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Menezes SM, Decanine D, Brassat D, Khouri R, Schnitman SV, Kruschewsky R, López G, Alvarez C, Talledo M, Gotuzzo E, Vandamme AM, Galvão-Castro B, Liblau R, Weyenbergh JV. CD80+ and CD86+ B cells as biomarkers and possible therapeutic targets in HTLV-1 associated myelopathy/tropical spastic paraparesis and multiple sclerosis. J Neuroinflammation 2014; 11:18. [PMID: 24472094 PMCID: PMC3922160 DOI: 10.1186/1742-2094-11-18] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 01/13/2014] [Indexed: 01/14/2023] Open
Abstract
Background Human T-cell lymphotropic virus (HTLV-1) is the causative agent of the incapacitating, neuroinflammatory disease HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Currently, there are no disease-modifying therapies with long-term clinical benefits or validated biomarkers for clinical follow-up in HAM/TSP. Although CD80 and CD86 costimulatory molecules play prominent roles in immune regulation and reflect disease status in multiple sclerosis (MS), data in HAM/TSP are lacking. Methods Using flow cytometry, we quantified ex vivo and in vitro expression of CD80 and CD86 in PBMCs of healthy controls, HTLV-1-infected individuals with and without HAM/TSP, and MS patients. We hypothesized ex vivo CD80 and CD86 expressions and their in vitro regulation by interferon (IFN)-α/β mirror similarities between HAM/TSP and MS and hence might reveal clinically useful biomarkers in HAM/TSP. Results Ex vivo expression of CD80 and CD86 in T and B cells increased in all HTLV-1 infected individuals, but with a selective defect for B cell CD86 upregulation in HAM/TSP. Despite decreased total B cells with increasing disease duration (p = 0.0003, r = −0.72), CD80+ B cells positively correlated with disease severity (p = 0.0017, r = 0.69) in HAM/TSP. B cell CD80 expression was higher in women with HAM/TSP, underscoring that immune markers can reflect the female predominance observed in most autoimmune diseases. In contrast to MS patients, CD80+ (p = 0.0001) and CD86+ (p = 0.0054) lymphocytes expanded upon in vitro culture in HAM/TSP patients. The expansion of CD80+ and CD86+ T cells but not B cells was associated with increased proliferation in HTLV-1 infection. In vitro treatment with IFN-β but not IFN-α resulted in a pronounced increase of B cell CD86 expression in healthy controls, as well as in patients with neuroinflammatory disease (HAM/TSP and MS), similar to in vivo treatment in MS. Conclusions We propose two novel biomarkers, ex vivo CD80+ B cells positively correlating to disease severity and CD86+ B cells preferentially induced by IFN-β, which restores defective upregulation in HAM/TSP. This study suggests a role for B cells in HAM/TSP pathogenesis and opens avenues to B cell targeting (with proven clinical benefit in MS) in HAM/TSP but also CD80-directed immunotherapy, unprecedented in both HAM/TSP and MS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Johan Van Weyenbergh
- Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.
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Hartung HP, Haas J, Meergans M, Tracik F, Ortler S. [Interferon-β1b in multiple sclerosis therapy: more than 20 years clinical experience]. DER NERVENARZT 2013; 84:679-704. [PMID: 23669866 DOI: 10.1007/s00115-013-3781-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The introduction of interferon-β1b in 1993 in the USA and 2 years later in Europe made it possible for the first time to alter the course of the disease in patients with relapsing-remitting multiple sclerosis (MS). Subsequently, interferon-β1b was approved for the treatment of patients with active secondary progressive MS (1999) and early relapsing-remitting MS following a first demyelinating event (clinically isolated syndrome, CIS) (2006). Here we provide an overview of the clinical experience gathered during more than 20 years of interferon-β use focusing on long-term efficacy and safety and the impact of early initiation of treatment. Furthermore, the following aspects will be discussed: putative mechanisms of action of interferon-β, indications for a disease-modifying therapy, clinical relevance of neutralizing antibodies, importance of adherence in MS therapy, high versus low frequency therapy, combination therapies with interferon-β and safety of interferon-β in children and adolescents with MS and during pregnancy.
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Affiliation(s)
- H-P Hartung
- Neurologische Klinik im UKD, Medizinische Fakultät, Heinrich-Heine Universität, Moorenstr. 5, 40225 Düsseldorf, Deutschland.
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López-Gómez C, Pino-Ángeles A, Órpez-Zafra T, Pinto-Medel MJ, Oliver-Martos B, Ortega-Pinazo J, Arnáiz C, Guijarro-Castro C, Varadé J, Álvarez-Lafuente R, Urcelay E, Sánchez-Jiménez F, Fernández Ó, Leyva L. Candidate gene study of TRAIL and TRAIL receptors: association with response to interferon beta therapy in multiple sclerosis patients. PLoS One 2013; 8:e62540. [PMID: 23658636 PMCID: PMC3639207 DOI: 10.1371/journal.pone.0062540] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 03/22/2013] [Indexed: 12/31/2022] Open
Abstract
TRAIL and TRAIL Receptor genes have been implicated in Multiple Sclerosis pathology as well as in the response to IFN beta therapy. The objective of our study was to evaluate the association of these genes in relation to the age at disease onset (AAO) and to the clinical response upon IFN beta treatment in Spanish MS patients. We carried out a candidate gene study of TRAIL, TRAILR-1, TRAILR-2, TRAILR-3 and TRAILR-4 genes. A total of 54 SNPs were analysed in 509 MS patients under IFN beta treatment, and an additional cohort of 226 MS patients was used to validate the results. Associations of rs1047275 in TRAILR-2 and rs7011559 in TRAILR-4 genes with AAO under an additive model did not withstand Bonferroni correction. In contrast, patients with the TRAILR-1 rs20576-CC genotype showed a better clinical response to IFN beta therapy compared with patients carrying the A-allele (recessive model: p = 8.88×10−4, pc = 0.048, OR = 0.30). This SNP resulted in a non synonymous substitution of Glutamic acid to Alanine in position 228 (E228A), a change previously associated with susceptibility to different cancer types and risk of metastases, suggesting a lack of functionality of TRAILR-1. In order to unravel how this amino acid change in TRAILR-1 would affect to death signal, we performed a molecular modelling with both alleles. Neither TRAIL binding sites in the receptor nor the expression levels of TRAILR-1 in peripheral blood mononuclear cell subsets (monocytes, CD4+ and CD8+ T cells) were modified, suggesting that this SNP may be altering the death signal by some other mechanism. These findings show a role for TRAILR-1 gene variations in the clinical outcome of IFN beta therapy that might have relevance as a biomarker to predict the response to IFN beta in MS.
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Affiliation(s)
- Carlos López-Gómez
- Research Laboratory. Clinical Neurosciences Institute, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Almudena Pino-Ángeles
- Department of Molecular Biology and Biochemistry, University of Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Málaga, Spain
| | - Teresa Órpez-Zafra
- Research Laboratory. Clinical Neurosciences Institute, Hospital Regional Universitario Carlos Haya, Málaga, Spain
- Red Española de Esclerosis Múltiple (REEM RD 07/0060), Málaga, Spain
| | - María Jesús Pinto-Medel
- Research Laboratory. Clinical Neurosciences Institute, Hospital Regional Universitario Carlos Haya, Málaga, Spain
- Red Española de Esclerosis Múltiple (REEM RD 07/0060), Málaga, Spain
| | - Begoña Oliver-Martos
- Research Laboratory. Clinical Neurosciences Institute, Hospital Regional Universitario Carlos Haya, Málaga, Spain
- Red Española de Esclerosis Múltiple (REEM RD 07/0060), Málaga, Spain
| | - Jesús Ortega-Pinazo
- Research Laboratory. Clinical Neurosciences Institute, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Carlos Arnáiz
- Department of Neurology. Clinical Neurosciences Institute, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Cristina Guijarro-Castro
- Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Red Española de Esclerosis Múltiple (REEM RD 07/0060), Málaga, Spain
| | - Jezabel Varadé
- Multiple Sclerosis Unit, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Red Española de Esclerosis Múltiple (REEM RD 07/0060), Málaga, Spain
| | - Roberto Álvarez-Lafuente
- Multiple Sclerosis Unit, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Red Española de Esclerosis Múltiple (REEM RD 07/0060), Málaga, Spain
| | - Elena Urcelay
- Multiple Sclerosis Unit, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
- Red Española de Esclerosis Múltiple (REEM RD 07/0060), Málaga, Spain
| | - Francisca Sánchez-Jiménez
- Department of Molecular Biology and Biochemistry, University of Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Málaga, Spain
| | - Óscar Fernández
- Department of Neurology. Clinical Neurosciences Institute, Hospital Regional Universitario Carlos Haya, Málaga, Spain
- Red Española de Esclerosis Múltiple (REEM RD 07/0060), Málaga, Spain
| | - Laura Leyva
- Research Laboratory. Clinical Neurosciences Institute, Hospital Regional Universitario Carlos Haya, Málaga, Spain
- Red Española de Esclerosis Múltiple (REEM RD 07/0060), Málaga, Spain
- * E-mail:
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Abstract
Interferon-β-1b has been used as a disease-modifying therapy in multiple sclerosis (MS) for many years. Although its mechanism of action in MS has not been fully elucidated, it appears to involve immunomodulatory effects mediated by interactions with specific receptors. Large, randomized, multicentre, clinical trials of 2-3.5 years' duration have demonstrated the efficacy of interferon-β-1b 250 μg subcutaneously every other day in patients with a first clinical event suggestive of MS (i.e. those with clinically isolated syndrome [CIS]) and in those with relapsing-remitting MS (RRMS). In terms of its efficacy on primary (or co-primary) endpoints, interferon-β-1b significantly reduced the risk of developing clinically definite MS compared with placebo in patients with CIS in the BENEFIT study. In patients with RRMS, interferon-β-1b was associated with a significantly lower annualized relapse rate and a significantly higher proportion of relapse-free patients compared with placebo in a registration trial conducted by the Interferon-β MS Study Group. The INCOMIN trial in patients with RRMS showed a significant advantage of interferon-β-1b over intramuscular interferon-β-1a in terms of the percentage of relapse- and progression-free patients and the proportion of patients without new MRI-documented lesions. Other active-comparator trials in RRMS used a variety of primary (or co-primary) endpoints and showed no significant differences between interferon-β-1b and either subcutaneous glatiramer acetate (BECOME and BEYOND trials) or subcutaneous interferon-β-1a (Danish MS Group trial) for these outcomes. In patients with secondary progressive MS (SPMS), the European Study Group showed that interferon-β-1b significantly increased the time to confirmed disease progression compared with placebo, although there was no significant between-group difference for this primary endpoint in a similar trial conducted by the North American Study Group. The studies allowed inclusion of patients with superimposed relapse, and both trials showed a significant reduction in annualized relapse rate with interferon-β-1b. The most frequently reported adverse events with interferon-β-1b are flu-like symptoms and injection-site reactions, which can usually be managed. The incidence of these adverse events generally declines markedly after the first year of treatment. Lymphopenia is the most frequently reported laboratory abnormality and occurs in the majority of patients. Depression, suicidal ideation and injection-site necrosis were the most serious adverse events reported with interferon-β-1b in clinical trials. Long-term safety data over a 16-year follow-up period showed no unexpected adverse events among patients treated with interferon-β-1b. Thus, interferon-β-1b is a well established, first-line, disease-modifying therapy that has demonstrated efficacy in newly emerging MS, RRMS and SPMS with superimposed relapse in well designed clinical trials, and has a generally manageable tolerability profile, with no unexpected adverse events after many years of follow-up.
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