Abstract

ObjectiveMultiple proteinases are present in the synovial fluid (SF) of an arthritic joint. We aimed to identify inflammatory cell populations present in psoriatic arthritis (PsA) SF compared to osteoarthritis (OA) and rheumatoid arthritis (RA), identify their proteinase-activated receptor 2 (PAR2) signaling function and characterize potentially active SF serine proteinases that may be PAR2 activators.MethodsFlow cytometry was used to characterize SF cells from PsA, RA, OA patients; PsA SF cells were further characterized by single cell 3’-RNA-sequencing. Active serine proteinases were identified through cleavage of fluorogenic trypsin- and chymotrypsin-like substrates, activity-based probe analysis and proteomics. Fluo-4 AM was used to monitor intracellular calcium cell signaling. Cytokine expression was evaluated using a multiplex Luminex panel.ResultsPsA SF cells were dominated by monocytes/macrophages, which consisted of three populations representing classical, non-classical and intermediate cells. The classical monocytes/macrophages were reduced in PsA compared to OA/RA, whilst the intermediate population was increased. PAR2 was elevated in OA vs. PsA/RA SF monocytes/macrophages, particularly in the intermediate population. PAR2 expression and signaling in primary PsA monocytes/macrophages significantly impacted the production of monocyte chemoattractant protein-1 (MCP-1). Trypsin-like serine proteinase activity was elevated in PsA and RA SF compared to OA, while chymotrypsin-like activity was elevated in RA compared to PsA. Tryptase-6 was identified as an active serine proteinase in SF that could trigger calcium signaling partially via PAR2.ConclusionPAR2 and its activating proteinases, including tryptase-6, can be important mediators of inflammation in PsA. Components within this proteinase-receptor axis may represent novel therapeutic targets.

Highlights

  • Inflammation is central to the pathogenesis of arthritis

  • psoriatic arthritis (PsA) synovial fluid (SF) cells were dominated by monocytes/macrophages, which consisted of three populations representing classical, non-classical and intermediate cells

  • Trypsin-like serine proteinase activity was elevated in PsA and rheumatoid arthritis (RA) SF compared to OA, while chymotrypsinlike activity was elevated in RA compared to PsA

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Summary

Introduction

Inflammation is central to the pathogenesis of arthritis. Targeting the IL-23–IL-17 pathway is effective in the management of PsA [3]. Almost 40% of patients fail to show a clinically meaningful response with these agents [4,5,6] and pain and inflammation persist, when these therapies are not introduced early in the disease course. It is critical to identify the underlying pathogenic mechanisms that lead to inflammation, joint damage, and persistent pain. This insight will generate new targets for therapies that can halt or reverse progressive joint damage, provide pain relief and improved the quality of life of patients with PsA

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