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Li X, Peng X, Zoulikha M, Boafo GF, Magar KT, Ju Y, He W. Multifunctional nanoparticle-mediated combining therapy for human diseases. Signal Transduct Target Ther 2024; 9:1. [PMID: 38161204 PMCID: PMC10758001 DOI: 10.1038/s41392-023-01668-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 09/14/2023] [Accepted: 10/10/2023] [Indexed: 01/03/2024] Open
Abstract
Combining existing drug therapy is essential in developing new therapeutic agents in disease prevention and treatment. In preclinical investigations, combined effect of certain known drugs has been well established in treating extensive human diseases. Attributed to synergistic effects by targeting various disease pathways and advantages, such as reduced administration dose, decreased toxicity, and alleviated drug resistance, combinatorial treatment is now being pursued by delivering therapeutic agents to combat major clinical illnesses, such as cancer, atherosclerosis, pulmonary hypertension, myocarditis, rheumatoid arthritis, inflammatory bowel disease, metabolic disorders and neurodegenerative diseases. Combinatorial therapy involves combining or co-delivering two or more drugs for treating a specific disease. Nanoparticle (NP)-mediated drug delivery systems, i.e., liposomal NPs, polymeric NPs and nanocrystals, are of great interest in combinatorial therapy for a wide range of disorders due to targeted drug delivery, extended drug release, and higher drug stability to avoid rapid clearance at infected areas. This review summarizes various targets of diseases, preclinical or clinically approved drug combinations and the development of multifunctional NPs for combining therapy and emphasizes combinatorial therapeutic strategies based on drug delivery for treating severe clinical diseases. Ultimately, we discuss the challenging of developing NP-codelivery and translation and provide potential approaches to address the limitations. This review offers a comprehensive overview for recent cutting-edge and challenging in developing NP-mediated combination therapy for human diseases.
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Affiliation(s)
- Xiaotong Li
- School of Pharmacy, China Pharmaceutical University, Nanjing, 2111198, PR China
| | - Xiuju Peng
- School of Pharmacy, China Pharmaceutical University, Nanjing, 2111198, PR China
| | - Makhloufi Zoulikha
- School of Pharmacy, China Pharmaceutical University, Nanjing, 2111198, PR China
| | - George Frimpong Boafo
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, 410013, PR China
| | - Kosheli Thapa Magar
- School of Pharmacy, China Pharmaceutical University, Nanjing, 2111198, PR China
| | - Yanmin Ju
- School of Pharmacy, China Pharmaceutical University, Nanjing, 2111198, PR China.
| | - Wei He
- Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China.
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Marasco E, Fabbriciani G, Rotunno L, Longhi M, De Luca P, de Girolamo L, Colombini A. Identification of biomarkers in patients with rheumatoid arthritis responsive to DMARDs but with progressive bone erosion. Front Immunol 2023; 14:1254139. [PMID: 37809106 PMCID: PMC10551039 DOI: 10.3389/fimmu.2023.1254139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that may cause joint destruction and disability. The pharmacological treatment of RA aims at obtaining disease remission by effectively ceasing joint inflammation and arresting progressive bone erosions. Some patients present bone lesions accrual even after controlling joint inflammation with current therapies. Our study aimed to analyze lymphocyte subsets and levels of circulating cytokines in patients with RA with progressive bone erosions. Methods We enrolled 20 patients with a diagnosis of RA and 12 healthy donors (HD). Patients with RA were divided into patients with bone erosions (RA-BE+) and without bone erosions (RA-BE-). Lymphocyte subsets in peripheral blood were evaluated by flow cytometry. Circulating cytokines levels were evaluated by protein array. Results The distribution of lymphocyte subsets was not able to separate HD from AR patients and RA-BE+ and RA-BE- in cluster analysis. We observed a significant expansion of CXCR5- PD1+ T peripheral helper cells (Tph cells) and a reduction in both total memory B cells and switched memory B cells in RA patients compared to HD. We observed an expansion in the frequency of total B cells in RA-BE+ patients compared to RA-BE- patients. Unsupervised hierarchical clustering analysis of 39 cytokines resulted in a fairly good separation of HD from RA patients but not of RA-BE+ patients from RA-BE- patients. RA-BE+ patients showed significantly higher levels of IL-11 and IL-17A than RA-BE- patients. Conclusion We show that patients with progressive erosive disease are characterized by abnormalities in B cells and in cytokines with a proven role in bone reabsorption. Understanding the role played by B cells and the cytokine IL-11 and IL-17A in progressive erosive disease can help identify novel biomarkers of erosive disease and design treatment approaches aimed at halting joint damage in RA.
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Affiliation(s)
- Emiliano Marasco
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy
- Ph.D. Course “Immunology, Molecular Medicine and Applied Biotechnology”, University of Rome Tor Vergata, Rome, Italy
| | | | - Laura Rotunno
- Unit of Rheumatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Matteo Longhi
- Unit of Rheumatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Paola De Luca
- Laboratorio di Biotecnologie Applicate all’Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Laura de Girolamo
- Laboratorio di Biotecnologie Applicate all’Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Alessandra Colombini
- Laboratorio di Biotecnologie Applicate all’Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Sehnert B, Valero-Esquitino V, Schett G, Unger T, Steckelings UM, Voll RE. Angiotensin AT2 Receptor Stimulation Alleviates Collagen-Induced Arthritis by Upregulation of Regulatory T Cell Numbers. Front Immunol 2022; 13:921488. [PMID: 35874732 PMCID: PMC9304956 DOI: 10.3389/fimmu.2022.921488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
The angiotensin AT2 receptor (AT2R) is a main receptor of the protective arm of the renin-angiotensin system and exerts for instance anti-inflammatory effects. The impact of AT2R stimulation on autoimmune diseases such as rheumatoid arthritis (RA) is not yet known. We investigated the therapeutic potential of AT2R-stimulation with the selective non-peptide AT2R agonist Compound 21 (C21) in collagen-induced arthritis (CIA), an animal model for inflammatory arthritis. Arthritis was induced by immunization of DBA/1J mice with collagen type II (CII). Prophylactic and therapeutic C21 treatment alleviates arthritis severity and incidence in CIA. Joint histology revealed significantly less infiltrates of IL-1 beta and IL-17A expressing cells and a well-preserved articular cartilage in C21- treated mice. In CIA, the number of CD4+CD25+FoxP3+ regulatory T (Treg) cells significantly increased upon C21 treatment compared to vehicle. T cell differentiation experiments demonstrated increased expression of FoxP3 mRNA, whereas IL-17A, STAT3 and IFN-gamma mRNA expression were reduced upon C21 treatment. In accordance with the mRNA data, C21 upregulated the percentage of CD4+FoxP3+ cells in Treg polarizing cultures compared to medium-treated controls, whereas the percentage of CD4+IL-17A+ and CD4+IFN-gamma+ T cells was suppressed. To conclude, C21 exerts beneficial effects on T cell-mediated experimental arthritis. We found that C21-induced AT2R-stimulation promotes the expansion of CD4+ regulatory T cells and suppresses IL-17A production. Thus, AT2R-stimulation may represent an attractive treatment strategy for arthritis.
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Affiliation(s)
- Bettina Sehnert
- Department of Rheumatology and Clinical Immunology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- *Correspondence: Bettina Sehnert, ; Reinhard Edmund Voll,
| | | | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Thomas Unger
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Ulrike Muscha Steckelings
- Institute of Molecular Medicine (IMM) – Department of Cardiovascular & Renal Research, University of Southern Denmark, Odense, Denmark
| | - Reinhard Edmund Voll
- Department of Rheumatology and Clinical Immunology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI) Freiburg, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- *Correspondence: Bettina Sehnert, ; Reinhard Edmund Voll,
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Chung SH, Ye XQ, Iwakura Y. Interleukin-17 family members in health and disease. Int Immunol 2021; 33:723-729. [PMID: 34611705 PMCID: PMC8633656 DOI: 10.1093/intimm/dxab075] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/25/2021] [Indexed: 12/15/2022] Open
Abstract
The interleukin-17 (IL-17) family consists of six family members (IL-17A-IL-17F) and all the corresponding receptors have been identified recently. This family is mainly involved in the host defense mechanisms against bacteria, fungi and helminth infection by inducing cytokines and chemokines, recruiting neutrophils, inducing anti-microbial proteins and modifying T-helper cell differentiation. IL-17A and some other family cytokines are also involved in the development of psoriasis, psoriatic arthritis and ankylosing spondylitis by inducing inflammatory cytokines and chemokines, and antibodies against IL-17A as well as the receptor IL-17RA are being successfully used for the treatment of these diseases. Involvement in the development of inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis and tumors has also been suggested in animal disease models. In this review, we will briefly review the mechanisms by which IL-17 cytokines are involved in the development of these diseases and discuss possible treatment of inflammatory diseases by targeting IL-17 family members.
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Affiliation(s)
- Soo-Hyun Chung
- Research Institute for Biomedical Sciences, Tokyo University of Science, 2669 Yamazaki, Noda, Chiba, Japan
| | - Xiao-Qi Ye
- Research Institute for Biomedical Sciences, Tokyo University of Science, 2669 Yamazaki, Noda, Chiba, Japan
| | - Yoichiro Iwakura
- Research Institute for Biomedical Sciences, Tokyo University of Science, 2669 Yamazaki, Noda, Chiba, Japan
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Jamaly S, Rakaee M, Abdi R, Tsokos GC, Fenton KA. Interplay of immune and kidney resident cells in the formation of tertiary lymphoid structures in lupus nephritis. Autoimmun Rev 2021; 20:102980. [PMID: 34718163 DOI: 10.1016/j.autrev.2021.102980] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 02/07/2023]
Abstract
Kidney involvement confers significant morbidity and mortality in patients with systemic lupus erythematosus (SLE). The pathogenesis of lupus nephritis (LN) involves diverse mechanisms instigated by elements of the autoimmune response which alter the biology of kidney resident cells. Processes in the glomeruli and in the interstitium may proceed independently albeit crosstalk between the two is inevitable. Podocytes, mesangial cells, tubular epithelial cells, kidney resident macrophages and stromal cells with input from cytokines and autoantibodies present in the circulation alter the expression of enzymes, produce cytokines and chemokines which lead to their injury and damage of the kidney. Several of these molecules can be targeted independently to prevent and reverse kidney failure. Tertiary lymphoid structures with true germinal centers are present in the kidneys of patients with lupus nephritis and have been increasingly recognized to associate with poorer renal outcomes. Stromal cells, tubular epithelial cells, high endothelial vessel and lymphatic venule cells produce chemokines which enable the formation of structures composed of a T-cell-rich zone with mature dendritic cells next to a B-cell follicle with the characteristics of a germinal center surrounded by plasma cells. Following an overview on the interaction of the immune cells with kidney resident cells, we discuss the cellular and molecular events which lead to the formation of tertiary lymphoid structures in the interstitium of the kidneys of mice and patients with lupus nephritis. In parallel, molecules and processes that can be targeted therapeutically are presented.
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Affiliation(s)
- Simin Jamaly
- Department of Medical Biology, Faculty of Health Science, UiT The Arctic University of Norway, N-9037 Tromsø, Norway; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Mehrdad Rakaee
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Reza Abdi
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - George C Tsokos
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kristin Andreassen Fenton
- Department of Medical Biology, Faculty of Health Science, UiT The Arctic University of Norway, N-9037 Tromsø, Norway
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Kondo N, Kuroda T, Kobayashi D. Cytokine Networks in the Pathogenesis of Rheumatoid Arthritis. Int J Mol Sci 2021; 22:ijms222010922. [PMID: 34681582 PMCID: PMC8539723 DOI: 10.3390/ijms222010922] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/13/2022] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic systemic inflammation causing progressive joint damage that can lead to lifelong disability. The pathogenesis of RA involves a complex network of various cytokines and cells that trigger synovial cell proliferation and cause damage to both cartilage and bone. Involvement of the cytokines tumor necrosis factor (TNF)-α and interleukin (IL)-6 is central to the pathogenesis of RA, but recent research has revealed that other cytokines such as IL-7, IL-17, IL-21, IL-23, granulocyte macrophage colony-stimulating factor (GM-CSF), IL-1β, IL-18, IL-33, and IL-2 also play a role. Clarification of RA pathology has led to the development of therapeutic agents such as biological disease-modifying anti-rheumatic drugs (DMARDs) and Janus kinase (JAK) inhibitors, and further details of the immunological background to RA are emerging. This review covers existing knowledge regarding the roles of cytokines, related immune cells and the immune system in RA, manipulation of which may offer the potential for even safer and more effective treatments in the future.
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Affiliation(s)
- Naoki Kondo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City 951-8510, Japan;
| | - Takeshi Kuroda
- Health Administration Center, Niigata University, 2-8050 Ikarashi, Nishi-ku, Niigata City 950-2181, Japan
- Correspondence: ; Tel.: +81-25-262-6244; Fax: +81-25-262-7517
| | - Daisuke Kobayashi
- Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City 951-8510, Japan;
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Schinocca C, Rizzo C, Fasano S, Grasso G, La Barbera L, Ciccia F, Guggino G. Role of the IL-23/IL-17 Pathway in Rheumatic Diseases: An Overview. Front Immunol 2021; 12:637829. [PMID: 33692806 PMCID: PMC7937623 DOI: 10.3389/fimmu.2021.637829] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/25/2021] [Indexed: 12/14/2022] Open
Abstract
Interleukin-23 (IL-23) is a pro-inflammatory cytokine composed of two subunits, IL-23A (p19) and IL-12/23B (p40), the latter shared with Interleukin-12 (IL-12). IL-23 is mainly produced by macrophages and dendritic cells, in response to exogenous or endogenous signals, and drives the differentiation and activation of T helper 17 (Th17) cells with subsequent production of IL-17A, IL-17F, IL-6, IL-22, and tumor necrosis factor α (TNF-α). Although IL-23 plays a pivotal role in the protective immune response to bacterial and fungal infections, its dysregulation has been shown to exacerbate chronic immune-mediated inflammation. Well-established experimental data support the concept that IL-23/IL-17 axis activation contributes to the development of several inflammatory diseases, such as PsA, Psoriasis, Psoriatic Arthritis; AS, Ankylosing Spondylitis; IBD, Inflammatory Bowel Disease; RA, Rheumatoid Arthritis; SS, Sjogren Syndrome; MS, Multiple Sclerosis. As a result, emerging clinical studies have focused on the blockade of this pathogenic axis as a promising therapeutic target in several autoimmune disorders; nevertheless, a greater understanding of its contribution still requires further investigation. This review aims to elucidate the most recent studies and literature data on the pathogenetic role of IL-23 and Th17 cells in inflammatory rheumatic diseases.
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Affiliation(s)
- Claudia Schinocca
- Rheumatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University Hospital "P. Giaccone", Palermo, Italy
| | - Chiara Rizzo
- Rheumatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University Hospital "P. Giaccone", Palermo, Italy
| | - Serena Fasano
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulia Grasso
- Rheumatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University Hospital "P. Giaccone", Palermo, Italy
| | - Lidia La Barbera
- Rheumatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University Hospital "P. Giaccone", Palermo, Italy
| | - Francesco Ciccia
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuliana Guggino
- Rheumatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University Hospital "P. Giaccone", Palermo, Italy
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8
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Diel R, Schaberg T, Nienhaus A, Otto-Knapp R, Kneitz C, Krause A, Fabri M, Mrowietz U, Bauer T, Häcker B. Joint Statement (DZK, DGRh, DDG) on the Tuberculosis Risk with Treatment Using Novel Non-TNF-Alpha Biologicals. Pneumologie 2021; 75:293-303. [PMID: 33598901 DOI: 10.1055/a-1294-1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND While the risk of tuberculosis (TB) reactivation is adequately documented in relation to TNF-alpha inhibitors (TNFi), the question of what the tuberculosis risk is for newer, non-TNF biologics (non-TNFi) has not been thoroughly addressed. METHODS We conducted a systematic review of randomized phase 2 and phase 3 studies, and long-term extensions of same, published through March 2019. Of interest was information pertaining to screening and treating of latent tuberculosis (LTBI) in association with the use of 12 particular non-TNFi. Only rituximab was excluded. We searched MEDLINE and the ClinicalTrial.gov database for any and all candidate studies meeting these criteria. RESULTS 677 citations were retrieved; 127 studies comprising a total of 34,293 patients who received non-TNFi were eligible for evaluation. Only 80 out of the 127 studies, or 63 %, captured active TB (or at least opportunistic diseases) as potential outcomes and 25 TB cases were reported. More than two thirds of publications (86/127, 68 %) mentioned LTBI screening prior to inclusion of study participants in the respective trial, whereas in only 4 studies LTBI screening was explicitly considered redundant. In 21 studies, patients with LTBI were generally excluded from the trials and in 42 out of the 127 trials, or 33 %, latently infected patients were reported to receive preventive therapy (PT) at least 3 weeks prior to non-TNFi treatment. CONCLUSIONS The lack of information in many non-TNFi studies on the number of patients with LTBI who were either excluded prior to participating or had been offered PT hampers assessment of the actual TB risk when applying the novel biologics. Therefore, in case of insufficient information about drugs or drug classes, the existing recommendations of the German Central Committee against Tuberculosis should be applied in the same way as is done prior to administering TNFi. Well designed, long-term "real world" register studies on TB progression risk in relation to individual substances for IGRA-positive cases without prior or concomitant PT may help to reduce selection bias and to achieve valid conclusions in the future.
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Affiliation(s)
- R Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Campus Kiel, Germany. Member of the German Center for Lung Research (ARCN).,LungClinic Grosshansdorf, Germany. Airway Research Center North (ARCN), German Center for Lung Research (DZL).,German Central Committee against Tuberculosis, Berlin, Germany
| | - T Schaberg
- German Central Committee against Tuberculosis, Berlin, Germany
| | - A Nienhaus
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany.,Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R Otto-Knapp
- German Central Committee against Tuberculosis, Berlin, Germany
| | - C Kneitz
- Medicine, Rheumatology, rheumatological main practice Schwerin, Germany
| | - A Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin, Germany
| | - M Fabri
- Department of Dermatology, University of Cologne, Germany
| | - U Mrowietz
- Psoriasis Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - T Bauer
- German Central Committee against Tuberculosis, Berlin, Germany
| | - B Häcker
- German Central Committee against Tuberculosis, Berlin, Germany
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Tang M, Lu L, Yu X. Interleukin-17A Interweaves the Skeletal and Immune Systems. Front Immunol 2021; 11:625034. [PMID: 33613566 PMCID: PMC7890031 DOI: 10.3389/fimmu.2020.625034] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
The complex crosstalk between the immune and the skeletal systems plays an indispensable role in the maintenance of skeletal homeostasis. Various cytokines are involved, including interleukin (IL)-17A. A variety of immune and inflammatory cells produces IL-17A, especially Th17 cells, a subtype of CD4+ T cells. IL-17A orchestrates diverse inflammatory and immune processes. IL-17A induces direct and indirect effects on osteoclasts. The dual role of IL-17A on osteoclasts partly depends on its concentrations and interactions with other factors. Interestingly, IL-17A exerts a dual role in osteoblasts in vitro. IL-17A is a bone-destroying cytokine in numerous immune-mediated bone diseases including postmenopausal osteoporosis (PMOP), rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (axSpA). This review will summarize and discuss the pathophysiological roles of IL-17A on the skeletal system and its potential strategies for application in immune-mediated bone diseases.
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Affiliation(s)
- Mengjia Tang
- Department of Endocrinology and Metabolism, Laboratory of Endocrinology and Metabolism, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Lingyun Lu
- Department of Integrated Traditional Chinese and Western Medicine, Laboratory of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Xijie Yu
- Department of Endocrinology and Metabolism, Laboratory of Endocrinology and Metabolism, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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Taams LS. Interleukin-17 in rheumatoid arthritis: Trials and tribulations. J Exp Med 2020; 217:133698. [PMID: 32023342 PMCID: PMC7062523 DOI: 10.1084/jem.20192048] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/14/2022] Open
Abstract
Interleukin-17A (IL-17A) is a pro-inflammatory cytokine with well-characterized biological effects on stromal cell activation, angiogenesis, and osteoclastogenesis. The presence of this cytokine in the inflamed joints of patients with rheumatoid arthritis (RA), together with compelling data from in vitro and experimental arthritis models demonstrating its pro-inflammatory effects, made this cytokine a strong candidate for therapeutic targeting. Clinical trials, however, have shown relatively modest success in RA as compared with other indications. Guided by recent insights in IL-17 biology, this review aims to explore possible reasons for the limited clinical efficacy of IL-17A blockade in RA, and what we can learn from these results going forward.
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Affiliation(s)
- Leonie S Taams
- Centre for Inflammation Biology and Cancer Immunology, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK
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11
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Kilian A, Chock YP, Huang IJ, Graef ER, Upton LA, Khilnani A, Krupnikova SDS, Almaghlouth I, Cappelli LC, Fernandez-Ruiz R, Frankel BA, Frankovich J, Harrison C, Kumar B, Monga K, Vega JAR, Singh N, Sparks JA, Sullo E, Young KJ, Duarte-Garcia A, Putman M, Johnson S, Grainger R, Wallace ZS, Liew JW, Jayatilleke A. Acute respiratory viral adverse events during use of antirheumatic disease therapies: A scoping review. Semin Arthritis Rheum 2020; 50:1191-1201. [PMID: 32931985 PMCID: PMC7832282 DOI: 10.1016/j.semarthrit.2020.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION COVID-19 is an acute respiratory viral infection that threatens people worldwide, including people with rheumatic disease, although it remains unclear to what extent various antirheumatic disease therapies increase susceptibility to complications of viral respiratory infections. OBJECTIVE The present study undertakes a scoping review of available evidence regarding the frequency and severity of acute respiratory viral adverse events related to antirheumatic disease therapies. METHODS Online databases were used to identify, since database inception, studies reporting primary data on acute respiratory viral infections in patients utilizing antirheumatic disease therapies. Independent reviewer pairs charted data from eligible studies using a standardized data abstraction tool. RESULTS A total of 180 studies were eligible for qualitative analysis. While acknowledging that the extant literature has a lack of specificity in reporting of acute viral infections or complications thereof, the data suggest that use of glucocorticoids, JAK inhibitors (especially high-dose), TNF inhibitors, and anti-IL-17 agents may be associated with an increased frequency of respiratory viral events. Available data suggest no increased frequency or risk of respiratory viral events with NSAIDs, hydroxychloroquine, sulfasalazine, methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide, or apremilast. One large cohort study demonstrated an association with leflunomide use and increased risk of acute viral respiratory events compared to non-use. CONCLUSION This scoping review identified that some medication classes may confer increased risk of acute respiratory viral infections. However, definitive data are lacking and future studies should address this knowledge gap.
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Affiliation(s)
- Adam Kilian
- Division of Rheumatology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Yu Pei Chock
- Division of Rheumatology, Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - Irvin J Huang
- Division of Rheumatology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Elizabeth R Graef
- Division of Rheumatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Laura A Upton
- Georgetown University School of Medicine, Washington, DC
| | - Aneka Khilnani
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Sonia D Silinsky Krupnikova
- Division of Rheumatology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | - Laura C Cappelli
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ruth Fernandez-Ruiz
- Division of Rheumatology, Department of Medicine, New York University Langone Health, New York, NY
| | - Brittany A Frankel
- Division of Rheumatology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Jourdan Frankovich
- Division of Rheumatology, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | | | - Bharat Kumar
- Division of Rheumatology, Department of Medicine, University of Iowa, Iowa City, IA
| | - Kanika Monga
- Division of Rheumatology, Department of Medicine, University of Texas Houston, Houston, TX
| | - Jorge A Rosario Vega
- Division of Rheumatology, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Namrata Singh
- Division of Rheumatology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Jeffrey A Sparks
- Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Elaine Sullo
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kristen J Young
- Division of Rheumatology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ali Duarte-Garcia
- Division of Rheumatology and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Michael Putman
- Division of Rheumatology, Department of Medicine, Northwestern Medicine, Chicago, IL
| | - Sindhu Johnson
- Division of Rheumatology, Toronto Western Hospital, Mount Sinai Hospital; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Zachary S Wallace
- Clinical Epidemiology Program, Division of Rheumatology, Allergy and Immunology, Massachuse General Hospital and Harvard Medical School, Boston, MA
| | - Jean W Liew
- Division of Rheumatology, Department of Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Aruni Jayatilleke
- Division of Rheumatology, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA.
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12
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George G, Shyni GL, Raghu KG. Current and novel therapeutic targets in the treatment of rheumatoid arthritis. Inflammopharmacology 2020; 28:1457-1476. [PMID: 32948901 DOI: 10.1007/s10787-020-00757-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/05/2020] [Indexed: 02/07/2023]
Abstract
Rheumatoid arthritis (RA), a multifactorial disease characterized by synovitis, cartilage destruction, bone erosion, and periarticular decalcification, finally results in impairment of joint function. Both genetic and environmental factors are risk factors in the development of RA. Unwanted side effects accompany most of the current treatment strategies, and around 20-40% of patients with RA do not clinically benefit from these treatments. The unmet need for new treatment options for RA has prompted research in the development of novel agents acting through physiologically and pharmacologically relevant targets. Here we discuss in detail three critical pathways, Janus kinase/signal transducer and activator of transcription (JAK/STAT), Th17, and hypoxia-inducible factor (HIF), and their roles as unique therapeutic targets in the field of RA. Some of the less developed but potential targets like nucleotide-binding and oligomerization domain-like receptor containing protein 3 (NLRP3) inflammasome and histone deacetylase 1 (HDAC1) are also discussed.
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Affiliation(s)
- Genu George
- Biochemistry and Molecular Mechanism Laboratory, Agro-Processing and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology, Thiruvananthapuram, 695019, Kerala, India
| | - G L Shyni
- Biochemistry and Molecular Mechanism Laboratory, Agro-Processing and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology, Thiruvananthapuram, 695019, Kerala, India
| | - K G Raghu
- Biochemistry and Molecular Mechanism Laboratory, Agro-Processing and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology, Thiruvananthapuram, 695019, Kerala, India.
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13
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Burisch J, Eigner W, Schreiber S, Aletaha D, Weninger W, Trauner M, Reinisch W, Narula N. Risk for development of inflammatory bowel disease under inhibition of interleukin 17: A systematic review and meta-analysis. PLoS One 2020; 15:e0233781. [PMID: 32459816 PMCID: PMC7252630 DOI: 10.1371/journal.pone.0233781] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/12/2020] [Indexed: 12/20/2022] Open
Abstract
Objective Cases of inflammatory bowel disease (IBD) during treatment with interleukin (IL)-17 antagonists have been reported from trials in psoriasis, psoriatic arthritis, and ankylosing spondylitis. The aim of this study was to assess the overall risk for development of IBD due to IL-17 inhibition. Design Systematic review and meta-analysis of studies conducted 2010–2018 of treatment with IL-17 antagonists in patients with psoriasis, psoriatic arthritis, ankylosing spondylitis, and rheumatoid arthritis. We compared risk of IBD development in anti-IL-17 treated patients compared to placebo treatments. We also computed incident rates of IBD overall. A ‘worst case scenario’ defining subjects ambiguous for prevalent versus incident cases for the latter was also applied. Results Sixty-six studies of 14,390 patients exposed to induction and 19,380 patients exposed to induction and/or maintenance treatment were included. During induction, 11 incident cases of IBD were reported, whereas 33 cases were diagnosed during the entire treatment period. There was no difference in the pooled risk of new-onset IBD during induction studies for both the best-case [risk difference (RD) 0.0001 (95% CI: -0.0011, 0.0013)] and worst-case scenario [RD 0.0008 (95% CI: -0.0005, 0.0022)]. The risk of IBD was not different from placebo when including data from maintenance and long-term extension studies [RD 0.0007 (95% CI: -0.0023, 0.0036) and RD 0.0022 (95% CI: -0.0010, 0.0055), respectively]. Conclusions The risk for development of IBD in patients treated with IL-17 antagonists is not elevated. Prospective surveillance of patients treated with IL-17 antagonists with symptom and biomarker assessments is warranted to assess for onset of IBD in these patients.
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MESH Headings
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/therapeutic use
- Arthritis, Psoriatic/drug therapy
- Arthritis, Psoriatic/epidemiology
- Arthritis, Psoriatic/immunology
- Arthritis, Psoriatic/pathology
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/epidemiology
- Arthritis, Rheumatoid/immunology
- Arthritis, Rheumatoid/pathology
- Female
- Humans
- Inflammatory Bowel Diseases/chemically induced
- Inflammatory Bowel Diseases/epidemiology
- Inflammatory Bowel Diseases/immunology
- Interleukin-17/antagonists & inhibitors
- Interleukin-17/immunology
- Male
- Randomized Controlled Trials as Topic
- Spondylitis, Ankylosing/drug therapy
- Spondylitis, Ankylosing/epidemiology
- Spondylitis, Ankylosing/immunology
- Spondylitis, Ankylosing/pathology
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Affiliation(s)
- Johan Burisch
- Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Wolfgang Eigner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Stefan Schreiber
- Department of Gastroenterology, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Daniel Aletaha
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Weninger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Walter Reinisch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Neeraj Narula
- Division of Gastroenterology, Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
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14
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Bilal J, Berlinberg A, Riaz IB, Faridi W, Bhattacharjee S, Ortega G, Murad MH, Wang Z, Prokop LJ, Alhifany AA, Kwoh CK. Risk of Infections and Cancer in Patients With Rheumatologic Diseases Receiving Interleukin Inhibitors: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e1913102. [PMID: 31626313 PMCID: PMC6813598 DOI: 10.1001/jamanetworkopen.2019.13102] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE The safety profile of interleukin (IL) inhibitors is not well established. OBJECTIVE To assess the risk of serious infections, opportunistic infections, and cancer in patients with rheumatologic diseases treated with IL inhibitors. DATA SOURCES Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations; Ovid MEDLINE Daily; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; Ovid Cochrane Database of Systematic Reviews; and Scopus were searched (inception to November 30, 2018). STUDY SELECTION Randomized, placebo-controlled trials that evaluated IL inhibitor therapies in rheumatic diseases and reported safety data were included in the analyses. DATA EXTRACTION AND SYNTHESIS This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Two investigators independently extracted study data and assessed risk of bias and certainty in the evidence. Fixed-effects meta-analysis was conducted to pool odds ratios (ORs) for serious infections, opportunistic infections, and cancers for IL inhibitors vs placebo. MAIN OUTCOMES AND MEASURES The outcomes of interest were the number of serious infections, opportunistic infections, and cancers in individuals receiving IL inhibitor therapies compared with placebo. RESULTS In this meta-analysis, 74 studies comprising 29 214 patients (24 236 patients for serious infections, 9998 for opportunistic infections, and 21 065 for cancer [number of patients overlaps for each outcome]) were included. Patients receiving IL inhibitors had a higher risk of serious infections (OR, 1.97; 95% CI, 1.58-2.44; P < .001, I2 = 0%; high certainty), opportunistic infections (OR, 2.35; 95% CI, 1.09-5.05; P = .03, I2 = 0%; moderate certainty), and cancer (OR, 1.52; 95% CI, 1.05-2.19; P = .03, I2 = 11%; moderate certainty). CONCLUSIONS AND RELEVANCE The risk of serious infections, opportunistic infections, and cancer appears to be increased in patients with rheumatologic diseases who are treated with IL inhibitors compared with placebo.
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Affiliation(s)
- Jawad Bilal
- Division of Rheumatology, Department of Medicine, University of Arizona, Tucson
| | - Adam Berlinberg
- Division of Rheumatology, Department of Medicine, University of Colorado, Denver
| | - Irbaz Bin Riaz
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Warda Faridi
- Division of Hematology/Oncology, Department of Medicine, University of Arizona, Tucson
| | - Sandipan Bhattacharjee
- College of Pharmacy, Department of Pharmacy Practice and Science, University of Arizona, Tucson
| | | | - Mohammad H. Murad
- Evidence-Based Practice Center, Mayo Clinic Rochester, Rochester, Minnesota
| | - Zhen Wang
- Evidence-Based Practice Center, Mayo Clinic Rochester, Rochester, Minnesota
| | - Larry J. Prokop
- Mayo Clinic Libraries, Mayo Clinic Rochester, Rochester, Minnesota
| | - Abdullah A. Alhifany
- College of Pharmacy, Department of Clinical Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - C. Kent Kwoh
- Division of Rheumatology, Department of Medicine, University of Arizona, Tucson
- University of Arizona Arthritis Center, University of Arizona, Tucson
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15
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Evans-Marin H, Rogier R, Koralov SB, Manasson J, Roeleveld D, van der Kraan PM, Scher JU, Koenders MI, Abdollahi-Roodsaz S. Microbiota-Dependent Involvement of Th17 Cells in Murine Models of Inflammatory Arthritis. Arthritis Rheumatol 2019; 70:1971-1983. [PMID: 29975009 PMCID: PMC6587816 DOI: 10.1002/art.40657] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 06/28/2018] [Indexed: 12/20/2022]
Abstract
Objective Intestinal microbiota are associated with the development of inflammatory arthritis. The aim of this study was to dissect intestinal mucosal immune responses in the preclinical phase of arthritis and determine whether the presence of Th17 cells, beyond involvement of the cytokine interleukin‐17 (IL‐17), is required for arthritis development, and whether the involvement of Th17 cells in arthritis depends on the composition of the host microbiota. Methods Mucosal T cell production of IL‐17, interferon‐γ, tumor necrosis factor α (TNFα), IL‐22, and granulocyte–macrophage colony‐stimulating factor (GM‐CSF) was analyzed by flow cytometry and Luminex assay before arthritis onset in mice immunized to develop collagen‐induced arthritis (CIA). Pathogenic features of arthritis in mice with CIA and mice with antigen‐induced arthritis were compared between Th17 cell–deficient (CD4‐Cre+Rorcflox/flox) and Th17 cell–sufficient (CD4‐Cre−Rorcflox/flox) mice. In addition, the impact of intestinal microbiota on the Th17 cell dependence of CIA was assessed. Results Lamina propria CD4 T cells were activated before the onset of arthritis in mice with CIA, with marked up‐regulation of several cytokines, including IL‐17A, TNFα, and GM‐CSF. CD4‐Cre+Rorcflox/flox mice showed a specific reduction in intestinal mucosal levels of Th17 cells and partially reduced levels of IL‐17–producing CD8 T cells. However, total levels of IL‐17A, mostly produced by γδ T cells and neutrophils, were unaffected. The severity of arthritis was significantly reduced in Th17 cell–deficient mice, suggesting that Th17 cells have additional, IL‐17A–independent roles in inflammatory arthritis. Accordingly, antigen‐stimulated T cells from Th17 cell–deficient mice produced less IL‐17A, IL‐17F, and GM‐CSF. Importantly, the dependence of CIA on the involvement of Th17 cells was mitigated in the presence of an alternative microbiome. Conclusion These data from murine models suggest that activation of mucosal immunity precedes the development of arthritis, and also that Th17 cells have a microbiota‐dependent role in arthritis. Therefore, a microbiome‐guided stratification of patients might improve the efficacy of Th17‐targeted therapies.
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Affiliation(s)
| | - Rebecca Rogier
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Julia Manasson
- New York University School of Medicine, New York, New York
| | | | | | - Jose U Scher
- New York University School of Medicine, New York, New York
| | | | - Shahla Abdollahi-Roodsaz
- New York University School of Medicine and Radboud University Medical Center, Nijmegen, The Netherlands
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16
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Efficacy and safety of secukinumab in active rheumatoid arthritis with an inadequate response to tumor necrosis factor inhibitors: a meta-analysis of phase III randomized controlled trials. Clin Rheumatol 2019; 38:2765-2776. [PMID: 31087226 DOI: 10.1007/s10067-019-04595-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/21/2019] [Accepted: 05/06/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To address the efficacy and safety of secukinumab in comparison with placebo in active rheumatoid arthritis (RA) patients who had an inadequate response to tumor necrosis factor (TNF) inhibitors. METHODS Databases of PubMed, Embase, and Web of Science were searched to identify the relevant randomized controlled trials (RCTs). Risk ratio (RR) and 95% confidence interval (95% CI) were calculated with the Mantel-Haenszel random effects method. Statistical heterogeneity was assessed using the Cochran Q and I2 tests. RESULTS A total of 1292 patients from three phase III RCT studies were included. Compared with placebo, secukinumab 150 mg was superior at 24 weeks in terms of ACR20 with RR (1.66, 95% CI 1.33, 2.08; P < 0.0001; I2 = 0%), ACR50 (1.88, 95% CI 1.29, 2.72; P = 0.0009; I2 = 0%), and ACR70 (2.15, 95% CI 1.15, 4.02; P = 0.02; I2 = 0%). Consistent effects were also observed in pooled group of 150 mg and 75 mg secukinumab. For secukinumab 75 mg alone, ACR20 response rate was significantly higher compared with placebo (RR 1.62, 95% CI 1.29, 2.03; P < 0.00001; I2 = 0%). Although ACR50 and ACR70 response rates showed a favorable trend to be higher, no statistical difference was observed (RR 1.68, 95% CI 0.99, 2.85, P = 0.05, I2 = 47%; RR 1.81, 95% CI 0.78, 4.21, P = 0.17, I2 = 34%, respectively). Compared with the placebo group, there was no increased risk of adverse effects (AEs) and serious AEs at 16 weeks in the pooled secukinumab group. CONCLUSIONS In active RA patients with an inadequate response to TNF inhibitors, secukinumab may be a therapeutic option. Secukinumab 150 mg showed significantly better clinical efficacy with no increased risk of AEs and serious AEs compared with placebo. TRIAL REGISTRATION Clinical Trials.gov identifier: NCT01770379, NCT01350804, NCT01377012 Key Points • Secukinumab 150 mg showed significantly better clinical efficacy in active RA patients with an inadequate response to TNF inhibitors. • No increased risk of AEs and serious AEs in secukinumab group compared with placebo.
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17
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Yasuda K, Takeuchi Y, Hirota K. The pathogenicity of Th17 cells in autoimmune diseases. Semin Immunopathol 2019; 41:283-297. [PMID: 30891627 DOI: 10.1007/s00281-019-00733-8] [Citation(s) in RCA: 276] [Impact Index Per Article: 55.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/05/2019] [Indexed: 12/14/2022]
Abstract
IL-17-producing T helper (Th17) cells have been implicated in the pathogenesis of many inflammatory and autoimmune diseases. Targeting the effector cytokines IL-17 and GM-CSF secreted by autoimmune Th17 cells has been shown to be effective for the treatment of the diseases. Understanding a molecular basis of Th17 differentiation and effector functions is therefore critical for the regulation of the pathogenicity of tissue Th17 cells in chronic inflammation. Here, we discuss the roles of proinflammatory cytokines and environmental stimuli in the control of Th17 differentiation and chronic tissue inflammation by pathogenic Th17 cells in humans and in mouse models of autoimmune diseases. We also highlight recent advances in the regulation of pathogenic Th17 cells by gut microbiota and immunometabolism in autoimmune arthritis.
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Affiliation(s)
- Keiko Yasuda
- Laboratory of Integrative Biological Science, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, 606-8507, Japan.,Department of Nephrology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yusuke Takeuchi
- Laboratory of Integrative Biological Science, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, 606-8507, Japan.,Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keiji Hirota
- Laboratory of Integrative Biological Science, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, 606-8507, Japan.
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18
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Bui VL, Brahn E. Cytokine targeting in rheumatoid arthritis. Clin Immunol 2018; 206:3-8. [PMID: 29621613 DOI: 10.1016/j.clim.2018.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/01/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Viet L Bui
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Ernest Brahn
- Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.
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19
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Safari F, Farajnia S, Arya M, Zarredar H, Nasrolahi A. CRISPR and personalized Treg therapy: new insights into the treatment of rheumatoid arthritis. Immunopharmacol Immunotoxicol 2018; 40:201-211. [DOI: 10.1080/08923973.2018.1437625] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Fatemeh Safari
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Medical Biotechnology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Safar Farajnia
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Arya
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Habib Zarredar
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ava Nasrolahi
- Molecular Medicine Department, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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20
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Tertiary Lymphoid Structures Among the World of Noncanonical Ectopic Lymphoid Organizations. Methods Mol Biol 2018; 1845:1-15. [PMID: 30141004 DOI: 10.1007/978-1-4939-8709-2_1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Tertiary lymphoid structures (TLOs), also known as ectopic lymphoid structures, are associated with chronic infections and inflammatory diseases. Despite their association with pathology, these structures are actually a normal, albeit transient, component of the immune system and facilitate local immune responses that are meant to mitigate inflammation and resolve infection. Many of the mechanisms controlling the formation and function of tertiary lymphoid structures have been identified, in part by experimentally triggering their formation using defined stimuli under controlled conditions. Here, we introduce the experimental and pathological conditions in which tertiary lymphoid tissues are formed, describe the mechanisms linked to their formation, and discuss their functions in the context of both infection and inflammation.
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21
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Maseda D, Johnson EM, Nyhoff LE, Baron B, Kojima F, Wilhelm AJ, Ward MR, Woodward JG, Brand DD, Crofford LJ. mPGES1-Dependent Prostaglandin E 2 (PGE 2) Controls Antigen-Specific Th17 and Th1 Responses by Regulating T Autocrine and Paracrine PGE 2 Production. THE JOURNAL OF IMMUNOLOGY 2017; 200:725-736. [PMID: 29237778 DOI: 10.4049/jimmunol.1601808] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/06/2017] [Indexed: 01/24/2023]
Abstract
The integration of inflammatory signals is paramount in controlling the intensity and duration of immune responses. Eicosanoids, particularly PGE2, are critical molecules in the initiation and resolution of inflammation and in the transition from innate to acquired immune responses. Microsomal PGE synthase 1 (mPGES1) is an integral membrane enzyme whose regulated expression controls PGE2 levels and is highly expressed at sites of inflammation. PGE2 is also associated with modulation of autoimmunity through altering the IL-23/IL-17 axis and regulatory T cell (Treg) development. During a type II collagen-CFA immunization response, lack of mPGES1 impaired the numbers of CD4+ regulatory (Treg) and Th17 cells in the draining lymph nodes. Ag-experienced mPGES1-/- CD4+ cells showed impaired IL-17A, IFN-γ, and IL-6 production when rechallenged ex vivo with their cognate Ag compared with their wild-type counterparts. Additionally, production of PGE2 by cocultured APCs synergized with that of Ag-experienced CD4+ T cells, with mPGES1 competence in the APC compartment enhancing CD4+ IL-17A and IFN-γ responses. However, in contrast with CD4+ cells that were Ag primed in vivo, exogenous PGE2 inhibited proliferation and skewed IL-17A to IFN-γ production under Th17 polarization of naive T cells in vitro. We conclude that mPGES1 is necessary in vivo to mount optimal Treg and Th17 responses during an Ag-driven primary immune response. Furthermore, we uncover a coordination of autocrine and paracrine mPGES1-driven PGE2 production that impacts effector T cell IL-17A and IFN-γ responses.
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Affiliation(s)
- Damian Maseda
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37202
| | - Elizabeth M Johnson
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37202
| | - Lindsay E Nyhoff
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37202
| | - Bridgette Baron
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37202
| | - Fumiaki Kojima
- Department of Pharmacology, Kitasato University, Tokyo 108-8641, Japan
| | - Ashley J Wilhelm
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37202
| | - Martin R Ward
- University of Kentucky Medical Center, Lexington, KY 40536; and
| | | | - David D Brand
- Division of Rheumatology, University of Tennessee, Memphis, TN 38104
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37202;
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22
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Rogier R, Evans-Marin H, Manasson J, van der Kraan PM, Walgreen B, Helsen MM, van den Bersselaar LA, van de Loo FA, van Lent PL, Abramson SB, van den Berg WB, Koenders MI, Scher JU, Abdollahi-Roodsaz S. Alteration of the intestinal microbiome characterizes preclinical inflammatory arthritis in mice and its modulation attenuates established arthritis. Sci Rep 2017; 7:15613. [PMID: 29142301 PMCID: PMC5688157 DOI: 10.1038/s41598-017-15802-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 11/02/2017] [Indexed: 12/12/2022] Open
Abstract
Perturbations of the intestinal microbiome have been observed in patients with new-onset and chronic autoimmune inflammatory arthritis. However, it is currently unknown whether these alterations precede the development of arthritis or are rather a consequence of disease. Modulation of intestinal microbiota by oral antibiotics or germ-free condition can prevent arthritis in mice. Yet, the therapeutic potential of modulation of the microbiota after the onset of arthritis is not well characterized. We here show that the intestinal microbial community undergoes marked changes in the preclinical phase of collagen induced arthritis (CIA). The abundance of the phylum Bacteroidetes, specifically families S24-7 and Bacteroidaceae was reduced, whereas Firmicutes and Proteobacteria, such as Ruminococcaceae, Lachnospiraceae and Desulfovibrinocaceae, were expanded during the immune-priming phase of arthritis. In addition, we found that the abundance of lamina propria Th17, but not Th1, cells is highly correlated with the severity of arthritis. Elimination of the intestinal microbiota during established arthritis specifically reduced intestinal Th17 cells and attenuated arthritis. These effects were associated with reduced serum amyloid A expression in ileum and synovial tissue. Our observations suggest that intestinal microbiota perturbations precede arthritis, and that modulation of the intestinal microbiota after the onset of arthritis may offer therapeutic opportunities.
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Affiliation(s)
- Rebecca Rogier
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Heather Evans-Marin
- Department of Medicine, Division of Rheumatology, New York University School of Medicine, New York, United States
| | - Julia Manasson
- Department of Medicine, Division of Rheumatology, New York University School of Medicine, New York, United States
| | - Peter M van der Kraan
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Birgitte Walgreen
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique M Helsen
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Fons A van de Loo
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter L van Lent
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Steven B Abramson
- Department of Medicine, Division of Rheumatology, New York University School of Medicine, New York, United States
| | - Wim B van den Berg
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marije I Koenders
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jose U Scher
- Department of Medicine, Division of Rheumatology, New York University School of Medicine, New York, United States
| | - Shahla Abdollahi-Roodsaz
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Medicine, Division of Rheumatology, New York University School of Medicine, New York, United States.
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Tahir H, Deodhar A, Genovese M, Takeuchi T, Aelion J, Van den Bosch F, Haemmerle S, Richards HB. Secukinumab in Active Rheumatoid Arthritis after Anti-TNFα Therapy: A Randomized, Double-Blind Placebo-Controlled Phase 3 Study. Rheumatol Ther 2017; 4:475-488. [PMID: 29138986 PMCID: PMC5696298 DOI: 10.1007/s40744-017-0086-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Indexed: 12/14/2022] Open
Abstract
Introduction ‘REASSURE’ (NCT01377012), a phase 3 study, evaluated the efficacy and safety of secukinumab in patients with active rheumatoid arthritis (RA) who had an inadequate response to, or intolerance of, tumor necrosis factor inhibitors (TNF-inhibitors). Methods A total of 637 patients were randomized (1:1:1) to receive intravenous secukinumab 10 mg/kg (baseline, weeks 2 and 4) followed by subcutaneous secukinumab 150 mg or 75 mg every 4 weeks (starting from week 8) or placebo at the same dosing schedule. The primary endpoint was the American College of Rheumatology 20% improvement criteria (ACR20) at week 24. Other predefined hierarchical endpoints included Health Assessment Questionnaire-Disability Index, van der Heijde modified total Sharp score (vdH-mTSS) at week 24, and major clinical response (MCR; continuous 6 month period of ACR70 response) at 1 year. Results The primary efficacy endpoint was met with both secukinumab dose groups: ACR20 response rate at week 24 was 35.2% for both secukinumab dose groups (P = 0.0009) vs 19.6% for placebo. The improvements in secondary endpoints were greater in the secukinumab dose groups vs placebo but did not meet statistical significance. The overall safety profile was similar across all treatment groups. Conclusion Secukinumab demonstrated efficacy in reducing disease activity over placebo as measured by ACR20 in patients with active RA who had an inadequate response to TNF-inhibitors. Secukinumab demonstrated a safety profile similar to other biologics currently approved for RA. Funding Novartis Pharma AG. Trial registration ClinicalTrials.gov identifier: NCT01377012. Electronic supplementary material The online version of this article (doi:10.1007/s40744-017-0086-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Atul Deodhar
- Oregon Health and Science University, Portland, OR, USA
| | | | | | - Jacob Aelion
- West Tennessee Research Institute, Jackson, TN, USA
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Abstract
PURPOSE OF REVIEW Sarcoidosis is a chronic granulomatous disease typically affecting the lung, lymph nodes, and other organ systems. Evidence suggests that the morbidity and mortality rates for sarcoidosis in the USA are rising, despite widespread use of anti-inflammatory therapies. In this review, we survey new therapies that target specific inflammatory pathways in other diseases (such as rheumatoid arthritis, Crohn's disease, and psoriasis) that are similar to pathways relevant to sarcoidosis immunopathogenesis, and therefore, represent potentially new sarcoidosis therapies. RECENT FINDINGS Immunopathogenesis of sarcoidosis has been well elucidated over the past few years. There is abundant evidence for T-cell activation in sarcoidosis leading to activation of both Th1 and Th17 inflammatory cascades. Therapies targeting T-cell activation, Th1 pathways (such as the interleukin-6 inhibitors), Th17 pathway mediators, and others have been Food and Drug Administration approved or under investigation to treat a variety of autoimmune inflammatory diseases, but have not been studied in sarcoidosis. Targeting the p38 mitogen-activated protein kinases and the ubiquitine proteasome system with new agents may also represent a novel therapeutic option for patients with sarcoidosis. SUMMARY Rising morbidity and mortality rates for patients with sarcoidosis strongly support the need to develop more effective anti-inflammatory therapies to treat chronic disease.
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Mease PJ, Jeka S, Jaller JJ, Kitumnuaypong T, Louthrenoo W, Mann H, Matsievskaia G, Soriano ER, Jia B, Wang C, Nie J, Hsia E. CNTO6785, a Fully Human Antiinterleukin 17 Monoclonal Antibody, in Patients with Rheumatoid Arthritis with Inadequate Response to Methotrexate: A Randomized, Placebo-controlled, Phase II, Dose-ranging Study. J Rheumatol 2017; 45:22-31. [PMID: 29093159 DOI: 10.3899/jrheum.161238] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the efficacy, safety, pharmacokinetics, and immunogenicity of CNTO6785, a fully human monoclonal antibody that binds to human interleukin 17A, in patients with active rheumatoid arthritis (RA) with inadequate response to methotrexate (MTX) therapy. METHODS This randomized, double-blind, placebo-controlled, dose-ranging study enrolled patients aged 18 to 80 years (inclusive) with active RA (≥ 6/66 swollen and ≥ 6/68 tender joints) who were refractory to MTX treatment (7.5-25 mg weekly, inclusive). The study duration was 38 weeks, containing a 10-week safety followup. Patients were randomized 1:1:1:1:1 to receive CNTO6785 15, 50, 100, or 200 mg every 4 weeks + MTX or placebo + MTX. The primary endpoint was American College of Rheumatology 20 (ACR20) response at Week 16. RESULTS There were no significant differences from placebo in the proportion of patients treated with CNTO6785 in the primary endpoint of ACR20 response at Week 16. There were no significant findings in any additional efficacy variables through Week 32. No dose-response relationships or specific patterns were observed in adverse event profiles among CNTO6785 treatment groups. Infections occurred with similar frequency across all groups, and injection site reactions were mild or moderate and did not demonstrate a dose-response relationship. Median serum CNTO6785 concentration increases through Week 38 were about dose-proportional; the incidence of neutralizing antidrug antibodies was 19.4% and was not associated with study drug dose level. CONCLUSION CNTO6785 was well tolerated, but did not demonstrate clinical efficacy in patients with active RA with inadequate response to MTX.
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Affiliation(s)
- Philip J Mease
- From the Swedish Medical Center and University of Washington, Seattle, Washington; Janssen Research and Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK, Bydgoszcz, Poland; Centro de Reumatologia y Ortopedia, Universidad Metropolitana, Barranquilla, Colombia; Rajavithi Hospital, Bangkok, Thailand; Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand; Institute of Rheumatology, Prague, Czech Republic; Clinical Rheumatology Hospital #25, St. Petersburg, Russia; Head Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Janssen (China) Research and Development Center, Beijing, China. .,P.J. Mease, MD, Swedish Medical Center and University of Washington; S. Jeka, Professor, MD, Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK; J.J. Jaller, MD, Scientific Director, Centro de Reumatologia y Ortopedia, Docente Investigador, Universidad Metropolitana; T. Kitumnuaypong, MD, Rajavithi Hospital; W. Louthrenoo, MD, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University; H. Mann, MD, Institute of Rheumatology; G. Matsievskaia, MD, Chief of Rheumatology Department, Clinical Rheumatology Hospital #25; E.R. Soriano, MD, MSc, Head Rheumatology Unit, Hospital Italiano de Buenos Aires; B. Jia, PhD, Janssen (China) Research and Development Center; C. Wang, MD, Immunology Therapeutic Area Head, Janssen (China) Research and Development Center; J. Nie, PhD, Senior Manager, Clinical Pharmacology, Janssen (China) Research and Development Center; E. Hsia, MD, MSCE, Janssen Research and Development LLC.
| | - Slawomir Jeka
- From the Swedish Medical Center and University of Washington, Seattle, Washington; Janssen Research and Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK, Bydgoszcz, Poland; Centro de Reumatologia y Ortopedia, Universidad Metropolitana, Barranquilla, Colombia; Rajavithi Hospital, Bangkok, Thailand; Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand; Institute of Rheumatology, Prague, Czech Republic; Clinical Rheumatology Hospital #25, St. Petersburg, Russia; Head Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Janssen (China) Research and Development Center, Beijing, China.,P.J. Mease, MD, Swedish Medical Center and University of Washington; S. Jeka, Professor, MD, Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK; J.J. Jaller, MD, Scientific Director, Centro de Reumatologia y Ortopedia, Docente Investigador, Universidad Metropolitana; T. Kitumnuaypong, MD, Rajavithi Hospital; W. Louthrenoo, MD, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University; H. Mann, MD, Institute of Rheumatology; G. Matsievskaia, MD, Chief of Rheumatology Department, Clinical Rheumatology Hospital #25; E.R. Soriano, MD, MSc, Head Rheumatology Unit, Hospital Italiano de Buenos Aires; B. Jia, PhD, Janssen (China) Research and Development Center; C. Wang, MD, Immunology Therapeutic Area Head, Janssen (China) Research and Development Center; J. Nie, PhD, Senior Manager, Clinical Pharmacology, Janssen (China) Research and Development Center; E. Hsia, MD, MSCE, Janssen Research and Development LLC
| | - Juan Jose Jaller
- From the Swedish Medical Center and University of Washington, Seattle, Washington; Janssen Research and Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK, Bydgoszcz, Poland; Centro de Reumatologia y Ortopedia, Universidad Metropolitana, Barranquilla, Colombia; Rajavithi Hospital, Bangkok, Thailand; Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand; Institute of Rheumatology, Prague, Czech Republic; Clinical Rheumatology Hospital #25, St. Petersburg, Russia; Head Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Janssen (China) Research and Development Center, Beijing, China.,P.J. Mease, MD, Swedish Medical Center and University of Washington; S. Jeka, Professor, MD, Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK; J.J. Jaller, MD, Scientific Director, Centro de Reumatologia y Ortopedia, Docente Investigador, Universidad Metropolitana; T. Kitumnuaypong, MD, Rajavithi Hospital; W. Louthrenoo, MD, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University; H. Mann, MD, Institute of Rheumatology; G. Matsievskaia, MD, Chief of Rheumatology Department, Clinical Rheumatology Hospital #25; E.R. Soriano, MD, MSc, Head Rheumatology Unit, Hospital Italiano de Buenos Aires; B. Jia, PhD, Janssen (China) Research and Development Center; C. Wang, MD, Immunology Therapeutic Area Head, Janssen (China) Research and Development Center; J. Nie, PhD, Senior Manager, Clinical Pharmacology, Janssen (China) Research and Development Center; E. Hsia, MD, MSCE, Janssen Research and Development LLC
| | - Tasanee Kitumnuaypong
- From the Swedish Medical Center and University of Washington, Seattle, Washington; Janssen Research and Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK, Bydgoszcz, Poland; Centro de Reumatologia y Ortopedia, Universidad Metropolitana, Barranquilla, Colombia; Rajavithi Hospital, Bangkok, Thailand; Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand; Institute of Rheumatology, Prague, Czech Republic; Clinical Rheumatology Hospital #25, St. Petersburg, Russia; Head Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Janssen (China) Research and Development Center, Beijing, China.,P.J. Mease, MD, Swedish Medical Center and University of Washington; S. Jeka, Professor, MD, Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK; J.J. Jaller, MD, Scientific Director, Centro de Reumatologia y Ortopedia, Docente Investigador, Universidad Metropolitana; T. Kitumnuaypong, MD, Rajavithi Hospital; W. Louthrenoo, MD, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University; H. Mann, MD, Institute of Rheumatology; G. Matsievskaia, MD, Chief of Rheumatology Department, Clinical Rheumatology Hospital #25; E.R. Soriano, MD, MSc, Head Rheumatology Unit, Hospital Italiano de Buenos Aires; B. Jia, PhD, Janssen (China) Research and Development Center; C. Wang, MD, Immunology Therapeutic Area Head, Janssen (China) Research and Development Center; J. Nie, PhD, Senior Manager, Clinical Pharmacology, Janssen (China) Research and Development Center; E. Hsia, MD, MSCE, Janssen Research and Development LLC
| | - Worawit Louthrenoo
- From the Swedish Medical Center and University of Washington, Seattle, Washington; Janssen Research and Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK, Bydgoszcz, Poland; Centro de Reumatologia y Ortopedia, Universidad Metropolitana, Barranquilla, Colombia; Rajavithi Hospital, Bangkok, Thailand; Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand; Institute of Rheumatology, Prague, Czech Republic; Clinical Rheumatology Hospital #25, St. Petersburg, Russia; Head Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Janssen (China) Research and Development Center, Beijing, China.,P.J. Mease, MD, Swedish Medical Center and University of Washington; S. Jeka, Professor, MD, Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK; J.J. Jaller, MD, Scientific Director, Centro de Reumatologia y Ortopedia, Docente Investigador, Universidad Metropolitana; T. Kitumnuaypong, MD, Rajavithi Hospital; W. Louthrenoo, MD, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University; H. Mann, MD, Institute of Rheumatology; G. Matsievskaia, MD, Chief of Rheumatology Department, Clinical Rheumatology Hospital #25; E.R. Soriano, MD, MSc, Head Rheumatology Unit, Hospital Italiano de Buenos Aires; B. Jia, PhD, Janssen (China) Research and Development Center; C. Wang, MD, Immunology Therapeutic Area Head, Janssen (China) Research and Development Center; J. Nie, PhD, Senior Manager, Clinical Pharmacology, Janssen (China) Research and Development Center; E. Hsia, MD, MSCE, Janssen Research and Development LLC
| | - Herman Mann
- From the Swedish Medical Center and University of Washington, Seattle, Washington; Janssen Research and Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK, Bydgoszcz, Poland; Centro de Reumatologia y Ortopedia, Universidad Metropolitana, Barranquilla, Colombia; Rajavithi Hospital, Bangkok, Thailand; Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand; Institute of Rheumatology, Prague, Czech Republic; Clinical Rheumatology Hospital #25, St. Petersburg, Russia; Head Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Janssen (China) Research and Development Center, Beijing, China.,P.J. Mease, MD, Swedish Medical Center and University of Washington; S. Jeka, Professor, MD, Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK; J.J. Jaller, MD, Scientific Director, Centro de Reumatologia y Ortopedia, Docente Investigador, Universidad Metropolitana; T. Kitumnuaypong, MD, Rajavithi Hospital; W. Louthrenoo, MD, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University; H. Mann, MD, Institute of Rheumatology; G. Matsievskaia, MD, Chief of Rheumatology Department, Clinical Rheumatology Hospital #25; E.R. Soriano, MD, MSc, Head Rheumatology Unit, Hospital Italiano de Buenos Aires; B. Jia, PhD, Janssen (China) Research and Development Center; C. Wang, MD, Immunology Therapeutic Area Head, Janssen (China) Research and Development Center; J. Nie, PhD, Senior Manager, Clinical Pharmacology, Janssen (China) Research and Development Center; E. Hsia, MD, MSCE, Janssen Research and Development LLC
| | - Galina Matsievskaia
- From the Swedish Medical Center and University of Washington, Seattle, Washington; Janssen Research and Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK, Bydgoszcz, Poland; Centro de Reumatologia y Ortopedia, Universidad Metropolitana, Barranquilla, Colombia; Rajavithi Hospital, Bangkok, Thailand; Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand; Institute of Rheumatology, Prague, Czech Republic; Clinical Rheumatology Hospital #25, St. Petersburg, Russia; Head Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Janssen (China) Research and Development Center, Beijing, China.,P.J. Mease, MD, Swedish Medical Center and University of Washington; S. Jeka, Professor, MD, Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK; J.J. Jaller, MD, Scientific Director, Centro de Reumatologia y Ortopedia, Docente Investigador, Universidad Metropolitana; T. Kitumnuaypong, MD, Rajavithi Hospital; W. Louthrenoo, MD, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University; H. Mann, MD, Institute of Rheumatology; G. Matsievskaia, MD, Chief of Rheumatology Department, Clinical Rheumatology Hospital #25; E.R. Soriano, MD, MSc, Head Rheumatology Unit, Hospital Italiano de Buenos Aires; B. Jia, PhD, Janssen (China) Research and Development Center; C. Wang, MD, Immunology Therapeutic Area Head, Janssen (China) Research and Development Center; J. Nie, PhD, Senior Manager, Clinical Pharmacology, Janssen (China) Research and Development Center; E. Hsia, MD, MSCE, Janssen Research and Development LLC
| | - Enrique R Soriano
- From the Swedish Medical Center and University of Washington, Seattle, Washington; Janssen Research and Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK, Bydgoszcz, Poland; Centro de Reumatologia y Ortopedia, Universidad Metropolitana, Barranquilla, Colombia; Rajavithi Hospital, Bangkok, Thailand; Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand; Institute of Rheumatology, Prague, Czech Republic; Clinical Rheumatology Hospital #25, St. Petersburg, Russia; Head Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Janssen (China) Research and Development Center, Beijing, China.,P.J. Mease, MD, Swedish Medical Center and University of Washington; S. Jeka, Professor, MD, Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK; J.J. Jaller, MD, Scientific Director, Centro de Reumatologia y Ortopedia, Docente Investigador, Universidad Metropolitana; T. Kitumnuaypong, MD, Rajavithi Hospital; W. Louthrenoo, MD, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University; H. Mann, MD, Institute of Rheumatology; G. Matsievskaia, MD, Chief of Rheumatology Department, Clinical Rheumatology Hospital #25; E.R. Soriano, MD, MSc, Head Rheumatology Unit, Hospital Italiano de Buenos Aires; B. Jia, PhD, Janssen (China) Research and Development Center; C. Wang, MD, Immunology Therapeutic Area Head, Janssen (China) Research and Development Center; J. Nie, PhD, Senior Manager, Clinical Pharmacology, Janssen (China) Research and Development Center; E. Hsia, MD, MSCE, Janssen Research and Development LLC
| | - Bin Jia
- From the Swedish Medical Center and University of Washington, Seattle, Washington; Janssen Research and Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK, Bydgoszcz, Poland; Centro de Reumatologia y Ortopedia, Universidad Metropolitana, Barranquilla, Colombia; Rajavithi Hospital, Bangkok, Thailand; Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand; Institute of Rheumatology, Prague, Czech Republic; Clinical Rheumatology Hospital #25, St. Petersburg, Russia; Head Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Janssen (China) Research and Development Center, Beijing, China.,P.J. Mease, MD, Swedish Medical Center and University of Washington; S. Jeka, Professor, MD, Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK; J.J. Jaller, MD, Scientific Director, Centro de Reumatologia y Ortopedia, Docente Investigador, Universidad Metropolitana; T. Kitumnuaypong, MD, Rajavithi Hospital; W. Louthrenoo, MD, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University; H. Mann, MD, Institute of Rheumatology; G. Matsievskaia, MD, Chief of Rheumatology Department, Clinical Rheumatology Hospital #25; E.R. Soriano, MD, MSc, Head Rheumatology Unit, Hospital Italiano de Buenos Aires; B. Jia, PhD, Janssen (China) Research and Development Center; C. Wang, MD, Immunology Therapeutic Area Head, Janssen (China) Research and Development Center; J. Nie, PhD, Senior Manager, Clinical Pharmacology, Janssen (China) Research and Development Center; E. Hsia, MD, MSCE, Janssen Research and Development LLC
| | - Caihong Wang
- From the Swedish Medical Center and University of Washington, Seattle, Washington; Janssen Research and Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK, Bydgoszcz, Poland; Centro de Reumatologia y Ortopedia, Universidad Metropolitana, Barranquilla, Colombia; Rajavithi Hospital, Bangkok, Thailand; Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand; Institute of Rheumatology, Prague, Czech Republic; Clinical Rheumatology Hospital #25, St. Petersburg, Russia; Head Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Janssen (China) Research and Development Center, Beijing, China.,P.J. Mease, MD, Swedish Medical Center and University of Washington; S. Jeka, Professor, MD, Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK; J.J. Jaller, MD, Scientific Director, Centro de Reumatologia y Ortopedia, Docente Investigador, Universidad Metropolitana; T. Kitumnuaypong, MD, Rajavithi Hospital; W. Louthrenoo, MD, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University; H. Mann, MD, Institute of Rheumatology; G. Matsievskaia, MD, Chief of Rheumatology Department, Clinical Rheumatology Hospital #25; E.R. Soriano, MD, MSc, Head Rheumatology Unit, Hospital Italiano de Buenos Aires; B. Jia, PhD, Janssen (China) Research and Development Center; C. Wang, MD, Immunology Therapeutic Area Head, Janssen (China) Research and Development Center; J. Nie, PhD, Senior Manager, Clinical Pharmacology, Janssen (China) Research and Development Center; E. Hsia, MD, MSCE, Janssen Research and Development LLC
| | - Jing Nie
- From the Swedish Medical Center and University of Washington, Seattle, Washington; Janssen Research and Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK, Bydgoszcz, Poland; Centro de Reumatologia y Ortopedia, Universidad Metropolitana, Barranquilla, Colombia; Rajavithi Hospital, Bangkok, Thailand; Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand; Institute of Rheumatology, Prague, Czech Republic; Clinical Rheumatology Hospital #25, St. Petersburg, Russia; Head Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Janssen (China) Research and Development Center, Beijing, China.,P.J. Mease, MD, Swedish Medical Center and University of Washington; S. Jeka, Professor, MD, Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK; J.J. Jaller, MD, Scientific Director, Centro de Reumatologia y Ortopedia, Docente Investigador, Universidad Metropolitana; T. Kitumnuaypong, MD, Rajavithi Hospital; W. Louthrenoo, MD, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University; H. Mann, MD, Institute of Rheumatology; G. Matsievskaia, MD, Chief of Rheumatology Department, Clinical Rheumatology Hospital #25; E.R. Soriano, MD, MSc, Head Rheumatology Unit, Hospital Italiano de Buenos Aires; B. Jia, PhD, Janssen (China) Research and Development Center; C. Wang, MD, Immunology Therapeutic Area Head, Janssen (China) Research and Development Center; J. Nie, PhD, Senior Manager, Clinical Pharmacology, Janssen (China) Research and Development Center; E. Hsia, MD, MSCE, Janssen Research and Development LLC
| | - Elizabeth Hsia
- From the Swedish Medical Center and University of Washington, Seattle, Washington; Janssen Research and Development LLC, Spring House, Pennsylvania, USA; Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK, Bydgoszcz, Poland; Centro de Reumatologia y Ortopedia, Universidad Metropolitana, Barranquilla, Colombia; Rajavithi Hospital, Bangkok, Thailand; Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand; Institute of Rheumatology, Prague, Czech Republic; Clinical Rheumatology Hospital #25, St. Petersburg, Russia; Head Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Janssen (China) Research and Development Center, Beijing, China.,P.J. Mease, MD, Swedish Medical Center and University of Washington; S. Jeka, Professor, MD, Department of Rheumatology and Connective Tissue Diseases, 2nd University Hospital, CM UMK; J.J. Jaller, MD, Scientific Director, Centro de Reumatologia y Ortopedia, Docente Investigador, Universidad Metropolitana; T. Kitumnuaypong, MD, Rajavithi Hospital; W. Louthrenoo, MD, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University; H. Mann, MD, Institute of Rheumatology; G. Matsievskaia, MD, Chief of Rheumatology Department, Clinical Rheumatology Hospital #25; E.R. Soriano, MD, MSc, Head Rheumatology Unit, Hospital Italiano de Buenos Aires; B. Jia, PhD, Janssen (China) Research and Development Center; C. Wang, MD, Immunology Therapeutic Area Head, Janssen (China) Research and Development Center; J. Nie, PhD, Senior Manager, Clinical Pharmacology, Janssen (China) Research and Development Center; E. Hsia, MD, MSCE, Janssen Research and Development LLC
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Abstract
Management and therapy of rheumatoid arthritis (RA) has been revolutionized by the development and approval of the first biological disease-modifying antirheumatic drugs (bDMARDs) targeting tumor necrosis factor (TNF) α at the end of the last century. Today, numerous efficacious agents with different modes of action are available and achievement of clinical remission or, at least, low disease activity is the target of therapy. Early therapeutic interventions aiming at a defined goal of therapy (treat to target) are supposed to halt inflammation, improving symptoms and signs, and preserving structural integrity of the joints in RA. Up to now, bDMARDs approved for therapy in RA include agents with five different modes of action: TNF inhibition, T cell co-stimulation blockade, IL-6 receptor inhibition, B cell depletion, and interleukin 1 inhibition. Furthermore, targeted synthetic DMARDs (tsDMARDs) inhibiting Janus kinase (JAK) and biosimilars also are approved for RA. The present review focuses on bDMARDs and tsDMARDS regarding similarities and possible drug-specific advantages in the treatment of RA. Furthermore, compounds not yet approved in RA and biosimilars are discussed. Following the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) recommendations, specific treatment of the disease will be discussed with respect to safety and efficacy. In particular, we discuss the question of favoring specific bDMARDs or tsDMARDs in the two settings of insufficient response to methotrexate and to the first bDMARD, respectively.
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Eich A, Urban V, Jutel M, Vlcek J, Shim JJ, Trofimov VI, Liam CK, Kuo PH, Hou Y, Xiao J, Branigan P, O'Brien CD. A Randomized, Placebo-Controlled Phase 2 Trial of CNTO 6785 in Chronic Obstructive Pulmonary Disease. COPD 2017; 14:476-483. [DOI: 10.1080/15412555.2017.1335697] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Andreas Eich
- IKF Pneumologie Frankfurt, Institut für Klinische Forschung Pneumologie, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany
| | | | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, ‘ALL-MED’ Medical Research Institute, Wrocław, Poland
| | - Jiri Vlcek
- Department for Pneumology, University Hospital of St. Anna, 2′d Clinic for Internal Diseases, Brno, Czech Republic
| | - Jae Jeong Shim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Vasiliy I. Trofimov
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia
| | - Chong-Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ping-Hung Kuo
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yanyan Hou
- Janssen (China) Research & Development Center, Beijing, China
| | - Jun Xiao
- Janssen (China) Research & Development Center, Beijing, China
| | - Patrick Branigan
- Janssen Clinical Research & Development, LLC, Spring House, PA, USA
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The Plasticity of Th17 Cells in the Pathogenesis of Rheumatoid Arthritis. J Clin Med 2017; 6:jcm6070067. [PMID: 28698517 PMCID: PMC5532575 DOI: 10.3390/jcm6070067] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/28/2017] [Accepted: 07/02/2017] [Indexed: 12/14/2022] Open
Abstract
Helper T (Th) cells play an important role in the pathogenesis of autoimmune diseases, including rheumatoid arthritis (RA). It has been revealed that Th17 cells can shift to Th1 cells (i.e., “nonclassic Th1 cells”), which are reported to be more pathogenic than Th17 cells per se. Thus, the association of Th cells in the pathogenesis of autoimmune disease has become more complicated. We recently reported using peripheral blood from untreated and early-onset RA patients that the ratio of CD161+Th1 cells (i.e., Th17-derived Th1 cells to CD161+Th17 cells) is elevated and that levels of interferon-γ (IFNγ)+Th17 cells are inversely correlated with levels of anti-CCP antibodies. Here, we review the plasticity of Th17 cells in the pathogenesis of RA, suggesting possible implications for novel therapies.
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Rogier R, Ederveen THA, Boekhorst J, Wopereis H, Scher JU, Manasson J, Frambach SJCM, Knol J, Garssen J, van der Kraan PM, Koenders MI, van den Berg WB, van Hijum SAFT, Abdollahi-Roodsaz S. Aberrant intestinal microbiota due to IL-1 receptor antagonist deficiency promotes IL-17- and TLR4-dependent arthritis. MICROBIOME 2017; 5:63. [PMID: 28645307 PMCID: PMC5481968 DOI: 10.1186/s40168-017-0278-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 05/23/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Perturbation of commensal intestinal microbiota has been associated with several autoimmune diseases. Mice deficient in interleukin-1 receptor antagonist (Il1rn -/- mice) spontaneously develop autoimmune arthritis and are susceptible to other autoimmune diseases such as psoriasis, diabetes, and encephalomyelitis; however, the mechanisms of increased susceptibility to these autoimmune phenotypes are poorly understood. We investigated the role of interleukin-1 receptor antagonist (IL-1Ra) in regulation of commensal intestinal microbiota, and assessed the involvement of microbiota subsets and innate and adaptive mucosal immune responses that underlie the development of spontaneous arthritis in Il1rn -/- mice. RESULTS Using high-throughput 16S rRNA gene sequencing, we show that IL-1Ra critically maintains the diversity and regulates the composition of intestinal microbiota in mice. IL-1Ra deficiency reduced the intestinal microbial diversity and richness, and caused specific taxonomic alterations characterized by overrepresented Helicobacter and underrepresented Ruminococcus and Prevotella. Notably, the aberrant intestinal microbiota in IL1rn -/- mice specifically potentiated IL-17 production by intestinal lamina propria (LP) lymphocytes and skewed the LP T cell balance in favor of T helper 17 (Th17) cells, an effect transferable to WT mice by fecal microbiota. Importantly, LP Th17 cell expansion and the development of spontaneous autoimmune arthritis in IL1rn -/- mice were attenuated under germ-free condition. Selective antibiotic treatment revealed that tobramycin-induced alterations of commensal intestinal microbiota, i.e., reduced Helicobacter, Flexispira, Clostridium, and Dehalobacterium, suppressed arthritis in IL1rn -/- mice. The arthritis phenotype in IL1rn -/- mice was previously shown to depend on Toll-like receptor 4 (TLR4). Using the ablation of both IL-1Ra and TLR4, we here show that the aberrations in the IL1rn -/- microbiota are partly TLR4-dependent. We further identify a role for TLR4 activation in the intestinal lamina propria production of IL-17 and cytokines involved in Th17 differentiation preceding the onset of arthritis. CONCLUSIONS These findings identify a critical role for IL1Ra in maintaining the natural diversity and composition of intestinal microbiota, and suggest a role for TLR4 in mucosal Th17 cell induction associated with the development of autoimmune disease in mice.
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Affiliation(s)
- Rebecca Rogier
- Experimental Rheumatology (272), Radboud University Medical Center, PO Box 9101, 6500HB Nijmegen, The Netherlands
| | - Thomas H. A. Ederveen
- Experimental Rheumatology (272), Radboud University Medical Center, PO Box 9101, 6500HB Nijmegen, The Netherlands
- Centre for Molecular and Biomolecular Informatics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos Boekhorst
- Centre for Molecular and Biomolecular Informatics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- NIZO food research, Ede, The Netherlands
| | - Harm Wopereis
- Danone Nutricia Research, Utrecht, The Netherlands
- Laboratory of Microbiology, Wageningen University, Wageningen, The Netherlands
| | - Jose U. Scher
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, 301 East 17th Street, Room 1611A, New York, USA
| | - Julia Manasson
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, 301 East 17th Street, Room 1611A, New York, USA
| | - Sanne J. C. M. Frambach
- Experimental Rheumatology (272), Radboud University Medical Center, PO Box 9101, 6500HB Nijmegen, The Netherlands
| | - Jan Knol
- Danone Nutricia Research, Utrecht, The Netherlands
- Laboratory of Microbiology, Wageningen University, Wageningen, The Netherlands
| | - Johan Garssen
- Danone Nutricia Research, Utrecht, The Netherlands
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Peter M. van der Kraan
- Experimental Rheumatology (272), Radboud University Medical Center, PO Box 9101, 6500HB Nijmegen, The Netherlands
| | - Marije I. Koenders
- Experimental Rheumatology (272), Radboud University Medical Center, PO Box 9101, 6500HB Nijmegen, The Netherlands
| | - Wim B. van den Berg
- Experimental Rheumatology (272), Radboud University Medical Center, PO Box 9101, 6500HB Nijmegen, The Netherlands
| | - Sacha A. F. T. van Hijum
- Centre for Molecular and Biomolecular Informatics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- NIZO food research, Ede, The Netherlands
| | - Shahla Abdollahi-Roodsaz
- Experimental Rheumatology (272), Radboud University Medical Center, PO Box 9101, 6500HB Nijmegen, The Netherlands
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, 301 East 17th Street, Room 1611A, New York, USA
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Attia A, Abushouk AI, Ahmed H, Gadelkarim M, Elgebaly A, Hassan Z, Abdel-Daim MM, Negida A. Safety and Efficacy of Brodalumab for Moderate-to-Severe Plaque Psoriasis: A Systematic Review and Meta-Analysis. Clin Drug Investig 2017; 37:439-451. [PMID: 28197901 DOI: 10.1007/s40261-017-0500-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Psoriasis is an inflammatory skin disease that affects 2-3% of the worldwide population. The interleukin-17 cytokine family has been proven to play a central role in the pathogenesis of psoriasis. Brodalumab is a novel biologic agent that targets interleukin-17 molecules and their receptors. We aimed to evaluate the safety and efficacy of brodalumab as a therapeutic agent for moderate-to-severe psoriasis in a meta-analysis framework. METHODS A computer literature search of PubMed, OVID, Cochrane Central, EMBASE, EBSCO, Scopus, and Web of Science was conducted using relevant keywords. Data were extracted from eligible trials and analyzed using RevMan (Version 5.3 for windows) and OpenMeta [Analyst] software. RESULTS Six clinical trials (n = 4118 patients) were pooled in the final analysis. The pooled effect size favored brodalumab over placebo in terms of the Psoriasis Area and Severity Index (PASI) 75 [risk ratio (RR) = 12.61, 95% confidence interval (CI) 9.74-16.34], PASI 90 (RR = 28.72, 95% CI 18.34-44.98), and PASI 100 (RR = 61.23, 95% CI 25.48-147.17). Analysis of secondary outcomes showed that brodalumab was superior to placebo in terms of static physician's global assessment (RR = 32.53, 95% CI 13.80-76.69) and psoriasis symptoms inventory scores (RR = 14.70, 95% CI 8.38-25.78). Meta-regression analysis found a significant linear association between the brodalumab dose and the effect size on PASI and psoriasis symptoms inventory scores. The rate of overall adverse events was slightly higher in the brodalumab group (RR = 1.13, 95% CI 1.06-1.22); however, none of the individual adverse events were significantly higher in the brodalumab group, compared to the placebo group. CONCLUSION Brodalumab showed an acceptable safety profile and a robust efficacy in the treatment of moderate-to-severe plaque psoriasis. However, the current evidence is insufficient to confirm maintenance of these results in the long term; therefore, larger studies with longer follow-up periods are required.
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Affiliation(s)
- Attia Attia
- Medical Research Group of Egypt, Cairo, Egypt. .,Faculty of Medicine, Al-Azhar University, Cairo, 31724, Egypt.
| | - Abdelrahman Ibrahim Abushouk
- Medical Research Group of Egypt, Cairo, Egypt.,Faculty of Medicine, Ain Shams University, Cairo, Egypt.,NovaMed Medical Research Association, Cairo, Egypt
| | - Hussien Ahmed
- Medical Research Group of Egypt, Cairo, Egypt.,Faculty of Medicine, Zagazig University, El Shrakia, Egypt.,Student Research Unit, Zagazig University, El Shrakia, Egypt
| | - Mohamed Gadelkarim
- Medical Research Group of Egypt, Cairo, Egypt.,Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Elgebaly
- Medical Research Group of Egypt, Cairo, Egypt.,Faculty of Medicine, Al-Azhar University, Cairo, 31724, Egypt
| | - Zeinab Hassan
- Medical Research Group of Egypt, Cairo, Egypt.,Faculty of Medicine, Zagazig University, El Shrakia, Egypt.,Student Research Unit, Zagazig University, El Shrakia, Egypt
| | - Mohamed M Abdel-Daim
- Medical Research Group of Egypt, Cairo, Egypt.,Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - Ahmed Negida
- Medical Research Group of Egypt, Cairo, Egypt.,Faculty of Medicine, Zagazig University, El Shrakia, Egypt.,Student Research Unit, Zagazig University, El Shrakia, Egypt
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31
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Blanco FJ, Möricke R, Dokoupilova E, Codding C, Neal J, Andersson M, Rohrer S, Richards H. Secukinumab in Active Rheumatoid Arthritis: A Phase III Randomized, Double‐Blind, Active Comparator– and Placebo‐Controlled Study. Arthritis Rheumatol 2017; 69:1144-1153. [DOI: 10.1002/art.40070] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 02/09/2017] [Indexed: 12/12/2022]
Affiliation(s)
| | - Rüdiger Möricke
- Institut für Präventive Medizin & Klinische ForschungMagdeburg Germany
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32
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Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by persistent joint inflammation. Without adequate treatment, patients with RA will develop joint deformity and progressive functional impairment. With the implementation of treat-to-target strategies and availability of biologic therapies, the outcomes for patients with RA have significantly improved. However, the unmet need in the treatment of RA remains high as some patients do not respond sufficiently to the currently available agents, remission is not always achieved and refractory disease is not uncommon. With better understanding of the pathophysiology of RA, new therapeutic approaches are emerging. Apart from more selective Janus kinase inhibition, there is a great interest in the granulocyte macrophage-colony stimulating factor pathway, Bruton's tyrosine kinase pathway, phosphoinositide-3-kinase pathway, neural stimulation and dendritic cell-based therapeutics. In this review, we will discuss the therapeutic potential of these novel approaches.
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33
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Venuturupalli S. Immune Mechanisms and Novel Targets in Rheumatoid Arthritis. Immunol Allergy Clin North Am 2017; 37:301-313. [PMID: 28366478 DOI: 10.1016/j.iac.2017.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Significant progress has been made in understanding the pathophysiology of rheumatoid arthritis. It is widely recognized that early institution of treatment is one of the best predictive factors for response to therapy. Several novel approaches are currently being investigated and several novel biologics are in various stages of development. With advances in the fields of proteomics, genomics, and metabolomics, specific phenotypes of the disease can be better identified and specific therapies for particular phases of the disease and specific patients will allow for improved control of this condition.
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Affiliation(s)
- Swamy Venuturupalli
- Division of Rheumatology- Cedars Sinai Medical Center, 8750 Wilshire Blvd, Suite 350, Beverly Hills, CA 90211, USA.
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34
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Banuelos J, Cao Y, Shin SC, Lu NZ. Immunopathology alters Th17 cell glucocorticoid sensitivity. Allergy 2017; 72:331-341. [PMID: 27646878 PMCID: PMC5315659 DOI: 10.1111/all.13051] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2016] [Indexed: 12/14/2022]
Abstract
Th17 cells contribute to several inflammatory conditions and increasing evidence supports that Th17 cells are glucocorticoid resistant. However, Th17 cells in psoriasis and related diseases are glucocorticoid sensitive. We compare glucocorticoid sensitive and resistant immunological diseases and suggest that several aspects in Th17-related diseases alter glucocorticoid sensitivity of Th17 cells. We identify molecular pathways that are implicated in glucocorticoid sensitivity of Th17 cells in the literature, as this information is useful for developing approaches to overcome glucocorticoid-resistant immunopathology.
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Affiliation(s)
- J. Banuelos
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Y. Cao
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - S. C. Shin
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - N. Z. Lu
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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35
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Shipman WD, Dasoveanu DC, Lu TT. Tertiary lymphoid organs in systemic autoimmune diseases: pathogenic or protective? F1000Res 2017; 6:196. [PMID: 28344775 PMCID: PMC5333609 DOI: 10.12688/f1000research.10595.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 12/14/2022] Open
Abstract
Tertiary lymphoid organs are found at sites of chronic inflammation in autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. These organized accumulations of T and B cells resemble secondary lymphoid organs and generate autoreactive effector cells. However, whether they contribute to disease pathogenesis or have protective functions is unclear. Here, we discuss how tertiary lymphoid organs can generate potentially pathogenic cells but may also limit the extent of the response and damage in autoimmune disease.
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Affiliation(s)
- William D. Shipman
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY, USA
- Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical Sciences, New York, NY, USA
- Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Dragos C. Dasoveanu
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY, USA
- Physiology, Biophysics, and Systems Biology Program, Weill Cornell Graduate School of Medical Sciences, New York, NY, USA
| | - Theresa T. Lu
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY, USA
- Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, New York, NY, USA
- Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, USA
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, NY, USA
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36
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Noack M, Miossec P. Selected cytokine pathways in rheumatoid arthritis. Semin Immunopathol 2017; 39:365-383. [DOI: 10.1007/s00281-017-0619-z] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/31/2017] [Indexed: 12/13/2022]
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37
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Roeleveld DM, Marijnissen RJ, Walgreen B, Helsen MM, van den Bersselaar L, van de Loo FA, van Lent PL, van der Kraan PM, van den Berg WB, Koenders MI. Higher efficacy of anti-IL-6/IL-21 combination therapy compared to monotherapy in the induction phase of Th17-driven experimental arthritis. PLoS One 2017; 12:e0171757. [PMID: 28158305 PMCID: PMC5291406 DOI: 10.1371/journal.pone.0171757] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/25/2017] [Indexed: 12/14/2022] Open
Abstract
Th17 cells and their cytokines are linked to the pathogenesis of rheumatoid arthritis, a chronic autoimmune disease characterized by joint inflammation. Th17 development is initiated by combined signaling of TGF-β and IL-6 or IL-21, and can be reduced in the absence of either IL-6 or IL-21. The aim of this study was to assess whether combinatorial IL-6/IL-21 blockade would more potently inhibit Th17 development, and be more efficacious in treating arthritis than targeting either cytokine. We assessed in vitro Th17 differentiation efficacy in the absence of IL-6 and/or IL-21. To investigate in vivo effects of IL-6/IL-21 blockade on Th17 and arthritis development, antigen-induced arthritis (AIA) was induced in IL-6-/- x IL-21R-/- mice. The therapeutic potential of this combined blocking strategy was assessed by treating mice with collagen-induced arthritis (CIA) with anti-IL-6R antibodies and soluble (s)IL-21R.Fc. We demonstrated that combined IL-6/IL-21 blocking synergistically reduced in vitro Th17 differentiation. In mice with AIA, absence of IL-6 and IL-21 signaling more strongly reduced Th17 levels and resulted in stronger suppression of arthritis than the absence of either cytokine. Additionally, anti-IL-6/anti-IL-21 treatment of CIA mice during the arthritis induction phase reduced disease development more potent than IL-6 or IL-21 inhibition alone, as effective as anti-TNF treatment. Collectively, these results suggest dual IL-6/IL-21 inhibition may be a more efficacious therapeutic strategy compared to single cytokine blockade to suppress arthritis development.
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Affiliation(s)
- Debbie M. Roeleveld
- Department of Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
- * E-mail:
| | - Renoud J. Marijnissen
- Department of Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Birgitte Walgreen
- Department of Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Monique M. Helsen
- Department of Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Fons A. van de Loo
- Department of Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter L. van Lent
- Department of Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter M. van der Kraan
- Department of Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim B. van den Berg
- Department of Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marije I. Koenders
- Department of Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
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38
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Abstract
The discovery of the key roles of interleukin-17A (IL-17A) and IL-17A producing cells in inflammation, autoimmune diseases and host defense has led to the experimental targeting of the IL-17A pathway in animal models of diseases as well as in clinical trials in humans. These therapeutic agents include biological products that target IL-17A and IL-23, an upstream regulator of IL-17A production. IL-17A producing T helper cells (Th17 cells) are a distinct lineage from the Th1 and Th2 CD4+ lineages and have been suggested to represent a good drug target in certain inflammatory conditions. Targeting IL-17A has been proven to be a good approach as anti-IL-17A is FDA approved for the treatment of psoriasis in 2015. In host defense, IL-17A has been shown to be mostly beneficial against infection caused by extracellular bacteria and fungi. This review will overview the discovery of IL-17A, the receptors used by this cytokine and its role in mucosal immunity and inflammation.
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Affiliation(s)
- Kong Chen
- Richard King Mellon Foundation Institute for Pediatric Research, Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Jay K Kolls
- Richard King Mellon Foundation Institute for Pediatric Research, Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.
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39
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Fasching P, Stradner M, Graninger W, Dejaco C, Fessler J. Therapeutic Potential of Targeting the Th17/Treg Axis in Autoimmune Disorders. Molecules 2017; 22:E134. [PMID: 28098832 PMCID: PMC6155880 DOI: 10.3390/molecules22010134] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 02/08/2023] Open
Abstract
A disruption of the crucial balance between regulatory T-cells (Tregs) and Th17-cells was recently implicated in various autoimmune disorders. Tregs are responsible for the maintenance of self-tolerance, thus inhibiting autoimmunity, whereas pro-inflammatory Th17-cells contribute to the induction and propagation of inflammation. Distortion of the Th17/Treg balance favoring the pro-inflammatory Th17 side is hence suspected to contribute to exacerbation of autoimmune disorders. This review aims to summarize recent data and advances in targeted therapeutic modification of the Th17/Treg-balance, as well as information on the efficacy of candidate therapeutics with respect to the treatment of autoimmune diseases.
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MESH Headings
- Animals
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Autoimmune Diseases/drug therapy
- Autoimmune Diseases/genetics
- Autoimmune Diseases/immunology
- Autoimmune Diseases/pathology
- Forkhead Transcription Factors/antagonists & inhibitors
- Forkhead Transcription Factors/genetics
- Forkhead Transcription Factors/immunology
- Gene Expression Regulation
- Humans
- Immunologic Factors/therapeutic use
- Inflammation
- Interleukin-17/antagonists & inhibitors
- Interleukin-17/genetics
- Interleukin-17/immunology
- Nuclear Receptor Subfamily 1, Group F, Member 3/antagonists & inhibitors
- Nuclear Receptor Subfamily 1, Group F, Member 3/genetics
- Nuclear Receptor Subfamily 1, Group F, Member 3/immunology
- Piperidines/therapeutic use
- Pyrimidines/therapeutic use
- Pyrroles/therapeutic use
- Signal Transduction
- T-Lymphocytes, Regulatory/drug effects
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/pathology
- Th17 Cells/drug effects
- Th17 Cells/immunology
- Th17 Cells/pathology
- Ustekinumab/therapeutic use
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Affiliation(s)
- Patrizia Fasching
- Department of Rheumatology and Immunology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
| | - Martin Stradner
- Department of Rheumatology and Immunology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
| | - Winfried Graninger
- Department of Rheumatology and Immunology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
| | - Christian Dejaco
- Department of Rheumatology and Immunology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
| | - Johannes Fessler
- Department of Rheumatology and Immunology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
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40
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Sharma J, Bhar S, Devi CS. A review on interleukins: The key manipulators in rheumatoid arthritis. Mod Rheumatol 2017; 27:723-746. [DOI: 10.1080/14397595.2016.1266071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jatin Sharma
- School of Biosciences and Technology, VIT University, Vellore, India
| | - Sutonuka Bhar
- School of Biosciences and Technology, VIT University, Vellore, India
| | - C. Subathra Devi
- School of Biosciences and Technology, VIT University, Vellore, India
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41
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Atkinson SM, Nansen A. Pharmacological Value of Murine Delayed-type Hypersensitivity Arthritis: A Robust Mouse Model of Rheumatoid Arthritis in C57BL/6 Mice. Basic Clin Pharmacol Toxicol 2016; 120:108-114. [PMID: 27553641 DOI: 10.1111/bcpt.12657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/16/2016] [Indexed: 12/12/2022]
Abstract
In this MiniReview, we summarize the body of knowledge on the delayed-type hypersensitivity arthritis (DTHA) model, a recently developed arthritis model with 100% incidence, low variation and synchronized onset in C57BL/6 (B6) mice, and compare it to other murine arthritis models. It is desirable to have robust arthritis models in B6 mice, as many transgene strains are bred on this background. However, several of the most widely used mouse model of arthritis cannot be induced in B6 mice without the drawback of lower incidence, reduced severity and higher variation, if at all. DTHA is induced by modifying a classical methylated bovine serum albumin (mBSA)-induced DTH response by administering a cocktail of anti-type II collagen antibodies (anti-CII) between immunization and challenge. Arthritis affects one, predefined paw in which acute inflammation and severe arthritis rapidly develop and peak after 4-7 days. Disease is self-resolving over the course of around 3 weeks. Disease manifestations resemble those seen in other arthritis models and include bone erosion, cartilage destruction, oedema, pannus and new bone formation. Induction of DTHA is dependent on CD4+ T cells while B cells are dispensable. The DTHA model is set apart from other murine arthritis models in that it can be induced in B6 mice with 100% incidence and with high and consistent severity. This is the clearest advantage of the model, as the mechanisms of disease and clinical manifestations can be found in other arthritis models. The model holds potential for future modifications that may improve the lack of chronicity.
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Affiliation(s)
- Sara Marie Atkinson
- Novo Nordisk & LIFE In Vivo Pharmacology Centre & the Danish In Vivo Pharmacology PhD Program, University of Copenhagen, Frederiksberg C, Denmark.,Diabetes Complications Research, Novo Nordisk A/S, Maaloev, Denmark
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42
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Differential Effects of Inflammation on Bone and Response to Biologics in Rheumatoid Arthritis and Spondyloarthritis. Curr Rheumatol Rep 2016; 18:72. [DOI: 10.1007/s11926-016-0620-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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43
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Jaleel T, Elmets C, Weinkle A, Kassira S, Elewski B. Secukinumab (AIN-457) for the treatment of Psoriasis. Expert Rev Clin Pharmacol 2016; 9:187-202. [PMID: 26647300 DOI: 10.1586/17512433.2016.1129894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Secukinumab (also known as AIN-457) is a human monoclonal antibody targeting IL-17A, which has been recently FDA-approved for the treatment of moderate to severe psoriasis and psoriatic arthritis with coexistent moderate to severe plaque psoriasis based on clinical trials demonstrating excellent efficacy. This review will address the rationale for targeting the IL-23/Th17/IL-17 axis, the role of IL-17 and Th17 cells in psoriasis and other chronic inflammatory diseases, and will examine pre-clinical studies, pharmacologic properties, clinical efficacy, and the safety profile of secukinumab.
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Affiliation(s)
- Tarannum Jaleel
- a Department of Dermatology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Craig Elmets
- a Department of Dermatology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Allison Weinkle
- c University of California San Diego School of Medicine , La Jolla , CA , USA
| | - Sama Kassira
- b University of Alabama School of Medicine , Birmingham , AL , USA
| | - Boni Elewski
- a Department of Dermatology , University of Alabama at Birmingham , Birmingham , AL , USA
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Koenders MI, van den Berg WB. Secukinumab for rheumatology: development and its potential place in therapy. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:2069-80. [PMID: 27445458 PMCID: PMC4928657 DOI: 10.2147/dddt.s105263] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Rheumatic disease is not a single disorder, but a group of more than 100 diseases that affect joints, connective tissues, and/or internal organs. Although rheumatic diseases like rheumatoid arthritis (RA), psoriatic arthritis, and ankylosing spondylitis (AS) differ in their pathogenesis and clinical presentation, the treatment of these inflammatory disorders overlaps. Non-steroid anti-inflammatory drugs are used to reduce pain and inflammation. Additional disease-modifying anti-rheumatic drugs are prescribed to slowdown disease progression, and is in RA more frequently and effectively applied than in AS. Biologicals are a relatively new class of treatments that specifically target cytokines or cells of the immune system, like tumor necrosis factor alpha inhibitors or B-cell blockers. A new kid on the block is the interleukin-17 (IL-17) inhibitor secukinumab, which has been recently approved by the US Food and Drug Administration for moderate-to-severe plaque psoriasis, psoriatic arthritis, and AS. IL-17 is a proinflammatory cytokine that has an important role in host defense, but its proinflammatory and destructive effects have also been linked to pathogenic processes in autoimmune diseases like RA and psoriasis. Animal models have greatly contributed to further insights in the potential of IL-17 blockade in autoimmune and autoinflammatory diseases, and have resulted in the development of various potential drugs targeting the IL-17 pathway. Secukinumab (AIN457) is a fully human monoclonal antibody that selectively binds to IL-17A and recently entered the market under the brand name Cosentyx(®). By binding to IL-17A, secukinumab prevents it from binding to its receptor and inhibits its ability to trigger inflammatory responses that play a role in the development of various autoimmune diseases. With secukinumab being the first in class to receive Food and Drug Administration approval, this article will further focus on this new biologic agent and review the milestones in its development and marketing.
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Affiliation(s)
- Marije I Koenders
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim B van den Berg
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
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Bhise V, Dhib-Jalbut S. Further understanding of the immunopathology of multiple sclerosis: impact on future treatments. Expert Rev Clin Immunol 2016; 12:1069-89. [PMID: 27191526 DOI: 10.1080/1744666x.2016.1191351] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The understanding of the immunopathogenesis of multiple sclerosis (MS) has expanded with more research into T-cell subtypes, cytokine contributors, B-cell participation, mitochondrial dysfunction, and more. Treatment options have rapidly expanded with three relatively recent oral therapy alternatives entering the arena. AREAS COVERED In the following review, we discuss current mechanisms of immune dysregulation in MS, how they relate to current treatments, and the impact these findings will have on the future of therapy. Expert commentary: The efficacy of these medications and understanding their mechanisms of actions validates the immunopathogenic mechanisms thought to underlie MS. Further research has exposed new targets, while new promising therapies have shed light on new aspects into the pathophysiology of MS.
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Affiliation(s)
- Vikram Bhise
- a Rutgers Biomedical and Health Sciences - Departments of Pediatrics , Robert Wood Johnson Medical School , New Brunswick , NJ , USA
| | - Suhayl Dhib-Jalbut
- b Rutgers Biomedical and Health Sciences - Departments of Neurology , Robert Wood Johnson Medical School , New Brunswick , NJ , USA
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Abstract
Diverse strategies to develop novel treatments for rheumatoid arthritis which specifically target those patients who do not respond to available medications, including biologics, are currently being explored. New potential therapeutic approaches which may become available as part of standard therapeutic regimens include the propagation of regulatory T cells and-in the future-of regulatory B cells. New biologic disease-modifying antirheumatic drugs (b-DMARDs) against interleukin-17 and -6, granulocyte-macrophage colony-stimulating factor, and complement component 5 are now standard components of clinical treatment programs. In addition, recent data indicate that bispecific monoclonal antibody therapies may be more effective than monoclonal antibody monotherapies. It is also becoming apparent that the use of more toxic b-DMARDs against B cells, a therapeutic strategy already being applied in the treatment of hematological diseases, may also be efficacious for treating B cell-mediated autoimmune diseases. Undoubtedly, more small molecules will be developed in the future, and combination therapies with, for example, kinase inhibitors and b-DMARDs, will most likely be tested. Finally, immunoproteasome inhibitors will become available for patients with B cell-mediated autoimmunities, which are refractory to currently available treatment options. The new and exciting extension of current treatment options for rheumatoid arthritis, biosimilars, will not be discussed in this review as details on these agents are available in recently published reports.
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Affiliation(s)
- Joachim R Kalden
- Division of Molecular Immunology, Nikolaus-Fiebiger-Center, Friedrich-Alexander University Erlangen-Nürnberg, Glückstraße 6, 91054, Erlangen, Germany.
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Ratio of Circulating IFNγ (+) "Th17 Cells" in Memory Th Cells Is Inversely Correlated with the Titer of Anti-CCP Antibodies in Early-Onset Rheumatoid Arthritis Patients Based on Flow Cytometry Methods of the Human Immunology Project. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9694289. [PMID: 27294146 PMCID: PMC4880694 DOI: 10.1155/2016/9694289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/11/2016] [Accepted: 04/19/2016] [Indexed: 12/22/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune disease with chronic joint inflammation characterized by activated T cells. IL-17 and Th17 cells play important roles in the pathogenesis of RA. Recently, plasticity in helper T cells has been demonstrated; Th17 cells can convert to Th1 cells. However, it remains to be elucidated whether this conversion occurs in the early phase of RA. Here, we validated the methods of the Human Immunology Project using only the cell-surface marker through measuring the actual expression of IL-17 and IFNγ. We also evaluated the expression of CD161 in human Th17 cells. We then tried to identify Th17 cells, IL-17+Th17 cells, and IFNγ+Th17 cells in the peripheral blood of early-onset RA patients using the standardized method of the Human Immunology Project. Our findings validated the method and the expression of CD161. The ratio of IFNγ+Th17 cells in memory T cells was inversely correlated to the titers of anti-CCP antibodies in the early-onset RA patients. These findings suggest that Th17 cells play important roles in the early phase of RA and that anti-IL-17 antibodies should be administered to patients with early phase RA, especially those with high titers of CCP antibodies.
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Anti-IL-17 therapy in treatment of rheumatoid arthritis: a systematic literature review and meta-analysis of randomized controlled trials. Rheumatol Int 2016; 36:1065-75. [DOI: 10.1007/s00296-016-3480-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 04/15/2016] [Indexed: 12/14/2022]
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DUREZ PATRICK. Is There a Future for Interleukin 17 Blocking Agents in Rheumatoid Arthritis? J Rheumatol 2016; 43:465-7. [DOI: 10.3899/jrheum.160010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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