Rheumatoid Arthritis: Prospects for Stopping the Runaway Train by Reintroduction of Tolerance

Abstract

Rheumatoid arthritis is a common, well studied autoimmune disease characterized by a loss of self-tolerance. Current therapies have significantly advanced the successful treatment of the disease, but have been unsuccessful for a large number of patients. Furthermore, they have failed to induce long term medication free remission because they target a consequence of the disease, not the origins of a dis-regulated immune system. Current research is now focused on finding ways to correct and restore the balance of the immune system rather than just suppress it. The scientific foundations for a number of potential approaches to restoring immune tolerance already have been laid. This paper reviews a number of proposed targets for immunotherapy including vaccinations, shifting from Th1 to Th2 responses, molecules that promote the resolution of inflammation, tolerogenic dendritic cells, mesenchymal stem cells, and T regulatory cells. These strategies will hopefully allow a closer approach to a "cure" for this potentially devastating disease.

Immunotherapies and Rheumatoid Arthritis-Introduction

“…This technique may then permit antigen-specific T reg cells to be used therapeutically to dampen abnormal immune responses in RA [25]. In another review, vaccination strategies are discussed which in one case would be designed to shift the balance between T h 1 and T h 2 towards T h 2 as well as to promote development of tolerogenic dendritic cells and functional T reg cells [26]. In another, the vaccination status of RA patients receiving immunotherapies is discussed with the emphasis on a consideration that the status of these individuals for maintaining protective antibodies could be uncertain.…”