Despite evidence that chemokines are increased in OA joints, few studies have examined their role in OA and the mechanism by which they promote joint destruction. The goal of this proposal is to determine if the CC- chemokine receptor 2 (CCR2) is a critical mediator of joint damage and pain in OA. Our preliminary studies and recent work by others suggest CCR2 inhibition may reduce both structural damage and pain in OA. If this is true, it would be a major breakthrough in the management of OA. However, more work is needed to confirm these findings and determine the optimal time to inhibit CCR2 during the OA process. Our data from a community- based cohort study of human OA shows that higher baseline serum levels of human CCL2 (which binds CCR2 receptor) correlates with progression of radiographic OA at 5-years follow up. Using the destabilized medial meniscus (DMM) murine model of injury-induced OA, we found that expression of CCL12 (the functional homologue of hCCL2), a CCR2 ligand we have previously found to be critical in joint development, increases in articular cartilage and bone during early OA. OA changes in articular cartilage (cartilage loss, increased MMP13 levels) and bone (bone sclerosis, osteophytes) and pain behavior were ameliorated by systemic blockade of the CCR2, if given for 4wks total within the first 8wks after DMM. However, if treatment was maintained for 8wks or more it was less effective on subsequent structural progression while still inhibiting pain, suggesting a disconnect between structure and pain that has been noted in human OA. These data suggest that CCR2 signaling has cellular and stage specific roles in OA, with beneficial effects when targeted at early stages. We hypothesize that injury-induced alterations in joint mechanics upregulate the CCR2 pathway in cartilage and bone in a time- dependent manner altering the structural organization of both tissues, ultimately leading to OA and pain. We propose to determine the role of dysregulated CCR2 signaling in cartilage at sequential times during injury- and age-induced OA, in order to establish the contribution of this tissue to the whole joint degeneration and OA pain (Aim 1). We will also evaluate whether osteoblast expression of CCR2 contributes to joint damage and pain during injury-induced OA (Aim 2). To accomplish this, we will obtain an inducible tissue-specific CCR2 deletion in chondrocytes (Aim 1) and osteoblasts (Aim 2) by combining chondrocyte- or osteoblast-specific expression of CreER with Tam injections in CCR2flox/flox mice crossed with Aggrecan-CreERT2 or Col1?1CreER, respectively. Because the myeloid infiltration consisting of macrophages and osteoclasts may cause accelerated OA bone remodeling that may reflect on bone damage and, indirectly, on cartilage homeostasis, we will also conditionally inactivate CCR2 in macropahges/osteoclasts (Aim 3) by crossing CCR2flox/flox mice with LysMERCre. We will also evaluate potential pathways altered by each tissue-selective CCR2 deletions. In addition, by using in-vitro human primary chondrocyte cultures, we will study the signaling pathways by which activation of CCR2 with its multiple ligands stimulates MMP production.

Public Health Relevance

The proposed research is relevant to public health because it will provide new targets to advance therapies for the early treatment of injury-induced osteoarthritis (OA). Six million patients in the US are afflicted with disabling OA induced by injury, in the hip, knee, or ankle and treatment accounts for at least 10% of the OA treatment cost. Adding to this burden is the fact that, unlike other forms of OA, injury-induced OA most often affects younger adults for whom joint replacement must be delayed. After injury, development of clinically measurable OA can require decades to become symptomatic, therefore preventing the early diagnosis and intervention thought to be crucial to slow OA damage. Our study provides a novel perspective to study OA pathophysiology in which cells of different joint tissues are not the passive ?victims? of the degenerative force of inflammation due to trauma but, rather, make their own contribution to OA pathogenesis by failing to maintain a controlled chemokine environment (such as CCR2 signaling). The information derived from our studies has major medical relevance and implications as will provide critical insights into the chain of events that lead to OA and will define the time-frame for the potential use of anti-CCR2 molecules as therapy.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project (R01)
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Skeletal Biology Structure and Regeneration Study Section (SBSR)
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Lester, Gayle E
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University of North Carolina Chapel Hill
Internal Medicine/Medicine
Schools of Medicine
Chapel Hill
United States
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Longobardi, L; Jordan, J M; Shi, X A et al. (2018) Associations between the chemokine biomarker CCL2 and knee osteoarthritis outcomes: the Johnston County Osteoarthritis Project. Osteoarthritis Cartilage 26:1257-1261