title: Connective tissue growth factor (CTGF/CCN2) in haemophilic arthropathy and arthrofibrosis: a histological analysis.
abstract: BACKGROUND
  Joint haemorrhage is the principal clinical manifestation of haemophilia frequently leading to advanced arthropathy and arthrofibrosis, resulting in severe disability. The degree and prevalence of arthrofibrosis in hemophilic arthropathy is more severe than in other forms of arthropathy. Expression of connective tissue growth factor (CTGF) has been linked to many fibrotic diseases, but has not been studied in the context of haemophilic arthropathy.
  
  
  OBJECTIVE
  We aim to compare synovial tissues histologically from haemophilia and osteoarthritis patients with advanced arthropathy in order to compare expression of proteins that are possibly aetiologic in the development of arthrofibrosis.
  
  
  METHODS
  Human synovial tissues were obtained from 10 haemophilia and 10 osteoarthritis patients undergoing joint surgery and processed for histology and immunohistochemistry.
  
  
  RESULTS
  All samples from haemophilia patients had synovitis with hypertrophy and hyperplasia of synovial villi. Histologically, synovial tissues contained hyperplastic villi with increased cellularity and abundant haemosiderin- and ferritin-pigmented macrophage-like cells (HMCs), with a perivascular localization in the sub-surface layer. CTGF staining was observed in the surface layer and sub-surface layer in all haemophilia patients, exclusively co-localizing with HMCs. Quantification showed that the extent of CTGF-positive areas was correlated with the degree of detection of HMCs. CTGF was not observed in any of the samples from osteoarthritis patients.
  
  
  CONCLUSIONS
  Using histological analysis, we showed that CTGF expression is elevated in haemophilia patients with arthrofibrosis and absent in patients with osteoarthritis. Additionally, we found that CTGF is always associated with haemosiderin-pigmented macrophage-like cells, which suggests that CTGF is produced by synovial A cells following the uptake of blood breakdown products.
authors.affiliation: Hemophilia Treatment Center at Orthopaedic Institute for Children, Los Angeles, CA, USA.|Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Jiang
authors.affiliation: Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
authors.forename: N L
authors.initials: NL
authors.lastname: Leong
authors.affiliation: Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
authors.forename: U
authors.initials: U
authors.lastname: Khalique
authors.affiliation: Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Phan
authors.affiliation: Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Lyons
authors.affiliation: Hemophilia Treatment Center at Orthopaedic Institute for Children, Los Angeles, CA, USA.|Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
authors.forename: J V
authors.initials: JV
authors.lastname: Luck
mesh_terms: D000328:Adult; D055513:Connective Tissue Growth Factor / Q000378:metabolism*; D005260:Female; D006395:Hemarthrosis / Q000150:complications / Q000378:metabolism*; D006467:Hemophilia A / Q000150:complications / Q000378:metabolism*; D006801:Humans; D007592:Joint Diseases / Q000209:etiology / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: C526317:CCN2 protein, human; D055513:Connective Tissue Growth Factor
keywords: 
  CTGF
  ; arthrofibrosis; haemophilic arthropathy; haemosiderin; macrophages; synovium