Abstract
Inflammatory arthritis is a chronic autoimmune disorder characterized by joint inflammation and pain, often requiring effective immunosuppressive treatment. In a rat model of inflammatory arthritis, the anti-immunosuppressive effects of 6-mercaptopurine (6-MP) and its derivatives were evaluated. Paw edema was induced via subplantar injection of CFA, followed by oral administration of 6-MP and 6-MP riboside (3, 6, or 10 mg/kg). Footpad thickness was measured to assess edema, and blood plasma samples were analyzed for pathogenic mediators (PGE2), oxidative stress biomarkers (H2O2), and pro-inflammatory cytokines (TNF-α, IL-1, IL-6) using ELISA. Results showed that 6-MP reduced PGE2 and pro-inflammatory cytokines in a dose-dependent manner, significantly decreasing edema. Repeated 6-MP doses (6 and 10 mg/kg) dramatically lowered pro-inflammatory cytokine production, similar to the NSAID diclofenac. Plasma PGE2 levels for 6 and 10 mg/kg 6-MP were 2357±624.7 pg/mL and 1670±150.2 pg/mL, respectively, compared to control. For 6-MP riboside, levels were 1931±305.2 pg/mL and 1710±249.2 pg/mL. TNF-α concentrations decreased significantly in plasma treated with 6 mg/kg 6-MP (36.18±4.71 pg/mL) and 10 mg/kg 6-MP riboside (42.02±3.46 pg/mL). IL-6 levels also showed significant reductions, while IL-1 remained unchanged. Additionally, peroxide and glutathione levels improved. Notably, the 10 mg/kg dose of both compounds exhibited superior immunosuppressive potency compared to diclofenac. These findings suggest that 6-MP and its riboside suppress pro-inflammatory mediators while enhancing antioxidant defense. Thus, 6-MP possesses anti-inflammatory and immunosuppressive properties beneficial for early-stage inflammatory arthritis and may serve as a promising disease-modifying anti-rheumatic drug (DMARD).
References
Brennan, P. & O’Neill, L.A. (1995). Effects of oxidants and antioxidants on nuclear factor kappa B activation in three different cell lines: evidence against a universal hypothesis involving oxygen radicals. Biochimica et Biophysica Acta, 1260:167–175.
https://doi.org/10.1016/0167-4781(94)00186-7
Brown, K.M. & Arthur, J.R. (2001). Selenium, selenoproteins and human health: a review. Public Health Nutritio,n 4(2B):593–599.
https://doi.org/10.1079/phn2001143
Bugatti, S., Vitolo, B., Caporali, R., Montecucco, C. & Manzo, A. (2014). B cells in rheumatoid arthritis: from pathogenic players to disease biomarkers. BioMed Research International, 1–14.
https://doi.org/10.1155/2014/415141
Dean, T., Dewey, A., Bara, A., Lasserson, T.J. & Walters, E.H. (2004). Azathioprine as an oral corticosteroid sparing agent for asthma. The Cochrane Database of Systematic Review, 1:CD003270.
https://doi.org/10.1002/14651858.CD003270.pub2
Dubinsky, M.C. (2004). Azathioprine, 6-mercaptopurine in inflammatory bowel disease: Pharmacology, efficacy, and safety. Clinical Gastroenterology and Hepatology, 2(9):731–743.
https://doi.org/10.1016/S1542-3565(04)00306-8
Firestein, G.S. (2003). Evolving concepts of rheumatoid arthritis. Nature, 423(6937):356–361.
10.1038/nature01661
Fox, D.A. (2000). Cytokine blockade as a new strategy to treat rheumatoid arthritis: Inhibition of tumor necrosis factor. Archives of Internal Medicine, 160:437–444.
https://doi.org/10.1001/archinte.160.4.437
García-González, A., Gaxiola-Robles, R. & Zenteno-Savín, T. (2015). Oxidative stress in patients with rheumatoid arthritis. Clinical and Translational Investigation, 67(1):46–53.
https://doi.org/10.1007/s12012-015-9381-6
Gheorghe, K.R., Thurlings, R.M., Westman, M., Boumans, M.J., Malmström, V., Trollmo, C & Tak, P.P. (2011). Prostaglandin E2 synthesizing enzymes in rheumatoid arthritis B cells and the effects of B cell depleting therapy on enzyme expression. PLoS ONE, 6(1):e16378.
https://doi.org/10.1371/journal.pone.0016378
Grell, M., Douni, E., Wajant, H., Lohden, M., Clauss, M., Maxeiner, B., Georgopoulos, S., Lesslauer, W., Kollias, G., Pfizenmaier, K. & Scheurich, P. (1995). The transmembrane form of tumour necrosis factor is the prime activating ligand of the 80 kDa tumour necrosis receptor. Cell, 83:793–802.
https://doi.org/10.1016/0092-8674(95)90192-2
Guo, L., Ye, C., Chen, W., Ye, H., Zheng, R., Li, J., Yang, H., Yu, X. & Zhang, D. (2008). Anti-inflammatory and analgesic potency of carboxyamidotriazole, a tumorostatic agent. The Journal of Pharmacology and Experimental Therapeutics, 297(1-2):156–161.
https://doi.org/10.1124/jpet.107.131888
Hassan, S.Z., Gheita, T.A., Kenawy, S.A., Fahim, A.T., El-Sorougy, I.M. & Abdou, M.S. (2011). Oxidative stress in systemic lupus erythematosus and rheumatoid arthritis patients: relationship to disease manifestations and activity. International Journal of Rheumatic Diseases, 14:325–331.
https://doi.org/10.1111/j.1756-185x.2011.01630.x
Hussein, S.Z., Mohd Yusoff, K., Makpol, S. & Mohd Yusof, Y.A. (2012). Gelam honey inhibits the production of proinflammatory, mediators NO, PGE2, TNF-α and IL-6 in carrageenan-induced acute paw edema in rats. Evidence-Based Complementary and Alternative Medicine. Article ID 109636:1–13.
https://doi.org/10.1155/2012/109636
Isomäki, P. & Punnonen, J. (1997). Pro- and anti-inflammatory cytokines in rheumatoid arthritis. Annual Medicine, 29:499–507.
https://doi.org/10.3109/07853899709007474
Jaspers, I., Zhang, W., Fraser, A., Samet, J.M. & Reed, W. (2001). Hydrogen peroxide has opposing effects on IKK Activity and IκBα breakdown in airway epithelial cells. American Journal of Respiratory Cell and Molecular Biology, 24:769–777.
https://doi.org/10.1165/ajrcmb.24.6.4344
Joosten, L.A., Radstake, T.R., Lubberts, E., van den Bersselaar, L.A., van Riel P.L., van Lent PL, Barrera, P. & van den Berg, W.B. (2003). Association of interleukin-18 expression with enhanced levels of both interleukin-1 beta and tumor necrosis factor alpha in knee synovial tissue of patients with rheumatoid arthritis. Arthritis Rheumatology, 48:339–347.
https://doi.org/10.1002/art.10814
Kawasaki, Y., Zhang, L., Cheng, J.K. & Ji, R.R. (2008). Cytokines mechanisms of central sensitization: distinct and overlapping role of interleukin-1β, interleukin-6 and tumor necrosis factor-α in regulating synaptic and neuronal activity in the superficial spinal cord. The Journal of Neuroscience, 28:5189–5194.
https://doi.org/10.1523/jneurosci.3338-07.2008
Kneusels, J., Kaehler, M., Cascorbi, I., Wedel, T., Neunlist, M., Lucius, R., & Cossais, F. (2021). Limited Impact of 6-Mercaptopurine on Inflammation-Induced Chemokines Expression Profile in Primary Cultures of Enteric Nervous System. Neurochem Res 46(7):1781-1793.
https://doi.org/10.1007/s11064-021-03324-y
Kurakula, K., Hamers, A.A., van Loenen, P. & de Vries, C.J.M. (2015). Mercaptopurine reduces cytokine and Muc5ac expression involving inhibition of NF-κB activation in airway epithelial cells. Respiratory Research, 16:73.
https://doi.org/10.1186/s12931-015-0236-0
Laufer, A., Ginsburg, I., Gery, I., & Davies, A. M. (1963). The effect of cortisone and 6-mercaptopurine on lesions induced by intramyocardial injection of Streptococci. Pathobiology, 26(3):263–273.
https://doi.org/10.1159/000161375
Louis, E., Yafi, F.A.N.E. & Belaiche, J. (2000). High doses of azathioprine but not 6-mercaptopurine inhibit the production of pro-inflammatory cytokines in inflammatory bowel diseases: An in vitro study. Gastroenterology, 118(4): A787.
Manna, S.K., Zhang, H.J., Yan, T., Oberley, L.W. & Aggarwal, B.B. (1998). Overexpression of manganese superoxide dismutase suppresses tumor necrosis. Journal of Biology Chemistry, 273:13245–13254.
https://doi.org/10.1074/jbc.273.21.13245
Mettelman, R. C., Allen, E. K. & Thomas, P.G. (2022). Mucosal immune responses to infection and vaccination in the respiratory tract. Immunity, 55(5): 749–780.
https://doi.org/10.1016/j.immuni.2022.04.013
O’Dwyer, P.J., Hamilton, T.C., Yao, K., Tew, K.D. & Ozols, R.F. (1995) Modulation of glutathione and related enzymes in reversal of resistance to anticancer drugs. Hematology/Oncology Clinics of North America, 9:383–396.
Proundman, S.M., Cleland, L.G. & Myarhofer, G. (1999). Effects of tumor necrosis factor-α, interleukin 1β and activated peripheral blood mononuclear cells on the expression of adhesion molecules and recruitment of leukocytes in rheumatoid synovial xenografts in SCID mice. Journal of Rheumatology, 26:1877–1889.
Quiñonez-Flores, C.M., González-Chávez, S.A., Del Río Nájera, D., & Pacheco-Tena, C. (2016). Oxidative stress relevance in the pathogenesis of the rheumatoid arthritis: a systematic review. BioMed Research International, 1–14.
https://doi.org/10.1155/2016/6097417
Roblin, X., Williet, N. & Peyrin-Biroulet, L. (2016). Thiopurine metabolism in the era of combotherapy. Inflammatory Bowel Disease, 22:1496–1501.
https://doi.org/10.1097/mib.0000000000000737
Schwartz, R., & Dameshekthe, W. (1960). Effects of 6-mercaptopurine on homograft reactions. Journal of Clinical Investigation, 39(6):952–958.
Sibilia, V., Lattuada, N., Rapetti, D., Pagani, F., Vincenza, D., Bulgarelli, I., Locatelli, V, Guidobono, F. & Netti, C. (2006). Ghrelin inhibits inflammatory pain in rats: Involvement of the opiod system. Neuropharmacology, 51(3):497–505.
https://doi.org/10.1016/j.neuropharm.2006.04.009
Srirangan, S. & Choy, E.H. (2010). The role of Interleukin 6 in the pathophysiology of rheumatoid arthritis. Therapeutic Advances in Musculoskeletal Disease, 2(5):247–256.
https://doi.org/10.1177/1759720x10378372
Taylor C.T. & Scholz C.C. (2022) The effect of HIF on metabolism and immunity. Nature Reviews Nephrology, 18, 573–587.
https://doi.org/10.1038/s41581-022-00587-8
True, A.L., Rahman, A. & Malik, A.B. (2000). Activation of NF-kappa B induced by H2O2 and TNF-alpha and its effects on ICAM-1 expression in endothelial cells. American Journal of Physiology, 279:L302–L311.
https://doi.org/10.1152/ajplung.2000.279.2.l302
Veselinovic, M., Barudzic, N., Vuletic, M., Zivkovic, V., Tomic-Lucic, A., Djuric, D. & Jakovljevic, V. (2014). Oxidative stress in rheumatoid arthritis patients: relationship to diseases activity. Molecular and Cellular Biochemistry, 391(1-2):225–232.
https://doi.org/10.1007/s11010-014-2006-6
Yang, X., Chang, Y. & Wei, W. (2016). Endothelial dysfunction and inflammation: immunity in rheumatoid arthritis. Mediators of Inflammation, 1–9.
https://doi.org/10.1155/2016/6813016
Zheng, X.X., Maslinski, W., Ferrari-Lacraz, S. & Strom, T.B. (2013). Cytokines in the treatment and prevention of autoimmune responses. in: Madame Curie Bioscience Database. Austin (TX): Landes Bioscience, 2000-2013.
Zimmermann, M. (1983). Ethical guidelines for investiagtions for experimental pain in conscious animals. Pain, 16:109–110.

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