Abstract
BackgroundIntravenous immunoglobulin (IVIg) has been used to treat a variety of autoimmune disorders including multiple sclerosis (MS); however its mechanism of action remains elusive. Recent work has shown that interleukin-11 (IL-11) mRNAs are upregulated by IVIg in MS patient T cells. Both IVIg and IL-11 have been shown to ameliorate experimental autoimmune encephalomyelitis (EAE), an animal model of MS. The objective of this study was to determine whether the protective effects of IVIg in EAE occur through an IL-11 and IL-11 receptor (IL-11R)-dependent mechanism.MethodsWe measured IL-11 in the circulation of mice and IL-11 mRNA expression in various organs after IVIg treatment. We then followed with EAE studies to test the efficacy of IVIg in wild-type (WT) mice and in mice deficient for the IL-11 receptor (IL-11Rα−/−). Furthermore, we evaluated myelin-specific Th1 and Th17 responses and assessed spinal cord inflammation and demyelination in WT and IL-11Rα−/− mice, with and without IVIg treatment. We also examined the direct effects of mouse recombinant IL-11 on the production of IL-17 by lymph node mononuclear cells.ResultsIVIg treatment induced a dramatic surge (>1000-fold increase) in the levels of IL-11 in the circulation and a prominent increase of IL-11 mRNA expression in the liver. Furthermore, we found that IL-11Rα−/− mice, unlike WT mice, although initially protected, were resistant to full protection by IVIg during EAE and developed disease with a similar incidence and severity as control-treated IL-11Rα−/− mice, despite initially showing protection. We observed that Th17 cytokine production by myelin-reactive T cells in the draining lymph nodes was unaffected by IVIg in IL-11Rα−/− mice, yet was downregulated in WT mice. Finally, IL-11 was shown to directly inhibit IL-17 production of lymph node cells in culture.ConclusionThese results implicate IL-11 as an important immune effector of IVIg in the prevention of Th17-mediated autoimmune inflammation during EAE.
Highlights
Intravenous immunoglobulin (IVIg) is a blood-derived therapeutic prepared by pooling the immunoglobulin of thousands of donors [1], and is widely used to treat patients suffering from diseases such as primary immunodeficiency, Kawasaki disease, immune thrombocytopenia, Guillain-Barresyndrome, and chronic inflammatory demyelinating polyneuropathy [1,2,3,4,5,6]
We show that mice that are deficient in IL-11Ra are more resistant to the protective effects of IVIg treatment in preventing EAE and that this relates to a failure of IVIg to attenuate the CNS trafficking and IL-17A production by autoreactive T cells
We observed that IVIg profoundly reduced the production of the T helper 1 (Th1) cytokines IFN-c and TNFa and moderately reduced the production of IL-2 and the Th17associated cytokine IL-17A by MOG35–55-reactive T cells (Figure 1B)
Summary
Intravenous immunoglobulin (IVIg) is a blood-derived therapeutic prepared by pooling the immunoglobulin of thousands of donors [1], and is widely used to treat patients suffering from diseases such as primary immunodeficiency, Kawasaki disease, immune thrombocytopenia, Guillain-Barresyndrome, and chronic inflammatory demyelinating polyneuropathy [1,2,3,4,5,6] In addition to these approved therapeutic uses, IVIg is efficacious in many ‘‘off-label’’ clinical applications, for autoimmune disorders such as myasthenia gravis and multiple sclerosis (MS) [7,8,9]. The objective of this study was to determine whether the protective effects of IVIg in EAE occur through an IL-11 and IL-11 receptor (IL-11R)-dependent mechanism
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