$$\rightleftharpoonup{xx}$$
$$\longleftharp{xx}$$,
$$\longrightharp{xx}$$,
Osteoarthritis (OA) is a debilitating and painful disease involving various pathologies of all tissues associated with the joint1. Affecting approximately 3.8% of the global population2, OA is one of the most prevalent musculoskeletal diseases and it is to become the 4th leading cause of disability worldwide by 20203. Post-traumatic OA occurs after a joint injury and accounts for at least 12% of all OA and up to 25% of OA in susceptible joints such as the knee4,5. Furthermore, joint injury increases the lifetime risk of OA by more than five times6. Not all injuries with apparently similar instability will go on to develop OA, and therefore defining factors that drive the long-term OA-risk remains challenging. It is crucial in order to develop effective treatments to prevent and/or treat post-traumatic OA, to investigate and better define the injury-specific pathology, causes, and mechanisms that predispose to OA1.
OA and its defining cartilage destruction was previously attributed entirely to mechanical stress and, thus, OA was considered a non-inflammatory disease2. However, more recent studies have shown an inflammatory infiltration of synovial membranes and an increase of inflammatory cells in the synovial tissue in patients with OA compared to healthy controls2, shedding light on an inflammatory component as a potential driving force in OA. Further studies indicated that abnormalities in both the CD4+ and CD8+ T-cell profile as well as monocytes/macrophages of the innate immune system may contribute to the pathogenesis of OA2,7. Detailed investigations into these abnormalities revealed relevant roles for various T cell subsets2, such as Th18, Th29, Th178 and T regulatory (Treg) populations10,11. Despite this compelling evidence, the causal relationship between the alteration of T-cell responses and the development and progression of OA is still unknown2.
In addition to specific T-cells having a role in OA, recent studies suggest that differentially polarized/activated macrophages may be associated with pathogenesis of OA12. In particular, macrophages originating from blood monocytes accumulate in the synovium and polarize into either classically activated macrophages (M1) or alternatively activated macrophages (M2) during OA development, implying a correlation between monocyte derived macrophages and OA13. In contrast, certain subsets of macrophages populate organs early during development and self-sustain their numbers in a monocyte independent matter14. Recently, a joint protective function mediated by a tight-junction barrier was shown for these synovial-tissue-resident macrophages (STRMs)14. These findings indicate that abnormalities in particular macrophage subsets may play a crucial role during development of OA. However, the interactions between this inflammatory cellular response and the structural changes in the joint subsequent to trauma is unknown.
Historically, analysis of immune cells in the synovial tissue was restricted to immunohistochemistry (IHC) or mRNA expression by reverse-transcription polymerase chain reaction (RT-PCR) approaches15,16. However, both IHC and RT-PCR lack the ability to identify multiple different cell types and their subsets simultaneously, thus, limiting the applicability of these methods. Furthermore, IHC is limited to analysis of small samples of tissue and may miss focal inflammatory cell accumulations. Over the last several years, a myriad of surface markers for various cell types have been developed, and subsets of immune cells can now be reliably identified by distinct combinations of these markers. Due to steady technical progress, flow cytometers are now capable of identifying a multitude of different fluorochromes simultaneously enabling analysis of large multicolor antibody panels.
Flow cytometry provides investigators with a powerful technique that allows simultaneous identification and quantification of a multitude of immune cells and their subsets at the single cell level. We have developed and optimized both an extracellular staining assay to identify monocytes/macrophages and their subsets as well as an extra/intracellular staining assay to identify T-cells and their subsets within murine spleen, bone marrow, lymph nodes and synovial tissue. Each step of this protocol was optimized and tested resulting in a highly reproducible assay that can be utilized for other surgical and non-surgical OA mouse models17.