Review Article

Molecular and Cellular Pathways Contributing to Joint Damage in Rheumatoid Arthritis

Table 1

Pro- and anti-inflammatory cytokines in RA.

CytokinesSourcesAffected cellsTypesMajor functions

Proinflammatory
 TNF-αFibroblast, endothelial cell, and macrophageSynoviocyte, chondrocyte, osteoclast, and endothelial cellNonePromotes pannus tissue formation; synovial inflammation; synthesis of MMPs, PGE2, and collagenase; vasospasm, joint destruction; osteoclastogenesis; and bone resorption [61].
 IFN-γNK cell, T cell, macrophage, B cell, and dendritic cellT cell, B cell, macrophage, endothelial cell, and APCNoneActivates antigen-presenting cells, upregulates the expression of MIC molecules on monocytes, and aggravates the local inflammatory responses in RA.
 IL-1Fibroblast, macrophage, endothelial cell, synovial cell, and chondrocyteSynovial cell, macrophage, neutrophil, B cell, T cell, osteoclast, synaptic cell, and chondrocyteIL-1α, IL-1β, IL-18, IL-1, F5-10, and IL-33Promotes TNF-α and IL-6 production, vasospasm, synaptic cell and chondrocyte synthesis, release of PGE2, secretion of MMPs, proliferation of synovial cells, and osteoclast differentiation and activity. Acts synergistically with TNF-α to damage the cartilage.
 IL-2T cell, monocyte, dendritic cell, and synovial cellT cell, B cell, macrophage, and NK cellNoneActivates and maintains T cell differentiation and proliferation, mediates phosphorylation of STAT5, and triggers active transcription in Treg cells [12].
 IL-6Osteoblast, stromal cell, T cell, B cell, fibroblast, endothelial cell, monocyte, and keratinocyteTh17 cell, B cell, osteoclast, macrophage, neutrophil, and synoviocyteNoneRegulates osteoclast formation and bone resorption, promotes proliferation and differentiation of activated B cells, enhances the effects of IL-1 and TNF-α, maintains differentiation and homeostasis of Th17 cells, triggers synthesis of acute-phase proteins, and induces synovial neovascularization.
 IL-8Monocyte, FLS, macrophage, synoviocyte, synovial lining cell, and endothelial cellNeutrophil, NK cell, T cell, synovial cell, chondrocyte, and macrophageNoneChemotactic and activation factor for neutrophils, stimulates NK and T cells to express γ-interferon and FasL, respectively, promotes apoptosis of T and B cells, stimulates synovial cells, and chondrocytes to produce NO, PGE2, MMPs, TNF-α, and IL-6.
 IL-15Macrophage, fibroblast, endothelial cell, dendritic cell, myocyte, epithelial cell, and astrocyteCD4+ and CD8+ T cell, monocyte, macrophage, and NK cellNonePromotes the accumulation and activation of T cells into the joints; secretion of other cytokines (TNF-α), adhesion molecules, proteases, and monocyte chemotactic factors (MCP-1 and IL-8); and expression of IL-17 and MMPs (MMP-1 and MMP3). It is associated with bone destruction and secretion of RF in RA [62].
 IL-17CD4+ Th17 cell, NK cell, neutrophil, eosinophil, monocyte, and mast cellT cell, fibroblast, synovial cell, macrophage, neutrophil, osteoclast, synaptic cell, chondrocyte, endothelial cell, and epithelial cellIL-17A, IL-17B, IL-17C, IL-17D, IL-17E, and IL-17FBy binding to IL-17RA/RC receptors, stimulates production of TNF-α, IL-1β, IL-6, IL-8, IL-23, chemokines, nitric oxide, prostaglandins, GM-CSF, and MMPs; promotes RANKL expression, NF-κB activation, and vasospasm formation; activates osteoblasts and osteoclasts by regulating the RANKL/RANK/OPG signaling pathway; and inhibits the synthesis of proteoglycans and collagen [63].
 IL-18Macrophage, synoviocyteTh1 cell, chondrocyte, synovial cellNonePromotes expression of mononuclear factors and TNF-α.
 IL-23Macrophage, dendritic cell, and B cell,T cell, dendritic cell, and macrophageNoneInduces formation and differentiation of Th17 cells, differentiation of osteoclasts, e production of IL-6, TNF-α, IL-1β, and chemokines (CXCL-1, GCP-2, and CXCL-8).

Anti-inflammatory
 IFN-αLeukocyte, dendritic cellT cell, monocyte, macrophage, NK cell, synoviocyte, and B cellNoneInhibits synthesis of collagen, expression of MHC antigens, proliferation of B cells, release of prostaglandins from monocytes, and bone resorption and disrupts the balance between collagen and fibronectin.
 IFN-βFLS, macrophage, dendritic cell, and osteoclastT cell, dendritic cell, macrophage, NK cell, fibroblast, and osteoclastNoneReduces the production of TNF-α, IL-1β, and IL-6 and increases the secretion of IL-1Rα and IL-10, modulates signaling molecules involved in the NF-κB pathway, and inhibits osteoclastogenesis and the negative feedback pathway of c-fos [64].
 IL-1RaMonocyte, macrophage, neutrophil, epithelial cell, and fibroblastMonocyte, macrophage, lymphocyte, epithelial cell, and fibroblastNoneAbolishes IL-1 activation.
 IL-4Th2 cell, mast cell, basophil, and dendritic cellB cell, T cell, macrophage, dendritic cell, chondrocyte, FLS, osteoclast, and APCNoneInhibits the production of MMPs, IL-1β, IL-6, IL-8, IL-12, IL-17, and TNF-α and promotes the production of IL-1Rα and soluble TNF receptors, directs B cells to produce antibodies like lgG1 and lgE, and promotes the expansion of Th2 cells and adhesion of macrophages to vascular endothelial cells [65].
 IL-10Th2 cell, B cell, macrophage, mast cell, monocyte, synovial cell, and chondrocyteB cell, Th1 cell, macrophage, APC, and monocyteNoneInhibits the expression of MHC class II antigens, proliferation of Th1 and B cells, and production of IFN-γ, TNF-α, IL-1, lL-3, GM-CSF, COX-2, and MMPs and promotes the production of IL-1Rα, soluble tumor necrosis factor receptor, and TIMPs.
 IL-13B cell, T cell, and macrophageB cell, monocyte, and endothelial cellNoneInhibits ADCC and production of inflammatory cytokines (IL-1, IL-6, IL-8, and TNF-α), induces expression of IL-1Ra, and promotes B cell differentiation and antibody synthesis.
 IL-25 (also called as IL-17E)Th17 cell, Th2 cell, mast cell, epithelial cell, and macrophageTh17 cell, NK cell, type 2 myeloid cell, Th9 cell, basophil, eosinophil, mast cell, endothelial cell, macrophage, dendritic cell, and CD4+ T cellNoneInhibits IL-17A and IFN-γ production and induces the expression of various chemokines and cytokines (IL-4, IL-5, and IL-13). Expression of IL-25 in articular cartilage inhibits the synthesis of cartilage and bone stimulates the release of NO and IL-6 production.

Cytokine with dual effects
 TGF-βFLS, macrophage, monocyte, NK cell, and T cellFibroblast, epithelial cell, Th17 cell, Treg cell, and macrophageNoneProinflammatory: chemotactic to fibroblasts, promotes fibroblast proliferation, epithelial cell differentiation, and the stability of Th17 cells.
Anti-inflammatory: in the absence of IL-6, promotes the differentiation and proliferation of Treg cells and inhibits activation of IFN-γ, TNF-α, macrophages, and antibody production.

Abbreviations: ADCC: antibody-dependent cellular cytotoxicity; APC: antigen-presenting cells; COX-2: cyclooxygenase-2; CXCL: chemokine (C-X-C motif) ligand; FLS: fibroblast-like synoviocytes; GCP-2: granulocyte chemotactic protein-2; GM-CSF: granulocyte-macrophage colony-stimulating factor; IFN: interferon; MHC: major histocompatibility complex; MCP-1: monocyte chemoattractant protein-1; MIC: macrophage inhibitory cytokine; MMP: matrix metalloproteinase; NO: nitric oxide; OPG: osteoprotegerin; PGE2: prostaglandin E2; RANK: receptor activator of nuclear factor-κB; RANKL: receptor activator of nuclear factor kappa Β ligand; TIMP: tissue inhibitors of metalloproteinase; TNF: tumor necrosis factor.