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Mariette X, Barone F, Baldini C, Bootsma H, Clark KL, De Vita S, Gardner DH, Henderson RB, Herdman M, Lerang K, Mistry P, Punwaney R, Seror R, Stone J, van Daele PL, van Maurik A, Wisniacki N, Roth DA, Tak PP. A randomized, phase II study of sequential belimumab and rituximab in primary Sjögren's syndrome. JCI Insight 2022; 7:163030. [PMID: 36477362 PMCID: PMC9746921 DOI: 10.1172/jci.insight.163030] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUNDPrimary Sjögren's syndrome (pSS) is characterized by B cell hyperactivity and elevated B-lymphocyte stimulator (BLyS). Anti-BLyS treatment (e.g., belimumab) increases peripheral memory B cells; decreases naive, activated, and plasma B cell subsets; and increases stringency on B cell selection during reconstitution. Anti-CD20 therapeutics (e.g., rituximab) bind and deplete CD20-expressing B cells in circulation but are less effective in depleting tissue-resident CD20+ B cells. Combined, these 2 mechanisms may achieve synergistic effects.METHODSThis 68-week, phase II, double-blind study (GSK study 201842) randomized 86 adult patients with active pSS to 1 of 4 arms: placebo, s.c. belimumab, i.v. rituximab, or sequential belimumab + rituximab.RESULTSOverall, 60 patients completed treatment and follow-up until week 68. The incidence of adverse events (AEs) and drug-related AEs was similar across groups. Infections/infestations were the most common AEs, and no serious infections of special interest occurred. Near-complete depletion of minor salivary gland CD20+ B cells and a greater and more sustained depletion of peripheral CD19+ B cells were observed with belimumab + rituximab versus monotherapies. With belimumab + rituximab, reconstitution of peripheral B cells occurred, but it was delayed compared with rituximab. At week 68, mean (± standard error) total EULAR Sjögren's syndrome disease activity index scores decreased from 11.0 (1.17) at baseline to 5.0 (1.27) for belimumab + rituximab and 10.4 (1.36) to 8.6 (1.57) for placebo.CONCLUSIONThe safety profile of belimumab + rituximab in pSS was consistent with the monotherapies. Belimumab + rituximab induced enhanced salivary gland B cell depletion relative to the monotherapies, potentially leading to improved clinical outcomes.TRIAL REGISTRATIONClinicalTrials.gov NCT02631538.FUNDINGFunding was provided by GSK.
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Affiliation(s)
- Xavier Mariette
- Department of Rheumatology, Université Paris-Saclay, Hôpital Bicêtre, Assistance Publique — Hôpitaux de Paris, INSERM UMR1184, Le Kremlin Bicêtre, Paris, France
| | - Francesca Barone
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Chiara Baldini
- Centro Farmacologia Clinica AOUP, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical Area, Azienda Ospedaliera Universitaria di Udine, Udine, Italy
| | - David H. Gardner
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Robert B. Henderson
- Clinical Pharmacology and Experimental Medicine, GSK, Stevenage, Hertfordshire, United Kingdom
| | - Michael Herdman
- Clinical Pharmacology and Experimental Medicine, GSK, Stevenage, Hertfordshire, United Kingdom
| | - Karoline Lerang
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Prafull Mistry
- R&D Biostatistics, GSK, Stevenage, Hertfordshire, United Kingdom
| | - Raj Punwaney
- Pharmaceutical Research and Development, GSK, Collegeville, Pennsylvania, USA
| | - Raphaele Seror
- Department of Rheumatology, Université Paris-Saclay, Hôpital Bicêtre, Assistance Publique — Hôpitaux de Paris, INSERM UMR1184, Le Kremlin Bicêtre, Paris, France
| | - John Stone
- R&D, GSK, Stevenage, Hertfordshire, United Kingdom
| | - Paul L.A. van Daele
- Department of Internal Medicine and Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - André van Maurik
- Clinical Pharmacology and Experimental Medicine, GSK, Stevenage, Hertfordshire, United Kingdom
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Jimenez-Royo P, Bombardieri M, Ciurtin C, Kostapanos M, Tappuni AR, Jordan N, Saleem A, Fuller T, Port K, Pontarini E, Lucchesi D, Janiczek R, Galette P, Searle G, Patel N, Kershaw L, Gray C, Ratia N, van Maurik A, de Groot M, Wisniacki N, Bergstrom M, Tarzi R. Advanced imaging for quantification of abnormalities in the salivary glands of patients with primary Sjögren's syndrome. Rheumatology (Oxford) 2021; 60:2396-2408. [PMID: 33221921 PMCID: PMC8121449 DOI: 10.1093/rheumatology/keaa624] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/21/2020] [Indexed: 12/23/2022] Open
Abstract
Objectives To assess non-invasive imaging for detection and quantification of gland structure, inflammation and function in patients with primary Sjogren's syndrome (pSS) using PET-CT with 11C-Methionine (11C-MET; radiolabelled amino acid), and 18F-fluorodeoxyglucose (18F-FDG; glucose uptake marker), to assess protein synthesis and inflammation, respectively; multiparametric MRI evaluated salivary gland structural and physiological changes. Methods In this imaging/clinical/histology comparative study (GSK study 203818; NCT02899377) patients with pSS and age- and sex-matched healthy volunteers underwent MRI of the salivary glands and 11C-MET PET-CT. Patients also underwent 18F-FDG PET-CT and labial salivary gland biopsies. Clinical and biomarker assessments were performed. Primary endpoints were semi-quantitative parameters of 11C-MET and 18F-FDG uptake in submandibular and parotid salivary glands and quantitative MRI measures of structure and inflammation. Clinical and minor salivary gland histological parameter correlations were explored. Results Twelve patients with pSS and 13 healthy volunteers were included. Lower 11C-MET uptake in parotid, submandibular and lacrimal glands, lower submandibular gland volume, higher MRI fat fraction, and lower pure diffusion in parotid and submandibular glands were observed in patients vs healthy volunteer, consistent with reduced synthetic function. Disease duration correlated positively with fat fraction and negatively with 11C-MET and 18F-FDG uptake, consistent with impaired function, inflammation and fatty replacement over time. Lacrimal gland 11C-MET uptake positively correlated with tear flow in patients, and parotid gland 18F-FDG uptake positively correlated with salivary gland CD20+ B-cell infiltration. Conclusion Molecular imaging and MRI may be useful tools to non-invasively assess loss of glandular function, increased glandular inflammation and fat accumulation in pSS.
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Affiliation(s)
| | - Michele Bombardieri
- Experimental Medicine and Rheumatology, Queen Mary University of London, London
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, University College London, London
| | - Michalis Kostapanos
- GlaxoSmithKline Clinical Unit Cambridge, Cambridge.,Department of Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Anwar R Tappuni
- Institute of Dentistry, Queen Mary University of London, London
| | - Natasha Jordan
- Rheumatology Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - Azeem Saleem
- Invicro, Centre for Imaging Sciences, A Konica Minolta Company, London.,Faculty of Health Sciences, University of Hull, Hull
| | - Teresa Fuller
- Research and Development, GlaxoSmithKline, Stevenage
| | - Kathleen Port
- Research and Development, GlaxoSmithKline, Stevenage
| | - Elena Pontarini
- Experimental Medicine and Rheumatology, Queen Mary University of London, London
| | - Davide Lucchesi
- Experimental Medicine and Rheumatology, Queen Mary University of London, London
| | | | - Paul Galette
- Research and Development, GlaxoSmithKline, Stevenage
| | - Graham Searle
- Invicro, Centre for Imaging Sciences, A Konica Minolta Company, London
| | - Neel Patel
- Research and Development, GlaxoSmithKline, Stevenage
| | - Lucy Kershaw
- Centre for Inflammation Research, University of Edinburgh.,Edinburgh Imaging, University of Edinburgh, Edinburgh
| | - Calum Gray
- Edinburgh Imaging, University of Edinburgh, Edinburgh
| | - Nirav Ratia
- Research and Development, GlaxoSmithKline, Stevenage
| | | | - Marius de Groot
- Research and Development, GlaxoSmithKline, Stevenage.,GlaxoSmithKline Clinical Unit Cambridge, Cambridge
| | | | | | - Ruth Tarzi
- Research and Development, GlaxoSmithKline, Stevenage
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Hillen MR, Urso K, Koppe E, Lopes AP, Blokland SLM, Pandit A, Slocombe T, van Maurik A, van Roon JAG, Radstake TRDJ. Autoantigen TRIM21/Ro52 is expressed on the surface of antigen-presenting cells and its enhanced expression in Sjögren's syndrome is associated with B cell hyperactivity and type I interferon activity. RMD Open 2021; 6:rmdopen-2020-001184. [PMID: 32540951 PMCID: PMC7431915 DOI: 10.1136/rmdopen-2020-001184] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/10/2020] [Accepted: 05/19/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Maarten R Hillen
- Centre for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Katia Urso
- GSK Immunology Network and Adaptive Immunity Research Unit, GlaxoSmithKline, Stevenage, UK
| | - Emma Koppe
- GSK Immunology Network and Adaptive Immunity Research Unit, GlaxoSmithKline, Stevenage, UK
| | - Ana Pinheiro Lopes
- Centre for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sofie L M Blokland
- Centre for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Aridaman Pandit
- Centre for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Tom Slocombe
- GSK Immunology Network and Adaptive Immunity Research Unit, GlaxoSmithKline, Stevenage, UK
| | - André van Maurik
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline, Stevenage, UK
| | - Joel A G van Roon
- Centre for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Timothy R D J Radstake
- Centre for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- GSK Immunology Network and Adaptive Immunity Research Unit, GlaxoSmithKline, Stevenage, UK
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4
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Keymeulen B, van Maurik A, Inman D, Oliveira J, McLaughlin R, Gittelman RM, Roep BO, Gillard P, Hilbrands R, Gorus F, Mathieu C, Van de Velde U, Wisniacki N, Napolitano A. A randomised, single-blind, placebo-controlled, dose-finding safety and tolerability study of the anti-CD3 monoclonal antibody otelixizumab in new-onset type 1 diabetes. Diabetologia 2021; 64:313-324. [PMID: 33145642 PMCID: PMC7801303 DOI: 10.1007/s00125-020-05317-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS Numerous clinical studies have investigated the anti-CD3ɛ monoclonal antibody otelixizumab in individuals with type 1 diabetes, but limited progress has been made in identifying the optimal clinical dose with acceptable tolerability and safety. The aim of this study was to evaluate the association between dose-response, safety and tolerability, beta cell function preservation and the immunological effects of otelixizumab in new-onset type 1 diabetes. METHODS In this randomised, single-blind, placebo-controlled, 24 month study, conducted in five centres in Belgium via the Belgian Diabetes Registry, participants (16-27 years old, <32 days from diagnosis of type 1 diabetes) were scheduled to receive placebo or otelixizumab in one of four dose cohorts (cumulative i.v. dose 9, 18, 27 or 36 mg over 6 days; planned n = 40). Randomisation to treatment was by a central computer system; only participants and bedside study personnel were blinded to study treatment. The co-primary endpoints were the incidence of adverse events, the rate of Epstein-Barr virus (EBV) reactivation, and laboratory measures and vital signs. A mixed-meal tolerance test was used to assess beta cell function; exploratory biomarkers were used to measure T cell responses. RESULTS Thirty participants were randomised/28 were analysed (placebo, n = 6/5; otelixizumab 9 mg, n = 9/8; otelixizumab 18 mg, n = 8/8; otelixizumab 27 mg, n = 7/7; otelixizumab 36 mg, n = 0). Dosing was stopped at otelixizumab 27 mg as the predefined EBV reactivation stopping criteria were met. Adverse event frequency and severity were dose dependent; all participants on otelixizumab experienced at least one adverse event related to cytokine release syndrome during the dosing period. EBV reactivation (otelixizumab 9 mg, n = 2/9; 18 mg, n = 4/8: 27 mg, n = 5/7) and clinical manifestations (otelixizumab 9 mg, n = 0/9; 18 mg, n = 1/8; 27 mg, n = 3/7) were rapid, dose dependent and transient, and were associated with increased productive T cell clonality that diminished over time. Change from baseline mixed-meal tolerance test C-peptide weighted mean AUC0-120 min following otelixizumab 9 mg was above baseline for up to 18 months (difference from placebo 0.39 [95% CI 0.06, 0.72]; p = 0.023); no beta cell function preservation was observed at otelixizumab 18 and 27 mg. CONCLUSIONS/INTERPRETATION A metabolic response was observed with otelixizumab 9 mg, while doses higher than 18 mg increased the risk of unwanted clinical EBV reactivation. Although otelixizumab can temporarily compromise immunocompetence, allowing EBV to reactivate, the effect is dose dependent and transient, as evidenced by a rapid emergence of EBV-specific T cells preceding long-term control over EBV reactivation. TRIAL REGISTRATION ClinicalTrials.gov NCT02000817. FUNDING The study was funded by GlaxoSmithKline. Graphical abstract.
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Affiliation(s)
- Bart Keymeulen
- Academic Hospital and Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium.
- Belgian Diabetes Registry, Brussels, Belgium.
| | | | - Dave Inman
- GlaxoSmithKline Medicines Research Centre, Stevenage, UK
| | - João Oliveira
- GlaxoSmithKline, Global Clinical Operations, Cambridge, UK
| | - Rene McLaughlin
- Department of Immunology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Bart O Roep
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Department of Diabetes Immunology, Diabetes & Metabolism Research Institute, Beckman Research Institute at the City of Hope, Duarte, CA, USA
| | - Pieter Gillard
- Department of Endocrinology, University Hospitals Leuven-KUL, Leuven, Belgium
| | - Robert Hilbrands
- Academic Hospital and Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
- Belgian Diabetes Registry, Brussels, Belgium
| | - Frans Gorus
- Academic Hospital and Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
- Belgian Diabetes Registry, Brussels, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven-KUL, Leuven, Belgium
| | - Ursule Van de Velde
- Academic Hospital and Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
- Belgian Diabetes Registry, Brussels, Belgium
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Blokland SLM, van Vliet-Moret FM, Hillen MR, Pandit A, Goldschmeding R, Kruize AA, Bouma G, van Maurik A, Olek S, Hoffmueller U, van Roon JAG, Radstake TRDJ. Epigenetically quantified immune cells in salivary glands of Sjögren's syndrome patients: a novel tool that detects robust correlations of T follicular helper cells with immunopathology. Rheumatology (Oxford) 2020; 59:335-343. [PMID: 31325310 PMCID: PMC7032543 DOI: 10.1093/rheumatology/kez268] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/22/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To investigate whether epigenetic cell counting represents a novel method to quantify immune cells in salivary glands of patients with different forms of Sjögren's and sicca syndrome and to capture immunopathology and potentially aid in diagnosis. METHODS DNA from frozen salivary gland tissue sections of sicca patients was used for bisulphite conversion of demethylated DNA cytosine residues, followed by cell-specific quantitative PCR to calculate cell percentages in relation to total tissue cell numbers as quantified by housekeeping gene demethylation. The percentages of epigenetically quantified cells were correlated to RNA expression of matched salivary gland tissue and histological and clinical parameters. RESULTS The percentages of epigenetically quantified CD3, CD4, CD8, T follicular helper (Tfh) cells, FoxP3+ regulatory T cells and B cells were significantly increased in the salivary glands of patients with SS. Unsupervised clustering using these percentages identified patient subsets with an increased lymphocytic focus score and local B cell hyperactivity and classifies patients different from conventional classification criteria. In particular, Tfh cells were shown to strongly correlate with the expression of CXCL13, lymphocytic focus scores, local B cell hyperactivity and anti-SSA positivity. CONCLUSION Epigenetic cell counting is a promising novel tool to objectively and easily quantify immune cells in the labial salivary gland of sicca patients, with a relatively small amount of tissue needed. In view of the potential of this technique to include a huge number of (cell-specific) biomarkers, this opens up new standardized ways of salivary gland analysis with high relevance for patient classification, understanding of immunopathology and monitoring of drug responses in clinical trials.
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Affiliation(s)
- Sofie L M Blokland
- Department of Immunology, Laboratory of Translational Immunology, Utrecht University, Utrecht, The Netherlands.,Department of Rheumatology & Clinical Immunology, Utrecht University, Utrecht, The Netherlands
| | - Fréderique M van Vliet-Moret
- Department of Immunology, Laboratory of Translational Immunology, Utrecht University, Utrecht, The Netherlands.,Department of Rheumatology & Clinical Immunology, Utrecht University, Utrecht, The Netherlands
| | - Maarten R Hillen
- Department of Immunology, Laboratory of Translational Immunology, Utrecht University, Utrecht, The Netherlands.,Department of Rheumatology & Clinical Immunology, Utrecht University, Utrecht, The Netherlands
| | - Aridaman Pandit
- Department of Immunology, Laboratory of Translational Immunology, Utrecht University, Utrecht, The Netherlands.,Department of Rheumatology & Clinical Immunology, Utrecht University, Utrecht, The Netherlands
| | - Roel Goldschmeding
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Aike A Kruize
- Department of Rheumatology & Clinical Immunology, Utrecht University, Utrecht, The Netherlands
| | - Gerben Bouma
- Immunoinflammation TAU, GlaxoSmithKline, Stevenage, UK
| | | | | | | | - Joel A G van Roon
- Department of Immunology, Laboratory of Translational Immunology, Utrecht University, Utrecht, The Netherlands.,Department of Rheumatology & Clinical Immunology, Utrecht University, Utrecht, The Netherlands
| | - Timothy R D J Radstake
- Department of Immunology, Laboratory of Translational Immunology, Utrecht University, Utrecht, The Netherlands.,Department of Rheumatology & Clinical Immunology, Utrecht University, Utrecht, The Netherlands
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6
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Ellis SDP, McGovern JL, van Maurik A, Howe D, Ehrenstein MR, Notley CA. Induced CD8+FoxP3+ Treg cells in rheumatoid arthritis are modulated by p38 phosphorylation and monocytes expressing membrane tumor necrosis factor α and CD86. Arthritis Rheumatol 2014; 66:2694-705. [PMID: 24980778 DOI: 10.1002/art.38761] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 06/24/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Limiting the severity of inflammation and promoting its eventual resolution are vital for protecting host tissues both in autoimmunity and chronic infection. The aim of this study was to determine the suitability of repurposing anti-CD3 monoclonal antibody (mAb) therapy for rheumatoid arthritis (RA) by analyzing its ability to induce CD8+FoxP3+ Treg cells from peripheral blood mononuclear cells (PBMCs). METHODS Anti-CD3 mAb was cultured with RA PBMCs to induce CD8+FoxP3+ Treg cells, which were analyzed by flow cytometry to determine their phenotype. Treg cell induction was investigated via neutralization or blocking antibodies, cellular depletion, or ImageStream technology. Blotting was used to determine the signaling pathways involved in CD8+FoxP3+ Treg cell induction. Suppression of CD4+ T cell effector responses was assessed by Treg cell suppression assays and Mosaic enzyme-linked immunosorbent assay. RESULTS Potent CD8+FoxP3+ Treg cells were induced from RA PBMCs by anti-CD3 mAb. Unlike their CD4+ counterparts, CD8+FoxP3+ Treg cells inhibited Th17 responses in a contact-dependent manner, thereby functioning to limit a wider range of inflammatory pathways. CD8+FoxP3+ Treg cell induction was supported both by p38 phosphorylation intrinsic to naive CD8+ T cells and by monocytes via CD86 and membrane tumor necrosis factor α (TNFα). Artificially increasing monocyte membrane TNFα or inhibiting CD8+ T cell p38 phosphorylation drove FoxP3 expression in a subset of initially unresponsive CD8+ T cells. CONCLUSION These data define an unknown mechanism of CD8+FoxP3+ Treg cell induction by anti-CD3 mAb, which could be combined with a p38 inhibitor to improve therapeutic efficacy in RA patients and resolve chronic inflammation via the restoration of tolerance.
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Vossenkämper A, Hundsrucker C, Page K, van Maurik A, Sanders TJ, Stagg AJ, Das L, MacDonald TT. A CD3-specific antibody reduces cytokine production and alters phosphoprotein profiles in intestinal tissues from patients with inflammatory bowel disease. Gastroenterology 2014; 147:172-83. [PMID: 24704524 DOI: 10.1053/j.gastro.2014.03.049] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS T cells mediate the development of inflammation in inflammatory bowel disease (IBD). We investigated the effects of an antibody against CD3 called otelixizumab, which induces immune tolerance, in intestinal mucosa samples from patients. METHODS Intestinal tissues were isolated from patients undergoing routine endoscopy or from patients undergoing intestinal surgery for colon cancer or IBD; healthy surrounding tissues were collected as controls. Isolated lamina propria mononuclear cells (LPMCs) and mucosal tissue explants were incubated with otelixizumab for 24 or 48 hours. Production of inflammatory cytokines was determined by enzyme-linked immunosorbent assay. Levels of 36 cytokines and chemokines and phosphorylation of 39 receptor tyrosine kinases and signaling molecules were measured using protein arrays. Immunoblot analysis was used to analyze T-cell transcription factors. RESULTS Incubation of intestinal tissues or LPMCs with otelixizumab reduced production of interferon gamma, interleukin (IL)-17A, and other inflammatory cytokines and chemokines, simultaneously increasing production of IL-10. Mucosal biopsy specimens from patients with IBD retained inflammation-associated tyrosine phosphoprotein profiles ex vivo. Incubation of the inflamed tissue with otelixizumab reduced phosphorylation of these proteins to levels observed in control tissues. Otelixizumab also markedly reduced phosphorylation of proteins associated with T-cell receptor activation. Neutralization of IL-10 blocked the anti-inflammatory effects of otelixizumab. CONCLUSIONS We observed anti-inflammatory effects of anti-CD3 in inflamed intestinal tissues from patients with IBD. The antibody appears to down-regulate T-cell activation via IL-10.
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Affiliation(s)
- Anna Vossenkämper
- Centre for Immunology and Infectious Disease, Barts and The London School of Medicine and Dentistry, Blizard Institute, London, England.
| | - Christian Hundsrucker
- Institute for Functional Genomics, Computational Diagnostics Group, University of Regensburg, Regensburg, Germany
| | - Kevin Page
- GlaxoSmithKline, Pharmaceuticals R&D Facility, Stevenage, Hertfordshire, England
| | - André van Maurik
- GlaxoSmithKline, Pharmaceuticals R&D Facility, Stevenage, Hertfordshire, England
| | - Theodore J Sanders
- Centre for Immunology and Infectious Disease, Barts and The London School of Medicine and Dentistry, Blizard Institute, London, England
| | - Andrew J Stagg
- Centre for Immunology and Infectious Disease, Barts and The London School of Medicine and Dentistry, Blizard Institute, London, England
| | - Lisa Das
- Centre for Digestive Diseases, Barts and The London School of Medicine and Dentistry, Blizard Institute, London, England
| | - Thomas T MacDonald
- Centre for Immunology and Infectious Disease, Barts and The London School of Medicine and Dentistry, Blizard Institute, London, England
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Li L, Nishio J, van Maurik A, Mathis D, Benoist C. Differential response of regulatory and conventional CD4⁺ lymphocytes to CD3 engagement: clues to a possible mechanism of anti-CD3 action? J Immunol 2013; 191:3694-704. [PMID: 23986534 PMCID: PMC3932531 DOI: 10.4049/jimmunol.1300408] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Several clinical trials have shown anti-CD3 treatment to be a promising therapy for autoimmune diabetes, but its mechanism of action remains unclear. Foxp3(+) regulatory T cells (Tregs) are likely to be involved, but through unknown mechanistic pathways. We profiled the transcriptional consequences in CD4(+) Tregs and conventional T cells (Tconvs) in the first hours and days after anti-CD3 treatment of NOD mice. Anti-CD3 treatment led to a transient transcriptional response, terminating faster than most Ag-induced responses. Most transcripts were similarly induced in Tregs and Tconvs, but several were differential, in particular, those encoding the IL-7R and transcription factors Id2/3 and Gfi1, upregulated in Tregs but repressed in Tconvs. Because IL-7R was a plausible candidate for driving the homeostatic response of Tregs to anti-CD3, we tested its relevance by supplementation of anti-CD3 treatment with IL-7/anti-IL-7 complexes. Although ineffective alone, IL-7 significantly improved the rate of remission induced by anti-CD3. Four anti-human CD3 mAbs exhibited the same differential effect on IL-7R expression in human as in mouse cells, suggesting that the mechanism also underlies therapeutic effect in human cells, and perhaps a rationale for testing a combination of anti-CD3 and IL-7 for the treatment of recent-onset human type 1 diabetes. Thus, systems-level analysis of the response to anti-CD3 in the early phase of the treatment demonstrates different responses in Tregs and Tconvs, and provides new leads to a mechanistic understanding of its mechanism of action in reverting recent-onset diabetes.
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MESH Headings
- Animals
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/metabolism
- Antibodies, Monoclonal/pharmacology
- CD3 Complex/immunology
- CD3 Complex/metabolism
- CD4-Positive T-Lymphocytes/drug effects
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/metabolism
- Cells, Cultured
- Drug Synergism
- Gene Expression Regulation/drug effects
- Humans
- Interleukin-7/pharmacology
- Mice
- Mice, Transgenic
- Protein Binding
- Receptors, Interleukin-7/genetics
- Receptors, Interleukin-7/metabolism
- T-Lymphocytes, Regulatory/drug effects
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/metabolism
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Affiliation(s)
- Li Li
- Division of Immunology, Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Junko Nishio
- Division of Immunology, Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA 02115, USA
| | - André van Maurik
- Immuno Inflammation, GlaxoSmithKline, Stevenage, SG1 2NY, United Kingdom
| | - Diane Mathis
- Division of Immunology, Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA 02115, USA
| | - Christophe Benoist
- Division of Immunology, Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA 02115, USA
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Sabarth N, Howard MK, Savidis-Dacho H, van Maurik A, Barrett PN, Kistner O. Comparison of single, homologous prime-boost and heterologous prime-boost immunization strategies against H5N1 influenza virus in a mouse challenge model. Vaccine 2010; 28:650-6. [DOI: 10.1016/j.vaccine.2009.10.105] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 10/14/2009] [Accepted: 10/19/2009] [Indexed: 11/29/2022]
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10
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van Maurik A, Sabarth N, Dacho HS, Brühl P, Schwendinger M, Crowe BA, Noel Barrett P, Kistner O, Keith Howard M. Seasonal influenza vaccine elicits heterosubtypic immunity against H5N1 that can be further boosted by H5N1 vaccination. Vaccine 2009; 28:1778-85. [PMID: 20018265 DOI: 10.1016/j.vaccine.2009.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 11/26/2009] [Accepted: 12/02/2009] [Indexed: 11/30/2022]
Abstract
Recent findings indicate that seasonal influenza vaccination or infection of healthy humans may contribute to heterosubtypic immunity against new influenza A subtypes, such as H5N1. Here, we investigated whether seasonal influenza vaccination in a mouse model could induce any immunity against the H5N1 subtype. It could be demonstrated that, largely due to the H1N1 component strain A/NewCaledonia/20/99, parenteral immunization of mice with a trivalent seasonal influenza vaccine elicited heterosubtype H5-reactive antibodies able to confer partial protection against H5N1 influenza virus infection. Furthermore, the trivalent seasonal influenza vaccine was found to be compatible with a whole virus H5N1 vaccine in a heterologous prime-boost immunization regimen, achieving superior efficacy compared to a single immunization with an equivalent low-dose of the H5N1 vaccine.
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Affiliation(s)
- André van Maurik
- Baxter Bioscience, Biomedical Research Centre, A-2304, Uferstrasse 15, Orth/Donau, Austria
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