Elevated fMET and GDF-15 Circulating Levels in Pediatric CNO Patients with Psoriasis Define a Distinct Mitochondrial-Inflammatory Signature

Arpit Rathee¹, Noor Kaur¹, Jorge A. Gonzalez-Chapa², Ryan D. Stultz¹, Emily Deng³, Ian Muse⁴, Yongdong Zhao³ and Christian Lood², ¹University of Washington, Division of Rheumatology, Seattle, WA, ²University of Washington, Division of Rheumatology, Seattle, ³University of Washington, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, ⁴University of Washington, Department of Pediatrics, Seattle Children's Hospital, Seattle

Meeting: ACR Convergence 2025

Keywords: Biomarkers, Cutaneous, Inflammation, Mitochondrial Dysfunction, Pediatric rheumatology

Session Information

Date: Tuesday, October 28, 2025

Title: (2124–2158) Pediatric Rheumatology – Clinical Poster III

Session Type: Poster Session C

Session Time: 10:30AM-12:30PM

Background/Purpose: Chronic nonbacterial osteomyelitis (CNO) is a pediatric autoinflammatory bone disorder marked by sterile skeletal inflammation. A subset of CNO patients presents with comorbid psoriasis, suggesting the existence of overlapping inflammatory circuits beyond the musculoskeletal system. Mitochondria-derived formyl peptides (fMET) and the stress-responsive cytokine GDF-15 are emerging as biomarkers of cellular damage and mitochondrial dysfunction, yet their role in CNO, particularly in psoriasis-associated cases, remains poorly defined.

Methods: We analyzed plasma samples from 120 pediatric participants: 30 healthy controls, 30 with inactive CNO, 30 with active CNO, and 30 juvenile idiopathic arthritis (JIA) patients serving as disease controls. Twenty-two participants had comorbid psoriasis (9 CNO-inactive, 11 CNO-active, 2 JIA). Levels of GDF-15 and fMET were analyzed using ELISA. Statistical analysis was conducted in R using ANOVA, Dunn’s multiple comparisons, and unpaired t-tests.

Results: The CNO cohort included 54.2% female participants, with a mean age of 12.56 years. Active and inactive subgroups showed consistent distributions in age and sex. fMET concentrations were significantly elevated in CNO-active patients compared to healthy controls (p < 0.05). GDF-15 levels were significantly higher in participants with comorbid psoriasis compared to those without (p = 0.0312). Notably, within the psoriasis subgroup, patients with active CNO exhibited the highest GDF-15 levels compared to those with inactive disease (p = 0.0044), suggesting enhanced mitochondrial stress when both skeletal and cutaneous inflammation are present.

Conclusion: These findings uncover a distinct immunometabolic profile in pediatric CNO patients with psoriasis, characterized by elevated fMET and GDF-15. This mitochondrial-inflammatory axis may represent a novel endotype within CNO, providing mechanistic insights into extra-skeletal involvement and offering potential avenues for biomarker-guided stratification and targeted therapy.

Disclosures: A. Rathee: None; N. Kaur: None; J. Gonzalez-Chapa: None; R. Stultz: None; E. Deng: None; I. Muse: None; Y. Zhao: None; C. Lood: Archon, 5, Boehringer-Ingelheim, 5, Citryll, 2, Gilead Sciences, 5, Neutrolis, 5, Pfizer, 5, Redd Pharma, 1, 2, 5, 11.

To cite this abstract in AMA style:

Rathee A, Kaur N, Gonzalez-Chapa J, Stultz R, Deng E, Muse I, Zhao Y, Lood C. Elevated fMET and GDF-15 Circulating Levels in Pediatric CNO Patients with Psoriasis Define a Distinct Mitochondrial-Inflammatory Signature [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/elevated-fmet-and-gdf-15-circulating-levels-in-pediatric-cno-patients-with-psoriasis-define-a-distinct-mitochondrial-inflammatory-signature/. Accessed .

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