Adenosine receptor expression in rheumatoid synovium: a basis for methotrexate action

Introduction

Methotrexate (MTX) exerts at least part of its anti-inflammatory effects through adenosine receptors (ADOR). The aims of this study were to determine the expression of all four adenosine receptor genes (ADORA₁, ADORA_2A, ADORA_2B, ADORA₃ and ADORA_3variant) in rheumatoid synovial tissue and any influence of MTX exposure on this expression. Furthermore, we investigated whether polymorphisms within ADORA₃ were associated with response and/or adverse effects associated with MTX.

Methods

Adenosine receptor gene expression was undertaken using PCR in 20 rheumatoid arthritis (RA) synovial samples. A separate cohort of 225 RA patients receiving MTX was genotyped for SNPs in the ADORA₃ receptor gene. Double immunofluorescence was used to identify cells expressing ADOR protein.

Results

All ADOR genes were expressed in all synovial samples. ADORA₃ and A_3variant were the dominant subtypes expressed irrespective of MTX therapy. Expression of ADORA_2A and ADORA_2B was increased in patients receiving MTX compared to those not receiving MTX. There was no association between the ADORA₃ rs1544224 SNP and high and low disease activity or MTX-associated adverse effects. ADORA_2B protein expression was most obvious in vascular endothelial cells whereas ADORA₃ protein was more abundant and expressed by synovial fibroblasts.

Conclusions

We have shown that adenosine receptors are expressed in RA synovium. There is differential expression of receptors such that ADORA₃ is expressed at significantly higher levels. This evidence demonstrates the potential for MTX to exert its anti-inflammatory effects at the primary site of pathology within the joints of patients with RA.