A better understanding of cytokine biology over the last two decades has allowed the successful development of cytokine inhibitors against tumour necrosis factor and interleukin (IL)-1 and IL-6. The introduction of these therapies should be considered a breakthrough in the management of several rheumatic diseases. However, many patients will exhibit no or only partial response to these therapies, thus emphasising the importance of exploring other therapeutic strategies. In this article, we review the most recent information on novel cytokines that are often members of previously described cytokine families such as the IL-1 superfamily (IL-18 and IL-33), the IL-12 superfamily (IL-27 and IL-35), the IL-2 superfamily (IL-15 and IL-21), and IL-17. Several data derived from experimental models and clinical samples indicate that some of these cytokines contribute to the pathophysiology of arthritis and other inflammatory diseases. Targeting of some of these cytokines has already been tested in clinical trials with interesting results.
IntroductionCytokines mediate a wide variety of immunologic actions and are key effectors in the pathogenesis of several human autoimmune diseases. In particular, their pleiotropic functions and propensity for synergistic interactions render them intriguing therapeutic targets. Single-cytokine targeting has proven useful in several rheumatic disease states, including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and across the spectrum of spondyloarthropathies. Strong pre-clinical and clinical evidence implicates tumour necrosis factor-alpha (TNF-α) and interleukin (IL)-6 as critical cytokine effectors in inflammatory synovitis. However, non-responders or partial clinical responders upon TNF blockade are not infrequent and disease usually flares up upon discontinuation of treatment. Registry datasets confirm gradual attrition of patients who do reach stable TNF blockade. Crucially, clinical remission is infrequently achieved. Thus, considerable unmet clinical needs remain. This has provoked considerable enterprise in establishing the presence and functional activities of novel cytokines in the context of synovitis. In this short review, we consider the biology and relevant pathophysiology of several novel cytokines present and implicated in synovial processes.
Novel interleukin-1-related cytokinesThe first members of the IL-1 family of cytokines included IL-1α, IL-1β, IL-1 receptor antagonist (IL-1Ra), and IL-18. Seven additional members of the IL-1 family of ligands have been identified on the basis of sequence homology, threedimensional structure, gene location, and receptor binding [1,2]. A new system of terminology has been proposed for the IL-1 cytokines such that IL-1α, IL-1β, IL-1Ra, and IL-18 become IL-1F1, IL-1F2, IL-1F3, and IL-1F4, respectively. The new IL-1 cytokines are termed IL-1F5 through IL-1F11, the latter representing IL-33. IL-1F6, IL-1F8, and IL-1F9 are ligands for the IL-1R-related protein 2 (IL-1Rrp2), requiring the co-receptor IL-1RAcP for activity...