Regulatory T cells in rheumatoid arthritis : contributions from different functional subsets

Rheumatoid arthritis (RA) is a complex and multifactorial disease characterized by chronic joint inflammation and tissue destruction, which can affect all ethnic groups with a prevalence of 0.5-1%. FOXP3+ regulatory T cells (Treg cells) are crucial for the maintenance of self-tolerance and loss of function or reduced frequencies have been implicated in chronic inflammatory and autoimmune diseases. In patients with inflammatory arthritis including RA, Treg cells are significantly enriched at the site of inflammation compared with levels in the circulation, and are further functional in suppressing autologous effector T cells from both peripheral blood and joint origin. Given the accumulation of functional Treg cells in the rheumatic joint, an unresolved question is why local inflammation processes persist in a chronic way. In this thesis, we investigated the presence, frequency and functionality of different Treg-cell subsets in patients with inflammatory arthritis, and further studied the impact of commonly used treatment regimes on the suppressive capacity of Treg cells. We could show that synovial FOXP3+ Treg cells were increased in frequency compared with peripheral blood, displayed a high degree of FOXP3 demethylation and a low capacity of secreting pro-inflammatory cytokines upon stimulation. Moreover, the activation status of effector T cells and locally produced pro-inflammatory cytokines reduced regulatory Treg cell function in vitro and presumably in the rheumatic joint. Furthermore, expression of CD39, an ecto-nucleotidase, which together with CD73 generates anti-inflammatory adenosine, was significantly increased on synovial FOXP3+ Treg cells. Such FOXP3+CD39+ Treg cells did not produce pro-inflammatory cytokines and were good suppressors of several effector T-cell functions including secretion of IFN-γ and TNF, but did not limit IL-17A, a cytokine implicated in RA pathogenesis. Additional investigations of FOXP3+ Treg cells in the context of Helios, a suggested marker of thymus-derived Treg cells, revealed that synovial Helios+FOXP3+ T cells were abundant in the joint, displayed a more classical Treg-cell phenotype with regard to expression of surface markers and cytokine secretion capacity compared with Helios-FOXP3+ T cells. Finally, biologicals commonly used for the treatment of RA were shown to have profound effects on Treg-cell function, however by different mechanisms. Blocking of IL-6 and TNF by tocilizumab or adalimumab increased suppressive capacity of synovial Treg cells. Abatacept, in contrast, had no beneficial effect on Treg-cell function, but due to its mutual effect on effector and regulatory T cells, the inflammatory pressure in the joint could still be alleviated. In summary, our data suggest that joint-derived Treg cells in general are not impaired in their function and rather the inflammatory pressure needs to be reduced to allow for optimal Treg-cell functionality. Further, this work emphasizes the importance of dissecting synovial Treg-cell subsets to gain a better understanding on how Treg cells could be targeted for the treatment of chronic arthritis. ::doi::10.1002/eji.201041004. ::pmid::21607944 ::isi::00029326430001

CTLA4-Ig (abatacept) therapy modulates T cell effector functions in autoantibody-positive rheumatoid arthritis patients

Rheumatoid arthritis is a chronic inflammatory disease with a strong MHC class II component and where many patients develop characteristic autoantibodies towards the noncoding amino acid citrulline. Such anti-citrullinated protein antibodies (ACPA) have recently been put forward as an independent predictive factor for treatment response by co-stimulation blockade by CTLA4-Ig (abatacept). We have performed a mechanism of action study to dissect T cell functionality in RA patients with long-standing disease undergoing abatacept treatment and the influence of ACPA status. Peripheral blood samples were collected from RA patients as they started CTLA4-Ig treatment and 3 and 6 months later. A general decrease of regulatory T cell subsets was observed in the cohort. Additionally within the ACPA-positive group significant down-regulation of all key T cell effector subsets including Th1, Th2, and Th17 was observed by analyzing cytokines by intracellular flow cytometry and in cell culture supernatants.RA synovial fluid samples were cultured in vitro in the presence or absence of CTLA4-Ig (abatacept). T cell cytokine production was diminished, but without increasing the functional capacity of CD4+CD25hi regulatory T cells as previously demonstrated in the context of TNF-blockade and anti-IL6R therapy. Our immunological study of T cell functionality in RA patients, both ACPA-positive and ACPA-negative starting biological therapy with the co-stimulation blockade abatacept (CTLA4-Ig) supports the recently published registry study implicating ACPA seropositivity as an independent predictive factor to treatment response as we observed the most striking effect on T cell subset modulation in ACPA-positive patients. These data further support the notion of RA as a disease with several sub-entities, where the ACPA-positive fraction represents a classical HLA-associated autoimmune disorder while ACPA-negative patients may have other driving forces apart from classical adaptive immune response

Heterogeneity and Lobularity of Pancreatic Pathology in Type 1 Diabetes during the Prediabetic Phase

Type 1 diabetes (T1D) is an autoimmune disease in which insulin-producing beta cells are destroyed in the islets of Langerhans. One of its main pathological manifestations is the hyper-expression of Major Histocompatibility Complex I (MHC-I) by beta cells, which was first described over 3 decades ago yet its cause remains unknown. It might not only be a sign of beta cell dysfunction but could also render the cells susceptible to autoimmune destruction; for example, by islet-infiltrating CD8 T cells. In this report, we studied pancreas tissue from a 22-year-old non-diabetic male cadaveric organ donor who had been at high risk of developing T1D, in which autoantibodies against GAD and IA-2 were detected. Pancreas sections were analyzed for signs of inflammation. Multiple insulin-containing islets were identified, which hyper-expressed MHC-I. However, islet density and MHC-I expression exhibited a highly lobular and heterogeneous pattern even within the same section. In addition, many islets with high expression of MHC-I presented higher levels of CD8 T cell infiltration than normal islets. These results demonstrate the heterogeneity of human pathology that occurs early during the pre-diabetic, autoantibody positive phase, and should contribute to the understanding of human T1D