title: Alteration of Chlamydia trachomatis biologic behavior in synovial membranes. Suppression of surface antigen production in reactive arthritis and Reiter's syndrome.
abstract: OBJECTIVE
  To investigate the biologic state of Chlamydia and its surface antigen expression in the synovial membranes of patients with Chlamydia-associated reactive arthritis/Reiter's syndrome (ReA/RS).
  
  
  METHODS
  Expression of chlamydial lipopolysaccharide (LPS), major outer membrane protein (MOMP), and elementary body (EB) antigens was studied by gold labeling immunoelectron microscopy on 6 synovial membrane and 2 synovial fluid (SF) pellet samples from 6 patients with Chlamydia-associated arthritis. The study findings were compared with 24-hour cultures of HeLa cells infected with Chlamydia trachomatis EB.
  
  
  RESULTS
  Persistent C trachomatis infection was found in all 6 synovial membrane samples from patients who had either early or chronic arthritis. The infection persisted despite antibiotic treatment, including a 1-month course of doxycycline therapy. Most persistent organisms were atypical reticulate bodies (RBs) found in both fibroblasts and macrophages. Specific, but weak, immunogold staining for all 3 antibodies was found on both intracellular RBs and extracellular EBs. In the SF samples, Chlamydia surface antigens were detected only in phagosomes containing degraded electron-dense materials.
  
  
  CONCLUSIONS
  The synovial membrane biopsies conducted in this study of Chlamydia-associated ReA/RS revealed atypical RBs with diminished MOMP and LPS expression. Such altered organisms may escape immune surveillance and contribute to disease chronicity; moreover, these organisms may be difficult to detect and treat in some ReA/RS patients.
authors.affiliation: KhonKaen University, Thailand.
authors.forename: R
authors.initials: R
authors.lastname: Nanagara
authors.forename: F
authors.initials: F
authors.lastname: Li
authors.forename: A
authors.initials: A
authors.lastname: Beutler
authors.forename: A
authors.initials: A
authors.lastname: Hudson
authors.forename: H R
authors.initials: HR
authors.lastname: Schumacher
mesh_terms: D000328:Adult; D000954:Antigens, Surface / Q000032:analysis*; D016918:Arthritis, Reactive / Q000276:immunology / Q000382:microbiology*; D001425:Bacterial Outer Membrane Proteins / Q000032:analysis*; D002690:Chlamydia Infections / Q000276:immunology / Q000382:microbiology*; D002692:Chlamydia trachomatis / Q000276:immunology*; D005260:Female; D006367:HeLa Cells; D006801:Humans; D008070:Lipopolysaccharides / Q000032:analysis; D008297:Male; D016253:Microscopy, Immunoelectron; D008875:Middle Aged; D018272:Porins; D000091402:Prohibitins; D013582:Synovial Fluid / Q000276:immunology / Q000382:microbiology; D013583:Synovial Membrane / Q000276:immunology / Q000382:microbiology*
chemical_list: D000954:Antigens, Surface; D001425:Bacterial Outer Membrane Proteins; D008070:Lipopolysaccharides; C000717331:PHB2 protein, human; D018272:Porins; D000091402:Prohibitins; C071677:omp1 protein, Chlamydia trachomatis