Terminal N-acetylglucosamine in chronic synovitis.

The distribution of terminal GlcNAc residues in normal and diseased synovial tissue has been studied using a mouse monoclonal antibody (mAb) which binds to terminal N-acetylglucosamine (GlcNAc). Normal human connective tissue, including synovium, showed no staining for terminal GlcNAc. Normal epithelial tissues, including tonsillar epithelium, skin, small intestinal epithelium and salivary epithelium showed cellular staining. Synovium from patients with definite rheumatoid arthritis showed dense granular staining of macrophages. In addition, synovium from 9 of 12 patients with definite rheumatoid arthritis showed reticular extracellular staining indicating deposition of material bearing terminal GlcNAc in the connective tissue stroma. The extracellular staining was not seen in synovium from patients with osteoarthritis. Extracellular material bearing terminal GlcNAc may act as an inflammatory stimulus in rheumatoid arthritis, either by acting as antigen or by interaction with receptors on macrophage membranes which also recognize GlcNAc on bacterial material, thus triggering biochemical pathways normally occurring in response to the presence of micro-organisms.