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2015 ; 90
(11
): 1027-35
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Vascular remodeling underlies rebleeding in hemophilic arthropathy
#MMPMID26257191
Bhat V
; Olmer M
; Joshi S
; Durden DL
; Cramer TJ
; Barnes RF
; Ball ST
; Hughes TH
; Silva M
; Luck JV
; Moore RE
; Mosnier LO
; von Drygalski A
Am J Hematol
2015[Nov]; 90
(11
): 1027-35
PMID26257191
show ga
Hemophilic arthropathy is a debilitating condition that can develop as a
consequence of frequent joint bleeding despite adequate clotting factor
replacement. The mechanisms leading to repeated spontaneous bleeding are unknown.
We investigated synovial, vascular, stromal, and cartilage changes in response to
a single induced hemarthrosis in the FVIII-deficient mouse. We found soft-tissue
hyperproliferation with marked induction of neoangiogenesis and evolving abnormal
vascular architecture. While soft-tissue changes were rapidly reversible,
abnormal vascularity persisted for months and, surprisingly, was also seen in
uninjured joints. Vascular changes in FVIII-deficient mice involved pronounced
remodeling with expression of ?-Smooth Muscle Actin (SMA), Endoglin (CD105), and
vascular endothelial growth factor, as well as alterations of joint perfusion as
determined by in vivo imaging. Vascular architecture changes and pronounced
expression of ?-SMA appeared unique to hemophilia, as these were not found in
joint tissue obtained from mouse models of rheumatoid arthritis and
osteoarthritis and from patients with the same conditions. Evidence that vascular
changes in hemophilia were significantly associated with bleeding and joint
deterioration was obtained prospectively by dynamic in vivo imaging with
musculoskeletal ultrasound and power Doppler of 156 joints (elbows, knees, and
ankles) in a cohort of 26 patients with hemophilia at baseline and during painful
episodes. These observations support the hypothesis that vascular remodeling
contributes significantly to bleed propagation and development of hemophilic
arthropathy. Based on these findings, the development of molecular targets for
angiogenesis inhibition may be considered in this disease.
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