Abstract

Rheumatoid arthritis (RA) is defined as a chronic autoimmune inflammatory disorder that causes damage to limb joints and progressive injuries to secondary organs. Medical practitioners prescribe Methotrexate (MTX) as standard care medicine for treating RA. However, the long-term application of MTX has shown to have adverse health-related effects. Divya Amvatari Ras (DAR), an Indian Ayurvedic herbo-mineral formulation, has been described in ancient texts to provide relief from RA inflammation associated distress. Therefore, in the present study, we explored the biocompatibility, anti-inflammatory, and anti-arthritic efficacy of DAR using in vivo and in vitro disease models. Using carrageenan (CA)-stimulated Wistar rat paw edema model, we showed a reduction in inflammation-induced paw edema at human equivalent dose of DAR. Anti-rheumatic efficacy of DAR was studied using collagen-antibody cocktail (C-Ab) Induced Arthritis (CAIA) mouse model. The onset of RA in the CAIA mice was determined using parameters such as the increase in arthritis score, and induction of disease associated lesions in the ankle and knee joints, and increase in mechanical and thermal hyperalgesia. Treatment of CAIA animals with a human equivalent dose of DAR significantly reversed the RA-associated pathogenesis. These effects were comparable with the standard of care RA drug, MTX. DAR acted at multiple levels of inflammation associated with RA to reduce progressive pathogenesis. Animal serum biochemistry showed DAR was capable of ameliorating RA induced increase in liver enzyme Alanine Aminotransferase (ALT) and pro-inflammatory cytokine interleukin 6 (IL-6). In the lipopolysaccharide stimulated THP-1 cells, DAR was found to inhibit the release of IL-6, IL-1β, TNF-α, and upstream inflammatory gene regulatory protein, NFκB. The study endorsed the anti-arthritic and anti-inflammatory activity of the Indian Traditional herbo-mineral medicine, DAR. These results also confirm that DAR was highly biocompatible and would show minimal health-related side effects than those associated with standard of care MTX. Taken together, we show that the DAR could be utilized as a promising alternative or complementary therapy for treating rheumatoid arthritis.

Highlights

  • Rheumatoid arthritis (RA) is a systemic autoimmune disease that causes chronic inflammation in the limb joints and other secondary organs

  • High Performance Liquid Chromatography (HPLC)-based phytochemical analysis of Divya Amvatari Ras (DAR) is shown in Supplementary Figure 1

  • Intraplantar injection of CA in rats led to a time-dependent increase in paw volume that was maximal at 3 h followed by marginal decrease at 5 h (Figure 1B)

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Summary

Introduction

Rheumatoid arthritis (RA) is a systemic autoimmune disease that causes chronic inflammation in the limb joints and other secondary organs. Site-specific pathogenesis of RA disease is centered around the role of localized systemic factors that affect particular anatomical sites, along with localized mechanical elements (Ospelt and FrankBertoncelj, 2017) Soluble mediators such as pro-inflammatory cytokines, chemokines, leukotrienes, prostaglandins, citrullinated proteins, and collagen-degrading proteases like matrix metalloproteinase act as precursors in inducing RA pathogenesis in the synovial region (McInnes and Schett, 2007; Brennan and McInnes, 2008; Bartok and Firestein, 2010; McInnes and Schett, 2011; Apel et al, 2018; Smolen et al, 2018). Topical and oral application of corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), disease modifying anti-rheumatic drugs (DMARDs), and cell signaling inhibitors may cause temporary relief Their prolonged application may have severe health-related side effects. These observed adverse effects have been attributed to the bioaccumulation of MTX and its metabolites in tissues (Shaikh et al, 2018; Arakawa et al, 2019)

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