In this study, we demonstrated that BZXD could effectively inhibit joint swelling, synovial inflammation, joint destruction and significantly decrease serum pro-inflammatory cytokine (TNF-α and IL-β) levels in CIA rats. The mechanisms of BZXD are complicated because of the complex ingredients of BZXD. Therefore, we conducted a proteomic study on the synovial tissue of CIA rats. Bioinformatic analysis identified several signaling pathways including the metabolic pathways, complement and coagulation cascades, focal adhesion, ECM-receptor interaction, glycolysis/gluconeogenesis, pyruvate metabolism and fatty acid metabolism. We analyzed the DEPs within the above-mentioned signaling pathways and verified a protein with a high node degree and important functions by western blot. Overall, BZXD has played a systemic role, enriching our understanding of the mechanism of treating RA.
ECM-receptor interaction is an important signaling pathway in the progression of RA, which is significantly enriched in the early stage. Extracellular matrices (ECMs) are involved in the pathological process of many genetic and autoimmune diseases and promote disease progression by regulating cell-matrix interactions.(28) ECMs are composed of collagen, elastin, fibronectin, laminins, proteoglycans, hyaluronan, and several glycoproteins such as matricellular proteins. Collagen is the oldest and most abundant component in ECMs, which builds fibers, networks and filaments in ECMs.(29) In our study, PPI analysis showed that multiple collagen subtypes (COL3A1, COL5A2, COL6A1 and COL6A5) are connected closely with high degrees. Among these collagen subtypes, COL3A1 is increased in osteoarthritis cartilage compared to normal cartilage, and its expression may be correlated with the radiographic severity of canine elbow osteoarthritis.(30) Studies have confirmed that IL-1β could induce the upregulated secretion of COL3A1 from the human synoviocyte.(31) Our research demonstrated that BZXD could inhibit the expression of IL-1β and COL3A1 is decreased in the BZXD group relative to the CIA group. Thence, COL3A1 may be a molecular marker for BZXD treating RA. In addition, COL5A2 and COL6A1 were demonstrated as upregulated genes associated with a pathological process of subchondral bone in osteoarthritis.(32, 33) These collagens also were upregulated in the CIA group, which indicates that these collagens have implications in the progression of RA. However, BZXD can downregulate the expression of these collagens, which may be the molecular mechanism of BZXD treating RA.
The focal adhesion pathway is a complex and multi-intersection network, which is closely related to the ECM receptor interaction pathway. It can regulate cell movement, proliferation, differentiation, expression and apoptosis.(34, 35) The formation of specific adhesion points focal adhesion kinase at the cell membrane-cytoplasm contact is an important step in the cell-matrix interaction.(34) Some studies have shown that the focal adhesion kinase family kinases are overexpressed in RA synovial tissues, which promote synovial fibroblast invasion and migration.(36, 37) Thence, the focal adhesion pathway plays an important role in the occurrence, development and progression of RA. This study also suggested that the focal adhesion pathway was significantly enriched in both early and late stages. DEPs (MYLPF, ACTN3, CAV1, CHAD, TLN2, COL3A1, COL5A2, COL6A1 and COL6A5) participated in the focal adhesion pathway. CAV1 is the main component of the caveolae structure, which promotes endocytosis, cell signaling, and endothelial-mediated inflammation.(38) Research has shown that silencing of CAV1 significantly decreased cell proliferation and promoted apoptosis in RA fibroblast-like synoviocytes.(39) Our research shows that BZXD reduces the expression of CAV1 in CIA rats, indicating that CAV1 may be a potential target for BZXD to exert therapeutic effects. In addition, CHAD is mainly localized in the territorial matrix of the deeper parts of the articular cartilage.(40) It mediates intracellular signal transduction between chondrocytes and the ECM through binding to the α2β1 integrin.(41, 42) CHAD also binds collagen type II and type VI can inhibit the spreading of chondrocytes.(43, 44) CHAD plays a critical role in regulating linkages between collagens and other ECM molecules in vivo, as well as the communication between chondrocytes and their surrounding matrices.(44) In our study, the BZXD group reduced the expression of CHAD compared with the CIA group. Therefore, we speculated that adhesion-related proteins may be an important feature of BZXD in treating RA.
The microenvironment of RA synovial tissue accumulates a variety of cytokines, adipocytokines and metabolic intermediates, which make a variety of metabolic pathways dysregulated, including glycolysis, tricarboxylic acid cycle, pentose phosphate pathway and lipid metabolism. The dysregulation of metabolic pathways deteriorates pro-inflammatory immune responses and chronic inflammation.(45) Some studies have shown that glycolysis is increased in the RA synovial tissues and leads to persistent synovial inflammation and joint damage.(46–48) In addition, the end product of glycolysis is pyruvate, which could stimulate the expression of vascular endothelial growth factor (VEGF) mRNA.(49) In our previous study,(50) we found that the expression of VEGF was increased in the synovial tissues of CIA rats, while BZXD significantly decreased its level, indicating that BZXD maybe reduce the symptoms of RA by modulating the pyruvate metabolism. This needs further study. In this study, metabolic pathways, pyruvate metabolism, glycolysis/gluconeogenesis were disturbed in the CIA group, while BZXD regulated these disordered metabolic pathways back to normal.
Fatty acid metabolism is a dynamic process of anabolic and catabolic reactions that maintain energy homeostasis.(51) The regulation of fatty acid synthesis is closely related to the physiological and pathophysiological processes regulated by immune cells.(52) Studies have also determined the role of fatty acids in immune response and inflammation, that is, saturated fatty acids promote inflammation, while polyunsaturated fatty acids play an anti-inflammatory effect.(53) In our study, KEGG showed that the CIA rat group was significantly enriched in fatty acid metabolism, and BZXD may exert anti-inflammatory effects by regulating fatty acid metabolism. Furthermore, FASN is a key enzyme in the de novo synthesis of lipids. It acts as a central regulator of lipid metabolism and is overexpressed in inflammation and the immune system.(54–56) Interestingly, the previous research(57) reported that FASN is specifically low-expressed in the synovial tissue of CIA rats. This is consistent with our findings. After the pro-inflammatory cytokines TNF-α, adipocytes reduce the secretion of adiponectin, resulting in a decrease in lipid accumulation, thereby inhibiting the expression of FASN in arthritic rats.(57) Our research showed that BZXD can effectively reduce the expression of TNF-α in CIA rats. Meanwhile, compared with the CIA group, the BZXD treatment group increased the expression of FASN. We speculate that BZXD may play a curative effect by regulating the expression of FASN.