In spite of advances and refinements in surgical technique, the development of post-traumatic arthritis following osteochondral injury remains one of the major unsolved problems faced by orthopedic surgeons. Of particular interest is the possibility that chondrocyte programmed cell death (PCD), or ‘apoptosis’, contributes to the subsequent development of post-traumatic arthritis 1–5 . Recent studies have shown that inhibitors of caspases, key enzymes in the apoptosis pathway, can block chondrocyte PCD in vitro 4–7 . The goal of the presented study was to test the hypothesis that short-term, intra-articular caspase inhibitor treatment can limit chondrocyte PCD in vivo following acute osteochondral injury. Adult New Zealand white rabbits underwent experimental osteochondral injury. One group of rabbits received daily intra-articular injections of the broadspectrum caspase inhibitor Z-VAD-fmk. A control group of rabbits received daily intra-articular injections of vehicle alone. After four days of treatment, the articular cartilage was analyzed for chondrocyte PCD. Treatment with Z-VADfmk resulted in a marked reduction in the percentage of chondrocytes undergoing PCD compared to controls [treated=7.4±1.8%; controls=32.5±8.6% (P<0.0001 by student’s t-test)]. The degree of PCD inhibition was dependent upon the distance from the site of injury, with levels of PCD reduced to background levels in areas beyond 1 mm from the drill hole. These results suggest that the intraarticular administration of PCD inhibitors may be a useful strategy for the treatment of osteochondral injury by limiting the extent of articular chondrocyte loss due to apoptosis. For these experiments, a drill with a cooled 2 mm bit was used to create osteochondral injuries in the hind limb femoral condyles of adult rabbits. The injuries were created in the weight bearing portions of the condyles and penetrated into the subchondral bone. Following surgery, five animals received daily intra-articular injections of the caspase inhibitor Z-VAD-fmk (100 µM in 0.1% DMSO, 0.5 cc; Calbiochem, CA) delivered via an indwelling catheter. A control group of five rabbits received daily intra-articular injections of vehicle alone. The knee tissue was harvested on post-injury day 4, decalcified in EDTA, embedded in paraffin, and then sectioned in the sagittal plane at 5 µm thickness for further analysis. Chondrocyte apoptosis was quantified by TUNEL analysis using the ApopTag ® Direct in situ apoptosis detection kit (Intergen, NY) with DAPI used as a counterstain. Fluorescence images were captured using appropriate filters with an Axiocam digital camera (Zeiss, NJ) at 1 megapixel resolution. Each captured field was subdivided into three ‘Zones’ with Zone 1 encompassing the full thickness of articular cartilage extending from 0 to 0.5 mm away from the drill hole; Zone 2 extending from 0.5 to 1 mm away from the drill hole; and Zone 3 extending from 1 to 1.5 mm away from the drill hole (Fig. 1). Semi-automated data collection and analysis were performed using custom
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