Sheldon M. Cooper

Germline Mutations in the Extracellular Domains of the 55 kDa TNF Receptor, TNFR1, Define a Family of Dominantly Inherited Autoinflammatory Syndromes

Autosomal dominant periodic fever syndromes are characterized by unexplained episodes of fever and severe localized inflammation. In seven affected families, we found six different missense mutations of the 55 kDa tumor necrosis factor receptor (TNFR1), five of which disrupt conserved extracellular disulfide bonds. Soluble plasma TNFR1 levels in patients were approximately half normal. Leukocytes bearing a C52F mutation showed increased membrane TNFR1 and reduced receptor cleavage following stimulation. We propose that the autoinflammatory phenotype results from impaired downregulation of membrane TNFR1 and diminished shedding of potentially antagonistic soluble receptor. TNFR1-associated periodic syndromes (TRAPS) establish an important class of mutations in TNF receptors. Detailed analysis of one such mutation suggests impaired cytokine receptor clearance as a novel mechanism of disease.

Interleukin-6 receptor blockade selectively reduces IL-21 production by CD4 T cells and IgG4 autoantibodies in rheumatoid arthritis.

Interleukin-6 (IL-6) levels are known to be increased in patients with rheumatoid arthritis (RA). Tocilizumab, a monoclonal antibody to the IL-6 receptor (IL-6R), reduces disease activity in RA, although its mechanisms of action remain unclear. Since IL-6 regulates cytokine production by CD4 T cells during activation, we investigated whether treatment with tocilizumab altered the phenotype and cytokine production by CD4 T cells in patients with rheumatoid arthritis. We show here that tocilizumab treatment does not change the production of cytokines by naïve CD4 T cells. However, tocilizumab treatment causes a selective decrease of IL-21 production by memory/activated CD4 T cells. Since IL-21 is known to promote plasma cell differentiation, we examined the effect of tocilizumab on the production of autoantibodies. We show that there is a decrease in the levels of IgG4 anti-CCP antibodies, but there is no effect on IgG1 anti-CCP antibodies. In addition, we show that IL-21 is a powerful inducer of IgG4 production by B cells. Thus, IL-6 contributes to the presence of IgG4-specific anti-CCP autoantibodies in RA patients, likely through its effect on IL-21 production by CD4 T cells, and IL-6R blockade down-regulates this pathway.

In vivo immunomodulation by monoclonal anti-L3T4: 1. Effects on humoral and cell-mediated immune response☆

The in vivo administration of monoclonal anti-L3T4 antibody has been shown to be an effective preventative and, in some cases, therapeutic treatment for several murine models of autoimmune disease. This report deals with the effect of such treatments on humoral and cell-mediated responses to T-dependent antigens. Both the primary and secondary IgG responses to tetanus toxoid were inhibited when anti-L3T4 was administered prior to immunization, but it was ineffective in modulating an ongoing IgG response. Cell-mediated immunity, as detected by in vitro antigen-specific proliferative responses, was inhibited only if anti-L3T4 was given prior to immunization. It was not effective if treatment was delayed until 48 hr prior to lymph node harvest even though greater than 90% of L3T4+ lymph node cells were depleted by this treatment. The refractory behavior of the lymph node cells to anti-L3T4 treatment was not exhibited by antigen-primed cells obtained from peripheral blood or spleen. The importance of these findings with regard to antibody therapy for chronic autoimmune disease is discussed.

In Vivo Modulation of Murine Collagen Induced Arthritis

The effects of in vivo modulation of murine collagen induced arthritis with monoclonal anti-CD4 antibodies, monoclonal anti-Ia antibodies, and gamma interferon are reviewed. We detail the mechanism of action of monoclonal anti-CD4 antibody on humoral and cell mediated immune responses and discuss the implications for designing therapeutic strategies. To further explore the induction of collagen induced arthritis, a syngeneic cell transfer system using collagen primed T lymphocytes is described. This cell transfer system provides an opportunity to study the role of CD4 positive T lymphocytes in arthritis induction during a short, defined time period.

Reactive arthritis and psittacosis

A 54-year old man had severe inflammatory polyarthritis 10 days after the onset of an acute febrile illness that was serologically documented to be psittacosis. The pattern and chronicity of the articular symptoms, the response to nonsteroidal anti-inflammatory agents, and the presence of HLA-B7-CREG strongly suggest that this was a reactive arthritis. The association of psittacosis and reactive arthritis has previously been reported in the British literature, but this may be the first reported North American case.