The cells of cartilage are constantly remodeling the matrix in which they are suspended. The stimulus to initiate remodeling is probably the chondrocyte's response to physical and or chemical changes in the environment. Heat, pressure, friction, load, pH, and growth are examples of such factors, which, if altered, would have a dramatic effect on the cell's state of health. The mode of response by the chondrocyte is specific for a given stimulus. Elevated temperature, for example, switches on a set of genes, the heat shock genes, in chondrocytes. This results in the synthesis of a series of cellular protein that presumably in turn protects the cell from the injurious effects of heat. Load and pressure affect both the synthetic rate of matrix protein and the degradation rates of preexisting matrix. A number of low-molecular-weight proteins appear to be involved in anabolic and catabolic processes of cartilage. A protein recently isolated from synovium stimulates the synthesis of degradative enzymes in cartilage. This factor is probably involved in the remodeling process under normal physiologic conditions. More recently, it has been found in elevated levels under pathologic conditions such as in the synovial fluid of patients with rheumatoid and osteoarthritis. The mechanism by which this factor turns on the degradative pathway appears complex and is under investigation.
From the Orthopaedic Research Laboratories, Massachusetts, General Hospital, Harvard Medical School, Boston, Massachusetts.