Abstract
Background: Inflammatory mediators released during synovitis, including S100A8 and -9, have been implicated in the regulation of pain. S100A8 and -9 may regulate pain either via direct stimulation of TLR4 on the nerve endings in the synovium or via stimulation at the site of the dorsal root ganglia (DRG), thereby inducing local inflammation which may cause sensitization. Objectives: We aimed to elucidate the role of S100A9 in the pain response after induction of an acute synovitis using streptococcal cell walls (SCW) as a trigger, comparing S100A9-/- mice and their WT controls. Methods: Synovial biopsies of 25 patients with early symptomatic OA were studied by micro-array analysis and subsequent functional annotation clustering (FAC). Patients with pain at t=5 years after biopsy isolation were compared to those without pain. Acute synovitis was induced by a single i.a. injection of SCW in the knee joint of C57Bl6 (WT) mice and S100A9-/- mice, control mice received an i.a. saline injection. Serum S100A8/A9 levels were investigated by ELISA and expression of S100A8 and S100A9 in synovium and DRG by immunohistochemistry (IHC). Joint swelling and cell influx was assessed by 99mTc accumulation and histology, respectively. Pain response were investigated Incapacitance Tester (weight bearing), Catwalk (gait analysis) and von Frey’s filaments (mechanical allodynia). Gene expression of inflammatory mediators and neuron activation markers in DRG were determined by q-PCR. Monocyte influx and protein expression of NAV1.7 and GAP43 was monitored by IHC. Results: In synovial biopsies of early symptomatic OA patients, approximately 750 genes were upregulated in patients that had pain 5 years after inclusion compared to patients without pain. FAC showed that inflammatory genes were highly significantly enriched (p=6,4*10-12). Among the upregulated genes were the alarmins S100A8 and S100A9. In mice, a single i.a. injection of SCW resulted in increased synovial expression of S100A8 and S100A9 and subsequent increased serum S100A8/A9 levels (2.6-fold, P Conclusion: These findings show that S100A9, which is released from the synovium upon inflammation, is an important mediator of inflammatory nociceptive pain response in the knee, rather than by being involved in peripheral sensitization. In acute inflammation S100A8/A9 is likely regulated via direct activation of TLR4 on nerve endings in the synovium. Disclosure of Interests: None declared
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