A solution containing synthetic liposomes was injected into rabbit knee joints. This induced light and electron microscopic findings very similar to those seen in acute or chronic arthritis, not attributable to any mechanism other than to spherulites, in humans. Synovial fluid studies revealed leukocytosis and abundant extracellular, and/or intracellular positively birefringent spherulites, which appeared as Maltese crosses. Histologic studies of synovial membranes showed infiltration with polymorphonuclear neutrophils or mononuclear cells. Examination of the synovial fluids and synovial membranes by electron microscopy revealed intracellular multilayered membranous arrays of varying shapes. These observations suggest that further consideration should be given to a phlogistic role for similar spherulites found in some patients.Intracellular birefringent lipid spherulites, appearing as Maltese crosses, have been reported in the synovial fluid (SF) of several patients with unexplained acute or chronic arthritis (1-3). These spherulites consist of multilayered structures similar to artificially prepared liposomes, smectic mesophases, or hydrated lipid liquid crystals (4). It was suggested that these liposome-like spherulites might have induced inflammation similar to that seen in crystal-induced arthritis (1-3), but there was no proof of phlogistic potential for such spherulites.In this paper, we have shown that synthetic liposomes which have the appearance of a Maltese cross can induce inflammation when injected into rabbit joints. We have also compared the pathologic findings in this experimental model with observations made in arthritis in humans.
MATERIALS AND METHODSLipids. L-a-phosphatidylcholine type VII-E and cholesterol were purchased from Sigma Chemical Company (St. Louis, MO). Dicetyl phosphate was obtained from Alfa Products (Danvers, MA).Preparation of liposomes. Liposomes were prepared under sterile conditions as described by . Briefly, for each set of experiments, 60 pmoles of phosphatidylcholine, 17.16 pmoles of dicetyl phosphate, and 8.58 pmoles of cholesterol (molar ratio 7:2: 1) were dissolved in chloroform in a 100-ml round-bottomed flask. After rotary evaporation, a uniformly thin lipid film was formed. Six milliliters of 0.145M KH2P04 (pH 7.4) solution was added to the flask and the lipid film was dispersed by vortexing (10 minutes at 23°C). Thereafter, the suspension (15 pmoles of lipid/ml) was allowed to equilibrate for 2 hours at 23°C.The resulting liposomes were viewed under compensated polarized light and were strongly positive birefringent spherulites (i.e., the 2 blue portions of the Maltese cross