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Extended report
The infrapatellar fat pad of patients with osteoarthritis has an inflammatory phenotype
  1. I R Klein-Wieringa1,
  2. M Kloppenburg1,
  3. Y M Bastiaansen-Jenniskens2,
  4. E Yusuf1,
  5. J C Kwekkeboom1,
  6. H El-Bannoudi1,
  7. R G H H Nelissen3,
  8. A Zuurmond4,
  9. V Stojanovic-Susulic5,
  10. G J V M Van Osch2,6,
  11. R E M Toes1,
  12. A Ioan-Facsinay1
  1. 1Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
  2. 2Department of Orthopaedics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  3. 3Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
  4. 4TNO Quality of Life, Leiden, The Netherlands
  5. 5Centocor, Philadelphia, Pennsylvania, USA
  6. 6Department of Otorhinolaryngology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Andreea Ioan-Facsinay, Department of Rheumatology, C1-R, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands; a.ioan{at}


Objectives Obesity is a risk factor for the development of osteoarthritis (OA) in hands and knees. Adipose tissue can secrete different adipokines with powerful immunomodulatory effects. The infrapatellar fat pad (IFP) is an intra-articular organ in the vicinity of the synovium and cartilage. It is hypothesised that IFP-derived soluble factors could contribute to pathological processes in the knee joint. A study was therefore undertaken to compare the release of inflammatory mediators in the IFP and subcutaneous adipose tissue (ScAT) and to characterise the adipocytes and immune cell infiltrate in these tissues.

Methods Paired IFP and ScAT samples were obtained from 27 patients with primary OA. The stromal vascular cell fraction (SVF) was isolated and characterised by fluorescence activated cell sorting. Cytokine and adipokine release in fat- and adipocyte-conditioned media was measured by luminex.

Results IFP secreted higher levels of inflammatory mediators such as interleukin 6 (IL-6), adipsin, adiponectin and visfatin than ScAT. This could be due to differences in the phenotype of adipocytes and/or in the composition and phenotype of the SVF cells. IFP adipocyte-conditioned media showed a trend towards more IL-6 and adipsin than ScAT. Moreover, the SVF fraction of IFP contained more cells/g tissue, a lower percentage of T cells and a higher percentage of mast cells than ScAT. In addition, T cells had a predominantly pro-inflammatory phenotype while macrophages had a mixed pro- and anti-inflammatory phenotype in the IFP.

Conclusion There are profound differences in secreted inflammatory factors and immune cell composition between the IFP and ScAT. These data indicate that IFP-derived soluble mediators could contribute to pathophysiological processes in the OA knee joint.

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  • Funding This work was financially supported by TI-Pharma, EU FP6 program Autocure, FP7 program Masterswitch and a grant from the Centre for Medical Systems Biology (CMSB) within the framework of the Netherlands Genomics Initiative (NGI).

  • Ethics approval This study was conducted with the approval of the Leiden University Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.