How environmental pollutants and genetics work together in rheumatoid arthritis

How environmental pollutants and genetics work together in rheumatoid arthritis

It has been known for more than three decades that individuals with a particular version of a gene -- human leukocyte antigen (HLA) -- have an increased risk for rheumatoid arthritis.

Meanwhile, in recent years, there has been a growing interest in the relationship between rheumatoid arthritis and environmental factors, such as cigarette smoking. In smokers who develop rheumatoid arthritis, the disease hits harder. Smokers who also carry the HLA gene variant have even higher likelihood to develop RA, and their disease is more severe. For these patients, this means not only greater pain and swelling, but also more severe bone destruction -- a lesser known and more dangerous aspect of the disease.

In a new mouse study, researchers probed the relationship between these two factors: the HLA gene and environmental pollutants.

"We found a particular enzyme that acts as a channel, or pathway, in the cell for a conversation between the two culprits, so they work together to do greater damage. Individually they are bad, but together, they're worse," says the senior author.

Authors uncovered a nuclear factor kappa B-mediated synergistic interaction between the SE (a five-amino acid sequence motif encoded by RA-associated HLA-DRB1 alleles) and AhR (the aryl hydrocarbon receptor) pathways that leads to markedly enhanced osteoclast differentiation and Th17 polarization in vitro. Administration of AhR pathway agonists to transgenic mice carrying human SE-coding alleles resulted in a robust increase in arthritis severity, bone destruction, overabundance of osteoclasts, and IL17-expressing cells in the inflamed joints and draining lymph nodes of arthritic mice.

The work is published in the Proceedings of the National Academy of Sciences.

Cigarettes are one of the top environmental concerns with rheumatoid arthritis. But many other environmental pollutants can also help trigger the condition. For example, living in urban areas or near highways is linked with RA, regardless of cigarette use.

The chemical dioxin may be to blame. It's the same contaminant that was found in soil near a Dow Chemical plant in Midland, Michigan. "One scenario is that air pollution from vehicles on highways produces dioxin or other pollutants. Dioxin is just one of many chemicals that similarly activate this pathway," says the senior author.

Dioxin also has been shown to increase severity in an experimental model of another autoimmune disease, multiple sclerosis.

Bone degeneration in rheumatoid arthritis is caused by hyperactivity of certain bone cells called osteoclasts, which absorb bone tissue. "In our research with the combination of dioxin and the HLA gene variant, we saw that osteoclasts are overactive and overabundant, and that bone is destroyed because of it," says the senior author.

Currently, the treatments available for rheumatoid arthritis focus primarily on the inflammation but do not directly target bone destruction, says the senior author. "Once we have better drugs that directly and specifically address bone destruction in this disease, we'll have better treatment."