The role, targets and mechanisms of traditional Chinese medicine in regulating the balance of T helper type 17/regulatory Tcells in rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is a persistent systemic autoimmune disease, having all the hallmarks of joint swelling, joint tenderness, and progressive joint destruction, with synovitis and pannus formation as the basic pathological changes. T‐lymphocyte infiltration is the key to its pathogenesis. During the growth of RA, the share of regulatory T (Treg) cells decreases, while the percentage of T helper type 17 (Th17) cells increases, giving rise to an imbalance of Th17/Treg cells. Modern medicine has made great advances in the treatment of RA and the selection of available drugs, but there are also the disadvantages of gastrointestinal reaction, high price, and low patient compliance. Therapy of RA remains a problem. Traditional Chinese medicine (TCM) has RA therapy developments, both in experimental research and clinical research, and its advantages of lasting effects and less detrimental reactions and fewer adverse effects are accepted by most patients. Numerous clinical and experimental studies have been performed in TCM on regulating Th17/Treg balance. However, the detailed mechanism of TCM intervention in Th17/Treg equilibrium in preventing and treating RA has not been discovered. In this article, the theory of regulating Th17/Treg cell equilibrium in RA is described from the perspectives of single Chinese medicine, active components of Chinese medicine, Chinese medicine compounds, and other therapies of TCM. It was found that TCM can regulate Th17/Treg cell balance and inhibit immunoreaction by intervening in cytokines, transcription factors, and signal pathways. It enables us to comprehensively and deeply understand the mechanism of TCM intervening in Th17/Treg balance in RA; provides direction for clinical therapy of RA; and offers new thoughts for understanding the pathogenesis of RA.

Research progress of targeted therapy regulating Th17/Treg balance in bone immune diseases

“…Traditional Chinese medicine is characterised by syndrome differentiation, disease combination, and the overall regulation, prevention, and treatment of RA and PMOP. By giving full play to its multi-target, multi-component, and multi-channel advantages, it can achieve the same effect as Western medicine; at the same time, it has few side effects, low price, convenient oral administration, high recognition and acceptance of patients, and has great potential in the treatment of RA and PMOP ( 247 , 248 ). In addition, traditional Chinese medicine compounds can not only improve the curative effect but also avoid serious side effects or drug resistance through multi-component comprehensive treatment ( 249 ).…”

Illuminating the connection: Unearthing the mechanisms linking COVID‐19 and rheumatoid arthritis

“…18 Fibroblasts,Tcells,Bcells, macrophages, neutrophils, osteoblasts, and osteoclasts interact witheachother,leadingtothecomplicatedpathophysiologyofRA, includingsynovialinflammationandbonedestruction. 19,20 Regard-ingtheimmuneresponseinpatientswithCOVID-19,cell-cellinteraction was also investigated but the connection with autoimmune diseasesstillneedstobefurthercomprehensivelyevaluated. 21 The pathwaymaybesimilarbetweenRAandCOVID-19,similarityleads toapossiblemutualassociation.…”

“…Cell–cell interactions play an important role in the pathogenesis of RA in recent studies, mainly on synovial inflammation and metabolic dysregulation of fibroblasts 18 . Fibroblasts, T cells, B cells, macrophages, neutrophils, osteoblasts, and osteoclasts interact with each other, leading to the complicated pathophysiology of RA, including synovial inflammation and bone destruction 19,20 . Regarding the immune response in patients with COVID‐19, cell–cell interaction was also investigated but the connection with autoimmune diseases still needs to be further comprehensively evaluated 21 .…”

No significant clinical value by adding on Jin-gu-lian Capsule in rheumatoid arthritis therapy: a real world study

“…[1] Traditional Chinese medicine or herbal medicine has been reported to be one possible complementary method in management of RA. [2,3] However, most of these reports were focused on basic research, including in vitro experiments and animal experiments, while clinical observations were not enough.…”