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Lysis of fibrillar collagen by neutrophils in synovial fluid. A role for surface-bound immunoglobulins.

Synovial fluids (SF) contain inhibitors capable of neutralizing the activity of proteases secreted by inflammatory cells and fibroblasts. To further define a potential role for SF polymorphonuclear neutrophils (PMN) in mediating joint destruction, peripheral blood PMN were suspended in SF and incubated with reconstituted collagen fibrils. Incubation of PMN-SF mixtures with collagen fibrils precoated with monomeric IgG resulted in significant lysis of the underlying fibrils relative to that seen with uncoated fibrils. Augmented fibril lysis by PMN-SF mixtures in which the PMN were activated with fluid-phase ligands such as phorbol myristate acetate or heat-aggregated IgG was not seen. Lysis of IgG-coated fibrils by PMN-SF was inhibited in the presence of EDTA or sodium azide. PMN-mediated resorption of fibrillar collagen occurred despite the presence of protease inhibitors in the SF at a concentration capable of neutralizing human neutrophil collagenase. These results suggest that the focal release and activation of human neutrophil collagenase during PMN stimulation by tissue-bound immunoglobulins may mediate the resorption of joint tissue collagens in rheumatoid arthritis, even in the presence of protease inhibitors.

Animals↗

Identification of alpha 1-acid glycoprotein (orosomucoid) in human synovial fluid by capillary electrophoresis.

Capillary electrophoresis of human synovial fluid in a phosphate borate run buffer containing sodium dodecyl sulphate separates a hydrophilic glycoprotein, hyaluronan and a number of low-molecular-mass components. The hydrophilic glycoprotein is identified as alpha 1-acid glycoprotein (AGP), orosomucoid, by co-injection methods with human AGP and by reaction with neuraminidase which released N-acetylneuraminic acid. Finally, a sample of the glycoprotein was isolated by micropreparative capillary electrophoresis, examined by sodium dodecyl sulphate-polyacrylamide gel electrophoresis methods and shown to give a positive reaction with AGP antibodies. The peak due to AGP in the capillary electrophoresis is broad and gives evidence for the presence of glycoforms.

Antibodies↗

[Ultrastructural changes in articular cartilage affected by a non-physiological pH value of the synovial fluid].

The physiological pH-value of the synovial fluid (pH 7.2-7.4) is important for the integrity of normal articular cartilage. After the intraarticular injection of acid (pH 4.0) or alkaline (pH 10.0) isoosmolale buffer solutions into the knee joints of young rabbits ultrastructural changes are seen by the aid of transmission electron microscopy. The number of cell organelles in the chondrocytes (rough endoplasmic reticulum, Golgi-complex, mitochondria) is diminished and the number of intracytoplasmic filaments is increased. The intercellular matrix shows a looseness of the collagen fibre mesh work, swollen and split collagen fibres, the appearance of numerous coarse rounded structures with an electron dense envelop, and a loss of matrix granules. These results are interpreted as regressive changes, and they are discussed in the context of an activation of proteinases.

Animals↗

D-penicillamine and D-penicillamine-protein disulphide in plasma and synovial fluid of patients with rheumatoid arthritis.

1. The plasma pharmacokinetics of D-penicillamine (D-pen) and D-penicillamine-albumin disulphide (D-pen-alb) were examined over a dosage interval in six patients with rheumatoid arthritis. In two of these, 24 h synovial fluid profiles of D-pen and D-pen-alb were also obtained. 2. D-pen was undetectable in plasma at the beginning of the study. The peak concentration (5.4 +/- 1.2 microM) occurred at between 45 min and 2 h and the mean elimination half-life was 0.6 h. D-pen-alb, however, was present at a mean plasma concentration of 19.1 microM prior to dosage, peaked at 26.2 microM and was eliminated with a half-life of 40 h. 3. D-pen concentrations in synovial fluid rose more slowly and peaked lower than in plasma. D-pen-alb was present in synovial fluid of the patients at 50.1% and 83.6%, respectively, of the simultaneous plasma concentration prior to dosage. Concentrations varied during the study interval, corresponding to changes in plasma concentrations. 4. These results demonstrate that D-pen forms stable conjugates with protein in treated patients. The presence of D-pen-alb in relatively high concentrations throughout the dosage interval contrasts with the low concentrations and rapid elimination of D-pen. Both D-pen and D-pen-alb were also shown to be present at the putative site of drug action (the inflamed synovial joint) in concentrations lower than those in plasma.

Adult↗

Adhesion of rheumatoid peripheral blood and synovial fluid mononuclear cells to high endothelial venules of gut mucosa.

Mononuclear cells isolated from paired blood and synovial fluid of seven patients with rheumatoid arthritis showed cytoadherence to porcine Peyer's patch high endothelial venules using the Stamper-Woodruff method. A significantly greater proportion of binding was found among the synovial fluid lymphocytes. These would appear to be a population of cells that share adherence characteristics with cells known to be of gut mucosal origin, suggesting that in rheumatoid arthritis some lymphocytes derived from mucosa migrate to joints.

Adult↗

T cell receptor V beta usage in synovial fluid of children with arthritis.

We have examined synovial fluid (SF) T cells from 5 children with various types of juvenile arthritis. Using the polymerase chain reaction (PCR) to determine the expression of 20 individual T cell receptor (TCR) beta variable (V) region families, we have shown with each patient that the SF T cells are polyclonal. Nevertheless, expanded usage of some families by SF T cells relative to peripheral blood T cells was evident in some cases. We conclude that the pattern of T lymphocytes in the inflamed joint may be a consequence in part of a polyclonal expansion or nonspecific homing of T cells to the joint, and in part a more restricted expansion of T cells potentially driven by arthritogenic antigens.

Antibodies, Antinuclear↗

Purification of a metalloproteinase inhibitor from human rheumatoid synovial fluid.

A metalloproteinase inhibitor present in human rheumatoid synovial fluid was purified by a combination of heparin-Sepharose chromatography, concanavalin A-Sepharose chromatography, ion-exchange chromatography and gel filtration. The Mr of the purified inhibitor was 28000 by SDS/polyacrylamide-gel electrophoresis and 30000 by gel filtration. The inhibitor blocked the activity of the metalloproteinases collagenase, gelatinase and proteoglycanase, but not thermolysin or bacterial collagenase. The serine proteinase trypsin was not inhibited. The inhibitory activity was lost after treatment with trypsin (0.5 micrograms/ml) at 37 degrees C for 30 min, 4-aminophenylmercuric acetate (1 mM) at 37 degrees C for 3 h, after incubation for 30 min at 90 degrees C and by reduction and alkylation. These properties suggest that the inhibitor closely resembles the tissue inhibitor of metalloproteinases ('TIMP') recently purified from connective-tissue culture medium.

Arthritis, Rheumatoid↗

Synovial fluid lymphocytes differ from peripheral blood lymphocytes in patients with rheumatoid arthritis.

Peripheral blood (PBL) and synovial fluid lymphocytes (SFL) from 12 patients with rheumatoid arthritis (RA) were analyzed using monoclonal antibodies that detect specific T cell surface antigens (OKT3, OKT4, OKT8, SC1) and antigens associated with lymphocyte activation (anti-Ia, OKT10, B3/25). RA patients' PBL contained 1010 +/- 74 OKT4+ and 401 +/- 62 OKT8+ cells/mm3 (ratio OKT4+/OKT8+ = 2.4 +/- 0.3). In contrast, SFL from these patients exhibited a significantly different proportion of T cell subsets (ratio OKT4+/OKT8+ = 1.1 +/- 0.5) (p less than 0.0001) with 630 +/- 180 OKT4+ and 595 +/- 225 OKT8+ cells/mm3. Synovial fluid contained significantly more activated T cells based on the presence of Ia-positive T cells (19 +/- 5%) and reactivity with antibody OKT10 (49 +/- 7%) compared with RA-PBL (8 +/- 3% Ia-positive T cells and 13 +/- 6% OKT10+). Compared with RA-PBL, normal PBL contained an elevated number of OKT8+ cells (610 +/- 48/mm3), a similar number of OKT4+ cells (1040 +/- 86/mm3), and a lower percentage of activated lymphocytes (3 +/- 2% Ia-positive T cells and 10 +/- 8% OKT10+ cells). SFL, RA-PBL, and normal PBL all showed less than 3% cells reactive with antibody B3/25 (anti-transferrin receptor antibody), a marker found on in vitro activated T cells. These findings demonstrate that the lymphocytes at the site of inflammation differ significantly from the lymphocytes present in the peripheral blood of the same patients. RA patients had a small but significant decrease in the number of OKT8+ cells/mm3 compared with normal PBL (p less than 0.01), suggesting that this lymphocyte subset may home to synovial tissues, where it becomes activated.

Antibodies, Monoclonal↗

Properties and reactivity of immune complexes in rheumatoid synovial fluid.

Fractionation of immune complexes (IC) from rheumatoid synovial fluid revealed the presence of three different fractions of IC. The largest molecular weight form, fraction I (above 1000 Kdaltons) was predominately composed of IgG and IgM and contained both IgM-RF and IgG-RF. The other IC, fraction II (480 Kdaltons) and fraction III (330 Kdaltons), contained predominately IgG with some IgA and only significant amounts of IgG-RF. All three fractions of IC can bind Clq and stimulate human monocyte prostaglandin E (PGE) production. Fraction I IC bound Clq most readily while fraction III IC were the most effective stimulators of monocyte PGE production. IC stimulation of monocyte PGE production was inhibited by staphylococcus protein A suggesting mediation via activation of Fc receptors. It remains to be determined whether this IC reactivity has any pathologic significance.

Antigen-Antibody Complex↗

Identification of collagen subtypes in synovial fluid sediments from arthritic patients.

Collagen fibers in synovial fluid sediment were described a decade ago. Since then, tissue-specific collagen molecules (types) have been characterized. Techniques were devised to identify the collagen types in joint fluid sediment. Collagens were found in 12 of 17 pellets prepared from fluid aspirates from 17 knee joints of patients with various forms of arthritis. Collagen types I and III and polypeptide chains A and B (basement membrane collagen) were specifically identified in four of seven fluids from patients with active systemic lupus erythematosus (SLE) and in a single fluid from a patient with severe septic arthritis. This "collagen profile" was identical to that of rheumatoid synovium. Type II collagen, characteristic of hyaline articular cartilage, was found in two of six fluids from osteoarthritic joints. The presence of sufficient collagen (about 5 micrograms) to permit typing was correlated with roentgenographic evidence of joint space narrowing; the presence of the "synovial" collagen profile was correlated with decreased joint fluid pH.

Arthritis↗

Cartilage oligomeric matrix protein (COMP) levels in digital sheath synovial fluid and serum with tendon injury.

Cartilage oligomeric matrix protein (COMP) is a noncollagenous extracellular matrix protein found predominantly in cartilage, but also in tendon, ligament and meniscus. Studies in man have demonstrated that it may be used as a prognostic marker in rheumatoid arthritis and osteoarthritis. The present study investigated whether tendon injury contributes to serum and tendon sheath synovial fluid levels of COMP in horses. COMP levels, analysed by competitive ELISA, in the digital sheath synovial fluid were more than 10-fold higher than in the serum. Levels were significantly raised when tendon damage or sepsis was present within the tendon sheath but showed only mild, statistically insignificant, elevation in cases of tenosynovitis alone. COMP concentrations in serum were found to vary with age. Foals (age < or = 1 year) had significantly (P<0.001) higher levels in comparison to older control horses. Total COMP concentrations in an age-matched group with tendinitis were not significantly different from the control group. Measurements of COMP levels in tendon sheath synovial fluid are therefore useful in depicting processes in tendon tissue, while elevated serum levels are likely to be more representative of joint disease than tendinitis.

Age Factors↗

Partial biochemical characterization and purification of IgG2b inducing factor as a new cytokine from synovial fluid of patients with rheumatoid arthritis.

Rheumatoid arthritis synovial fluid (RA-SF) contains a novel biological activity, which selectively induces IgG2b antibody production in lipopolysaccharide (LPS)-activated mouse spleen cells in vitro and in vivo. Our previous studies have shown that this activity is not functionally identical to other well-known cytokines and interleukins. In this study we demonstrate the partial purification and biochemical characterization of the IgG2b inducing activity in RA-SF. Biochemical characterization revealed that the IgG2b inducing activity in RA-SF has the following properties: it is a protein, sensitive to pH > 11 and < 4, which is precipitated by 50% of saturated ammonium sulphate and has a molecular weight of 50-70 kDa; it binds to Cibacron-blue and heparin and its activity is not mediated by immunoglobulins or immune complexes, which are present in RA-SF. Biochemical characteristics of the IgG2b inducing activity also differ from other cytokines and interleukins. The term IgG2b inducing factor is proposed for this novel activity.

Arthritis, Rheumatoid↗

Measurement of colony-stimulating factors in synovial fluid: potential clinical value.

In this study, 100 synovial fluid (SF) samples from patients with a variety of arthritides were assayed for levels of colony-stimulating factors (CSFs) using a human bone-marrow bioassay and enzyme immunoassays for granulocyte (G-) and granulocyte-macrophage (GM-) CSFs. GM-CSF was found more frequently in samples from rheumatoid arthritis (RA) subjects (49%) than in non-RA samples (29%). Absence of GM- but not G- or bioassay CSFs characterised samples from subjects with psoriatic arthritis and ankylosing spondylitis (n = 14). There was strong evidence of an antagonistic relationship between levels of G- and GM-CSFs in samples from RA patients, an effect independent of drug treatment. However, treatment with non-steroidal anti-inflammatory agents (NSAIDs) may affect reported CSF concentrations: G-CSF levels were significantly lower in samples from subjects not taking NSAIDs. These results suggest that SF-CSF estimations using commercially available assays could provide useful diagnostic clues for clinicians, but careful interpretation is warranted particularly in patients on long-term NSAID treatment.

Arthritis, Rheumatoid↗

Measurements of C-reactive protein in serum and lactate dehydrogenase in serum and synovial fluid of patients with osteoarthritis.

Diagnosis of osteoarthritis (OA) is based upon the clinical orthopaedic examination and the radiographic assessment, both of which can be non-specific and insensitive in early joint disease. The aim of our study was to investigate if there is an increase in serum levels of C-reactive protein (CRP) in degenerative joint disease (DJD) and if CRP could be used to help diagnose OA. We also wished to investigate whether it was possible to distinguish a joint with clinically and radiographically confirmed OA from a healthy joint by comparing lactate dehydrogenase (LDH) levels within the synovial fluid and the serum. We have shown a difference in synovial LDH levels between diseased and healthy joints (P<0.0001). There was also a significant difference between LDH in arthritic synovial fluid and serum, with no correlation between the values. Despite the fact that the values of our clinical patients tended to be higher than the values of our control group (P=0.05) all measured values were within the normal limits of previous publications. From these data, we conclude that single measurements of serum CRP do not permit detection of OA in clinical patients and that serum LDH is not a reliable marker for osteoarthritis. LDH levels in the synovial fluid could be of diagnostic value for identifying osteoarthritis.

Animals↗

Tumor necrosis factor-alpha in synovial fluid and plasma from patients with chronic connective tissue disease and its relation to temporomandibular joint pain.

PURPOSE: The purpose of this study was to determine the level of tumor necrosis factor-alpha (TNF-alpha) in the temporomandibular joint (TMJ) synovial fluid (SF-TNF-alpha) and blood plasma (P-TNF-alpha) of patients with chronic inflammatory connective tissue disease and investigate its relation to TMJ pain, hyperalgesia, and allodynia. PATIENTS AND METHODS: Twenty-four patients with a diagnosis of chronic inflammatory connective tissue disease and TMJ pain were included in the study. Visual analog scale, tenderness of the TMJ, and pain at mandibular movements were registered, and the pressure pain threshold and pressure pain tolerance levels were measured. TMJ synovial fluid samples and blood plasma were analyzed for TNF-alpha and the levels related to TMJ pain, hyperalgesia, and allodynia. RESULTS: TNF-alpha was present in the TMJ synovial fluid of 8 of 24 patients at levels significantly exceeding those in plasma at the same visit. The presence of SF-TNF-alpha showed a significant positive correlation to TMJ pain at maximum voluntary mouth opening and tenderness to posterior palpation of the TMJ. CONCLUSION: Local production of TNF-alpha occurs in the TMJ synovium of patients with chronic inflammatory connective tissue disease. Pain on mandibular movement and tenderness on posterior palpation (allodynia) of the TMJ is related to the level of SF-TNF-alpha.

Arthralgia↗

Antigenic specificity of rheumatoid synovial fluid lymphocytes.

The majority of rheumatoid arthritis (RA) synovial fluid lymphocytes (SFL) demonstrate markers that are suggestive of prior activation. While the mechanism(s) responsible is unknown, prior studies have suggested that certain Mycobacterium tuberculosis (MT) antigens may preferentially activate SFL in vitro. We therefore examined the ability of RA SFL to respond to purified protein derivative and an acetone-precipitable MT antigenic complex (AP-MT) and compared this with the responses by peripheral blood lymphocytes (PBL). The responses were contrasted with those elicited with tetanus toxoid (TT) and mitogenic anti-CD3. In patients with RA, the SF proliferative responses to both TT and anti-CD3 were reduced compared with responses by PB. In contrast, the SF response to purified protein derivative was maintained, and that to AP-MT was significantly increased, compared with PB. SF responses to AP-MT antigens were significantly greater than those to TT. The AP-MT activation of T lymphocytes from RA SF was characterized by an earlier peak proliferative response than that noted with matched PB. AP-MT responsiveness was not restricted to HLA-DR4 positive patients. These observations suggest that an epitope(s) contained within the MT complex of antigens, and enriched in the AP-MT complex, may be important in maintaining the chronic inflammation in at least some patients with RA.

Acetone↗

A population pharmacokinetic study of alminoprofen penetration into synovial fluid.

The pharmacokinetics of alminoprofen in plasma and synovial fluid (SF) at steady state (300 mg t.i.d.) was studied in 45 patients with knee effusion. Plasma and SF samples, one each per patient, were obtained. Six groups were made according to the time of sampling after ingestion of the 13th dose: 1 h (n = 7), 2 h (n = 7), 4 h (n = 7), 6 h (n = 10), 8 h (n = 6), 12 h (n = 8). A three-compartment model was used to describe alminoprofen kinetics in plasma and SF, with two parameterizations, a 'classical' and a 'physiological' one. The non-linear mixed effect model approach was used to estimate the mean and variance of the pharmacokinetic parameters. The mean +/- SE of the estimates (coefficient of variation of interindividual variability as a percentage) were volume of distribution, 11.0 +/- 1.711 (12%); elimination rate constant, 0.236 +/- 0.025 h-1 (18%); absorption rate constant 2.80 +/- 0.31 h-1 (464%), clearance of influx into SF, 0.29 +/- 0.14 mL min-1; clearance of efflux into plasma, 0.56 +/- 0.25 mL min-1. These two clearances were not significantly different, which indicates that passive diffusion occurs in both directions. The mean +/- SD alminoprofen concentration versus time curve in plasma and SF at steady state was simulated and showed that the mean +/- SD maximal concentration in SF was 8.1 +/- 6.3 mg L-1 and was obtained 4 h after dose administration.

Absorption↗

High percentage of CD8+, Leu-7+ cells in rheumatoid arthritis synovial fluid.

OBJECTIVE: While analyzing the phenotype of the synovial fluid mononuclear cells (SFMC) clustered about dendritic cells in rheumatoid arthritis (RA) joint effusions, it was noted that most of the clustering cells were CD8+ and coexpressed Leu-7. Therefore, the present study was conducted to investigate the frequency of CD8+, Leu-7+ cells in RA SF: METHODS: SFMC from 13 patients with RA and from 12 patients with non-RA inflammatory arthritides were examined for CD8 and Leu-7 expression using 2-color immunofluorescence flow cytometry. RESULTS: RA SFMC had statistically significantly greater percentages of total CD8+ cells, total Leu-7+ cells, and CD8+, Leu-7+ cells, compared with SFMC from the non-RA patients. These RA CD8+, Leu-7+ SFMC had a distinctive electron microscopic appearance compared with CD8+, Leu-7- SFMC. When peripheral blood mononuclear cells (PBMC) from 31 RA patients (including 7 from the SFMC group) were compared with PBMC from 15 normal controls, the percentage of CD8+, Leu-7+ cells was not significantly greater in the RA patients. However, the combination of a modest increase in CD8+, Leu-7+ cells and a decrease in total CD8 cells in RA PBMC altered the composition of the RA CD8 population compared with normal PBMC, such that over 40% of RA peripheral blood CD8 cells coexpressed Leu-7. CONCLUSION: The increased frequency of CD8+, Leu-7+ cells in RA SFMC may arise from the fact that a high percentage of the CD8+ PBMC in RA patients are also Leu-7+. This altered composition of CD8 cells in RA SF may have a role in the pathogenesis of the disease.

Antigens, Differentiation↗