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Autophagy and cartilage homeostasis mechanisms in joint health, aging and OA

Nature Reviews Rheumatology volume 7, pages 579–587 (2011)Cite this article

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Abstract

Osteoarthritis (OA) is the most prevalent joint disease, but neither preventive measures nor disease-modifying drugs are available and a continuing need exists for safe and effective symptom-modifying therapies. Clinical trials of candidate disease-modifying OA drugs in patients with established or advanced disease have not demonstrated their efficacy, but these failed trials have motivated investigation into the mechanisms that maintain joint health. The enhancement of such mechanisms could be a novel approach to reducing the risk of OA. Aging is one of the most important risk factors for OA; however, aging of joint cartilage is a process that is distinct from the subsequent cartilage changes that develop following the onset of OA. This Review focuses on the mechanisms that maintain cell and tissue homeostasis, and how these mechanisms fail during the aging process. Autophagy is a cellular homeostasis mechanism for the removal of dysfunctional organelles and macromolecules. Defective autophagy is involved in the pathogenesis of aging-related diseases and recent observations indicate that this process is compromised in aging cartilage. Augmentation of homeostasis mechanisms is discussed as a novel avenue to delay joint aging and reduce OA risk.

Key Points

  • In clinical trials in patients with established or advanced osteoarthritis (OA), candidate disease-modifying drugs have failed to show efficacy

  • Aging represents one of the main risk factors for OA, and pharmacological approaches that aim to delay cartilage aging could reduce OA risk

  • Failure of cellular homeostasis mechanisms is among the earliest events that precede cartilage cell death and extracellular matrix damage in the pathogenesis of OA

  • Autophagy is a central cellular homeostasis mechanism that is compromised in aging cartilage

  • Approaches to enhance autophagy and other homeostasis mechanisms might protect against aging-related cell dysfunction, and could be effective in reducing the risk for aging-related degenerative diseases such as OA

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Figure 1: Pathogenesis pathways in established OA.
Figure 2: Mechanisms of cartilage superficial zone disruption.
Figure 3: Determinants of cartilage homeostasis.
Figure 4: Regulation and execution of autophagy.

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Acknowledgements

The writing of this manuscript was supported by NIH grants AG007996 and AR056026, and a grant from Cargill, Inc.

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  1. Department of Molecular and Experimental Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, 92037, CA, USA

    Martin K. Lotz & Beatriz Caramés

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B. Caramés and M. K. Lotz researched the data for the article, provided substantial contributions to discussions of the content, and contributed to writing the article and to review and/or editing of the manuscript before submission.

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M. K Lotz has acted as a consultant for and received grant/research support from Cargill, Inc. B. Caramés declares no competing interests.

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Lotz, M., Caramés, B. Autophagy and cartilage homeostasis mechanisms in joint health, aging and OA. Nat Rev Rheumatol 7, 579–587 (2011). https://doi.org/10.1038/nrrheum.2011.109

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