Intra-articular etanercept attenuates pain and hypoxia from TMJ loading in the rat

Mechanical overloading of the temporomandibular joint (TMJ) and biochemical changes, like inflammation and hypoxia, contribute to cartilage degeneration and pain associated with osteoarthritis (OA). Yet, how overloading contributes to early dysregulation of chondrocytes is not understood, limiting the development of diagnostics and treatments for TMJ OA. Hypoxia-inducible factors (HIF)-1 alpha/2 alpha in chondrocytes were evaluated at Days 8 and 15 in a rat TMJ pain model induced by jaw loading (1 h/day for 7 days) using immunohistochemistry and compared between cases that induce persistent (3.5 N), acute (2 N), or no (0 N) sensitivity. Hypoxia was measured on Day 8 by immunolabeling of the tracer EF5 and F-18-EF5 PET imaging. To assess the role of tumor necrosis factor (TNF) in painful TMJ loading, intra-articular etanercept was given before loading. Orofacial sensitivity was evaluated during and after loading. Facial grimace, TNF-alpha, HIF-2 alpha, and hypoxia levels in the TMJ were measured after loading. HIF-2 alpha was elevated (P = .03) after 3.5 N loading at Day 8, but HIF-1 alpha was unchanged. EF5 uptake increased on Day 8 in the 3.5 N group (P < .048) by tissue assay and F-18-EF5 PET. At Day 8, both HIF-2 alpha (P = .01) and EF5 uptake (P = .005) were correlated with loading magnitude. Etanercept attenuated sensitivity (P < .01) and the facial grimace on Day 7 (P = .01). It also reduced (P < .01) HIF-2 alpha and EF5 uptake on Day 8; but TNF-alpha levels were not different from controls at that time. Findings suggest that TMJ loading that induces persistent sensitivity upregulates the catabolic factor HIF-2 alpha and reduces oxygen levels in the cartilage, which may be TNF-driven.