Pleiotropic targets: the problem of shared signaling circuitry in rheumatoid arthritis disease progression and protection

The immune response is replete with feedback control at many levels. These protective circuits are even functional within the arthritic joint, tempering disease to varying extents. An optimal therapy would inhibit autoimmune processes while maintaining protective circuitry. However, many of the cells and proteins that serve as important mediators of disease progression also play an active role in these protective circuits. The hypothesis considered in this review is that the inadvertent inhibition of protective circuitry adversely affects efficacy. Conversely, if therapeutics can be designed, which avoid inhibiting known regulatory circuits, efficacy will be improved. Understanding where these processes share signaling molecules will be crucial to the development of the next generation of therapeutics. This review discusses three well-defined signal transduction cascades; IL-2, IFNγ and TNF-α, and demonstrate within two cell types, T cells and macrophages, how these cytokines may contribute both to protection and to disease progression.

Feedback mechanisms between T helper cells and macrophages in the determination of the immune response

The interactions between macrophages and T helper (Th) cells are a complex interplay of positive and negative signals. Some of the mathematical models of interactions between T helpers have indeed taken the influence of macrophages into account. In this work the macrophage is not considered as an extrinsic agent, that is duly directed by the T cells to be cytotoxic, nor is there consideration of T helper cell populations that are dominantly regulated by extrinsic properties of antigens per se, or by certain classes of presenting cells that preferentially select certain classes of lymphocytes or bias their commitment. Rather, a simplified model of feedback loops between Th cells and macrophages is formulated and analyzed. It is suggested how the mutual influence between Th and macrophages can determine the cytokine secretion pattern of these populations. The model provides a feedback scenario to account for experimental findings concerning reversal in the dominance of a specific cytokine profile in the course of some infections. A possible scenario accounting for the difference between the stability of Th1 and Th2 cytokine pattern is put forward. The model suggests explanations for the variability in the outcome of the immune response according to different body compartments. A rationale is presented that accounts for paradoxical findings indicating that Th1 cytokines are sometimes responsible for the downregulation of a Th1 dominated response.

Experimental Autoimmune Encephalomyelitis Is Exacerbated in Mice Lacking the NOS2 Gene

Nitric oxide is believed to be a prominent mediator of inflammation based in part on the correlative expression of the inducible nitric oxide synthase (iNOS) gene in various pathologies. The resulting high output of the highly reactive molecule nitric oxide is then believed to play an important role in the evolving inflammatory response. Studies have shown that iNOS and nitric oxide are present in the tissues of patients with multiple sclerosis (MS). In rodent models of MS, experimental autoimmune encephalomyelitis (EAE), it has been shown that nonspecific NOS inhibitors partially ameliorate the disease. To determine the importance of iNOS in this model of MS, we induced EAE in mice containing a disrupted iNOS (NOS2) gene. Surprisingly, by day 24, the NOS2 knockout mice had a greater incidence of EAE than wild-type control mice (75 vs 12%), and had a higher average severity score (2.42 vs 0.44). These differences appear to result largely from the failure of the disease to remit in NOS2 KO mice. Wild-type mice have a profound ability to reverse EAE (82%) compared with the knockout mice (19%). This result implies that iNOS may in some instances play a protective role in autoimmune-mediated tissue destruction.