Synovial Macrophages in Osteoarthritis: The Key to Understanding Pathogenesis?

Amanda Thomson, Catharien M U Hilkens, Amanda Thomson, Catharien M U Hilkens

Abstract

Effective treatment of osteoarthritis (OA) remains a huge clinical challenge despite major research efforts. Different tissues and cell-types within the joint contribute to disease pathogenesis, and there is great heterogeneity between patients in terms of clinical features, genetic characteristics and responses to treatment. Inflammation and the most abundant immune cell type within the joint, macrophages, have now been recognised as possible players in disease development and progression. Here we discuss recent findings on the involvement of synovial inflammation and particularly the role of synovial macrophages in OA pathogenesis. Understanding macrophage involvement may hold the key for improved OA treatments.

Keywords: inflammation; macrophage subsets; osteoarthritis; pathogenesis; synovial tissue.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Thomson and Hilkens.

Figures

Figure 1
Figure 1
Knee osteoarthritis pathology and macrophage involvement. Common features of OA including cartilage loss, narrowing of the joint space, synovitis and the development of subchondral bone cysts and sclerosis are shown. Macrophages in the synovium can contribute to OA via the release of inflammatory molecules which are able to stimulate resident fibroblast populations to produce cartilage extracellular matrix degrading enzymes. Inflammatory molecules are also able to activate chondrocytes, promoting an abnormal molecular and cellular phenotype, again promoting cartilage loss. We suggest that the same or similar macrophage populations newly identified in inflammatory arthritis studies will be found in OA tissues, may differ between clinical states and could provide therapeutic targets for subgroups of patients. The identification and impact of such populations in OA development is yet to be determined.

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