Janus kinase (JAK) inhibitors act at low doses (e.g., tofacitinib, 0.2–0.4 μmol/kg bid) in
clinical use,
suggesting an efficient underlying mode of action. We hypothesized
that their effectiveness is due to their ability to raise the ratio
of IL-10 to TNFα. Unlike other JAK isoforms, JAK3 is expressed
mainly in hematopoietic cells and is essential for immune function.
We used JAK3 selective inhibitors with preferential distribution to
immune cells. Inhibition of JAK3 in human leukocytes reduced TNFα
and IL-6 but maintained levels of IL-10, while pan-JAK inhibitors
increased TNFα, IL-6, and IL-10. JAK1 is required for IL-10
receptor signaling, which suggests that, at exposure above the IC50 (55 nM for tofacitinib on JAK1), there is less feedback
control of TNFα levels. This leads to self-limiting effects
of JAK1 inhibitors and could place an upper limit on appropriate doses. In vivo, treating mice with JAK3 inhibitors before LPS administration
decreased plasma TNFα and increased IL-10 above vehicle levels,
suggesting that JAK3 inhibition may limit TNFα release by increasing
IL-10 while leaving the IL-10 receptor functional. This mechanism
should have general utility in controlling autoimmune diseases and
can be conveniently observed by measuring the ratio of IL-10 to TNFα.
In summary, our targeted, “leukotropic” inhibitors more
effectively increased IL-10/TNFα ratios than unselective control
compounds and could, therefore, be ideal for autoimmune therapy.