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REVIEW

The Involvement of Glucose and Lipid Metabolism Alteration in Rheumatoid Arthritis and Its Clinical Implication

, ORCID Icon, , &
Pages 1837-1852 | Received 25 Nov 2022, Accepted 19 Apr 2023, Published online: 26 Apr 2023

Figures & data

Figure 1 Glycolytic activity is enhanced in FLS of RA patients. Up-regulation of HK2 enhances the migration and invasion ability of FLS, which serves as an example how glycolysis drives RA. Many glycolytic intermediates like succinate up-regulate glycolysis-related genes via HIF-1α, further facilitate this metabolic process. Above changes eventually fuel vascular proliferation, inflammation, and cartilage damages. HIF-1α plays a key role in related signal transduction and pathological changes.

Abbreviations: FLS, fibroblast-like synoviocyte; HK2, Hexokinase 2; G6P, glucose-6-phosphate; GLUT-1, Glucose transporter 1; LDH, lactate dehydrogenase; HIF-1α, Hypoxia-inducible factor 1-alpha; mTOCR, mammalian target of rapamycin complex; PI3K, Phosphatidylinositol 3-hydroxykinase.
Figure 1 Glycolytic activity is enhanced in FLS of RA patients. Up-regulation of HK2 enhances the migration and invasion ability of FLS, which serves as an example how glycolysis drives RA. Many glycolytic intermediates like succinate up-regulate glycolysis-related genes via HIF-1α, further facilitate this metabolic process. Above changes eventually fuel vascular proliferation, inflammation, and cartilage damages. HIF-1α plays a key role in related signal transduction and pathological changes.

Figure 2 RA conditions favor PPP in CD4+ T cells. Increased PFKFB3/G6PD ratio serves as the fundament for the accelerated PPP in RA T cells. It leads to the production of large amounts of NADPH in cytoplasm. By supporting lipid synthesis, NADPH facilitates membranes construction, which makes T cells more reproductive and invasive. The increase in NADPH eventually depletes ROS. It directly prolongs the longevity of T cells, and induces them to rapidly proliferate by bypassing ATM-controlled G2/M cell cycle checkpoint. The low oxidative stress condition is also favorable for Th1 and Th17 differentiation. Concurrently, decreased NMT1 expression in T cells results in the inability to target AMPK to lysosomes, leading to elevated and unrestricted activation of mTORC1, which promotes Th1 and Th17 differentiation by mediating HIF-1α.

Abbreviations: G6P, glucose 6-phosphate 6; G6PD, Glucose-6-phosphate Dehydrogenase; ROS, Reactive oxygen species; NADPH, Nicotinamide Adenine Dinucleotide Phosphate; ATM, ataxia telangiectasia mutated; PFKFB3, 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase 3; NMT1, N-myristoyltransferase 1; AMPK, AMP-activated protein kinase; HIF-1α, Hypoxia inducible factor-1 alpha; Th, T helper.
Figure 2 RA conditions favor PPP in CD4+ T cells. Increased PFKFB3/G6PD ratio serves as the fundament for the accelerated PPP in RA T cells. It leads to the production of large amounts of NADPH in cytoplasm. By supporting lipid synthesis, NADPH facilitates membranes construction, which makes T cells more reproductive and invasive. The increase in NADPH eventually depletes ROS. It directly prolongs the longevity of T cells, and induces them to rapidly proliferate by bypassing ATM-controlled G2/M cell cycle checkpoint. The low oxidative stress condition is also favorable for Th1 and Th17 differentiation. Concurrently, decreased NMT1 expression in T cells results in the inability to target AMPK to lysosomes, leading to elevated and unrestricted activation of mTORC1, which promotes Th1 and Th17 differentiation by mediating HIF-1α.