Measurement of terminal complement complexes in rheumatoid arthritis.

Though complement activation is recognized as a central event in inflammation in the rheumatoid joint, little attention has been paid to the role of the cytolytic membrane attack complex of complement in the pathogenesis of this disease. The membrane attack complex causes a variety of non-lethal effects in nucleated cells, including stimulation of release of inflammatory mediators, and cell proliferation. Thus in the rheumatoid synovium, non-lethal effects of complement membrane attack may play a major role in disease pathology. In order to investigate this possibility, assays for the detection of terminal complement complexes in biological fluids have been established, and used to demonstrate membrane attack pathway activation in rheumatoid arthritis. Terminal complement complexes were present in increased levels in synovial fluid (mean, 1,334 ng/ml) and plasma (mean, 513 ng/ml) in 20 patients with rheumatoid arthritis when compared with controls (mean, 285 ng/ml and 129 ng/ml respectively). Using an assay specific for the SC5b-9 complex it was demonstrated that the raised levels of terminal complement complexes in rheumatoid synovial fluid consisted of a mixture of inactive SC5b-9 complexes and fluid-phase complement membrane attack complexes.     

Human rheumatoid synovial cell stimulation by the membrane attack complex and other pore-forming toxins in vitro: the role of calcium in cell activation.

The effects of non-lethal amounts of a variety of pore-forming agents on cultured human rheumatoid synovial cells (HRSC) have been investigated. Non-lethal complement membrane attack and non-lethal amounts of melittin, perforin and ionomycin all caused a biphasic release of prostaglandin E2 (PGE2) from HRSC, an early phase of release occurring within 1 hr and a second larger phase commencing after 4 hr and continuing over the 24-hr time-course. Removal of extracellular calcium abolished the release of PGE2 under all conditions of non-lethal attack. Modulation of G-protein activity reduced the second phase of release caused by non-lethal doses of the membrane-attack complex (MAC) from 800 ng/10(6) cells PGE2 to around 300 ng/10(6) cells. Non-lethal levels of the MAC also caused release of interleukin-6 (IL-6) from HRSC over the 24-hr time-course, with levels reaching 550 ng/10(6) cells at 24 hr compared to background levels of 200 ng/10(6) cells. No detectable release of IL-1 alpha could be measured at any time following non-lethal complement membrane attack. These results suggest a role for the MAC as an initiating mediator inducing the inflammation associated with rheumatoid arthritis.     

Analysis of function-associated receptor molecules on peripheral blood and synovial fluid granulocytes from patients with rheumatoid and reactive arthritis

In this study we report the expression pattern of 13 different function-associated surface molecules on synovial fluid and peripheral blood granulocytes from rheumatoid and reactive arthritis patients. We found increased expression of the complement receptors 1 (CD35) and 3 (CD11b) and of the activation-associated antigens CD67, CD24, and M5 on synovial fluid granulocytes from rheumatoid and/or reactive arthritis patients compared to autologous peripheral blood granulocytes. In addition, synovial fluid granulocytes expressed IgG Fc receptor 1 (CD64) and complement receptor 4 (CD11c), neither of which can be found on peripheral blood granulocytes. Peripheral blood granulocytes from rheumatoid and reactive arthritis patients expressed higher levels of leucocyte function-associated antigen 1 (CD11a) and of the membrane proteins CD31, CD24, M5, and M6 compared to peripheral blood granulocytes from healthy controls and patients with degenerative joint disease. No significant differences in the expression of any of the molecules studied could be observed between cells from rheumatoid and cells from reactive arthritis patients, suggesting a similar activation process for granulocytes in these two diseases.     

Stimulation of human rheumatoid synovial cells by non-lethal complement membrane attack.

The effects of non-lethal complement attack on cultured human rheumatoid synovial cells have been investigated by measuring a variety of parameters. Within 3-4 min of initiating non-lethal complement membrane attack there was a rise in reactive oxygen metabolite release from cultured synovial cells, which slowly returned to basal levels over a period of 45 min. The response was dependent on the formation of the complete C5b-9 complex. Prostaglandin E2 was also released during non-lethal attack in a biphasic manner, an early phase of release occurring within the first hour and a second, larger phase commencing at 4 hr and rising to levels of over 1000 ng/10(6) cells at 24 hr, compared to control levels at this time of less than 100 ng/10(6) cells. This response was dependent on the formation of the C5b-8 complex but did not require C9. Removal of extracellular calcium reduced release of prostaglandin E2 to background levels, and inclusion of an inhibitor of protein synthesis abolished the second phase of release but not the first phase. Non-lethal attack caused release of small amounts of leukotriene B4 but no detectable release of tumour necrosis factor.     

Relationship between leukotriene B4 and immunological parameters in rheumatoid synovial fluids

Leukotriene B₄ (LTB₄) was measured in synovial fluid from 20 patients with rheumatoid arthritis and 15 patients with osteoarthritis. The level of LTB₄ was significantly higher in synovial fluid from rheumatoid arthritis patients as compared with synovial fluid from osteoarthritis patients. LTB₄ levels also significantly correlated with cell numbers, rheumatoid factor, and immune complexes in synovial fluid from rheumatoid arthritis patients. There was an inverse correlation between LTB₄ levels and complement components. The high-pressure liquid chromatography peak of immunoreactivity extracted from the synovial fluid occurred at a retention volume identical to that of authentic LTB₄. These results suggest that the increased level of this mediator in synovial fluid may contribute to perpetuation of inflammation and tissue destruction in rheumatoid arthritis.     

Immunopathological changes in rheumatoid arthritis and other joint diseases.

A comparative study of the distribution of immunoglobulins G, M, and A and C3 in the synovium and inside synovial fluid leucocytes and of the relative levels of IgG, IgM, AND C3 in paired samples of serum and synovial fluid from both seropositive and seronegative patients with rheumatoid arthritis and other types of non-infective synovitis shows that although there is no distinctive immunopathological feature of rheumatoid arthritis, the incidence of immune complexes containing IgG and IgM with and without detectable C3 in the affected synovium or inside synovial fluid granulocytes is higher in rheumatoid arthritis and especially so in seropositive cases. The mean level of C3 in synovial fluid from patients with rheumatoid arthritis is lower than that from the group without rheumatoid arthritis. In contrast to previous reports, extracellular clumps of IgA could be detected in the affected synovium of a number of affected patients. Aggretated human IgG could be bound by some of the synovial biopsies and synovial fluid leucocytes from both seropositive and seronegative rheumatoid arthritis patients. Antinuclear factor and rheumatoid factor could be detected in the synovial fluid but not in the serum of several patients suggesting either selective sequestration or local synthesis of antinuclear and rheumatoid factors in the affected joints.     

C1 activation, with C1q in excess of functional C1 in synovial fluid from patients with rheumatoid arthritis

Free Clq, in functionally active form was present in increased amounts in the synovial fluid of patients with rheumatoid arthritis. The presence of free Clq was associated with low concentrations of hemolytic C1, low C4 and raised amounts of C3dg/d fragments in the synovial fluid. The findings suggested intra-articular C1 activation with dissociation of C1 into free C1q and complexes containing C1r, C1s, and C1 inactivator. However, the immunochemical properties of synovial fluid C1r-C1s-C1 inactivator complexes appeared to differ from those of the complexes formed in serum, which hampered quantification with the assay used. Control patients with osteoarthritis or spondylarthritic syndromes did not show evidence of intra-articular complement activation, even though 1 patient with Reiter's disease had unexplained low concentrations of synovial fluid C4 and C3. The concentrations of circulating complement components were largely normal in the patients. Slightly increased concentrations of free C1q and C1r-C1s-C1 inactivator complexes in serum and C3dg/d fragments in EDTA plasma were observed, particularly in the patients with rheumatoid arthritis.     

Polyamine oxidase activity in rheumatoid arthritis synovial fluid.

Oxidation of polyamides by polyamine oxidases (PAO) leads to the generation of highly reactive aminoaldehydes which have been shown to have a variety of effects, including killing of pathogenic microorganisms and regulation of leucocyte functions. Data presented here show that PAO are present in synovial fluid from patients with rheumatoid arthritis. This finding may have important implications in the various properties attributed to synovial fluid which includes anti-inflammatory activity.     

Morphology and functional roles of synoviocytes in the joint

The joint capsule exhibits a unique cellular lining in the luminal surface of the synovial membrane. The synovial intimal cells, termed synoviocytes, are believed to be responsible for the production of synovial fluid components, for absorption from the joint cavity, and for blood/synovial fluid exchanges, but their detailed structure and function as well as pathological changes remain unclear. Two types of synoviocytes, macrophagic cells (type A cells) and fibroblast-like cells (type B cells) have been identified. Type A synoviocytes are non-fixed cells that can phagocytose actively cell debris and wastes in the joint cavity, and possess an antigen-presenting ability. These type A cells, derived from blood-borne mononuclear cells, can be considered resident macrophages (tissue macrophages) like hepatic Kupffer cells. Type B synoviocytes are characterized by the rich existence of rough endoplasmic reticulum, and dendritic processes which form a regular network in the luminal surface of the synovial membrane. Their complex three-dimensional architecture was first revealed by our recent scanning electron microscopy of macerated samples. The type B cells, which are proper synoviocytes, are involved in production of specialized matrix constituents including hyaluronan, collagens and fibronectin for the intimal interstitium and synovial fluid. The proliferative potentials of type B cells in loco are much higher than type A cells, although the transformation of subintimal fibroblasts into type B cells can not be excluded. In some mammals, type B cells show features suggesting endocrine and sensory functions, but these are not recognized in other species. The synoviocytes, which form a discontinuous cell layer, develop both fragmented basement membranes around the cells and junctional apparatus such as desmosomes and gap junctions. For an exact understanding of the mechanism of arthritis, we need to establish the morphological background of synoviocytes as well as their functions under normal conditions.     

Terminal complement complexes and C1/C1 inhibitor complexes in rheumatoid arthritis and other arthritic conditions.

Terminal complement complex (TCC) and C1r-C1s-C1 inhibitor complex (C1/C1 INH) concentrations were measured in plasma and synovial fluid from patients with arthritis and related to other measures of disease activity. Both TCC and C1/C1 INH concentrations were significantly increased in patients with rheumatoid arthritis (RA) compared with patients with osteoarthritis (plasma and synovial fluid, P less than 0.05) and normal subjects (plasma only, P less than 0.001). In the patients with RA, there was no correlation between plasma or synovial fluid TCC concentrations and IgM rheumatoid factor, immune complex or C1/C1 INH levels. However, in 10 patients with seronegative RA, C1/C1 INH and immune complex levels correlated significantly in synovial fluid (r = 0.69, P less than 0.05) although not in plasma (r = 0.52). Plasma and synovial fluid TCC and C1/C1 INH concentrations did not differ in rheumatoid patients with severe compared with mild joint disease (categorized by the Ritchie score). These results confirm a role for complement activation in RA but suggest that several mechanisms are involved in its pathogenesis.     

Molecular analysis of complement-fixing rheumatoid synovial fluid immune complexes.

The characteristics of the solid-phase conglutinin method for the isolation of C3-containing complexes from the synovial effusions of rheumatoid arthritis patients were assessed. All major proteins in such complexes were identified and shown to be either immunoglobulin or complement components. The high proportion of IgM and the association between complexed IgM and latex agglutination titre suggest that IgM rheumatoid factor, probably binding to self-associated IgG antiglobulins, is of major importance in the formation of complement-fixing complexes. A minority of samples contained unidentified trace components and these differed from one fluid to another. The levels of complexed immunoglobulins were closely correlated to the titres of synovial fluid antiglobulins. The data accords with the view that autosensitization to IgG plays the primary role in the development of immunopathological features of rheumatoid arthritis.     

Correlation of anti-cytoskeleton antibody activities in synovial fluid with interleukin-6 in patients with osteoarthritis and inflammatory joint disease

Summary Synovial fluids and sera from patients with rheumatoid arthritis, psoriatic arthritis, yersinia arthritis, Behçet's syndrome, Crohn's disease, and osteoarthritis were tested for antinuclear antibodies and antibodies to five cytoskeletal components in sensitive enzyme-linked immunosorbent assay (ELISA) systems and for IL-6 concentrations in a proliferation assay (IL-6 dependent hybridoma cell line B13.29, subclone B9). Statistically significant correlations between antibody activities and IL-6 levels were found for vimentin antibodies (r= 0.56; p<0.05) and actin antibodies (r= 0.44;p<0.05). In patients with chronic and active disease like rheumatoid arthritis and psoriatic arthritis, optical densities measured by vimentin- and actin-ELISA were significantly different from those measured in patients with osteoarthritis. To date only a few reports exist concerning the incidence of antibodies in synovial fluids. We have shown to our knowledge for the first time that IL-6 seems to induce synovial fluid antibody activities restricted to cytoskeletal components of synoviocytes (i.e., vimentin and actin). Synovial fluid antibody activities against vimentin and actin appear to be markers of activity in patients with inflammatory joint disease.Abbreviations ELISA enzyme-linked immunosorbent assay - ANA antinuclear antibodies - ACA antibodies against cytoplasmic components - RA rheumatoid arthritis - OA osteoarthritis - SF synovial fluid - RF rheumatoid factors - FCS fetal calf serum - IFT immunofluorescence microscopy - PBS phosphate buffered saline - BSA bovine serum albumin - OD optical density - SLE systemic lupus erythematosus - IL-6 interleukin-6 - HGF hybridoma growth factor - BSF-2 B-cell-stimulatory factor - DMEM Dulbecco's modified Eagles Medium     

Complement activating properties of complexes containing rheumatoid factor in synovial fluids and sera from patients with rheumatoid arthritis.

The relationship between complexes containing rheumatoid factor and complexes activating complement was examined in synovial fluids and sera from patients with rheumatoid arthritis (RA). In each case this was performed by quantifying the amount of rheumatoid factor bound by solid phase Fab'2 anti-C3 and/or solid phase conglutinin. Both anti-C3 coated and conglutinin coated microtitre plates bound high levels of complexes containing rheumatoid factor from sera of RA patients with vasculitis. Unexpectedly, these complexes were detected in synovial fluids from only a minority of RA patients with synovitis. However, RA synovial fluids did contain other complexes as shown by the presence of complement consuming activity, C1q binding material and immunoglobulin attaching to conglutinin. It is considered that in RA synovial fluids the complexes containing RF and those activating complement are not necessarily the same whilst in vasculitic sera the complexes containing rheumatoid factor also activate complement.     

雌激素对RA滑膜细胞增殖和炎性介质表达的影响

目的探讨雌激素对类风湿关节炎(rheumatoid arthritis,RA)患者成纤维型滑膜细胞增殖和炎性细胞因子产生的影响,明确雌激素在RA病理过程中的作用。方法处于活动期、有膝关节积液的9例女性RA患者作为研究对象,无菌采集膝关节液,分离培养成纤维型滑膜细胞,待细胞传至第3～4代时,用终浓度分别为10-10、10-9、10-8、10-7、10-6 mol/L的雌二醇(E2)处理48 h,同时设未加E2的空白孔作为对照组,MTT法测定细胞增殖率,ELISA法检测培养上清中IL-1、IL-6、GM-CSF、MMP1、MMP2和MMP3水平。结果①与对照组相比,E2浓度为10-6、10-7、10-8 mol/L时RA滑膜细胞增殖率显著增高,并具有浓度依赖性,而E2浓度为10-9、10-10 mol/L时细胞增殖率没有显著改变。②不同浓度E2处理后,培养上清中IL-1水平显著高于对照组(P<0.05);E2浓度为10-6、10-7、10-8、10-9 mol/L时,IL-6和MMP-2浓度显著升高(P<0.05);培养上清中均未测得GM-CSF和MMP-1、MMP3,说明三者在体外培养的RA滑膜细胞中低表达。结论雌激素在RA的发生发展中具有重要作用,其机理可能是通过刺激RA滑膜细胞增殖和促进某些致炎细胞因子的分泌而导致RA患者关节滑膜增生和炎性病变。     

HLA-DR4Dw4-restricted T cell recognition of self antigen(s) in the rheumatoid synovial compartment

The pathogenesis of joint destruction in rheumatoid arthritis remains ill defined, although it is thought to be the result of tissue damage mediated by T cells. This prompted us to isolate and characterize in vivo activated T cells from rheumatoid arthritis synovial fluid in an attempt to determine their specificity. Heterogeneous synovial fluid cells, containing both adherent and non-adherent cell types, were recovered from joint aspirates and cultured in the presence of IL-2. After 2 weeks, the non-adherent cells were phenotyped as CD3-positive and TCR alpha beta-positive T cells. Polyclonal T cell lines were derived from four rheumatoid arthritis patients; of these, two proliferated, in a dose-dependent manner to only autologous synovial fluid in the presence of autologous or DR4Dw4 histocompatible antigen presenting cells. T cell proliferation to the synovial fluid could be inhibited by monomorphic anti-HLA-DR monoclonal antibody, but not by anti-DQ or anti-class I antibodies. T cell clones were established by limiting dilution of a synovial T cell line in the presence of autologous synovial fluid and DR4Dw4 histocompatible accessory cells. Examination of the antigen specificity of these T cell clones demonstrated that they were reactive with a component of synovial fluid. The results of these experiments suggest the presence of an MHC class II-restricted antigen in the rheumatoid arthritis synovial compartment that induces proliferation of in vivo activated T cells.     

Thyroid follicular cell function after non-lethal complement membrane attack

Terminal complement complexes have been identified around thyroid follicles in Graves' disease and Hashimoto's thyroiditis, and the concentrations of such complexes are increased in the sera of these patients, suggesting a role for complement activation and membrane attack complexes (MAC) in autoimmune thyroiditis. This has been investigated further using cultured human and rat thyroid cells. Thyrocytes were resistant to lysis by homologous complement, in contrast to the effects of heterologous (rabbit) complement. The formation of non-lethal amounts of MAC, using reactive lysis or classical pathway activation, significantly reduced cAMP production by these cells in response to thyroid-stimulating hormone (TSH) (P less than 0.01); similar effects were seen with thyroid-stimulating antibodies. Thyroid cells were able to recover rapidly from complement attack after washing and incubation for 30 min. Non-lethal MAC formation also resulted in reactive oxygen metabolite production, detected by luminol-dependent chemiluminescence in three out of five thyroid cell preparations tested. Ionomycin, but not TSH, also stimulated reactive oxygen metabolite production. These results suggest that repeated or continuous sub-lethal complement attack on thyroid cells may exacerbate hypothyroidism in Hashimoto's thyroiditis, or partially counter the effects of thyroid-stimulating antibodies in Graves' disease. Furthermore, the production of reactive oxygen metabolites in these circumstances could increase the intra-thyroidal inflammatory response; oxygen radical scavenging by anti-thyroid drugs (which are concentrated by thyrocytes) may account in part for the amelioration of thyroiditis observed with such treatment.     

Evidence for immune complexes containing antibody to the pepsin site of IgG in rheumatoid synovial fluids

In seventy cases of rheumatoid arthritis, the synovial fluid to serum ratio for the titre of pepsin agglutinator, i.e. the antibody to the pepsin site of IgG, was studied. This was compared with the corresponding ratio for another antibody of the same immunoglobulin class and for other proteins. By this method there was evidence for local production of pepsin agglutinator in two cases and for local inhibition in two other cases. Density gradient ultracentrifugation, performed at pH 7·4 and 3·0, suggested that pepsin agglutinator in immune complexes was present in most of the synovial fluids containing this antibody. Complexes of pepsin agglutinator and F(ab'')₂ IgG, prepared in vitro, appeared to fix only small amounts of human complement. Neither did fixation of pepsin agglutinator to immune precipitates increase their complement binding activity.     

Modulation of leukocyte recruitment and IL-8 expression by the membrane attack complex of complement (C5b-9) in a rabbit model of antigen-induced arthritis

The complement system is thought to be a major physiological mediator of injury in a number of diseases including rheumatoid arthritis (RA). The membrane attack complex (MAC) of complement has been detected in RA tissue, suggesting that the MAC may be relevant to the pathogenesis of the disease. Deposition of sublytic concentrations of the MAC has been shown to promote the expression of proinflammatory mediators. In the present study, we utilized rabbits deficient in the complement protein C6 to elucidate the role of the MAC in mediating the pathogenesis of antigen-induced arthritis. Swelling, leukocyte accumulation, IL-8 expression, proteoglycan, and hydroxyproline content were assessed. Analysis of synovial tissue demonstrated a significant decrease in leukocyte influx and a parallel decrease in tissue associated IL-8 in joints of C6-deficient animals as compared to C6-sufficient animals. However, this did not correlate with the preservation of connective tissue. The results derived from this study provide evidence that the MAC has an important function in mediating leukocyte recruitment in antigen-induced arthritis but does not play a direct role in connective tissue breakdown.     

Monoclonal antibodies which react with lymphocyte-lysed target cells and which cross-react with complement-lysed ghosts.

Monoclonal antibodies were raised against a human natural killing system and screened against targets lysed either by human lymphocytes in antibody-dependent cellular cytotoxicity (ADCC), or by human complement. Two monoclonals were identified which bound specifically to both types of killed targets. More detailed studies with one antibody showed that it inhibited ADCC, both as intact antibody and as the F(ab')2 fragment. Intact antibody enhanced natural (NK) killing, although the F(ab')2 fragment inhibited NK killing. The data support the hypothesis that lymphocyte-mediated killing involves a complex analogous in nature to the complement membrane attack complex. In addition, the antibodies provide evidence to suggest that this complex has antigenic determinants in common with the complement membrane attack complex, and indicate the possibility that the two systems are derived from a common ancestor.     

Kappa: lambda light chain ratio in IgG eluted from rheumatoid arthritis synovium

The light chain ratio in IgG eluted from rheumatoid arthritis synovial membrane was studied using quantitative immunodiffusion. The ratio obtained in synovial IgG was different from that of IgG in peripheral blood. In several instances a marked domination of one type light chain was noted in the eluted IgG, which also showed a limited electrophoretic dispersion on immunoelectrophoresis. This suggests that synovial IgG in rheumatoid arthritis is antibody, and not derived non-specifically from the immunoglobulin pool. Lambda type light chains dominated over kappa type in most eluates, suggesting preferential involvement of cells producing lambda type molecules.