Cytotoxicity of crystals involves RIPK3-MLKL-mediated necroptosis.

Crystals cause injury in numerous disorders, and induce inflammation via the NLRP3 inflammasome, however, it remains unclear how crystals induce cell death. Here we report that crystals of calcium oxalate, monosodium urate, calcium pyrophosphate dihydrate and cystine trigger caspase-independent cell death in five different cell types, which is blocked by necrostatin-1. RNA interference for receptor-interacting protein kinase 3 (RIPK3) or mixed lineage kinase domain like (MLKL), two core proteins of the necroptosis pathway, blocks crystal cytotoxicity. Consistent with this, deficiency of RIPK3 or MLKL prevents oxalate crystal-induced acute kidney injury. The related tissue inflammation drives TNF-α-related necroptosis. Also in human oxalate crystal-related acute kidney injury, dying tubular cells stain positive for phosphorylated MLKL. Furthermore, necrostatin-1 and necrosulfonamide, an inhibitor for human MLKL suppress crystal-induced cell death in human renal progenitor cells. Together, TNF-α/TNFR1, RIPK1, RIPK3 and MLKL are molecular targets to limit crystal-induced cytotoxicity, tissue injury and organ failure.

A 90-day subchronic toxicity study of beta-calcium pyrophosphate in rat.

beta-calcium pyrophosphate has been used as a bone-graft extender. The present study evaluated the toxicity from the subchronic administration of beta-calcium pyrophosphate to male and female Sprague-Dawley rats. Animals were divided into two groups consisting of 10 male and 10 female rats each and fed beta-calcium pyrophosphate extract (30 mg/kg body weight/day) and saline, 7 days per week for 90 consecutive days. During the experiment, no deaths were observed in any groups, and there were no remarkable changes in clinical signs, body weight, food and water consumption, hematological and serum biochemical parameters, organ weight, and histopathological findings between the control and treated groups. The results show no adverse toxic effects of beta-calcium pyrophosphate extract (30 mg/kg body weight/day) for rats of either sex.

Advances in understanding calcium-containing crystal disease.

PURPOSE OF REVIEW: Calcium pyrophosphate dihydrate and basic calcium phosphate crystals are the two most common calcium-containing crystals involved in rheumatic diseases. Recent literature concerning their role in the pathogenesis of osteoarthritis is reviewed. RECENT FINDINGS: In some instances, these calcium crystals might worsen osteoarthritis cartilage destruction. Laboratory investigations have identified determinants of cartilage calcification, especially a better characterization of matrix vesicle content and a better understanding of the regulation of inorganic pyrophosphate and phosphate concentration. In-vitro studies have highlighted new pathogenic mechanisms of calcium crystal-induced cell activation. Several intracellular signalling pathways are activated by calcium crystals. Recent studies suggested the implication of the inflammasome complex and a pivotal role for IL-1 in pseudogout attacks and chondrocyte apoptosis in basic calcium phosphate crystal-related arthropathies. SUMMARY: Animal models of osteoarthritis and in-vitro studies using calcium pyrophosphate dihydrate and basic calcium phosphate crystals will improve our knowledge of these common crystals and could suggest new targets for drugs, as these common diseases are 'orphan' with respect to therapy.

TLR2 signaling in chondrocytes drives calcium pyrophosphate dihydrate and monosodium urate crystal-induced nitric oxide generation.

Microcrystals of calcium pyrophosphate dihydrate (CPPD) and monosodium urate (MSU) deposited in synovium and articular cartilage initiate joint inflammation and cartilage degradation in large part by binding and directly activating resident cells. TLRs trigger innate host defense responses to infectious pathogens, and the expression of certain TLRs by synovial fibroblasts has revealed the potential for innate immune responses to be triggered by mesenchymally derived resident cells in the joint. In this study we tested the hypothesis that chondrocytes also express TLRs and that one or more TLRs centrally mediate chondrocyte responsiveness to CPPD and MSU crystals in vitro. We detected TLR2 expression in normal articular chondrocytes and up-regulation of TLR2 in osteoarthritic cartilage chondrocytes in situ. We demonstrated that transient transfection of TLR2 signaling-negative regulator Toll-interacting protein or treatment with TLR2-blocking Ab suppressed CPPD and MSU crystal-induced chondrocyte release of NO, an inflammatory mediator that promotes cartilage degeneration. Conversely, gain-of-function of TLR2 in normal chondrocytes via transfection was associated with increased CPPD and MSU crystal-induced NO release. Canonical TLR signaling by parallel pathways involving MyD88, IL-1R-associated kinase 1, TNF receptor-associated factor 6, and IkappaB kinase and Rac1, PI3K, and Akt critically mediated NO release in chondrocytes stimulated by both CPPD and MSU crystals. We conclude that CPPD and MSU crystals critically use TLR2-mediated signaling in chondrocytes to trigger NO generation. Our results indicate the potential for innate immunity at the level of the articular chondrocyte to directly contribute to inflammatory and degenerative tissue reactions associated with both gout and pseudogout.

Biodegradation behavior and cytotoxicity of the composite membrane composed of beta-dicalcium pyrophosphate and glucose mediated (polyethylene glycol/chitosan).

The purpose of this study is to prepare and evaluate the biodegradation behavior and cytotoxicity of a composite membrane, G-beta-DCP, combining beta-dicalcium pyrophosphate (beta-DCP) ceramic particles and glucose mediated chitosan-polyethylene glycol (PEG) membrane. The cytotoxicity of the G-beta-DCP was examined by the in vitro method of NIH 3T3 fibroblast cell culture. Extracts were obtained by soaking the G-beta-DCP composite in lysozyme containing phosphate buffer solution for 2, 7, 14, 21 and 28 days, respectively. The substances released from the G-beta-DCP composite were analyzed by gas chromatography-mass spectrometry (GC-MAS) and inductively coupled plasma atomic emission spectrometry (ICP-AES). The change in morphologies, chemical composition and crystal structure was examined by scanning electron microscopy (SEM) and X-ray diffraction pattern (XRD). The results of extracts cocultured with fibroblasts show that the growth of fibroblasts would increase for the extracts obtained from different beta-DCP feeding weight G-beta-DCP composites after soaking for 7 days. After further increasing the soaking time, the cell number still increases. It is found that the glucose amine and calcium are gradually released from the G-beta-DCP composites, which is considered to be nutritious for the growth of the fibroblast. The release rate of calcium ion and glucosamine concentration can be regulated by feeding the beta-DCP. The degradation behavior of G-beta-DCP composite is considered as an "onion degradation model" that the G-beta-DCP degrades from outer layer to inner layer. The developed material should have a great potential as a cell substrate in the field of tissue engineering.

Inhibitory effect of low density lipoprotein on the inflammation-inducing activity of calcium pyrophosphate dihydrate crystals.

OBJECTIVE: It has been proposed that low density lipoprotein (LDL) plays a role in the self-limiting nature of pseudogout inflammation. We investigated changes of LDL concentration in rat air pouch fluid during periods of acute and subsiding inflammation to evaluate whether LDL contributes to inhibiting inflammation of pseudogout. We examined whether LDL binds to calcium pyrophosphate dihydrate (CPPD) crystals as a possible mechanism for reduction of inflammation. METHODS: In this in vivo study, 5 mg suspensions of CPPD crystals and saline were injected into the rat air pouch. Fluid samples were taken from rat air pouch at 0, 3, 6, 12, 24, and 48 h after injection. White blood cells in the samples were counted; the remaining fluid was centrifuged and concentrations of beta-glucuronidase and PGE2 in the supernatant were measured as inflammatory markers. LDL in the supernatant was immunochemically identified by Western blotting, then pellets containing crystals were examined by the same technique. RESULTS: LDL was identified in the air pouch 3 h after CPPD crystal injection, and its concentration increased and reached a peak level after 24 h. Inflammatory markers reached maximal level from 6 to 12 h, then decreased after 24 h. In the pellets containing crystals, LDL could not be identified in every specimen. CONCLUSION: LDL in the rat air pouch increased during the inflammatory course induced by CPPD crystal and the inflammation subsided as the LDL increased. Since some reports indicate LDL was related to reduction of crystal induced inflammation such as gout or pseudogout, we concluded that LDL could contribute to the resolution of acute pseudogout arthritis in vivo with or without binding to CPPD crystals.

Mechanical properties and histological evaluation of sintered beta-Ca2P2O7 with Na4P2O7.10H2O addition.

The ultimate goal of implantation of biomaterials in the skeleton is to reach full integration of the non-living implant with the living bone. The biomaterial can be used much as a bone graft, resorbing or dissolving as bone growth occurs, and the end result is a new remoulded bone. Calcium pyrophosphate, Ca2P2O7, is one of the intermediate products of bone mineralization. beta-Dicalcium pyrophosphate (beta-DCP) doped with certain amounts of Na4P2O7.10H2O was prepared as the developed material. Na4P2O7.10H2O was used as a liquid-phase additive to improve the sintering process and promote physiological bioresorbability. Compressive strength and four-point bending strength were measured by the Bionix test system 858. The mechanical strength of the sintered beta-DCP increased with the addition of Na4P2O7.10H2O up to 5 wt%, but thereafter decreased. The microstructure and crystal structure were analysed by the techniques of SEM, EPMA, TEM and XRD. The relationship between the mechanical strength of the sintered bioceramics and the Na4P2O7.10H2O dopant was examined in terms of the presence of NaCa(PO3)3, grain growth and abnormal grain coalescence while the dopant increased. Preliminary in vivo evaluation was studied by rabbit femur condyle implantation. There was no inflammation or any toxic sign during the experimental period. The histological section of intraosseous implantation revealed that the new bone deposited directly on the surface of the material in the fourth week after operation. The implant gradually decreased in volume and was replaced by the surrounding regenerated bone in the rabbit condyle in vivo environment. The results led us to conclude that the developed material has great potential as a biodegradable bone substitute.

Crystal-induced inflammation: studies of the mechanism of crystal-membrane interactions.

Studies of the interactions of monosodium urate monohydrate (MSUM) crystals and calcium pyrophosphate dihydrate triclinic (CPPD) crystals with biomembranes have been reviewed. Crystal-membrane binding and crystal-induced membranolysis have been studied using human erythrocytes as a model membrane system. The extent of MSUM-membrane binding was determined by incorporating a hydrophobic, fluorescent probe into the membranes, centrifugation to separate free membranes from membranes with bound crystals and quantitation of free membranes by measuring the total fluorescence intensity. The ability of MSUM and CPPD to hemolyse red cells was used as a measure of the membranolytic potential of the crystals. Fluorescence polarization studies showed that MSUM-membrane binding resulted in fluidization of the membrane. Cross-linking of the membrane proteins of the erythrocyte or the presence of divalent cations in the incubation medium inhibited MSUM induced hemolysis. These findings were explained by hypothesizing a "pore" model mechanism for MSUM induced membranolysis as follows. Binding of crystals to membranes induces the redistribution of transmembrane proteins into clusters or aggregates leading to "pore" formation. The "pores" permit the leakage of low molecular weight soluble compounds and ions acoss the membrane which is followed by osmotic rupture of the membrane.

Protection of crystal-induced polymorphonuclear leukocyte membranolysis by phosphocitrate.

The protection afforded by phosphocitrate, a phosphorylated polycarboxylic acid, against crystal-induced membrane damage to polymorphonuclear leukocytes was studied in vitro. Membranolysis was assessed by nitro blue tetrazolium salt reduction, lactate dehydrogenase release, and scanning electron microscopy. Phosphocitrate protected strongly against hydroxyapatite crystal-induced damage, an action attributable to crystal surface binding of phosphocitrate rather than to the membrane. The ability of phosphocitrate to prevent hydroxyapatite crystallization, together with its membrane protective effect against preformed crystals, would suggest that the compound might have a useful future role against crystal-induced arthropathies.

Interleukin 1 (IL 1) as a mediator of crystal arthritis. Stimulation of T cell and synovial fibroblast mitogenesis by urate crystal-induced IL 1.

We reported before that monosodium urate (MSU) crystals were potent stimulators of endogenous pyrogen (EP) production from human and rabbit mononuclear phagocytes, and proposed that this property of MSU crystals may be important in the pathogenesis of gout. EP activity is now attributed to interleukin 1 (IL 1) peptides but IL 1 is not the only pyrogenic monocyte-derived cytokine, since both interferon-alpha (alpha-IFN) and tumor necrosis factor (TNF) are also pyrogenic in rabbits. Using a T cell comitogenic assay based on a murine helper T cell clone that does not respond to IFN or TNF, we now report the release of IL 1 activity from human blood monocytes and synovial fluid mononuclear cells (MNC), following stimulation with MSU crystals. MSU-induced supernatants with IL 1 activity were neutralized with rabbit antiserum to human IL 1 and also stimulated the growth ([3H]thymidine incorporation) of long-term fibroblast-like cell lines derived from human synovial rheumatoid exudate. Two other crystals associated with articular inflammation were tested: hydroxyapatite was a much less potent stimulus compared with MSU crystals, and calcium pyrophosphate dihydrate did not stimulate IL 1 release from human monocytes or synovial fluid MNC. As a model for the inflammatory consequences of acute and chronic overproduction of IL 1, gout is the only sterile inflammatory disease where the local and systemic pathology is compatible with such overproduction; raised IL 1 levels have been found at the site of inflammation, and a necessary etiologic agent, crystalline urate, has been shown unequivocally to be a direct activator of mononuclear IL 1 release.

Crystal-induced inflammation in the rat subcutaneous air-pouch.

Monosodium urate (MSU) and calcium pyrophosphate dihydrate (CPPD) crystals initiated acute inflammatory reactions characterized by increased plasma extravasation and polymorphonuclear leukocyte (PMNL) accumulation in the rat subcutaneous air-pouch. Pretreatment of rats with colchicine (1 mg kg-1, s.c.) inhibited PMNL accumulation induced by either crystal type but had a greater inhibitory effect on MSU-induced plasma extravasation compared with that induced by CPPD crystals. Colchicine (1 mg kg-1, s.c.) did not reduce histamine-induced plasma extravasation in the air-pouch. The lipoxygenase product of arachidonic acid metabolism, leukotriene B4 (LTB4), was detected in MSU-induced exudates but not in CPPD-induced exudates. Pretreatment of rats with colchicine (1 mg kg-1, s.c.) inhibited LTB4 production in MSU-induced exudates.

Sequential study of pleural peritoneal and blood cells in acute pleurisy induced by calcium pyrophosphate in the rat.

We studied the sequential cellular events that occur during nonspecific pleurisy induced by a nondiffusible, nonantigenic and endotoxin-free irritant, calcium pyrophosphate (CaPP). The study was conducted over 10 days and concerned not only the pleural cavity but also the peritoneal cavity and the blood. After injection of CaPP, the first cellular event in the pleural space was a "leukocyte disappearance reaction," followed by an important increase in the polymorphonuclear leukocytes (PMN) and then by an increase in the macrophages. This phase is also characterized by the appearance of submesothelial nodules composed of macrophages and numerous polymorphonuclear cells. All the cell populations returned to their normal value on day 10, although granulomatous submesothelial nodules were present. In the blood, the principal observation was an increased PMN count associated with a decreased lymphocyte count at 4 h. In the peritoneal cavity, it was remarkable that, although functional modifications have been reported in the same model, the different leukocyte populations did not vary during the reaction.

Effects of sera and exudate from carrageenan-treated rats on two models of acute inflammation.

The air bleb has been studied as a cavity suitable for the production of a chronic inflammatory response. The ability of carrageenan and CPPD crystals to produce a chronic response in this cavity has been studied and the nature of the reaction described quantitatively and qualitatively. Carrageenan produced a fluid exudation predominated by mononuclear cells and histologically chronic in nature. However, CPPD failed to produce an inflammatory response apart from the formation of a few foreign body giant cells. Using the model described, experiments were undertaken to examine the ability of exudates and sera taken from animals undergoing either an acute or chronic reaction to modify two models of acute inflammation. Firstly the carrageenan complement dependent pleurisy and secondly the CPPD complement independent pleurisy. Volume of chronic and acute total cell numbers were reduced by chronic and acute exudates and sera on the carrageenan pleural model. No significant effect was on the CPPD pleural model.