Incomplete response of infl ammatory arthritis to blockade is associated with the Th17 pathway

Saba Alzabin, Sonya M. Abraham, Taher E. Taher, Andrew Palfreeman, Dobrina Hull, Kay McNamee, Ali Jawad, Ejaz Pathan, Anne Kinderlerer, Peter C. Taylor, Richard Williams, Rizgar Mageed

Research output: Contribution to journalArticlepeer-review

134 Scopus citations

Abstract

Objectives: To establish if changes in Th1/Th17 cell populations previously reported in experimental arthritis occur in patients with rheumatoid arthritis (RA) treated with anti-tumour necrosis factor α (TNFα) agents, and whether the therapeutic response to anti-TNFα is compromised in patients and mice because of elevated Th17/IL-17 levels. Finally, to assess the efficacy of combined blockade of anti-TNFα and anti-IL-17 in experimental arthritis. Methods: A longitudinal study of two independent cohorts (cohort 1, n=24; cohort 2, n=19) of patients with RA treated with anti-TNFα biological agents was carried out to assess their Th17/IL-17 levels before and after the start of anti-TNFá therapy. IL-12/23p40 production was assessed in plasma Peripheral blood lymphocytes (PBLs) and monocytes. Mice with collagen-induced arthritis (CIA) were treated with anti-TNFα alone, anti-IL17 alone or a combination of the two. Efficacy of treatment and response was assessed from changes in Disease Activity Score 28-erythrocyte sedimentation rate scores in patients, and in clinical scores and histological analysis in CIA. Results: Significant increases in circulating Th17 cells were observed in patients after anti-TNFα therapy and this was accompanied by increased production of IL-12/23p40. There was an inverse relationship between baseline Th17 levels and the subsequent response of patients with RA to anti-TNFα therapy. In addition, PBLs from non-responder patients showed evidence of increased IL-17 production. Similarly, in anti-TNFα-treated mice, there was a strong correlation between IL-17 production and clinical score. Finally combined blockade of TNFα and IL-17 in CIA was more effective than monotherapy, particularly with respect to the duration of the therapeutic effect. Conclusions: These findings, which need to be confirmed in a larger cohort, suggest that a Th17-targeted therapeutic approach may be useful for anti-TNFα nonresponder patients or as an adjunct to anti-TNFα therapy, provided that safety concerns can be addressed.

Original languageEnglish
Pages (from-to)1741-1748
Number of pages8
JournalAnnals of the Rheumatic Diseases
Volume71
Issue number10
DOIs
StatePublished - Oct 2012
Externally publishedYes

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