Background
Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by immune cell infiltration and proliferation in the synovium, leading to progressive joint destruction. Although the etiology of RA is not fully understood, recent evidence indicates that resident fibroblast-like synoviocytes (FLS) play a major role in initiating and driving RA [
1]. RA-FLS exhibit anchorage-independent proliferation, lack contact inhibition in vitro, and can attach to and invade articular cartilage [
1,
2]. Furthermore, RA-FLS survive autonomously in a tumor-like environment that is enriched with oxygen radicals, nitric oxide, and cytokines [
3,
4]. In recent years, the development of biologic therapies that target pro-inflammatory cytokines and immune cells have greatly improved the treatment of RA; however, some patients remain resistant to these therapies. Thus, new therapies designed to suppress RA-FLS proliferation could replace or complement existing RA treatments, increasing the therapeutic efficacy for the nonresponding population.
Many inflammation and hypoxia-induced signaling pathways have profound effects on intracellular metabolism, leading to effects on cell growth and survival. Recent studies of cancer cell metabolism have revealed cancer-specific metabolic changes that have led to the identification of new therapeutic targets. Most cancer cells consume glucose at higher rates than normal cells, a phenomenon known as the Warburg effect [
5]. Many studies have shown that glycolytic enzyme inhibitors efficiently inhibit tumor growth, both in vitro and in vivo, by shifting glucose metabolism from glycolysis to glucose oxidation. This shift results in the release of proapoptotic mediators and reduces malignant cell proliferation, thus eliminating actively growing tumor cells while leaving normal cells unaffected [
6]. Glutamine is another carbon source that is important in cell growth and energy metabolism [
7,
8]. Glutamine provides a major energy source for respiration and serves as a precursor for the synthesis of macromolecules such as nucleotides and proteins [
9,
10]. In tumor cells, pyruvate generated from the glycolytic pathway is converted to lactate, rather than being used in the tricarboxylic acid (TCA) cycle. Although the requirement for mitochondrial ATP production is reduced in tumor cells, the demand for biosynthetic precursors and NADPH is increased [
11]. To compensate for these changes and to maintain a functional TCA cycle, cancer cells often rely on elevated glutaminolysis [
12‐
15]. Several cancer cells, such as HeLa and basal-type breast cancer cells [
12,
16,
17], even favor glutamine over glucose as an energy source.
RA-FLS exhibit several tumor cell-like characteristics, but the role of glycolysis in RA-FLS proliferation is unclear. The microenvironment in RA inflamed joints is characterized by hypoxia and low nutrient concentrations [
18‐
20]. A few reports have addressed the metabolic changes in RA-FLS. For example, metabolome analysis showed the different metabolomic profiling between RA-FLS and osteoarthritis (OA)-FLS [
21]. In addition, the inhibition of glucose transporter 1, choline kinase, monocarboxylate transporter (MCT4), and 6-phosphofructo-2-kinase, or the activation of pyruvate dehydrogenase or administration of fructose 1,6-bisphosphate, have each been shown to inhibit RA-FLS proliferation and/or ameliorate inflammatory arthritis in mice [
22‐
27]. The metabolic changes identified in RA-FLS represent novel mechanisms that contribute to the pathogenesis of rheumatic diseases, and the targeting of metabolic dysfunction may provide a new therapeutic approach for RA.
Since the roles of glycolysis and glutaminolysis in RA have not been thoroughly investigated, here we examined the role of these pathways in RA-FLS proliferation and the development of arthritis in SKG mice. The glutamine catabolism pathway is initiated by the conversion of glutamine to glutamate by glutaminase (GLS)1, and several studies have shown that GLS1 inhibition significantly suppresses cancer cell proliferation [
28‐
31]. Here, we found that GLS1 expression was upregulated in RA-FLS, and that RA-FLS cell growth was decreased under glutamine-deprived, but not glucose-deprived, conditions. We also found that GLS1 inhibition suppressed RA-FLS proliferation and ameliorated inflammatory arthritis in SKG mice.
Methods
Mice
Female SKG mice were obtained from CLEA Japan (Tokyo, Japan). The mice were housed in the Kobe University animal facility at a constant temperature, with laboratory chow and water provided ad libitum. All animal protocols received prior approval by the institutional review board and all procedures were performed in accordance with the recommendations of the Institutional Animal Care Committee of Kobe University.
Reagents and antibodies
Zymosan A (ZyA) was obtained from Sigma-Aldrich (St. Louis, MO, USA). Cytokines and platelet-derived growth factor (PDGF) were from R&D Systems (Minneapolis, MN, USA). Compound 968, 5-(3-bromo-4-(dimethylamino)phenyl)-2,2-dimethyl-2,3,5,6-tetrahydrobenzo[a]phenanthridin-4(1H)-one, was obtained from Calbiochem (La Jolla, CA, USA). Anti-glutaminase and anti-Ki-67 antibodies were obtained from Abcam (Cambridge, UK).
Fibroblast-like synoviocytes and cell culture
Human studies were approved by the ethics committees of the Kobe University Hospital and conducted in accordance with the Declaration of Helsinki. Synovial tissue samples were obtained from RA and OA patients undergoing joint replacement surgery or synovectomy. The RA patients fulfilled the American College of Rheumatology 1987 criteria [
32]. Collected synovial tissue samples were minced and incubated first with 4 mg/ml collagenase, and then with 0.05% trypsin (Difco, Detroit, MI, USA), as described previously [
33]. The isolated cells were cultured in Dulbecco’s modified Eagle’s medium (DMEM) supplemented with 10% fetal bovine serum (FBS; GIBCO BRL, Palo Alto, CA, USA), 1% penicillin-streptomycin (Lonza Walkersville Inc., Walkersville, MD, USA), and 2 mM
l-glutamine (GIBCO BRL). FLS cultures (used between passages 3–6) were maintained as previously described [
33]. To determine the effects of glutamine or glucose deprivation, the FLS were cultured in DMEM with both
l-glutamine and
d-glucose (Wako, Osaka, Japan 044-29765), DMEM without
l-glutamine (Wako 045-30285), or DMEM without
d-glucose (Wako 042-32255), each of which was supplemented with 10% dialyzed FBS (Biowest, Nuaillé, France) and 1% penicillin-streptomycin.
FLS intracellular metabolites (0.2–1.0 × 10
6 cells) were analyzed by gas chromatography-mass spectrometry (GC/MS) and capillary electrophoresis-mass spectrometry (CE-MS; C-SCOPE, Human Metabolome Technologies Inc., Tsuruoka, Japan). GC/MS analysis was performed using a GC/MSQP2010 Ultra (Shimadzu Co., Kyoto, Japan) with a fused silica capillary column (CP-SIL 8 CB low bleed/MS; 30 m × 0.25 mm inner diameter, 0.25 μm film thickness; Agilent Technologies, Waldbronn, Germany), as described previously [
34,
35]. 2-Isopropylmalic acid solution (Sigma-Aldrich) was added as an internal standard. The C-SCOPE analysis was performed as described previously [
36]. 5-Hydroxy-N-methyl-tryptamine (Human Metabolome Technologies Inc.) was added as an internal standard.
Real-time polymerase chain reaction
Total RNA was isolated using RNeasy (Qiagen, Hilden, Germany), and 1 μg of total RNA was reverse-transcribed with a QuantiTect reverse transcription kit (Qiagen). Quantitative real-time polymerase chain reaction (PCR) was performed using a QuantiTect SYBR Green PCR Kit (Qiagen) with an ABI Prism 9900 instrument (Applied Biosystems, Foster City, CA, USA), according to the manufacturer’s instructions. The primer pairs were from Qiagen and are shown in Additional file
1: Table S1. The mRNA levels were normalized to that of glyceraldehyde-3-phosphate dehydrogenase (GAPDH; QT01192646, Qiagen).
Western blotting
Cell lysates were analyzed by Western blotting with anti-GLS and anti-β-actin antibodies (Sigma-Aldrich). The bound antibodies were visualized using a chemiluminescence reagent (Super Signal West Dura Extended Duration Substrate, Thermo Fisher Scientific, Waltham, MA, USA) following the manufacturer’s instructions. Immunoblot signals were quantified by densitometric scanning of the films, using ImageJ software.
Cell viability assays
Cell viability was determined using a WST-8 Cell Proliferation Cytotoxicity Assay Kit (Dojindo Laboratories, Kumamoto, Japan). Cells were seeded into 96-well plates (1 × 104 cells/well). After the culture period, the wells were pulsed with WST-8 for 3 h, and the optical density at 450 nm was measured with a microplate reader (Bio-Rad, Hercules, CA, USA).
Cell proliferation assays
Cells were seeded into 96-well plates (1 × 104 cells/well). After the culture period, cell proliferation was determined using a cell proliferation enzyme-linked immunosorbent assay (ELISA; BrdU; Roche, Basel, Switzerland) following the manufacturer’s instructions, and by measuring optical densities at 450 nm with a microplate reader (Bio-Rad).
Arthritis induction and evaluation
Eight-week-old SKG mice were treated with 2 mg ZyA as previously described [
37]. Briefly, ZyA suspended in saline was intraperitoneally injected on day 0, and arthritis developed 14 to 21 days later. Arthritis severity was assessed using a previously described scoring system (0 = no joint swelling, 0.1 = swelling of one digit joint, 0.5 = mild swelling of the wrist or ankle, and 1.0 = severe swelling of the wrist or ankle [
38,
39]). The individual joint scores were totaled for each mouse.
Histology and immunohistochemistry
The hind paws of the mice were removed, fixed in 4% paraformaldehyde, decalcified in EDTA, embedded in paraffin, and sectioned. The samples were then stained with hematoxylin and eosin, and histological evaluation was performed. Histological evaluation was performed using a previously described scoring system (0 = no inflammation, 1 = slight thickening of the synovial cell layer and/or the presence of some inflammatory cells in the sublining, 2 = thickening of the synovial lining, infiltration of the sublining, and localized cartilage erosions, and 3 = infiltration in the synovial space, pannus formation, cartilage destruction, and bone erosion [
39]). Paraffin-embedded tissue sections (5 μm) were deparaffinized and hydrated with xylene and graded alcohols using a standard protocol, and incubated overnight with primary antibodies at 4 °C in a humidified chamber, and then rinsed and incubated with biotinylated secondary antibodies for 30 min at room temperature. The slides were developed using the ImmunoCruz™ ABC Staining System (Santa Cruz Biotechnology, Santa Cruz, CA, USA) and were counterstained with Mayer’s hematoxylin solution (Wako). Immunohistochemical staining of proliferating cells was performed with an anti-Ki-67 antibody. The Ki-67-positive cells in the lining of the synovium were quantified using ImageJ software.
Treatment of SKG mice with compound 968
Compound 968 was dissolved in dimethyl sulfoxide (DMSO; Sigma-Aldrich) and administered intraperitoneally to SKG mice at 25 mg/kg three times per week from day 14 (before the onset of arthritis) to day 42 after ZyA injection. DMSO was used as a negative control.
Statistical analysis
Results are expressed as the mean ± SEM. Statistical comparisons were performed using the Student’s t test, Mann-Whitney U test, and Welch’s t test, and two-way analysis of variance (ANOVA) using GraphPad Prism software as appropriate. P values less than 0.05 were considered statistically significant.
Discussion
In this study, we showed that GLS1 expression and glutamine and glutamate consumption were higher in RA-FLS than in OA-FLS. We also showed that glutamine deprivation or GLS1 inhibition suppressed RA-FLS proliferation. Finally, we showed that the administration of a GLS1 inhibitor ameliorated inflammatory arthritis in a mouse model of RA by suppressing FLS proliferation. Taken together, this is the first report to show the importance of glutaminolysis in the pathogenesis of RA.
We found that mRNAs encoding HK2, MCT4, and PDK1 were more highly expressed in RA-FLS than in OA-FLS, although we could not find demonstrate the upregulation of these enzymes at the protein level. We also showed that levels of glucose, glutamine, glutamate, and lactate tended to be lower in RA-FLS than in OA-FLS. The reduction of the lactate level seen in CE-MS may be due to the elevation of the MCT4, which exports intracellular lactate to the extracellular space. These results, together with the mRNA expression profile and the intracellular metabolomic profiles, indicate that both the glycolytic and glutaminolytic pathways are upregulated in RA-FLS, and are consistent with previous reports showing that the inhibition of HK2, MCT4, or PDK1 suppresses RA-FLS proliferation and arthritis in a mouse model [
22,
24,
26]. In addition, we found that silencing of MCT4, PDK1, or GLS1 did not significantly affect IL-6 or MMP-3 production from RA-FLS, suggesting that silencing of glycolytic or glutaminolytic enzymes may have little impact on cytokine production of these cells. Our findings that GLS1 plays key roles in RA-FLS proliferation and in a mouse model of arthritis further confirm that metabolic enzymes are involved in the pathogenesis of RA.
Cancer cells or highly proliferative cells exhibit a “glutamine addiction” phenotype [
12]. To determine whether RA-FLS exhibit a similar phenotype, we investigated the effect of glucose or glutamine deprivation on RA-FLS proliferation. We found that RA-FLS proliferation was more dependent on glutamine than on glucose (Fig.
3b), and that GLS1 knockdown, but not HK2 knockdown, inhibited RA-FLS proliferation (Fig.
3a), consistent with a “glutamine addiction” phenotype of RA-FLS. Furthermore, we found that PDGF stimulation did not enhance the proliferation of RA-FLS under the glutamine-deprived condition. Notably, Colombo et al
. [
40] showed that HeLa cells, which strongly depend on glutamine for proliferation [
14], transit through the S and enter the G2/M phase in the absence of glucose, but fail to enter G2/M in the absence of glutamine, suggesting that glutamine is critical for the entrance of highly proliferative cells into G2/M. They also showed that GLS1 is a substrate for the ubiquitin ligase anaphase promoting complex/cyclosome (APC/C)-Cdh1 in some cells [
40,
41]. APC/C-Cdh1 inactivation is necessary for S phase initiation, and APC/C-Cdh1 substrates are targeted for degradation through specific recognition motifs such as the KEN box. These previous findings are consistent with our result that compound 968 treatment of SKG mice significantly decreased the number of Ki-67-positive synovial cells.
Although the regulation of GLS1 in cancer cells is not well understood, several studies indicate a functional link between the oncogene
MYC and glutamine metabolism. Bush et al
. showed that three of the five enzymes involved in glutamine metabolism are directly regulated by MYC at the transcriptional level [
42]. c-MYC, which is known to stimulate cell proliferation, transcriptionally represses miR-23a and miR-23b, which are repressors of GLS1 expression. In addition, Gao et al
. reported that GLS1 levels are closely correlated with MYC expression levels [
16]. Studies also showed that the MYC expression is elevated in RA-FLS [
43‐
45], raising the possibility that GLS1 expression is upregulated by MYC in these cells.
Our finding that PDGF or IL-17 augmented the GLS1 expression in RA-FLS at a mRNA level further supported the notion that glutaminolysis is important in RA-FLS metabolism, although we did not confirm the upregulation of GLS1 at the protein level nor the change in the intracellular glutamine and glutamate levels after IL-17 or PDGF stimulation. PDGF is a well-known growth factor for RA-FLS, and induces MYC expression [
46]. IL-17 is also abundant in the rheumatoid synovium and contributes to RA pathogenicity by inducing RANKL expression. Interestingly, IL-17 is reported to upregulate MYC in some cancer cells [
47,
48]. IL-1β, TNF-α, and LPS are known to have potent effects on the invasiveness of RA-FLS. In human neurons, GLS1 expression was upregulated by IL-1β or TNF-α treatment, and in a rat hepatoma model IL-6 or TNF-α treatment indirectly upregulated c-MYC expression [
49,
50]. However, we did not observe upregulation of GLS1 by IL-1β, TNF-α, or LPS. Although the mechanism is unclear, IL-17-specific upregulation of GLS1 might be a cellular characteristic of RA-FLS, and suggests a novel role for IL-17 in RA-FLS and the pathogenesis of RA.
Since both glycolysis and glutaminolysis are associated with T-cell activation [
51], GLS1 inhibition may also affect the immune system. Th17 cells and Treg cells show contrasting characteristics in terms of cellular metabolism; Th17 cells rely mainly on glycolysis [
52], whereas Treg cells depend on glycolysis and fatty acid oxidation (FAO), and oxidative phosphorylation [
53]. As Th17 cells and Treg cells are known to be two key players in the onset and maintenance of autoimmune arthritis in SKG mice [
54], we studied the effect of GLS1 inhibition on Th17 and Treg cells. However, we found no difference in the number of Th17 cells and a decrease in the number of Treg cells in the spleens from compound 968- versus DMSO-treated SKG mice, suggesting that GLS1 inhibition minimally affected immune cells in our experimental system.
Several limitations of this study should be acknowledged. First, although we have revealed the critical role of GLS1 on cell proliferation of RA-FLS, we did not demonstrate the role of GLS1 on the invasive phenotype of RA-FLS. Second, we found that GLS1 mRNA was upregulated after cytokine stimulation, but we could not confirm the upregulation of GLS1 at the protein level. Third, we did not illustrate a precise molecular mechanism that is regulated by glutaminolysis in RA-FLS. To address this point, we examined the expression of c-MYC by immunoblotting (Additional file
9: Figure S8). Although there was no significant difference in c-MYC expression between RA-FLS and OA-FLS, we found that c-MYC expression tended to be higher in RA-FLS than in OA-FLS. Taken together, our in vitro and in vivo experiments suggest that glutaminolysis is activated in RA-FLS and that blocking glutaminolysis may be a novel therapeutic strategy for RA.
Acknowledgements
The authors thank Shino Tanaka for providing technical assistance.