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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Pharmacol.</journal-id>
<journal-title>Frontiers in Pharmacology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Pharmacol.</abbrev-journal-title>
<issn pub-type="epub">1663-9812</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">883835</article-id>
<article-id pub-id-type="doi">10.3389/fphar.2022.883835</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Pharmacology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Dihydroarteannuin Ameliorates Collagen-Induced Arthritis <italic>Via</italic> Inhibiting B Cell Activation by Activating the Fc&#x3b3;RIIb/Lyn/SHP-1 Pathway</article-title>
<alt-title alt-title-type="left-running-head">Hu et al.</alt-title>
<alt-title alt-title-type="right-running-head">DHA Ameliorates CIA</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Hu</surname>
<given-names>Congqi</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="fn" rid="FN1">
<sup>&#x2020;</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1015171/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Wu</surname>
<given-names>Danbin</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="fn" rid="FN1">
<sup>&#x2020;</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Yu</surname>
<given-names>Jiahui</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1765915/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Xu</surname>
<given-names>Jia</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Liu</surname>
<given-names>Lijuan</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1603982/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Zhang</surname>
<given-names>Mingying</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1769876/overview"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Jiao</surname>
<given-names>Wei</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Chen</surname>
<given-names>Guangxing</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="corresp" rid="c001">&#x2a;</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1594746/overview"/>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>First Clinical Medical School</institution>, <institution>Guangzhou University of Chinese Medicine</institution>, <addr-line>Guangzhou</addr-line>, <country>China</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Department of Rheumatology</institution>, <institution>The First Affiliated Hospital of Guangzhou University of Chinese Medicine</institution>, <addr-line>Guangzhou</addr-line>, <country>China</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>Lingnan Medical Research Center of Guangzhou University of Chinese Medicine</institution>, <addr-line>Guangzhou</addr-line>, <country>China</country>
</aff>
<aff id="aff4">
<sup>4</sup>
<institution>Baiyun Hospital of The First Affiliated Hospital of Guangzhou University of Chinese Medicine</institution>, <addr-line>Guangzhou</addr-line>, <country>China</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>
<bold>Edited by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/548516/overview">Runyue Huang</ext-link>, Guangdong Provincial Hospital of Chinese Medicine, China</p>
</fn>
<fn fn-type="edited-by">
<p>
<bold>Reviewed by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/517471/overview">Pawan Kumar Raghav</ext-link>, University of California, San Francisco, United States</p>
<p>
<ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/274855/overview">Larissa G. Pinto</ext-link>, King&#x2019;s College London, United Kingdom</p>
</fn>
<corresp id="c001">&#x2a;Correspondence: Guangxing Chen, <email>cgx02@hotmail.com</email>
</corresp>
<fn fn-type="equal" id="FN1">
<label>
<sup>&#x2020;</sup>
</label>
<p>These authors have contributed equally to this work and share first authorship</p>
</fn>
<fn fn-type="other">
<p>This article was submitted to Ethnopharmacology, a section of the journal Frontiers in Pharmacology</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>03</day>
<month>05</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="collection">
<year>2022</year>
</pub-date>
<volume>13</volume>
<elocation-id>883835</elocation-id>
<history>
<date date-type="received">
<day>25</day>
<month>02</month>
<year>2022</year>
</date>
<date date-type="accepted">
<day>20</day>
<month>04</month>
<year>2022</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2022 Hu, Wu, Yu, Xu, Liu, Zhang, Jiao and Chen.</copyright-statement>
<copyright-year>2022</copyright-year>
<copyright-holder>Hu, Wu, Yu, Xu, Liu, Zhang, Jiao and Chen</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>
<bold>Background:</bold> Dihydroarteannuin (DHA), which is extracted from the traditional Chinese herb <italic>Artemisia annua L</italic>, exhibits potent immunosuppressive activity in rheumatoid arthritis (RA). Strong evidence indicates that B cells act as an essential factor in the pathogenesis of RA, but research on the immunosuppressive function of DHA in regulating B cells is limited.</p>
<p>
<bold>Objective:</bold> To investigate the modulatory effects of DHA on joint destruction, proinflammatory cytokine production, activation, apoptosis and proliferation of B cells and to explore the possible associated mechanism in RA treatment.</p>
<p>
<bold>Methods:</bold> Collagen-induced arthritis (CIA) model was established. Weight and joint oedema were record weekly, and joint damage was detected by micro-CT scan. Human Burkitt B lymphoma cells lacking endogenous Fc gamma receptor b (Fc&#x3b3;RIIb) gene were transfected with a 232Thr loss-of-function mutant to construct a mutant cell model ST486. The proliferation of ST486 cells was assessed with Cell Counting Kit-8. Apoptosis and activation were tested by flow cytometry. The effects of DHA on the activation of Fc&#x3b3;RIIb, protein tyrosine kinases (Lyn), and SH2-containing tyrosine phosphatase-1 (SHP-1) signaling pathways were determined by western blotting.</p>
<p>
<bold>Results:</bold> In comparison to model group, bone volume/tissue volume (BV/TV) and bone mineral density (BMD) were increased, whereas joint oedema was decreased in both of the DHA and MTX group. The mRNA and protein expression levels of Interleukin-6 (IL-6) and Tumor necrosis factor-alpha (TNF-&#x3b1;) were decreased after treatment with DHA. In addition, DHA treatment promoted the apoptosis, inhibited the activation and proliferation of ST486 cells. Furthermore, the protein expression levels of Fc&#x3b3;RIIb, SHP-1, and Lyn were increased after treatment with DHA. Moreover, the expression of phosphorylated CD19 was also inhibited by DHA.</p>
<p>
<bold>Conclusion:</bold> We provide the first evidence that DHA may alleviate collagen-induced arthritis by activating the Fc&#x3b3;RIIb/Lyn/SHP-1 signaling pathway in B cell, indicating that DHA is a novel and valuable candidate for RA therapy.</p>
</abstract>
<kwd-group>
<kwd>dihydroarteannuin</kwd>
<kwd>Fc&#x3b3;RIIb</kwd>
<kwd>rheumatoid arthritis</kwd>
<kwd>ST486</kwd>
<kwd>CIA mice</kwd>
</kwd-group>
<contract-sponsor id="cn001">National Natural Science Foundation of China<named-content content-type="fundref-id">10.13039/501100001809</named-content>
</contract-sponsor>
<contract-sponsor id="cn002">Guangzhou Science, Technology and Innovation Commission<named-content content-type="fundref-id">10.13039/501100010843</named-content>
</contract-sponsor>
</article-meta>
</front>
<body>
<sec id="s1">
<title>Highlights</title>
<p>
<list list-type="simple">
<list-item>
<p>&#x2022; Studies on the immunosuppressive function of DHA in regulating B cells are limited.</p>
</list-item>
<list-item>
<p>&#x2022; Restoring the inhibitory function of Fc&#x3b3;RIIB may be a new strategy for the treatment of RA.</p>
</list-item>
<list-item>
<p>&#x2022; We used gene transfection technique to construct Fc&#x3b3;RIIB mutant cell line ST486.</p>
</list-item>
<list-item>
<p>&#x2022; DHA inhibits B cell activation by activating the Fc&#x3b3;RIIb/Lyn/SHP-1 pathway.</p>
</list-item>
<list-item>
<p>&#x2022; This is the first report showing that DHA achieves these effects by activating this pathway.</p>
</list-item>
</list>
</p>
</sec>
<sec id="s2">
<title>Introduction</title>
<p>Rheumatoid arthritis (RA) is a common autoimmune disease, which seriously endangers human health. Although the etiology is still unknown, many studies have shown that genetic defects and environmental factors interact to cause the pathogenesis of RA (<xref ref-type="bibr" rid="B29">Smolen et al., 2016</xref>). Genetic, immunological and clinical studies show that B cells play a key role in the occurrence, development and treatment of RA. Activated B cells produce a large number of antibodies against autoantigens, which is one of the main differences between RA and other inflammatory arthritis, including rheumatoid factors (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies, which are present in patients&#x2019; sera before the clinical symptoms of RA (<xref ref-type="bibr" rid="B30">van Gaalen et al., 2005</xref>). Additionally, a randomized clinical study have shown that Rituximab, a monoclonal antibody against B cell, not only significantly improves the autoantibody level of RA patients, but also reduces radiological progress. Its efficacy is closely related to the clearance of memory B cells, strongly suggesting the important role of B cells in RA (<xref ref-type="bibr" rid="B17">Nakou et al., 2009</xref>; <xref ref-type="bibr" rid="B2">Chatzidionysiou et al., 2016</xref>).</p>
<p>Fc gamma receptor b (Fc&#x3b3;RIIb) is an important molecule in immune regulation, which can prevent excessive activation of B cell receptor (BCR) signals and reduce the risk of autoimmune diseases. The down-regulation or functional deficiency of Fc&#x3b3;RIIb will not only increase the incidence of RA or systemic lupus erythematosus (SLE), but also aggravate the joint destruction of RA (<xref ref-type="bibr" rid="B18">Nimmerjahn and Ravetch, 2006</xref>). In addition, a study of single nucleotide polymorphism (SNP) in 246 patients with RA was followed up for 6&#xa0;years and it was found that the 695T &#x3e; C (Ile232Thr) polymorphism in exon five of Fc&#x3b3;RIIb gene could attenuate the signal of inhibitory receptor and aggravate the condition of RA and joint destruction (<xref ref-type="bibr" rid="B11">Li et al., 2003</xref>; <xref ref-type="bibr" rid="B21">Radstake et al., 2006</xref>). More importantly, a clinical study showing that Fc&#x3b3;RIIb can be regulated, it is dysfunctional in active RA but normal in inactive RA where the disease is controlled (<xref ref-type="bibr" rid="B15">Magnusson et al., 2014</xref>). Additionally, after Fc&#x3b3;RIIb binds to the BCR and tyrosine phosphorylates, it can bind to SH2-containing tyrosine phosphatase-1(SHP-1). The effect of SHP-1 on the function of B cells is not only on their proliferative capacity, but also on apoptosis and cell killing, which can be regulated by interacting with different molecules downstream of B cell surface receptors (<xref ref-type="bibr" rid="B24">Raghav et al., 2018a</xref>; <xref ref-type="bibr" rid="B25">Raghav et al., 2018b</xref>; <xref ref-type="bibr" rid="B26">Raghav et al., 2018c</xref>).</p>
<p>Disease-modifying antirheumatic drugs (DMARDs) are the basic drugs for the treatment of RA (<xref ref-type="bibr" rid="B28">Singh et al., 2015</xref>), especially methotrexate (MTX) is the anchoring drug of RA. In spite of this, these drugs still have many side effects (<xref ref-type="bibr" rid="B19">Otero et al., 2017</xref>). Therefore, the development of alternative drugs with fewer side effects is very important to achieve a better clinical outcome (<xref ref-type="bibr" rid="B37">Zhang et al., 2010</xref>).</p>
<p>Dihydroarteannuin (DHA; MW: 284.35, molecular formula: C<sub>15</sub>H<sub>24</sub>O<sub>5</sub>), a semisynthetic derivative of artemisinin, is a widely used antimalarial drug with anti-inflammatory, anticancer, and immunosuppressive activities (<xref ref-type="bibr" rid="B36">Yu et al., 2021</xref>). Increasing evidence suggests that DHA exerts an immunosuppressive function in several autoimmune diseases, including RA and SLE (<xref ref-type="bibr" rid="B12">Li et al., 2006</xref>; <xref ref-type="bibr" rid="B4">Fan et al., 2018a</xref>; <xref ref-type="bibr" rid="B14">Li et al., 2019</xref>; <xref ref-type="bibr" rid="B33">Wang et al., 2021</xref>). Previous studies have found that DHA promotes apoptosis in B cells and that B cell lymphoma-2 (Bcl-2) is an anti-apoptotic protein that determines B cell apoptosis by interacting with pro-apoptotic members of the Bcl-2 family (<xref ref-type="bibr" rid="B22">Raghav et al., 2012a</xref>; <xref ref-type="bibr" rid="B23">Raghav et al., 2012b</xref>; <xref ref-type="bibr" rid="B27">Raghav et al., 2019</xref>). Therefore, we speculate that DHA may promote B-cell apoptosis by inhibiting Bcl-2 to achieve therapeutic effects in RA. In addition, some studies have demonstrated that DHA can diminish CD8&#x2b;T cell memory, affect Th and regulatory T cell functions, restore the Treg/Th17 cell balance, and so on (<xref ref-type="bibr" rid="B39">Zhao et al., 2012</xref>; <xref ref-type="bibr" rid="B5">Fan et al., 2018b</xref>; <xref ref-type="bibr" rid="B3">Chen et al., 2020</xref>). However, how DHA affects the function of B cells is still unclear. More importantly, the potential immune regulation mechanism of DHA is worthy of further study.</p>
<p>In the present study, CIA in DBA/1 mice was established. Human Burkitt B lymphoma cells (lacking endogenous Fc&#x3b3;RIIb gene) were transfected with a 232Thr loss-of-function mutant to construct a mutant cell model ST486. We investigated the effects of DHA on joint damage in CIA mice, and the proinflammatory cytokine production, activation, proliferation and apoptosis of ST486 cells. In addition, we further confirmed whether these effects correlated with the Fc&#x3b3;RIIb/Lyn/SHP-1 signaling pathway.</p>
</sec>
<sec sec-type="materials|methods" id="s3">
<title>Materials and Methods</title>
<sec id="s3-1">
<title>Chemicals and Reagents</title>
<p>DHA (D7439, 150&#xa0;mg), lipopolysaccharide (LPS), phorbol myristate acetate (PMA) and MTX hydrate (M8407) were purchased from Sigma-Aldrich (St. Louis, MO, United States). Complete Freund&#x2019;s adjuvant (CFA) (7001, 10&#xa0;ml), incomplete Freund&#x2019;s adjuvant (IFA) (7002, 10&#xa0;ml), and bovine type II collagen (20021, 10&#xa0;ml) were purchased from Chondrex, Inc. (Redmond, WA, United States). ST486 cell line (70014502, CRL-1647), RPMI 1640 culture medium and fetal bovine serum (FBS) were purchased from ATCC Co., Ltd. (United States). AffiniPure goat anti-human IgM (109-005-129) was obtained from Jackson ImmunoResearch Co., Ltd. (PA, United States). Fluo-4 AM (F312) was purchased from Dojindo Co., Ltd. (Japan). The primary antibody against CD32B (ab45143, EP888Y) was purchased from Abcam Co., Ltd. (Cambridge, United Kingdom). The primary antibody against GAPDH (10494-1-AP) was obtained from Proteintech Group, Inc. (United States). The primary antibodies against Lyn (C13F9) (2796), SHP-1 (C14H6) (3759), and phospho-CD19 (Tyr531) (3571) were purchased from CST Co., Ltd. (United States).</p>
</sec>
<sec id="s3-2">
<title>Animals</title>
<p>The animals used for this experiment were male DBA/1J mice (Vital River Laboratory Animal Technologies Co. Ltd. Beijing, China) that were 8 weeks old. The mice were housed in a laminar flow cabinet with a 12&#xa0;h light/dark cycle and maintained on specific pathogen-free (SPF) laboratory chow and water ad libitum. All the experimental studies were strictly in accordance with Guangzhou University of Chinese Medicine Animal Ethics Committee guidelines for the rational use of animals.</p>
</sec>
<sec id="s3-3">
<title>Induction and Evaluation of Collagen-Induced Arthritis</title>
<p>After 1&#xa0;week of adaptation, 24 DBA/1J mice were randomly divided into two groups: control group (<italic>n</italic> &#x3d; 6), arthritis-induced group (<italic>n</italic> &#x3d; 18). To prepare mouse CIA model, 0.1&#xa0;ml of emulsion of bovine type II collagen and CFA (1:1, v/v) was injected intradermally into the tail base of mice in arthritis-induced group on day 0, as the primary immunization. A booster injection of 0.1&#xa0;ml of emulsion of bovine type II collagen and IFA (1:1, v/v) was administered intradermally into the back on day 21, as the secondary immunization (<xref ref-type="bibr" rid="B38">Zhang et al., 2013</xref>; <xref ref-type="bibr" rid="B16">Miyoshi and Liu, 2018</xref>). Mice in control group injected normal saline at the same location and frequency as arthritis-induced group. The clinical symptoms were recorded weekly since the secondary immunization, with the arthritis index scores according to the following criteria: 0 &#x3d; normal; 1 &#x3d; erythema and mild swelling; 2 &#x3d; erythema and swelling extending to ankle joints and one or two toes; 3 &#x3d; erythema and swelling extending to metatarsal joints and more than two toes; and 4 &#x3d; ankylosing deformity with joint swelling. The scores from each paw were added to obtain a cumulative score between 0 and 16. In addition, swelling in the paw was measured using digital calipers, and body weight was recorded during the course.</p>
</sec>
<sec id="s3-4">
<title>Drug Administration</title>
<p>After the secondary immunization on day 21, mice in the arthritis-induced group were randomly divided into three groups (<italic>n</italic> &#x3d; 6 per group): model group, DHA group (20&#xa0;mg/kg, daily), MTX group (2&#xa0;mg/kg, every 3&#xa0;days). DHA and MTX was dissolved in corn oil and administrated by oral gavage from day 21 to day 49. Control and model mice were orally given an equal volume of corn oil in parallel.</p>
</sec>
<sec id="s3-5">
<title>Micro-CT Analysis</title>
<p>After 4&#xa0;weeks of drug administration, the right hind knee and ankle of each mouse was withdrawn and scanned by Skyscan 1176 micro-CT scanner (Bruker micro-CT, Kontich, Belgium). The scanning was carried out using following settings: voltage, 80&#xa0;kV; source current, 88&#xa0;&#x3bc;A; pixel size 4&#xa0;&#x3bc;m. Two and three-dimensional images were generated using Data-viewer and CTvol softwares (Bruker micro-CT, Kontich, Belgium) respectively. The bone mineral density (BMD) and bone volume/tissue volume (BV/TV, %) were measured using CT Analyser program (Bruker micro-CT, Kontich, Belgium).</p>
</sec>
<sec id="s3-6">
<title>Plasmid Constructs, Transfections, and ST486 Cell Culture</title>
<p>ST486 cells were maintained in RPMI-1640 medium in a humidified chamber with 37&#xb0;C at 5% CO<sub>2</sub>. ST486 cells that expressed wild-type human Fc&#x3b3;RIIb or the I232T loss-of-function mutant were constructed. Murine stem cell virus (pMSCV) puro plasmids contained human Fc&#x3b3;RIIb-I232T or Fc&#x3b3;RIIb-WT were used as templates, and inserted into lentiviral expression vector (pLVX) <italic>via</italic> the EcoRI and MluI restriction enzyme sites after PCR amplification. Then the expression vector constructs of human Fc&#x3b3;RIIb-WT or Fc&#x3b3;RIIb-I232T were transfected to ST486 by electroporation. The stable sublines of ST486 cells expressing equivalent levels of human Fc&#x3b3;RIIb-I232T or Fc&#x3b3;RIIb-WT were sorted by at least two rounds of fluorescence-activated cell sorting. Quantitative real-time PCR (qRT-PCR) assays were performed to verify the transfection. The methods for RNA purification and qRT-PCR will be described below. The specific primer sets in <xref ref-type="sec" rid="s12">Supplementary Table S1</xref>. After the transfection, transfected cells (Mut group) were incubated with or without different concentrations of DHA or MTX to perform the following studies.</p>
</sec>
<sec id="s3-7">
<title>Measurement of Proinflammatory Cytokine Levels by Enzyme-Linked Immuno Sorbent Assay</title>
<p>ELISA kit (Beijing 4A Biotech Co., Ltd., Beijing, China) were used to determine the cytokine production under DHA treatment. Transfected cells (Mut group) were divided into six groups: NC (without DHA and LPS), LPS (150&#xa0;ng/ml), DHA (250&#xa0;ng/ml), DHA (500&#xa0;ng/ml), DHA (1000&#xa0;ng/ml), and MTX (500&#xa0;ng/ml, positive control group). Twenty-4&#xa0;hours after transfection, the cells (1 &#xd7; 10<sup>5</sup>/ml) were seeded in 24-well plates and treated with different concentrations of DHA or MTX (500&#xa0;ng/ml) for 48&#xa0;h, then PMA was added and incubated at 37&#xb0;C with 5% CO<sub>2</sub> for 48&#xa0;h. The supernatant was then discarded, LPS (150&#xa0;ng/ml) was added to each group except the NC group, and the cells were incubated overnight at 37&#xb0;C with 5% CO<sub>2</sub>. The culture supernatants were collected, and the amount of TNF-&#x3b1; released from the cells was detected according to the manufacturer&#x2019;s instructions. IL-6 cytokine assays were carried out using the same method.</p>
</sec>
<sec id="s3-8">
<title>RNA Purification and a Quantitative Real-Time PCR Assay</title>
<p>qRT-PCR was performed to analyze the expression of TNF-&#x3b1; and IL-6 in ST486 cells treated with DHA or MTX. Total RNA was isolated with TRIzol (Invitrogen, United States) and reverse transcribed into cDNA using a Prime Script RT Reagent kit (Takara Biotechnology, Dalian, China) according to the manufacturer&#x2019;s protocol. qRT-PCR was completed after 40 cycles of 95&#xb0;C for 30&#xa0;s, 60&#xb0;C for 1&#xa0;min, and 72&#xb0;C for 1&#xa0;min. The relative fold-changes of gene transcriptions were determined by 2<sup>&#x2212;&#x25b3;&#x25b3;Ct</sup> method with the specific primer sets in <xref ref-type="sec" rid="s12">Supplementary Table S1</xref>.</p>
</sec>
<sec id="s3-9">
<title>Cell Viability Assay</title>
<p>The experiment was divided into six groups, which involved Fc&#x3b3;RIIb-WT (control group), Fc&#x3b3;RIIb-Mut (model group), MTX (500&#xa0;ng/ml, positive control group), DHA (250&#xa0;ng/ml), DHA (500&#xa0;ng/ml) and DHA (1000&#xa0;ng/ml). 10&#xa0;&#x3bc;L of CCK-8 solution was added after culturing with different concentrations of DHA or MTX for 48&#xa0;h. Then cells were incubated under the same conditions for another 2&#xa0;h. The absorbance at 490&#xa0;nm was measured by a microplate reader (iMark, Thermo Fisher Scientific, United States) to evaluate cell viability.</p>
</sec>
<sec id="s3-10">
<title>Apoptosis Assays</title>
<p>Annexin V apoptosis detection kit (BD Biosciences, United States) was used to measure cell apoptosis. After treating with different concentration of DHA or MTX as described above, the transfected cells were harvested and incubated with 7-AAD and Annexin V antibody following the manufacturer&#x2019;s instructions. Then, cells were immediately analyzed by a FACSCalibur flow cytometer.</p>
</sec>
<sec id="s3-11">
<title>Measurement of Cytoplasmic Ca<sup>2&#x2b;</sup> Concentrations</title>
<p>Multiple signal transduction pathways can affect changes in intracellular Ca<sup>2&#x2b;</sup> concentration, and thus the detection of intracellular Ca<sup>2&#x2b;</sup> changes can help to understand the initiation, enhancement or inhibition of cellular functions. In this study, we used flow cytometry to monitor the dynamic changes of intracellular Ca<sup>2&#x2b;</sup> concentration in order to dynamically observe the degree of B-cell activation and thus verify whether DHA can inhibit the B-cell activation. After treating with different concentration of DHA or MTX as described above, the transfected cells (1.5 &#xd7; 10<sup>6</sup>/ml) were incubated in RPMI 1640 medium containing Fluo-4 AM (5&#xa0;&#x3bc;&#x39c;) for 1&#xa0;h in a humidified chamber with 37&#xb0;C at 5% CO<sub>2</sub> to load with Fluo-4 AM. Then it was washed 3 times and detected by a flow cytometer constantly. The cells were stimulated with anti-human IgM (20&#xa0;&#x3bc;g/ml) at 50&#xa0;s, CaCl<sub>2</sub> was added back to a final concentration of 2&#xa0;mM at 400&#xa0;s, and intracellular Ca<sup>2&#x2b;</sup> flux was measured for 800&#xa0;s.</p>
</sec>
<sec id="s3-12">
<title>Western Blot Analysis</title>
<p>After treating with different concentration of DHA or MTX as described above, cells were stimulated with anti-human IgM (20&#xa0;&#x3bc;g/ml) for 15&#xa0;min. Protein lysates obtained from equal numbers of ST486 cells were separated by SDS-PAGE and then transferred to 0.4&#xa0;&#x3bc;m PVDF membranes <italic>via</italic> electroblotting. After being blocked by skimmed milk for 1&#xa0;h, membranes were incubated with antibodies against GAPDH, phospho-CD19, CD32B, Lyn, and SHP-1 overnight at 4&#xb0;C. Then the membranes were incubated with the corresponding secondary antibodies at room temperature for 1&#xa0;h. GAPDH was used as an internal control. Immunoreactive bands were visualized through Enhanced Chemiluminescence method and recorded in gel documentation system.</p>
</sec>
<sec id="s3-13">
<title>Statistical Analysis</title>
<p>All experiments were repeated at least three times, and all data are presented as the mean &#xb1; SEM. Statistics were analyzed using SPSS (version 20.0, IBM, Armonk, NY) while graphs were drawn by GraphPad Prism software (version 7.0). Significant differences between multiple groups were calculated using one-way ANOVA followed by Tukey&#x2019;s test. Values of <italic>p</italic> &#x3c; 0.05 were considered significant.</p>
</sec>
</sec>
<sec sec-type="results" id="s4">
<title>Results</title>
<sec id="s4-1">
<title>Dihydroarteannuin Alleviated Joint Destruction in Collagen-Induced Arthritis Mice</title>
<p>DHA and MTX treatment did not cause weight loss in CIA mice (<xref ref-type="fig" rid="F1">Figure 1A</xref>). Mice in DHA (20&#xa0;mg/kg, daily), MTX (2&#xa0;mg/kg, every 3&#xa0;days) group showed significant reduction in paw oedema between day 28 and day 49 compared with mice in model group (<italic>p</italic> &#x3c; 0.05, <xref ref-type="fig" rid="F1">Figures 1B,C</xref>). Collagen challenge induced arthritis in mice, as evidenced by red swelling in the paw (<xref ref-type="fig" rid="F1">Figure 1D</xref>). Micro-CT analysis showed that DHA or MTX treatment ameliorated the bone loss, as BMD and BV/TV in both DHA and MTX group were significantly higher than those in model group (<italic>p</italic> &#x3c; 0.05, <xref ref-type="fig" rid="F1">Figures 1D&#x2013;H</xref>). Besides, no significant difference was observed between DHA and MTX groups in any of the above analyses.</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption>
<p>DHA alleviated inflammation and joint destruction in CIA mice. <bold>(A)</bold> Body weight were recorded weekly during the experiment. <bold>(B)</bold> The thickness of hind paws was measured weekly by digital calipers. <bold>(C)</bold> Arthritis index score was used to score each mice every week, with the highest score of 16. <bold>(D)</bold> Images of swollen hind paws of mice. The right hind ankle and knee of mice were scanned by the Skyscan 1176 Micro-CT Imaging System. <bold>(E&#x2013;H)</bold> The BV/TV and BMD in knee and ankle were calculated. &#x2a;<italic>p</italic> &#x3c; 0.05, &#x2a;&#x2a;<italic>p</italic> &#x3c; 0.01 vs. the model group. <sup>&#x23;</sup>
<italic>p</italic> &#x3c; 0.05, <sup>&#x23;&#x23;</sup>
<italic>p</italic> &#x3c; 0.01 vs. the control group.</p>
</caption>
<graphic xlink:href="fphar-13-883835-g001.tif"/>
</fig>
</sec>
<sec id="s4-2">
<title>Fc&#x3b3;RIIb mRNA Expression in Transfected ST486 Cells</title>
<p>As seen in <xref ref-type="fig" rid="F2">Figure 2A</xref>, after the plasmid was digested, an obvious band could be seen around 8000bp, and there were 23bp bases between the two digestion sites, so it could not be detected. After the plasmids were digested by EcoRI &#x2b; MluI, obvious bands could be seen at 8000&#xa0;bp and 1000&#xa0;bp attachment, indicating that the 951&#xa0;bp sequence of the target gene had been inserted. The sequencing results showed correct and the plasmids were confirmed. <xref ref-type="fig" rid="F2">Figure 2B</xref> shows the sequence maps of wild-type and variant Fc&#x3b3;RIIb encoding membrane penetrating proteins, showing that variant Fc&#x3b3;RIIb has a variation at site 232. As shown in <xref ref-type="fig" rid="F2">Figure 2C</xref>, successful plasmid transfection was verified by qRT-PCR, and our results showed that when compared to the WT group, the relative expression of Fc&#x3b3;RIIb was significantly decreased in both of the Con and Mut groups (<italic>p</italic> &#x3c; 0.0001 and <italic>p</italic> &#x3c; 0.01, respectively).</p>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption>
<p>Design of the Fc&#x3b3;RIIb-mutant cell lines. <bold>(A)</bold> Plasmid constructs: The human Fc&#x3b3;RIIb coding gene was amplified by PCR and inserted into PLVX by EcoRI and MluI digestion sites. Obvious bands could be seen in 8000-bp and 1000-bp fragments, indicating that the 951-bp sequence of the target gene was successfully inserted. <bold>(B)</bold> Fc&#x3b3;RIIb-Mut and Fc&#x3b3;RIIb-WT encoded transmembrane proteins. Variants exist at locus 232. <bold>(C)</bold> Detection of plasmid transfection effect by qRT-PCR. The experiments were repeated three times and analyzed using one-way ANOVA. &#x2a;&#x2a;<italic>p</italic> &#x3c; 0.01, &#x2a;&#x2a;&#x2a;&#x2a;<italic>p</italic> &#x3c; 0.0001 vs. the WT group.</p>
</caption>
<graphic xlink:href="fphar-13-883835-g002.tif"/>
</fig>
</sec>
<sec id="s4-3">
<title>Dihydroarteannuin Suppresses Proinflammatory Cytokine Expression Stimulated by Lipopolysaccharide</title>
<p>Accumulated evidence reveals that certain proinflammatory cytokines contribute to the pathogenic factors supporting the proliferation and activation of B cells (<xref ref-type="bibr" rid="B1">Carvalho et al., 2011</xref>; <xref ref-type="bibr" rid="B6">Gottenberg et al., 2012</xref>; <xref ref-type="bibr" rid="B10">Lee et al., 2017</xref>). Therefore, we assessed the role of DHA in the regulation of inflammatory cytokine production by LPS-stimulated ST486 cells. As shown in <xref ref-type="fig" rid="F3">Figures 3A,B</xref>, compared with the LPS group, the protein expression levels of TNF-&#x3b1; and IL-6 were significantly lower in both the DHA and MTX-treated groups, except for the protein expression level of TNF-&#x3b1; in the DHA (250&#xa0;ng/ml) group. In addition, as seen in <xref ref-type="fig" rid="F3">Figures 3C,D</xref>, we also found that IL-6 and TNF-&#x3b1; mRNA levels were decreased in the DHA-treated group compared to the LPS group, while the difference compared with the MTX group was not statistically significant.</p>
<fig id="F3" position="float">
<label>FIGURE 3</label>
<caption>
<p>DHA inhibited the protein and mRNA expression of inflammatory cytokines in ST486. <bold>(A,B)</bold> The protein expression level of TNF-&#x3b1; and IL-6 were detected by ELISA. <bold>(C,D)</bold> The mRNA expression level of TNF-&#x3b1; and IL-6 were detected by qRT-PCR. The experiments were repeated three times and analyzed using one-way ANOVA. &#x2a;<italic>p</italic> &#x3c; 0.05, &#x2a;&#x2a;<italic>p</italic> &#x3c; 0.01, &#x2a;&#x2a;&#x2a;<italic>p</italic> &#x3c; 0.001 and &#x2a;&#x2a;&#x2a;&#x2a;<italic>p</italic> &#x3c; 0.0001 vs. the LPS group; <sup>&#x23;</sup>
<italic>p</italic> &#x3c; 0.05 and <sup>&#x23;&#x23;&#x23;&#x23;</sup>
<italic>p</italic> &#x3c; 0.0001 vs. the MTX group.</p>
</caption>
<graphic xlink:href="fphar-13-883835-g003.tif"/>
</fig>
</sec>
<sec id="s4-4">
<title>The Proliferation of ST486 Cells Were Suppressed Under Dihydroarteannuin Treatment</title>
<p>CCK-8 is used to detect the proliferation of ST486 cells and to evaluated the influence of DHA on the proliferation of ST486 cells. <xref ref-type="fig" rid="F4">Figure 4A</xref> showed that when compared with those in the Mut group, the proliferation of ST486 in the WT, MTX and different dose of DHA goroup were all significantly decreased (<italic>p</italic> &#x3c; 0.0001, <italic>p</italic> &#x3c; 0.0001, <italic>p</italic> &#x3c; 0.0001, <italic>p</italic> &#x3c; 0.0001, and <italic>p</italic> &#x3c; 0.0001, respectively). Besides, when compared with the MTX group, the proliferation of ST486 in the different dose of DHA group were all significantly increased (<italic>p</italic> &#x3c; 0.01, <italic>p</italic> &#x3c; 0.05, and <italic>p</italic> &#x3c; 0.05, respectively).</p>
<fig id="F4" position="float">
<label>FIGURE 4</label>
<caption>
<p>DHA inhibited the proliferation and promoted the apoptosis of ST486 cells. <bold>(A)</bold> The proliferation rate was determined by CCK-8 method. <bold>(B,C)</bold> Using Annexin V apoptosis detection kit, the apoptosis rate was detected according to the manufacturer&#x2019;s instructions. The levels of Annexin V and 7AAD were detected by FACSCalibur flow cytometry. The experiments were repeated three times and analyzed using one-way ANOVA. &#x2a;&#x2a;&#x2a;&#x2a;<italic>p</italic> &#x3c; 0.0001 vs. the Mut group. <sup>&#x23;</sup>
<italic>p</italic> &#x3c; 0.05, <sup>&#x23;&#x23;</sup>
<italic>p</italic> &#x3c; 0.01 and <sup>&#x23;&#x23;&#x23;&#x23;</sup>
<italic>p</italic> &#x3c; 0.0001 vs. the MTX group.</p>
</caption>
<graphic xlink:href="fphar-13-883835-g004.tif"/>
</fig>
</sec>
<sec id="s4-5">
<title>Dihydroarteannuin Promoted the Apoptosis of ST486 Cells</title>
<p>The apoptotic cells were detected by flow cytometry. As shown in <xref ref-type="fig" rid="F4">Figures 4B,C</xref>, when compared with that in the Mut group, the number of apoptotic cells in the WT, MTX and DHA-treated groups were all significantly increased (<italic>p</italic> &#x3c; 0.0001, <italic>p</italic> &#x3c; 0.0001, <italic>p</italic> &#x3c; 0.0001, <italic>p</italic> &#x3c; 0.0001, and <italic>p</italic> &#x3c; 0.0001, respectively). Additionally, when compared with the MTX group, the numbers of apoptotic cells in the DHA-treated (250&#xa0;ng/ml) was significantly decreased (<italic>p</italic> &#x3c; 0.0001), the numbers of apoptotic cells in the WT group was increased (<italic>p</italic> &#x3c; 0.0001).</p>
</sec>
<sec id="s4-6">
<title>Dihydroarteannuin Regulated the CD19 Pathway and Decreased Intracellular Ca<sup>2&#x2b;</sup> Flux in ST486 Cells</title>
<p>Previous studies have showed that Fc&#x3b3;RIIb selectively dephosphorylated CD19 in consequence with an inhibition of BCR signaling (<xref ref-type="bibr" rid="B9">Koncz et al., 1998</xref>). Therefore, the western blot analysis was used to investigate whether the effect of DHA is correlated with the CD19 pathway. When compared to the cells in the WT group, the intracellular Ca<sup>2&#x2b;</sup> level in the Mut group was remarkably increased after 100&#xa0;s. However, when compared with the Mut group, the calcium concentration decreased more rapidly in DHA and MTX group after 200&#xa0;s (<xref ref-type="fig" rid="F5">Figure 5B</xref>). Besides, as illustrated in <xref ref-type="fig" rid="F5">Figure 5F</xref>, when compared with the Mut group, the protein expression levels of phosphorylated CD19 were all downregulated in the WT, DHA-treated (500 and 1000&#xa0;ng/ml) and MTX groups (<italic>p</italic> &#x3c; 0.05, <italic>p</italic> &#x3c; 0.05, <italic>p</italic> &#x3c; 0.05, and <italic>p</italic> &#x3c; 0.01, respectively). These data all indicated that DHA inhibited B cell activation.</p>
<fig id="F5" position="float">
<label>FIGURE 5</label>
<caption>
<p>Regulation of DHA on CD19/Fc&#x3b3;RIIb-Lyn-SHP-1 pathway and effect of intracellular Ca<sup>2&#x2b;</sup> flux in ST486 cells. <bold>(A)</bold> The cells were treated as above, and then stimulated with anti-human IgM (20&#xa0;&#x3bc;g/ml) for 1&#xa0;h. The protein expression levels of CD32b (Fc&#x3b3;RIIb), GAPDH, Lyn, phospho-CD19 and SHP-1 were detected by western blot. This part of the experiment was repeated three times. <bold>(B)</bold> The cells were incubated in RPMI 1640 medium containing 10% fetal bovine serum and Fluo-4 AM (5&#xa0;&#x3bc;mol), incubated at 37&#xb0;C for 1&#xa0;h, washed 3 times, and continuously monitored by flow cytometry. Anti-human IgM (20&#xa0;&#x3bc;g/ml) was added at 50&#xa0;s, add CaCl<sub>2</sub> to the final concentration of 2&#xa0;mM at 400&#xa0;s, and the intracellular Ca<sup>2&#x2b;</sup> flux was continuously detected to 800&#xa0;s <bold>(C&#x2013;F)</bold> With GAPDH as the internal reference, the relative expression of each protein was expressed as the protein/GAPDH. The experiments were repeated three times and analyzed using one-way ANOVA. &#x2a;<italic>p</italic> &#x3c; 0.05 and &#x2a;&#x2a;<italic>p</italic> &#x3c; 0.01 vs. the Mut group; <sup>&#x23;</sup>
<italic>p</italic> &#x3c; 0.05 vs. the MTX group.</p>
</caption>
<graphic xlink:href="fphar-13-883835-g005.tif"/>
</fig>
</sec>
<sec id="s4-7">
<title>Dihydroarteannuin Regulated the Fc&#x3b3;RIIb/Lyn/SHP-1 Pathway in ST486 Cells</title>
<p>Previous studies have shown that Fc&#x3b3;RIIb signal pathway plays an important role in B cell activation (<xref ref-type="bibr" rid="B7">Hippen et al., 1997</xref>), so we further study the effect of DHA on this signal pathway. (<xref ref-type="fig" rid="F5">Figure 5A</xref>). The results showed that when compared to those in the Mut group, there were a significant increased in CD32B, Lyn and SHP-1 expression in the WT group (<italic>p</italic> &#x3c; 0.05, <italic>p</italic> &#x3c; 0.05, and <italic>p</italic> &#x3c; 0.01, respectively, <xref ref-type="fig" rid="F5">Figures 5C&#x2013;E</xref>). Additionally, the protein expression of CD32B in DHA (500 and 1000&#xa0;ng/ml) groups were much higher than that in the Mut group (<italic>p</italic> &#x3c; 0.05 and <italic>p</italic> &#x3c; 0.05, respectively). Besides, the Lyn expression in the DHA (1000&#xa0;ng/ml) and MTX groups were significantly higher than that in the Mut group (<italic>p</italic> &#x3c; 0.05 and <italic>p</italic> &#x3c; 0.05, respectively). Correspondingly, when compared with the Mut group, consistent results for the SHP-1expression in the DHA (1000&#xa0;ng/ml) and MTX groups (<italic>p</italic> &#x3c; 0.01 and <italic>p</italic> &#x3c; 0.05, respectively). In all, these data suggested that DHA impeded B cells activation induced by IgM through the modulation of the Fc&#x3b3;RIIb/Lyn/SHP-1 pathway.</p>
</sec>
</sec>
<sec sec-type="discussion" id="s5">
<title>Discussion</title>
<p>To date, DMARDs have been the primary choice for RA patient treatment, especially MTX, which is the anchoring drug of RA (<xref ref-type="bibr" rid="B28">Singh et al., 2015</xref>). However, MTX is a slow-acting anti-rheumatic drug, its effect is slow. In addition, MTX also has a large number of side effects. Therefore, it is urgent to develop alternative drugs with low toxicity. DHA is the most active component of artemisinin, it is extracted from traditional Chinese herbal medicine <italic>Artemisia annua L</italic>. Previous studies have shown that DHA has immunosuppressive effects on some diseases, such as RA and SLE. However, the exact molecular mechanism of DHA in treating RA is still unclear. In our study, we demonstrated that DHA achieved therapeutic effects in joint destruction in CIA mice. Besides, DHA could not only suppress the proinflammatory cytokine production of B cells but also promote the apoptosis, and inhibit the proliferation and activation of these cells. More importantly, we provided the first evidence that DHA might achieve these effects by activating the Fc&#x3b3;RIIb/Lyn/SHP-1 pathway.</p>
<p>Strong evidence indicates that B cell activation play a key role in the occurrence, development and treatment of RA (<xref ref-type="bibr" rid="B30">van Gaalen et al., 2005</xref>; <xref ref-type="bibr" rid="B17">Nakou et al., 2009</xref>; <xref ref-type="bibr" rid="B2">Chatzidionysiou et al., 2016</xref>). Previous studies have focused on autoantigen-driven B cell activation, but recent studies have found that B cells from RA patients have defects in autoimmune tolerance during bone marrow development. During the development of B cells, pre-B cells in bone marrow can greatly reduce the production of autoreactive B cells through the mechanisms of receptor rearrangement, clone deletion and Anergy, which is a normal central immune tolerance. But in spite of this, a small number (6%) of autoreactive B cells were released to the periphery (<xref ref-type="bibr" rid="B32">von Boehmer and Melchers, 2010</xref>; <xref ref-type="bibr" rid="B20">Pillai et al., 2011</xref>). At this time, the mechanism of peripheral B cell immune tolerance plays a role, which is regulated by Fc&#x3b3;RIIb. After BCR signal is activated by autoantigen, Fc&#x3b3;RIIb inhibits CD19 phosphorylation by cross-linking with BCR, activates Lyn and immune receptor tyrosine inhibitory motif (ITIM), and recruits SHP-1. SHP-1 dephosphorylates multiple signal molecules, inhibits the metabolism of Ca<sup>2&#x2b;</sup>, hinders the cascade of activation signals triggered by BCR, and induces immune tolerance (<xref ref-type="bibr" rid="B8">Karnell et al., 2014</xref>). However, the 695T &#x3e; C (Ile232Thr) polymorphism in exon five of Fc&#x3b3;RIIb gene could attenuate the signal of inhibitory receptor, aggravate the condition of RA and joint destruction. More importantly, a clinical study indicated that Fc&#x3b3;RIIb can be regulated, showing dysfunction in active RA and normal function in inactive RA where the disease is controlled. Therefore, human Burkitt B lymphoma cells (lacking endogenous Fc&#x3b3;RIIb gene) were transfected with a 232Thr loss-of-function mutant to construct a mutant cell model ST486 for cell experiments.</p>
<p>The level of inflammation plays an important role in the pathogenesis of RA and magnifying local tissue injury. In previous studies, found that DHA inhibited the release of TNF-&#x3b1; and IL-6 in a dose-dependent manner <xref ref-type="bibr" rid="B13">Li et al. (2008)</xref>. DHA can also improve lupus symptoms in BXSB mice by inhibiting the production of TNF-&#x3b1;(<xref ref-type="bibr" rid="B12">Li et al., 2006</xref>). In the study, our results are similar to the findings of previous studies.</p>
<p>We further investigated the effects of DHA on the apoptosis and proliferation of ST486 cells. Our data show that DHA can not only inhibit the proliferation of ST486 cells, but also promote its apoptosis. We speculate that the effect of DHA on ST486 cells may be related to Fc&#x3b3;RIIb/Lyn/SHP-1 pathway. Previous studies have shown that this signaling pathway is an important pathway for B cell activation, which is closely related to B cell activation and apoptosis (<xref ref-type="bibr" rid="B34">Xiang et al., 2007</xref>; <xref ref-type="bibr" rid="B31">Veri et al., 2010</xref>). Therefore, we further evaluated the effect of DHA on Fc&#x3b3;RIIb/Lyn/SHP-1 signal pathway by WB, and found that the protein levels of CD32B(Fc&#x3b3;RIIb), Lyn and SHP-1 were all up-regulated after DHA treatment. The results not only confirmed our hypothesis but were also consistent with previously published findings showing that Fc&#x3b3;RIIb can be regulated (<xref ref-type="bibr" rid="B15">Magnusson et al., 2014</xref>).</p>
<p>Previous studies have shown that when cross-linked with BCR, Fc&#x3b3;RIIb inhibits the activation of B cells by blocking the co-localization of CD19 and BCR (<xref ref-type="bibr" rid="B35">Xu et al., 2014</xref>). In order to further evaluate the specific mechanism of DHA in the treatment of RA, we studied the changes of CD19 phosphorylation level and intracellular Ca<sup>2&#x2b;</sup> after DHA intervention. Our data show that DHA can inhibit not only the phosphorylation level of CD19, but also the level of Ca<sup>2&#x2b;</sup>. All these results indicate that DHA can inhibit the activation of B cells. Overall, our data demonstrate that DHA achieves these effects through a process that associated with the Fc&#x3b3;RIIb/Lyn/SHP-1 pathway. However, there are some shortcomings in our study. This study did not involve the validation of <italic>in vivo</italic> molecular mechanisms, other than the effects of DHA on patients were not assessed in our study. Therefore, further clinical studies will be conducted to evaluate the clinical efficacy of DHA.</p>
<p>In conclusion, as far as we know, our study first demonstrated that DHA can not only reduce the level of inflammation in CIA mice, but also reduce the risk of bone destruction. In addition, we found that DHA can not only inhibit the production of B cell pro-inflammatory cytokines, but also inhibit B cell proliferation and activation, and promote B cell apoptosis. More importantly, we have demonstrated for the first time that DHA can inhibit B cell activation by activating Fc&#x3b3;RIIb/Lyn/SHP-1 signaling pathway, thus achieving the therapeutic effect of RA. Therefore, our study highlights the potential of DHA as an alternative drug for RA.</p>
</sec>
</body>
<back>
<sec id="s6">
<title>Data Availability Statement</title>
<p>The original contributions presented in the study are included in the article/<xref ref-type="sec" rid="s12">Supplementary Material</xref>, further inquiries can be directed to the corresponding author.</p>
</sec>
<sec id="s7">
<title>Ethics Statement</title>
<p>The animal study was reviewed and approved by Ethics Committee of Laboratory Animals in The First Affiliated Hospital of Guangzhou University of Chinese Medicine.</p>
</sec>
<sec id="s8">
<title>Author Contributions</title>
<p>CH wrote manuscript. CH and DW. performed most experiments. GC designed and supervised the experiments as the PI. LL and MZ prepared all figures and tables. JX, WJ, and JY. performed the analyses study. All authors reviewed the manuscript before submission.</p>
</sec>
<sec id="s9">
<title>Funding</title>
<p>This work was supported by the Guangzhou Science Technology and Innovation Commission Technology Research Projects (No. 201904010336) and the National Natural Science Foundation of China (No. 81573850). These funders are not involved in the design of the study, data collection and analysis, published decisions or preparation of manuscripts.</p>
</sec>
<sec sec-type="COI-statement" id="s10">
<title>Conflict of Interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="disclaimer" id="s11">
<title>Publisher&#x2019;s Note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<sec id="s12">
<title>Supplementary Material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fphar.2022.883835/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fphar.2022.883835/full&#x23;supplementary-material</ext-link>
</p>
<supplementary-material xlink:href="Table1.DOCX" id="SM1" mimetype="application/DOCX" xmlns:xlink="http://www.w3.org/1999/xlink"/>
</sec>
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</ref-list>
<sec id="s13">
<title>Glossary</title>
<def-list>
<def-item>
<term id="G1-fphar.2022.883835">
<bold>ACPA</bold>
</term>
<def>
<p>anti-cyclic citrullinated peptide antibodies</p>
</def>
</def-item>
<def-item>
<term id="G2-fphar.2022.883835">
<bold>BCR</bold>
</term>
<def>
<p>B cell receptor</p>
</def>
</def-item>
<def-item>
<term id="G3-fphar.2022.883835">
<bold>BMD</bold>
</term>
<def>
<p>bone mineral density</p>
</def>
</def-item>
<def-item>
<term id="G4-fphar.2022.883835">
<bold>BV/TV</bold>
</term>
<def>
<p>bone volume/tissue volume</p>
</def>
</def-item>
<def-item>
<term id="G5-fphar.2022.883835">
<bold>Bcl-2</bold>
</term>
<def>
<p>B cell lymphoma-2</p>
</def>
</def-item>
<def-item>
<term id="G6-fphar.2022.883835">
<bold>CCP</bold>
</term>
<def>
<p>cyclic citrullinated peptide</p>
</def>
</def-item>
<def-item>
<term id="G7-fphar.2022.883835">
<bold>CFA</bold>
</term>
<def>
<p>complete Freund&#x2019;s adjuvant</p>
</def>
</def-item>
<def-item>
<term id="G8-fphar.2022.883835">
<bold>CIA</bold>
</term>
<def>
<p>collagen-induced arthritis</p>
</def>
</def-item>
<def-item>
<term id="G9-fphar.2022.883835">
<bold>DHA</bold>
</term>
<def>
<p>dihydroarteannuin</p>
</def>
</def-item>
<def-item>
<term id="G10-fphar.2022.883835">
<bold>DMARDs</bold>
</term>
<def>
<p>disease-modifying antirheumatic drugs</p>
</def>
</def-item>
<def-item>
<term id="G11-fphar.2022.883835">
<bold>ELISA</bold>
</term>
<def>
<p>enzyme-linked immuno sorbent assay</p>
</def>
</def-item>
<def-item>
<term id="G12-fphar.2022.883835">
<bold>FBS</bold>
</term>
<def>
<p>fetal bovine serum</p>
</def>
</def-item>
<def-item>
<term id="G13-fphar.2022.883835">
<bold>Fc&#x3b3;RIIb</bold>
</term>
<def>
<p>Fc gamma receptor b</p>
</def>
</def-item>
<def-item>
<term id="G14-fphar.2022.883835">
<bold>IFA</bold>
</term>
<def>
<p>incomplete Freund&#x2019;s adjuvant</p>
</def>
</def-item>
<def-item>
<term id="G15-fphar.2022.883835">
<bold>IL-6</bold>
</term>
<def>
<p>interleukin-6</p>
</def>
</def-item>
<def-item>
<term id="G16-fphar.2022.883835">
<bold>ITIM</bold>
</term>
<def>
<p>immunoreceptor tyrosine-based inhibitory motif</p>
</def>
</def-item>
<def-item>
<term id="G17-fphar.2022.883835">
<bold>LPS</bold>
</term>
<def>
<p>lipopolysaccharide</p>
</def>
</def-item>
<def-item>
<term id="G18-fphar.2022.883835">
<bold>Lyn</bold>
</term>
<def>
<p>protein tyrosine kinases</p>
</def>
</def-item>
<def-item>
<term id="G19-fphar.2022.883835">
<bold>LVX</bold>
</term>
<def>
<p>lentiviral expression vector</p>
</def>
</def-item>
<def-item>
<term id="G20-fphar.2022.883835">
<bold>MTX</bold>
</term>
<def>
<p>methotrexate</p>
</def>
</def-item>
<def-item>
<term id="G21-fphar.2022.883835">
<bold>MSCV</bold>
</term>
<def>
<p>murine stem cell virus</p>
</def>
</def-item>
<def-item>
<term id="G22-fphar.2022.883835">
<bold>PMA</bold>
</term>
<def>
<p>phorbol myristate acetate</p>
</def>
</def-item>
<def-item>
<term id="G23-fphar.2022.883835">
<bold>qRT-PCR</bold>
</term>
<def>
<p>Quantitative real-time PCR</p>
</def>
</def-item>
<def-item>
<term id="G24-fphar.2022.883835">
<bold>RA</bold>
</term>
<def>
<p>rheumatoid arthritis</p>
</def>
</def-item>
<def-item>
<term id="G25-fphar.2022.883835">
<bold>RF</bold>
</term>
<def>
<p>rheumatoid factors</p>
</def>
</def-item>
<def-item>
<term id="G26-fphar.2022.883835">
<bold>SHP-1</bold>
</term>
<def>
<p>SH2-containing tyrosine phosphatase-1</p>
</def>
</def-item>
<def-item>
<term id="G27-fphar.2022.883835">
<bold>SLE</bold>
</term>
<def>
<p>systemic lupus erythematosus</p>
</def>
</def-item>
<def-item>
<term id="G28-fphar.2022.883835">
<bold>SNP</bold>
</term>
<def>
<p>single nucleotide polymorphism</p>
</def>
</def-item>
<def-item>
<term id="G29-fphar.2022.883835">
<bold>SPF</bold>
</term>
<def>
<p>specific pathogen-free</p>
</def>
</def-item>
<def-item>
<term id="G30-fphar.2022.883835">
<bold>ST486</bold>
</term>
<def>
<p>Burkitt&#x2019;s lymphoma ST486 human B cells</p>
</def>
</def-item>
<def-item>
<term id="G31-fphar.2022.883835">
<bold>TNF-&#x3b1;</bold>
</term>
<def>
<p>tumor necrosis factor-alpha</p>
</def>
</def-item>
<def-item>
<term id="G32-fphar.2022.883835">
<bold>WT</bold>
</term>
<def>
<p>wild type</p>
</def>
</def-item>
</def-list>
</sec>
</back>
</article>