Synovial macrophage activation mediates pain experiences in experimental knee osteoarthritis

It has been suggested that synovial macrophages mediate nociceptive signals in knee osteoarthritis (OA) but the underlying mechanisms are unknown. Our objectives were to investigate the role of synovial macrophages and their activation via signal transducer and activator of transcription (STAT) signaling in mediating OA pain experiences. We induced experimental OA in rats via knee destabilization surgery and then performed RNA sequencing analysis in sorted synovial macrophages to identify signaling pathways associated with macrophage activation. Next, we repeated intra-articular injections of liposomal clodronate to deplete macrophages, or liposomal inhibitors of STAT1 or STAT6 to block macrophage activation, and tested the effects on local and distal mechanical pain sensitivity. We also assessed synovitis, cartilage damage, and synovial macrophage infiltration with histopathology and immunofluorescence, and crosstalk between liposomal drug-treated synovium and articular chondrocytes in co-culture. Most enriched signaling pathways in activated OA macrophages involved STAT signalling. Macrophage depletion and STAT6 inhibition led to marked, sustained improvements in mechanical pain sensitivity and synovial inflammation compared to controls, but macrophage depletion caused increased synovial fibrosis and vascularization. In contrast, STAT1 and STAT6 inhibition in macrophages did not worsen synovial or cartilage pathology. In crosstalk assays, macrophage STAT1-inhibited synovium caused the greatest increases in the expression of anabolic and catabolic chondrocyte genes and sulphated glycosaminoglycan secretion in chondrocytes. Our results suggest that synovial macrophages play a key role in mediating pain experiences in experimental knee OA, and that selectively blocking STAT6 in synovial macrophages may reduce OA-related pain without accelerating joint tissue damage. (248/250) One Sentence Summary Selective drug targeting to synovial macrophages improves pain experiences in surgical joint destabilization-induced experimental rodent knee OA. (145/150) ### Competing Interest Statement C.T. Appleton: consulting AbbVie, Lily, Novartis, Pfizer. GB, YLZ, JK, HTP, KKP, AM, BF, LAW, ERG have no disclosures