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Front. Immunol. | doi: 10.3389/fimmu.2019.00266

Extremely-low Frequency Pulsed Electromagnetic Field Modulate Inflammation and Restore Homeostasis in Rheumatoid Arthritis (RA)

  • 1Wake Forest School of Medicine, United States
  • 2Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, United States

Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation of synovium (synovitis), with inflammatory/immune cells and resident fibroblast-like synoviocytes (FLS) acting as major players in the pathogenesis of this disease. The resulting inflammatory response poses considerable risks as loss of bone and cartilage progresses, destroying the joint surface, causing joint damage, joint failure, articular dysfunction, and pre-mature death if left untreated. At the cellular level, early changes in RA synovium include inflammatory cell infiltration, synovial hyperplasia, and stimulation of angiogenesis to the site of injury. Different angiogenic factors promote this disease, making the role of anti-angiogenic therapy a focus of RA treatment. To control angiogenesis, mesenchymal stromal cells/pericytes (MSCs) in synovial tissue play a vital role in tissue repair. While recent evidence reports that MSCs found in joint tissues can differentiate to repair damaged tissue, this repair function can be repressed by the inflammatory milieu. Extremely-low frequency pulsed electromagnetic field (PEMF), a biophysical form of stimulation, has an anti-inflammatory effect by causing differentiation of MSCs. PEMF has also been reported to increase the functional activity of MSCs to improve differentiation to chondrocytes and osteocytes. Moreover, PEMF has been demonstrated to accelerate cell differentiation, increase deposition of collagen, and potentially return vascular dysfunction back to homeostasis. The aim of this report is to review the effects of PEMF on MSC modulation of cytokines, growth factors, and angiogenesis, and describe its effect on MSC regeneration of synovial tissue to further understand its potential role in the treatment of RA.
Keywords: Pulsed Electromagnetic Field (PEMF); Rheumatoid Arthritis (RA); Mesenchymal Stromal Cells/pericytes (MSCs); Osteogenesis; Chondrogenesis; Angiogenesis

Keywords: Pulsed electromagnetic field (PEMF), Mesenchymal stem/stromal cells (MSCs), rheumatoid arthritis (RA), Angiogenesis, Chondrogenesis, Osteogenesis

Received: 27 Aug 2018; Accepted: 31 Jan 2019.

Edited by:

Guido Moll, Charité Medical University of Berlin, Germany

Reviewed by:

Rita Consolini, University of Pisa, Italy
Jérôme Avouac, Université Paris Descartes, France  

Copyright: © 2019 Ross, Almeida-Porada and Ang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Christina L. Ross, Wake Forest School of Medicine, Winston-Salem, United States, chrross@wakehealth.edu