Rheumatoid arthritis (RA) is a common autoimmune and inflammatory disease worldwide, but understanding its pathogenesis is still limited. In this study, plasma untargeted metabolomics of a discovery cohort and targeted analysis of a verification cohort were performed by gas chromatograph mass spectrometry (GC/MS). Univariate and multivariate statistical analysis were utilized to reveal differential metabolites, followed by the construction of biomarker panel through random forest (RF) algorithm.The pathways involved in RA were enriched by differential metabolites using Ingenuity Pathway Analysis (IPA) suite. Untargeted metabolomics revealed eighteen significantly altered metabolites in RA. Among these metabolites, a three-metabolite marker panel consisting of L-cysteine, citric acid and L-glutamine was constructed, using random forest algorithm that could predict RA with high accuracy, sensitivity and specificity based on a multivariate exploratory receiver operator characteristic (ROC) curve analysis. The panel was further validated by support vector machine (SVM) and partial least squares discriminant analysis (PLS-DA) algorithms, and also verified with targeted metabolomics using a verification cohort. Additionally, the dysregulated taurine biosynthesis pathway in RA was revealed by an integrated analysis of metabolomics and transcriptomics. Our findings in this study not only provided a mechanism underlying RA pathogenesis, but also offered alternative therapeutic targets for RA.
K E Y W O R D Sbiomarker, metabolomics, rheumatoid arthritis, taurine biosynthesis, transcriptomics 1 INTRODUCTION Rheumatoid arthritis (RA) is a chronic autoimmune joint disease where persistent inflammation affects bone remodeling, leading to progressive bone destruction [1]. The prevalence of RA worldwide is between 0.5% and 1%, and RA often leads to disablement and subsequently reduced quality of life [2]. In RA, abnormal activation of the immune system elevates pro-inflammatory cytokines and chemokines levels, which can promote synovial angiogenesis and inflammation [3]. The synovium forms a hyperplastic pannus with infiltrated macrophage-like and fibroblast-like synoviocytes (FLS), which invades joints by secret-ing proteinases and inducing osteoclast differentiation [4-6]. In addition, RA is probably associated with various environmental triggers, and its symptoms can develop at different rates and in different joints from young age to old age [7]. Over the past decades, the treatment paradigms and therapeutic approaches have been rapidly enhanced, which transformed RA from a chronic and disabling condition requiring palliative measures to a potentially curable illness [8].Early disease diagnosis generally increases the chances for successful treatment, however, for RA patients at early stage the bone damage will not be detected by x-ray before months of diagnosis [9].Biomarkers, as an indicator of pathogenic processes, have been proved