20CIA = collagen-induced arthritis; CII = collagen type II; G6PI = glucose-6-phosphate isomerase; IL = interleukin; MHC = major histocompatibility complex; RA = rheumatoid arthritis; TCR = T-cell receptor; Th = T helper; TNF = tumour necrosis factor.
Arthritis Research & Therapy Vol 7 No 1 Kamradt and Schubert
IntroductionThe aetiology of rheumatoid arthritis (RA), which affects approximately 1% of the population, remains obscure. There is considerable evidence suggesting that RA is an autoimmune disease in which autoreactive lymphocytes trigger macrophages, synoviocytes and other effector cells that mediate synovitis and the destruction of cartilage and bone [1][2][3][4][5][6][7].
B and T lymphocytes in rheumatoid arthritis and experimental modelsApproximately two-thirds of RA patients produce rheumatoid factors -autoantibodies that are directed against IgG [8]. Because of this strong and diagnostically relevant association, B lymphocytes were long suspected to be the main culprits in RA pathogenesis [1,8]. RA susceptibility and severity are strongly associated with certain HLA-DR haplotypes in Caucasians [9]. The discovery of this linkage led to a more T-cell centred view [3,9-13] because antigen presentation to T lymphocytes is the only known immunological function of MHC class II molecules such as HLA-DR. The difficulty in detecting cellular immune responses against autoantigens in RA patients [14][15][16], together with the failure of some T-cell directed immunomodulatory treatment strategies [17][18][19][20][21][22] and impressive successes of therapeutic tumour necrosis factor (TNF)-α blockade in RA, appeared to implicate macrophages as the major effector cells in the clinically overt stages of RA [7,23].
AbstractThe antigens that trigger the pathogenic immune response in rheumatoid arthritis (RA) remain unknown. Until recently it was assumed that either viral or microbial antigens, or joint-specific antigens were the target of arthritogenic T and B lymphocytes in RA. Consequently, murine models of arthritis are induced by immunization with either joint-specific antigens such as type II collagen or microbial products such as streptococcal cell wall. In the K/B×N T-cell receptor transgenic mouse model arthritis is caused by a systemic autoimmune response to the ubiquitously expressed glycolytic enzyme glucose-6-phosphate isomerase (G6PI). The autoreactive transgenic T cells recognize G6PI and provide help for the production of arthritogenic IgG antibodies against G6PI. More recently it was shown that G6PI immunization induces severe symmetrical peripheral polyarthritis in genetically unaltered DBA/I mice. In that model CD4 + T cells are necessary not only for the induction but also for the effector phase of arthritis. Here we review the pathomechanisms that lead from systemic autoreactivity to arthritis in these models, consider the relevance of anti-G6PI immune reactivity for RA, and discuss the insights into the pathogenesis of RA and possibly other autoimmune conditions that can be gained from these mo...