Abstract
The concept behind the resolution of inflammation has changed in the past decades from a passive to an active process, which reflects in novel avenues to understand and control inflammation-driven diseases. The time-dependent and active process of resolution phase is orchestrated by the endogenous biosynthesis of specialized pro-resolving lipid mediators (SPMs). Inflammation and its resolution are two forces in rheumatic diseases that affect millions of people worldwide with pain as the most common experienced symptom. The pathophysiological role of SPMs in arthritis has been demonstrated in pre-clinical and clinical studies (no clinical trials yet), which highlight their active orchestration of disease control. The endogenous roles of SPMs also give rise to the opportunity of envisaging these molecules as novel candidates to improve the life quality of rhematic diseases patients. Herein, we discuss the current understanding of SPMs endogenous roles in arthritis as pro-resolutive, protective, and immunoresolvent lipids.
Introduction
Rheumatic diseases, represented by varied forms of arthritis and other musculoskeletal disorders, affect millions of people around the world. Rheumatoid arthritis (RA), osteoarthritis (OA), septic arthritis, and gouty arthritis are some examples of this painful group of diseases () and the focus of this review. Historically, pain in rheumatic disease is mostly attributed to tissue damage mainly due to neutrophil recruitment during the active phase of the diseases (). These immune cells are equipped with a vast arsenal of molecules that are released with the aim of protecting the host during infections, for example, but at the same time cause inflammation and pain. The release of pro-inflammatory cytokines such as TNF-α, IL-1β, IL-33, and the process of NETosis are widely known to aggravate arthritis disease status and pain (). Recent evidence also suggests that antibody immunocomplex activates nociceptors. By acting on FcγRI and FcγRIIb receptors expressed by mouse TRPV1+ dorsal root ganglion (DRG) neurons, these immunocomplexes induce the release of neuropeptide and activation of nociceptors to produce pain ().
Arthritis, in their different forms, are traditionally regarded as a life-long disease. As for diabetes, hypertension, and certain forms of cancer, current therapies for arthritis focus on disease control as cure still seems out of reach. Therefore, life-long treatment to control the inflammatory process is required to effectively prevent further cartilage and bone destruction. To the date, disease-modifying anti-rheumatic drugs (DMARDs) are one the current choice (alone or in combination) for the treatment of different types of arthritis (; ). DMARDs can be categorized into conventional synthetic (cs) DMARDs (e.g., methotrexate), biologic (b) DMARDs (anakinra, etanercept) and, most recently introduced, targeted synthetic (ts) DMARDs [Janus Kinase inhibitor] (). While many patients experience good disease control with DMARDs, a fraction of patients continues to experience significant pain even with low disease activity (; ) or in remission (). In addition, typical side effects such as increase susceptibility to infections, development of adaptive immunity against the biological agents (; ; ), relapse of active disease, and the concomitant increase of joint pain are not uncommon (). Infectious arthritis are treated with a combination of broad-spectrum antibiotic with corticosteroids, immunobiological agents, or opioids for pain management, which might facilitate pathogen spread due to immunosuppression (; ; ). The high cost and wide range of side effects of these drugs frequently restricts their usage, which highlights this unmet need of new compounds to treat arthritis.
Exogenous administration of different specialized pro-resolving lipid mediators (SPMs) at low doses has been shown effectiveness at treating pain and infection in experimental models (; ; ). In oppose to the current clinically active drugs for arthritis treatment, SPMs present long lasting analgesic and anti-inflammatory effects and are not immunosuppressive compounds (; ; ). This characteristic of SPMs of blocking pain without immunosuppression rendered the term “immunoresolvent” to this class of molecules. Therefore, we review pre-clinical and clinical data involving SPMs in arthritis as well as the potential outcomes of this knowledge to arthritis therapeutics.
Specialized Pro-Resolving Lipid Mediators and Resolution of Inflammation
While it is commonly attributed to Hippocrates the use of willow bark to treat the signs of inflammation around 400 Before Common Era (BCE), it is known that the use of willow extracts dates from around 4,000 BCE by ancient civilization such as the Assyrians (). From then, to the total organic synthesis of salicylic acid (1850s), and later to the acetylation of salicylic acid (1900s), aspirin remains one of the most used drugs (). Part of that is attributed to the seminal discoveries of Prof Sergio H. Ferreira and Sir John R. Vane in the field of pharmacology by showing how aspirin works and why it reduces inflammation and inflammatory pain (; ; ). Drug discovery to treat inflammation and pain, therefore, mainly focused on mimicking aspirin mechanism of action giving rise to the COX-blockers. However, COX-2 acetylation by aspirin changes the activity of this enzyme leading to the production of SPMs, which are responsible, in part, for the anti-inflammatory and analgesic mechanisms of aspirin. This knowledge makes clear now that stimulation of endogenous pathways involved in the resolution of inflammation can lead to a new road for drug discovery.
The resolution of inflammation is controlled by a time-dependent mechanism of SPM production (; ). A seminal study using an air-pouch model of inflammation induced by TNF-α shows the occurrence of a biosynthetic shift from pro-inflammatory to pro-resolving lipid mediators (). This work demonstrates that an increase of lipoxin A4 (LXA4) levels correlates with the reduction in PGE2 production, neutrophil recruitment, and consequently, the resolution of inflammation (). SPMs are divided into four main families: the LX, the maresin (MaR), the resolvin (Rv), and the protectin (PD; ; ; ). Endogenous biosynthesis of SPMs depends on the action of different enzymes to convert arachidonic acid (AA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), or docosahexaenoic acid (DHA) into distinct molecules within the different SPM classes (; ; ). The biological effects of SPMs are receptor-dependent and occur via the activation of specific G protein-couple receptors. The receptors and expressing cellular types are summarized in Table 1. The activity of SPMs has been widely explored since several studies demonstrate these molecules might produce an enduring effect. Treatment with LXA4 72 h before stimulus increases the efficacy of this mediator against skin damage induced by ultraviolet B radiation. For RvD1, when treatment is performed before the development of tactile allodynia, RvD1 produces 30 days of analgesic effect in opposed to its limited analgesic effect with treatment at later time points provide limited analgesia (). MaR1, on the other hand, upon a single treatment, displays 5 days of analgesic effect when treatment is performed before stimulus with CFA and 3 days of analgesia when treatment is performed 24 h after the stimulus (). In corroboration to our study, Allen and colleagues demonstrated that MaR1 presents 14 days of analgesia after repeated treatments (). These sets of data show that isolated SPMs demonstrate time-dependent and long-term efficacy even upon single treatment, which might be useful for the treatment of inflammatory diseases.
TABLE 1
| SPM family | SPM | Receptor | Cell type | References | |
| Lipoxins | LXA4 | GPR32 ALX/FPR2 | ALX/FPR2 – macrophage, neutrophil, lymphocyte, natural killer, ILC2. GPR32 – macrophage, neutrophil, and lymphocyte. | ||
| AT-LXA4 | |||||
| Resolvins | D-series | RvD1 | |||
| AT-RvD1 | |||||
| RvD2 | GPR18 | Macrophage, neutrophil, neurons, and astrocytes | ; | ||
| RvD3 | ALX/FPR2 | Macrophage, neutrophil, lymphocytes, natural killer, ILC2. | |||
| RvD5 | GPR101 | Macrophages, neutrophils, and monocytes. | |||
| E-series | RvE1 | ChemR23 | Macrophage, dendritic cell, natural killer, ILC2, and neurons. | ; ; | |
| RvE2 | |||||
| Protectins | PD1/NPD1 | GPR37 | Macrophage and neutrophil | ; | |
| Maresins | MaR1 | LGR6 | Macrophage and neutrophil | ||
SPMs and their receptors.
SPMs, Specialized pro-resolving mediators; LXA4, Lipoxin A4; AT-LXA4, aspirin-triggered lipoxin A4; RvD1, resolvin D1; AT-RvD1, aspirin-triggered resolvin D1; GRP32, G Protein-Coupled Receptor 32; ALX/FPR2, G-protein coupled formyl peptide receptor 2; ILC2, type 2 innate lymphoid cells; RvD2, resolvin D2; GPR18, G Protein-Coupled Receptor 18; RvD3, resolvin D3; RvD5, resolvin D5; GRP101, G Protein-Coupled Receptor 101;RvE1, resolvin E1; RvE2, resolvin E2; ChemR23, Chemerin Receptor 23; PD1, protectin D1; NPD1, neuroprotectin D1; GRP37, G Protein-Coupled Receptor 37; MaR1, maresin 1; and LGR6, leucine rich repeat containing G protein-coupled receptor 6.
Further studies focusing on the immune cell side of the resolution, show that the initial production of SPMs are followed by the recruitment of a distinct subpopulation of pro-resolving macrophages, which correlates with the resolution of inflammation (). This was demonstrated using the self-resolving model of peritonitis induced by zymosan (1 mg, ip; ). Subsequent studies using the same self-resolving model of peritonitis induced by zymosan (but now using 0.1 mg, ip) by Derek Gilroy’s group, shed light on the role and phenotype of these pro-resolving macrophages (; ; ). These cells possess a unique phenotype that is controlled by cAMP while sharing some markers with M1 macrophages such as inducible nitric oxide synthase (iNOS) and COX-2 (). Transcriptomic analysis reveals that, while the resolution was also achieved after injection of 10 mg of zymosan, a higher number of M1-like macrophages without the acquisition of the pro-resolving phenotype were generated when compared to stimulus with 0.1 mg of zymosan (). These results might indicate that hyperinflammatory states possibly compromise host response against subsequent injury and complete resolution (). Subsequent analysis 60 days after injection of zymosan (0.1 mg, ip) shows that resolving inflammation changes the immune cell landscape of the peritoneal cavity. This new immune cell landscape provides a more rapid and effective response against secondary tissue injury, indicating the existence of a possible tissue memory mediated by pro-resolving macrophages (). Therefore, in addition to the production of SPMs, complete resolution might be only achieved after this third phase of leukocyte recruitment that is mainly dominated by tissue memory-generating macrophages (; ; ).
SPM Levels and Arthritis Status
SPM Levels and Arthritis Status in Humans
In this section, we discuss the profile and role of SPMs in arthritis. Figures 1, 2, and Table 2 summarize our discussion. Despite the common sense of arthritis patients’ abilities to predict weather changes, the balance between pro-inflammatory and SPMs could be closely related to this phenotype. Previous studies have shown that the deficiency of 12/15-lipoxigenase, a key enzyme in the synthesis of SPMs, are related to worsened outcome in an arthritis model of K/BxN serum transfer in mice (). In corroboration, the overexpression of 15-lipoxigenase reduces inflammation, tissue damage, and increases SPM levels (). Those evidence contributed to the advances in lipidomic research in the last decade, and useful methodologies have been placed to identify and determine levels of lipid mediators in serum or synovial fluid, paving new paths toward understanding its physiological role (). In fact, the development of enzyme immunoassay () and the application of LC-MS/MS () for SPM or their precursors detection were key steps for the understanding of the role and temporal profiling of lipids in diseases in humans and rodents. They might be also used to stratify patients in different phases of disease or even be used as predictive for drug responsiveness. A recent study highlights that plasma levels of SMP are a potential biomarker for DMARD responsiveness in patients with RA (). It was found, using supervised machine-learning methodologies, that increased levels of RvD4, 10S,17S-diHDPA, 15R-LXA4, and MaR1 are linked to DMARD (methotrexate, mono or co-therapy) responsiveness in RA patients. If confirmed in a larger clinical study (the comparison in that study was conducted by assessing 36 DMARD responders vs 26 non-responders), these results might provide important insights for clinicians in terms of disease activity, therapy choice and efficacy ().
FIGURE 1
FIGURE 2
TABLE 2
| Disease | n | Medication | Sample | Method | SPM measured | Observations | References |
| Rheumatoid arthritis | HC – 30 RA – 30 | – | Serum | UPLC-MS/MS | MaR1 | Patients with active RA have lower levels of MaR1 than healthy controls, or patients with inactive arthritis. | |
| HC – 30 RA – 30 | – | Serum | UPLC-MS/MS | RvD1 | RA patients have lower levels of RvD1 in the serum compared to healthy controls. RvD1 levels is negatively correlated to connective tissue growth factor, which is elevated in the serum of RA patients. | ||
| HC – 3 RA – 3 | – | Serum | LC-MS/MS | Lipidomic | RA patients have a disruption in SPM levels. Lower levels of RvD3, RvD4, RvE3, AT- LXA4, and PGD2, and high levels of TxB2. | ||
| Rheumatoid arthritis/osteoarthritis | RA – 30 | Prednisolone (90%) NSAIDs (83%) Aspirin (13%) | Synovial fluid | ELISA | LXA4, 15-epi- LXA4, PGE2, and LTB4 | OA patients have lower levels of LXA4, 15-epi-LXA4, mRNA expression of ALX/FPR2, and 15-LOX, compared to RA patients. | |
| OA – 15 | Prednisolone (0%) NSAIDs (6%) Aspirin (1%) Statin (1%) | ||||||
| RA – 18 OA – 26 | NSAIDs (27%) Prednisolone (50%) Other (23%) NSAIDs (70%) Acetaminophen (30%) | Synovial fluid | ESI-MS | Lipidomic | OA patients have lower levels of PD1, LXA4, and LXB4. RA patients show higher levels of LTB4, and LTB5. Patients under treatment with NSAIDs, in particular Loxoprofen have higher levels of PGE2 when compared to patients taking celecoxib. | ||
| Osteoarthritis | HC – 52 OA – 62 | – | Serum | LC-MS/MS | Lipidomic | No changes in E-series and D-series SPMs between groups. Thermic pain is associated with the levels of the precursor 17-HDHA. |
SPM and other lipid mediator levels in patients with arthritis and healthy subjects.
17-HDHA, 17-hydroxy docosahexaenoic acid; AT-LXA4, aspirin-trigged lipoxin A4; ELSA, enzyme-linked immunosorbent assay; ESI-MS, electrospray ionization-tandem mass spectrometry; HC, Healthy control; LC-MS/MS, liquid chromatography– tandem mass spectrometry; 15-LOX, 15-lipoxygenase; LTB4, leukotriene B4, LXB4, lipoxin B4; MaR1, maresin 1; NSAIDs, non-steroidal anti-inflammatory drugs; OA, osteoarthritis; PD1, protectin D1; PGD2, prostaglandin D2, PGE2, prostaglandin E2, RA: Rheumatoid arthritis; RvD1, resolvin D1, RvD3, resolvin D3; RvD4, resolvin D4; RvE3, resolvin E3; and UPLC-MS/MS, ultra-performance liquid chromatography-tandem mass spectrometry.
Compelling evidence have shown, in fact, that there is a sharp edge between arthritis disease status and lipid mediator levels (
Importantly, not only the levels of SPMs are effective in reducing disease symptoms, but also the precursors of those molecules might be related to analgesic and anti-inflammatory outcome. In a cohort study, higher levels of 17-HDHA is negatively correlated to thermic pain in patients with OA and healthy controls, whereas there are no changes in E- or D-series SPM levels (
SPM Levels and Arthritis Status in Animal Models
There are several models (acute and chronic) used to study the pathogenesis of arthritis as well as the mechanisms of novel anti-inflammatory and anti-rheumatic compounds. Table 3 summarizes the best-known models to study different forms of arthritis with the human symptomatic features phenocopied by them. Serum-transfer of K/BxN mice induces polyarthritis with a T- and B cell-independent component and a major role of neutrophils (
TABLE 3
| Duration | Model | Stimulus (route)/Previous immunization | Mono or polyarthritis | Human phenocopied symptoms | References |
| Acute | Gout | MSU crystals (intra-articular, knee joint) | Monoarthritis | Increased pro-inflammatory cytokine production in the knee joint Synovial inflammation Pain | |
| Zymosan | Zymosan (intra-articular, knee joint) | Monoarthritis | |||
| LPS | LPS (intra-articular, knee joint) | Monoarthritis | |||
| Chronic | AIA | mBSA (intra-articular, knee joint)/immunization with CFA | Monoarthritis | Adaptive and innate component Cartilage destruction Increased cytokine production in the knee joint Synovial inflammation | |
| CAIA | Cocktail of monoclonal antibodies (intravenous) | Polyarthritis | Adaptive and innate component Antibodies against cartilage epitopes Cartilage destruction Chronic synovial inflammation Increased cytokine production in the knee joint | ||
| CIA | Type II collagen (intravenous)/immunization with CFA | Polyarthritis | Adaptive immune component Antibodies against Bone and cartilage destruction Chronic synovial inflammation Joint-specific epitopes Synovial inflammation | ||
| K/BxN | Serum transfer containing anti-GPI antibodies (intraperitoneal) | Polyarthritis | Cartilage and bone destruction Innate component Pain Synovial inflammation | ||
| Prosthesis-related | TiO2 (intra-articular, knee joint) | Monoarthritis | Cartilage destruction Increased cytokine production in the knee joint Innate component Pain Synovial inflammation | ||
| Septic arthritis | Staphylococcus aureus (intra-articular, knee joint) | Monoarthritis | Bacterial growth and spread Cartilage and bone destruction Chronic synovial inflammation Pain Synovial inflammation | ||
| Staphylococcus aureus (intravenous) | Polyarthritis |
Animal models of arthritis.
AIA, adjuvant-induced arthritis; CAIA, collagen antibody-induced arthritis; CFA, complete Freund adjuvant; CIA, collagen-induced arthritis, LPS, lipopolysaccharide; MSU, monosodium urate; and TiO2, titanium dioxide.
In mice, a temporal regulation of lipid mediators was also recently established (
In conclusion, pre-clinical and clinical data (Table 2) demonstrate that the fluctuation in SPMs levels has an inverse correlation to arthritis status and associated symptoms. Therefore, boosting SPM levels might be a potential approach for the treatments of rheumatic diseases.
Endogenous SPM’s Role and Levels in Arthritis Guiding Possible Therapeutic Approaches
The contemporary understanding of the inflammation resolution process transformed the field and opened novel avenues to a diverse niche of therapeutic possibilities. Also, the publication of web-based resource named as Atlas of Inflammation Resolution (
Although peripheral inflammation fluctuates between asymptomatic and symptomatic periods, the pain is still commonly persistent between those phases (
TABLE 4
| Mediator | Species | Model/Stimulus | Dose or concentration | Route | Outcome | References | |
| AA | 14,15-EET | Mouse | Ovariectomy-induced bone loss | 17 mg/kg | i.p. | Inhibits osteoclastogenesis and bone loss. Decreases RANKL:OPG ratio and inflammatory cytokines | |
| In vitro – Raw264.7 macrophages | RANKL | 2 μM | – | Suppresses RANKL-induced osteoclast differentiation, phosphorylation of NF-kB, ERK, and JNK. Prevents the production of reactive oxygen species. | |||
| EC1728 (sEHi – EET indirect) | Dog | Self-occurring arthritis | 5 mg/kg | p.o. | Decreases pain. | ||
| ETT mixture | In vitro – canine chondrocytes | IL-1β | 0.4 μg/mL | – | Increases cell viability and decreases levels of TNF-a and IL-6. | ||
| TPPU (sEHi – EET indirect) | Mouse | CIA | 10 mg/kg | p.o. | Ameliorates hyperalgesia, histopathological score, and cartilage destruction. Decreases Th1- and Th17-related cytokine levels and increases Treg-related ones. | ||
| PGD2 | Mouse | CIA | 0.6 mg/kg | i.pl. | Reduces immune cell infiltration, bone erosion, and arthritis incidence. | ||
| 15d-PGJ2 | Rat | CIA | 10 μg/kg | i.p. | Decreases paw volume, arthritis score, mononuclear cell infiltration, and pannus invasion. | ||
| Mouse | CIA | 30 μg/kg | i.p. | Decreases clinical, histopathological and radiographic scores, edema, and lipid peroxidation. | |||
| In vitro – human synovial fibroblasts | TNF-α | 1–3 μM | – | Reduces MMP-13 expression and NF-kB activation. | |||
| In vitro – human osteoarthritic chondrocytes | IL-1β | 10 μM | – | Blocks PGE2 synthesis, and partially reduces the expression of COX-2. | |||
| 15d-PGJ2 nanocapsule | Mouse | Gouty arthritis/MSU crystals | 30 μg/kg | s.c. | Reduces mechanical hyperalgesia, edema, leucocyte recruitment, oxidative stress, pro-inflammatory cytokines, and mRNA expression of NLRP3 inflammasome components. Increases levels of IL-10. | ||
| In vitro – bone marrow-derived macrophages. | MSU crystal | 3 μM | – | Decreases IL-1β release. | |||
| LXA4 | Mouse | Zymosan-induced | 20 ng | i.a. | Reduces edema and leucocyte recruitment. | ||
| DPA/DHA | RvD1 | In vitro – human osteoarthritic chondrocytes. | IL-1β | 10 μM | – | Suppress COX-2, iNOS, and MMP-13 expression. Reduces PGE2 and NO levels. | |
| HNE | 10 μM | – | Reduces apoptosis, caspase-3 activation and lactate LDH release. Increases the levels of Bcl2, AKT, and GSH. | ||||
| Mouse | CIA | 100 ng | i.v. | Decreases angiogenesis and CTGF levels. Increases miRNA-146a-5p expression. | |||
| In vitro – fibroblast-like synoviocyte | – | 100 nM | – | Decreases the expression of pro-inflammatory cytokines and CTGF by upregulating the expression of miRNA-146a-5p and inhibiting STAT3 activation. | |||
| Mouse | CIA | 500 ng | i.p. | Attenuates clinical score, cartilage degradation, and bone resorption. Decreases synovial proliferation, serum markers of cartilage and bone damage, and inflammatory mediators. | |||
| In vitro – Raw264.7 | LPS M-CSF RANK-L | 500 nM | – | Reduces osteoclast differentiation, expression of inflammatory mediators, and bone erosion. | |||
| AT-RvD1 | Rat | CFA-induced arthritis | 100 ng | i.p. | Decreases mechanical hyperalgesia and levels of pro-inflammatory cytokines (TNF-α and IL-1β). | ||
| RvD3 | Mouse | K/BxN serum | 100 ng | i.p. | Decreases arthritis clinical score, edema, and leucocyte recruitment. Reduces local eicosanoid levels (e.g., LTB4, PGE2, and TXB2) in an ALX/FPR2-deperndent manner. | ||
| RvD5 | Mouse | K/BxN serum | 150 ng | i.p. | Reduces arthritis clinical score, edema, arthritis-induced weight loss, and levels of prostaglandin and LTB4. The effects were dependent of GPR101 receptor. | ||
| MaR1 | Mouse | K/BxN serum | 100 ng | i.p. | Attenuates mechanical hypersensitivity; reduces monocyte/macrophage infiltration in the DRG. | ||
| Mouse | CIA | 100 ng | i.v. | Reduces arthritis clinical score, and pro-inflammatory cytokine levels (TNF-α, IL-β, IL-6, IFN-γ, IL-17A). Increases levels of IL-10, TGF-β, and miR-21. Regulates Treg/Th17 balance. | |||
| EPA | RvE1 | In vitro – Raw264.7 | RANKL | 100 nM | – | Reduces osteoclast differentiation, bone resorption, and expression of osteoclast-related genes. Decreases IL-17-induced expression of RANKL, COX-2 mRNA, and synthesis of PGE2. |
Pre-clinical effects of SPMs in rheumatic conditions.
AA, arachidonic acid; AKT, protein kinase B; AT-RvD1, aspirin-trigged Resolvin D1; Bcl2, B-cell lymphoma 2; EET, epoxyeicosatrienoic acid; 15d-PGJ2, 15-deoxy-delta-12,14-prostaglandin J2; CIA, collagen-induced arthritis; COX-2, cyclooxygenase-2; CTGF, connective tissue growth factor; DHA, docosahexaenoic Acid; DPA, docosapentaenoic acid; DRG, dorsal root ganglia; ERK, extracellular-signal-regulated kinase; GSH, reduced glutathione; HNE, 4-hydroxy-2-non-enal; i.a., intra-articular; i.p., intraperitoneal; i.pl., intraplatar; i.v. intravenous; IFN-γ, interferon-gamma; IL-10, interleukin-10; IL-17, interleukin-17; IL-1β, interleukin-1β; IL-6, interleukin-6; iNOS, inducible nitric oxide synthase; JNK, c-Jun N-terminal kinase; LDH, lactate dehydrogenase; LPS, lipopolysaccharide; LTB4, leukotriene B4; M-CSF, macrophage colony-stimulating factor; MaR1, maresin 1; MMP-13, matrix metalloproteinase-13; MSU, monosodium urate; NF-κB, nuclear factor-κB; NLRP3, NLR Family Pyrin Domain Containing 3; NO, nitric oxide; OPG, osteoprotegerin; p.o., per oral; PGD2, prostaglandin D2; PGE2, prostaglandin E2; RANKL, receptor activator of nuclear factor-kappa B ligand; RvD1, resolvin D1, RvD3, resolvin D3; RvD5, resolvin D5; RvE1, resolvin E1; s.c., subcutaneously; sEHi, soluble epoxy hydrolase; STAT3, signal transducer and activator of transcription 3; TGF- β, transforming growth factor beta; TNF-α, tumor necrosis factor-α; TPPU, N-[1-(1-oxopropyl)-4-piperidinyl]-N’-[4-(trifluoromethoxy)phenyl)-urea; and TXB2, thromboxane B2.
AA-Derived SPMs
The AA is rapidly correlated to inflammation and fever. However, under the action of different enzymes, AA is metabolized in lipids with anti-inflammatory, analgesic, and pro-resolutive proprieties, such as, epoxyeicosatrienoic acids (EETs;
Epoxyeicosatrienoic acids are precursors for several SPMs (
In spite the potent effects, ETTs are rapidly metabolized by soluble epoxy hydrolase (sEH) in ineffective molecules. Considering the instability of the compound, a therapeutic approach relaying in the use of soluble epoxy hydrolase inhibitors (sEHi), which potentialize endogenous ETT effects and SPM synthesis, can be useful. Interestingly, the administration of ETT, or sEHi have similar effects in suppressing RANKL-induced osteoclast (
Downstream AA metabolization, prostanoids are a major group comprehending for example, prostaglandin E2 (PGE2), prostaglandin D2 (PGD2), and its degradation product, the 15-deoxy-Δ12,14-PGJ2 (15d-PGJ2). PGD2 has been described to have a complex role in inflammation, with pro- and anti-inflammatory effects in differences circumstances (
15deoxy-Δ12,14-prostaglandin J2 is a natural and potent agonist of peroxisome proliferator–activated receptor γ (PPARγ) and is well described to have anti-inflammatory actions (
The lipoxins are the first described SPMs (
In conclusion, AA-derived SPMs include EETs, prostaglandins, and lipoxins, have been shown to have pro-resolving effects in arthritic-related psychopathological events, by decreasing inflammation, cytokine and chemokine levels, osteoclast activation, bone degradation, and importantly reducing arthritis-related pain.
DPA/DHA-Derived SPMs
The D-serie lipid mediators comprehend Rvs, MaRs, and PDs, which have been shown to act in the reduction of inflammation, activation of non-phlogistic macrophages, or direct blockage of neuronal activity (
In arthritis, the persistent inflammation could lead to extended joint destruction, bone resorption, and function loss (
In vivo, RvD1 reduces CIA clinical score, inflammation, bone and joint destructions (
RvD3 is another GPR32 and ALX/FPR agonist that is also described to resolve preclinical arthritis (
Compelling evidence have shown that MaR1, an agonist of LGR6 receptor (
In addition to the isolated D-serie SPMs biologic activity, here reviewed, metabolomic pathways also generate pro-resolving sulfido-conjugates, which are effective in elicit pro-resolving phagocyte functions and tissue regeneration (
In summary, the presented pre-clinical data highlight the important endogenous role of D-serie Rvs, MaRs, and PDs in the control of arthritis symptoms. The current literature demonstrates a series of protective effects, in which the SPMs orchestrate the resolution of the inflammatory process, by decreasing the expression and/or release of pro-inflammatory cytokines, chemokines, and lipid mediators. Furthermore, in vitro or in vivo treatment diminish the differentiation and activation of osteoclasts, which decrease bone degradation. Combined, the pro-resolutive, protective, immunoresolvent and analgesic properties of D-serie SPMs improve the overall disease outcome.
EPA-Derived SPMs
The E-serie resolvins include RvE1, RvE2, and RvE3. While their anti-inflammatory effects have been demonstrated in models of asthma (
Conclusion and Future Perspectives
Focusing on the therapeutic point of view, we envision at least 4 different SPM-based therapeutic approaches based on their pathophysiological roles in arthritis: (1) Development of more stable SPM analogs. BML-111 (a LXA4 analog) and benzo-diacetylenic-17R-RvD1-methyl ester (RvD1 analog) are examples that we can highlight. These compounds are the agonists of ALX/FPR2 and GPR32, respectively. BML-111 has demonstrated activity in two different models of arthritis (
Interestingly, SPMs might be also useful for infectious arthritis. If not by bactericidal effect per se, SPMs stimulate the phagocytosis and clearance of different pathogens. For instance, RvD1 synergizes with ciprofloxacin to promote the non-phlogistic phagocytosis of Pseudomonas aeruginosa during lung infection (
Concluding, in the past decades, the advent of SPM characterization allowed the establishment of their pivotal endogenous role in different disease status and symptomatology. There are pre-clinical and clinical evidence that arthritis initiation, symptoms development, and its resolution line up well with the fluctuation in endogenous SPMs levels in a manner that low levels of SPMs correlate with disease severity. In turn, using the reverse approach, treatment with/replenishing/diminishing the metabolization of AA-, DHA/DPA-derived SPMs was demonstrated to improve overall disease outcome, effectively reducing inflammation, pain, and bone destruction. Those lipids reprogram immune cells, block neuronal activity, or modulate the host response, without compromising the immune system or offering undesired side effects. Thus, the understanding of SPMs endogenous roles in arthritis has open novel venues for better understanding the disease itself, therapeutic approaches, and monitoring disease activity and treatment efficacy.
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Statements
Author contributions
All authors contributed significantly to the writing and conception of this review article as well as approved the final version of the manuscript.
Funding
This work was supported by grants from the Department of Science and Technology from the Science, Technology and Strategic Inputs Secretariat of the Ministry of Health (Decit/SCTIE/MS, Brazil) intermediated by the National Council for Scientific and Technological Development (CNPq, Brazil) with support of Araucária Foundation and State Health Secretariat, Paraná (SESA−PR, Brazil; PPSUS Grant agreement 041/2017, protocol 48.095); Programa de Apoio a Grupos de Excelência (PRONEX) grant supported by SETI/Araucária Foundation and MCTI/CNPq; and Paraná State Government (agreement 014/2017, protocol 46.843). TZ acknowledges the Ph.D. scholarship from Coordination for the Improvement of Higher Education Personnel (CAPES, Brazil, finance code 001). WV acknowledges the CNPq Senior Research fellowship.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Summary
Keywords
rheumatic diseases, DMARDs, SPMs, rheumatoid arthritis, osteoarthritis
Citation
Zaninelli TH, Fattori V and Verri Jr. WA (2021) Harnessing Inflammation Resolution in Arthritis: Current Understanding of Specialized Pro-resolving Lipid Mediators’ Contribution to Arthritis Physiopathology and Future Perspectives. Front. Physiol. 12:729134. doi: 10.3389/fphys.2021.729134
Received
22 June 2021
Accepted
12 August 2021
Published
01 September 2021
Volume
12 - 2021
Edited by
Jue Wang, The University of Texas Health Science Center at Tyler, United States
Reviewed by
Javier Conde, Health Research Institute of Santiago de Compostela (IDIS), Spain; Paul “Li-Hao” Huang, Fudan University, China
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© 2021 Zaninelli, Fattori and Verri.
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: Victor Fattori, vfattori@outlook.com; victor.fattori@childrens.harvard.eduWaldiceu A. Verri, waldiceujr@yahoo.com.br; waverri@uel.br
†ORCID: Tiago H. Zaninelli, orcid.org/0000-0001-7233-477X; Victor Fattori, orcid.org/0000-0002-4565-7706; Waldiceu A. Verri, orcid.org/0000-0003-2756-9283
This article was submitted to Lipid and Fatty Acid Research, a section of the journal Frontiers in Physiology
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