Thromb Haemost 2014; 112(05): 1044-1050
DOI: 10.1160/th14-01-0029
Animal Models
Schattauer GmbH

Deferasirox limits cartilage damage following haemarthrosis in haemophilic mice

Laurens Nieuwenhuizen
1   Rheumatology & Clinical Immunology, University Medical Center, Utrecht, The Netherlands
2   Haematology & Van Creveldkliniek, University Medical Center, Utrecht, The Netherlands
,
Goris Roosendaal
2   Haematology & Van Creveldkliniek, University Medical Center, Utrecht, The Netherlands
,
Simon C. Mastbergen
1   Rheumatology & Clinical Immunology, University Medical Center, Utrecht, The Netherlands
,
Katja Coeleveld
2   Haematology & Van Creveldkliniek, University Medical Center, Utrecht, The Netherlands
,
Douwe H. Biesma
2   Haematology & Van Creveldkliniek, University Medical Center, Utrecht, The Netherlands
3   Internal Medicine, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
,
Floris P. J. G. Lafeber
1   Rheumatology & Clinical Immunology, University Medical Center, Utrecht, The Netherlands
,
Roger E. G. Schutgens
2   Haematology & Van Creveldkliniek, University Medical Center, Utrecht, The Netherlands
› Author Affiliations
Financial support: This study was supported by an unrestricted research grant from Novartis.
Further Information

Publication History

Received: 11 January 2014

Accepted after major revision: 30 May 2014

Publication Date:
20 November 2017 (online)

Summary

Joint bleeds in haemophilia result in iron-mediated synovitis and cartilage damage. It was evaluated whether deferasirox, an iron chelator, was able to limit the development of haemophilic synovitis and cartilage damage. Haemophilic mice were randomly assigned to oral treatment with deferasirox (30 mg/kg) or its vehicle (control) (30 mg/kg). Eight weeks after start of treatment, haemarthrosis was induced. After another five weeks of treatment, blood-induced synovitis and cartilage damage were determined. Treatment with deferasirox resulted in a statistically significant (p< 0.01) decrease in plasma ferritin levels as compared to the control group (823 ng/ml ± 56 and 1220 ng/ml ±114, respectively). Signs of haemophilic synovitis, as assessed by the Valentino score [range 0 (normal) – 10 (most affected)], were not different (p=0.52) when comparing the control group with the deferasirox group. However, deferasirox treatment resulted in a statistically significant (p< 0.01) reduction in cartilage damage, as assessed by the loss in Safranin O staining [range 0 (normal) – 6 (most affected)], when comparing the deferasirox group with the control group: score 2 (65.4 % vs 4.2 %), score 3 (26.9 % vs 4.2 %), score 4 (7.7 % vs 20.8 %), score 5 (0 % vs 54.2 %), and score 6 (0 % vs 16.7 %). Treatment with deferasirox limits cartilage damage following the induction of a haemarthrosis in haemophilic mice. This study demonstrates the role of iron in blood-induced cartilage damage. Moreover, these data indicate that iron chelation may be a potential prevention option to limit the development of haemophilic arthropathy.

 
  • References

  • 1 Roosendaal G, Vianen ME, van den Berg HM. et al. Cartilage damage as a result of haemarthrosis in a human in vitro model. J Rheumatol 1997; 24: 1350-1354.
  • 2 Roosendaal G, Vianen ME, Marx JJ. et al. Blood-induced joint damage: a human in vitro study. Arthritis Rheum 1999; 42: 1025-1032.
  • 3 Saksena J, Platts AD, Dowd GS. Recurrent haemarthrosis following total knee replacement. Knee 2010; 17: 7-14.
  • 4 Shaerf D, Banerjee A. Assessment and management of posttraumatic haemarthrosis of the knee. Br J Hosp Med 2008; 69: 459-463.
  • 5 Lofqvist T, Nilsson IM, Berntorp E. et al. Haemophilia prophylaxis in young patients--a long-term follow-up. J Intern Med 1997; 241: 395-400.
  • 6 Valentino LA, Mamonov V, Hellmann A. et al. A randomized comparison of two prophylaxis regimens and a paired comparison of on-demand and prophylaxis treatments in haemophilia. A management J Thromb Haemost 2012; 10: 359-367.
  • 7 Lafeber FP, Miossec P, Valentino LA. Physiopathology of haemophilic arthropathy. Haemophilia 2008; 14 (Suppl. 04) 3-9.
  • 8 Hooiveld MJ, Roosendaal G, van den Berg HM. et al. Haemoglobin-derived iron-dependent hydroxyl radical formation in blood-induced joint damage: an in vitro study. Rheumatology 2003; 42: 784-790.
  • 9 Morris CJ, Blake DR, Wainwright AC. et al. Relationship between iron deposits and tissue damage in the synovium: an ultrastructural study. Ann Rheum Dis 1986; 45: 21-26.
  • 10 Hakobyan N, Kazarian T, Jabbar AA. et al. Pathobiology of haemophilic synovitis: overexpression of mdm2 oncogene. Blood 2004; 104: 2060-2064.
  • 11 Nishiya K. Stimulation of human synovial cell DNA synthesis by iron. J Rheumatol 1994; 21: 1802-1807.
  • 12 Wen FQ, Jabbar AA, Chen YX. et al. c-myc proto-oncogene expression in haemophilic synovitis: in vitro studies of the effects of iron and ceramide. Blood 2002; 100: 912-916.
  • 13 Roosendaal G, Vianen ME, Wenting MJ. et al. Iron deposits and catabolic properties of synovial tissue from patients with haemophilia. J Bone Joint Surg Br 1998; 80: 540-545.
  • 14 Hoots WK. Pathogenesis of haemophilic arthropathy. Semin Haematol 2006; 43: S18-S22.
  • 15 Lindsey WT, Olin BR. Deferasirox for transfusion-related iron overload: a clinical review. Clin Ther 2007; 29: 2154-2166.
  • 16 Galanello R, Piga A, Alberti D. et al. Safety, tolerability, and pharmacokinetics of ICL670, a new orally active iron-chelating agent in patients with transfusion-dependent iron overload due to beta-thalassemia. J Clin Pharmacol 2003; 43: 565-572.
  • 17 Nick H, Allegrini PR, Fozard L. et al. Deferasirox reduces iron overload in a murine model of juvenile haemochromatosis. Exp Biol Med 2009; 234: 492-503.
  • 18 Hakobyan N, Enockson C, Cole AA. et al. Experimental haemophilic arthropathy in a mouse model of a massive haemarthrosis: gross, radiological and histological changes. Haemophilia 2008; 14: 804-809.
  • 19 Valentino LA, Hakobyan N. Histological changes in murine haemophilic synovitis: a quantitative grading system to assess blood-induced synovitis. Haemophilia 2006; 12: 654-662.
  • 20 Rosenberg L. Chemical basis for the histological use of safranin O in the study of articular cartilage. J Bone Joint Surg Am 1971; 53: 69-82.
  • 21 Glasson SS, Chambers MG, Van Den Berg WB. et al. The OARSI histopathology initiative - recommendations for histological assessments of osteoarthritis in the mouse. Osteoarthritis Cartilage 2010; 18 (Suppl. 03) S17-S23.
  • 22 Weiss HM, Fresneau M, Camenisch GP. et al. In vitro blood distribution and plasma protein binding of the iron chelator deferasirox (ICL670) and its iron complex Fe-[ICL670]2 for rat, marmoset, rabbit, mouse, dog, and human. Drug Metab Dispos 2006; 34: 971-975.
  • 23 Ibrahim AS, Gebermariam T, Fu Y. et al. The iron chelator deferasirox protects mice from mucormycosis through iron starvation. J Clin Invest 2007; 117: 2649-2657.
  • 24 Del RM, Fibbi G, Matucci CM. The urokinase-type plasminogen activator system and inflammatory joint diseases. Clin Exp Rheumatol 1999; 17: 485-498.
  • 25 Nieuwenhuizen L, Roosendaal G, Coeleveld K. et al. Haemarthrosis stimulates the synovial fibrinolytic system in haemophilic mice. Thromb Haemost 2013; 110: 173-183.
  • 26 Heli H, Mirtorabi S, Karimian K. Advances in iron chelation: an update. Expert Opin Ther Pat 2011; 21: 819-856.
  • 27 Motekaitis R, Martel AE. Stabilities of the Iron (III) chelates of 1, 2-dimethyl-3-hydroxy-4-pyridinine and related ligands. Inorg Chim Acta 1991; 183: 71-80.
  • 28 Britton RS, Leicester KL, Bacon BR. Iron toxicity and chelation therapy. Int J Haematol 2002; 76: 219-228.
  • 29 Kocaoglu B, Akgun U, Erol B. et al. Preventing blood-induced joint damage with the use of intra-articular iron chelators: an experimental study in rabbits. Arch Orthop Trauma Surg 2009; 129: 1571-1575.
  • 30 Bates EJ, Lowther DA, Handley CJ. Oxygen free-radicals mediate an inhibition of proteoglycan synthesis in cultured articular cartilage. Ann Rheum Dis 1984; 43: 462-469.
  • 31 Bates EJ, Johnson CC, Lowther DA. Inhibition of proteoglycan synthesis by hydrogen peroxide in cultured bovine articular cartilage. Biochim Biophys Acta 1985; 838: 221-228.
  • 32 Schalkwijk J, Van Den Berg WB, van de Putte LB. et al. Hydrogen peroxide suppresses the proteoglycan synthesis of intact articular cartilage. J Rheumatol 1985; 12: 205-210.
  • 33 Henrotin Y, by-Dupont G, Deby C. et al. Production of active oxygen species by isolated human chondrocytes. Br J Rheumatol 1993; 32: 562-567.
  • 34 Morris CJ, Earl JR, Trenam CW, Blake DR. Reactive oxygen species and iron--a dangerous partnership in inflammation. Int J Biochem Cell Biol 1995; 27: 109-122.
  • 35 Winterbourn CC. Toxicity of iron and hydrogen peroxide: the Fenton reaction. Toxicol Lett 1995; 82 (83) 969-974.
  • 36 Halliwell B. Free radicals, antioxidants, and human disease: curiosity, cause, or consequence?. Lancet 1994; 344: 721-724.
  • 37 Jansen NW, Roosendaal G, Bijlsma JW. et al. Exposure of human cartilage tissue to low concentrations of blood for a short period of time leads to prolonged cartilage damage: an in vitro study. Arthritis Rheum 2007; 56: 199-207.