Mary B. Goldring

The control of chondrogenesis

Chondrogenesis is the earliest phase of skeletal development, involving mesenchymal cell recruitment and migration, condensation of progenitors, and chondrocyte differentiation, and maturation and resulting in the formation of cartilage and bone during endochondral ossification. This process is controlled exquisitely by cellular interactions with the surrounding matrix, growth and differentiation factors, and other environmental factors that initiate or suppress cellular signaling pathways and transcription of specific genes in a temporal‐spatial manner. Vertebrate limb development is controlled by interacting patterning systems involving prominently the fibroblast growth factor (FGF), bone morphogenetic protein (BMP), and hedgehog pathways. Both positive and negative signaling kinases and transcription factors, such as Sox9 and Runx2, and interactions among them determine whether the differentiated chondrocytes remain within cartilage elements in articular joints or undergo hypertrophic maturation prior to ossification. The latter process requires extracellular matrix remodeling and vascularization controlled by mechanisms that are not understood completely. Recent work has revealed novel roles for mediators such as GADD45β, transcription factors of the Dlx, bHLH, leucine zipper, and AP‐1 families, and the Wnt/β‐catenin pathway that interact at different stages during chondrogenesis. J. Cell. Biochem.

Osteoarthritis: A Disease of the Joint as an Organ

Richard F. Loeser, MD*, Department of Internal Medicine, Section of Molecular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA Steven R. Goldring, MD, Chief Scientific Officer and Richard L. Menschel Chair, The Hospital for Special Surgery and Department of Medicine, Weill Cornell Medical College, New York, New York, USA Carla R. Scanzello, MD, PhD, and Department of Internal Medicine, Section of Rheumatology, Rush Medical College, Chicago, IL, USA Mary B. Goldring, PhD The Hospital for Special Surgery and Department of Cell and Developmental Biology, Weill Cornell Medical College, New York, New York, USA

The role of the chondrocyte in osteoarthritis

Osteoarthritis (OA) is a slowly progressive degenerative disease characterized by gradual loss of articular cartilage. Since the OA lesion is often localized to weight-bearing cartilage or to sites of trauma, repetitive mechanical injury has been proposed as the critical signal for the initiation and progression of OA. It is now generally accepted that the chondrocyte is the target of these abnormal biomechanical factors, and that biochemical and genetic factors also contribute to alterations in the normal functional activities of these cells. Although OA has been regarded primarily as a noninflammatory arthropathy, symptoms of local inflammation and synovitis are present in many patients and have been observed in animal models of OA. Even in the absence of classic inflammation, which is characterized by infiltration of neutrophils and macrophages into joint tissues, elevated levels of inflammatory cytokines have been measured in OA synovial fluid. Although the OA cartilage lesion is present at sites remote from the synovium, the fibroblastand macrophage-like synovial cells, as well as the chondrocyte itself, are potential sources of cytokines that could induce chondrocytes to synthesize and secrete cartilagedegrading proteases, cytokines, and other inflammatory mediators. These synoviumand chondrocyte-derived products represent potential targets for the development of therapeutic agents, such as proteinase inhibitors, cytokine antagonists, and cytokine receptor blocking antibodies, which could be used to prevent or retard the progression of the OA articular lesion. This review will focus on evidence that implicates chondrocyte responses to cytokines in the pathogenesis of OA and will discuss the potential therapeutic applications of these findings.

Inflammation in osteoarthritis.

Purpose of reviewThis review focuses on the novel stress-induced and proinflammatory mechanisms underlying the pathogenesis of osteoarthritis, with particular attention to the role of synovitis and the contributions of other joint tissues to cellular events that lead to the onset and progression of the disease and irreversible cartilage damage. Recent findingsStudies during the past 2 years have uncovered novel pathways that, when activated, cause the normally quiescent articular chondrocytes to become activated and undergo a phenotypic shift, leading to the disruption of homeostasis and ultimately to the aberrant expression of proinflammatory and catabolic genes. Studies in animal models and retrieved human tissues indicate that proinflammatory factors may be produced by the chondrocytes themselves or by the synovium and other surrounding tissues, even in the absence of overt inflammation, and that multiple pathways converge on the upregulation of aggrecanases and collagenases, especially MMP-13. Particular attention has been paid to the contribution of synovitis in posttraumatic joint injury, such as meniscal tears, and the protective role of the pericellular matrix in mediating chondrocyte responses through receptors, such as discoidin domain receptor-2 and syndecan-4. New findings about intracellular signals, including the transcription factors NF-&kgr;B, C/EBP&bgr;, ETS, Runx2, and hypoxia-inducible factor-2&agr;, and their modulation by inflammatory cytokines, chemokines, adipokines, Toll-like receptor ligands, and receptor for advanced glycation end-products, as well as CpG methylation and microRNAs, are reviewed. SummaryFurther work on mediators and pathways that are common across different models and occur in human osteoarthritis and that impact the osteoarthritis disease process at different stages of initiation and progression will inform us about new directions for targeted therapies.

Articular cartilage and subchondral bone in the pathogenesis of osteoarthritis.

The articular surface plays an essential role in load transfer across the joint, and conditions that produce increased load transfer or altered patterns of load distribution accelerate the development of osteoarthritis (OA). Current knowledge segregates the risk factors into two fundamental mechanisms related to the adverse effects of “abnormal” loading on normal cartilage or “normal” loading on abnormal cartilage. Although chondrocytes can modulate their functional state in response to loading, their capacity to repair and modify the surrounding extracellular matrix is limited in comparison to skeletal cells in bone. This differential adaptive capacity underlies the more rapid appearance of detectable skeletal changes, especially after acute injuries that alter joint mechanics. The imbalance in the adaptation of the cartilage and bone disrupts the physiological relationship between these tissues and further contributes to OA pathology. This review focuses on the specific articular cartilage and skeletal features of OA and the putative mechanisms involved in their pathogenesis.

Interleukin-1 beta-modulated gene expression in immortalized human chondrocytes.

Immortalized human chondrocytes were established by transfection of primary cultures of juvenile costal chondrocytes with vectors encoding simian virus 40 large T antigen and selection in suspension culture over agarose. Stable cell lines were generated that exhibited chondrocyte morphology, continuous proliferative capacity (> 80 passages) in monolayer culture in serum-containing medium, and expression of mRNAs encoding chondrocyte-specific collagens II, IX, and XI and proteoglycans in an insulin-containing serum substitute. They did not express type X collagen or versican mRNA. These cells synthesized and secreted extracellular matrix molecules that were reactive with monoclonal antibodies against type II collagen, large proteoglycan (PG-H, aggrecan), and chondroitin-4- and chondroitin-6-sulfate. Interleukin-1 beta (IL-1 beta) decreased the levels of type II collagen mRNA and increased the levels of mRNAs for collagenase, stromelysin, and immediate early genes (egr-1, c-fos, c-jun, and jun-B). These cell lines also expressed reporter gene constructs containing regulatory sequences (-577/+3,428 bp) of the type II collagen gene (COL2A1) in transient transfection experiments, and IL-1 beta suppressed this expression by 50-80%. These results show that immortalized human chondrocytes displaying cartilage-specific modulation by IL-1 beta can be used as a model for studying normal and pathological repair mechanisms.

Cartilage homeostasis in health and rheumatic diseases

As the cellular component of articular cartilage, chondrocytes are responsible for maintaining in a low-turnover state the unique composition and organization of the matrix that was determined during embryonic and postnatal development. In joint diseases, cartilage homeostasis is disrupted by mechanisms that are driven by combinations of biological mediators that vary according to the disease process, including contributions from other joint tissues. In osteoarthritis (OA), biomechanical stimuli predominate with up-regulation of both catabolic and anabolic cytokines and recapitulation of developmental phenotypes, whereas in rheumatoid arthritis (RA), inflammation and catabolism drive cartilage loss. In vitro studies in chondrocytes have elucidated signaling pathways and transcription factors that orchestrate specific functions that promote cartilage damage in both OA and RA. Thus, understanding how the adult articular chondrocyte functions within its unique environment will aid in the development of rational strategies to protect cartilage from damage resulting from joint disease. This review will cover current knowledge about the specific cellular and biochemical mechanisms that regulate cartilage homeostasis and pathology.

Artificial Cavitation Nuclei Significantly Enhance Acoustically Induced Cell Transfection

The efficiency of ultrasound-mediated gene transfection was enhanced three- to fourfold, compared to previous results, through the use of green fluorescent protein reporter gene, cultured immortalized human chondrocytes and artificial cavitation nuclei in the form of Albunex. Cells were exposed to 1.0-MHz ultrasound transmitted through the bottom of six-well culture plates containing immortalized chondrocytes, media, DNA at a concentration of 40 micrograms/mL and Albunex at 50 x 10(6) bubbles/mL. Transfection efficiency increased linearly with ultrasound exposure pressure with a transfection threshold observed at a spatial average peak positive pressure (SAPP) of 0.12 MPa and reaching about 50% of the living cells when exposed to 0.41 MPa SAPP for 20 s. Adding fresh Albunex at 50 x 10(6) bubbles/mL prior to sequential 1-s, 0.32- or 0.41-MPa exposures increased transfection with each exposure, reaching 43% transfection after four exposures. Efficient in vitro and in vivo transfection now appear possible with these enhancements.

Interleukin 1 suppresses expression of cartilage-specific types II and IX collagens and increases types I and III collagens in human chondrocytes.

In inflammatory diseases such as rheumatoid arthritis, functions of chondrocytes including synthesis of matrix proteins and proteinases are altered through interactions with cells of the infiltrating pannus. One of the major secreted products of mononuclear inflammatory cells is IL-1. In this study we found that recombinant human IL-1 beta suppressed synthesis of cartilage-specific type II collagen by cultured human costal chondrocytes associated with decreased steady state levels of alpha 1 (II) and alpha 1(IX) procollagen mRNAs. In contrast, IL-1 increased synthesis of types I and III collagens and levels of alpha 1(I), alpha 2(I), and alpha 1(III) procollagen mRNAs, as we described previously using human articular chondrocytes and synovial fibroblasts. This stimulatory effect of IL-1 was observed only when IL-1-stimulated PGE2 synthesis was blocked by the cyclooxygenase inhibitor indomethacin. The suppression of type II collagen mRNA levels by IL-1 alone was not due to IL-1-stimulated PGE2, since addition of indomethacin did not reverse, but actually potentiated, this inhibition. Continuous exposure of freshly isolated chondrocytes from day 2 of culture to approximately half-maximal concentrations of IL-1 (2.5 pM) completely suppressed levels of type II collagen mRNA and increased levels of types I and III collagen mRNAs, thereby reversing the ratio of alpha 1(II)/alpha 1(I) procollagen mRNAs from greater than 6.0 to less than 1.0 by day 7. IL-1, therefore, can modify, at a pretranslational level, the relative amounts of the different types of collagen synthesized in cartilage and thereby could be responsible for the inappropriate repair of cartilage matrix in inflammatory conditions.

The role of cytokines as inflammatory mediators in osteoarthritis: lessons from animal models.

Studies in animal models of osteoarthritis (OA) have been used extensively to gain insight into the pathogenesis of OA, but early studies largely ignored inflammation except as a secondary phenomenon. Synovitis has often been noted as a feature in experimental OA, and more recent work has established a central role for inflammatory cytokines as biochemical signals which stimulate chondrocytes to release cartilage-degrading proteinases. Thus, proteinase inhibitors, cytokine antagonists and receptor blocking antibodies, and growth/differentiation factors have been considered as potential therapeutic agents and targets for gene therapy. Although there is some disagreement, it is generally accepted that IL-1 is the pivotal cytokine at early and late stages, while TNF-alpha is involved primarily in the onset of arthritis. Other cytokines released during the inflammatory process in the OA joint may be regulatory (IL-6, IL-8) or inhibitory (IL-4, IL-10, IL-13, IFN-gamma). Furthermore, studies in animal models have illustrated the potentially beneficial effects of anticytokine therapy with monoclonal antibodies or receptor antagonists, although local rather than systemic delivery would be necessary for the largely localized OA in humans. Transgenic or knockout mice have also provided insights into general mechanisms of cytokine-induced cartilage degradation but have not directly addressed OA pathogenesis. Similarly, animals with spontaneous or transgenic modifications in cartilage matrix components, growth/differentiation factors, or developmentally regulated transcription factors have provided information about potential gene defects that predispose to OA without addressing the role of inflammatory mediators in cartilage destruction. Although the multiple etiologies of human OA indicate that it is more complex than any animal model, the use of appropriate, well-defined animal models will establish the feasibility of novel forms of therapy.