Focus on pain mechanisms and pharmacotherapy in the treatment of fibromyalgia syndrome.

OBJECTIVE: To critically evaluate the role of several notable 'pain pathways' in the fibromyalgia syndrome (FMS). METHODS: PubMed provided the data base for peer-reviewed basic and clinical science studies on musculoskele-tal and neuropathic pain mechanisms with a principal emphasis on critically appraising papers from 2002 to the present. RESULTS: FMS pharmacotherapy is more prevalent in clinical practice as our understanding of the cellular, molecular and pathophysiologic mechanisms contributing to widespread musculoskeletal and neuropathic pain has emerged. Thus, several 'pain pathways' including high-voltage activated Ca2+ channels and the K(v)1 family of K+ channels ion channels appear related to the efficacy of pregabalin and amitryptyline, respectively, in FMS. Additionally, serotonergic and serotonergic/norepinephrine receptor-mediated mechanisms may explain the reported pharmacologic efficacy in FMS of mirtazapine, duloxetine and milnacipran. By contrast, the decreased level of micro-opioid receptors in the CNS of FMS patients suggests a mechanism as to why opioid therapy should be avoided. However, increased peripheral benzodiazepine receptors on monocytes from FMS patients suggested an explanation for the reported efficacy of olanzapine in FMS. CONCLUSION: Pregabalin was the first drug approved by the FDA for the treatment of FMS-related pain. Drugs that have been assessed for their potential use in FMS pharmacotherapy include gabapentin and tricylic antidepressants. These drugs appear to target specific Ca2+ or K+ ion channels notable for their involvement in mediating neuropathic pain. Serotonin and norepinephrine reuptake inhibitors including, mirtazapine, duloxetine and milnacipran appear to be more efficacious in FMS than selective serotonin reuptake inhibitors. Milnacipran became the second FDA-approved drug for FMS.

Deficient type I protein kinase A isozyme activity in systemic lupus erythematosus T lymphocytes.

Systemic lupus erythematosus (SLE) is an autoimmune disorder of indeterminate etiology characterized by a dysfunctional cellular immune response. We have previously identified a metabolic disorder of the adenylate cyclase/cAMP/protein kinase A (AC/cAMP/PKA) pathway characterized by impaired cAMP-inducible, PKA-catalyzed protein phosphorylation in intact T lymphocytes from subjects with severe SLE disease activity. Because this metabolic disorder may contribute to abnormal T cell immune effector functions, we tested the hypothesis that impaired PKA-dependent protein phosphorylation is the result of a PKA isozyme deficiency in SLE T lymphocytes. Compared with healthy and rheumatoid arthritis (RA) controls, subjects with severe SLE activity exhibited reduced PKA-catalyzed phosphorylation of proteins in the T lymphocyte plasma membrane where the type I isozyme of PKA (PKA-I) is predominantly localized. Both silver staining and biosynthetic labeling of membrane-associated proteins with [35S]methionine demonstrated that reduced protein phosphorylation was not due to either an altered distribution of or absence of proteins. Moreover, phosphorylation of SLE membrane-associated proteins with the PKA catalytic (C) subunit showed a similar distribution and extent of phosphorylation compared with membrane proteins from healthy T cells, suggesting that SLE T cell membrane proteins could be phosphorylated. Sequential column chromatography of the type I and type II isozymes of PKA (PKA-I, PKA-II) demonstrated a deficiency of PKA-I isozyme activity. Compared with a ratio of PKA-I to PKA-II activity of 4.2:1 in healthy T cells, the activity ratio in T cells from subjects with severe SLE disease activity was 0.99:1 (P = 0.01, SLE versus healthy controls for PKA-I). The deficient PKA-I activity was associated with a significant increase of free C-subunit activity (P = 0.04, SLE versus healthy controls for C-subunit). T cells from subjects with mild/moderate SLE disease activity also exhibited diminished PKA-I activity, yielding a ratio of PKA-I to PKA-II activity of 2.4:1. By contrast, T cells from RA controls possessed increased PKA-I, PKA-II, and free C-subunit activities compared with healthy controls, resulting in a ratio of PKA-I to PKA-II activity of 3.6:1. We conclude that the reduced PKA-catalyzed protein phosphorylation in the plasma membrane of SLE T cells is the result of deficient PKA-I isozyme activity. This is the first identification of a deficiency of PKA activity in SLE T lymphocytes; the deficiency, resulting in diminished protein phosphorylation, may alter cellular homeostasis, contributing to the cellular immune dysfunctions observed in SLE.

Secretion of an articular cartilage proteoglycan-degrading enzyme activity by murine T lymphocytes in vitro.

Destruction of articular cartilage is the hallmark of inflammatory arthritides. Enzymes elaborated by mononuclear cells infiltrating the synovium mediate, in part, the degradation of the cartilage extracellular matrix. Since mononuclear cells are the dominant cell type found in chronic inflammatory synovitis, we investigated whether interaction of immune mononuclear cells with antigen initiated the synthesis and secretion of a proteoglycan-degrading enzyme activity. Proteoglycan-degrading enzyme activity was monitored by the capacity of murine spleen cell conditioned medium to release [3H]serine/35SO4 incorporated into rabbit cartilage proteoglycan monomer fraction (A1D1), and by the relative change in specific viscosity of bovine nasal cartilage proteoglycan monomer. The results demonstrated that both virgin and immune mononuclear cells spontaneously generated proteoglycan-degrading enzyme activity and that cellular activation and proliferation induced by the antigen keyhole limpet hemocyanin or the mitogen phytohemagglutinin was not required. Kinetic studies demonstrated stable release of the enzyme activity over 72 h. Cell separation studies showed that T lymphocytes, a thymoma line, and macrophages separately produced proteoglycan-degrading enzyme activity. The enzyme activity has been partially characterized and appears to belong to a class of neutral pH metal-dependent proteinases. These observations, the first to demonstrate that T lymphocytes secrete an enzyme capable of degrading cartilage proteoglycan, raise the possibility that this enzyme activity contributes to cartilage extracellular matrix destruction in vivo. Moreover, these data support the conclusion that production of this enzyme by T lymphocytes is independent of an antigen-specific stimulus.

Degradation of cartilage proteoglycan by human leukocyte granule neutral proteases--a model of joint injury. I. Penetration of enzyme into rabbit articular cartilage and release of 35SO4-labeled material from the tissue.

The present work was undertaken to explore the effect of two purified neutral proteases derived from human peripheral blood polymorphonuclear leukocytes (PMN) on articular cartilage as a model of joint injury. Human leukocyte elastase and chymotrypsin-like enzyme, purified by affinity chromatography, released 32SO4 from labeled rabbit articular cartilage slices in vitro. Release of isotope was initially delayed, suggesting that either a lag in enzyme penetration occurs or that size of degradation fragments is a limiting factor in diffusion of label out of the tissue. The release of 35SO4 was inhibited by preincubation of elastase and chymotrypsin-like enzyme with human alpha 1-anti-trypsin, or with their specific chloromethyl ketone inactivators, and the action of elastase was also inhibited by a monospecific antiserum to PMN elastase, freed of major serum proteinase inhibitors. Immunohistochemical staining procedures revealed the presence of PMN elastase inside the matrix of cartilage slices after a 20-min exposure of tissue to either the pure enzyme or crude PMN granule extract. Serum alpha 1-antitrypsin failed to penetrate into the cartilage slices under identical in vitro conditions. In association with the results reported in the accompanying paper, these findings suggest a model of cartilage matrix degradation by PMN neutral proteases in which local protease-antiprotease imbalance, coupled with different rates of penetration of protease and antiprotease into target tissue, plays a key role in accounting for matrix damage.

Small molecular weight inhibitors of stress-activated and mitogen-activated protein kinases.

The stress-activated protein kinase (SAPK) and mitogen-activated protein kinase (MAPK) sub-families are crucial to environmental stress responses and responses to growth factors that cause transcriptional activation of genes required for cell proliferation, differentiation and programmed cell death. Small molecular compounds with specific structure/activity characteristics have been developed that competitively block SAPK/MAPK binding to ATP. Chemically modified compounds based on ATP binding pocket characteristics have improved selectivity and specificity for SAPK/MAPK isoforms. In addition, site-specific mutagenesis of MAPKs has helped identify the MAPK structures required for binding recognition and selectivity of these inhibitors. A group of extracellular-signal regulated protein kinase (ERK) inhibitors has been constructed based almost exclusively on their ability to inhibit the ERK activation cascade. Inhibitors have been employed in vitro to identify protein targets and mechanism of action of SAPKs/MAPKs. The efficacy of SAPK/MAPK inhibitors in animal models of inflammation, arthritis, heart failure, cancer and neurological degeneration has provided the impetus for using them in human studies of inflammation and in clinical trials.

The inhibition of human leucocyte elastase and chymotrypsin-like protease by elastatinal and chymostatin.

The ability of elastatinal and chymostatin, protease inhibitors of microbial origin, to inhibit human leucocyte proteases (EC 3.4.-) was studied. Elastatinal and chymostatin are capable of inhibiting the pancreatic enzymes elastase and chymotrypsin, respectively. It was found in these studies, with synthetic substrates, that elastatinal is a much weaker inhibitor of human leucocyte elastase than it is of porcine pancreatic elastase. Elastatinal caused no inhibition of the activity of human leucocyte chymotrypsin-like protease. Chymostatin was found to be a powerful inhibitor of human leucocyte chymotrypsin-like protease. Its affinity to the leucocyte protease was higher than its affinity to bovine pancreatic alpha-chymotrypsin. Chymsotatin had a weak inhibitory effect on the activity of human leucocyte elastase. Studies were also carried out on the ability of chymostatin to inhibit the release of 35SO2-4 from rabbit articular cartilage by human leucocyte chymotrypsin-like protease. Preincubation of the chymostatin with the protease before the latter was added to the 35SO2-4 -labeled cartilage caused inhibition of proteolysis as measured by 35SO2-4 release. Preincubation of chymostatin with 35SO2-4 -labeled cartilage prior to addition of the human chymotrypsin-like protease to the tissue also inhibited 35SO2-4 release. However, in the case of preincubation of cartilage with alpha1 -antitrypsin there was no such inhibition. It therefore appeared that chymostatin, unlike alpha1 -antitrypsin, was capable of penetrating the cartilage matrix and exerting its inhibitory effect upon the human leucocyte chymotrypsin-like protease that was subsequently added to the tissue.

Prostaglandin biosynthesis by lapine articular chondrocytes in culture.

Secondary monolayer and spinner cultures of rabbit articular chondrocytes released into the culture medium prostaglandins the synthesis of which was inhibited by sodium meclofenamate. The prostaglandins measured by radioimmunoassay were, in order of decreasing abundance, prostaglandin E2, 6-oxo-prostaglandin F1 alpha (the stable metabolite of prostacyclin) and prostaglandin F2 alpha. Several lines of evidence indicated that chondrocytes synthesize little if any thromboxane B2 (the stable metabolite of thromboxane A2). The presence of prostaglandins was confirmed by radiometric thin-layer chromatography of extracts of culture media incubated with [3H]arachidonic acid-labeled cells. In monolayer culture, chondrocytes synthesized immunoreactive prostaglandins in serum-free as well as serum-containing medium. Monolayer chondrocytes produced higher levels of prostaglandin E2 relative to 6-oxo-prostaglandin F1 alpha than did spinner cells, but the latter synthesized more total prostaglandins. The identity of endogenous prostaglandins as well as those synthesized in short-term culture by rabbit cartilage slices was compared to those produced by chondrocytes in long-term culture. Chondrocytes synthesized all of the prostaglandins found in articular cartilage. Minimal quantities of thromboxane B2 were detected in cartilage. A higher percentage of 6-oxo-prostaglandin F1 alpha relative to other prostaglandins was found in cartilage than in either monolayer or spinner chondrocyte cultures. These results demonstrate that articular chondrocytes synthesize prostaglandins and prostacyclin. These prostaglandins may exert significant physiological effects on cartilage, since exogenous prostaglandins depress chondrocyte sulfated-proteoglycan synthesis and may even promote proteoglycan degradation.

Arachidonic acid metabolism by rabbit synovial cells in culture. Studies of non-cyclooxygenase pathways.

We have investigated arachidonic acid (20:4) metabolism by rabbit synovial cells in culture. The lipoxygenase products 5-HETE, 12-HETE and 15-HETE were not detected, despite the presence of a cyclooxygenase inhibitor sodium meclofenamate (20 microM), nor after incubation with ionophore A23187 (1 microM), 20:4 (10 microM), prostaglandin E2, (1 microM), N-formylmethionylleucylphenylalanine (0.01 microM), or murine spleen cell-conditioned medium. [3H]20:4 (10 microM) was incorporated into phospholipids, triacylglycerols and diacylglycerols. A majority of the 3H content of phosphatidylinositol/phosphatidylserine and of diacylglycerols was already present at 1 min, in contrast to the slower accumulation of 3H in triacylglycerols, phosphatidylcholine and phosphatidylethanolamine. The diacylglycerol fraction contained sn-glycerol-1-acyl-2-20:4. These observations are consistent with phospholipase C activity in synovial cells under those culture conditions. The products generated by these enzymes may play important roles in the physiological processes of synovium.

Correlation of the biosynthesis of prostaglandin and cyclic AMP in monolayer cultures of rabbit articular chondrocytes.

We have utilized ionophores to test whether stimulation of chondrocyte prostaglandin biosynthesis is accompanied by an increase in cyclic nucleotide levels in these cells. Radioimmunoassay of prostaglandin E2, 6-oxo-prostaglandin F1 alpha (the stable metabolite of prostaglandin I2) and prostaglandin F2 alpha showed that synthesis of each was stimulated by the divalent-cation ionophore, A23187 after short-term incubation (1-7 min) in serum-free medium. No stimulation of thromboxane B2 was detected. Two monovalent ionophores, lasalocid and monensin failed to stimulate prostaglandin biosynthesis after short-term incubation. Ionophore A23187-stimulated prostaglandin biosynthesis was variably and partially inhibited by sodium meclofenamate, indomethacin and aspirin, but not by sodium salicylate. Ionophore A23187-stimulated prostaglandin biosynthesis was accompanied by a 7.5-fold increase in cyclic AMP levels after 15 min. Sodium meclofenamate, indomethacin and aspirin which inhibited prostaglandin E2 biosynthesis also reduced cyclic AMP levels. Exogenous prostaglandin E2 (1 microgram/ml) stimulated cyclic AMP biosynthesis, which was not inhibited by aspirin. These results indicated that prostaglandins can be considered as one of the local effectors controlling cyclic AMP production in articular cartilage.

Neutral proteinases from articular chondrocytes in culture. 2. Metal-dependent latent neutral proteoglycanase, and inhibitory activity.

Monolayer and spinner cultured rabbit articular chondrocytes released into the medium latent metal-dependent enzyme with activity against bovine proteoglycan. Pretreatment of medium with p-aminophenylmercuric acetate or trypsin followed by soybean trypsin inhibitor significantly increased enzyme activity. The monolayer-cultured chondrocytes released more of this activity than spinner cultures. The neutral proteoglycanase activity increased with medium concentration and incubation time. Like the human cartilage proteoglycanase, its pH optimum on proteoglycan subunit was 7.25. Gel filtration on BioGel P-30 indicated that the proteoglycanase occurred in two molecular weight forms: 20 000--30 000 and 13 000. The latent enzyme was about 30 000--40 000. The metal-chelators, o-phenanthroline (5 mM) and EDTA (10 mM) inhibited the activated proteoglycanase almost completely, but trypsin and chymotrypsin inhibitors had little effect. The cultured chondrocytes also released into the media a heat-labile inhibitor against the proteoglycanase. The inhibitory activity was present in the nonactivated media and eluted on Sephadex G-100 chiefly at a position corresponding to molecular weights of 10 000--13 000.

Neutral proteinases from articular chondrocytes in culture. I. A latent collagenase that degrades human cartilage type II collagen.

Culture media collected from secondary monolayer and spinner cultures of rabbit articular chondrocytes showed evidence of collagenolytic activity by the following criteria: (1) Amicon PM-10 concentrates of culture medium released [14C] glycine from reconstituted rabbit skin collagen fibrils at 37 degrees C; (2) medium concentrated by lyophilization decreased the relative viscosity of human cartilage collagen in solution. The loss in viscosity was partially inhibited if medium was preincubated with o-phenanthroline, and (3) degradation of human cartilage collagen after 60 h incubation at 24 degrees C was characterized primarily by the appearance of 75 000 dalton (TCA) and 25 000 dalton ((TCB) products. The majority of the collagenase (EC 3.4.24.3) from cultured chondrocytes was secreted in latent form, since preincubation with either trypsin or p-aminophenylmercuric acetate significantly increased activity against human cartilage collagen. Chondrocyte collagenase may be important in mediating the normal slow turnover of cartilage collagen and may be particularly active in collagen destruction associated with early stages of synovial joint arthritides, before attack by non-cartilage cells or extra-articular soft tissues.

'Gelatinase-like' activity from articular chondrocytes in monolayer culture.

In addition to releasing collagenase and proteoglycanase activity, rabbit articular chondrocytes in monolayer culture released into the culture medium, latent, neutral enzyme activity which when activated by p-aminophenylmercuric acetate degraded fluorescein-labeled polymeric rat tail tendon Type I collagen and the tropocollagen TCA and TCB fragments of human Type II collagen into smaller peptides at 37 degrees C. Enzyme activity was abolished if p-aminophenylmercuric acetate-activated culture medium was preincubated with 1.10-phenanthroline, a metal chelator. Thus, articular chondrocytes in monolayer culture are capable of producing neutral proteinases which acting together can result in complete degradation of tendon and cartilage collagen to small peptides.

Stimulation of cyclic AMP in chondrocyte cultures: effects on sulfated-proteoglycan synthesis.

The effects of N6,O2'-dibutyryladenosine 3':5'-cyclic monophosphate (DBcAMP), 8-bromoadenosine 3':5'-cyclic monophosphate (8Br-cAMP), 3':5'-cyclic monophosphate (cAMP), L-isoproterenol and L-epinephrine on sulfated-proteoglycan synthesis by rabbit articular chondrocytes were compared. DBcAMP and 8Br-cAMP in the presence or absence of 3-isobutyl-1-methylxanthine (IBMX) stimulated sulfated-proteoglycan biosynthesis after 20 h of incubation. cAMP had no significant effect. Both DBcAMP and 8Br-cAMP increased the hydrodynamic size of the newly synthesized proteoglycan monomer (A1D1) relative to control cultures. By contrast, although isoproterenol and epinephrine stimulated total cAMP synthesis, neither stimulated sulfated-proteoglycan synthesis. Whereas intracellular cAMP accumulated after incubation with DBcAMP and 8Br-cAMP, this was not the case with isoproterenol whether IBMX was present or not. Thus, stimulation of sulfated-proteoglycan synthesis by cAMP analogues in chondrocyte cultures appears to be dependent on increased intracellular cAMP accumulation rather than total cAMP biosynthesis.

Qualitative changes in human osteoarthritic hip cartilage proteoglycan synthesis during long-term explant culture.

Cartilage explants from 14 human osteoarthritic (OA) femoral heads synthesize 4 subpopulations of proteoglycan (PG) based on hydrodynamic size on Sepharose CL-2B (Kav: I, 0.05; II, 0.28; III, 0.68; IV, 0.9-1.0). A detailed analysis of newly synthesized PG monomer from each PG subpopulation was made during protracted (20 days vs. 1 day) explant culture of the cartilage specimens. Subpopulations I and II--high-density PG each eluted off Sepharose CL-2B as a unimodal peak, Kav, 0.2-0.25. High-density PG from subpopulation II appeared as a broad polydisperse symmetrical peak. Subpopulation IV eluted as 2 peaks; a minor peak of large size, and a major peak, Kav, 0.9. Large pore composite polyacrylamide gel electrophoresis (CAPAGE) of intact PG monomer (fraction D1D1) resolved at least 2 discrete PG subpopulations as constituents of both subpopulations I and II. Subpopulations III and IV PG monomer consisted of several heterogeneous subpopulations. The size of the high-density PG from subpopulations I and II decreased with time-in-culture. No significant differences were found in the average glycosaminoglycan (GAG) chain size (Kav, 0.65 on Sepharose CL-6B) or in susceptibility to chondroitinase ABC or AC-II (both 80%) in subpopulations I, II and III high density PG as a function of time-in-culture. The average GAG chain length of subpopulation IV high density PG (Kav, 0.75-0.9) was significantly shorter than the high-density PG of other subpopulations. Variations in the average GAG length and chondroitinase susceptibility did not appear to underly the smaller size of subpopulations I and II high-density PG with culture age. By contrast, keratanase susceptibility of subpopulations I and II high-density PG increased as a function of culture time.

An in vitro model of ageing of human articular cartilage sulphated-proteoglycans.

Six cases of non-pathological articular cartilage were studied by organ explant culture to assess alterations in tissue sulphated proteoglycans (PGs) as a function of time in culture and donor age. Neosynthesized, 35SO4-labeled and endogenous, or already existing, uronic acid-containing PG populations were studied at several time points over 3-4 weeks. PG extractability did not vary with donor age. The proportion of non-extractable endogenous, but not of neosynthesized, PGs increased with time in culture. Sepharose CL-2B chromatography of neosynthesized and endogenous PGs eluted with associate buffer (0.5 M sodium acetate, pH 5.8) revealed 4 PG subpopulations with Kavs of 0.05, 0.28, 0.68 and 0.9-1.0. With culture time, the percentage distribution of newly synthesized PG subpopulations of large hydrodynamic size increased significantly with a concomitant decrease in the relative amount of smaller PGs. Isopycnic cesium chloride density gradients were performed on pooled Sepharose CL-2B peaks under associative (0.5 M GuHCl) and dissociative (4 M GuHCl) conditions to assess component subclasses of PG aggregates and PG monomers within each PG subpopulation. An analysis of the Kav, 0.05 subpopulation indicated an enrichment in dense PG aggregate (A1) and PG monomer (D1). Both A1 and D1 decreased with in vitro age parallelled by an increase in the respective subclasses of least buoyant density, A4 and D4. Sepharose CL-2B chromatography of D1 fractions within this PG subpopulation indicated a progressive decrease in PG monomer hydrodynamic size with time in culture. In contrast to these age-in-culture related alterations in neosynthesized PGs, the endogenous PGs showed neither a significant change in distribution of PG subpopulations nor PG subclasses over the time period of study. These findings showed the ability of human articular cartilage to alter the profile of neosynthesized PG while maintaining the in situ PG population during in vitro cartilage aging. Such findings suggest that this system may be useful in the elucidation of specific changes in articular cartilage PGs associated with time in culture.

Fundamental pathways in osteoarthritis: an overview.

Osteoarthritis (OA) is a significant world-wide health problem owing to the progressive and debilitating nature of the condition which results in high morbidity and a marked decrease in the quality of life. Significant advances in the medical and surgical management of OA have resulted from an understanding of the fundamental pathways governing the health and disease of synovial joint tissues. Continuing investigations into the nature of synovial joint pathophysiology at both the molecular and biochemical level should pave the way for the development of novel therapeutic strategies, including gene therapy and tissue engineering, in the treatment of the OA patient.

Metabolic disturbances and synovial joint responses in osteoarthritis.

Previously held views that the pathogenesis of idiopathic osteoarthritis (OA) originated in the synovial joint and was not influenced by systemic metabolic disturbances in the patient is inconsistent with recent data demonstrate skewing of the growth hormone/insulin-like growth factor-1 axis in the symptomatic OA patient. In light of this novel information, the role of growth hormone and insulin-like growth factor-1 in the pathogenesis and progression of OA requires further definition. In male patients with OA, the red blood cell sequesters more growth hormone than an aged-matched control group. Thus, this growth hormone "depot" may provide a mechanism for removal of "toxic" levels of growth hormone from the circulation. Storage of "excess" growth hormone in red cells may reduce the inflammatory or otherwise undesirable "toxic" actions of GH. In some patients, serum growth hormones levels may exceed three-times the average value considered normal. These "episodic" variations in growth hormone levels may play a significant role in the elevated levels of serum growth hormone seen in the OA patient. The connection between elevated growth hormone and decreased insulin-like growth factor-1 levels and the defined cartilage anabolic and catabolic pathways defined in in vitro assays of articular cartilage derived from the OA patients remain to be more precisely defined. However, the dampened insulin-like growth factor-1 response in OA coupled with elevated cartilage extracellular matrix degradation (mediated by metalloproteinases) and depressed compensatory biosynthesis (induced and perpetuated by the presence of cytokines such as interleukin-1 and tumor necrosis factor-alpha) may, in fact, act synergistically to suppress normal cartilage repair mechanisms thus resulting in progressive destructive lesions of the cartilage and bone.

Future directions for research and treatment of osteoarthritis.

Future directions in the research and treatment of osteoarthritis (OA) will be based on the emerging picture of pathophysiological events that govern the initiation and progression of OA. The fundamental event resulting in the destruction of articular cartilage in OA arises from an imbalance between anabolic and catabolic pathways. The extracellular matrix (ECM) of cartilage is degraded by matrix metalloproteinases (MMPs) induced by cytokines. Cytokines also blunt chondrocyte compensatory synthesis pathways required to restore the integrity of the degraded ECM. Inhibition of the MMPs, their activators, and cytokines that induce MMP gene up-regulation would appear to be fertile targets for drug development in the treatment of OA. Restoration of damaged articular surfaces via tissue engineering strategies which could employ chondroprogenitor cells in biomatrices appropriate for transplantation to cartilage surfaces appears feasible. A reduction in cytokine-mediated up-regulation of MMP gene expression as well as augmentation of cartilage ECM biosynthesis may also be possible by employing the principles of gene transfer using suitable vectors that establish long-term stable expression of genes which suppress MMPs while at the same time supporting cartilage ECM biosynthesis.

Intact proteoglycan is a polyclonal activator of murine B-lymphocytes.

Destruction of articular cartilage is the hallmark of both inflammatory and degenerative arthritides. Since degradation of cartilage results in the release of proteoglycan (PG) monomers and fragments into the synovial fluid, the present study was initiated to determine whether hyaline cartilage PG can induce a cellular immune response. Nonimmune spleen cells obtained from A/St and C57Bl/6 mice were cultured with a crude extract of bovine nasal cartilage, a PG aggregate fraction, PG monomer or degraded PG monomer for varying time periods. Only intact PG monomer induced a proliferative response which peaked at day 2. The responding cell was a B-lymphocyte which did not require T-helper cell activity. Our results suggest that intact PG monomer is a polyclonal activator of B-lymphocytes.