Suppression of autoimmunity via microbial mimics of altered peptide ligands

Antigen-specific tolerogenic and immunomodulatory strategies for the treatment of autoimmune arthritis

OBJECTIVES

To review various antigen-specific tolerogenic and immunomodulatory approaches for arthritis in animal models and patients in regard to their efficacy, mechanisms of action, and limitations.

METHODS

We reviewed the published literature in Medline (PubMed) on the induction of antigen-specific tolerance and its effect on autoimmune arthritis, as well as the recent work on B-cell-mediated tolerance from our laboratory. The prominent key words used in different combinations included arthritis, autoimmunity, immunotherapy, innate immunity, tolerance, treatment, and rheumatoid arthritis (RA). Although this search spanned the years 1975 to 2007, the majority of the short-listed articles belonged to the period 1990 to 2007. The relevant primary as well as cross-referenced articles were then collected from links within PubMed and reviewed.

RESULTS

Antigen-specific tolerance has been successful in the prevention and/or treatment of arthritis in animal models. The administration of soluble native antigen or an altered peptide ligand intravenously, orally, or nasally, and the delivery of the DNA encoding a particular antigen by gene therapy have been the mainstay of immunomodulation. Recently, the methods for in vitro expansion of CD4+CD25+ regulatory T-cells have been optimized. Furthermore, interleukin-17 has emerged as a promising new therapeutic target in arthritis. However, in RA patients, non-antigen-specific therapeutic approaches have been much more successful than antigen-specific tolerogenic regimens.

CONCLUSION

An antigen-specific treatment against autoimmune arthritis is still elusive. However, insights into newly emerging mechanisms of disease pathogenesis provide hope for the development of effective and safe immunotherapeutic strategies in the near future.

Immunoregulation of Autoimmune Diseases

Since the discovery of human leukocyte antigen (HLA) as a genetic system, the search for the biological function of HLA molecules has been a very intense and attractive area of immunological research. It has been a major factor in the development of our understanding of the role of T cells in the initiation and regulation of autoimmune diseases. The currently increasing incidences of chronic inflammatory diseases, such as allergies but also several autoimmune diseases, possibly due to our Westernized modern life-style, are asking for novel intervention or prevention strategies. Heat shock proteins (or stress proteins) can be an example of relevant microbial antigens with an intrinsic capacity to trigger anti-inflammatory T cell regulation. Heat shock proteins may be part of an ancient system, which includes several stress-induced self-antigens, seen by a self-protective immune system. Peptide-based intervention, including clinical trials with HSP60 and HSP70 peptides, is now an area of intensive clinical research.