Background Fibroblast-like synoviocytes (FLS) exhibit a transformed aggressive phenotype characterized by increased secretion of pro-inflammatory cytokines and matrix metalloproteinases (MMPs). Early pathological mechanisms that explain the change to an altered phenotype in FLS of chronic inflammatory arthropathies remain largely unknown. The composition of synovial fluids (SF) is very complex and strongly influences the microenvironment of joints including FLS thus representing an inseparable element of the disease. The MMP-9 is a gelatinase expressed in three major forms: dimer, monomer and a complex with neutrophil gelatin-associated lipocalin (NGAL). Interleukin-(IL)-6 is a pleiotropic cytokine expressed by a variety of immune and non-immune cells. However, the mechanisms by which IL-6 contributes to the pathogenesis of chronic arthropathies are not fully understood.
Objectives The purpose of the present work was to perform a comparative study of the IL-6 production and MMP-9 activity in FLS stimulated with SF from patients with osteoarthritis (OA), rheumatoid arthritis (RA) or spondyloarthritis (SpA). In addition, the effect of IL-6 blockade on MMP-9 activity was evaluated.
Methods Primary FLS were obtained from SF of the RA patients. Furthermore, the SW982 human synovial cell line was used. The SF of patients with OA (n=11), RA (n=11) or SpA (n=9) patients were pooled. The FLS were stimulated with OA, RA or SpA SF pools and supernatants (SN) were collected after 24, 48 and 72 h. The IL-6 levels were assessed in the SN by ELISA. The gelatinase activity of the SN was determined by zymography. The IL-6 function was blocked with the anti-IL-6 receptor antagonist tocilizumab (TCZ) (200μg/ml).
Results Earlier induction of IL-6 in SW982 cell line was observed by RA and SpA SF stimulation since significant levels were detected at 24 h (p<0.001 and p<0.01 compared with non-stimulated cells, respectively), whilst OA SF induced significant IL-6 secretion at 72 h (p<0.01). Similar results were observed in primary FLS. In contrast to SF of OA patients, SF of patients with RA or SpA induced increased and sustained secretion of active MMP-9. Moreover, the molecular weight band corresponding with NGAL-MMP-9 complex, considered a protected form of MMP-9, was detected with higher intensity in the SN of FLS stimulated with RA or SpA SF compared with OA SF (p<0.001). In the presence of TCZ, significant inhibition in the gelatinase activity of all MMP-9 forms was observed at 48h of stimulation with RA or SpA SF (p<0.001 for MMP-9 dimer and NGAL-MMP-9 complex; p<0.01 for MMP-9 monomer, compared with FLS stimulated in absence of TCZ).
Conclusions We conclude that SF of patients with inflammatory arthritis recreate a differential microenvironment for FLS that impacts on early phenotypic changes of these cells. The IL-6 provokes augmented and persistent MMP-9 activity in FLS stimulated with RA or SpA SF. This work identifies TCZ as an inhibitor of all forms of MMP-9.
Disclosure of Interest None declared