Effects of PTH [1-34] on synoviopathy in an experimental model of osteoarthritis preceded by osteoporosis L. Lugo, A. Villalvilla, R. Gómez, M. Bellido,

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Effects of PTH [1-34] on synoviopathy in an experimental model of osteoarthritis preceded by osteoporosis L. Lugo, A. Villalvilla, R. Gómez, M. Bellido, O. Sánchez-Pernaute, R. Largo, G. Herrero-Beaumont, J.A. Roman-Blas Osteoarthritis and Cartilage Volume 20, Issue 12, Pages 1619-1630 (December 2012) DOI: 10.1016/j.joca.2012.08.010 Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 Histopathological evaluation of synovial changes. (A) The Krenn scores were obtained from the sum of partial scores evaluating the synovial lining layer enlargement, the presence of vessels and matrix fibrosis and inflammatory infiltration in synovial membranes from HEALTHY, OPOA + VEH, and OPOA + PTH (n = 6, each group). Values are expressed as mean ± 95% CI; *P < 0.05 vs HEALTHY, &P < 0.05 vs OPOA + VEH. (B–D) Representative 10× hematoxylin-eosin staining images in synovial membranes from healthy (B), OPOA + VEH (C), and OPOA + PTH (D) groups. (E) Correlation between synovitis and cartilage damage as assessed by the Krenn and Mankin scores, respectively. The analysis was carried out by Spearman analysis using five independent samples of each group. Osteoarthritis and Cartilage 2012 20, 1619-1630DOI: (10.1016/j.joca.2012.08.010) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Subchondral bone assessment. (A) Representative qualitative 2D reconstructed from each group, by using the CTAn software (Skyscan, Aartselaar, Belgium). (B) Microstructural subchondral bone parameters represented as mean and 95% CI (lower limit, upper limit). Significance differences between the groups represented by P-value have been calculated by Mann–Whitney non-parametric analyses. (C) Correlations between microstructural parameters as: bone area/tissue area fraction (B.Ar/T.Ar%), trabecular thickness (Tb.Th), fractal dimension (FD) and polar moment of inertia (Ip) at subchondral bone and the Krenn score. Correlation coefficients were obtained comparing healthy, vehicle-treated OPOA and PTH-treated OPOA groups (n = 3 for each) by Spearman bivariate analysis. *Correlation is significant at the 0.05 level (two-tailed), and **correlation is significant at the 0.001 level (two-tailed). Osteoarthritis and Cartilage 2012 20, 1619-1630DOI: (10.1016/j.joca.2012.08.010) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 Inflammatory infiltration in synovial membranes. (A) Dot blots representing the percentage of RAM-11-stained area per total tissue surface analyzed in synovial membranes from HEALTHY, OPOA + VEH, and OPOA + PTH (n = 5, each group). Values are expressed as mean ± 95% CI; *P < 0.05 vs HEALTHY (upper panel). (B–E) Representative (20×) images of specific macrophage staining by RAM-11 antibody in synovial membranes from HEALTHY (B), OPOA + VEH (C), OPOA + PTH (D) and negative control (E). (F–I) Representative (10×) images of B lymphocyte infiltration staining in synovial membranes from HEALTHY (F), OPOA + VEH (G), OPOA + PTH (H) and negative control (I). Osteoarthritis and Cartilage 2012 20, 1619-1630DOI: (10.1016/j.joca.2012.08.010) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 PTH effects in pro-inflammatory modulators in synovial membrane. (A) Dot blots showing −ΔCt of IL-1β, MCP-1, COX-2, MMP-9, and MMP-13 mRNA expression in synovial membranes from HEALTHY (n = 5), OPOA + VEH (n = 6), and OPOA + PTH (n = 6) knees. Values are expressed as mean ± 95% CI; *P < 0.05 vs HEALTHY, &P < 0.05 vs OPOA + VEH. Osteoarthritis and Cartilage 2012 20, 1619-1630DOI: (10.1016/j.joca.2012.08.010) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 PTH counteracts fibrosis associated with OA. (A) Dot blots displaying −ΔCt of Collagen, type I, alpha 1 (Col1A1) mRNA expression in synovial membranes from HEALTHY (n = 5), OPOA + VEH (n = 6), and OPOA + PTH (n = 6) groups. Values are expressed as mean ± 95% CI; *P < 0.05 vs HEALTHY, &P < 0.05 vs OPOA + VEH. (B–E) Representative (10×) images of immunohistochemistry for type I Collagen in synovial membranes from HEALTHY (B), OPOA + VEH (C), OPOA + PTH (D) and negative control (E). Osteoarthritis and Cartilage 2012 20, 1619-1630DOI: (10.1016/j.joca.2012.08.010) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 6 PTH1R expression in synovial membrane. (A) Bar graph showing a densitometric analysis of PTH1R protein synthesis in synovial membranes from HEALTHY, OPOA + VEH, and OPOA + PTH (n = 4, each group), as assessed by Western blot. Results are expressed as mean ± 95% CI; *P < 0.05 vs HEALTHY. To the right, representative images of the Western blot for PTH1R and Actin (as loading control) in synovial membranes of each group. (B–G) Immunohistochemistry analysis of PTH1R at 5 μm thick synovial membranes. Representative (20×) images for HEALTHY (B,E), OPOA + VEH (C,F), and OPOA + PTH (D,G) knees are displayed showing PTH1R localization whether in lining layer (upper panel) or in vessels (lower panel). (H–K) Representative images (40×) of PTH1R-stained lining layer area (H), PTH1R-stained blood vessel (J), and respective negative controls (I–K). Osteoarthritis and Cartilage 2012 20, 1619-1630DOI: (10.1016/j.joca.2012.08.010) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 7 Evaluation of synovial cell proliferation. (A) Dot blots representing the lining thickness in A.U (pixels) analyzed in synovial membranes from HEALTHY, OPOA + VEH, OPOA + PTH groups (n = 5, each group). Values are expressed as mean ± 95% CI; *P < 0.05 vs HEALTHY, and &P < 0.05 vs OPOA. (B–E) Representative (20×) images of specific PCNA staining in synovial membranes from HEALTHY (B), OPOA + VEH (C), OPOA + PTH (D) and negative control (E). A 40× image of synovial membrane from OPOA + VEH shows nuclear PCNA staining. Osteoarthritis and Cartilage 2012 20, 1619-1630DOI: (10.1016/j.joca.2012.08.010) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions