Methotrexate (MTX) is a widely used treatment for inflammatory diseases such as rheumatoid arthritis and psoriasis, based on the concept that it is immunosuppressive.Its mechanism of action, however, remains unclear, although it is thought to depend on adenosine. Caffeine and theophylline, which have several targets including adenosine receptors, have been shown to suppress the beneficial clinical effects of MTX. Here we show that MTX and caffeine and theophylline differentially affect a motogenic T-cell mechanism driven by endogenous thrombospondin-1 (TSP-1) and its receptor, low density lipoprotein receptor-related protein 1 (LRP1). MTX stimulated TSP-1 expression and the motogenic TSP-1/TSP-1 receptor mechanism in primary human T cells, hence mimicking IL-2 and CXCL12, which similar to MTX, dampen inflammatory disease. SiRNAmediated gene silencing of TSP-1 and LRP1 inhibited this stimulatory effect. Caffeine and theophylline inhibited the TSP-1/TSP-1 receptor mechanism by inhibiting LRP1 expression. These results indicate that the effect of MTX on T cells is immunoregulatory rather than immunosuppressive, and suggest a pathway dependent on TSP-1/TSP-1 receptor interactions for the regulation of immune responses.Keywords: Cytokines r Lipoprotein receptor related protein1 r Lymphocytes r Methotrexate r Thrombospondin-1 Additional supporting information may be found in the online version of this article at the publisher's web-site
IntroductionThe pharmacological treatment of inflammatory diseases of autoimmune and allergic origin plays a pivotal role for the possibility to dampen symptoms and control the disease process in affected individuals. Widespread chronic inflammatory diseases, such as rheumatoid arthritis, Crohn's disease, ulcerous colitis, vasculitis, psoriasis, and multiple sclerosis, often require Correspondence: Prof. Karl-Gösta Sundqvist e-mail: Karl.Sundqvist@karolinska.se extensive long-term treatment. These diseases are generally considered to reflect an overactive immune system owing to poor suppression by regulatory T (Treg) cells [1][2][3][4][5]. Accordingly, the treatments applied are based on an immunosuppressive concept, which includes cytostatics, glucocorticoids, and an increasing number of so-called biological treatments in the form of monoclonal antibodies to lymphocytes and cytokines.MTX is a cornerstone immunosuppressive therapy for juvenile idiopathic arthritis, rheumatoid arthritis, and psoriasis and useful in inflammatory bowel disease, multiple sclerosis, vasculitis, and transplantation [6]. Although MTX is one of the most effective and Eur. J. Immunol. 2016. 46: 1279-1290 commonly used medicines to treat various forms of autoimmune diseases, the mechanism of action of MTX remains unclear. MTX is a folic acid antagonist but its immunosuppressive effects are thought to be mediated through the anti-inflammatory signaling molecule adenosine [7][8][9][10][11][12]. Adenosine is produced by Treg cells, promotes their immunoregulatory activity, and is an integral part of the immune reg...