Relapsing polychondritis presenting as cutaneous polyarteritis nodosa

Summary Relapsing polychondritis is an infrequently diagnosed, though not neccessarily uncommon, systemic disorder characterized by recurrent and potentially destructive inflammation of cartilaginous structures, the eye, and the audiovestibular and cardiovascular systems. Although dermal involvement occurs in approximately 25% of patients with relapsing polychondritis, in only few cases has a skin biopsy been obtained revealing lesions such as leukocytoclastic vasculitis, livedo reticularis, erythema nodosum or keratodermia blenorrhagicum. We describe a patient with relapsing polychondritis in whom a cutaneous polyarteritis nodosa preceded cartilage inflammation by 6 months. Cutaneous polyarteritis nodosa is a rare form of vasculitis that appears to be limited primarily to the skin, muscles, and joints. In contrast to the systemic form of the disease it is characterized by the absence of visceral lesions and a relapsing but benign course. The present case and the fact that vasculitis is a concomitant feature in approximately 30% of patients with relapsing polychondritis [21] demonstrates that this condition may not represent a distinct clinical entity.Abbreviations CPN cutaneous polyarteritis nodosa - RP relapsing polychondritis Dedicated to Prof. Dr. N. Zöllner on the occasion of his 70th birthday     

Light and electron microscopic study of ear cartilage in a case of relapsing polychondritis evolving under corticoid treatment

Summary Light and electron microscope studies of the ear cartilage in a patient with relapsing polychondritis (RP) under corticoid treatment are reported. Unilateral auricular deformation evolved without inflammatory episodes and the lesions consisted mainly of marginal erosions filled with fine collagen fibrils and containing degenerating perichondrial cells in their basal parts. Degenerative cells were scattered throughout the perichondrium, but cartilage erosions only occured when numerous cells were affected in a same area. Cartilage outside the eroded zones did not seem to be modified. Cartilage lesions thus appear to be a result of a chondrocyte renewal defect leading to loss of proteoglycans and elastic fibers, with only collagen remaining. These data suggest that inflammation is probably not the initial pathogenic process responsible for cartilage injury in RP, but that a metabolic defect in perichondrial cells might be involved.This work was carried out with a grant from the INSERM, CRL No 79. 1 218 4     

Relapsing polychondritis

Summary In a case of relapsing polychondritis, ultrastructural study of ear cartilage using tannic acid staining showed patterns of degradation of elastic and collagen fibres. The participation of macrophages and chondrocytes in the resorption of ear cartilage is discussed.     

Vaccination with collagen‐pulsed dendritic cells prevents the onset and reduces the disease severity in the mouse model of spontaneous polychondritis

Immature dendritic cells (iDCs) have a tolerogenic potential due to low expression of important co‐stimulatory cell surface molecules required for antigen presentation and induction of an effective immune response. We report here that injection of iDCs pulsed with chick type II collagen (CII) delayed the onset significantly and suppressed the severity of spontaneous polychondritis (SP) in the human leucocyte antigen (HLA)‐DQ6αβ8αβ transgenic mouse model. Bone marrow‐derived iDCs were pulsed in vitro with CII and transferred into 6‐week‐old HLA‐DQ6αβ8αβ transgenic mice. Mice receiving CII‐pulsed iDCs did not display any clinical signs of disease until 5·5 months of age, indicating the ability of the DC vaccine to delay significantly the onset of SP. Control groups receiving unpulsed iDCs or phosphate‐buffered saline (PBS) developed polyarthritis at 3·5 months, as we have reported previously. The severity and incidence of disease was reduced in mice injected with CII‐pulsed iDCs. Proinflammatory cytokines were in low to undetectable levels in the serum and tissue in the CII‐pulsed iDC mice, correlating with the protection. This is the first evidence of iDC therapy controlling SP and suggests that iDC vaccination may provide a tool to reducing clinical manifestations in human inflammatory autoimmune disease such as relapsing polychondritis and rheumatoid arthritis.     

口服耐受预防大鼠复发性类风湿性关节炎的研究

目的建立实验性类风湿性关节炎(RA)的动物模型,研究口服可溶性鸡II型胶原(CCII)诱导免疫耐受对大鼠复发性RA的预防作用.方法以CCII和完全弗氏佐剂免疫Wistar大鼠,建立RA大鼠模型.在大鼠致炎前和反复造病后,口服CCII,观察其对RA复发的预防作用.并以ELISA法对大鼠血清中的抗CCII抗体进行检测.结果在Wistar大鼠成功地诱发了RA,发病率为90%.大鼠在致炎前口服CCII可明显延迟RA的发病时间并降低RA的发病率,且大鼠RA的临床症状也明显减轻.而耐受大鼠由CCII引起的迟发性超敏反应(DTH)明显受到抑制.ELISA检测结果显示口服可溶性CCII对大鼠体内抗CCII抗体的产生有一定的抑制作用.结论口服CCII可诱导特异性免疫耐受,从而对大鼠RA的发生有着明显的预防作用.     

Type II collagen distribution during cranial development in Xenopus laevis

Epithelially expressed type II collagen is thought to play a prominent role in the embryonic patterning and differentiation of the vertebrate skull, primarily on the basis of data derived from amniotes. We describe the spatiotemporal distribution of type II collagen in the embryonic head of the African clawed frog, Xenopus laevis, using whole-mount and serial-section immunohistochemical analysis. We studied embryos spanning Nieuwkoop and Faber (1967) stages 21–39, a period including cranial neural crest cell migration and ending immediately before the onset of neurocranial chondrogenesis. Xenopus displays a transient expression of type II collagen beginning at least as early as stage 21; staining is most intense and widespread at stages 33/34 and 35/36 and subsequently diminishes. Collagen-positive areas include the ventrolateral surface of the brain, sensory vesicles, notochord, oropharynx, and integument. This expression pattern is similar, but not identical, to that reported for the mouse and two bird species (Japanese quail, domestic fowl); thus epithelially expressed type II collagen appears to be a phylogenetically widespread feature of vertebrate cranial development. Consistent with the proposed role of type II collagen in mediating neurocranial differentiation, most collagen-positive areas lie adjacent to subsequent sites of chondrogenesis in the neurocranium but not the visceral skeleton. However, much of the collagen is expressed after the migration of cranial neural crest, including presumptive chondrogenic crest, seemingly too late to pattern the neurocranium by entrapment of these migrating cells.     

高纯度猪软骨II型胶原的制备与检测

探讨以猪透明软骨为原材料制备高纯度II型胶原的方法,为批量化生产提供依据.以猪透明软骨为原料,采用盐酸胍抽提蛋白多糖,酸性条件下酶解,中间过程经多步纯化去除杂胶原、降解及变性产物,最后经Sepharose H.P.阴离子柱层析纯化制备出产品并以Sigma公司产品作对照.SDS-PAGE电泳、氨基酸成份分析和紫外最大吸收光谱的结果表明,所提取的II型胶原性质符合文献报导,纯度比Sigma公司的产品高.所提取的II型胶原为高纯度的II型胶原,由于采用肉用猪作原料,来源丰富,成本低,适合批量化的产品开发.     

Immunoregulatory defects of V alpha 24V+ beta 11+ NKT cells in development of Wegener's granulomatosis and relapsing polychondritis

The frequency of either CD4(-)8(-) (double negative; DN) or CD4(+) V alpha 24(+)V beta 11(+) NKT cells, the expression of CD1d and the binding of CD1d-tetramer loaded with alpha-galactosylceramide (alpha-GalCer) to NKT cells were analysed in peripheral blood mononuclear cells (PBMCs) of patients with Wegener's granulomatosis (WG), relapsing polychondritis (RP) and healthy subjects (HS). DN and CD4(+) V alpha 24(+)V beta 11(+) NKT cells as well as CD1d-alpha-GalCer tetramer-positive NKT cells, were significantly decreased in number in both WG and RP patients compared to those from HS. When cytokine profiles were analysed in these PBMCs upon stimulation with phorbol ester and calcium ionophore, CD4(+) T cells from patients with WG and RP exhibited a Th1 bias, whereas CD4(+) NKT cells from WG patients in remission showed a Th2 bias. These findings suggest that NKT cells (especially CD4(+) NKT cells) play a regulatory role in Th1 autoimmunity in patients with WG and RP. The reduction in NKT cell counts appears to be associated with the low responsiveness to alpha-GalCer. The dysfunction of NKT cells to recognize ligands such as alpha-GalCer may also contribute to the defects observed in NKT cells from WG and RP patients.     

检测体内异种II型胶原异体移植引起的细胞毒反应

检测用猪II型胶原免疫新西兰大白兔的异种异体细胞免疫反应。用II型胶原免疫新西兰大白兔60 d,定期抽取血浆检测抗II型胶原抗体;第60 d取兔的外周血淋巴细胞、兔脾细胞、淋巴结分别分离淋巴细胞,进行体外二次II型胶原刺激,检测由此引起的反应性的细胞增殖规律。实验分为二组,第一组加入不同浓度植物血凝素(PHA)作阳性对照,并测定非特异性免疫;第二组加入不同浓度II型胶原,检测特异性免疫。正常兔的淋巴细胞在PHA剌激下发生增殖,但对II型胶原的第一次剌激不发生增殖,而免疫兔对PHA和II型胶原的剌激均能发生显著的增殖。表明异种II型胶原在一定浓度下,可以引起免疫兔的抗II型胶原抗体的升高,并可引起兔脾、外周血淋巴细胞增殖,异种II型胶原能在体内引起细胞免疫反应。     

Chondrocyte-seeded collagen matrices implanted in a chondral defect in a canine model

The objective of our study was to evaluate reparative tissues formed in chondral defects in an adult canine model implanted with cultured autologous articular chondrocytes seeded in type I and II collagen–GAG matrices. Two defects were produced in the trochlea grooves of the knees of 21 dogs, with cartilage removed down to the tidemark. This study includes the evaluation of 36 defects distributed among five treatment groups: Group A, type II collagen matrix seeded with autologous chondrocytes under a sutured type II collagen flap; Group B, type I collagen matrices seeded with chondrocytes under a sutured fascia flap; Group C, unseeded type I collagen matrix implanted under a sutured fascia flap; Group D, fascia lata flap alone; and Group E, untreated defects. All animals were killed 15 weeks after implantation. Six other defects were created at the time of death and evaluated immediately after production as ‘acute defect controls’. In three additional defects, unseeded matrices were sutured to the defect and the knee closed and reopened after 30 min to determine if early displacement of the graft was occurring; these defects served as ‘acute implant controls’. The areal percentages of four tissue types in the chondral zone of the original defect were determined histomorphometrically: fibrous tissue (FT); hyaline cartilage (HC); transitional tissue (TT, including fibrocartilage); and articular cartilage (AC). New tissue formed in the remodeling subchondral bone underlying certain defects was also assessed. Bonding of the repair tissue to the subchondral plate and adjacent cartilage, and degradation of the adjacent tissues were evaluated.

There were no significant differences in the tissues filling the original defect area of the sites treated with chondrocyte-seeded type I and type II matrices. Most of the tissue in the area of the original defect in all of the groups was FT and TT. The areal percentage of HC plus AC was highest in group E, with little such tissue in the cell-seeded groups, and none in groups C and D. The greatest total amount of reparative tissue, however, was found in the cell-seeded type II matrix group. Moreover, examination of the reparative tissue formed in the subchondral region of defects treated with the chondrocyte-seeded collagen matrices (Groups A and B) demonstrated that the majority of the tissue was positive for type II collagen and stained with safranin O. These results indicate an influence of the exogenous chondrocytes on the process of chondrogenesis in this site. In all groups with implants (A–D), 30–50% of the FT and TT was bonded to the adjacent cartilage. Little of this tissue (6–22%) was attached to the subchondral plate, which was only about 50% intact. Remarkable suture damage was found in sections from each group in which sutures were used. Harvest sites showed no regeneration of normal articular cartilage, 18 weeks after the biopsy procedure.

Future studies need to investigate other matrix characteristics, and the effects of cell density and incubation of the seeded sponges prior to implantation on the regenerative response.     

Evidence for polyreactivity seen with monoclonal antibodies produced against type II collagen

Specific type II collagen monoclonal antibodies are needed for the quantification of articular cartilage collagen. In this study we produced and characterized 29 type II collagen monoclonal antibodies. Hybridomas were generated from mice immunized with rat type II collagen, selected for high antibody production against type II collagen using ELISA. Antibodies from selected and cloned hybridoma cells were purified by affinity chromatography and their reactivity tested by ELISA against a panel of antigens including actin, thyroglobulin, and single stranded DNA, all of which have been used to characterize the ‘naturally occurring antibodies’. It was found that many of the anti-type II collagen monoclonal antibodies reacted to more than one antigen. The monospecific antibodies had higher affinity to type II collagen than the antibodies which demonstrated multireactivity. Because of the prevalence of polyreactive anti-type II collagen antibodies, it is advisable to employ highly selective methodologies to isolate high affinity monospecific antibodies to type II collagen.     

Processing and presentation of type II collagen,a fibrillar autoantigen,by H-2q antigen-presenting cells

Native type II collagen (CII) is a high molecular-weight fibrillar molecule which induces a chronic polyarthritis in mice expressing the H-2^q haplotype. The present study was initiated to analyze the processing and the presentation of this nonglobular protein by H-2^q antigen-presenting cells (APC). Efficiency of presentation was assessed by the ability of antigen-pulsed APC to activate collagenspecific CD4⁺ T cell hybridomas. Fixation of APC or the presence of chloroquine completely blocked the reactivity of the T cell hybrids to native, denatured and cyanogen bromide (CB) degraded CII, thus indicating the requirement of intracellular processing for adequate presentation of CII peptides to T cells. In the presence of various processing inhibitors (brefeldin A, leupeptin and Ntosyl-L-phenylalanine chloromethylketone) stimulation of T hybrids by CIIpulsed APC was reduced, pointing to the need of newly synthesized class II molecules, the use of several intracellular compartments and the implication of different proteases in the generation of CII peptides. Peritoneal macrophages and, to a lesser extent, total spleen cells, presented native and denatured CII with higher efficiency than purified splenic dendritic cells, naive or even immune B cells from CII-primed mice. In contrast, these dendritic and B cells were fully competent to present intact ovalbumin to a specific T cell hybrid. The stimulation by dendritic cells and immune B cells was greater when CB peptides of CII were added instead of the native molecule. Similarly, the cleavage of CII was an absolute requirement for its presentation by epidermal cells and B cell lymphomas to the T cell hybridomas. Taken together, these findings emphasize the crucial role of intracellular processing for recognition of soluble CII, similar to most antigens. However, in contrast to ovalbumin, the size and fibrillar nature of the native CII molecule influences its capture by the APC, thus limiting the type of APC able to present this antigen.     

Inhibition of Proteoglycan Biosynthesis Decreases the Calcification of Chondrocyte Cultures

In order to determine the role of proteoglycan in the calcification of cartilage, the effects on calcifying chondrocyte cultures of treatments that disrupt proteoglycan biosynthesis have been studied. Treatment of secondary cultures of embryonic chick chondrocytes with non-toxic concentrations of the β-xyloside p-nitrophenyl β-D-xylopyranoside (PNPX) resulted in dose-dependent inhibition of both proteoglycan and mineral deposition. Based on the expression of Type X collagen, however, PNPX is also a potent inhibitor of chondrocyte differentiation. Under-sulfation of proteoglycans was effected by growth of chondrocyte cultures in sulfate-depleted medium. Growth in low-sulfate medium did not significantly affect the growth or differentiation of these cultures, but caused an approximate two-fold decrease in mineral content compared to cultures grown in normal medium. These findings indicate that disruption of proteoglycan biosynthesis in chondrocyte cultures results in decreased levels of calcification. Therefore, proteoglycans appear to function as promoters of chondrocyte calcification.     

Basement membrane composition of cartilage canals during development and ossification of the epiphysis

Background: Cartilage canals are perichondral invaginations of blood vessels and connective tissue that are found within the epiphyses of most mammalian long bones. Functionally, they provide a means of transport of nutrients to the hyaline cartilage, a mechanism for removal of metabolic wastes, and a conduit for stem cells that are capable of initiating and sustaining ossification of the chondroepiphysis. Morphological and biomolecular changes of the chondroepiphyses appear to potentiate vascular invasion and enable regional formation of secondary centers of ossification within the chondroepiphyses of developing bones. Methods: As both cell migration and vascular invasion are anchorage dependent processes, antibodies to laminin and Type IV collagen were used to assess compositional changes in the basement membrane of cartilage canals accompanying epiphyseal ossification. Results: Differences in chronological appearance, as well as, in distribution between the two components were noted in the chondroepiphysis. Laminin was distributed throughout the connective tissue of cartilage canal at all stages of developement, and not limited to an association with the vascular lumen. Type IV collagen was not Present during the initial perichondral invagination. Although staining for Type IV collagen was later acquired, its distribution was restricted to a discontinuous rimming of the periphery of the canal, and a diffuse presence within the intra-canalicular mesenchyme. Conclusions: Concurrent with chondrocyte hypertrophy and mineralization of the hyaline matrix, rapid changes in both the morphology of the vessel and distribution of the antibodies were detected. In addition to the presence of laminin at the interface of the endothelium and the hyaline matrix, a wide distribution within the connective tissue components of the newly ossifying matrix of epiphyseal bone could be detected. Type IV collagen remained closely associated with the lumens of the intra-canalicular vessels throughout the transition. Following ossification of the secondary center, staining for Type IV collagen could then be detected in the boneforming regions of transforming matrix as well, clearly delineating the individual vessels within the newly formed marrow spaces. This suggests that bone formation is intimately related to vessel staining for collagen type IV, and that acquired vessel competence is a facet of endochondral bone formation that results from provisional matrix changes. Furthermore, the data suggests that during bone formation under tension, basement membrane deposition can be demonstrated without an intermediary hyaline matrix hypertrophic chondrocyte phase. This data was interpreted to suggest that chondrocyte hypertrophy at the growth plate may be a reaction to vascular invasion, that in turn, stimulates adjacent chondrocyte proliferation. © 1995 Wiley-Liss, Inc.     

Culture Duration Modulates Collagen Hydrolysate-Induced Tissue Remodeling in Chondrocyte-Seeded Agarose Hydrogels

Media supplementation with collagen hydrolysate was hypothesized to increase the collagen content in engineered cartilage. By d28, hydrolysate at 0.5 mg/mL increased type II collagen content and 1 mg/mL increased mechanical properties, total collagen content, and type II collagen content over controls. By d42, however, controls possessed the highest GAG content and compressive Young’s modulus. Real-time PCR found that 1 mg/mL increased type II collagen gene expression in d0 constructs, but increased MMP expression with no effect on type II collagen on d28. A 10 mg/mL concentration produced the lowest tissue properties, the lowest type II collagen gene expression on d0, and the highest MMP gene expression on d28. These results indicate that the duration of culture modulates the response of chondrocytes to collagen hydrolysate in 3D culture, transforming the response from positive to negative. Therefore, collagen hydrolysate as a media supplement is not a viable long-term method to improve the collagen content of engineered cartilage tissue.     

Autosomal dominant spondylarthropathy due to a type II procollagen gene(COL2A1) point mutation

Osteoarthrosis represents a very common disease with heterogeneous etiology. In some pedigrees linkage of the condition with the type II collagen gene (COL2A1) has been established, but information on the underlying gene defect is still incomplete as only one mutation causing this phenotype has been identified. We analyzed the COL2A1 gene in a 27-year-old woman and her 47-year-old mother presenting with severe premature osteoarthrosis and X-ray signs compatible with mild spondyloepiphyseal dysplasia. Examination of the complete gene in both patients was done by amplification of all 54 exons, screening of the PCR products by SSCP-analysis, and subsequent sequencing. In mother and daughter a G to A transition at the 5′-end of exon 21 was detected, leading to a substitution of serine for glycine at position 274 of the triple helical domain. The mutation was not present in unaffected family members or in healthy control individuals. The autosomal dominant spondylarthropathies may represent the less severe entities of the clinical spectrum of type II collagenopathies. © 1994 Wiley-Liss, Inc.     

Absence of immunity to type II collagen and proteoglycan in osteoarthritic C57BL mice

We measured immunity to type II collagen and proteoglycans in osteoarthritic C57BL mice to determine whether it is related to osteoarthritis pathogenesis. Histological examination revealed articular cartilage lesions in all mice and synovitis in only a few mice. Immunological responses to type II collagen were found in collagen arthritic mice, but not in C57BL mice. Furthermore, immunological responses to proteoglycans were observed in proteoglycan-immunized mice, but not in C57BL mice. Therefore, articular cartilage degeneration may not result in autoimmunity to type II collagen and proteoglycans in osteoarthritis of C57BL mice, and immune responses to these components may not be a primary etiology of osteoarthritis in this model.