Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 4 uppsatser.

Rheumatoid arthritis (RA) which affects 0.5-1% of the world population and is characterised by joint erosions and presence of the autoantibodies anti-citrullinated protein antibodies (ACPA) and rheumatoid factor. Collagen II (CII) is a joint-specific antigen and we have shown that antibodies against CII (anti-CII) are present in around 8% of RA patients. RA patients with anti-CII are characterized by acute RA onset with elevated CRP and early joint erosions at the time of RA onset. Polymorphonuclear granulocytes (PMN) and peripheral blood mononuclear cells (PBMC) are abundant in RA synovial fluids, where they can interact with anti-CII, thus forming immune complexes (IC) with CII. In my thesis I have shown that PMN upregulated the cell surface markers CD66b and CD11b and downregulated CD16 and CD32 after stimulation with anti-CII IC. These changes in CD66b and CD16 associated to joint erosions to a larger extent than did PBMC responses to anti-CII IC. PMN cocultured with PBMC and stimulated with anti-CII IC showed augmented chemokine production that was dependent on TLR4 and functionally active PMN enzymes. This mechanism can lead to accumulation of inflammatory cells in joints of RA patients who are anti-CII positive around the time of RA diagnosis, and may thus help explain the acute onset RA phenotype associated with anti-CII. In a large Swedish RA cohort, anti-CII associated with elevations in clinical and laboratory measures of disease activity at diagnosis and until 6 months, whereas ACPA associated with late inflammation. Anti-CII seropositive RA was associated with improvements in clinical measurements and was negatively associated with smoking in contrast to ACPA that was associated with worseneing of clinical symptoms and associated positively with smoking. Anti-CII levels associated to  HLADRB1*03 and  HLADRB1*01 whereas ACPA showed negative association to HLA-DRB1*03. In a Malaysian RA cohort anti-CII also associated to elevated CRP at the time of diagnosis. Anti-CII seropositive RA represents a distinct phenotype, in many respects representing the converse  to the clinical, genetic and smoking associations described for ACPA. Early determinations of anti-CII in parallel to ACPA predict the inflammatory outcome in RA.

Abstract   Introduction Failure in the mechanism of self-tolerance in T or B cells can lead to autoimmunity. One of the autoimmune diseases is rheumatoid arthritis (RA), which is a chronic inflammatory disease of unknown cause and is characterized by systemic inflammation, autoantibodies and joint destruction. Serology is crucial for the classification of this disease. The first autoantibody found in RA patients was Rheumatoid factor (RF). However, anti-citrullinated peptide antibodies (ACPAs), a relatively new group of autoantibodies found in 70-90% of RA patients, are diagnostically more specific than RF. Type II collagen (CII) is the most abundant protein in human cartilage. In RA patients, immunity against CII leads to cartilage degradation and loss of joint function. Already from the 1970s, antibodies to CII (anti-CII) were found in RA sera, suggesting that CII autoimmunity might be pathogenetically important. Previous studies from our group show that a subgroup of patients with high levels of anti-CII at the time of diagnosis at the same time have high levels of inflammation in the joints. This is probably caused by anti-CII immune complexes (IC) inducing pro-inflammatory cytokines from macrophages. Although anti-CII positive patients have high inflammatory activity early on, as anti-CII levels decrease during the first year, the associated inflammation also diminishes. Thus, anti-CII positive patients have a rather good prognosis. Moreover, it is assumed that since anti-CII positive patients have a better prognosis than ACPA positive, patients with elevated anti-CII at the time of diagnosis might benefit from different and milder treatment. Previous studies from the group were performed on stored patient samples from the time before modern treatments with biologic agents (1995-2005). In this study, we aimed to investigate patients belonging to a more recent RA cohort, diagnosed between 2005-2014, with the aim to investigate whether patients with the anti-CII-associated RA phenotype would respond differently depending on the use of different modern RA therapies. Patients and Methods The primary cohort consisted of 2335 RA patients and 480 non-RA controls from the Epidermiological Investigations in Rheumatoid Arthritis (EIRA) case-control study. As we run into methodological problems two subgroups with 62 and 40 RA patients from the previous anti-CII studies were investigated when modifying the ELISA procedure, as well as a group of earlier investigated patients with non-specific ELISA reactivity. Totally 2776 RA patients were investigated. All investigated patients fulfilled the American College of Rheumatology classification criteria. To measure the anti-CII levels in RA patients and healthy controls anti-CII ELISA was performed. During the experiments, several different sources of CII from human, rat and bovine origin, and two different alternative coating buffers were used. The optical density (OD) was measured at 450 nm and anti-CII concentrations were calculated against the standard curve from an RA patient with high anti-CII levels.   Results My first analysis of the EIRA cohort showed that anti-CII are higher in RA patients than in controls, but could not confirm the association with acute onset RA. This was an unexpected finding and changed the focus of this master thesis project, to modify the measurement of anti-CII. Re-investigation of EIRA I showed that a proprietary coating buffer is important in the assay. Moreover, when different samples from RA patients were tested with bovine, rat and three different lots of human CII, correlation tests with clinical measures showed that bovine collagen and a new lot of human CII- prepared by the supplying company solely for this project- showed the strongest associations. Thereafter the EIRA cohort was re-investigated with two ELISAs, using bovine and human CII coated with the proprietary buffer. At the time of thesis writing almost all of the EIRA samples have been re-analysed, and results from both the modified ELISAs show the awaited clinical associations to early inflammation.   Conclusion Keeping the integrity of triple helical collagen is very important for the identification anti-native CII in RA patients. Our results show that the use of the proprietary coating buffer appears to be instrumental in this assay, irrespective of what source of CII was used. The new lot of human CII shows significant associations with the clinical measures, but associations are somewhat stronger with bovine CII. After finalising the re-investigations, we will be able to conclude which of the two analyses is most appropriate, and the corresponding dataset will then be merged with data from the first part of the EIRA study investigated previously by other group members. As anti-CII analysis shows the association to disease activity and prognosis, it can be used for predicting prognosis of RA and choosing the appropriate therapy in newly diagnosed RA patients, which might be clinically useful for rheumatologists. Our hypothesis is that as anti-CII positive patients have strong early inflammatory response but good long-term prognosis, they might benefit from other and perhaps short-term treatment compared to other RA patients.  If this is correct, our finding can have impact on the economy as it can define the patients who will not need expensive long-term medications. As modern anti-rheumatic therapies carry the risk of infections, such individualized therapies might also benefit anti-CII positive patients.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Le but de cette étude était d’évaluer si la bone morphogenetic protein (BMP)-2 pouvait aider à contrôler le phénotype de chondrocytes humains dans des conditions de culture à long terme nécessaires pour la transplantation de chondrocytes autologues (TCA). Nous avons aussi évalué le potentiel de la BMP-2 comme facteur de réparation du cartilage, en combinaison avec un biomatériau à base de collagène, pour étendre la technique aux lésions arthrosiques. Des chondrocytes humains ont été cultivés selon la procédure utilisée pour la TCA. Nous avons évalué la réponse des chondrocytes à la BMP-2 en culture monocouche ou dans les éponges de collagène par des analyses par PCR en temps réel, par Western blotting et Immunohistochimie.L’ajout de BMP-2 améliore le caractère chondrogénique des chondrocytes humains amplifiés en monocouche. L’effet stimulateur de la BMP-2 sur l’expression du collagène de type II a été observé au niveau des gènes mais aussi des protéines, ce qui est une propriété essentielle pour la reconstruction d’une matrice cartilagineuse. Nos résultats ont aussi montré que dans des chondrocytes tout d’abord amplifiés en monocouche puis cultivés en éponges de collagène en présence de BMP-2, la BMP-2 est capable de restaurer l’expression du gène COL2A1 et la synthèse de collagène de type II qui avaient été perdues pendant l’amplification. De manière importante, aucun signe de maturation hypertrophique ou d’induction ostéogénique n’a été détecté. Cette étude est la première à révéler le bénéfice de l’ajout de BMP-2 à des chondrocytes humains comme un agent thérapeutique pour la réparation du cartilage. / The aim of this study was to investigate if bone borphogenetic brotein (BMP)-2 could help to control human chondrocytes phenotype in long-term culture conditions necessary for autologous chondrocyte implantation (ACI). We also evaluated the potential of BMP-2 as a repair factor in combination with collagen-based biomaterials, to extend the technique to osteoarthritic lesions. Human chondrocytes were cultured independently, according to the procedure used for ACI. We evaluated the responsiveness of chondrocytes to BMP-2 when cultured in monolayer or within collagen sponges using Real-time PCR, Western blotting and Immunohistochemistry. Exogenous BMP-2 improved the chondrogenic character of human chondrocytes when amplified in monolayer. The stimulatory effect of BMP-2 on type II collagen expression was observed not only at the mRNA level but also at the protein level, and this is crucial for cartilage matrix reconstruction. Our data with human chondrocytes first amplified in monolayer then cultured in collagen sponges in the presence of BMP-2 have revealed that BMP-2 is able to restore COL2A1 gene expression and type II collagen synthesis that were lost during the amplification step. Importantly, no sign of hypertrophic maturation or osteogenic induction was detected beside the chondrogenic stimulatory effect of BMP-2. This study is the first to reveal the benefit of adding exogenous BMP-2 to human chondrocytes as a therapeutic agent for cartilage repair.

Tesis por compendio / [ES] El cartílago hialino es un tejido conectivo denso con poca capacidad de auto regeneración cuando es afectado por patologías degenerativas. Por lo tanto, la estimulación eléctrica se ha propuesto como una terapia alternativa no invasiva para mejorar la reparación del cartílago hialino. De acuerdo con esto, este trabajo presenta un enfoque computacional y experimental combinado para entender mejor la biología del cartílago hialino y su respuesta a la estimulación eléctrica usando diferentes modelos in vitro. En primer lugar, se ha desarrollado un modelo mecanobiológico para simular el proceso de osificación endocondral. Por otro lado, se ha evaluado el efecto de la estimulación eléctrica sobre el cartílago hialino en tres escenarios diferentes. Inicialmente se ha analizado la proliferación celular y la síntesis de glicosaminoglicanos de condrocitos cultivados en monocapa y estimulados con campos eléctricos. Luego, se ha realizado un análisis histomorfométrico a explantes de condroepífisis que fueron estimulados eléctricamente. Por último, se ha evaluado el efecto de los campos eléctricos sobre la diferenciación condrogénica de células madre mesenquimales cultivadas en hidrogeles. Los resultados indican que la estimulación eléctrica es un estímulo biofísico prometedor, ya que este tipo de estimulación mejora la viabilidad y la proliferación celular, induce cambios morfológicos en los condrocitos, y estimula la síntesis de las principales moléculas que componen el cartílago hialino, tales como SOX-9, glicosaminoglicanos y agrecan. Además, este proyecto es el primer paso hacia la implementación de un estímulo biofísico alternativo que modifica la dinámica celular de los condrocitos de la placa de crecimiento en condiciones ex vivo. Adicionalmente, este estudio resalta el efecto potencial de los campos eléctricos para inducir el proceso de condrogénesis de células madre mesenquimales cultivadas en condiciones basales. En general, la evaluación de la estimulación eléctrica sobre condrocitos, tejidos y andamios es una herramienta útil que puede contribuir al conocimiento actual de las terapias regenerativas enfocadas en la regeneración del cartílago hialino. / [CA] El cartílag hialí és un teixit connectiu dens amb poca capacitat d'auto regeneració quan es veu afectat per patologies degeneratives. Per tant, l'estimulació elèctrica s'ha proposat com una teràpia alternativa no invasiva per millorar la reparació del cartílag articular. D'acord amb això, aquest treball presenta un enfoc computacional i experimental combinat per entendre millor la biologia del cartílag hialí i la seva resposta a l'estimulació elèctrica usant diferents models in vitro. En primer lloc, s'ha desenvolupat un model mecanobiològic per simular el procés d'ossificació endocondral. D'altra banda, s'ha avaluat l'efecte de l'estimulació elèctrica sobre el cartílag hialí en tres escenaris diferents. Inicialment s'ha analitzat la proliferació cel·lular i la síntesi de glicosaminoglicans de condròcits cultivats en monocapa i estimulats amb camps elèctrics. Després, s'ha realitzat una anàlisi histomorfomètrica a explants de condroepífisis que van ser estimulats elèctricament. Finalment, s'ha avaluat l'efecte dels camps elèctrics sobre la diferenciació condrogénica de cèl·lules mare mesenquimals cultivades en hidrogels. Els resultats indiquen que l'estimulació elèctrica és un estímul biofîsic prometedor, ja que aquest tipus d'estimulació millora la viabilitat i la proliferació cel·lular, indueix canvis morfològics en els condròcits, i estimula la síntesi de les principals molècules que componen el cartílag hialí, com ara SOX-9, glicosaminoglicans i agrecan. A més, aquest projecte és el primer pas cap a la implementació d'un estímul biofísic alternatiu que modifica la dinàmica cel·lular dels condròcits de la placa de creixement en condicions ex vivo. Addicionalment, aquest estudi ressalta l'efecte potencial dels camps elèctrics per induir el procés de condrogènesi de cèl·lules mare mesenquimals cultivades en condicions basals. En general, l'avaluació de l'estimulació elèctrica sobre condròcits, teixits i scaffolds és una eina útil que pot contribuir al coneixement actual de les teràpies regeneratives enfocades a la regeneració del cartílag hialí. / [EN] Hyaline cartilage is a dense connective tissue with low self-healing capacity when is affected by degenerative pathologies. Therefore, electrical stimulation has been proposed as a possible non-invasive alternative therapy to enhance the restoration of the cartilaginous tissue. Accordingly, this work presents a combined computational and experimental approach to understand better the hyaline cartilage biology and its response to electrical stimulation using different in vitro models. On the one hand, a mechanobiological model was developed to simulate the endochondral ossification process. On the other hand, the electrical stimulation on hyaline cartilage was evaluated in three different scenarios. Initially, cell proliferation and glycosaminoglycans synthesis of chondrocytes, cultured in monolayer and stimulated with electric fields, was analyzed. Then, a histomorphometric analysis was performed to chondroepiphysis explants that were electrically stimulated. Finally, the effects of the electric fields on chondrogenic differentiation of mesenchymal stem cells cultured in hydrogels was assessed. The results indicated that electrical stimulation is a promising biophysical stimulus, due to the fact that this type of stimulation enhances the viability and the proliferation of cells, induces morphological changes in the chondrocytes, and stimulates the synthesis of the main molecules that compose the hyaline cartilage, such as SOX-9, glycosaminoglycans and aggrecan. Moreover, this project is the first step towards the implementation of an alternative biophysical stimulus that modifies the cellular dynamics of growth plate chondrocytes in ex vivo conditions. Additionally, this study highlights the potential effect of electric fields to induce the chondrogenesis process of mesenchymal stem cells cultured in basal conditions. Overall, the assessment of electrical stimulation on chondrocytes, tissues and scaffolds is a useful tool that may contribute to the current knowledge of regenerative therapies focused on hyaline cartilage healing. / To the financial support from COLCIENCIAS – COLFUTURO through the fellowship No. 647 for national doctorates. To the financial support from COLCIENCIAS through the research grant 712-2015 No. 50457. To the financial support from the Spanish Ministry of Economy and Competitiveness through the MAT2016-76039-C4-1-R project. / Vaca González, JJ. (2019). The effect of electric fields on hyaline cartilage: an in vitro and in silico study [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/120023 / Compendio

Les objectifs de ce travail étaient l’évaluation de stades précoces et tardifs de l’arthrose grâce à une étude histologique et biologique de l’arthrose sur un modèle de rupture de ligament croisé crânial chez le lapin (RLCC) et l’évaluation de l’effet de l’âge sur l’évolution de la maladie. L’étude biologique a été réalisée par le dosage sérique d’un marqueur de la dégradation du collagène de type II, le CTX-II, jusqu’à 20 semaines post-chirurgie. Chez les animaux adultes, les concentrations du CTX-II étaient influencées par la chirurgie et par le développement de la pathologie. Chez les jeunes animaux, les niveaux de CTX-II étaient plus élevés en début d’étude et diminuaient au cours du temps. Chez ce groupe d'animaux, les taux de CTX-II n’étaient pas modifiés par l’intervention chirurgicale. L’étude histologique a été réalisée avec une analyse histomorphologique du cartilage et des analyses histomorphométriques du cartilage et de l’os sous-chondral. L’évaluation histologique a permis d’observer des changements liés à l’arthrose chez tous les animaux opérés. Les altérations au niveau du cartilage étaient plus sévères chez les animaux adultes que chez les jeunes, ces derniers présentant une meilleure capacité de compensation à l’instabilité articulaire. Il a été démontré que l’analyse de la plaque osseuse sous-chondrale a permis de distinguer les animaux opérés des animaux non-opérés dans les 2 groupes d’âge, mais les surfaces articulaires affectées n’étaient pas toujours les mêmes. En conclusion, ce travail suggère l’intérêt du CTX-II dans l’évaluation de l’arthrose, mais aussi la pertinence d’effectuer plusieurs temps d’analyse pour mieux connaître l’évolution de la maladie. Les analyses histologiques ont permis de mettre en évidence des changements au niveau du cartilage et de l’os sous-chondral. Les différences observées entre les lapins adultes et les jeunes remettent en question l'utilisation d’animaux trop jeunes dans les études portant sur l’arthrose / The goals of this work were the evaluation of early and late stages of osteoarthritis through a histological and biological study of osteoarthritis using a rabbit model of the anterior cruciate ligament transaction (ACLT) and the evaluation of the effect of age on the evolution of the disease. Biological study was performed with longitudinal analysis of serum level of CTX-II, a marker a type II collagen degradation. In adult animals, serum concentration of CTX-II was influenced by the ACLT surgery and varied with time. In the young rabbits, the serum levels of CTX-II were more elevated at the beginning of study and decrease after. In this animal group, the rates of CTX-II were not influenced by surgical operation. Histological study was accomplished with both histomorphological analysis of the cartilage and with histomorphometric study of both cartilage and sub-chondral bone. Histological evaluation showed osteoarthritis changes in all operated animals. Changes of the cartilage appeared more severe in the adult group compared to the young rabbits, suggesting that these last have a better compensation capacity during articular instability. Bony changes allowed to differentiate operated animals from the unoperated, but the affected articular surfaces were not always the same. In conclusion, this study suggest the interest of the CTX-II biomarker in the evaluation of osteoarthritis, but also the pertinence to perform several time points of analysis to know better the disease evolution. The histological analysis allowed to put in an obvious place changes at the levels of the cartilage and of the sub-chondral bone. Difference noticed between the adult animals and the young rabbits offers a new look for the use of too young animals in osteoarthritis studies