Role of antibody and T cells in the long-term inhibition of IgE synthesis

High IgE in rheumatoid arthritis (RA) patients is complexed with anti-IgE autoantibodies

This study presents data on more than 300 RA and allergic patients analysed for their serum levels of anti-immunoglobulin isotype autoantibodies and IgE. We observed high levels of IgE in sera of RA and allergic patients. Interestingly, we measured significantly higher specific IgE levels against Alternaria but not against nine other allergens in the RA compared with the allergic group. As expected, anti-IgG autoantibodies (rheumatoid factors (RF)) of different isotypes were detected in sera from RA patients only. However, we found increased titres of complexed anti-IgE autoantibodies in all RF+ groups and in the allergic group. These findings may explain why despite elevated IgE levels a decreased prevalence of allergic diseases in RA patients has been observed.

Is vaccination against IgE possible?

A substantial reduction in the levels of both total and antigen specific IgE will most likely result in improved symptom scores in atopic individuals. Based on this assumption we initiated a project to study the possibility of reducing levels of circulating and mast cell bound IgE, by inducing a strong autoimmune antibody response against IgE in the host. Bacterially produced fusion proteins containing constant domains two (CH2) and three (CH3) of rat IgE directly linked to the glutathione-S-transferase (GST) protein from Schistosoma japonicum or to the maltose binding protein of Esherichia coli were used as the active components of the allergy vaccine. Injection of either of these fusion proteins together with adjuvant led to the induction of a strong autoimmune anti-IgE response in several IgE low or medium responder strains of rats. Vaccination of ovalbumin sensitised Wistar rats with the GST-C2C3 fusion protein resulted in a profound decrease in serum IgE levels and later in a nearly complete block in histamine release from mast cells and basophils upon challenge with either a cross-linking polyclonal anti-IgE antiserum or a specific allergen. This shows that it is possible to reduce IgE levels in an animal to such an extent that it gives a clear clinical effect. Recent studies with an extended panel of rat strains including four IgE high responder strains, indicate that induction of the autoimmune response is dependent on the plasma concentration of IgE before vaccination. A high concentration of IgE has a negative effect on the induction of autoimmunity, most likely by inducing a B-cell tolerance in the host. Vaccinated subjects with very high IgE concentrations thereby responds poorly to the vaccine. Current studies are aimed at overcoming this potential limitation of the vaccination procedure.

Anti-IgE therapy

Controlling the IgE response at either the synthesis level or the effector phase should have a profound impact on the allergic cascade. For more than a decade, researchers have focused on ways of interfering with the binding of IgE to its high-affinity receptor on proinflammatory cells. Several approaches have also been taken to antagonize the complex interplay of cytokines and cell-associated molecules (CD40, CD23) that are implicated in IgE synthesis. Recently, anti-IgE antibodies have been developed that are potent IgE antagonists. These antibodies are currently under clinical investigation as potential therapeutics for allergic disease.

Inhibition of human IgE synthesis by anti-IgE antibodies requires divalent recognition

We used a selection of well-characterized murine monoclonal anti-IgE antibodies to investigate their effect on human in vitro IgE synthesis. We found anti-IgE antibodies that either inhibited or enhanced interleukin-4 plus anti-CD40-induced in vitro IgE synthesis in peripheral blood mononuclear cells (PBMC). This differential activity was isotype specific as neither IgM nor IgG synthesis were affected. Interestingly, only coding IgE mRNA was down-regulated, whereas germ-line epsilon RNA expression was not influenced by anti-IgE monoclonal antibody (mAb). On purified B cells all anti-IgE mAb inhibited interleukin-4 plus anti-CD40-induced IgE synthesis, implying a role of non-B cells for the enhancing activity observed in PBMC. Using Fab and F(ab')2 of an inhibitory anti-IgE mAb we could show that divalent recognition was required for inhibition of IgE synthesis.