F8-IL-4 is a recently developed immunocytokine that delivers IL-4 to sites of inflammationby targeting the neovasculature. We previously reported that F8-IL-4, in combination with dexamethasone (DXM), provides a durable therapy in mice with collagen-induced arthritis (CIA). Therefore, the objective of this study was to identify the mechanism by which IL-4 and DXM combination therapy provides long-lasting disease remission. F8-IL-4 alone attenuated inflammation in CIA and this was associated with increased T H 2 and decreased T H 17 cell numbers in the joints. Similarly, DXM alone had an antiinflammatory effect associated with lower T H 17 cell numbers. In both cases, these therapeutic benefits were reversed once treatment was stopped. On the other hand, combination therapy with F8-IL-4 plus DXM led to a synergistic increase in the percentage of regulatory T (Treg) cells and antiinflammatory macrophages in the arthritic joint and spleen as well as IL-10 levels in serum and spleen. The net result of this was a more pronounced attenuation of inflammation and, more importantly, protection from arthritis relapse post therapy retraction. In conclusion, F8-IL-4 plus DXM is a durable treatment for arthritis that acts by promoting Treg cells in a synergistic manner, and by producing a sustained increase in antiinflammatory macrophages.Keywords: Arthritis r Dexamethasone r IL-4 r Macrophages r Tolerance Additional supporting information may be found in the online version of this article at the publisher's web-site
IntroductionRheumatoid arthritis (RA) is a chronic autoimmune disease affecting joints, in which the delicate balance between pro-and antiinflammatory cells and their cytokines is perturbed. This is illustrated by the fact that targeting proinflammatory cytokines (TNF-α, IL-1β, and IL-6) in RA patients and in mouse models of Correspondence: Dr. Joanna Z. Kawalkowska e-mail: joanna.kawalkowska@kennedy.ox.ac.uk RA, as well as boosting levels of antiinflammatory cytokines (IL-10 and IL-4) leads to a reduction in disease severity [1][2][3]. IL-4 is an antiinflammatory cytokine, which has been under investigation for the treatment of autoimmune arthritis since the late 1990s. IL-4 downregulates the production of proinflammatory cytokines such as IL-1, TNF-α, and IL-6, which have been implicated in the pathogenesis of RA [4,5]. The ex vivo delivery of IL-4 has been shown to be effective in attenuating inflammation in mouse models of arthritis [2,6,7]. Furthermore, IL-4 has been identified in mice with arthritis during disease remission [8], which suggests that this cytokine also plays a role in the resolution of disease. Sustained treatment-free remission in patients with autoimmune diseases has long been the unattainable holy grail of autoimmune disease treatment. Tolerizing strategies with dexamethasone (DXM) and immunogenic peptides have shown great promise in mouse models of diabetes [22]. We showed previously that F8-IL-4 attenuates collagen-induced arthritis (CIA) in DBA/1 mice, a preclinical model for RA [23]. ...