Crosstalk between ferroptosis and NLRP3, a possible therapeutic target in experimentally-induced rheumatoid arthritis: role of P2Y12R inhibition in modulating P53/SLC7A11/ALOX15 signaling

Abstract

Ferroptosis is critical in progressing and exacerbating rheumatoid arthritis (RA) and other inflammatory joint diseases. Inhibition of the P2Y12 receptors reduced iron overload in macrophages displaying an anti-inflammatory response. Herein, the ameliorative effect of ticagrelor, a reversible P2Y12 inhibitor, against adjuvant-induced arthritis (AIA) in rats was investigated, with a special emphasis on the possible modulation of some inflammatory signals linked to ferroptosis. Particularly, correlation analyses were conducted between nod-like receptor protein 3 (NLRP3) and all assessed parameters. Four groups of rats were assigned: Control group, AIA group (0.1 ml intradermal injection of complete Freund's adjuvant), Ticagrelor group (30 mg/kg, p.o.), and Ticagrelor + AIA group. Ticagrelor exhibited an anti-arthritic effect, evidenced by significant improvements in both macroscopic and histopathological alterations. It effectively inhibited ferroptosis, indicated by a marked upregulation of the ferroptotic inhibitors, solute carrier family 7 member 11 (SLC7A11), glutathione peroxidase 4 (GPX4) and ferritin heavy chain 1 (FTH1) to reach 9.80, 2.20, and 8.49-folds (p < 0.0001), along with a notable reduction in the ferroptotic promoters, P53, acyl-CoA synthetase long-chain family member 4 (ACSL4) and arachidonic acid 15-lipoxygenase-1 (ALOX15) by 89.46%, 41.45% and 49.85% (p < 0.0001). It reduced TNF-α and various chemokines (RANTES, MIP-1α, eotaxin-3) to suppress matrix metalloproteinases expression. Furthermore, ticagrelor decreased NLRP3 expression by 48.63% (p < 0.0001) to pinpoint its anti-inflammatory effect. Overall, amending the P53/SLC7A11/ALOX15 axis by ticagrelor mediated its anti-inflammatory and anti-ferroptotic effects. These findings provide preliminary experimental evidences for further investigating the potential impacts of ticagrelor as a treatment for RA.