Non-invasive techniques for studying macrophages in joint inflammation

Folate-based radiotracers have been used in patients with cancer and inflammatory diseases to visualize folate receptor expressing cells using PET or SPECT techniques. Activated macrophages express folate receptor beta (FR-b) and this allows specific imaging of these cells in-vivo. From previous work using SPECT imaging to visualize folate receptor expressing macrophages in both animal models and in patients with OA we know that macrophages are present in OA affected joints. However, it remains unclear what role these macrophages play in the different stages of OA and whether their role can be influenced by specific targeting. In Wistar rats osteoarthritis was induced using a low dose of intra-articular papain injections in one knee joint combined with exposure to a moderate exercise protocol. After six weeks and twelve an in vivo folate SPECT/CT scan and micro-CT analyses were performed. Macrophages from human peripheral blood monocytes were cultured (7 days) in the presence of GM-CSF (M1 proinflammatory phenotype) or M-CSF (M2 anti-inflammatory phenotype). Subsequently the macrophages were treated with LPS, cytokines (IL-4, IL-10, IFN-y) or a corticoid steroid (triamcinolone acetonide, 1μg/ml). Folate receptor beta (FRb) as well as other macrophage marker expressions were measured using FACS. Intra-articular injections with triamcinolone strongly enhanced FRb+ macrophage activation and fully prevented osteophyte formation. There were no beneficial effects of