Email updates

Keep up to date with the latest news and content from Arthritis Research & Therapy and BioMed Central.

Open Access Highly Accessed Research article

Preventing autoimmune arthritis using antigen-specific immature dendritic cells: a novel tolerogenic vaccine

Igor Popov1, Mu Li1, Xiufen Zheng1, Hongtao San1, Xusheng Zhang1, Thomas E Ichim1, Motohiko Suzuki1, Biao Feng1, Costin Vladau1, Robert Zhong1234, Bertha Garcia13, Gill Strejan1, Robert D Inman5 and Wei-Ping Min1234*

Author Affiliations

1 Department of Surgery, Microbiology and Immunology, and Pathology, London Health Science Centre, London, Canada

2 Multi-Organ Transplant Program, London Health Science Centre, London, Canada

3 Immunology and Transplantation, Lawson Health Research Institute, London, Canada

4 Robarts Research Institute, London, Canada

5 Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University Health Network, Toronto, Canada

For all author emails, please log on.

Arthritis Research & Therapy 2006, 8:R141  doi:10.1186/ar2031

The electronic version of this article is the complete one and can be found online at: http://arthritis-research.com/content/8/5/R141


Received:9 March 2006
Revisions received:18 July 2006
Accepted:15 August 2006
Published:15 August 2006

© 2006 Popov et al., licensee BioMed Central Ltd.

This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Conventional treatments for autoimmune diseases have relied heavily on nonspecific immune suppressants, which possess a variety of adverse effects without inhibiting the autoimmune process in a specific manner. In the present study we demonstrate the effectiveness of antigen-specific, maturation-resistant, tolerogenic dendritic cells (DC) in suppressing collagen-induced arthritis, a murine model of rheumatoid arthritis. Treatment of DC progenitors with the NF-κB inhibiting agent LF 15-0195 (LF) resulted in a population of tolerogenic DC that are characterized by low expression of MHC class II, CD40, and CD86 molecules, as well as by poor allostimulatory capacity in a mixed leukocyte reaction. Administering LF-treated DC pulsed with keyhole limpet hemocyanin antigen to naïve mice resulted hyporesponsiveness specific for this antigen. Furthermore, administration of LF-treated DC to mice with collagen-induced arthritis resulted in an improved clinical score, in an inhibited antigen-specific T-cell response, and in reduced antibody response to the collagen. The efficacy of LF-treated DC in preventing arthritis was substantiated by histological examination, which revealed a significant decrease in inflammatory cell infiltration in the joints. In conclusion, we demonstrate that in vitro-generated antigen-specific immature DC may have important potential as a tolerogenic vaccine for the treatment of autoimmune arthritis.

Introduction

The natural function of immature dendritic cells (DC) is to provide conditions for self-tolerance, either through the generation of regulatory T cells or through the induction of apoptosis or anergy of autoreactive effector cells [1-3]. Several attempts have been made to utilize immature DC therapeutically. Some hurdles unfortunately still exist that prevent the therapeutic use of immature DC: first, only limited protocols are available for generating immature DC; and second, there is a danger that once immature DC are introduced into the host, a maturation event may occur that would actually cause immunogenicity instead of tolerance [4,5]. A direct method of targeting DC maturation involves blocking signal transduction pathways that are necessary for the DC to differentiate. A pathway known to be involved in DC maturation is the cascade that leads to activation of the transcription factor NF-κB. Zanetti and colleagues established that the RelB component of NF-κB is critical for DC maturation in vivo [6].

LF 15-0195 (LF) is a chemically synthesized analog of the immune suppressant 15-deoxyspergualin that possesses higher immunosuppressive activity and less in vivo degradation than its parent compound [7]. It has been demonstrated that part of the immune suppressive effects of LF are due to activation of caspases in reactive T cells [8].

Our laboratory has focused on the antigen-presenting cell arm of the immune system. We have been the first to demonstrate that LF specifically interferes with DC maturation through inhibiting the activity of IκB kinase (IKK) on its target IKB [9]. The unique ability of LF to target IKK in DC therefore suggests that it may possess distinctive properties allowing the generation of immature tolerogenic DC. Supporting the role of LF as a tolerogenic agent are studies describing induction of 'active' long-term tolerance in situations of autoimmunity, as illustrated in models of experimental autoimmune encephalomyelitis [10,11] and of myasthenia gravis [12].

Our group has also successfully induced tolerance in transplantation by LF treatment [13]. LF had a significant cytotoxic impact in vivo, however, thus emphasizing the possible deleterious effects of LF therapy [7]. To avoid such negative side effects, we chose to generate Tol-DC in vitro by treatment with LF, which may represent a safer, more natural, and potentially clinically applicable alternative to LF systemic administration.

Rheumatoid arthritis (RA) is an autoimmune disease that selectively targets joint tissue, causing significant disability and loss of function. Although we have previously demonstrated that systemic LF treatment combined with T-cell modulation can selectively expand tolerogenic DC in a transplantation model [14], the ability of tolerogenic DC generated in vitro to serve as an antigen-specific tolerogenic tool has not been shown. Stimulated by the possibility of combining the immunosuppressant properties of LF and the therapeutic potential of DC, we sought to generate antigen-specific Tol-DC in vitro using LF, and to use these cells as therapeutic tools to inhibit RA.

In the present study, we evaluated the ability of LF to generate a population of Tol-DC. Using collagen-induced arthritis (CIA), a murine model of RA, we show that LF-treated DC when pulsed with antigen and adoptively transferred into naïve syngeneic recipients selectively induce hyporesponsiveness at the level of both T cells and B cells. We further investigated whether such LF-treated DC can be used in a therapeutic context in order to induce amelioration of ongoing arthritis pathology, and show that the treated mice exhibited decreased inflammatory cell infiltration in the joints. Taken together, these data indicate that LF-generated tolerogenic DC have a therapeutic role in the inhibition of CIA.

Materials and methods

Animals

Male DBA/1 LacJ mice and BALB/c mice (Jackson Laboratories, Bar Harbor, ME, USA) were kept in filter-top cages at the Animal Facility, University of Western Ontario according to National Canadian Council for Animal Guidelines. Mice were allowed to settle for 2 weeks before the initiation of experimentation, which had ethical approval from the university board.

Collagen-induced arthritis model

DBA/1 mice, 7 weeks of age, were intradermally immunized at several sites into the base of the tail with 200 μg bovine type 2 collagen (CII) dissolved in 100 μl of 0.05 M acetic acid and mixed with an equal volume of complete Freund's adjuvant (Sigma, Oakville, ON, Canada). CII was dissolved at a concentration of 2 mg/ml by stirring overnight at 4°C. On day 21, the mice received an intraperitoneal booster injection with 200 μg CII in an equal volume (100 μl) of PBS. The booster injection was necessary to induce reproducible CIA, which normally developed at about day 28.

Each mouse was examined visually three times per week for the appearance of arthritis in limb joints, and the arthritis score was given as follows: 0, no detectable arthritis; 1, erythema and mild swelling confined to the mid-foot or ankle joint; 2, significant swelling and redness; 3, severe swelling and redness from the ankle to digits; and 4, maximal swelling and redness or obvious joint destruction associated with visible joint deformity or ankylosis. Each limb was graded and expressed as the average score per affected paw, resulting in a maximum score of 4 per animal. Scoring was performed by two independent observers, without knowledge of experimental protocols.

Dendritic cell cultures

At day 0, bone marrow cells were flushed from the femurs and tibias of DBA/1 mice, and were washed and cultured in six-well plates (Corning, Acton, MA, USA) at 4 × 106 cells/well in 4 ml complete medium (RPMI 1640 supplemented with 2 mM L-glutamine, 100 U/ml penicillin, 100 μg streptomycin, 50 μM 2-ME, and 10% FCS (all from Invitrogen, Grand Island, NY, USA) supplemented with recombinant granulocyte-macrophage colony-stimulating factor (GM-CSF) (10 ng/ml) and recombinant mouse IL-4 (10 ng/ml) (both from PeproTech, Rocky Hill, NJ, USA). Cultures were incubated at 37°C in 5% humidified CO2.

Nonadherent cells were then removed (day 2) and fresh medium was added. At day 4 the DC were treated either with LF (5–10 μg/ml) or with PBS, and fresh medium was added every 24 hours. At day 7 we pulsed LF-treated DC or PBS-treated DC with CII (10 μg/ml) for 24 hours. DC were then activated with lipopolysaccharide (LPS) (10 ng/ml; Sigma) and tumor necrosis factor alpha (TNFα) (10 ng/ml; PeproTech) for an additional 24 hours, were washed extensively, and were used for subsequent transfer experiments. On day 12 after the CII priming, different groups of mice with four to six animals per group were injected intraperitoneally with these LF-treated DC or untreated DC (5 × 106 cells/mouse).

Dendritic cell vaccination and antigen-specific response

In some experiments, day 4 bone marrow DC from BALB/c mice, cultured in GM-CSF/IL-4, were treated with LF (0.1, 1 or 10 μg/ml) or PBS, and fresh medium without LF was added every 24 hours. At day 7, we pulsed LF-treated or PBS-treated DC with keyhole limpet hemocyanin (KLH) (10 μg/ml) (Sigma) for 24 hours. DC were then activated with LPS/TNF-α for an additional 24 hours and injected subcutaneously (5 × 105 cells/mouse) into syngeneic mice. The mice were sacrificed after 10 days, and T lymphocytes from draining lymph nodes and spleens were isolated. Finally, a KLH-specific recall response was performed as described later.

Mixed lymphocyte reaction

At day 4 of culture, bone marrow DC from DBA/1 LacJ mice were treated with LF (10 μg/ml) or PBS, followed by addition of LPS/TNFα at day 8 for 24 hours. Activated DC were irradiated (3,000 rad) and seeded in triplicate into a flat-bottom 96-well plate (Corning) as stimulators. Spleen T cells from BALB/c mice were isolated by gradient centrifugation over Ficoll-Paque (Amersham, Canada) and added as responders (5 × 105 cells/well). The mixed lymphocytes were cultured at 37°C for 72 hours in 200 μl RPMI 1640 supplemented with 10% FCS, 100 U/ml penicillin, and 100 μg/ml streptomycin, and were pulsed with 1 μCi/well [3H-labeled] thymidine (Amersham) for the last 16 hours of culture. Finally, cells were harvested onto glass fiber filters, and the radioactivity incorporated was quantitated using a Wallac Betaplate liquid scintillation counter (Beckman, Fullerton, CA, USA). Results were expressed as the mean counts per minute of triplicate cultures ± SEM.

Proliferation assays

Proliferative responses to KLH and CII in subsequent groups of mice were measured with a standard microtiter assay using either draining lymph node cells or splenocytes, using KLH or CII, and using 3H-labeled thymidine. T cells at 5 × 105/well were seeded into a 96-well flat-bottom microtiter plate in triplicate and mixed with serial dilutions of KLH or CII (5–50 μg/well). Following a 72-hour incubation, 1 μCi [3H] thymidine was added to each well for 16 hours. Using a cell harvester, the cells were collected onto a glass microfiber filter, and the radioactivity incorporated was measured by a Wallac Betaplate liquid scintillation counter.

Anti-type II collagen antibody measurement

CII-specific antibodies were evaluated using a standard indirect ELISA in which 500 ng CII was absorbed to each well of a 96-well microtiter plate. Following blocking and washing steps, serial dilutions of immune mouse serum (1:100-1:100,000) were added to the appropriate wells in duplicate and were incubated overnight at 4°C. To develop the ELISA, horseradish peroxidase-conjugated goat anti-mouse IgG Fc and orthophenylenediamine dihydrochloride substrate buffer (Sigma) were used. Finally, the optical density into each well was measured at 490 nm wavelength in an ELISA plate reader.

Cytokine quantification

LF-treated DC of DBA/1 origin were cultured alone or with the allogeneic (BALB/c) T cells for 48 hours. Supernatants were collected and assessed for DC (IL-10, IL-12) and for T-cell cytokines (interferon gamma, IL-4). An ELISA (Endogen, Rockford, IL, USA) was used for detecting cytokine concentrations in the supernatants according to the manufacturer's instructions using a Benchmark Microplate Reader (Bio-Rad, Hercules, CA, USA).

Histology

Paws of freshly dissected mice were removed and joint tissues were immersion-fixed for 4 days in 10% (wt/vol) neutral buffered formalin in 0.15 M PBS (pH 7.4). After decalcification in Decalcifier I solution (Surgipath, Richmond, IL, USA) overnight and subsequent dehydration in a gradient of alcohols, tissues were rinsed in running water. The specimens were processed for paraffin embedding in paraplast (BDH, Dorset, UK) as routine procedure. Serial paraffin sections throughout the joint were cut at 5 μm thickness on a microtome, heated at 60°C for 30 minutes, and were deparaffinized. Hydration was achieved by transferring the sections through the following solutions: three times through xylene for 6 minutes, and then for 2 minutes through 100% ethanol twice, 95% ethanol, and 70% ethanol, respectively. The sections were stained with H & E and were mounted on glass slides.

Flow cytometry

Phenotypic analysis of cells was performed using flow cytometry on a FACScan (Becton Dickinson, San Jose, CA, USA). DC were pretreated with LF (5-10 μg/ml) beginning at day 4. Activation of DC maturation was performed by addition of TNFα/LPS for 24 hours. The cells were stained with FITC-conjugated mAbs against surface markers associated with DC maturation (anti-mouse CD11c, I-A, CD40, and CD86; Cedarlane, Hornby, ON, Canada). Immunoglobulins of the same isotype were used as controls.

Statistical analysis

Data are expressed as the mean ± SEM. Differences in the arthritis score between different populations of mice were compared using the Mann-Whitney U test for nonparametric data. P < 0.05 was considered significant.

Results

Modulation of dendritic cell maturation and function by LF 15-0195

Our previous studies have demonstrated that LF together with anti-CD45RB mAb can induce a population of tolerogenic DC in transplant recipients that are responsible for maintenance of tolerance [14]. Furthermore, we have previously demonstrated that LF treatment of isolated DC in vitro is capable of inhibiting the maturation-inducing kinase IKK, as well as the downstream transcription factor NF-κB [14]. We therefore investigated the potential of LF to generate immature tolerogenic DC that could be used for antigen-specific immunotherapy in vivo. Bone-marrow-derived DC were generated using a standard 7-day culture in GM-CSF/IL-4. LF was added at day 4 of culture, whereas control DC were treated with PBS alone. Activation of control DC and LF-treated DC was performed by addition of TNFα/LPS for 24 hours. Assessment of MHC class II, CD40, and CD86 expression by flow cytometry revealed that control DC underwent marked maturation, whereas LF-treated DC did not upregulate maturation markers (Figure 1a). Both nonactivated control DC and LF-treated DC expressed low levels of the maturation markers, similar to the TNFα/LPS-activated LF-treated DC (data not shown).

thumbnailFigure 1. LF 15-0195 prevents maturation and function of dendritic cells. (a) Phenotypic analysis of LF-treated dendritic cells (DC). Bone-marrow-derived DC were cultured in the presence of granulocyte-macrophage colony-stimulating factor (10 ng/ml) and IL-4 (10 ng/ml) for 7 days. Control mature DC (upper panels) were activated using tumor necrosis factor alpha (TNFα)/lipopolysaccharide (LPS) in the last 24-hour culture. DC (lower panel) were treated by addition of LF (10 ng/ml) in the culture medium from day 4 onwards, and fresh medium was added every 24 hours. DC were stained with FITC-conjugated mAbs and analyzed by flow cytometry. Results represent one of three experiments (n = 4 per group/experiment). (b) LF regulates cytokine expression in DC. DC were treated with LF as in (a). The supernatants of DC culture were collected and used to measure IL-12 and IL-10 levels by ELISA as described in Materials and methods. *P < 0.05, comparing untreated control DC.(c) LF inhibits DC allostimulatory capacity in a mixed leukocyte reaction. DC were pretreated with LF and subsequently stimulated with 10 ng/ml TNFα/LPS as described in (a). DBA/1 control DC and LF-treated DC, at indicated concentrations, were used as stimulators, and BALB/c splenocytes (1 × 105/well) were used as responders. Stimulators and responders were cocultured, and proliferation was assessed as described in Materials and methods. Data shown are representative of three independent experiments (n = 4 per group/experiment).P < 0.05, comparing untreated control DC.(d) LF-treated DC regulate T helper cell deviation. LF-treated DC and PBS-treated control DC (106) (DBA/1) were subsequently cultured with allogeneic (BALB/c) T cells (107) for 48 hours. Supernatants were collected from the cultures and interferon gamma (IFNγ; Th1) and IL-4 cytokine (Th2) levels were measured by ELISA. Results represent one of three experiments (n = 4 per group/experiment). P < 0.05, comparing untreated control DC.

We next assessed whether LF is involved in regulation of DC cytokine expression. LF-treated DC following activation with LPS/TNFα were cultured alone for 48 hours. Supernatants were then used to measure levels of IL-12 and IL10 cytokines. As shown in Figure 1b, IL-12 production of LF-treated DC was reduced, whereas IL-10 production reciprocally upregulated.

Functional assessment of LF-treated DC was performed using these cells as allogeneic stimulators in a mixed lymphocyte reaction (MLR). In contrast to control-DC-expressed potent allostimulatory activity, LF-treated DC evoked a much weaker proliferative response (Figure 1c). Using LF-treated DC as stimulators of MLR resulted in preferential production by T cells of the Th2 cytokine IL-4 and reduction of the Th1 cytokine interferon gamma (Figure 1d), in contrast to stimulation with control DC. These data suggest that LF treatment can effectively endow DC with an immature phenotypic and functional state.

LF 15-0195-treated dendritic cells inhibit an antigen-specific T-cell response

We next used LF-treated DC as a platform for the delivery of antigens in a tolerogenic context. It has previously been reported that antigen-pulsed DC with a blocked NF-κB pathway can induce specific hyporesponsiveness to that antigen [15]. Since we have recently demonstrated that LF blocks NF-κB translocation [9], and we have shown here that LF treatment inhibits DC maturation, we sought to assess whether LF-treated DC could induce tolerance to a nominal antigen such as KLH.

Pulsing of DC with antigen requires active cellular phagocytosis and processing of the antigen. The in vivo administration of the antigen-pulsed DC is subjected to conditions that may induce maturation not normally present in vitro. Since this is the first use of LF for treatment of DC before antigen pulsing, we performed optimization experiments to determine the most effective concentration of LF. On day 4 of culture, bone marrow DC were treated with 0.1, 1, and 10 μg/ml LF, and control DC were treated with PBS. KLH was added to DC at day 7 for 24 hours, and subsequently cells were activated with TNFα/LPS. On day 9, 5 × 105 DC were injected intraperitoneally into BALB/c mice.

To test the T-cell expansion and activation, the recall response to KLH was assessed in vitro 10 days after the administration of KLH-pulsed control DC and LF-treated DC. KLH-specific responses from lymph node T cells were suppressed at all KLH concentrations used, in an LF dose-dependent manner (Figure 2a). To determine whether bystander tolerization occurred in LF-treated DC-induced immune suppression, we used a 'double immunization' system, in which mice were immunized with CII-pulsed DC alone with an immunization with KLH. The immunization with LF-treated DC and CII antigen-pulsed DC only suppressed the immune response to CII specifically (Figure 2b), but not the immune response to the nonrelevant antigen KLH (Figure 2C).

thumbnailFigure 2. LF 15-0195-treated dendritic cells inhibit antigen-specific T-cell responses. (a) LF-treated dendritic cells (DC) inhibit anti-keyhole limpet hemocyanin (KLH) T-cell responses. Day 4 bone-marrow-derived DC cultured in granulocyte-macrophage colony-stimulating factor (10 ng/ml) and IL-4 (10 ng/ml) were treated with different concentrations of LF (0.1, 1, and 10 μg/ml) or PBS alone. On day 7 of culture, 10 μg/ml KLH was added to the cells for 24 hours and then cells were activated with TNFα (10 ng/ml) and lipopolysaccharide (10 ng/ml). On day 9 of DC culture, 5 × 105 cells/mouse were injected intraperitoneally into syngeneic BALB/c mice. After 10 days, the mice were sacrificed and T cells from lymph nodes were isolated. A KLH-specific recall response was determined by the proliferation, as described in Materials and methods. *P < 0.05 versus nontreated control DC. (b) and (c) LF-treated DC-induced immune suppression is antigen specific. DC were cultured, treated with LF, pulsed with type II collagen (CII) antigen, and immunized mice as described in (a). Two days prior to LF-treated DC or untreated control DC immunization, the mice were immunized with 10 μg KLH subcutaneously. Ten days after immunization, lymph node cells were harvested and proliferated in vitro in the presence of CII (b) and KLH (c), respectively, at the indicated concentrations. Results represent one of three experiments. *P < 0.05 versus nontreated control DC. cpm, counts per minute.

Inhibition of collagen-induced arthritis development by LF 15-0195-treated dendritic cells

The CIA model of arthritis is a well-established method of evaluating therapeutic interventions in autoimmune arthritis. Several induction protocols have been reported, all of which in essence induce a T-cell-dependent inflammatory infiltration of the synovial membrane, leading to cartilage destruction and bone erosion. Since we have been able to induce T-cell hyporesponsiveness to KLH using LF-treated DC (Figure 2), we sought to determine whether pulsing LF-treated DC with CII would inhibit CIA development and histopathology. On day 12 post CII priming, DBA/1 mice were administered 5 × 106 intraperitoneal CII-pulsed LF-treated DC or control DC. A booster injection of CII was made at day 21. The clinical onset of CIA as determined by the average arthritis score per effected paw began approximately on day 28.

Initiation of arthritis was delayed by 7 days in the CII-pulsed LF-treated DC group as compared with the control group. Furthermore, the control group had an average score per affected paw twice as high as that of the LF-treated DC group (Figure 3), but a score that ranged from less than twofold to fivefold depending on the time point. These results imply that LF-treated DC are not only capable of inducing antigen-specific hyporesponsiveness, but are also capable of reducing clinical manifestations and delaying disease onset in a model of autoimmunity.

thumbnailFigure 3. Type II collagen-pulsed LF 15-0195-treated dendritic cells inhibit clinical development of collagen-induced arthritis. Twelve days after intradermal challenge with type II collagen (CII) (200 μg/mouse in complete Freund's adjuvant), DBA/1 LacJ mice were injected intraperitoneally with LF-treated dendritic cells (DC) (5 μg/ml) and CII-pulsed DC (10 μg/ml) (5 × 106 cells/mouse). Controls were either treated with non-LF-treated but CII-pulsed DC or remained untreated. All mice were boosted by an intraperitoneal injection with the same dose of CII in PBS 9 days later. The mice were observed for 37 days after arthritis onset. Each limb was graded on a scale from 0 to 4 and the average clinical score per affected paw was calculated. Each point denotes the score of six mice in each group. Results represent one of three experiments. *P < 0.05 versus the control DC-treated group.

Inhibition of collagen-induced arthritis is associated with long-term T-cell hyporesponsiveness

Given that T cells play a key role in the initiation of CIA [16], antigen-specific T-cell proliferative responses to CII were assessed. At the end of the monitoring of CIA development, mice were sacrificed and lymph node cells were collected for proliferative analysis in response to CII. In vitro 3H-labeled thymidine incorporation assays revealed that a decrease in CII-specific recall responses were observed of mice receiving LF-treated DC in comparison with those receiving control DC (Figure 4). The response was antigen specific since modulation of responses to other control antigens was not affected (data not shown). The hyporesponsiveness of CII-specific T cells confirms clinical observations that CII-pulsed LF-treated DC could be useful in therapeutic intervention for antigen-specific T-cell-associated diseases.

thumbnailFigure 4. T-cell hyporesponsiveness to type II collagen in collagen-induced arthritis-susceptible mice with LF-treated dendritic cells. Day 4 bone-marrow-derived dendritic cells (DC) cultured in granulocyte-macrophage colony-stimulating factor/IL-4 were treated with 5 μg/ml LF or PBS alone, and fresh medium was added every 24 hours. On day 7, both LF-treated DC and control PBS-treated DC were pulsed with type II collagen (CII) (10 μg/ml) for 24 hours. On day 8, CII-pulsed cell cultures were activated with TNFα/lipopolysaccharide for the next 24 hours, and 5 × 106 cells/mouse were injected intraperitoneally into DBA/1 LacJ mice primed with CII (200 μg/mouse in complete Freund's adjuvant) 12 days earlier. Twenty-one days after priming, the mice were boosted intraperitoneally with the same dose of CII in PBS. At the end of clinical assessment of collagen-induced arthritis development, the mice were sacrificed and T cells from lymph nodes were isolated. A CII-specific response from different groups of animals was performed by proliferation, as described in Materials and methods. Lymphocytes were restimulated in vitro with different concentrations of CII (5, 25, and 50 μg/ml) or PBS alone and a 3H-labeled thymidine incorporation was measured. Results represent one of three experiments (n = 4 per group/experiment). *P < 0.05 versus the control DC-treated group. cpm, counts per minute.

Inhibition of collagen-induced arthritis is also associated with prolonged inhibition of anti-type II collagen antibodies

The importance of antibodies in development of CIA pathology is well known [17]. Although it has been previously suggested that LF directly inhibits antibody production [18], the ability of the LF-treated DC to induce this effect has not been studied. Tolerogenic DC may directly block antibody production through inhibition of BlyS and APRIL, factors that DC use to directly induce immunoglobulin production and class switching in B cells [19]. Alternatively, tolerogenic DC may indirectly prevent antibody production through the inhibition of T-cell helper function.

In order to assess whether LF-treated DC pulsed with CII actually inhibit CII-specific antibody responses, we evaluated the serum levels of anti-CII immunoglobulin in DBA/1 mice 37 days following the arthritis onset. Using the same protocol as for induction of CIA, we used mice receiving LF-treated DC pulsed with CII, mice receiving LF-treated DC pulsed with PBS, mice receiving PBS-treated DC pulsed with CII, and mice receiving PBS-treated DC pulsed with PBS. A high titer of anti-CII antibody was seen in control DC pulsed with CII (Figure 5). Administration of LF-treated DC pulsed with CII resulted in a marked decrease in antibody production, although there was no essential difference between the two concentrations of LF used on the DC (Figure 5).

thumbnailFigure 5. Inhibition of CII-specific antibody production in arthritis mice with LF-treated dendritic cells. Blood was taken 40 days after arthritis onset and serum levels of anti-type II collagen (anti-CII) immunoglobulin were determined using sandwich ELISA. Results show average levels of antibody expressed as the optical density for experimental and control groups (n = 6 per group/experiment). P < 0.05 versus the control DC-treated group. KLH, keyhole limpet hemocyanin.

The control for this experiment omitted DC immunization, in which there was no inhibition of antibody production as compared with animals that received CII-pulsed DC without LF treatment. This suggests that CIA is not augmented by CII-pulsed DC, but instead that the CII-pulsed LF-treated DC actually inhibit the initiated autoimmune process.

Histological assessment

Although we have demonstrated a clear inhibition of arthritis manifestation using the average arthritis score per affected paw, we further sought to examine histological differences induced by treatment with the CII-pulsed LF-treated DC. Animals injected with LF-treated DC, or control animals, were therefore sacrificed 37 days after arthritis onset and their joints were examined in serial sections. We observed that control DC-treated mice exhibited severe synovitis, pannus formation, and bone erosion (Figure 6a). A marked mononuclear cell infiltration was also observed. In contrast, the joint histology of the mice injected with LF-treated DC revealed markedly attenuated morphological changes, cellular infiltration, and the preservation of normal-appearing cartilage (Figure 6b). The histological verification of the arthritis score (Table 1) strongly suggests that the CII-pulsed LF-treated DC are a potent tolerogenic agent that is useful for inhibition of T-cell-mediated autoimmune responses.

thumbnailFigure 6. Histological joint sections from arthritic mice with CII-pulsed treated dendritic cells. H & E-stained sagittal sections of proximal interphalangeal joints from collagen-induced arthritis mice. (a) Control mouse shows severe edema, congestion, and monocyte infiltration; the bone surface became uneven. (b) The majority of joints from mice injected with LF 15-0195-treated dendritic cells have normal morphology with a smooth articulation cartilage surface, and an absence of inflammatory cell infiltrate and edema. Original magnification × 100.

Table 1. Joint pathology score

Discussion

The utilization of DC as adjuvants for vaccination has been well described in the literature [20-22]. This is due to the fact that mature DC are recognized as the most potent antigen-presenting cells. It is also well known, however, that immature DC can act as tolerogenic DC and are also potent inducers of tolerance in an antigen-specific manner [23,24]. Attempts have been made to prevent autoimmune diseases through the use of DC-based vaccination [25-27]. Unfortunately, the advances of the understanding of DC vaccine have not been paralleled by development of a means of actually inducing tolerance to the autoantigens.

The use of immature DC as therapeutic tools has had limited success in the treatment of autoimmune diseases. One reason preventing DC-based tolerance is the fact that, once immature DC are introduced into the host, a maturation event may occur that would actually cause immunogenicity instead of tolerance [4,5]. Nevertheless, investigators have attempted to generate such 'tolerogenic DC' using alterations in culture conditions, including low-dose GM-CSF in culture [28], the addition of inhibitory cytokines (IL-10 or IL-4) [29,30], or crosslinking of such DC suppressive surface molecules as the CD200 receptor [31].

A more direct method of targeting DC maturation involves blocking signal transduction pathways that are necessary for the DC to differentiate. A pathway known to be involved in DC maturation is the cascade that leads to activation of the transcription factor NF-κB. Zanetti and colleagues established that the RelB component of NF-κB is critical for DC maturation in vivo [6]. Through ablating the RelB gene, they showed a lack of mature DC in vivo, as well as immune hyporesponsiveness [6]. The demonstration that immature DC from RelB knockout mice were actually tolerogenic was made through experiments in which DC from RelB knockout animals were pulsed with KLH and used to immunize mice. This resulted in an antigen-specific hyporesponsiveness to KLH that was transferable through a T-regulatory-like cell [32].

The blockade of NF-κB activation has been used therapeutically to generate immature DC by Saemann and colleagues [33] using the thiol antioxidant pyrolidine dithiocarbamate. These DC were able to inhibit alloreactive T-cell responses, as demonstrated by a reduced ability to stimulate a MLR. Another method of suppressing NF-κB activity is through chemical blockade of proteasomes. The proteasome inhibitor PSI, a low molecular inhibitor of IκB-degrading proteasomes, was used to induce the in vitro generation of immature DC. These DC were unable to stimulate a MLR and caused a Th1 to Th2 shift in cytokine production [34]. Unfortunately, pyrolidine dithiocarbamate and PSI are both associated with nonspecific suppressive effects on other cellular metabolism pathways, and have not been used for clinical purposes. In this study, we generated a type of tolerogenic DC using the selective IKK/NF-κB inhibitor, LF, for applications as a tolerogenic agent. LF-treated DC exhibited potent tolerogenic properties, which inhibit specific autoimmune responses.

Other inhibitors of DC maturation have been described to inhibit activation of NF-κB directly or indirectly. Among such inhibiting agents are curcumin [35], ganglioside GD1a [36], dexamethasone [37], vascular endothelial growth factor [38], n-acetylcysteine [39], and aspirin [40]. Conversely, agents that induce DC maturation – such as TLR-7 agonists [41], TRANCE [42,43], tumor necrosis factor and its related homolog LIGHT [44] – are also known to activate NF-κB. Based on the critical importance of this pathway on DC maturation, ex vivo inhibition of NF-κB on DC has been performed using decoy oligonucleotides for the prevention of transplant rejection in liver [45] and cardiac models [46]. Unfortunately, although immune modulation was observed, the effects were not clinically significant.

The immunopathogenesis of RA pathology is complex and incompletely understood. There is strong evidence to implicate MHC class II as an important marker of genetic susceptibility to RA, which implicates T cell-antigen-presenting cell interaction in a fundamental way in the initiation and perpetuation of the autoimmune process. Indeed, the synovitis of RA is characterized by extensive T-cell activation [47]. Clinical efficacy of immune modulating agents, such as methotrexate [48] and infliximab [49], implicates chronic inflammation being secondary to an immune-mediated process. Indeed, successful T-cell-based therapies such as inhibition of costimulation by CTLA4 have recently been reported. Current concepts suggest that synovitis in RA is the result of increased autoreactive effector cell activity and the corresponding decrease in immune regulatory cell function. Furthermore, clinically effective treatments, such as infliximab [50] and autoantigenic vaccination [51], are associated with increased numbers of regulatory T cells in the periphery. Animal models of RA have attempted to recapitulate key elements of RA, although none has done so with complete fidelity. For example, in experimental models the transfer of regulatory cells can prevent arthritis [52], while the depletion of said cells results in accelerated disease [53]. On the basis of the link between immune regulation and remission of RA pathology, we decided to explore the use of LF as an immune modulator in this system.

In order to determine the possible clinical relevance of such LF-treated DC for inducing antigen-specific tolerance or hyporesponsiveness, we assessed their ability to modulate disease progression in the murine CIA, as an experimental model of RA. CIA mirrors many aspects of RA in terms of cellular and immune responses, and has been extensively used to screen therapeutic agents in RA. There are, however, several aspects in which the processes differ. The formation of anti-CCP antibodies and rheumatoid factors is the serological signature of RA, but these autoantibodies are absent from CIA. We chose to examine CIA as a well-defined model of autoimmune arthritis that allows an examination of the role of host immune response to an autoantigen, in this case CII. Our experimental protocols consisted of administering CII-pulsed LF-treated DC on day 12 following the CII priming of animals. This delayed administration of the LF-treated DC was performed to assess whether there was inhibition of an already established immune response. We observed a decrease in the mean clinical score per affected paw in the mice injected with LF-treated DC, compared with control DC. At day 11 after arthritis onset, there was a fivefold difference between the control DC and the LF-treated DC groups in terms of clinical score. Differences in the clinical scores between the control DC and LF-treated DC groups were maintained for the length of the experimental observation, which was 37 days after the arthritis onset. Dutartre's group previously reported that systemic LF administration to CIA mice inhibited development of arthritis but did not modify the Th1/Th2 balance, inducing a switch towards Th2 for preventing arthritis [18]. Owing to some concern regarding the in vivo toxicity of LF, however, which has been previously reported [7], herein we used an alternative approach to generate tolerogenic DC by in vitro treatment with LF. In addition, in vitro treatment of the DC with LF may allow exposure of DC to higher concentrations than would be available in vivo.

This study serves as a foundation for establishing parameters for the generation of an antigen-specific tolerogenic treatment approach using LF-treated DC. This is the first demonstration that in vitro-generated antigen-specific immature DC may be used as a tolerogenic vaccine for the treatment of autoimmune arthritis.

Abbreviations

CIA = collagen-induced arthritis; CII = type II collagen; DC = dendritic cells; ELISA = enzyme-linked immunosorbent assay; FCS = fetal calf serum; GM-CSF = granulocyte-macrophage colony-stimulating factor; H & E = hematoxylin and eosin; IKK = IκB kinase; IL = interleukin; KLH = keyhole limpet hemocyanin; LF = LF 15-0195; LPS = lipopolysaccharide; mAb = monoclonal antibody; MHC = major histocompatibility complex; MLR = mixed leukocyte reaction; PBS = phosphate-buffered saline; RA = rheumatoid arthritis; Th = T helper cell; TNFα = tumor necrosis factor alpha.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

IP carried out the CIA studies and the in vivo immune assays, and drafted the manuscript. ML carried out in vitro and in vivo immune assays. XfZ, XsZ, and TEI participated in the CIA assessment. HS and BG performed the pathology examinations. TEI, BF, MS, and CV helped to draft the manuscript. RZ, GS, RDI, and W-PM participated in the study design and coordination, and helped to draft the manuscript. All authors read and approved the final manuscript.

Acknowledgements

The authors thank Weihua Liu, Department of Pathology, University of Western Ontario. LF was provided by Fournier Laboratory, Daix, France. This study is partially supported by grants from the Canadian Institutes of Health Research and an Internal Research Fund from the Lawson Health Research Institute.

References

  1. Vosters O, Neve J, De Wit D, Willems F, Goldman M, Verhasselt V: Dendritic cells exposed to nacystelyn are refractory to maturation and promote the emergence of alloreactive regulatory t cells.

    Transplantation 2003, 75:383-389. PubMed Abstract | Publisher Full Text OpenURL

  2. Mahnke K, Schmitt E, Bonifaz L, Enk AH, Jonuleit H: Immature, but not inactive: the tolerogenic function of immature dendritic cells.

    Immunol Cell Biol 2002, 80:477-483. PubMed Abstract | Publisher Full Text OpenURL

  3. Steinman RM, Hawiger D, Nussenzweig MC: Tolerogenic dendritic cells.

    Annu Rev Immunol 2003, 21:685-711. PubMed Abstract | Publisher Full Text OpenURL

  4. Roncarolo MG, Levings MK, Traversari C: Differentiation of T regulatory cells by immature dendritic cells.

    J Exp Med 2001, 193:F5-F9. PubMed Abstract | Publisher Full Text OpenURL

  5. de Heusch M, Oldenhove G, Urbain J, Thielemans K, Maliszewski C, Leo O, Moser M: Depending on their maturation state, splenic dendritic cells induce the differentiation of CD4(+) T lymphocytes into memory and/or effector cells in vivo.

    Eur J Immunol 2004, 34:1861-1869. PubMed Abstract | Publisher Full Text OpenURL

  6. Zanetti M, Castiglioni P, Schoenberger S, Gerloni M: The role of relB in regulating the adaptive immune response.

    Ann N Y Acad Sci 2003, 987:249-257. PubMed Abstract | Publisher Full Text OpenURL

  7. Zhou D, O'Brien C, Shum J, Garcia B, Min W, Jevnikar AM, Dutartre P, Zhong R: LF 15-a novel immunosuppressive agent prevents rejection and induces operational tolerance in a mouse cardiac allograft model.

    Transplantation 2003, 76:644-650. PubMed Abstract | Publisher Full Text OpenURL

  8. Ducoroy P, Micheau O, Perruche S, Dubrez-Daloz L, de Fornel D, Dutartre P, Saas P, Solary E: LF 15-0195 immunosuppressive agent enhances activation-induced T-cell death by facilitating caspase-8 and caspase-10 activation at the DISC level.

    Blood 2003, 101:194-201. PubMed Abstract | Publisher Full Text OpenURL

  9. Yang J, Bernier SM, Ichim TE, Li M, Xia X, Zhou D, Huang X, Strejan GH, White DJ, Zhong R, Min WP: LF15-0195 generates tolerogenic dendritic cells by suppression of NF-kappaB signaling through inhibition of IKK activity.

    J Leukoc Biol 2003, 74:438-447. PubMed Abstract | Publisher Full Text OpenURL

  10. Duplan V, Dutartre P, Mars LT, Liblau RS, Druet P, Saoudi A: LF 15-0195 inhibits the development of rat central nervous system autoimmunity by inducing long-lasting tolerance in autoreactive CD4 T cells.

    J Immunol 2003, 170:2179-2185. PubMed Abstract | Publisher Full Text OpenURL

  11. Duplan V, Stennevin A, Ipinazar K, Druet P, Dutartre P, Saoudi A: Beneficial effect of the immunosuppressant LF 15-0195 on passively induced rat experimental autoimmune encephalomyelitis.

    Transplant Proc 2002, 34:2966-2969. PubMed Abstract | Publisher Full Text OpenURL

  12. Duplan V, Dutartre P, Druet P, Saoudi A: The immunosuppressant LF 15-0195 prevents experimental autoimmune myasthenia gravis in Brown-Norway rats.

    Transplant Proc 2002, 34:2962-2965. PubMed Abstract | Publisher Full Text OpenURL

  13. Min WP, Zhou D, Ichim TE, Xia X, Zhang X, Yang J, Huang X, Garcia B, Dutartre P, Jevnikar AM, et al.: Synergistic tolerance induced by LF15-0195 and anti-CD45RB monoclonal antibody through suppressive dendritic cells.

    Transplantation 2003, 75:1160-1165. PubMed Abstract | Publisher Full Text OpenURL

  14. Min WP, Zhou D, Ichim TE, Strejan GH, Xia X, Yang J, Huang X, Garcia B, White D, Dutartre P, et al.: Inhibitory feedback loop between tolerogenic dendritic cells and regulatory T cells in transplant tolerance.

    J Immunol 2003, 170:1304-1312. PubMed Abstract | Publisher Full Text OpenURL

  15. Nouri-Shirazi M, Guinet E: Direct and indirect cross-tolerance of alloreactive T cells by dendritic cells retained in the immature stage.

    Transplantation 2002, 74:1035-1044. PubMed Abstract | Publisher Full Text OpenURL

  16. Wooley PH: Immunotherapy in collagen-induced arthritis: past, present, and future.

    Am J Med Sci 2004, 327:217-226. PubMed Abstract | Publisher Full Text OpenURL

  17. Takagishi K, Hotokebuchi T, Arai K, Arita C, Kaibara N: Collagen arthritis in rats: the importance of humoral immunity in the initiation of the disease and perpetuation of the disease by suppressor T cells.

    Int Rev Immunol 1988, 4:35-48. PubMed Abstract OpenURL

  18. Ducoroy P, de Fornel D, Dubrez-Daloz L, Solary E, Dutartre P: Longterm protection of mice against collagen-induced arthritis after short-term LF 15-0195 treatment: modulation of B and T lymphocyte activation.

    J Rheumatol 2003, 30:918-925. PubMed Abstract OpenURL

  19. Litinskiy MB, Nardelli B, Hilbert DM, He B, Schaffer A, Casali P, Cerutti A: DCs induce CD40-independent immunoglobulin class switching through BLyS and APRIL.

    Nat Immunol 2002, 3:822-829. PubMed Abstract | Publisher Full Text OpenURL

  20. Pouniotis DS, Proudfoot O, Bogdanoska V, Apostolopoulos V, Fifis T, Plebanski M: Dendritic cells induce immunity and long-lasting protection against blood-stage malaria despite an in vitro parasite-induced maturation defect.

    Infect Immun 2004, 72:5331-5339. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL

  21. Pandha HS, John RJ, Hutchinson J, James N, Whelan M, Corbishley C, Dalgleish AG: Dendritic cell immunotherapy for urological cancers using cryopreserved allogeneic tumour lysate-pulsed cells: a phase I/II study.

    BJU Int 2004, 94:412-418. PubMed Abstract | Publisher Full Text OpenURL

  22. Akbar SM, Furukawa S, Hasebe A, Horiike N, Michitaka K, Onji M: Production and efficacy of a dendritic cell-based therapeutic vaccine for murine chronic hepatitis B virus carrierer.

    Int J Mol Med 2004, 14:295-299. PubMed Abstract OpenURL

  23. Yang JS, Xu LY, Huang YM, Van Der Meide PH, Link H, Xiao BG: Adherent dendritic cells expressing high levels of interleukin-10 and low levels of interleukin-12 induce antigen-specific tolerance to experimental autoimmune encephalomyelitis.

    Immunology 2000, 101:397-403. PubMed Abstract | Publisher Full Text OpenURL

  24. Rutella S, Lemoli RM: Regulatory T cells and tolerogenic dendritic cells: from basic biology to clinical applications.

    Immunol Lett 2004, 94:11-26. PubMed Abstract | Publisher Full Text OpenURL

  25. Myers LK, Sakurai Y, Rosloniec EF, Stuart JM, Kang AH: Ananalog peptide that suppresses collagen-induced arthritis.

    Am J Med Sci 2004, 327:212-216. PubMed Abstract | Publisher Full Text OpenURL

  26. Narendran P, Mannering SI, Harrison LC: Proinsulin – a pathogenic autoantigen in type 1 diabetes.

    Autoimmun Rev 2003, 2:204-210. PubMed Abstract | Publisher Full Text OpenURL

  27. Mor F, Quintana F, Mimran A, Cohen IR: Autoimmune encephalomyelitis and uveitis induced by T cell immunity to self beta-synuclein.

    J Immunol 2003, 170:628-634. PubMed Abstract | Publisher Full Text OpenURL

  28. Lutz MB, Suri RM, Niimi M, Ogilvie AL, Kukutsch NA, Rossner S, Schuler G, Austyn JM: Immature dendritic cells generated with low doses of GM-CSF in the absence of IL-4 are maturation resistant and prolong allograft survival in vivo.

    Eur J Immunol 2000, 30:1813-1822. PubMed Abstract | Publisher Full Text OpenURL

  29. Muller G, Muller A, Tuting T, Steinbrink K, Saloga J, Szalma C, Knop J, Enk AH: Interleukin-10-treated dendritic cells modulate immune responses of naive and sensitized T cells in vivo.

    J Invest Dermatol 2002, 119:836-841. PubMed Abstract | Publisher Full Text OpenURL

  30. Roelen DL, Schuurhuis DH, van den Boogaardt DE, Koekkoek K, van Miert PP, van Schip JJ, Laban S, Rea D, Melief CJ, Offringa R, et al.: Prolongation of skin graft survival by modulation of the alloimmune response with alternatively activated dendritic cells.

    Transplantation 2003, 76:1608-1615. PubMed Abstract | Publisher Full Text OpenURL

  31. Gorczynski RM, Chen Z, Kai Y, Wong S, Lee L: Induction of tolerance-inducing antigen-presenting cells in bone marrow cultures in vitro using monoclonal antibodies to CD200R.

    Transplantation 2004, 77:1138-1144. PubMed Abstract | Publisher Full Text OpenURL

  32. Martin E, O'Sullivan B, Low P, Thomas R: Antigen-specific suppression of a primed immune response by dendritic cells mediated by regulatory T cells secreting interleukin-10.

    Immunity 2003, 18:155-167. PubMed Abstract | Publisher Full Text OpenURL

  33. Saemann MD, Kelemen P, Bohmig GA, Horl WH, Zlabinger GJ: Hyporesponsiveness in alloreactive T-cells by NF-kappaB inhibitor-treated dendritic cells: resistance to calcineurin inhibition.

    Am J Transplant 2004, 4:1448-1458. PubMed Abstract | Publisher Full Text OpenURL

  34. Yoshimura S, Bondeson J, Brennan FM, Foxwell BM, Feldmann M: Role of NFkappaB in antigen presentation and development of regulatory T cells elucidated by treatment of dendritic cells with the proteasome inhibitor PSI.

    Eur J Immunol 2001, 31:1883-1893. PubMed Abstract | Publisher Full Text OpenURL

  35. Kim GY, Kim KH, Lee SH, Yoon MS, Lee HJ, Moon DO, Lee CM, Ahn SC, Park YC, Park YM: Curcumin inhibits immunostimulatory function of dendritic cells: MAPKs and translocation of NF-kappa B as potential targets.

    J Immunol 2005, 174:8116-8124. PubMed Abstract | Publisher Full Text OpenURL

  36. Shen W, Ladisch S: Ganglioside GD1a impedes lipopolysaccharide-induced maturation of human dendritic cells.

    Cell Immunol 2002, 220:125-133. PubMed Abstract | Publisher Full Text OpenURL

  37. Matasic R, Dietz AB, Vuk-Pavlovic S: Dexamethasone inhibits dendritic cell maturation by redirecting differentiation of a subset of cells.

    J Leukoc Biol 1999, 66:909-914. PubMed Abstract | Publisher Full Text OpenURL

  38. Gabrilovich D, Ishida T, Oyama T, Ran S, Kravtsov V, Nadaf S, Carbone DP: Vascular endothelial growth factor inhibits the development of dendritic cells and dramatically affects the differentiation of multiple hematopoietic lineages in vivo.

    Blood 1998, 92:4150-4166. PubMed Abstract | Publisher Full Text OpenURL

  39. Verhasselt V, Vanden Berghe W, Vanderheyde N, Willems F, Haegeman G, Goldman M: N-acetyl-l-cysteine inhibits primary human T cell responses at the dendritic cell level: association with NF-kappaB inhibition.

    J Immunol 1999, 162:2569-2574. PubMed Abstract | Publisher Full Text OpenURL

  40. Hackstein H, Morelli AE, Larregina AT, Ganster RW, Papworth GD, Logar AJ, Watkins SC, Falo LD, Thomson AW: Aspirin inhibits in vitro maturation and in vivo immunostimulatory function of murine myeloid dendritic cells.

    J Immunol 2001, 166:7053-7062. PubMed Abstract | Publisher Full Text OpenURL

  41. Gibson SJ, Lindh JM, Riter TR, Gleason RM, Rogers LM, Fuller AE, Oesterich JL, Gorden KB, Qiu X, McKane SW, et al.: Plasmacytoid dendritic cells produce cytokines and mature in response to the TLR7 agonists, imiquimod and resiquimod.

    Cell Immunol 2002, 218:74-86. PubMed Abstract | Publisher Full Text OpenURL

  42. Wong BR, Josien R, Lee SY, Vologodskaia M, Steinman RM, Choi Y: The TRAF family of signal transducers mediates NF-kappaB activation by the TRANCE receptor.

    J Biol Chem 1998, 273:28355-28359. PubMed Abstract | Publisher Full Text OpenURL

  43. Grohmann U, Belladonna ML, Bianchi R, Orabona C, Ayroldi E, Fioretti MC, Puccetti P: IL-12 acts directly on DC to promote nuclear localization of NF-kappaB and primes DC for IL-12 production.

    Immunity 1998, 9:315-323. PubMed Abstract | Publisher Full Text OpenURL

  44. Tamada K, Shimozaki K, Chapoval AI, Zhai Y, Su J, Chen SF, Hsieh SL, Nagata S, Ni J, Chen L: LIGHT, a TNF-like molecule, costimulates T cell proliferation and is required for dendritic cell-mediated allogeneic T cell response.

    J Immunol 2000, 164:4105-4110. PubMed Abstract | Publisher Full Text OpenURL

  45. Xu MQ, Suo YP, Gong JP, Zhang MM, Yan LN: Prolongation of liver allograft survival by dendritic cells modified with NF-kappaB decoy oligodeoxynucleotides.

    World J Gastroenterol 2004, 10:2361-2368. PubMed Abstract | Publisher Full Text OpenURL

  46. Tiao MM, Lu L, Tao R, Wang L, Fung JJ, Qian S: Prolongation of cardiac allograft survival by systemic administration of immature recipient dendritic cells deficient in NF-kappaB activity.

    Ann Surg 2005, 241:497-505. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL

  47. Norman MU, Hickey MJ: Mechanisms of lymphocyte migration in autoimmune disease.

    Tissue Antigens 2005, 66:163-172. PubMed Abstract | Publisher Full Text OpenURL

  48. Wijngaarden S, van Roon JA, van de Winkel JG, Bijlsma JW, Lafeber FP: Down-regulation of activating Fcgamma receptors on monocytes of patients with rheumatoid arthritis upon methotrexate treatment.

    Rheumatology (Oxford) 2005, 44:729-734. PubMed Abstract | Publisher Full Text OpenURL

  49. Winterfield LS, Menter A: Infliximab.

    Dermatol Ther 2004, 17:409-426. PubMed Abstract | Publisher Full Text OpenURL

  50. Ehrenstein MR, Evans JG, Singh A, Moore S, Warnes G, Isenberg DA, Mauri C: Compromised function of regulatory T cells in rheumatoid arthritis and reversal by anti-TNFalpha therapy.

    J Exp Med 2004, 200:277-285. PubMed Abstract | Publisher Full Text OpenURL

  51. Prakken BJ, Samodal R, Le TD, Giannoni F, Yung GP, Scavulli J, Amox D, Roord S, de Kleer I, Bonnin D, et al.: Epitope-specific immunotherapy induces immune deviation of proinflammatory T cells in rheumatoid arthritis.

    Proc Natl Acad Sci USA 2004, 101:4228-4233. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL

  52. Holoshitz J, Matitiau A, Cohen IR: Role of the thymus in induction and transfer of vaccination against adjuvant arthritis with a T lymphocyte line in rats.

    J Clin Invest 1985, 75:472-477. PubMed Abstract | PubMed Central Full Text OpenURL

  53. Morgan ME, Sutmuller RP, Witteveen HJ, van Duivenvoorde LM, Zanelli E, Melief CJ, Snijders A, Offringa R, de Vries RR, Toes RE: CD25+ cell depletion hastens the onset of severe disease in collagen-induced arthritis.

    Arthritis Rheum 2003, 48:1452-1460. PubMed Abstract | Publisher Full Text OpenURL