Long term follow up of SHR rats with experimental yersinia associated arthritis

Bacteria-Triggered reactive arthritis: implications for antibacterial treatment

Reactive arthritis (ReA) is definitely caused by an infection. Several observations suggest that the triggering microbe may persist in the tissues of the patient for a prolonged time. The obvious conclusion is to consider antibacterial treatment. In two instances antibacterial agents are of definite value: in the primary and secondary prevention of rheumatic fever and for early eradication of Borrelia burgdorferi in order to prevent development of the arthritis associated with Lyme disease. Altogether, clinical and experimental data exist to indicate that if antibacterial treatment of ReA can be started very early during the pathogenetic process, the disease can be prevented or the prognosis improved. In fully developed ReA, the value of antibacterial agents is less certain. All available evidence indicates that short term antibacterial treatment has no effect on the prognosis and final outcome of ReA, and the results with long term administration of antibacterials are also overall poor. In some instances sulfasalazine appears useful, rather as a result of its antirheumatic effect or influence on an underlying inflammatory bowel disease than its action as an antibacterial agent. Tetracyclines have also been found to have an effect on ReA, but again, this is probably due to their anti-inflammatory action rather than any antibacterial effect.

Construction of urease-negative mutants of Yersinia enterocolitica serotypes O:3 and o:8: role of urease in virulence and arthritogenicity

Yersinia enterocolitica serotype O:3 and O:8 urease-negative mutants unable to express the 19-kDa beta subunit of urease were constructed and tested for virulence and arthritogenicity. Our results indicate that urease is needed for full virulence in oral infections and that it is not an arthritogenic factor in the rat model.

Tumor necrosis factor receptor p55 controls the severity of arthritis in experimental Yersinia enterocolitica infection

OBJECTIVE

To dissect the host defense mechanisms in relation to the development of Yersinia-associated arthritis by evaluating the impact of tumor necrosis factor receptor p55 (TNFRp55) deficiency on Yersinia enterocolitica infection.

METHODS

TNFRp55-/- and C57BL/6 mice were inoculated intravenously with arthritogenic strain 8081 of Yenterocolitica serotype 0:8. Mice were observed daily for generating survival curves and monitoring arthritis. In subsequent sets of experiments, mice were sacrificed at day 14 after infection for examination of histopathology of joints, bacterial clearance, macrophage microbicidal activity, nitric oxide (NO) production, oxidative burst generation, and cytokine production.

RESULTS

There was an 80% mortality rate in TNFRp55-/- mice compared with 25% in the controls at 8 weeks after inoculation with 70 colony-forming units of Y. enterocolitica 0:8. Histologic examination of joint tissues revealed that TNFRp55-/- mice developed more severe arthritis, including cartilage degradation and bony destruction, than controls at day 14 after infection. The more extensive joint pathology in TNFRp55-/- mice was correlated with the higher bacterial load in liver, spleen, and lungs, and with the increased levels of interleukin-10. TNFRp55-/- mice displayed impaired intracellular killing of bacteria by macrophages. This was associated with decreased NO production and impaired oxidative burst activity.

CONCLUSION

This study demonstrates that TNF signaling through TNFRp55 controls the severity of Yersinia-induced arthritis and implicates TNF-mediated macrophage microbicidal activity as a central event in this process.

Antibiotic prophylaxis and treatment of reactive arthritis. Lessons from an animal model

OBJECTIVE

To study the effect of antibiotic prophylaxis and treatment of reactive arthritis (ReA), using an experimental model.

METHODS

Yersinia enterocolitica O:8, when injected intravenously into Lewis rats, causes a sterile arthritis closely resembling human ReA in 70% of the animals. Arthritis develops in 1-2 weeks; in some of the animals it remains chronic, and exacerbations occur. This model was applied to study the effect of a 7-day treatment with ciprofloxacin, using 2 different dosages (20 or 100 mg/kg/day) and 4 different schedules for initiation of treatment. The effects were evaluated by determining the daily arthritis score, the number of rats developing arthritis, and fecal excretion of Yersinia. In addition, weight gain was monitored. At autopsy (35 or 60 days after inoculation with bacteria), samples were obtained for determination of Yersinia-specific antibodies in the serum. At the same time, samples were collected from mesenteric lymph nodes, lung, spleen, and liver for bacterial cultures, and from the ankle joints for histologic evaluation. In a separate experiment, ciprofloxacin concentrations in samples from serum and mesenteric lymph nodes were analyzed by high performance liquid chromatography.

RESULTS

A 7-day course with 100 mg/kg/day of ciprofloxacin, started on day 3 after bacterial inoculation, completely prevented the development of ReA and eliminated Yersinia during the 60-day experiment. If a dosage of 20 mg/kg/day was used, development of acute arthritis was prevented, but some of the animals had positive fecal cultures at the end of experiment. If antibiotic treatment was started on day 5, the preventive effect was still observed, but was less pronounced. If the treatment was started at the peak of the development of arthritis, no effect on arthritis was observed.

CONCLUSION

These results indicate that if any effect of antibiotic treatment in Yersinia-triggered ReA is to be expected, the treatment must be started early and given in sufficient dosage. However, antibiotic treatment has no effect on fully developed arthritis.

Role of endogenous enteric organisms in the reactivation of arthritis

Reactive arthritis is an acute form of arthritis apparently caused by a combination of bacterial infection and genetic influences. Recent experiments using an animal model suggest that certain bacterial cell wall polymers originating from endogenous enteric bacteria may be responsible for the condition.

Role of YadA-mediated collagen binding in arthritogenicity of Yersinia enterocolitica serotype O:8: experimental studies with rats

Outer membrane protein YadA, Yersinia adhesin, is one of the plasmid-encoded virulence factors of yersiniae. YadA protects bacteria against host defense through several different mechanisms. One important role of YadA is to mediate binding to several collagen types. Our recent study revealed that a yadA null mutant of Yersinia enterocolitica serotype O:8 has a drastically reduced arthritogenic capacity when injected intravenously into Lewis rats. To further characterize the arthritogenic role of YadA, we repeated the rat experiments with strain Y. enterocolitica O:8/pYV082; this strain expresses a YadA deletion derivative lacking 22 amino acids from the amino-terminal hydrophobic region and does not bind to collagen. Y. enterocolitica O:8/pYV082 induced arthritis in 5 to 14% of rats inoculated with arthritogenic doses, whereas the arthritis incidence with the wild-type parent strain was 65%. The parent strain was slightly more virulent than Y. enterocolitica O:8/pYV082, as determined by rat mortality. It also frequently induced skin abscesses, whereas Y. enterocolitica O:8/pYV082 did not. Infection kinetics in spleen and mesenteric lymph nodes were about the same with both of the bacterial strains used, and the same was true of the Yersinia-specific antibody response. Altogether, these results suggest that YadA-mediated collagen binding contributes to the arthritogenicity of Y. enterocolitica O:8.

Arthritogenicity of genetically manipulated Yersinia enterocolitica serotype O8 for Lewis rats

Yersinia enterocolitica strains of serotype O8 but not strains of other human pathogenic serotypes (e.g., O3 or O9) are able to induce a reactive arthritis-like disease in Lewis rats after intravenous inoculation (J. L. Hill and D. T. Yu, Infect. Immun. 55:721-726, 1987). To assess which bacterial components or pathogenic factors are crucial for arthritis induction, six genetically manipulated Y. enterocolitica O8 derivatives have been compared with the parental strain in Lewis rats. Neither differences in the length of the lipopolysaccharide side chain (smooth to semirough) of Y. enterocolitica O8 nor replacement of the virulence plasmid (pYVO8) of Y. enterocolitica O8 with that of the nonarthritogenic Y. enterocolitica O9 (pYVO9) had a significant influence on arthritogenic potential or virulence in rats. Transposon insertional inactivation of the plasmid gene yadA encoding the Yersinia adhesin and the collagen-binding protein or of the secretion of YopH resulted in decreased arthritogenicity (increase of the arthritogenic infectious dose) and pathogenicity (decreased persistence of the pathogen in spleens and livers of rats and increase of the 50% lethal dose for mice). However, mutants impaired in yersiniabactin production or uptake proved to be nonarthritogenic for rats, probably because of pronounced attenuation in virulence. From these results, we conclude that the arthritogenic potential of Y. enterocolitica serotype O8 is closely related to the virulence potential determined as the 50% lethal dose in mice and the ability to persist in lymphatic tissue of Lewis rats. A specific arthritogenic determinant of Y. enterocolitica could not be identified.

Role of YadA in arthritogenicity of Yersinia enterocolitica serotype O:8: experimental studies with rats

Outer membrane protein YadA, the Yersinia adhesin, is one of the plasmid-encoded virulence factors of yersiniae. To evaluate the role of YadA in the pathogenesis of reactive arthritis experimentally, we used YadA- strain YeO8-116, a kanamycin GenBlock insertion mutant derived from Yersinia enterocolitica O:8 wild-type strain 8081. As control strains, a plasmid-cured derivative (8081-c) of 8081 and a YopH- mutant (8081-yoph) were used. In addition, YeO8-116, with the yadA mutation transcomplemented with plasmid pMW10, was used. YeO8-116 induced arthritis to a considerably lesser extent than did wild-type strain 8081 when inoculated intravenously into Lewis rats. In rats surviving for over 14 days after the bacterial inoculation, the arthritis incidences were 6% (4 of 72) among those inoculated with the yadA mutant and 51% (33 of 65) among those inoculated with wild-type strain 8081. When the yadA gene was transcomplemented back to YeO8-116, YeO8-116/pMW10 induced arthritis in 47% (9 of 19) of the inoculated rats. Plasmid-cured strain 8081-c did not induce arthritis in any of the 24 inoculated rats, whereas YopH- mutant 8081-yoph induced arthritis in 20% (5 of 25) of the rats inoculated. Although the 50% lethal dose of YeO8-116 was about sixfold higher than that of 8081, the kinetics of bacterial elimination from the spleen and mesenteric lymph nodes were about the same with both strains. Antibody responses in rats infected with the two strains were also indistinguishable. Our results indicate that YadA contributes to the arthritogenicity of Y. enterocolitica in the rat model.

Infection and arthritis

Reactive arthritis is caused by an infection, and components of the triggering agent can be demonstrated at the site of inflammation. This fact has opened new views in studies regarding other rheumatic diseases, such as rheumatoid arthritis and ankylosing spondylitis. The possible role of infectious agents in their etiology and pathogenesis is being re-evaluated.

Group II phospholipase A2 in synovial fluid and serum in acute arthritis

Increased catalytic activity of synovial-type (group II) phospholipase A2 (syn-PLA2), has been associated with cartilage erosions in rheumatoid arthritis and osteoarthritis. The catalytic activity of phospholipase A2 and the concentration of syn-PLA2 were measured in a prospective study in synovial fluid (SF) samples from 66 patients with acute knee joint effusion. The median (range) of the concentration of syn-PLA2 in SF was 210 micrograms/l (80-1480 micrograms/l) in culture-positive septic arthritis, 460 micrograms/l (270-1040 micrograms/l) in reactive arthritis, 780 micrograms/l (120-2710 micrograms/l) in osteoarthritis and 230 micrograms/l (80-1400 micrograms/l) in traumatic joint effusions. High concentrations of syn-PLA2 are found also in SF of patients with arthritides not expected to lead to permanent destruction of cartilage.

Variability in the induction of experimental arthritis: Yersinia associated arthritis in Lewis rats

Lewis rats of different microbiological status were studied for susceptibility to experimentally-induced Yersinia associated arthritis. Status A rats were serologically positive for Bacillus piliformis, Kilham rat virus and Toolan H-1 virus, whereas status B rats were serologically negative for these same microorganisms. When status A and status B rats were kept in the same room, incidence of arthritis was low (0-13% for status A rats and 27-33% for status B rats). When status B rats only were kept in different environments, increased incidence (up to 89%) of arthritis was observed. These findings suggest that the microbiological status of the host has an effect on the susceptibility to experimentally-induced arthritis. They call attention to the need for strictly defined conditions, including those of the host and the environment, in studies on experimental arthritides.

Yersinia associated arthritis in SHR rats: effect of the microbial status of the host

Following the intravenous injection of live Yersinia enterocolitica O:8, 50-69% of SHR rats developed arthritis; these rats were antibody free against all rat pathogens tested. In contrast, only 20-25% of SHR rats which had serum antibodies against Bacillus piliformis, Kilham rat virus, and Toolan H-1 virus developed arthritis. The results indicate that the microbial load of the host has a profound effect on the susceptibility to experimental arthritis.