Subchondral cyst development and MMP-1 expression during progression of osteoarthritis: An immunohistochemical study - 26/06/13

Doi : 10.1016/j.otsr.2013.03.019

A. Kaspiris ^a,^⁎ , L. Khaldi ^b, T.B. Grivas ^c, E. Vasiliadis ^a, I. Kouvaras ^a, S. Dagkas ^a, E. Chronopoulos ^d, E. Papadimitriou ^e
^a Department of Trauma and Orthopaedics, Thriasio General Hospital of Attica – NHS, G. Gennimata avenue, Magoula, 19600 Athens, Greece
^b Department of Osteopathology, Laboratory for Research of the Musculoskeletal System, School of Medicine, University of Athens, Attica, Greece
^c Department of Trauma and Orthopaedics, Tzanio General Hospital of Piraeus – NHS, Piraeus, 18536 Attica, Greece
^d Department of Orthopaedics, Laboratory for Research of the Musculoskeletal System, School of Medicine, University of Athens, Attica, Greece
^e Laboratory of Molecular Pharmacology, School of Health Sciences, University of Patras, Patras, Greece

^⁎Corresponding author. Tel.: +30 213 2028248; fax: +30 261 0623049.

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Summary

Background

Subchondral bone cyst (SBC) formation is often identified in patients with osteoarthritis. Furthermore, several studies have shown that expression of matrix metalloproteinases (MMPs) is elevated in patients with OA.

Objectives

The aim of our study is to correlate the presence of SBCs and MMP-1 expression with the osteochondral alterations during OA progression.

Methods

We studied the cartilage and subchondral bone of 15 patients who had undergone total knee or hip replacement due to primary OA. As controls, we used the femoral heads of three patients without macroscopic OA changes. We evaluated three specimens per patient.

Results

Specimens were divided in four groups based on the Mankin histological severity score. Using immunohistochemistry, we noted SBCs at the site of greatest disease severity. Specifically, these were present more frequently in group III (Mankin score: 6–7) and IV (Mankin: ≥8), compared with group I (Mankin: 1–3) and II (Mankin: 4–5). Mild OA stages (Mankin: 1–6) were characterized by degeneration and thinning of the cartilage, followed by increased osteoblast and osteoclast activity of the subjacent bone and the subsequent appearance of SBCs. Simultaneously, we observed expression of MMP-1 in groups I and II in the cartilage and III and IV in both the cartilage and the subchondral bone. Moreover, osteoblast-like cells in the lining of the SBCs showed an increased expression of MMP-1 in stages III and IV.

Conclusion

Our study provides immunohistological evidence that SBCs accumulate in advanced OA and contain activated cells, which express MMP-1, suggesting that they may thus participate in the osteochondral changes of OA.