokine production in human RA tissue. These data highlight the antiarthritic potential of the SSRI drug family and provide further evidence of the involvement of TLRs in the pathogenesis of RA. The SSRIs may provide a template for potential antiarthritic drug development.

     

Membrane complement regulators protect against the development of type II collagen–induced arthritis in rats

Objective

To investigate changes in the distribution patterns of membrane complement regulators (MCRs) during the development of type II collagen–induced arthritis (CIA) and to examine the protective effects of these molecules against the augmentation of CIA in the knee joint.

Methods

Immunohistochemistry was used to examine the distribution of the MCRs Crry, DAF, and CD59 in the synovium of knee joints before and 2, 4, and 10 weeks after induction of CIA by immunization with type II collagen. In addition, at 2 or 10 weeks after induction of CIA, rats were injected intraarticularly with anti‐Crry and/or anti‐CD59 as the F(ab′)₂ fraction of monoclonal antibodies (mAb). Knee joint swelling and histologic changes in the synovium were examined 2 weeks after mAb injection.

Results

Synovial expression of Crry, DAF, and CD59 decreased in parallel with increased inflammation. When Crry and CD59 were functionally blocked at 2 weeks after the induction of CIA, swelling of the knee joints was markedly increased. Blocking of either regulator alone had no effect on swelling. Thickening of the synovial surface and proliferation of subsynovial tissue were all increased after blocking Crry and CD59, whereas blocking of either MCR alone had no effect. When both Crry and CD59 were blocked, deposits of membrane attack complex were found in the synovium.

Conclusion

Our findings indicate that in rats with CIA and severely inflamed synovium, local expression of MCR is reduced. The MCRs Crry and CD59 appear to suppress the development of CIA.

     

Laser‐mediated microdissection facilitates analysis of area‐specific gene expression in rheumatoid synovium

Objective

Current approaches to analyzing gene expression in rheumatoid arthritis (RA) synovium are based on RNA isolated either from cultured synovial cells or from synovial biopsy specimens. This strategy does not, in general, allow distinction of specific gene expression between cells originating from different synovial areas, due to potential mixture of expression profiles. Therefore, we established the combination of laser‐mediated microdissection (LMM) and differential display to analyze profiles of gene expression in histologically defined areas of rheumatoid synovium. The present study was undertaken to establish parameters for this technique and assess its usefulness for gene expression analysis.

Methods

Cryosections derived from RA synovial tissues were used to obtain cell samples from synovial lining versus sublining, using a microbeam laser microscope. RNA was isolated and analyzed by nested RNA arbitrarily primed–polymerase chain reaction (RAP‐PCR) for differential display fingerprinting. Differentially expressed bands were cut out, and PCR products were eluted, cloned, and sequenced. Differential expression of identified sequences was confirmed by in situ hybridization and immunohistochemistry analysis.

Results

Microdissected sections of RA synovial tissue containing ∼600 cells yielded enough RNA to produce a reproducible RNA fingerprint pattern. Several genes could be identified as being expressed differentially between the synovial lining and the sublining, and their expression could be confirmed at the messenger RNA and protein levels.

Conclusion

The combination of LMM and RAP‐PCR presents a valuable tool to obtain novel insights into the area‐dependent differential regulation of gene expression in RA synovium. Both known and previously unknown genes were revealed with this technique. This study is the first to demonstrate the potential of this analytic strategy in the investigation of a nonmalignant, multifactorial, inflammatory disease.

     

Synovial intracellular citrullinated proteins colocalizing with peptidyl arginine deiminase as pathophysiologically relevant antigenic determinants of rheumatoid arthritis–specific humoral autoimmunity

Objective

To address the ongoing debate concerning the specificity of synovial citrullinated proteins for rheumatoid arthritis (RA) and to analyze their pathophysiologic relevance to the induction or perpetuation of the RA‐specific anti–citrullinated protein antibodies (ACPAs).

Methods

Synovium of 19 RA patients and 19 non‐RA controls was immunostained for the presence of citrullinated proteins with a mouse monoclonal antibody (F95), for the citrullinating enzyme peptidyl arginine deiminase type 2 (PAD‐2), and for the free citrulline–producing enzyme inducible nitric oxide synthase (iNOS). Extending the RA cohort to 61 patients, the findings of anticitrulline staining in synovium were related to serum and synovial fluid ACPA levels, as measured by enzyme‐linked immunosorbent assay.

Results

F95 staining indicated the presence of synovial intracellular citrullinated proteins in 53% of RA samples versus 5% of control samples, whereas extracellular staining was not RA specific. Immunoblotting and inhibition experiments confirmed that the antibody recognized citrullinated proteins but not free citrulline. Accordingly, iNOS was equally found in RA and control synovium and in intracellular citrullinated protein–positive and intracellular citrullinated protein–negative samples. In contrast, intracellular citrullinated proteins colocalized with PAD‐2, which was found in 59% of RA samples versus 17% of control samples. Independent of local disease activity, the presence of the RA‐specific synovial intracellular citrullinated proteins was associated with significantly higher systemic and local ACPA levels and with local ACPA production in the joint.

Conclusion

These data confirm the presence of RA‐specific intracellular citrullinated proteins in synovium. The link with PAD‐2 and local and systemic ACPA levels emphasizes their pathophysiologic relevance for RA‐specific humoral autoimmunity.