The association of serum RANKL levels with disease activity and hematological parameters in Syrian patients with rheumatoid arthritis

Nanotransethosomal dual-drug loaded gel of methotrexate and mangiferin as a potent synergistic intervention for rheumatoid arthritis via transdermal delivery

The goal of this study is to assess the potential advantages of utilising methotrexate (MTH), and mangiferin (MFR), in nanoparticulate configuration which is transethosomes (TRS), which could result in increased stability and solubility, as well as improved infiltration into the arthritic tissues under investigation. The synthesised MTH-MFR-TRS demonstrated a particle size of 151.7 nm and a PDI of 0.1199. Additionally, the zeta potential was observed to be favourable at -30.43 mV. Supplementary evaluations were performed, comprising transmission electron microscopy (TEM), confocal microscopy and skin permeation analysis. The CLSM study revealed that the MTH-MFR-TRS gel formulation demonstrated enhanced permeation of MTH and MFR through the skin layers in comparison with MTH-MFR suspension gel. The results of the in vivo investigation indicate that the MTH-MFR-TRS gel displays favourable anti-arthritic characteristics compared to the diclofenac standard gel. The aforementioned phenomenon was evidenced by means of histopathological investigations and radiographic scrutiny. The study at hand has validated the utility of TRS vesicles as a carrier for the transdermal administration of MTH and MFR, thereby offering a promising therapeutic approach for the management of rheumatoid arthritis.

Associations of RANKL levels and polymorphisms with rheumatoid arthritis: A meta-analysis

OBJECTIVES

This study examined the correlation between circulating receptor activator for nuclear factor-κB ligand (RANKL) levels and rheumatoid arthritis (RA), and investigated the association between polymorphisms in the RANKL gene and susceptibility to RA.

METHOD

We searched the Medline, Embase, and Cochrane databases for relevant publications up to September 2024. A meta-analysis was conducted to assess serum/plasma RANKL levels in patients with RA and controls, and to explore the relationship between RANKL rs9533156 and rs2277438 polymorphisms and RA susceptibility.

RESULTS

Ten studies encompassing 1,682 RA patients and 1,288 controls were analyzed. RANKL levels were significantly higher in RA patients compared to controls (SMD = 0.665, 95% CI = 0.290-1.040, P = 0.001). Subgroup analysis affirmed these findings' consistency across different sample sizes and publication years. RANKL levels were positively associated with rheumatoid factor (RF) and Disease Activity Score-28 (DAS28) (RF correlation coefficient = 0.157, 95% CI = 0.028-0.282, P = 0.018; DAS28 correlation coefficient = 0.151, 95% CI = 0.125-0.370, P < 0.001). Additionally, the meta-analysis revealed significant associations between the susceptibility to RA and the RANKL rs9533156 C allele (OR = 0.609, 95% CI = 0.520-0.714, P < 0.010) as well as the rs2277438 G allele (OR = 1.206, 95% CI = 1.003-1.451, P = 0.047). These associations were consistent across homozygote comparisons and different genetic models.

CONCLUSIONS

This meta-analysis underscores the elevated circulating RANKL levels in RA patients and their significant correlation with RF and DAS28. Additionally, the RANKL rs9533156 and rs2277438 polymorphisms were significantly associated with RA susceptibility.

Vertebral marrow fat fraction is associated with circulating RANKL in postmenopausal females

Objective

To investigate the relationship between circulating receptor activator of nuclear factor-kappa B ligand (RANKL) levels and marrow adipose tissue in postmenopausal females.

Methods

A total of 164 postmenopausal females were included in the study. Serum levels of osteoprotegerin (OPG) and RANKL were measured using ELISA kits. Body composition and bone mineral density (BMD) were assessed using dual-energy X-ray absorptiometry. Complex-based chemical shift imaging-based MRI was employed to evaluate the vertebral marrow proton density fat fraction (PDFF). A multivariate linear regression model was utilized to analyze the predictive effects of PDFF and BMD on circulating levels of OPG and RANKL.

Results

Simple regression analysis showed significant associations among the marrow PDFF, BMD at either site, serum RANKL, and the RANKL/OPG ratio. In multivariate linear regression models, marrow PDFF was found to have a positive correlation (β = 3.15, 95% CI 2.60 to 3.70) and BMD had negative correlations (β = -0.200, 95% CI -0.348 to -0.051 for vertebral BMD; β = -0.383, 95% CI -0.589 to -0.177 for total hip BMD; and β =-0.393, 95% CI -0.598 to -0.188 for femoral neck BMD, all p < 0.01) with circulating soluble RANKL levels after adjusting for age, body mass index, physical activity, total fat mass, android/gynoid ratio, and lean mass. Similar results were observed for the RANKL/OPG ratio. Additionally, multivariate linear regression analyses revealed that marrow PDFF was a significant independent contributor of circulating soluble RANKL (β = 1.34, 95% CI 1.10 to 1.58, p < 0.001) after further controlling for BMD. However, marrow PDFF or BMD had no associations with circulating levels of OPG after adjusting for all potential confounders mentioned above.

Conclusions

Vertebral marrow fat fraction is independently associated with circulating soluble RANKL levels in postmenopausal females.

Interferon-induced protein 44 (IFI44) and interferon regulatory factor 4 (IRF4) gene expression in rheumatoid arthritis

BACKGROUND AND OBJECTIVES

The type I interferon (IFN) signature has been found to be overactivated in many systemic autoimmune diseases. This may be explained by impaired regulation of interferon-stimulated genes (ISGs) as well as interferon-induced protein 44 (IFI44) expression via their regulatory mechanisms via interferon regulatory factors (IRFs).

PATIENTS AND METHODS

This case-control study includes two groups: 50 RA patients and 50 healthy controls. The quantification of IFI44 and IRF4 expression levels by the real-time PCR technique was estimated. Disease Activity Score-28 (DAS-28) was estimated for RA patients only.

RESULTS

Among the RA patients, there were statistically significant increased ESR, CRP, TLC, RF, and anti-CCP levels (p value < 0.001) and significant increased expression of the IFI44 and IRF4 genes (p value < 0.001). There was a significant positive correlation between the IFI44 and IRF4, and there was a significant correlation between both and ESR and anti-CCP among RA patients. At a cutoff point of 1.95, IFI44 shows higher sensitivity and specificity values than IRF4 for the diagnosis of RA.

CONCLUSION

IFI44 was more sensitive for RA diagnosis than IRF4. IFI44 and IRF4 overexpression could be promising predictors of RA diagnosis and might become useful clinical tools to guide therapeutic strategies.

Synergistically engineered nanotransethosomes for co-delivery of methotrexate and baicalin for enhanced transdermal delivery against rheumatoid arthritis: formulation, characterisation and in vivo pharmacodynamic evaluation

Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease that significantly impacts the quality of life of those affected. Owing to the complex pathophysiology of RA, it is not possible for any singular treatment to entirely impede the progression of the disease. Hence, the current study aimed to adopt a holistic and synergistic approach towards the management of RA by means of a co-delivery strategy involving methotrexate (MTH), a conventional slow-acting anti-rheumatic drug, and baicalin (BCN), a bioactive phytochemical using a transethosomal (TRS) gel formulation.Purpose: The present study aims to evaluate the potential benefits of administering MTH and BCN in nanoparticulate form, which may lead to improved stability and solubility, as well as enhanced penetration into the arthritic tissues of interest.Methods and results: The MTH-BCN-TRS that were synthesised exhibited small particle size of 151.3 nm and polydispersity index of 0.125, as well as a favourable zeta potential of -32.22 mV. Additional assessments were conducted, including a pharmacokinetic analysis, TEM, skin permeation analysis and confocal microscopy. According to the Confocal laser scanning microscopy (CLSM) study, the formulated MTH-BCN-TRS gel exhibited superior MTH and BCN permeation through the skin layers when compared to the MTH-BCN suspension gel. The MTT experiment on Raw 264.7 and SW982 cell lines revealed a considerable reduction (p < .05) in the IC50 value of the MTH-BCN-TRS formulation (9.2 mM and 43.2 mM, respectively) in comparison to the drug suspension. According to the findings of the in vivo study, it was found that the MTH-BCN-TRS gel exhibits significantly promising anti-arthritic properties when compared to the conventional diclofenac gel. This was demonstrated through histopathological studies and radiographic analysis. Furthermore, skin irritation investigation on Wistar albino rats confirmed that the formulated MTH-BCN-TRS is a safe option for topical treatment on the skin. The present study has confirmed that the formulated TRS vesicles are a valuable carrier for the transdermal delivery of MTH and BCN, which may be used for the management of rheumatoid arthritis.

Development of pH-Sensitive Nanoparticle Incorporated into Dissolving Microarray Patch for Selective Delivery of Methotrexate

PURPOSE

Rheumatoid arthritis (RA) is a systemic autoimmune disease that attacks human joints. Methotrexate (MTX), as one the most effective medications to treat RA, has limitations when administered either orally or by injection. To overcome this limitation, we formulated MTX through a smart nanoparticle (SNP) combined with dissolving microarray patch (DMAP) to achieve selective-targeted delivery of RA.

METHODS

SNP was made using the combination of polyethylene glycol (PEG) and polycaprolactone (PCL) polymers, while DMAP was made using the combination of hyaluronic acid and polyvinylpyrrolidone K-30. SNP-DMAP was then evaluated for its mechanical and chemical characteristics, ex vivo permeation test, in vivo pharmacokinetic study, hemolysis, and hen's egg test-chorioallantoic membrane (HET-CAM) test.

RESULT

The results showed that the characteristics of the SNP-DMAP-MTX formulas meet the requirements for transdermal delivery, with the particle size of 189.09 ±12.30 nm and absorption efficiency of 65.40 ± 5.0%. The hemolysis and HET-CAM testing indicate that this formula was non-toxic and non-irritating. Ex vivo permeation shows a concentration of 51.50 ± 3.20 µg/mL of SNP-DMAP-MTX in PBS pH 5.0. The pharmacokinetic profile of SNP-DMAP-MTX showed selectivity and sustained release compared with oral and DMAP-MTX with values of t1/2 (4.88 ± 0 h), Tmax (8 ± 0 h), Cmax (0.50 ± 0.04 μg/mL), AUC (3.15 ± 0.54 μg/mL.h), and mean residence time (MRT) (9.13 ± 0 h).

CONCLUSION

The developed SNP-DMAP-MTX has been proven to deliver MTX transdermal and selectively at the RA site, potentially avoiding conventional MTX side effects and enhancing the effectiveness of RA therapy.