Introduction
Osteoarthritis (OA) and rheumatoid arthritis (RA) involve degenerative changes in the joint, leading to loss of function, pain and significant disability [
1]. OA and RA are not only common joint diseases in the elderly population but increasingly they affect young individuals. Collectively, they represent a large proportion of orthopaedic cases [
2]. Articular cartilage is an avascular, alymphatic and aneural tissue with bradytrophic characteristics and a very poor capacity for self-repair and regeneration [
3]. Cartilage repair is ineffective and often leads to replacement of the articular cartilage by a mechanically inferior fibrocartilage tissue thus promoting progressive degeneration and impairment of joint function [
4]. This inherent weakness in cartilage repair highlights the acute need for novel treatments using tissue engineering and regenerative medicine, and innovative new regenerative strategies that involve stimulation of articular cartilage repair
in vivo.
OA is characterized by an imbalance between cartilage anabolism and catabolism. The local production and release of pro-inflammatory cytokines (interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)) play a central role in the pathogenesis of OA [
5‐
7]. It is well known that IL-1β and TNF-α production activates the transcription factor nuclear factor-κB (NF-κB) in chondrocytes. Once activated, NF-κB translocates into the nucleus, where it induces the expression of distinct subsets of genes encoding inflammatory, apoptotic and extracellular matrix (ECM) degrading enzymes. NF-κB activates the expression of matrix degrading enzymes such as matrix metalloproteinases (MMPs) and enzymes responsible for production of prostaglandins (that is, cyclooxygenase-2 (COX-2)) leading to enhanced degradation of the ECM and induction of pain [
8]. Additionally, in articular chondrocytes, NF-κB stimulates the production of pro-inflammatory catabolic cytokines, which induce apoptosis through activation of the pro-apoptotic enzyme caspase-3 and cleavage of the DNA repair enzyme poly(ADP-ribose)polymerase (PARP) [
9].
During embryonic development, cartilage develops from mesenchymal stem cells (MSCs) by condensation and differentiation. Recent studies have shown that MSC-like progenitors also exist in the superficial zone of articular cartilage and that their abundance in arthritic cartilage is elevated [
10]. Despite this, cartilage regeneration
in vivo is inefficient and the resulting fibrocartilage is structurally and functionally inadequate. A possible explanation for this lack of regeneration is that the ongoing inflammatory processes that occur during the course of OA/RA result in higher synovial and circulating levels of pro-inflammatory cytokines, which may in turn impede the chondrogenic differentiation of cartilage resident progenitors. Therefore, blocking the pro-inflammatory cytokine induced cartilage degeneration and inflammatory cascades might create a more suitable microenvironment for the chondrogenesis of MSC-like progenitors.
In recent years the phytochemical curcumin has been identified as a potent anti-inflammatory substance in several diseases such as cancer, inflammatory bowel disease, pancreatitis, chronic anterior uveitis and arthritis [
9,
11‐
16]. Curcumin is a natural yellow orange dye derived from the rhizome of
Curcuma longa. It is insoluble in water but is soluble in ethanol, dimethylsulfoxide and other organic solvents. It has a melting point of 183°C and a molecular weight of 368.37. Commercial curcumin contains three major components: Diferuloylmethane (82%) and its derivatives demethoxycurcumin (15%) and bisdemethoxycurcumin (3%), together referred to as curcuminoids [
9,
11‐
16], all of which have anti-inflammatory activity. Curcumin reduces tumor cell survival, tumor expansion and secondary inflammation via NF-κB inhibition [
13,
17]. Further, it suppresses constitutive IκBα phosphorylation through the inhibition of IκB kinase [
13,
18]. There is increasing interest in curcumin as a therapeutic option for OA and RA, with evidence that curcumin inhibits the IL-1β-induced activation of NF-κB in human articular chondrocytes [
9,
14]. Furthermore, in a recent study we have demonstrated that curcumin exerts anti-apoptotic effects on IL-1β stimulated human chondrocytes through inhibition of caspase-3 activation and PARP cleavage [
15].
The aim of the present investigation was to evaluate whether IL-1β stimulated MSCs (either alone or in a co-culture model of OA with primary chondrocytes) pre-treated with curcumin may impede the adverse effects of this pro-inflammatory cytokine and create a more suitable microenvironment for the chondrogenic differentiation of cartilage resident progenitor cells.
Materials and methods
Antibodies and reagents
Polyclonal anti-collagen type II antibody (PAB746), monoclonal anti-adult cartilage-specific proteoglycan antibody (MAB2015), anti-β1-integrin antibody (MAB1965), and alkaline phosphatase linked sheep anti-mouse (AP303A) and sheep anti-rabbit secondary antibodies (AP304A) for immunoblotting and immuno-electron labelling were purchased from Chemicon International, Inc. (Temecula, CA, USA). Monoclonal anti-β-Actin (A4700) was purchased from Sigma, St. Louis, MO, USA). Monoclonal anti-Sox-9 was purchased from Acris Antibodies GmbH, Hiddenhausen, Germany. Monoclonal anti-phospho-p42/p44 ERK1/2 antibody (610032) and polyclonal anti-Shc antibody (610082) were purchased from BD (BD Biosciences, Erembodegem, Belgium). Polyclonal anti-active caspase-3 (AF835) was purchased from R&D Systems (Abingdon, UK). Antibodies against phospho-specific IκBα (Ser 32/36) and against anti-phospho-specific p65(NF-κB)/(Ser536) were obtained from Cell Technology (Beverly, MA, USA). Curcumin with a purity > 95% was purchased from Indsaff (Punjab, India). This commercial source of curcumin contains three major components: Diferuloylmethane (the most abundant and active component of turmeric) (82%) and its derivatives demethoxycurcumin (15%) and bisdemethoxycurcumin (3%), together referred to as curcuminoids [
9,
11‐
16]. Curcumin was dissolved in dimethylsulfoxide (DMSO) as a stock concentration of 500 μM and stored at -80°C. Serial dilutions were prepared in culture medium.
Cell culture
Mesenchymal stem cells (MSCs) were isolated from canine adipose tissue biopsies and primary canine chondrocytes were isolated from cartilage from the femoral head. Samples were obtained during total hip replacement surgery with fully-informed owner consent and ethical project approval from the ethical review committee of the Ludwig-Maximilians-University, Munich, Germany. Chondrocytes and MSCs used in co-culture experiments were always from the same animal. In total, the experiments were performed three times and samples from three different donors were used. Donor ages ranged from five to seven years.
Briefly, for MSCs isolation, adipose tissue was cut into small pieces and digested with collagenase 0.2% in Ham's-F12 in a water bath at 37°C for two hours. Digested adipose tissue was centrifuged at 1,000 g for five minutes and the pellet was resuspended in cell culture medium consisting of DMEM/Ham's-F12 1:1, 10% FCS, 1% partricin solution, 1% penicillin/streptomycin solution (10 000 IU/10 000 IU), 75 μg/ml ascorbic acid, 1% essential amino acids and 1% Glutamine, all obtained from Seromed (Munich, Germany) in a T75 cell culture flask and incubated at 37°C/5%CO
2, 95% humidity. After four days, non-adherent cells were discarded by washing with Hank's salt solution. The medium was changed three times per week. Adherent cells were split following formation of fibroblast-like cell colonies and upon reaching 60 to 70% confluence, and were sub-cultured until the third or fourth passage was achieved. As there are no definitive MSC specific cellular markers, we identified them by their ability to adhere to tissue culture plastic
in vitro, through their multilineage differentiation potential
in vitro and through a combination of expression and lack of defined markers (CD105
+, CD90
+, CD45
-, CD34
-) [
19‐
22].
For chondrocyte isolation the cartilage sample was sliced into 1 to 2 mm thick slices and incubated first with pronase (2%/Hams-F12) (Roche Diagnostics, Mannheim, Germany), followed by collagenase incubation (0.2%/Ham's-F12) (Sigma) in a shaking water bath at 37°C. The digested sample was centrifuged at 1,000 g for five minutes and cells plated at 1 × 106 cells per T75 flask at 37°C/5%CO2. The first medium change was performed after 24 hours, and the following medium changes three times per week. Chondrocytes were split at approximately 70% confluency and passaged twice.
High-density culture
Three-dimensional high-density cultures at the air-liquid interface were prepared as previously described [
23]. Cells were centrifuged at 1,000 g for five minutes and around one million cells (approximately 8 μl) from the cell pellet were pipetted directly onto a nitrocellulose filter on a steel grid. This model allows the cells to aggregate, forming a distinct pellet, which was examined after 14 days.
High-density culture pellets either consisted only of MSCs or primary chondrocytes, or a mixture of MSCs and primary chondrocytes (1:1) (co-culture). In all experiments, cultures and co-cultures were either incubated with cell culture medium (10% FCS) or with a chondrogenic induction medium as described by Pittenger
et al. [
24] consisting of DMEM base medium, D-(+)-glucose 0.35 g/100 ml (Sigma, Cat No. G7021), ITS+ 1 liquid media supplement (10 μg/ml insulin, 5.5 μg/ml transferrin, 5 ng/ml selenium, 0.5 mg/ml bovine albumin, 4.7 μg/ml linoleic acid (Sigma, Cat. No. I-2521), 0.1 mM ascorbate-2-phosphate (Sigma, Cat. No. A-8960), 10
-7 M dexamethasone (Sigma, Cat. No. D-8893), penicillin/streptomycin solution (10,000 IU/10,000 IU/100 ml). 10 ng/ml hTGFβ1 (Acris Antibodies GmbH, Hiddenhausen, Germany) were added fresh to the medium before each medium change. Furthermore, some cultures and co-cultures were then incubated with one of the following treatments: curcumin only; pre-stimulated with curcumin for four hours in suspension and then transferred to high-density culture; 10 ng/ml IL-1β; curcumin and IL-1β; pre-stimulated with curcumin for four hours in suspension and then brought into high-density culture and stimulated with IL-1β; or pre-stimulated with curcumin for four hours in suspension and then brought into high-density culture and stimulated with IL-1β and curcumin. Medium changes were made every three days.
Time and concentration dependent experiments in monolayer culture
To examine in more detail the interaction between curcumin and IL-1β in MSCs and the pathological pathways involved, monolayer cultures of MSCs were evaluated. First, MSCs were cultured with various concentrations of curcumin (0, 0.5, 1, 2 and 5 μM) for four hours, followed by 24 hours 10 ng/ml IL-1β stimulation. Second, MSC cultures were pre-treated for four hours with 5 μM curcumin followed by one hour 10 ng/ml IL-1β stimulation. Whole cell lysates, cytoplasmic extracts and nuclear extracts were taken at various time points and evaluated with Western blotting.
Electron microscopy
Transmission electron microscopy was performed as previously described [
25]. High-density co-cultures were fixed for one hour in Karnovsky-fixative fixative and post-fixed in 1% OsO
4 solution. After dehydration, pellets were embedded in Epon, ultrathin cuts were made on a Reichert-Ultracut E and contrasted with a mixture of 2% uranyl acetate/lead citrate. A transmission electron microscope (TEM 10, Zeiss, Jena, Germany) was used to examine the co-cultures. To quantify apoptosis, the number of cells exhibiting typical morphological features of apoptotic cell death was determined by scoring 100 cells from 30 different microscopic fields per culture and the number of apoptotic cells expressed as an indicator of MSC culture degradation.
Western blot analysis
For Western blotting, total cell proteins were either extracted from the cell cultures with lysis buffer on ice for 30 minutes or nuclear extracts and cytoplasmic extracts prepared as previously described [
9]. Total protein content was measured with the bicinchoninic acid system (Uptima, France) using bovine serum albumin as a standard. Samples were further reduced with 2-mercaptoethanol and total protein concentrations adjusted. Proteins (500 ng per lane total protein) were separated with SDS-PAGE under reducing conditions on 5%, 7%, 10% or 12% gels and then blotted onto nitrocellulose membranes using a trans blot apparatus (Bio-Rad, Munich, Germany). After blocking for two hours in 5% (w/v) skimmed milk powder in phosphate buffered saline (PBS)/0.1% Tween 20, membranes were incubated with the primary antibodies (overnight, 4°C), followed by incubation with the alkaline phosphatase conjugated secondary antibodies for two hours at room temperature. Finally, specific antigen-antibody complexes were detected using nitroblue tetrazolium and 5-bromo-4-chloro-3-indoylphosphate (
p-toluidine salt; Pierce, Rockford, IL, USA) as substrates for alkaline phosphatase. Specific binding was quantified by densitometry using "Quantity One" (Bio-Rad Laboratories Inc. Munich, Germany).
Discussion
The aim of this study was to evaluate whether curcumin has the capacity to modulate inflammatory processes in MSCs and thus support chondrogenesis in an in vitro model of OA incorporating MSCs, primary chondrocytes and pro-inflammatory cytokines.
Our observations lead to the following conclusions: (1) Curcumin itself does not have any chondro-inductive potential in MSCs, and treatment of MSCs with IL-1β leads to cell apoptosis. (2) Although co-treatment of MSCs with curcumin and IL-1β does not promote chondrogenesis, it clearly inhibits up-regulation of pro-inflammatory and apoptotic signalling cascades in MSCs; (3) If MSCs receive a chondrogenic stimulus, curcumin mediated inhibition of IL-1β-induced catabolic signalling cascades enables chondrogenic differentiation. (4) This effect is observed either by pre-treatment with curcumin (four hours) or curcumin incubation over the entire culture period. (5) Chondrogenic stimulation can be achieved either with a chondro-inductive medium or through direct, close contact co-culture of MSCs with primary chondrocytes; (6) Similar to chondrocytes, curcumin in MSCs targets the Iκ-Bα cascade, inhibiting IL-1β-induced Iκ-Bα phosphorylation and NF-κB nuclear translocation; (7) The effects of curcumin on the IL-1β signalling pathway in MSCs are time and concentration dependent.
OA and RA are characterised by high levels of pro-inflammatory cytokines in the articular joint. These are produced by synovial lining cells, macrophages and the chondrocytes themselves further exacerbating cartilage degrading and degenerative processes [
29,
30]. Although, as in numerous other tissues, MSC-like progenitors are also resident in adult cartilage tissue [
10], these degrading and degenerative processes gradually lead to an imbalance between cartilage catabolism and anabolism, impeding MSC chondrogenesis. It has been reported that activation of NF-κB is the key to induction of inflammation during OA and RA, and that NF-κB inhibition might prove to be a potential concept for arthritis treatment [
31,
32].
The polyphenol curcumin, derived from the rhizomes of
Curcuma longa is a promising therapeutic agent for the treatment of OA and RA as it has pro-apoptotic properties in synovial lining cells [
33,
34] and has been shown to have anti-inflammatory and anti-apoptotic effects in chondrocytes [
14,
15]. In chondrocytes these effects are mainly mediated by inhibiting IL-1β-induced activation of NF-κB and thus suppression of caspase-3 activation, of production of COX-2 and upregulation of MMPs [
9].
In this study we demonstrate that the IL-1β-induced catabolic signalling cascade is suppressed by curcumin in MSCs as well as in chondrocytes. Further, we clearly demonstrate that IL-1β induced Iκ-Bα activation is suppressed by curcumin, resulting in suppression of NF-κB translocation to the nucleus and attenuated activation of caspase-3 and COX-2 production. Taken together, our experiments on MSCs demonstrate that time and concentration dependent effects of curcumin inhibit the induction of degradative and inflammatory pathways by IL-1β through revoking activation of caspase-3, production of COX-2, phosphorylation of Iκ-Bα and inhibition of nuclear translocation of NF-κB.
Interestingly, although we demonstrated that MSCs in high-density culture cannot survive without a chondrogenic stimulus, stimulating these untreated cultures with IL-1β and curcumin neither activated caspase-3 nor production of COX-2. This suggests that although MSCs alone in this high-density model do not survive without a necessary stimulus, they become necrotic rather than apoptotic.
We did not observe a chondrogenic effect of curcumin alone on MSCs, despite demonstrating anti-inflammatory and anti-apoptotic effects of curcumin in MSCs. However, given the necessary stimulus, chondrogenesis was observed. This demonstrates that curcumin interferes with the IL-1β induced apoptotic pathways in MSCs thus providing a suitable microenvironment allowing MSCs to undergo chondrogenesis even in the presence of IL-1β, as long as MSCs simultaneously receive the correct differentiation stimulus. This was confirmed through high production of ECM and adhesion and signalling molecules such as β1-Integrin. Similar observations have been made in chondrocytes [
15]. Interestingly, integrins have already been shown in several tissues to be able to mediate curcumin action [
35,
36]. As β1-integrins are highly expressed in developing and adult cartilage, it is possible that the mechanism of action of curcumin in MSCs and chondrocytes might involve the β1-integrin receptor signalling pathway.
Several studies have suggested that curcumin interacts with the TGF-β signaling cascade, modulating the action of TGF-β. For example in renal cells curcumin blocks multiple sites of the TGF-β signaling [
37] or Smad inhibition in human proximal tubule cells [
38]. However, no previously published
in vitro studies have explored the potential interaction between TGF-β and curcumin in chondrocytes.
In our experiments we did not observe inhibition (or a major difference in) the amounts of extracellular matrix production and signaling cascades when co-cultures were treated with the chondrogenic induction medium and curcumin or only with curcumin, we assume that here a possible interaction between curcumin and the TGF-β signaling pathway does not have an inhibitory effect on positive chondrogenic signaling. However, interaction of curcumin and TGF-β signaling in chondrocytes is an interesting point and will require further detailed investigations.
In the present study we demonstrated that a fairly low concentration of curcumin (0.5 μM) was sufficient to inhibit IL-1β induced activation of degradative pathways in MSCs. It must be noted that in this study we worked with low concentrations of curcumin, the highest concentration used being 5 μM. We chose this concentration based on previous studies in our laboratory demonstrating that canine MSCs do not tolerate curcumin concentrations higher than 5 μM. A recent study by Kim and co-workers demonstrated that chick MSCs treated with 20 μM curcumin become apoptotic and do not undergo chondrogenesis [
39]. This clearly demonstrates that MSCs can only tolerate lower concentrations of curcumin in contrast to chondrocytes [
40]. However,
in vivo administered doses of curcumin in clinical trials differ greatly from this and have ranged between 2 to 10 g per day [
41‐
43]. An explanation for these high concentrations is that intestinal absorption of curcumin is fairly low, mainly due to the fact that curcumin is practically insoluble in water, and that it has a low bio-availability [
44,
45]. Despite its low bio-availability, efficacy has been demonstrated in several
in vivo studies [
46‐
48].
In order to develop a therapeutic strategy for OA/RA treatment with curcumin it would be interesting to determine bioavailability of curcumin in the synovial fluid following various routes of administration (that is, oral, intra articular or topical). This is especially interesting as it may be also possible that in vivo curcumin exerts its effects via another organ (that is, the liver), which then leads to positive anabolic signalling in the joint. Therefore, to integrate our in vitro data with results from other studies, it is important to design and perform further in vivo studies. Furthermore, our experiments were carried out using canine derived cells and it may not be possible to make generalised statements about the activity of curcumin on MSC-like cells in other species.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
CB carried out the experimental work, data collection and interpretation, and manuscript preparation. AM, UM and MS conceived of the study design and coordinated the studies, data interpretation and manuscript preparation. All authors have read and approved the final manuscript.