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Published in: Arthritis Research & Therapy 6/2012

Open Access 01-12-2012 | Research article

IL-32 and IL-17 interact and have the potential to aggravate osteoclastogenesis in rheumatoid arthritis

Authors: Young-Mee Moon, Bo-Young Yoon, Yang-Mi Her, Hye-Joa Oh, Jae-Seon Lee, Kyoung-Woon Kim, Seon-Yeong Lee, Yun-Ju Woo, Kyung-Su Park, Sung-Hwan Park, Ho-Youn Kim, Mi-La Cho

Published in: Arthritis Research & Therapy | Issue 6/2012

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Abstract

Introduction

Interleukin (IL)-32 and IL-17 play critical roles in pro-inflammatory responses and are highly expressed in the synovium of patients with rheumatoid arthritis (RA). We investigated the relations between these two cytokines (IL-17 and IL-32) for their ability to induce each other and to stimulate osteoclasts in RA fibroblast-like synoviocytes (FLSs) and T cells.

Methods

FLSs were isolated through surgical synovectomy obtained from patients with RA or osteoarthritis (OA). Real-time PCR were performed to evaluate the expression of IL-32, IL-17 and osteoclast-related genes. Immunohistochemical staining and tartrate-resistant acid phosphatase (TRAP) staining were performed to determine the distribution of inflammatory cytokines and the presence of osteoclastogenesis.

Results

IL-17 induced the expression of IL-32 in the FLSs from RA patients, as assessed by microarray. IL-32 production was increased by IL-17. IL-32 in the FLSs from RA patients induced the production of IL-17 in CD4+ T cells. IL-32 and IL-17 were colocalized near TRAP-positive areas in joint specimens. IL-17 and IL-32 synergistically induced the differentiation of osteoclasts, as demonstrated by the expression of osteoclast-related genes. IL-32 and IL-17 also could induce resorption by osteoclasts in a RANKL-dependent manner.

Conclusions

IL-17 affected the expression of IL-32 in FLSs of RA patients and IL-32 induced the production of IL-17 in CD4+ T cells. Both IL-17 and IL-32 cytokines can reciprocally influence each other's production and amplify the function of osteoclastogenesis in the in RA synovium. Separately, IL-17 and IL-32 each stimulated osteoclastogenesis without RANKL. Together, the two cytokines synergistically amplified the differentiation of osteoclasts, independent of RANKL stimulation.
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Literature
1.
go back to reference Bucala R, Ritchlin C, Winchester R, Cerami A: Constitutive production of inflammatory and mitogenic cytokines by rheumatoid synovial fibroblasts. J Exp Med. 1991, 173: 569-574. 10.1084/jem.173.3.569.CrossRefPubMed Bucala R, Ritchlin C, Winchester R, Cerami A: Constitutive production of inflammatory and mitogenic cytokines by rheumatoid synovial fibroblasts. J Exp Med. 1991, 173: 569-574. 10.1084/jem.173.3.569.CrossRefPubMed
2.
go back to reference Van Boxel JA, Paget SA: Predominantly T-cell infiltrate in rheumatoid synovial membranes. N Engl J Med. 1975, 293: 517-520. 10.1056/NEJM197509112931101.CrossRefPubMed Van Boxel JA, Paget SA: Predominantly T-cell infiltrate in rheumatoid synovial membranes. N Engl J Med. 1975, 293: 517-520. 10.1056/NEJM197509112931101.CrossRefPubMed
3.
go back to reference Yamamura Y, Gupta R, Morita Y, He X, Pai R, Endres J, Freiberg A, Chung K, Fox DA: Effector function of resting T cells: activation of synovial fibroblasts. J Immunol. 2001, 166: 2270-2275.CrossRefPubMed Yamamura Y, Gupta R, Morita Y, He X, Pai R, Endres J, Freiberg A, Chung K, Fox DA: Effector function of resting T cells: activation of synovial fibroblasts. J Immunol. 2001, 166: 2270-2275.CrossRefPubMed
4.
go back to reference Langrish CL, Chen Y, Blumenschein WM, Mattson J, Basham B, Sedgwick JD, McClanahan T, Kastelein RA, Cua DJ: IL-23 drives a pathogenic T cell population that induces autoimmune inflammation. J Exp Med. 2005, 201: 233-240. 10.1084/jem.20041257.PubMedCentralCrossRefPubMed Langrish CL, Chen Y, Blumenschein WM, Mattson J, Basham B, Sedgwick JD, McClanahan T, Kastelein RA, Cua DJ: IL-23 drives a pathogenic T cell population that induces autoimmune inflammation. J Exp Med. 2005, 201: 233-240. 10.1084/jem.20041257.PubMedCentralCrossRefPubMed
5.
go back to reference Kotake S, Udagawa N, Takahashi N, Matsuzaki K, Itoh K, Ishiyama S, Saito S, Inoue K, Kamatani N, Gillespie MT, Martin TJ, Suda T: IL-17 in synovial fluids from patients with rheumatoid arthritis is a potent stimulator of osteoclastogenesis. J Clin Invest. 1999, 103: 1345-1352. 10.1172/JCI5703.PubMedCentralCrossRefPubMed Kotake S, Udagawa N, Takahashi N, Matsuzaki K, Itoh K, Ishiyama S, Saito S, Inoue K, Kamatani N, Gillespie MT, Martin TJ, Suda T: IL-17 in synovial fluids from patients with rheumatoid arthritis is a potent stimulator of osteoclastogenesis. J Clin Invest. 1999, 103: 1345-1352. 10.1172/JCI5703.PubMedCentralCrossRefPubMed
6.
go back to reference Lubberts E, van den Bersselaar L, Oppers-Walgreen B, Schwarzenberger P, Coenen-de Roo CJ, Kolls JK, Joosten LA, van den Berg WB: IL-17 promotes bone erosion in murine collagen-induced arthritis through loss of the receptor activator of NF-kappa B ligand/osteoprotegerin balance. J Immunol. 2003, 170: 2655-2662.CrossRefPubMed Lubberts E, van den Bersselaar L, Oppers-Walgreen B, Schwarzenberger P, Coenen-de Roo CJ, Kolls JK, Joosten LA, van den Berg WB: IL-17 promotes bone erosion in murine collagen-induced arthritis through loss of the receptor activator of NF-kappa B ligand/osteoprotegerin balance. J Immunol. 2003, 170: 2655-2662.CrossRefPubMed
7.
go back to reference Kirkham BW, Lassere MN, Edmonds JP, Juhasz KM, Bird PA, Lee CS, Shnier R, Portek IJ: Synovial membrane cytokine expression is predictive of joint damage progression in rheumatoid arthritis: a two-year prospective study (the DAMAGE study cohort). Arthritis Rheum. 2006, 54: 1122-1131. 10.1002/art.21749.CrossRefPubMed Kirkham BW, Lassere MN, Edmonds JP, Juhasz KM, Bird PA, Lee CS, Shnier R, Portek IJ: Synovial membrane cytokine expression is predictive of joint damage progression in rheumatoid arthritis: a two-year prospective study (the DAMAGE study cohort). Arthritis Rheum. 2006, 54: 1122-1131. 10.1002/art.21749.CrossRefPubMed
8.
go back to reference Hwang SY, Kim JY, Kim KW, Park MK, Moon Y, Kim WU, Kim HY: IL-17 induces production of IL-6 and IL-8 in rheumatoid arthritis synovial fibroblasts via NF-kappaB- and PI3-kinase/Akt-dependent pathways. Arthritis Res Ther. 2004, 6: R120-128. 10.1186/ar1038.PubMedCentralCrossRefPubMed Hwang SY, Kim JY, Kim KW, Park MK, Moon Y, Kim WU, Kim HY: IL-17 induces production of IL-6 and IL-8 in rheumatoid arthritis synovial fibroblasts via NF-kappaB- and PI3-kinase/Akt-dependent pathways. Arthritis Res Ther. 2004, 6: R120-128. 10.1186/ar1038.PubMedCentralCrossRefPubMed
9.
go back to reference Cho ML, Jung YO, Kim KW, Park MK, Oh HJ, Ju JH, Cho YG, Min JK, Kim SI, Park SH, Kim HY: IL-17 induces the production of IL-16 in rheumatoid arthritis. Exp Mol Med. 2008, 40: 237-245. 10.3858/emm.2008.40.2.237.PubMedCentralCrossRefPubMed Cho ML, Jung YO, Kim KW, Park MK, Oh HJ, Ju JH, Cho YG, Min JK, Kim SI, Park SH, Kim HY: IL-17 induces the production of IL-16 in rheumatoid arthritis. Exp Mol Med. 2008, 40: 237-245. 10.3858/emm.2008.40.2.237.PubMedCentralCrossRefPubMed
10.
go back to reference Kim HR, Cho ML, Kim KW, Juhn JY, Hwang SY, Yoon CH, Park SH, Lee SH, Kim HY: Up-regulation of IL-23p19 expression in rheumatoid arthritis synovial fibroblasts by IL-17 through PI3-kinase-, NF-kappaB- and p38 MAPK-dependent signalling pathways. Rheumatology (Oxford). 2007, 46: 57-64. 10.1093/rheumatology/kel159.CrossRef Kim HR, Cho ML, Kim KW, Juhn JY, Hwang SY, Yoon CH, Park SH, Lee SH, Kim HY: Up-regulation of IL-23p19 expression in rheumatoid arthritis synovial fibroblasts by IL-17 through PI3-kinase-, NF-kappaB- and p38 MAPK-dependent signalling pathways. Rheumatology (Oxford). 2007, 46: 57-64. 10.1093/rheumatology/kel159.CrossRef
11.
go back to reference Agarwal S, Misra R, Aggarwal A: Interleukin 17 levels are increased in juvenile idiopathic arthritis synovial fluid and induce synovial fibroblasts to produce proinflammatory cytokines and matrix metalloproteinases. J Rheumatol. 2008, 35: 515-519.PubMed Agarwal S, Misra R, Aggarwal A: Interleukin 17 levels are increased in juvenile idiopathic arthritis synovial fluid and induce synovial fibroblasts to produce proinflammatory cytokines and matrix metalloproteinases. J Rheumatol. 2008, 35: 515-519.PubMed
12.
go back to reference Dahl CA, Schall RP, He HL, Cairns JS: Identification of a novel gene expressed in activated natural killer cells and T cells. J Immunol. 1992, 148: 597-603.PubMed Dahl CA, Schall RP, He HL, Cairns JS: Identification of a novel gene expressed in activated natural killer cells and T cells. J Immunol. 1992, 148: 597-603.PubMed
13.
go back to reference Heinhuis B, Koenders MI, van de Loo FA, Netea MG, van den Berg WB, Joosten LA: Inflammation-dependent secretion and splicing of IL-32{gamma} in rheumatoid arthritis. Proc Natl Acad Sci USA. 2011, 108: 4962-4967. 10.1073/pnas.1016005108.PubMedCentralCrossRefPubMed Heinhuis B, Koenders MI, van de Loo FA, Netea MG, van den Berg WB, Joosten LA: Inflammation-dependent secretion and splicing of IL-32{gamma} in rheumatoid arthritis. Proc Natl Acad Sci USA. 2011, 108: 4962-4967. 10.1073/pnas.1016005108.PubMedCentralCrossRefPubMed
14.
go back to reference Shioya M, Nishida A, Yagi Y, Ogawa A, Tsujikawa T, Kim-Mitsuyama S, Takayanagi A, Shimizu N, Fujiyama Y, Andoh A: Epithelial overexpression of interleukin-32alpha in inflammatory bowel disease. Clin Exp Immunol. 2007, 149: 480-486. 10.1111/j.1365-2249.2007.03439.x.PubMedCentralCrossRefPubMed Shioya M, Nishida A, Yagi Y, Ogawa A, Tsujikawa T, Kim-Mitsuyama S, Takayanagi A, Shimizu N, Fujiyama Y, Andoh A: Epithelial overexpression of interleukin-32alpha in inflammatory bowel disease. Clin Exp Immunol. 2007, 149: 480-486. 10.1111/j.1365-2249.2007.03439.x.PubMedCentralCrossRefPubMed
15.
go back to reference Cagnard N, Letourneur F, Essabbani A, Devauchelle V, Mistou S, Rapinat A, Decraene C, Fournier C, Chiocchia G: Interleukin-32, CCL2, PF4F1 and GFD10 are the only cytokine/chemokine genes differentially expressed by in vitro cultured rheumatoid and osteoarthritis fibroblast-like synoviocytes. Eur Cytokine Netw. 2005, 16: 289-292.PubMed Cagnard N, Letourneur F, Essabbani A, Devauchelle V, Mistou S, Rapinat A, Decraene C, Fournier C, Chiocchia G: Interleukin-32, CCL2, PF4F1 and GFD10 are the only cytokine/chemokine genes differentially expressed by in vitro cultured rheumatoid and osteoarthritis fibroblast-like synoviocytes. Eur Cytokine Netw. 2005, 16: 289-292.PubMed
16.
go back to reference Netea MG, Azam T, Ferwerda G, Girardin SE, Walsh M, Park JS, Abraham E, Kim JM, Yoon DY, Dinarello CA, Kim SH: IL-32 synergizes with nucleotide oligomerization domain (NOD) 1 and NOD2 ligands for IL-1beta and IL-6 production through a caspase 1-dependent mechanism. Proc Natl Acad Sci USA. 2005, 102: 16309-16314. 10.1073/pnas.0508237102.PubMedCentralCrossRefPubMed Netea MG, Azam T, Ferwerda G, Girardin SE, Walsh M, Park JS, Abraham E, Kim JM, Yoon DY, Dinarello CA, Kim SH: IL-32 synergizes with nucleotide oligomerization domain (NOD) 1 and NOD2 ligands for IL-1beta and IL-6 production through a caspase 1-dependent mechanism. Proc Natl Acad Sci USA. 2005, 102: 16309-16314. 10.1073/pnas.0508237102.PubMedCentralCrossRefPubMed
17.
go back to reference Dinarello CA, Kim SH: IL-32, a novel cytokine with a possible role in disease. Ann Rheum Dis. 2006, 65 (Suppl 3): iii61-64.PubMedCentralPubMed Dinarello CA, Kim SH: IL-32, a novel cytokine with a possible role in disease. Ann Rheum Dis. 2006, 65 (Suppl 3): iii61-64.PubMedCentralPubMed
18.
go back to reference Joosten LA, Netea MG, Kim SH, Yoon DY, Oppers-Walgreen B, Radstake TR, Barrera P, van de Loo FA, Dinarello CA, van den Berg WB: IL-32, a proinflammatory cytokine in rheumatoid arthritis. Proc Natl Acad Sci USA. 2006, 103: 3298-3303. 10.1073/pnas.0511233103.PubMedCentralCrossRefPubMed Joosten LA, Netea MG, Kim SH, Yoon DY, Oppers-Walgreen B, Radstake TR, Barrera P, van de Loo FA, Dinarello CA, van den Berg WB: IL-32, a proinflammatory cytokine in rheumatoid arthritis. Proc Natl Acad Sci USA. 2006, 103: 3298-3303. 10.1073/pnas.0511233103.PubMedCentralCrossRefPubMed
19.
go back to reference Zrioual S, Ecochard R, Tournadre A, Lenief V, Cazalis MA, Miossec P: Genome-wide comparison between IL-17A- and IL-17F-induced effects in human rheumatoid arthritis synoviocytes. J Immunol. 2009, 182: 3112-3120. 10.4049/jimmunol.0801967.CrossRefPubMed Zrioual S, Ecochard R, Tournadre A, Lenief V, Cazalis MA, Miossec P: Genome-wide comparison between IL-17A- and IL-17F-induced effects in human rheumatoid arthritis synoviocytes. J Immunol. 2009, 182: 3112-3120. 10.4049/jimmunol.0801967.CrossRefPubMed
20.
go back to reference Heinhuis B, Koenders MI, van Riel PL, van de Loo FA, Dinarello CA, Netea MG, van den Berg WB, Joosten LA: Tumour necrosis factor alpha-driven IL-32 expression in rheumatoid arthritis synovial tissue amplifies an inflammatory cascade. Ann Rheum Dis. 2011, 70: 660-667. 10.1136/ard.2010.139196.CrossRefPubMed Heinhuis B, Koenders MI, van Riel PL, van de Loo FA, Dinarello CA, Netea MG, van den Berg WB, Joosten LA: Tumour necrosis factor alpha-driven IL-32 expression in rheumatoid arthritis synovial tissue amplifies an inflammatory cascade. Ann Rheum Dis. 2011, 70: 660-667. 10.1136/ard.2010.139196.CrossRefPubMed
21.
go back to reference Jung MY, Son MH, Kim SH, Cho D, Kim TS: IL-32gamma induces the maturation of dendritic cells with Th1- and Th17-polarizing ability through enhanced IL-12 and IL-6 production. J Immunol. 2011, 186: 6848-6859. 10.4049/jimmunol.1003996.CrossRefPubMed Jung MY, Son MH, Kim SH, Cho D, Kim TS: IL-32gamma induces the maturation of dendritic cells with Th1- and Th17-polarizing ability through enhanced IL-12 and IL-6 production. J Immunol. 2011, 186: 6848-6859. 10.4049/jimmunol.1003996.CrossRefPubMed
22.
go back to reference Turner-Brannen E, Choi KY, Arsenault R, El-Gabalawy H, Napper S, Mookherjee N: Inflammatory cytokines IL-32 and IL-17 have common signaling intermediates despite differential dependence on TNF-receptor 1. J Immunol. 2011, 186: 7127-7135. 10.4049/jimmunol.1002306.CrossRefPubMed Turner-Brannen E, Choi KY, Arsenault R, El-Gabalawy H, Napper S, Mookherjee N: Inflammatory cytokines IL-32 and IL-17 have common signaling intermediates despite differential dependence on TNF-receptor 1. J Immunol. 2011, 186: 7127-7135. 10.4049/jimmunol.1002306.CrossRefPubMed
23.
go back to reference Mabilleau G, Sabokbar A: Interleukin-32 promotes osteoclast differentiation but not osteoclast activation. PLoS One. 2009, 4: e4173-10.1371/journal.pone.0004173.PubMedCentralCrossRefPubMed Mabilleau G, Sabokbar A: Interleukin-32 promotes osteoclast differentiation but not osteoclast activation. PLoS One. 2009, 4: e4173-10.1371/journal.pone.0004173.PubMedCentralCrossRefPubMed
24.
go back to reference Kim YG, Lee CK, Oh JS, Kim SH, Kim KA, Yoo B: Effect of interleukin-32gamma on differentiation of osteoclasts from CD14+ monocytes. Arthritis Rheum. 2010, 62: 515-523.PubMed Kim YG, Lee CK, Oh JS, Kim SH, Kim KA, Yoo B: Effect of interleukin-32gamma on differentiation of osteoclasts from CD14+ monocytes. Arthritis Rheum. 2010, 62: 515-523.PubMed
25.
go back to reference Astry B, Harberts E, Moudgil KD: A cytokine-centric view of the pathogenesis and treatment of autoimmune arthritis. J Interferon Cytokine Res. 2011, 31: 927-940. 10.1089/jir.2011.0094.PubMedCentralCrossRefPubMed Astry B, Harberts E, Moudgil KD: A cytokine-centric view of the pathogenesis and treatment of autoimmune arthritis. J Interferon Cytokine Res. 2011, 31: 927-940. 10.1089/jir.2011.0094.PubMedCentralCrossRefPubMed
26.
go back to reference McInnes IB, Leung BP, Liew FY: Cell-cell interactions in synovitis. Interactions between T lymphocytes and synovial cells. Arthritis Res. 2000, 2: 374-378. 10.1186/ar115.PubMedCentralCrossRefPubMed McInnes IB, Leung BP, Liew FY: Cell-cell interactions in synovitis. Interactions between T lymphocytes and synovial cells. Arthritis Res. 2000, 2: 374-378. 10.1186/ar115.PubMedCentralCrossRefPubMed
27.
go back to reference Alsaleh G, Sparsa L, Chatelus E, Ehlinger M, Gottenberg JE, Wachsmann D, Sibilia J: Innate immunity triggers IL-32 expression by fibroblast-like synoviocytes in rheumatoid arthritis. Arthritis Res Ther. 2010, 12: R135-10.1186/ar3073.PubMedCentralCrossRefPubMed Alsaleh G, Sparsa L, Chatelus E, Ehlinger M, Gottenberg JE, Wachsmann D, Sibilia J: Innate immunity triggers IL-32 expression by fibroblast-like synoviocytes in rheumatoid arthritis. Arthritis Res Ther. 2010, 12: R135-10.1186/ar3073.PubMedCentralCrossRefPubMed
28.
go back to reference Shoda H, Fujio K, Yamaguchi Y, Okamoto A, Sawada T, Kochi Y, Yamamoto K: Interactions between IL-32 and tumor necrosis factor alpha contribute to the exacerbation of immune-inflammatory diseases. Arthritis Res Ther. 2006, 8: R166-10.1186/ar2074.PubMedCentralCrossRefPubMed Shoda H, Fujio K, Yamaguchi Y, Okamoto A, Sawada T, Kochi Y, Yamamoto K: Interactions between IL-32 and tumor necrosis factor alpha contribute to the exacerbation of immune-inflammatory diseases. Arthritis Res Ther. 2006, 8: R166-10.1186/ar2074.PubMedCentralCrossRefPubMed
29.
go back to reference Jeong HJ, Shin SY, Oh HA, Kim MH, Cho JS, Kim HM: IL-32 up-regulation is associated with inflammatory cytokine production in allergic rhinitis. J Pathol. 2011, 224: 553-563. 10.1002/path.2899.CrossRefPubMed Jeong HJ, Shin SY, Oh HA, Kim MH, Cho JS, Kim HM: IL-32 up-regulation is associated with inflammatory cytokine production in allergic rhinitis. J Pathol. 2011, 224: 553-563. 10.1002/path.2899.CrossRefPubMed
30.
go back to reference Yagi Y, Andoh A, Imaeda H, Aomatsu T, Ohsaki R, Inatomi O, Bamba S, Tsujikawa T, Shimizu T, Fujiyama Y: Interleukin-32alpha expression in human colonic subepithelial myofibroblasts. Int J Mol Med. 2011, 27: 263-268.PubMed Yagi Y, Andoh A, Imaeda H, Aomatsu T, Ohsaki R, Inatomi O, Bamba S, Tsujikawa T, Shimizu T, Fujiyama Y: Interleukin-32alpha expression in human colonic subepithelial myofibroblasts. Int J Mol Med. 2011, 27: 263-268.PubMed
31.
go back to reference Mun SH, Kim JW, Nah SS, Ko NY, Lee JH, Kim JD, Kim do K, Kim HS, Choi JD, Kim SH, Lee CK, Park SH, Kim BK, Kim HS, Kim YM, Choi WS: Tumor necrosis factor alpha-induced interleukin-32 is positively regulated via the Syk/protein kinase Cdelta/JNK pathway in rheumatoid synovial fibroblasts. Arthritis Rheum. 2009, 60: 678-685. 10.1002/art.24299.CrossRefPubMed Mun SH, Kim JW, Nah SS, Ko NY, Lee JH, Kim JD, Kim do K, Kim HS, Choi JD, Kim SH, Lee CK, Park SH, Kim BK, Kim HS, Kim YM, Choi WS: Tumor necrosis factor alpha-induced interleukin-32 is positively regulated via the Syk/protein kinase Cdelta/JNK pathway in rheumatoid synovial fibroblasts. Arthritis Rheum. 2009, 60: 678-685. 10.1002/art.24299.CrossRefPubMed
Metadata
Title
IL-32 and IL-17 interact and have the potential to aggravate osteoclastogenesis in rheumatoid arthritis
Authors
Young-Mee Moon
Bo-Young Yoon
Yang-Mi Her
Hye-Joa Oh
Jae-Seon Lee
Kyoung-Woon Kim
Seon-Yeong Lee
Yun-Ju Woo
Kyung-Su Park
Sung-Hwan Park
Ho-Youn Kim
Mi-La Cho
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Arthritis Research & Therapy / Issue 6/2012
Electronic ISSN: 1478-6362
DOI
https://doi.org/10.1186/ar4089

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