Abstract Psoriatic arthritis (PsA) is an inflammatory disorder associated with psoriasis (PsO) and is part of the broader spectrum of psoriatic diseases. Persistent psoriatic synovitis causes joint pain, structural damage, and various systemic manifestations. Th17 cells, central to PsA pathogenesis, secrete pro-inflammatory cytokines (such as IL-17A, IL-22, IFN-γ and TNF-α) and interact with immune and stromal cells, notably synovial fibroblasts. When activated, synovial fibroblasts produce a broad range of pro-inflammatory cytokines (e.g. IL-6 and IL-8), matrix metalloproteinases (MMPs), and RANKL, facilitating immune response persistence, tissue destruction, and bone erosion. Understanding PsA pathogenesis has led to biological treatments targeting key pro-inflammatory cytokines, particularly TNFα and IL-17A. However, many patients experience suboptimal efficacy or treatment discontinuation. Additionally, vitamin D deficiency is prevalent among PsA patients, with low serum 25(OH)D levels (<20 ng/mL) linked to higher anti-TNF treatment discontinuation risk.1 We hypothesized that 1,25(OH)2D3 could provide additional value to cytokine-targeting therapies in PsA. CCR6+ CD25−/low memory Th17 cells were sorted from peripheral blood mononuclear cells of healthy donors and co-cultured with synovial fibroblasts derived from PsA patients for 3 days, with or without adalimumab (anti-TNFα antibody), secukinumab (anti-IL-17A antibody), or 1,25(OH)2D3. Immunoassays evaluated treatment efficacy. CCR6+ CD25−/low memory Th17 cells and PsA fibroblasts formed a pro-inflammatory feedback loop, significantly promoting pro-inflammatory niche development in the ex vivo synovitis model. Our results showed that blocking TNFα and/or IL-17A suppressed fibroblast activation, decreasing IL-6, IL-8, and MMPs. However, neither single nor dual inhibition of TNFα and IL-17A adequately regulated IFN-γ and IL-22 levels in the synovitis model. Individual 1,25(OH)2D3 treatment broadly suppressed pro-inflammatory cytokines and fibroblast activation, particularly IL-17A and IL-22, but not TNFα. When combined with biologics, 1,25(OH)2D3 demonstrated additive regulatory effects, comprehensively modulating major pro-inflammatory cytokines such as TNFα, IL-17A, IFN-γ and IL-22. Additional inhibition of fibroblast activation was observed for IL-6, IL-8 and MMPs. Moreover, 1,25(OH)2D3 boosted anti-inflammatory cytokine IL-10 production, providing a regulatory advantage in PsA treatment. To conclude, 1,25(OH)2D3 provided a comprehensive regulatory effect on Th17-induced synovitis, presenting a promising therapeutic strategy to improve PsA anti-cytokine therapy. Further research on supplementation, timing, dosage and outcome evaluation in both in vivo and clinical studies is needed.
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