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Molecular mechanisms and clinical studies of iguratimod for the treatment of ankylosing spondylitis

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Abstract

Iguratimod (IGU) is a novel small molecule anti-rheumatic drug with the effect of non-steroidal anti-inflammatory drug and disease-modifying anti-rheumatic drug. IGU has various mechanisms of action, including inhibition of prostaglandin E2, tumor necrosis factor-α (TNF-α), interleukin-17 (IL-17) production, inhibition of macrophage migration inhibitory factor (MIF)-induced proinflammatory effects, inhibition of osteoclastogenesis, and promotion of osteoblastic differentiation. Ankylosing spondylitis (AS) is the major subtype of spondyloarthritis that affects the axial skeleton, causing inflammatory back pain, which can lead to impairments in structure and function and a decrease in quality of life. Theories on pathogenesis of AS include misfolding of human leukocyte antigen-B27 during its assembly leading to endoplasmic reticulum stress and unfolded protein response (UPR). Activation of UPR genes results in release of TNF-α and IL-17, which have been shown to be important in the development of AS. In addition, current evidence suggests the importance of cyclooxygenase-2/prostaglandin E2 pathway and MIF in the pathogenesis of AS. Current drugs for the treatment of AS are limited and exploration of effective drugs is needed. IGU may be effective for the treatment of AS given that its mechanisms of action are closely related to the pathogenesis of AS. In fact, several small-scale clinical trials have shown the efficacy of IGU for the treatment of AS. This article reviews the molecular mechanisms of IGU that are related to the pathogenesis of AS and clinical trials of IGU for the treatment of AS, providing a reference for future clinical application of IGU for AS.

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Funding

Science and technology general project of Guangzhou, China. Funding number: 201804010028.

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  1. Shantou University Medical College, Shantou, Guangdong Province, China

    Suling Liu

  2. Department of Rheumatology and Immunology, Guangdong Provincial People’s General Hospital, Guangdong Academy of Medical Sciences, No.106 2nd Zhongshan Road, Yuexiu district, Guangzhou, 510080, China

    Suling Liu, Yang Cui & Xiao Zhang

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Yang Cui had the original idea for the article, Suling Liu performed the literature search, data analysis and drafted the manuscript. Yan Cui and Xiao Zhang critically revised the manuscript.

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Correspondence to Yang Cui.

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Liu, S., Cui, Y. & Zhang, X. Molecular mechanisms and clinical studies of iguratimod for the treatment of ankylosing spondylitis. Clin Rheumatol 40, 25–32 (2021). https://doi.org/10.1007/s10067-020-05207-z

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