Abstract

BackgroundThe inhibition of pyrimidine biosynthesis by blocking the dihydroorotate dehydrogenase (DHODH) activity, the prime target of leflunomide (LEF), has been proven to be an effective strategy for rheumatoid arthritis (RA) treatment. However, a considerable proportion of RA patients are refractory to LEF. Here, we investigated lapachol (LAP), a natural naphthoquinone, as a potential DHODH inhibitor and addressed its immunosuppressive properties.MethodsMolecular flexible docking studies and bioactivity assays were performed to determine the ability of LAP to interact and inhibit DHODH. In vitro studies were conducted to assess the antiproliferative effect of LAP using isolated lymphocytes. Finally, collagen-induced arthritis (CIA) and antigen-induced arthritis (AIA) models were employed to address the anti-arthritic effects of LAP.ResultsWe found that LAP is a potent DHODH inhibitor which had a remarkable ability to inhibit both human and murine lymphocyte proliferation in vitro. Importantly, uridine supplementation abrogated the antiproliferative effect of LAP, supporting that the pyrimidine metabolic pathway is the target of LAP. In vivo, LAP treatment markedly reduced CIA and AIA progression as evidenced by the reduction in clinical score, articular tissue damage, and inflammation.ConclusionsOur findings propose a binding model of interaction and support the ability of LAP to inhibit DHODH, decreasing lymphocyte proliferation and attenuating the severity of experimental autoimmune arthritis. Therefore, LAP could be considered as a potential immunosuppressive lead candidate with potential therapeutic implications for RA.

Highlights

  • The inhibition of pyrimidine biosynthesis by blocking the dihydroorotate dehydrogenase (DHODH) activity, the prime target of leflunomide (LEF), has been proven to be an effective strategy for rheumatoid arthritis (RA) treatment

  • LAP inhibits lymphocyte proliferation through inhibition of pyrimidine biosynthesis We assessed the antiproliferative effect of LAP

  • The antiproliferative effect of LEF is completely reversed by supplementation of uridine, supporting that DHODH is the target for LEF [4]

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Summary

Introduction

The inhibition of pyrimidine biosynthesis by blocking the dihydroorotate dehydrogenase (DHODH) activity, the prime target of leflunomide (LEF), has been proven to be an effective strategy for rheumatoid arthritis (RA) treatment. The current first-line therapy for RA patients includes the use of conventional disease-modifying antirheumatic drugs (DMARDs), such. The use of LEF is normally reserved for RA patients whose disease failed to respond to first-line DMARDs, before the introduction of biological DMARDs [6]. Despite it having demonstrated safety and efficacy, a substantial proportion of patients (around 30–40%) do not have an appropriate response to LEF [7]. It is highly desirable to discover novel DHODH inhibitors as lead compounds for the development of new DMARD candidates

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