Activation of Indian hedgehog promotes chondrocyte hypertrophy and upregulation of MMP-13 in human osteoarthritic cartilage F. Wei, J. Zhou, X. Wei,

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Activation of Indian hedgehog promotes chondrocyte hypertrophy and upregulation of MMP-13 in human osteoarthritic cartilage F. Wei, J. Zhou, X. Wei, J. Zhang, B.C. Fleming, R. Terek, M. Pei, Q. Chen, T. Liu, L. Wei Osteoarthritis and Cartilage Volume 20, Issue 7, Pages 755-763 (July 2012) DOI: 10.1016/j.joca.2012.03.010 Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 Increased Ihh expression in OA cartilage. Ihh was analyzed with immunohistochemistry in knee joint cartilage from OA knees (n = 17) and resection specimens with normal cartilage (n = 6). The expression of Ihh is significantly increased in OA cartilage. Increased staining for Ihh protein is associated with increased severity of OA cartilage damage as demonstrated by Safranin-O staining. In contrast, Ihh staining was minimal in normal cartilage. Osteoarthritis and Cartilage 2012 20, 755-763DOI: (10.1016/j.joca.2012.03.010) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Increased Ihh expression in OA synovial fluid. (A) Radiographs confirmed cartilage damage and joint space narrowing in the OA patients and no joint changes in the normal controls. (B) Representative Western blot demonstrates a high level of Ihh in human OA synovial fluid compared to normal control (54-year-old male healthy volunteer). Coomassie Blue staining was used to confirm equal loading. (C) Densitometry showed that the mean Ihh concentration was 137.2% higher in the OA group (n = 32) relative to the control group (n = 31) (P = 0.002). Osteoarthritis and Cartilage 2012 20, 755-763DOI: (10.1016/j.joca.2012.03.010) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 Increased expression of Ihh, type X collagen, and MMP-13 in OA cartilage. (A) Representative histologic sections from OA cartilage and adjacent relatively normal cartilage are shown. (B) Expression of Ihh, and typical molecular markers of chondrocyte hypertrophy: type X collagen and MMP-13, were determined by qPCR. Samples from the relatively normal are arbitrarily defined as 1. Bar graphs show the averages with SD, N = 3, ∗: P = 0.0019. (C) Representative immunohistochemistry for type X collagen and MMP-13 in OA cartilage and cartilage from a control patient without OA. Osteoarthritis and Cartilage 2012 20, 755-763DOI: (10.1016/j.joca.2012.03.010) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 Ihh expression is associated with cartilage damage and chondrocyte morphological changes. (A) An increase in Ihh staining in OA cartilage correlates with OA grade and a larger cell size. Bar graphs show the averages of quantified data of Ihh intensity and cell size from 228 cells from nine patients. (B) There was a significant correlation (P < 0.0001) between Ihh intensity of the chondrocytes and Mankin score (R2 = 0.89) (left) and between cell size and Mankin score (R2 = 0.80) (right). (C) Chondrocytes change in shape from spindle to spherical (decrease ratio of major: minor axis, major/minor) with OA progression. Bar graphs show the averages of quantified data of major/minor ratio from 228 cells (left) from nine patients. Log-transformed major/minor ratio was used as dependent variable to capture its nonlinear relationships between Mankin score (R2 = 0.84) (right). (D) The detail information for plot B and C. ∗: compared to grade I, P < 0.0001; ^: compared to grade II OA, P < 0.0001. Osteoarthritis and Cartilage 2012 20, 755-763DOI: (10.1016/j.joca.2012.03.010) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 Ihh induces chondrocyte hypertrophy and regulates type X collagen and MMPs in OA chondrocytes. Human OA chondrocytes were transfected with Ihh siRNA or treated with recombinant Ihh protein (5.0 μg/ml). The mRNA levels of Ihh, type X collagen, and MMPs were determined by qPCR. The endogenous Ihh was knocked down 70% by Ihh siRNA (P = 0.0003). Knockdown of Ihh inhibited the expression of type X collagen and MMP-13. Ihh treatment increased the expression of type X collagen (P = 0.0001), and MMP-1 (P = 0.0089), MMP-3 (P = 0.045), and MMP-13 (P = 0.001). Samples treated with carrier or siRNA control (a scrambled sequence) are arbitrarily defined as “1”, and data from samples treated with either siRNA for Ihh or recombinant Ihh protein are given as a mean. Bar graphs show the means and SD of data from three independent experiments (chondrocytes from three different patients) using qPCR. ∗: compared to Mock for Ihh protein or to siRNA control for siRNA treatment. Osteoarthritis and Cartilage 2012 20, 755-763DOI: (10.1016/j.joca.2012.03.010) Copyright © 2012 Osteoarthritis Research Society International Terms and Conditions