Sylvie Trembleau

Manipulation of the Th1/Th2 Cell Balance: An Approach to Treat Human Autoimmune Diseases?

Differentiated T cells produce a restricted set of lymphokines, allowing their subdivision into two major subsets: Th1 and Th2 cells. This has lead to a new paradigm for immunoregulation based on the Th1/Th2 dichotomy. A strict compartmentalization of T cells into Th1 and Th2 is clearly an oversimplification: regulatory and effector mechanisms in the immune system encompass much more than Th1 and Th2 cells. This oversimplification is nevertheless useful to carry out experiments designed to test the paradigm. Based on results obtained in different experimental models of autoimmune diseases, the subdivision of T cells into Th1 and Th2 subsets has been extended to suggest that Th1 cells contribute to the pathogenesis of several organ-specific autoimmune diseases, whereas Th2 cells may inhibit disease development. Although more slowly and maybe less clearly, a similar dichotomy is starting to emerge in human autoimmune diseases. It will soon be possible to formally test immunointervention based on Th1/Th2 cell manipulation in clinical situations: the tools and a conceptual frame are already available. In this review we will examine two key factors affecting the Th1/Th2 balance: antigen and the role of cytokines influencing the development of Th1 and Th2 cells. The rational manipulation of these two variables may ultimately lead to an effective control of Th1 and Th2 cells potentially able to alter the natural course of human autoimmune diseases.

Early Th1 Response in Unprimed Nonobese Diabetic Mice to the Tyrosine Phosphatase-Like Insulinoma-Associated Protein 2, an Autoantigen in Type 1 Diabetes

The insulinoma-associated protein 2 (IA-2) is a phosphatase-like autoantigen inducing T and B cell responses associated with human insulin-dependent diabetes mellitus (IDDM). We now report that T cell responses to IA-2 can also be detected in the nonobese diabetic (NOD) mouse, a model of human IDDM. Cytokine secretion in response to purified mouse rIA-2, characterized by high IFN-γ and relatively low IL-10 and IL-6 secretion, was elicited in spleen cells from unprimed NOD mice. Conversely, no response to IA-2 was induced in spleen cells from BALB/c, C57BL/6, or Biozzi AB/H mice that express, like NOD, the I-Ag7 class II molecule, but are not susceptible to spontaneous IDDM. The IA-2-induced IFN-γ response in NOD spleen cells could already be detected at 3 wk and peaked at 8 wk of age, whereas the IL-10 secretion was maximal at 4 wk of age and then waned. IA-2-dependent IFN-γ secretion was induced in CD4+ cells from spleen as well as pancreatic and mesenteric lymph nodes. It required Ag presentation by I-Ag7 molecules and engagement of the CD4 coreceptor. Interestingly, cytokines were produced in the absence of cell proliferation and IL-2 secretion. The biological relevance of the response to IA-2 is indicated by the enhanced IDDM following a single injection of the recombinant protein emulsified in IFA into 18-day-old NOD mice. In addition, IFN-γ production in response to IA-2 and IDDM acceleration could be induced by IL-12 administration to 12-day-old NOD mice. These results identify IA-2 as an early T cell-inducing autoantigen in the NOD mouse and indicate a role for the IA-2-induced Th1 cell response in IDDM pathogenesis.

IL-12 Administration Reveals Diabetogenic T Cells in Genetically Resistant I-Eα-Transgenic Nonobese Diabetic Mice: Resistance to Autoimmune Diabetes Is Associated with Binding of Eα-Derived Peptides to the I-Ag7 Molecule

Nonobese diabetic (NOD) and NOD-DRα transgenic (tg) mice, expressing Aαd:Aβg7 and Aαd:Aβg7 plus DRα:Eβg7 class II molecules, respectively, both develop insulin-dependent diabetes mellitus (IDDM), whereas NOD-Eα tg mice expressing Aαd:Aβg7 plus Eα:Eβg7 are protected. We show that IL-12 administration induces rapid IDDM onset in NOD-DRα but fails to provoke insulitis and diabetes in NOD-Eα tg mice. Nevertheless, T cells from IL-12-treated NOD-Eα tg mice secrete IFN-γ and transfer IDDM to NOD-SCID and NOD-Eα-SCID recipients, demonstrating the presence of peripheral diabetogenic Th1 cells in the protected mice. Surprisingly, regulatory cells were undetectable. Moreover, Eα:Eβg7 could substitute for DRα:Eβg7 in Ag presentation, arguing against mechanisms of protection involving capture of diabetogenic I-Ag7-restricted epitopes by Eα:Eβg7molecules. Interestingly, the expression of naturally processed epitopes derived from DRα- and Eα-chains bound to I-Ag7 is different in the two strains of tg mice, and the difference is enhanced by IL-12 administration. I-Ag7 molecules from both NOD-DRα and NOD-Eα tg mice present the conserved DRα/Eα 52-68 sequence, at high and low levels, respectively. In addition, only IDDM-resistant NOD-Eα tg mice possess APCs bearing Eα65-77/I-Ag7 complexes, which tolerize the specific T cells. This is associated with the selective inhibition of the response to insulinoma-associated protein 2 (IA-2), an autoantigen in IDDM. Our results support protective mechanisms based on I-Ag7 blockade by peptides unique to the Eα-chain, such as Eα65-77 and/or tolerance of diabetogenic T cells cross-reactive with Eα-peptide/I-Ag7 complexes.

Advances in Selective Immunosuppression

Publisher Summary The progress in understanding the mechanisms of T-cell activation and inactivation is currently being translated into strategies able to induce selective immunosuppression to treat different pathological situations, notably autoimmune diseases, allergies, and allograft rejection. The medical need for selective immunosuppression is very high, as the available immunosuppressive drugs are inadequate because of limited efficacy, modest selectivity, and considerable toxicity. Based on the recent progress is understanding antigen presentation to T-cells, key attack points for selective immunointervention have been identified: major histocompatibility complex molecules, T-cell receptor, CD4/CD8, and other accessory molecules. Therefore, to selectively interfere with the activation of pathogenic T-cells, immunosuppressive therapy can be essentially directed to three cellular targets: antigen-presenting cells, autoreactive T-cells, and regulatory T-cells. The common goal is to selectively inhibit the activation of pathogenic class II-restricted CD4 + T-cells. Induction of tolerance in mature pathogenic T-cells represents in theory the ideal form of specific immunotherapy not only in the treatment of autoimmune diseases, but also in induction of selective immunosuppression to control graft rejection and allergy. Peripheral tolerance can be easily and reproducibly induced in experimental models, but understanding the underlying mechanisms and optimizing protocols to implement them is far from ideal. Based on recent research, expectations have raised for exploiting the same strategies to inhibit the activation of human autoreactive T-cells. This chapter examines recent advances toward induction of selective immunosuppression potentially applicable to the treatment of autoimmune diseases, allograft rejection, and allergies.