Abstract
BACKGROUND: Posttraumatic osteoarthritis (PTOA) arises secondarily to joint trauma and is driven by catabolic inflammatory pathways. Alpha-2-macroglobulin (α(2)M) is a naturally occurring proteinase inhibitor found in human serum and synovial fluid that binds proteases as well as proinflammatory cytokines involved in the pathogenesis of PTOA. PURPOSE: (1) To investigate the therapeutic potential of intra-articular α(2)M injections during the acute stages of PTOA by inhibiting inflammatory pathways driven by the cytokines expressed by the synovium in a large preclinical Yucatan minipig model and (2) to determine if 3 intra-articular α(2)M injections have greater chondroprotective effects compared with 1 intra-articular injection. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 48 Yucatan minipigs were randomized into 4 groups (n = 12 each): (1) modified intra-articular drilling (mIAD) and saline (mIAD + saline), (2) mIAD and 1 intra-articular α(2)M injection (mIAD +α(2)M-1), (3) mIAD and 3 α(2)M injections (mIAD +α(2)M-3), and (4) sham control. Surgical hindlimbs were harvested at 15 weeks after surgery. Cartilage degeneration, synovial changes, inflammatory gene expression, and matrix metalloproteinase levels were evaluated. Gait asymmetry was measured before and after surgery using a pressure-sensing walkway system. RESULTS: Macroscopic lesion areas and microscopic cartilage degeneration scores were lower in the mIAD +α(2)M-1 and mIAD +α(2)M-3 groups compared with the mIAD + saline group (P < .05) and similar to those in the sham group (P > .05). Synovial membrane scores of the mIAD +α(2)M-1 and mIAD +α(2)M-3 groups were lower than that of the mIAD + saline group (P < .05) and higher than that of the sham group (P < .05). Interleukin-1 beta, nuclear factor kappa B, and tumor necrosis factor alpha mRNA expression in the synovium and matrix metalloproteinase-1 levels in synovial fluid were significantly lower in the mIAD +α(2)M-1 and mIAD +α(2)M-3 groups compared with the mIAD + saline group (P < .05). No significant differences were observed between the mIAD +α(2)M-1 and mIAD +α(2)M-3 groups for all measured outcomes. There were early changes in gait (P < .05) between preoperative and postoperative time points for the mIAD + saline, mIAD +α(2)M-1, and mIAD +α(2)M-3 groups that normalized by 15 weeks. CONCLUSION: Animals receiving early α(2)M treatment exhibited less cartilage damage, milder synovitis, and lower inflammation compared with animals with no α(2)M treatment. These results exemplify the early anti-inflammatory effects of α(2)M and provide evidence that intra-articular α(2)M injections may slow the progression of PTOA. CLINICAL RELEVANCE: In patients presenting with an acute joint injury, an early intervention with α(2)M may have the potential to reduce cartilage degeneration from catabolic pathways and delay the development of PTOA.