Purpose: Joint trauma is a risk factor for osteoarthritis (OA), and about 50% of patients with ACL or meniscal injury develop posttraumatic OA (PTOA) within 10-20 years. The acute response to joint trauma increases transcription of pro-inflammatory cytokines and proteinases such as matrix metalloproteinases (MMPs), which trigger the onset of OA changes. Bromodomain protein 4 (Brd4) and cyclin-dependent kinase 9 (CDK9) control the rate-limiting step of the transcription of primary response genes, including most pro-inflammatory genes, by positively regulating mRNA elongation with phosphorylating and releasing the RNA polymerase II. The purpose of this study is to investigate the effects of small molecule inhibitors of Brd4 (JQ1) and CDK9 (Flavopiridol) on the activation of inflammatory genes using chondrocytes and cartilage tissue under inflammatory stimuli, and a mouse PTOA model. Methods: • Treatment of chondrocytes Human chondrocytes were cultured 5 hours with inflammatory stimuli (either 10ng/ml IL1b, 10ng/ml TNFa, or 100ng/ml IL6 and 60ng/ml IL6 receptor), with or without drugs. Treatment conditions were: 1) vehicle only (Ctrl), 2) no drug with cytokine, 3) Hi JQ1 (1200nM) with cytokine, 4) Hi Flavopiridol (250nM) with cytokine, 5) Combination of Lo JQ1 (250nM) and Lo Flavopiridol (60nM) with cytokine. Total RNA was extracted and analyzed by real time RT-PCR and microarray. • Treatment of cartilage explants Bovine cartilage explants were isolated and randomly assigned to 5 groups cultured as described above, with the cytokine being 10ng/ml IL1b. Glycosaminoglycan (GAG) released into the culture media was measured. • PTOA animal model The right knees of mice were injured with a mechanical compression, which causes rupture of the anterior cruciate ligament and leads to PTOA. Immediately after injury, mice were treated daily with JQ1 and/or Flavopiridol. Treatment conditions were: 1) vehicle only (Ctrl), 2) Hi JQ1 (50mg/kg), 3) Hi Flavopiridol (7.5mg/kg), 4) Combination of Lo JQ1 (17mg/kg) and Lo Flavopiridol (2.5mg/kg) Flavopiridol. • MMPSense Assay To assess MMP activity, MMPSense 750 was injected to mice and the intensity of signal from the MMPSense in the knees was measured by in vivo imaging. Results: • The mRNA expression levels of pro-inflammatory genes (iNOS, Cox2) and catabolic genes (MMP-1, -3, -9, and -13, and ADAMTS4) were significantly induced by all 3 inflammatory cytokines, and this induction was suppressed by all 3 drug treatments. The combination of both drugs at lower doses suppressed gene expression similarly or more strongly than single high doses of each individual drug. • Microarray showed that expression, 873 genes were induced >1.5-fold by IL1b compared to baseline. IL-1b treatment in the presence of either JQ1 or Flavopiridol alone prevented the induction of many genes. However, a combination of both drugs prevented the induction of most IL-1b response genes. (Fig.1) • IL1b treatment of cartilage explants induced significant release of GAG within 3-6 days. GAG release was effectively prevented when IL-1b treatment in the presence of either or both drugs. (Fig2) • In PTOA mouse model, knee injury caused significant increases of IL1b and IL6 expression in the injured joint. All 3 treatments showed effect to prevent increases of these cytokines and drug combination was more effective than single drugs. (Fig3A, B) MMP activity in injured knee was suppressed by all 3 treatment similarly at 24h and 48h after injury. (Fig3C, D) Conclusions: JQ1 and Flavopiridol are each able to effectively repress a panel of pro-inflammatory and catabolic genes in chondrocytes induced by inflammatory stimulus. We found that the combination of the 2 drugs showed a synergistic interaction, with similar or better repression achieved at reduced drug doses. Although previous reports indicated that Brd4 and CDK9 control mRNA transcription by regulating a common checkpoint, microarray analysis showed that there were also inflammatory genes only affected by each drug individually. Ex vivo and in vivo study also demonstrated the combination of lower dose of the drugs has similar or better intensity of effect. This indicates that using both drugs together may be able to suppress inflammation after trauma with preventing side effects induced by overdose, leading to novel treatment for PTOA.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)
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