Higher efficacy of anti-IL-6/IL-21 combination therapy compared to monotherapy in the induction phase of Th17-driven experimental arthritis

PLoS One. 2017 Feb 3;12(2):e0171757. doi: 10.1371/journal.pone.0171757. eCollection 2017.

Abstract

Th17 cells and their cytokines are linked to the pathogenesis of rheumatoid arthritis, a chronic autoimmune disease characterized by joint inflammation. Th17 development is initiated by combined signaling of TGF-β and IL-6 or IL-21, and can be reduced in the absence of either IL-6 or IL-21. The aim of this study was to assess whether combinatorial IL-6/IL-21 blockade would more potently inhibit Th17 development, and be more efficacious in treating arthritis than targeting either cytokine. We assessed in vitro Th17 differentiation efficacy in the absence of IL-6 and/or IL-21. To investigate in vivo effects of IL-6/IL-21 blockade on Th17 and arthritis development, antigen-induced arthritis (AIA) was induced in IL-6-/- x IL-21R-/- mice. The therapeutic potential of this combined blocking strategy was assessed by treating mice with collagen-induced arthritis (CIA) with anti-IL-6R antibodies and soluble (s)IL-21R.Fc. We demonstrated that combined IL-6/IL-21 blocking synergistically reduced in vitro Th17 differentiation. In mice with AIA, absence of IL-6 and IL-21 signaling more strongly reduced Th17 levels and resulted in stronger suppression of arthritis than the absence of either cytokine. Additionally, anti-IL-6/anti-IL-21 treatment of CIA mice during the arthritis induction phase reduced disease development more potent than IL-6 or IL-21 inhibition alone, as effective as anti-TNF treatment. Collectively, these results suggest dual IL-6/IL-21 inhibition may be a more efficacious therapeutic strategy compared to single cytokine blockade to suppress arthritis development.

MeSH terms

  • Animals
  • Arthritis, Experimental / chemically induced
  • Arthritis, Experimental / drug therapy*
  • Arthritis, Experimental / metabolism
  • CD4-Positive T-Lymphocytes
  • Cell Differentiation / drug effects
  • Collagen / toxicity*
  • Female
  • Flow Cytometry
  • Interleukin-21
  • Interleukin-6 / therapeutic use*
  • Interleukins / therapeutic use*
  • Male
  • Mice
  • Signal Transduction / drug effects
  • Th17 Cells / metabolism*

Substances

  • Interleukin-6
  • Interleukins
  • Collagen
  • Interleukin-21

Grants and funding

DR received funding from the Innovative Medicines Initiative Joint Undertaking funded project BTCure [http://btcure.eu/ grant number: 115142-2]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.