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The Journal of Immunology, 2000, 165: 5255-5261.
Copyright © 2000 by The American Association of Immunologists

Fibrin(ogen)-Induced Expression of ICAM-1 and Chemokines in Human Synovial Fibroblasts1

Xiufang Liu* and Theresa H. Piela-Smith2,*,{dagger}

* Division of Rheumatology, University of Connecticut Health Center, Farmington, CT 06030; and {dagger} Research Service, Veterans Administration Connecticut Healthcare System, Newington, CT 06111


    Abstract
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
It has long been recognized that in most inflamed arthritic joints the coagulation system is activated, leading to the local generation of fibrin, and it has long been hypothesized that the local fibrin deposition promotes inflammation and tissue destruction. However, only recently has the direct effect of fibrin on the inflammatory process been seriously investigated, and specific roles assigned to fibrin or its products as mediators of the inflammatory process. Although fibrin and/or fibrinogen (fibrin(ogen)) is abundantly present in inflamed tissues and joints rich in fibroblastic cells, no significant data on fibrin(ogen)-induced gene expression by fibroblasts have been published. We now demonstrate that coculture of human synovial fibroblasts with fibrin(ogen) results in the up-regulation of ICAM-1 as well as increased production of the chemokines IL-8 and growth-related oncogene-{alpha}. Increased ICAM-1 expression was fibrin(ogen) dose-dependent and was demonstrated by ELISA, flow cytometry, and functional adhesion assays. Levels of ICAM-1 induced by fibrin(ogen) were comparable to those that could be induced by cytokine stimulation. Fibrin(ogen) stimulation of ICAM-1 could be suppressed by pyrrolidinedithiocarbamate, an inhibitor of NF-{kappa}B activation. Chemokine production was induced by fibrin(ogen) in cell culture supernatants >100-fold as compared with controls. Thus, through its activation of synovial fibroblasts, fibrin(ogen) deposition may promote the recruitment (via chemokines) and retention (via adhesion molecules) of lymphocytes within the arthritic joint.


    Introduction
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Fibrin deposition, long recognized as a hallmark of acute and chronic inflammatory processes, has been localized within various inflamed tissues by histological, ultrastructural, and immunofluorescent procedures (1, 2). A common theme of many studies is the suggestion that fibrin plays an active role in the induction of inflammation and can function beyond its classic role as a hemostatic plug or temporary matrix in response to injury (3, 4, 5, 6, 7, 8). However, only recently has the direct impact of fibrin metabolism on the inflammatory process been seriously investigated, and specific roles assigned to fibrin or its products as mediators of the process (9, 10, 11, 12).

Our laboratory has previously focused on cytokine pathways of adhesion molecule induction and adhesion molecule-related mechanisms thought to be of importance in connective tissue diseases such as rheumatoid arthritis (RA).3 In this disease, evidence for altered fibrinolysis has been demonstrated, for example, in plasma and synovial fluids in RA (13, 14). It has long been recognized that in most inflamed joints the coagulation system is activated, leading to the local generation of fibrin (15), and it has been hypothesized that the local fibrin deposition in arthritic joints could promote inflammation and destruction (16). Indeed, animal studies in which fibrin is implanted locally within joints induces a reaction that resembles human RA (17). More recent animal studies have shown that synovial fibrin deposition can sustain chronic arthritis. For example, Ag-induced arthritis in transgenic urokinase-deficient mice had more severe inflammation of longer duration, increased synovial thickness and bone erosions, and increased accumulation of fibrin as compared with controls (18). A double blind clinical trial of stanozolol (enhances both systemic and intra-articular fibrinolytic activity) in RA patients (19) resulted in clinical benefit, i.e., decrease in erythrocyte sedimentation rate, improvement in articular index, decreased duration of morning stiffness, decrease in pain, and decreased plasma fibrinogen concentrations. It was felt by these authors that the clinical improvement likely could have been due to the induced reduction of synovial fibrin. Additional studies have attempted to correlate associations between synovial fibrinolysis and levels of joint destruction in RA (20), a disease in which resident fibroblasts (FB) appear to play a crucial role. However, to our knowledge, direct effects of fibrin and/or fibrinogen (fibrin(ogen)) on FB have not been previously examined with regard to the generation and/or maintenance of inflammation within connective tissue. We used an in vitro assay to mimic fibrin(ogen) deposition on human synovial FB cultures derived from patients with RA. Our results suggest that the ability of fibrin(ogen) to induce adhesion molecule expression and potent chemokine production in human synovial FB may be a new and underappreciated pathway of inflammation occurring within the rheumatoid joint.


    Materials and Methods
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
RA synovial cell cultures

Human RA synovial tissue samples were obtained from patients undergoing joint replacement surgery at the University of Connecticut Health Center according to an Institutional Review Board-approved protocol. Tissues were minced and digested with 0.2% collagenase (Worthington type 1; Freehold, NJ) for 30–40 min at 37°C with agitation. Debris was allowed to settle and the supernatant containing single cells and small clusters was centrifuged to pellet the remaining cells. The cell pellets were washed two times with RPMI medium (Life Technologies, Grand Island, NY) containing 10% FCS (HyClone, Logan, UT), supplemented with 100 U/ml penicillin, 100 µg/ml streptomycin, and 2 mM L-glutamine. The synovial cells were seeded into 100-mm plastic tissue culture dishes (Costar, Cambridge, MA) and grown to confluence in the same medium. The outgrowth of FB-like synoviocytes are referred to as synovial FB cells. More than eight independently derived synovial cell lines were used for this study, and lines were used between passages 2 and 10.

ICAM-1 ELISA

The ELISA for determination of cell surface ICAM-1 expression was performed as described by us previously (21) in 96-well plates. Confluent cultures of synovial cells were stimulated with fibrinogen or other factors as indicated in the text. After stimulation, cells were incubated with Ab to ICAM-1 (CD54) (RR1/1, a gift of Dr. T. Springer, Center for Blood Research, Boston, MA, or clone 15.2, purchased from Leinco, St. Louis, MO). Similar experimental data were obtained using Ab obtained from either source. Secondary Ab was HRP-conjugated goat anti-mouse IgG from Organon Teknika (Durham, NC). The substrate used was ortho-phenylenediamine in phosphate-citrate buffer, pH 5.0. Color development was terminated after ~10–15 min of incubation by the addition of 2 M H2SO4. Absorbance at 492 nm was determined by using a Dynatech ELISA reader (MR 700; Dynatech Laboratories, Chantilly, VA). Background absorbance was determined using an isotype-matched mAb to murine CMV (a gift of Dr. J. Shanley, University of Connecticut Health Center, Farmington, CT). ELISA data are presented as the mean ± SD of triplicate determinations.

Flow cytometry

Cytometric analysis of synovial FB was performed as described previously (21, 22). Briefly, ICAM-1-specific fluorescence was assessed by staining the FB with mAb to ICAM-1 (RR1/1 or clone 15.2) followed by FITC anti-Ig (Organon Teknika). Nonspecific fluorescence was assessed by staining with irrelevant isotype-matched mAb followed by FITC anti-Ig. Samples were analyzed with a Coulter Epics Profile II flow cytometer (Coulter Electronics, Hialeah, FL).

Positive regions were set to exclude 97% of nonspecifically stained cells. Cells were analyzed by selective gating on the parameters of forward and 90° light scatter. Ag density was indirectly determined by assessing the mean fluorescence channel (MFC) of the samples. As possible, a minimum of 10,000 cells per sample was analyzed.

Preparation of human lymphocytes

PBMC were obtained from normal, healthy donors of both sexes and prepared by Ficoll-diatrizoate (Sigma, St. Louis, MO) centrifugation and passage through a nylon wool column (23). Nonadherent cells were depleted of residual monocytes by a brief treatment with 5 mM L-leucine methyl ester (24). This T cell-enriched population (>98% OKT3+ cells, <0.5% monocytes) was used as the source of cells for adherence studies.

Cell-cell adhesion assay

Details of the cell adherence assay have been described previously (21, 22). Briefly, monolayers of confluent synovial FB in 96-well plates were incubated at 37°C with various control or experimental factors as described in the text. At the end of incubation, factors were removed and cell layers were washed with medium or warm PBS before the addition of 100 µl of a suspension containing 3 x 106 T cells/ml. After an incubation period of 1 h at 37°C, nonadherent T cells were removed by repeated gentle washing of the monolayers with warm PBS and aspiration using a blunted 21-gauge needle. Where indicated in the text, mAb were added to FB cultures for 60 min at 37°C, followed by washing of the cell layer before the addition of T cells.

Quantitation of adherent T cells was obtained by microscopic examination after the monolayers were air dried and stained with 1% methylene blue. Two random fields in each well were counted using an ocular grid; fields were selected away from the edges of the well where washing may have been incomplete in removing nonadherent lymphocytes. Adhesion is expressed as the number of adherent lymphocytes per grid. Each experiment was performed with triplicate cultures, and results are expressed as mean ± SD.

Reagents

Purified human fibrinogen (95% clottable) was purchased from Sigma Diagnostics (St. Louis, MO). Fibrinogen purity was assessed by SDS-PAGE followed by silver staining and was observed to be undegraded and free of contaminating proteins. For use in experiments, fibrinogen concentrations were prepared in chemically defined serum-free medium (AIM V; Life Technologies), and the cell cultures were maintained in the same serum-free medium. Purified human thrombin (T6634), plasmin (P7911), and pyrrolidinedithiocarbamate (PDTC) were obtained from Sigma. Polymerized native type 1 collagen gels (Vitrogen 100; Collagen Aesthetics, Palo Alto, CA ) were prepared as described by Delvos et al. (25). Low melting point agarose was obtained from Life Technologies. Human rIL-1ß was purchased from Genome Therapeutics (Bedford, MA). Human TNF-{alpha} was obtained from R&D Systems (Minneapolis, MN). Human recombinant IFN-{gamma} (activity 1.6 x 104 U/µg) was obtained from Biogen (Cambridge, MA). Kits for the determination of the chemokines IL-8 (sensitivity <10 pg/ml), growth-related oncogene-{alpha} (GRO-{alpha}; sensitivity <5 pg/ml), and IL-1ß (sensitivity <0.3 pg/ml) in culture supernatants were purchased from R&D Systems.


    Results
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Fibrin(ogen) induces ICAM-1 expression in human synovial FB

The ability of fibrin(ogen) to induce ICAM-1 surface expression in synovial FB was initially evaluated by ELISA. FB monolayers were grown to confluence in 96-well plates. Freshly prepared, human fibrinogen (FGN) was added to the cultures, and the cells were incubated overnight at 37°C before beginning the ELISA. Table IGo shows that incubation of three different human synovial FB lines with fibrinogen led to an increase in the surface expression of ICAM-1. The increase in ICAM-1 caused by FGN was usually comparable to that which could be induced by incubation with the cytokine IFN-{gamma}, a known inducer of ICAM-1 for these cells.


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Table I. Fibrinogen induces ICAM-1 on synovial FB1

 
To determine whether the ICAM-1 response to FGN was dose dependent, FB monolayers were incubated overnight with varying concentrations of FGN (from 1.2 mg/ml to 1.0 µg/ml). Fig. 1Go shows a dose-dependent increase in synovial FB expression of ICAM-1 as the concentration of FGN was increased. The highest concentration of FGN used (1.2 mg/ml) could induce a >5-fold increase in the baseline expression of ICAM-1. As little as 0.01 mg/ml produced a 50% increase in baseline expression. Concentrations of FGN <0.01 mg/ml did not significantly alter the baseline expression of ICAM-1.



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FIGURE 1. FGN dose-dependent ICAM-1 expression in synovial FB. FB were cultured overnight with various concentrations (1.2–0.001 mg/ml) of FGN. IFN-{gamma} (200 U/ml) was used as a positive control. Surface ICAM-1 expression was determined by ELISA. Results are presented as a percentage of control (untreated) cultures. Baseline expression of ICAM-1 (OD492) was 0.15 ± 0.03. Data shown are representative of three separate experiments.

 
FGN-induced FB ICAM-1 expression was further assessed by flow cytometry. The percentage of synovial cells expressing baseline ICAM-1 (control medium) varied with the cell line used. However, as shown in Table IIGo, with each line tested, we observed that incubation with FGN led to both an increase in the number of cells expressing ICAM-1 and/or an increase in the MFC of the samples (MFC is in log scale), indicating an increase of ICAM-1 density on a per cell basis as well.


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Table II. Flow cytometric analysis of FGN-stimulated synovial FB1

 
Addition of thrombin to FGN does not influence the induction of ICAM-1 by FGN alone

We previously reported that polymerized fibrin, but not unpolymerized FGN, could induce adhesion molecule expression on human vascular endothelial cells (26). Therefore, we wanted to assess the effect of the addition of thrombin to our FGN synovial cell coculture. As thrombin itself has been implicated in the up-regulation of adhesion molecules in other in vitro cell assays (27, 28), we first performed a thrombin titration experiment to examine such direct effects in our assay. In our previous studies on endothelial cells, we used 0.24 U/ml of purified human thrombin to polymerize the equivalent concentrations of FGN used here in our synovial cell study. Fig. 2Go shows clearly that this amount of thrombin in our synovial cell cultures had no direct effect on ICAM-1 expression. Indeed, no effect on ICAM-1 expression was noted when up to a 40-fold increase in this amount of thrombin was used. We then compared the ability of FGN and the combination of FGN plus thrombin (to promote FGN polymerization to fibrin clot) to induce ICAM-1 on the synovial cells. We incubated several lines of synovial cells with FGN (0.6 and 0.3 mg/ml) or with the same concentrations of FGN with added thrombin (0.24 U/ml) to induce polymerization of the FGN. Visible polymerization of the FGN was usually evident in the culture wells within the first 30 min following thrombin addition. After an overnight incubation at 37°C, all reagents and the loosely adherent fibrin clots were removed by aspiration and the cells were washed twice with medium. Visual inspection of the cell monolayers was performed to assess that the monolayers remained intact following clot and reagent removal. ICAM-1 expression of the synovial cells was determined by ELISA. Table IIIGo shows that the levels of ICAM-1 induced by the combination of FGN and thrombin was not significantly different from the levels of ICAM-1 observed with FGN alone. We observed a tendency for the cultures receiving both FGN and thrombin to display somewhat lower ICAM-1 values by ELISA. These culture wells contained the semisolid clots that formed contacts with the cell monolayer, albeit loosely, and some cell loss could occasionally be noted following clot removal. This could have contributed to the slightly lower values obtained. Therefore, we used flow cytometry to eliminate this source of variability to examine further whether the addition of thrombin could influence FGN-induced ICAM-1 expression. As shown in Table IVGo, using cytometry, we observed no significant decrease or increase in the expression of ICAM-1 induced by FGN as compared with the FGN and thrombin combination. Cytometry also confirmed our earlier ELISA results that baseline expression of ICAM-1 remained stable in the presence of thrombin alone.



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FIGURE 2. Thrombin does not increase ICAM-1 expression in human synovial FB. FB were cultured overnight with control medium (C, negative control) or medium containing FGN (1.2 mg/ml), IFN-{gamma} (200 U/ml, positive control), or thrombin as indicated. After overnight incubation, ICAM-1 expression of the synovial cells was assayed by ELISA. The experiment shown is representative of three individual cell lines tested.

 

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Table III. Polymerization of FGN with thrombin does not alter ICAM-1 expression induced by FGN alone1

 

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Table IV. Polymerization of FGN with thrombin does not alter ICAM-1 expression induced by FGN alone1

 
The possibility existed that FGN incubation with the synovial cells could have resulted in some polymerization to fibrin in the absence of a visual clot. Even though FGN incubation with the synovial cells was performed using serum-free medium to lessen the chances of FGN degradation and polymerization, it was possible that factors such as thrombin-like proteases, known to be released from synovial cells (29), could have caused small amounts of polymerization to occur close to the cell surface. Thus it was possible that nonspecific "matrix"-associated effects such as mechanical pressure, gel contraction, and impaired diffusion of metabolites and/or oxygen could be responsible for the increased ICAM-1 expression of the cells. Therefore, we polymerized either native type 1 collagen gels (Vitrogen 100) or agarose (low melting point; Life Technologies) on cultures of three separate synovial FB cell lines. The concentrations of these matrices were prepared using the same concentrations as those of the FGN used. Visually, these polymerized substances also had a consistency similar to clots prepared with FGN and thrombin. Fig. 3Go shows that synovial cell incubation with agarose or collagen gels did not induce a strong up-regulation of ICAM-1, in contrast to the effect observed in synovial cultures incubated with equal concentrations of FGN. In addition, in an effort to reduce or eliminate possible effects of endogenous protease production by the synovial cells, we preincubated cultures with the following protease inhibitors (40–1 µg/ml) for 30 min to 1 h before the addition of FGN: benzamidine, soybean trypsin inhibitor, PMSF, leupeptin, iodoacetamide, and aprotinin. ICAM-1 expression induced by FGN, as determined by ELISA, was unchanged by the addition of these inhibitors as compared with identical cultures prepared in the absence of the inhibitors (data not shown).



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FIGURE 3. Effect of nonspecific "matrix" on synovial cell ICAM-1 expression. ICAM-1 expression of three separate synovial lines stimulated with FGN was compared with that of cells stimulated with agarose or fibrillar collagen by in situ polymerization. After overnight incubation, ICAM-1 expression was assayed by ELISA. Data from all three separate cell lines are presented.

 
Fibrin(ogen) induces increased T cell adhesion to synovial FB

We examined whether the increase in ICAM-1 expression induced in the synovial FB by FGN would correlate with a functional increase in the adhesion of human T lymphocytes. Synovial FB were plated in 96-well culture plates and allowed to reach confluence. After an overnight incubation with FGN, the cultures were washed and a suspension of T cells was added (100 µl containing 3 x 105 T cells) to each well, and the cultures were incubated for an additional hour at 37°C to allow the T cells to settle onto the monolayer. Cells were again washed with warm medium or PBS to remove nonadherent T cells. After drying and staining, numbers of adherent T cells were counted under a microscope using an ocular grid. The cytokine IFN-{gamma} was used as a positive control for increased T cell adhesion to the synovial FB.

FGN-stimulated FB increased their adhesiveness for T lymphocytes over that of the unstimulated control cells (baseline adherent T cells/grid was 81 ± 5 compared with 215 ± 21 for FGN treatment) (Fig. 4Go). We considered the possibility that the increase in adhesion we observed may be due, in part, to nonspecific attachment of the T cells to the FGN-treated FB, and possibly to nonspecific attachment to residual FGN itself, for the following reasons: 1) FGN, by nature, is a "sticky" substance, which may not be completely removed from the synovial monolayers by washing (indeed, we obtained immunohistochemical evidence of small amounts of residual FGN remaining in the culture wells after washing using FGN-specific Abs) and 2) it has been previously shown by D’Souza et al. that FGN may itself directly bind to ICAM-1 on Raji cell surfaces (30). Such directly bound FGN (if it occurs on synovial cells) may provide a nonspecific substrate for the T cells in our assay. We determined that after removal of FGN by aspiration and washing, any residual FGN could be completely removed (as assayed by immunohistochemistry) by a 1-h treatment of the washed cultures with 1 U/ml of purified plasmin. As shown in Fig. 4Go, cells stimulated with FGN and followed by a 1-h plasmin treatment to remove residual FGN before the addition of T cells displayed a similar increase in adhesion as was observed in the absence of plasmin. Control experiments demonstrated that the plasmin treatment did not affect either the baseline levels of adhesion or the level of increased adhesion due to stimulation of the cells with IFN-{gamma}. To more directly determine the role of specificity in our adhesion assay, replicate experimental cultures were pretreated with adhesion-blocking Ab to ICAM-1 (Leinco) for 1 h before the addition of T cells. The inclusion of the Ab confirmed that the increase in adhesion we observed in FGN-treated cells was, in part, truly ICAM-1 dependent. As inclusion of blocking Ab to ICAM-1 did not reduce the FGN-stimulated adhesion fully to baseline levels, FGN, as is already known for IFN-{gamma}, may also induce the expression of additional adhesion molecules on synovial FB.



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FIGURE 4. T cell adhesion to fibrinogen-stimulated synovial FB. Synovial FB cultures were treated with medium alone (control, C) or medium containing IFN-{gamma} (200 U/ml), or 0.6 mg/ml FGN. After overnight incubation, cultures were washed and subsequently incubated with 1 U/ml plasmin where indicated. After further washing, T cells were added for 1 h and nonadherent T cells were removed by washing. Where indicated, anti-ICAM-1 was used to pretreat the FB immediately before the addition of T cells. Results are expressed as the number of adherent T cells per grid (mean ± SD) as described in Materials and Methods.

 
PDTC inhibits ICAM-1 induction by fibrinogen

PDTC is an antioxidant that prevents both NF-{kappa}B activation and translocation to the nucleus (31, 32), and has been used to demonstrate a role for NF-{kappa}B signaling in ICAM-1 expression in cytokine-treated cells such as FB (33). We pretreated synovial FB with 25 µM PDTC for 1 h before stimulating the cells with either FGN or IL-1 to induce ICAM-1 synthesis. As expected, pretreatment of FB with PDTC inhibited the increase in ICAM-1 expression induced by the cytokine IL-1 (Table VGo). Similarly, PDTC was able to inhibit the increase in ICAM-1 expression induced by FGN. These results imply a mechanistic role for NF-{kappa}B in the induction of ICAM-1 in synovial FB promoted by FGN.


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Table V. PDTC inhibits ICAM-1 upregulation by fibrinogen1

 
Fibrin(ogen) induces chemokine secretion from synovial FB

Fibrinogen has been shown to induce the production of the chemokine IL-8 in addition to ICAM-1 in human endothelial cells (25, 34). We investigated the possibility of IL-8 induction by FGN stimulation of the synovial FB by examining culture supernatants for the presence of IL-8 by using a commercial ELISA kit. Supernatants were collected from 96-well cultures of three different synovial cell lines that had been incubated overnight in medium alone (control) or in medium containing 0.3 mg/ml FGN. Table VIGo shows that FGN was able to induce significant amounts of IL-8 secretion into the supernatants of all three lines. In two of the three lines tested, baseline IL-8 production was undetectable, yet increased to 5500 and 6500 pg/ml with overnight FGN exposure. The third line tested also reached similar levels of FGN-induced IL-8 secretion, up from a baseline value of 750 pg/ml. As also shown in Table VIGo, FGN stimulated the production of GRO-{alpha} into the culture supernatants well over 100-fold over the unstimulated levels. IL-1 was not detected in the culture supernatants of either control or FGN-stimulated cultures. Stimulation of the synovial cells by TNF-{alpha} and IFN-{gamma} is included for comparison.


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Table VI. Fibrinogen stimulation of synovial cells induces IL-8 and GRO-{alpha} secretion1

 

    Discussion
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Fibrinogen is a large glycoprotein of ~340 kDa, and occurs in normal plasma at concentrations of ~3 mg/ml. Because fibrinogen is also an acute phase reactant, levels in the plasma can rise as high as 7 mg/ml in some diseases (35). In both acute and chronic inflammatory reactions, fibrin deposition and leukocyte accumulation are classic histopathologic hallmarks. The interrelationship between fibrin deposition and leukocyte accumulation is just beginning to be examined in such instances.

In the chronic inflammatory setting of RA, synovial hyperplasia, inflammatory cell recruitment, and intra-articular fibrin deposition are important features of the disease (36). Although normal synovial fluid does not contain fibrinogen (37), many studies attest to the presence of an abundance of fibrinogen as well as fibrinogen fragments, breakdown products, and coagulation-associated factors in both the synovial fluids and tissues of patients with RA (indicative of the complex coagulopathy that exists in RA; Refs. 28, 38, 39, 40, 41). Quantitative studies of fibrinogen antigenic proteins in synovial fluid have correlated higher levels of these substances with higher inflammatory indices (38, 39, 42). A suspected role for fibrin in the pathogenesis of the disease is supported by many studies beginning with the early demonstration that chronic arthritis could be induced in rabbits by intra-articular fibrin injection (43). Fibrin(ogen) and its breakdown products of liberated chains and fragments are beginning to be identified as specific mediators of cellular processes (44, 45, 46, 47) and are now suspected to play active roles in the induction and maintenance of inflammatory conditions (16, 17, 18, 19, 20, 25, 34).

We and others have previously reported that fibrin deposition onto endothelial cell monolayers in vitro resulted in the increased expression of cell adhesion molecules as well as enhanced IL-8 production (25, 34), proposing an active role for intravascular fibrin deposition in leukocyte recruitment and retention. As prominent adhesion molecule expression, leukocyte accumulation, and fibrin(ogen) deposition are all important features of inflammatory RA, we similarly investigated whether fibrin(ogen) deposition in vitro on synovial FB from patients with RA would also lead to increased adhesion molecule expression and/or chemokine production.

We were able to demonstrate by using ELISA, flow cytometry, and functional adhesion assays that fibrin(ogen) coculture with human synovial FB resulted in the up-regulation of ICAM-1, a key component of inflammation in the rheumatic joint. By flow cytometry, we determined that some synovial cell lines increased their expression of ICAM-1 in two ways, an increase in the percentage of cells displaying surface ICAM-1, as well as an increase in the surface density of ICAM-1. Cell lines that initially contained a high percentage of ICAM-1-expressing cells (>96%) responded primarily by an increase in their surface density of ICAM-1. By the use of cell-cell adhesion assays, we determined that the increase in ICAM-1 correlated with an increase in the adhesive capacity of the synovial FB for T cells, an increase that could largely, but not completely, be inhibited by Ab to ICAM-1. Therefore, we hypothesize that fibrin(ogen) may induce additional adhesion molecules on the synovial FB.

We showed earlier that polymerization of fibrinogen to fibrin was necessary for the induction of ICAM-1 on endothelial cells (25). Sporn et al. (44) showed that fibrin prepared by thrombin cleavage resulted in maximal proliferation of human endothelial cells and FB when cultured on fibrin(ogen) surfaces. Inclusion of thrombin to polymerize fibrinogen did not appreciably alter our findings of increased ICAM-1 on synovial cells. Thrombin itself can alter many cell functions such as adhesion molecule expression and chemotaxis, and can produce mitogenic effects (26, 27, 48); however, at the concentrations tested in our assays, thrombin was not an effective stimulator of ICAM-1. However, we needed to consider that synovial cells, especially those derived from patients with active disease, can secrete a variety of proteases, including thrombin-like proteases, that could have fibrinolytic effects (28, 41), resulting in a layer of polymerized fibrin occurring close to the cell surface, thereby necessitating our use of the term fibrin(ogen). This polymerized layer could have altered cell functions by such nonspecific means as physical gel contraction, mechanical pressure, or impaired oxygen or nutrient diffusion. Experiments in which we polymerized native collagen and agarose gels while these substances were in contact with the synovial cells were without effect on ICAM-1 expression and argue against such a nonspecific mechanism. However, our experiments using various protease inhibitors notwithstanding, we have not eliminated the possibility that fibrinogen polymerization at the cell surface due to endogenous proteases may be a specific mechanism by which the effects we observed on synovial cells occurred. Harley et al. have recently reported that cleavage of fibrinopeptide B from the B/ß chain of fibrinogen by endogenous urokinase plasminogen activator on endothelial cells permits the exposure of a previously sequestered amino acid sequence that alone can up-regulate the expression of ICAM-1 on these cells (42). We have also observed that certain internal sequences of the A/{alpha} chain of fibrinogen, which may become exposed during fibrinogenesis, can increase the ICAM-1 expression on synovial FB (X. Liu and T. H. Piela-Smith, manuscript in preparation). However, it must be remembered that in vivo, intact fibrinogen as well as fibrin monomers, polymerized fibrin, fibrin fragments of various sizes, and "fibrin-like material," are all found associated with synovial fluids and tissues as well as numerous activators and inhibitors of fibrinolysis (28, 38, 39, 40, 41). Precise substrate(s) responsible for synovial cell activation are likely complex and remain to be identified.

Induction of synovial ICAM-1 by fibrin(ogen) was inhibited by PDTC, an antioxidant that prevents NF-{kappa}B activation and its translocation to the nucleus (31, 32). NF-{kappa}B is well known to affect a broad array of immediate-early gene products such as TNF, ILs, chemokines, and CSFs, genes that are tightly regulated during inflammation and wound healing. ICAM-1 expression by human tracheal smooth muscle cells is dependent upon NF-{kappa}B, and PDTC has been shown to inhibit the up-regulation of ICAM-1 on human FB stimulated by IL-1ß, IFN-{gamma}, and PMA (33, 49). Our experiments suggest the addition of fibrin(ogen) to this list of PDTC-sensitive inducers of FB ICAM-1.

The secretion of potent chemotactic factors by synovial cells is thought be an important mechanism by which lymphocyte recruitment occurs in the inflamed joint. Elevated levels of the chemokines IL-8, monocyte chemoattractant protein-1, and RANTES are detected in the synovial tissue of RA patients but not in normal synovial tissues, and can be detected in the supernatants of in vitro cultures of synovial FB derived from RA patients (50, 51). We found that stimulation of the synovial FB with fibrin(ogen) resulted in the enhanced production of the chemokines IL-8 and GRO-{alpha}.

Because the genesis of immune reactions is largely at fixed tissue sites that are rich in FB, an understanding of the processes involved in lymphocyte recruitment, localization, and residence at these sites is critical not only in normal inflammation, but in chronic inflammatory conditions in which FB/lymphocyte interactions are thought to be pathogenic, such as in RA. Our results demonstrating that fibrin(ogen) deposition on synovial FB can enhance the expression of adhesion molecules and lymphocyte chemotactic factors add further information supporting earlier findings that indirectly suggested a role for fibrin(ogen) in the promotion of inflammation. Synovial FB are in direct contact with extravascular spaces or compartments where fibrin can be formed, and could be expected to undergo such activation. We hypothesize that, in vivo, fibrin(ogen)-induced activation of synovial FB (through induction of adhesion molecules and chemokine production), could lead to the recruitment, activation, attachment, and retention of lymphocytes, all of which occur to a tremendous degree in the chronically inflamed joint.


    Acknowledgments
 
We thank Stephan Thibodeau for excellent technical assistance.


    Footnotes
 
1 This work was supported by grants from the Veterans Administration Merit Review Program (to T.P.-S.) and from the National Arthritis Foundation (to T.P.-S). Back

2 Address correspondence and reprint requests to Dr. Theresa H. Piela-Smith, Veterans Administration Connecticut Health Care System, Research Building 5, 555 Willard Avenue, Newington, CT 06111. Back

3 Abbreviations used in this paper: RA, rheumatoid arthritis; PDTC, pyrrolidinedithiocarbamate; GRO-{alpha}, growth-related oncogene-{alpha}; FB, fibroblast(s); fibrin(ogen), fibrin and/or fibrinogen; MFC, mean fluorescence channel; FGN, human fibrinogen. Back

Received for publication April 6, 2000. Accepted for publication August 10, 2000.


    References
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

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