Increased expression of glycodelin mRNA and protein in rat lungs during ovalbumin-induced allergic airway inflammation

Asthma is a chronic inflammatory disease accompanied by airway obstruction and hyper-responsiveness. Asthmatic inflammation is characterized by the expression of multiple genes for inflammatory mediators. Glycodelin is a glycoprotein with several functions in cell recognition and differentiation. There is substantial evidence that glycodelin may be a mediator for immunomodulatory and immunosuppressive effects on several human tissues. To determine the potential role of glycodelin in the pulmonary immune response, we examined the distribution of the glycodelin mRNA and protein in an experimental rat model of allergen-induced airway inflammation. The experimental model developed an airway response to inhaled nebulized ovalbumin in adult rats. Two groups of rats (ovalbumin and saline) were challenged for 3 weeks, lungs were fixed and embedded, and sections were studied for expression of glycodelin mRNA by in situ hybridization and protein by immunohistochemistry. Glycodelin is expressed in Clara cells of bronchial epithelium, type II pneumocytes and alveolar macrophages. Densitometric analyses show a significant increase of the glycodelin mRNA and protein expression in rat lungs after ovalbumin challenge. Induced glycodelin amounts in tissue, particularly in Clara cells and alveolar macrophages were found. The altered expression pattern of glycodelin may contribute to the pulmonary immune response in asthmatic inflammation. Results of this study were presented in part on the 49th Symposium of the Society of Histochemistry 2007 in Freiburg     

The transfer of maternal antigen-specific IgG regulates the development of allergic airway inflammation early in life in an FcRn-dependent manner

Asthma is a chronic inflammatory airway disease characterized by airway hyperreactivity, increased mucus production, and reversible airway contraction. Asthma is a complex genetic trait caused by environmental factors in genetically predisposed individuals. The transportation of maternal antigen-specific IgG via amniotic fluid, placenta and breast milk plays an important role in passive immunity. First, to examine whether maternal passive immunity by the transportation of antigen-specific IgG via FcRn regulates allergic airway inflammation, ovalbumin-immunized FcRn^+/− female mice were bred with FcRn^−/− male mice to evaluate the degree of ovalbumin-induced allergic airway inflammation of FcRn^−/− offspring. Maternal passive immunity regulated allergic airway inflammation in an FcRn-dependent manner. Second, to examine the role of maternal antigen-specific IgG1 injection into mothers, we intravenously injected ovalbumin-specific IgG1 into wild-type or FcRn^+/− mice immediately after they gave birth. The offspring were sensitized and challenged with ovalbumin. Antigen-specific IgG1 administered to lactating mice reduced allergic airway inflammation in their offspring in an FcRn-dependent manner. Last, to exclude the factor of maternal passive immunity other than ovalbumin-specific IgG1, we administered ovalbumin-specific IgG1 orally to offspring after birth. Oral administration of ovalbumin-specific IgG1 to offspring during the lactating period prevented the development of allergic airway inflammation in an FcRn-dependent manner. These data show that the transfer of maternal antigen-specific IgG regulates the development of allergic airway inflammation early in life in an FcRn-dependent manner.     

Suppression of hypoxia inducible factor-1alpha (HIF-1alpha) by YC-1 is dependent on murine double minute 2 (Mdm2)

Inhibition of HIF-1alpha activity provides an important strategy for the treatment of cancer. Recently, 3-(5'-hydroxymethyl-2'-furyl)-1-benzyl indazole (YC-1) has been identified as an anti-HIF-1alpha drug in cancer therapy with unclear molecular mechanism. In the present study, we aimed to investigate the effect and mechanism of YC-1 on HIF-1alpha in a hepatocellular carcinoma cell line under hypoxic condition, which was generated by incubating cells with 0.1% O(2). The phenotypic and molecular changes of cells were determined by cell proliferation assay, apoptosis assay, luciferase promoter assay, and Western blot analysis. YC-1 arrested tumor cell growth in a dose-dependent manner, whereas it did not induce cell apoptosis. Hypoxia-induced upregulation of HIF-1alpha was suppressed by YC-1 administration. YC-1 inhibited HIF-1alpha protein synthesis under normoxia and affected protein stability under hypoxia. YC-1 suppressed the expression of total and phosphorylated forms of murine double minute 2 (Mdm2), whereas this inhibitory effect was blocked by overexpression of Mdm2. In conclusion, YC-1 suppressed both protein synthesis and stability of HIF-1alpha in HCC cells, and its inhibitory effects on HIF-1alpha were dependent on Mdm2.     

HIF-1alpha和COX-2在溃疡性结肠炎患者外周血及黏膜组织中表达及意义

目的：探讨HIF-1琢和COX-2 在溃疡性结肠炎（UC）患者外周血及黏膜组织中表达及意义。方法：87 例UC患者根据临床病 情分为活动期（n=63）和缓解期（n=24）,同期选取行结肠镜检查无异常健康者40 名作为对照组,利用qRT-PCR 对外周血及黏膜 组织标本中HIF-1alpha和COX-2 表达进行检测。结果：活动期UC 患者外周血和黏膜组织中HIF-1alpha mRNA和COX-2 mRNA相对表 达量均高于缓解期患者,且均高于对照组,差异均有统计学意义（P<0.05）;活动期UC 患者中,临床病情重型患者外周血及黏膜组 织中HIF-1-alpha mRNA 和COX-2 mRNA 相对表达量高于中型及轻型患者,差异均有统计学意义（P<0.05）,内镜表现分级Ⅲ 级患者 外周血及黏膜组织中HIF-1-alpha mRNA和COX-2 mRNA相对表达量高于Ⅱ级及Ⅰ级患者,差异均有统计学意义（P<0.05）;Pearson 相关分析显示,活动期UC患者外周血及黏膜组织中HIF-1alphamRNA和COX-2 mRNA相对表达量均与Mayo 评分呈正相关（r=0. 592、0.722 和0.694、0.456,P<0.05）;Spearman 相关分析显示,活动期UC 患者外周血及黏膜组织中HIF-1-mRNA 和COX-2 mRNA 相对表达量均与临床病情呈正相关（r=0.804、0.826 和0.752、0.763,P<0.05）,且与内镜表现分级呈正相关（r=0.803、0.749和 0.858、0.793,P<0.05）。结论：HIF-1-alpha 和COX-2 在UC患者外周血及黏膜组织中呈高表达,且与患者病情严重程度有关。     

Anti-IL-33 antibody treatment inhibits airway inflammation in a murine model of allergic asthma

Interleukin (IL)-33 is a recently described member of the IL-1 family and has been shown to induce production of T helper type 2 cytokines. In this study, an anti-IL-33 antibody was evaluated against pulmonary inflammation in mice sensitized and challenged with ovalbumin. The anti-IL-33 or a control antibody (150 μg/mouse) was given intraperitoneally as five doses before the sensitization and antigen challenge. Treatment with anti-IL-33 significantly reduced serum IgE secretion, the numbers of eosinophils and lymphocytes, and concentrations of IL-4, IL-5, and IL-13 in bronchoalveolar lavage fluid compared with administration of a control antibody. Histological examination of lung tissue demonstrated that anti-IL-33 significantly inhibited allergen-induced lung eosinophilic inflammation and mucus hypersecretion. Our data demonstrate for the first time that anti-IL-33 antibody can prevent the development of asthma in a mouse model and indicate that blockade of IL-33 may be a new therapeutic strategy for allergic asthma.     

Bulleyaconitine A inhibits the lung inflammation and airway remodeling through restoring Th1/Th2 balance in asthmatic model mice

ABSTRACT

The current study aimed to study the effects of Bulleyaconitine A (BLA) on asthma. Asthmatic mice model was established by ovalbumin (OVA) stimulation, and the model mice were treated by BLA. After BLA treatment, the changes in lung and airway resistances, total and differential leukocytes in the bronchoalveolar lavage fluid (BALF) were detected, and the changes in lung inflammation and airway remodeling were observed. Moreover, the secretion of IgE, Th1/Th2-type and IL-17A cytokines in BALF and serum of the asthmatic mice were determined. The resuts showed that BLA attenuated OVA-induced lung and airway resistances, inhibited the inflammatory cell recruitment in BALF and the inflammation and airway remodeling of the asthmatic mice. In addition, BLA suppressed the secretion of IgE, Th2-type cytokines, and IL-17A, but enhanced secretions of Th1-type cytokines in BALF and serum. The current study discovered that BLA inhibited the lung inflammation and airway remodeling via restoring the Th1/Th2 balance in asthmatic mice.     

Schistosoma japonicum peptide SJMHE1 suppresses airway inflammation of allergic asthma in mice

Helminths and their products can shape immune responses by modulating immune cells, which are dysfunctional in inflammatory diseases such as asthma. We previously identified SJMHE1, a small molecule peptide from the HSP60 protein of Schistosoma japonicum. SJMHE1 can inhibit delayed‐type hypersensitivity and collagen‐induced arthritis in mice. In the present study, we evaluated this peptide's potential intervention effect and mechanism on ovalbumin‐induced asthma in mice. SJMHE1 treatment suppressed airway inflammation in allergic mice, decreased the infiltrating inflammatory cells in the lungs and bronchoalveolar lavage fluid, modulated the production of pro‐inflammatory and anti‐inflammatory cytokines in the splenocytes and lungs of allergic mice, reduced the percentage of Th2 cells and increased the proportion of Th1 and regulatory T cells (Tregs). At the same time, Foxp3 and T‐bet expression increased, and GATA3 and RORγt decreased in the lungs of allergic mice. We proved that SJMHE1 can interrupt the development of asthma by diminishing airway inflammation in mice. The down‐regulation of Th2 response and the up‐regulation of Th1 and Tregs response may contribute to the protection induced by SJMHE1 in allergic mice. SJMHE1 can serve as a novel therapy for asthma and other allergic or inflammatory diseases.     

IL-1beta and TNF-alpha induce increased expression of CCL28 by airway epithelial cells via an NFkappaB-dependent pathway

CCL28 is a mucosal chemokine that attracts eosinophils and T cells via the receptors CCR3 and CCR10. Consequently, it is a candidate mediator of the pathology associated with asthma. This study examined constitutive and induced expression of CCL28 by A549 human airway epithelial-like cells. Real-time RT-PCR and ELISA of cultured cells and supernatants revealed constitutive levels of CCL28 expression to be low, whereas IL-1beta and TNF-alpha, induced significantly increased expression. Observations from induced sputum and human airway biopsies supported this. Signal transduction studies revealed that IL-1beta and TNF-alpha stimulation induced NFkappaB phosphorylation in A549 cells, but antagonist inhibition of NFkappaB p50-p65 phosphorylation correlated with marked reduction of IL-1beta or TNF-alpha induced CCL28 expression. Together these studies imply a role for CCL28 in the orchestration of airway inflammation, and suggest that CCL28 is one link between microbial insult and the exacerbation of pathologies such as asthma, through an NFkappaB-dependent mechanism.     

Opposite effects of prostaglandin-J2 on VEGF in normoxia and hypoxia: role of HIF-1

The vascular endothelial growth factor (VEGF) is produced in response to hypoxia or inflammatory cytokines. In normoxia VEGF synthesis is upregulated by 15-deoxy-Delta(12,14)-prostaglandin-J(2) (15d-PGJ(2)) via induction of heme oxygenase-1 (HO-1). Here we compared the influence of 15d-PGJ(2) on VEGF expression in human microvascular endothelial cells in normoxia (approximately 20% O(2)) and hypoxia ( approximately 2% O(2)). Regardless of the oxygen concentration, 15d-PGJ(2) inhibited activity of hypoxia inducible factor-1 (HIF-1), the major hypoxic regulator of VEGF. However, in normoxic conditions 15d-PGJ(2) (1-10microM) activated the VEGF promoter and increased synthesis of the VEGF protein. Concomitantly, it strongly induced expression of HO-1. In contrast, in hypoxia, 15d-PGJ(2) decreased VEGF promoter activity and reduced VEGF release by 50%. Inhibition of HO-1 activity additionally attenuated VEGF synthesis in hypoxia. We conclude that induction of HO-1 by 15d-PGJ(2) results in augmentation of VEGF synthesis in normoxia. In hypoxia, however, the stimulatory effect of HO-1 is outweighed by 15d-PGJ(2)-mediated inhibition of the HIF-1 pathway.     

流感病毒感染巨噬细胞对缺氧诱导因子-1α诱导炎症反应通路的机制研究

为探索缺氧诱导因子(hypoxia inducible factor,HIF)-1α诱导甲型流感病毒毒株感染小鼠巨噬细胞引起炎症反应的具体机制,本研究以甲型H1N1流感病毒(简称H1N1)株A/PR/8感染小鼠巨噬细胞RAW264.7后,在显微镜下观察其在感染后的表型变化,分别在不同时间段收集样本,通过聚合酶链反应(polymerase chain reaction,PCR)检测HIF-1α、干扰素(interferon,IFN)-γ、白细胞介素(interleukin,IL)-6、肿瘤坏死因子(tumor necrosis factor,TNF)-α和M蛋白(M protein,MBP)mRNA的变化,通过蛋白质印迹法(Western blot, WB)检测HIF-1α、核转录因子-κB(nuclear factor-κB,NF-κB)、促分裂原活化的蛋白激酶(mitogenactivated protein kinase,MAPK)、蛋白激酶B(protein kinase B,Akt)以及M蛋白的变化。随后,加入抑制剂2-MeOE-2(10 nmol/L)进行抑制试验,采用PCR和WB检测HIF-1α表达被抑制后上述炎症因子mRNA表达水平及炎症蛋白通路的变化。结果显示,H1N1PR8感染小鼠巨噬细胞RAW264.7后,H1N1PR8复制率在24 h达到峰值,HIF-1α mRNA在感染6 h后开始升高,12 h迅速上升,24 h达到峰值。IFN-γ、IL-6、TNF-α mRNA变化趋势基本与HIF-1α一致,但在感染12 h并未进入快速上升期。HIF-1α蛋白在感染后6 h表达明显增多,24 h达到峰值,与mRNA变化水平基本一致。NF-κB通路蛋白在感染12 h后明显增多,48 h开始减少。加入抑制剂2-MeOE-2后,培养感染细胞24 h,抑制剂组IL-6、TNF-α mRNA水平较对照组显著下降(P<0.05),抑制剂组NF-κB通路蛋白较对照组表达下降。本研究结果表明,小鼠巨噬细胞被H1N1感染后,HIF-1α可能通过激活NF-κB通路促进IL-6、TNF-α等炎症因子的分泌参与炎症反应。     

MicroRNA‐125b modulates inflammatory chemokine CCL4 expression in immune cells and its reduction causes CCL4 increase with age

Chemokines play a pivotal role in regulating the immune response through a tightly controlled expression. Elevated levels of inflammatory chemokines commonly occur with aging but the mechanism underlying this age‐associated change is not fully understood. Here, we report the role of microRNA‐125b (miR‐125b) in regulating inflammatory CC chemokine 4 (CCL4) expression in human immune cells and its altered expression with aging. We first analyzed the mRNA level of CCL4 in eight different types of immune cells including CD4 and CD8 T‐cell subsets (naïve, central and effector memory), B cells and monocytes in blood from both young (≤42 years) and old (≥70 years) adults. We observed that monocytes and naïve CD8 T cells expressed higher levels of CCL4 and exhibited an age‐related increase in CCL4. We then found the level of miR‐125b was inversely correlated with the level of CCL4 in these cells, and the level of miR‐125b was reduced in monocytes and naïve CD8 T cells of the old compared to the young adults. Knock‐down of miR‐125b by shRNA in monocytes and naïve CD8 T cells led to an increase of CCL4 protein, whereas enhanced miR‐125b expression by transfection in naïve CD8 T cells resulted in a reduction of the CCL4 mRNA and protein in response to stimulation. Finally, we demonstrated that miR‐125b action requires the ‘seed’ sequence in 3′UTR of CCL4. Together these findings demonstrated that miR‐125b is a negative regulator of CCL4 and its reduction is partially responsible for the age‐related increase of CCL4.     

Trichinella spiralis: infection reduces airway allergic inflammation in mice

In an effort to define the mechanism underlying the host immune downregulation inherent to Trichinella spiralis infection, we compared the levels of Th1, Th2, and regulatory cytokines and CD4⁺CD25⁺ forkhead box P3 (FoxP3)⁺ T (T_reg) cell recruitment, as well as cellular pathology in the airway between T. spiralis infected and uninfected asthma-induced mice. After the induction of allergic airway inflammation, we noted influxes of inflammatory cells into the peribronchial tree. However, in the T. spiralis infection groups, cellular infiltration was minimal around the bronchial tree, with only a smattering of inflammatory cells. In the OVA-challenged group after T. spiralis infection, the numbers of macrophages and eosinophils in the bronchial alveolar lavage fluid were reduced by 23% and 52%, respectively, as compared to those of the OVA-challenged group. Airway hyperresponsiveness of OVA-challenged mice after T. spiralis infection was significantly suppressed as compared to the OVA-only challenged mice. The T. spiralis-infected mice exhibited a significant reduction in IL-5 concentrations relative to that noted in the OVA-challenged group (p < 0.01). Nevertheless, the regulatory cytokines IL-10 and TGF-β levels were increased significantly as the result of T. spiralis infection, and we verified the recruitment of T_reg cells in lung draining lymph nodes via T. spiralis infection. Therefore, T_reg cells, which were recruited by T. spiralis infection, might ameliorate lung function and reduce allergic airway inflammation.     

The pathological effects of CCR2+ inflammatory monocytes are amplified by an IFNAR1-triggered chemokine feedback loop in highly pathogenic influenza infection

Background

Highly pathogenic influenza viruses cause high levels of morbidity, including excessive infiltration of leukocytes into the lungs, high viral loads and a cytokine storm. However, the details of how these pathological features unfold in severe influenza infections remain unclear. Accumulation of Gr1 + CD11b + myeloid cells has been observed in highly pathogenic influenza infections but it is not clear how and why they accumulate in the severely inflamed lung. In this study, we selected this cell population as a target to investigate the extreme inflammatory response during severe influenza infection.

Results

We established H1N1 IAV-infected mouse models using three viruses of varying pathogenicity and noted the accumulation of a defined Gr1 + CD11b + myeloid population correlating with the pathogenicity. Herein, we reported that CCR2+ inflammatory monocytes are the major cell compartments in this population. Of note, impaired clearance of the high pathogenicity virus prolonged IFN expression, leading to CCR2+ inflammatory monocytes amplifying their own recruitment via an interferon-α/β receptor 1 (IFNAR1)-triggered chemokine loop. Blockage of IFNAR1-triggered signaling or inhibition of viral replication by Oseltamivir significantly suppresses the expression of CCR2 ligands and reduced the influx of CCR2+ inflammatory monocytes. Furthermore, trafficking of CCR2+ inflammatory monocytes from the bone marrow to the lung was evidenced by a CCR2-dependent chemotaxis. Importantly, leukocyte infiltration, cytokine storm and expression of iNOS were significantly reduced in CCR2−/− mice lacking infiltrating CCR2+ inflammatory monocytes, enhancing the survival of the infected mice.

Conclusions

Our results indicated that uncontrolled viral replication leads to excessive production of inflammatory innate immune responses by accumulating CCR2+ inflammatory monocytes, which contribute to the fatal outcomes of high pathogenicity virus infections.     

Caveolin-1 is required for contractile phenotype expression by airway smooth muscle cells

Airway smooth muscle cells exhibit phenotype plasticity that underpins their ability to contribute both to acute bronchospasm and to the features of airway remodelling in chronic asthma. A feature of mature, contractile smooth muscle cells is the presence of abundant caveolae, plasma membrane invaginations that develop from the association of lipid rafts with caveolin-1, but the functional role of caveolae and caveolin-1 in smooth muscle phenotype plasticity is unknown. Here, we report a key role for caveolin-1 in promoting phenotype maturation of differentiated airway smooth muscle induced by transforming growth factor (TGF)-β(1). As assessed by Western analysis and laser scanning cytometry, caveolin-1 protein expression was selectively enriched in contractile phenotype airway myocytes. Treatment with TGF-β(1) induced profound increases in the contractile phenotype markers sm-α-actin and calponin in cells that also accumulated abundant caveolin-1; however, siRNA or shRNAi inhibition of caveolin-1 expression largely prevented the induction of these contractile phenotype marker proteins by TGF-β(1). The failure by TGF-β(1) to adequately induce the expression of these smooth muscle specific proteins was accompanied by a strongly impaired induction of eukaryotic initiation factor-4E binding protein(4E-BP)1 phosphorylation with caveolin-1 knockdown, indicating that caveolin-1 expression promotes TGF-β(1) signalling associated with myocyte maturation and hypertrophy. Furthermore, we observed increased expression of caveolin-1 within the airway smooth muscle bundle of guinea pigs repeatedly challenged with allergen, which was associated with increased contractile protein expression, thus providing in vivo evidence linking caveolin-1 expression with accumulation of contractile phenotype myocytes. Collectively, we identify a new function for caveolin-1 in controlling smooth muscle phenotype; this mechanism could contribute to allergic asthma.     

雾化吸入雷公藤内酯醇对哮喘大鼠气道平滑肌增生及NF-κB、Bcl-2表达的影响

目的：探讨雷公藤内酯醇对哮喘气道重构及核因子-kappaB（NF-κB）、Bcl-2表达的影响。方法：将40只SD大鼠随机分为5组（n=8）：正常对照组（A组）;哮喘4周组（B组）;哮喘6周组（C组）;治疗4周组（D组）;治疗6周组（E组）。测定气道反应性并观察气道壁嗜酸性粒细胞浸润;图像分析软件测定支气管壁厚度、支气管平滑肌厚度及支气管平滑肌细胞核数量;免疫组织化学染色、Western印迹法检测PCNA、NF-κB、Bcl-2蛋白的表达,逆转录聚合酶链式反应（RT-PCR）检测Bcl-2mRNA表达。结果：①B组、C组NF-κB的蛋白表达量显著高于A组（P均〈0.01）,E组上述指标较B组、C组、D组均显著降低（P〈0.01、P〈0.01、P〈0.05）;②B组、C组Bcl-2蛋白及mRNA表达水平显著高于A组（P〈0.01）;E组蛋白表达量较B组、C组、D周组均显著降低（依次为P〈0.05、P〈0.01、P〈0.01）,mRNA表达水平与上述各组比较亦均显著降低（P〈0.01）,E组蛋白及mRNA表达水平与A组相比仍较高（依次为P〈0.05、P〈0.01）;③B组、C组PCNA的蛋白表达量明显高于A组（P〈0.01）;④B组及C组支气管壁厚度、支气管壁平滑肌厚度、支气管壁平滑肌细胞核数量均较A组明显增加（P〈0.01）,而E组上述指标较B组、C组、D组均显著降低（P〈0.01）;⑤B组、C组的气道反应性均高于A组（P均〈0.01）,E组较B组、C组、D组均显著降低（P〈0.01、P〈0.01、P〈0.05）。结论：哮喘气道平滑肌增生与气道平滑肌细胞（ASMCs）凋亡不足相关。NF-κB可能通过抑制ASMCs凋亡,参与哮喘气道高反应性及气道重构过程。雷公藤内酯醇可能通过下调NF-κB而抑制Bcl-2的表达,从而促进ASMCs凋亡、抑制气道平滑肌增生。     

Elevated expression of ICAM-1 in synovium is associated with early inflammatory response for cartilage degeneration in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is increasingly being recognized as an independent risk factor for the onset and progression of osteoarthritis (OA). Extensive studies have focused on the contribution of obesity (excessive mechanical stress), comorbidity frequently found in T2DM, to cartilage destruction during OA development. However, a little is known about how diabetes-related inflammation may affect the local cartilage in a diabetic objective. In the present study, we were able to establish a T2DM rat model using a combination of a low dose of streptozotocin with high-fat and high-sugar diet. Although the cartilage integrity was comparable between the control and T2DM groups, the expression of matrix metalloproteinases-13 (MMP-13) was significantly upregulated in T2DM, indicating the initiation of an early cascade of cartilage degeneration. In parallel, an obvious alteration of subchondral bone remodeling (inhibition of bone formation) was observed, as evidenced by the reduction of osterix-expressing positive cells. Moreover, we demonstrated that the expression of intercellular adhesion molecule-1 (ICAM-1) in the serum and synovium of T2DM rats was elevated, accompanied by an increase of synovitis score. We also noticed that the number of F4/80-positive macrophage cells was significantly increased in the T2DM group. Mechanistically, the expression of ICAM-1 in fibroblast-like synoviocytes can be triggered by glucose and interleukin-1β, which are the two important factors within the joint of T2DM. Given that MMP-13 expression was significantly upregulated in the T2DM cartilage, and that ICAM-1-mediated filtration of macrophage was associated with synovitis, we propose that ICAM-1 is essential for triggering a vicious cycle of inflammation within the joint, which together subsequently drivers the cartilage degradation.