Metabolic-secretory decoupling defines a disease-intrinsic state in rheumatoid arthritis monocytes

ObjectivesCirculating monocytes from rheumatoid arthritis (RA) patients are pre-primed for inflammatory activation, but their disease-intrinsic features have not been systematically characterized. Given the important role of metabolism in shaping immune cell function, we aimed to determine how this pre-primed state is underpinned metabolically and whether these changes persist across different activation states, using an unbiased multi-omics approach. MethodsPeripheral blood CD14 monocytes from RA patients and matched healthy donors were analyzed in an undifferentiated state (M0) and after differentiation into classically activated M(IFN{gamma}+LPS) and alternatively activated M(IL-4) macrophages, followed by acute lipopolysaccharide (LPS) stimulation. Metabolomic (untargeted LC-MS/MS), transcriptomic (RNA-seq), and proteomic (label-free mass LC-MS/MS) profiling were performed. Data was comprehensively analyzed by weighted gene correlation network analysis, differential analysis, gene set enrichment analysis, multi-omics factor analysis and metabolic flux modeling. ResultsRA monocytes exhibited a stable disease-driven signature across activation states. Integration of metabolomic, transcriptomic and proteomic data revealed an unexpected convergence on metabolic-secretory coupling, with depletion of nucleotide and redox metabolites, downregulation of mitochondrial and translational pathways, and remodeling of the secretory apparatus, including loss of cis-Golgi components. Consistently, metabolic modeling predicted reduced glycosylation fluxes, connecting metabolic changes to altered secretory capacity. ConclusionsRA monocytes adopt a stable, disease-intrinsic state that persists across activation conditions. Multi-omics data identify a linked metabolic and secretory defect, with reduced glycosylation capacity as a potential functional consequence. This metabolic-secretory coupling represents a defining feature of RA monocyte dysfunction and a potential therapeutic target.