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New discoveries on how tissue cells, known as stromal cells contribute to chronic joint inflammation could hold the key to innovative targeted treatments for patients with refractory joint disease.

Stromal cells of mesenchymal origin including fibroblasts, tissue resident macrophages and endothelial cells are crucial populations that regulate health and disease in musculoskeletal tissues.

New data are beginning to reveal the mechanisms underpinning the activation and dysfunction of these mesenchymal stromal cells and their contribution to sustaining chronic joint inflammation.

"Our review discusses how resident stromal cells behave and change their characteristics during inflammatory joint disease, advancing understanding of why inflammation persists in common diseases of the joint. Some patients with chronic joint disease are refractory to current therapies that target immune cells. Improved knowledge of how stromal cells drive chronic inflammation and cause tissue damage advances the development of effective new therapies targeting the cells driving disease", says Associate Professor Stephanie Dakin.

"The discovery that distinct synovial fibroblast subsets mediate joint inflammation and tissue damage informs precision therapeutic targeting of pathogenic stromal cell populations. In addition to directly targeting stromal cells, there is also a requirement to target the cross-talk between tissue resident stromal cells and infiltrating immune cells, as these interactions fuel persistent inflammation. These discoveries shape the future therapeutic landscape, presenting exciting new approaches to address the pathogenic stromal microenvironment and resolve chronic inflammation in debilitating joint disease", she adds.

Read the full paper

Pathogenic stromal cells as therapeutic targets in joint inflammation

Nature Reviews Rheumatology 14, pages714–726 (2018)