Virus-induced autoimmune disease

The braking of tolerance or unresponsiveness to self-antigens, involving the activation of autoreactive lymphocytes, is a critical event leading to autoimmune diseases. The precise mechanisms by which this can occur are mostly unknown. Viruses have been implicated in this process, among other etiological factors, such as genetic predisposition and cytokine activity. Several ways have been proposed by which a viral infection might break tolerance to self and trigger an autoreactive cascade that ultimately leads to the destruction of a specific cell type or an entire organ. The process termed ‘molecular mimicry’ and the use of transgenic models in which viral and host genes can be manipulated to analyze their effects in causing autoimmunity have been particular focuses for research. For example, there is a transgenic murine model of virus-induced autoimmune disease, in which a known viral gene is selectively expressed as a self-antigen in β cells of the pancreas. In these mice, insulin-dependent diabetes develops after either a viral infection, the release of a cytokine such as IFN-γ, or the expression of the costimulatory molecule B7.1 in the islets of Langerhans. Recent studies using this model have contributed to the understanding of the pathogenesis of virus-induced autoimmune disease and have furthered the design and testing of novel immunotherapeutic approaches.     

Regulation of self-tolerance by CD80/CD86 interactions

Antigen presentation by CD80/CD86-positive ‘professional APCs’ induces T-cell activation, whereas antigen presentation in the absence of sufficient CD80/CD86 costimulation may induce a form of tolerance. Blocking CD80/CD86 costimulation inhibits autoimmune disease progression in a variety of animal models, but whether these effects result from restoration of self-tolerance or temporary disease blockade is still unclear. The individual roles of CD80 and CD86 in autoimmune diseases are complicated by multiple factors in vivo. Data from B7 gene knockout mice further clarify the importance of CD80/CD86 in the regulation of T-cell activation and tolerance.     

Genetics of autoimmune diabetes in animal models

Type I diabetes has resisted direct genetic analysis in humans but two excellent models of disease in rodents provide a more readily manipulated alternative for study. These rodent models are being used successfully to localize the genes that are involved in disease pathogenesis in preparation for positional cloning. In addition, mice carrying transgenes and null mutations related to T cell function have been used to demonstrate potential mechanisms for both MHC-dependence and specific effector functions, such as cytokine release and cytotoxicity.     

Organ-specific autoimmunity

The past year has seen advances in our understanding of the mechanisms that control the expression of organ-specific autoimmunity. Attempts to develop therapeutic strategies for the prevention of autoimmune disease have largely been based on deviation of the T-cell response away from an autoaggressive, pro-inflammatory Th1 response. Manipulation of the cytokine environment at the site of antigen uptake or presentation, the source of endogenous antigen, costimulatory molecules or peptides processed and presented has yielded interesting results.     

Systemic autoimmune disease as a consequence of defective lymphocyte death

A major group of systemic autoimmune diseases is associated with abnormal lymphoproliferation, as a result of defects in the termination of lymphocyte activation and growth. Recent progress has been made in understanding the causes and consequences of these abnormalities. At the molecular level, the defects in CD95 and its ligand are only the most obvious reasons for the breakdown of ‘clonal contraction’ which in fact requires the participation of multiple gene products, including the IL-2—IL-2-receptor system, to set up a functional apoptotic machinery.     

Immunotherapy of allergy: anergy, deletion, and immune deviation

Decreased allergen-specific T cell proliferation and dysregulated cytokine synthesis accompany allergen immunotherapy, consistent with mechanisms of anergy and immune deviation. Recent studies emphasise the pivotal role of decreased T cell IL-4:IFN-γ ratios. A landmark clinical trial of T cell epitope peptides for venom-immunotherapy shows efficacy and safety; murine models suggest intramolecular epitope-suppression inhibits responses to the whole allergen.     

Biology and genetics of atopic disease

Several immunological disorders including allergic rhinitis, bronchial asthma, atopic dermatitis, food allergies, urticaria, nonhereditary angioedema, systemic anaphylaxis, and allergic conjunctivitis are associated with a positive family history, and share a positive response in the Prausnitz-Kuster (wheal and flare) reaction. Studies have shown that 20–30% of the population has a strong genetic predisposition for this condition, termed atopy, whose hallmark is a greatly elevated serum IgE concentration. A great deal is known about the cellular interactions that mediate the sensitization, immediate and late-phase reactions that follow encounters with allergen, as well as about the cell surface and signaling events that result in mediator release from inflammatory cells. Less is known of the genes that confer genetic predisposition for atopy; however, a worldwide effort to identify atopy genes is making significant progress.     

Genetic susceptibility factors in type 1 diabetes: linkage, disequilibrium and functional analyses

Continuing progress has been made in elucidating the genetic factors involved in type 1 diabetes (insulin-dependent diabetes mellitus [IDDM]) in the past year. Two genome scans suggested additional susceptibility intervals and provided supporting evidence for several previously reported linkages. Other studies focused on the confirmation of linkage using multipoint sibpair analyses with densely spaced markers and multiethnic collections of families. Although significant and consistent linkage evidence was reported for the susceptibility intervals IDDM8 (on human chromosome 6q27), IDDM4 (on 11q) and IDDM5 (on 6q25), evidence for most other intervals varies in different data sets — probably due to a weak effect of the disease genes, genetic heterogeneity or random variation. Linkage disequilibrium mapping has become an increasingly important tool for both the confirmation and fine-mapping of susceptibility intervals, as well as identification of etiological mutations. Functional studies indicate, firstly, that the susceptible and protective HLA class II molecules HLA-DR and -DQ bind and present nonoverlapping peptides and, secondly, that the variable number of tandem repeats at the 5′ end of the insulin gene (susceptibility interval IDDM2) regulates insulin expression in the thymus.     

Manipulation of the Th1/Th2 balance in autoimmune disease

Many autoimmune diseases are caused by autopathogenic Th1 cells. Because in vitro Th1 and Th2 cells cross-regulate each other, it is likely that the induction of self-antigen-specific Th2 cells can prevent autoimmune disease. In the past year, investigators have further defined the role of Th1 and Th2 cytokines in the induction and regulation of autoimmunity. Furthermore, the role of MHC—antigen—T-cell avidity (strength of signal) in inducing such protective immune responses has been elucidated.     

Histamine-releasing factors

There is increasing evidence that human basophils accumulate at sites of chronic inflammation, and, in particular, in allergic asthma. Investigators have, therefore, become very interested in identifying proteins that activate these cells. Recently, the gene encoding a candidate for this function, a novel molecule, the IgE-dependent histamine-releasing factor, was cloned.     

Costimulation and autoimmunity

The past year has seen significant advances in our understanding of the role of the B7-CD28/CTLA-4 pathway in T cell activation and self-tolerance. Recent studies have demonstrated that CTLA-4 is a critical negative regulator of T cell activation and autoreactivity, revealing a previously unsuspected means by which costimulation is involved in the maintenance and breakdown of self-tolerance. Manipulation of this costimulatory pathway in animal models of autoimmunity has shown an important role for this pathway in both the initiation and progression of autoimmune diseases.     

CD8 T cells in atopic disease

In recent years there has been a tremendous expansion in our understanding about CD8⁺ T cells. We now know that, as for CD4⁺ T cells, they can be divided into subsets (Tc1 and Tc2) according to the cytokines they secrete. These subsets may differ in their capacity to kill and may even, in some cases, provide help for B cell antibody production or be involved in the induction of inflammatory responses. In addition, there is a host of cross-regulatory networks between different CD4⁺ and CD8⁺ subsets that control the magnitude and duration of immune responses. The observation that some antigens that are normally presented by MHC class II and seen by CD4⁺ T cells can be presented by MHC class I and stimulate CD8⁺ T cells increases the possibility for such interactions. During the next few years we can expect that our understanding of the biology of CD8⁺ T cells and their role in immunity will increase.     

B cells in systemic autoimmune disease: recent insights from Fas-deficient mice and men

In mice functionally deficient for either Fas or Fas ligand expression, the failure of Fas-ligand-expressing cytotoxic T cells to eliminate autoreactive B cells can result in excessive autoantibody production. Recent in vitro studies have shown that B cells activated by CD40 ligand become extremely sensitive to Fas-mediated apoptosis while IL-4 and/or surface IgM receptor engagement protects B cells from Fas ligand cytolysis. Potential in vivo sites for Fas ligand regulation of self-reactive B cells have been suggested and implications for human disease have been investigated.     

Regulation of autoimmunity by proinflammatory cytokines

Studies extending over a decade have provided compelling evidence to suggest that chronic expression of proinflammatory cytokines in vivo leads to unique regulatory properties that target the cognate immune response in a way that appears to be beneficial to the host. This review focuses on the prototypic proinflammatory cytokine tumour necrosis factor α, because recent studies of autoimmune disease in mice and man have unraveled a novel and unexpected immunosuppressive role for this inflammatory mediator during the effector phase of the autoimmune process. So far, T lymphocytes would appear to be important cellular targets of this immunoregulatory effect.     

T cells and cytokines in Crohn's disease

Recent findings indicate that activated T lymphocytes, showing restricted T-cell receptor repertoire and a Th1-like profile of cytokine production, are responsible for macrophage activation and release of inflammatory cytokines, toxic oxygen metabolites and nitric oxide, which initiate and maintain the transmural intestinal inflammation in Crohn's disease. A critical event in the promotion of Th1-type response at gut level may involve up-regulation of IL-12 production and the breakdown of tolerance against the intestinal flora.     

Epitope spreading

Epitope (determinant) spreading is the development of immune responses to endogenous epitopes secondary to the release of self antigens during a chronic autoimmune or inflammatory response. The past year has seen considerable advances in our understanding of the contribution of epitope spreading to the chronic pathogenesis of experimental T-cell-mediated and antibody-mediated autoimmune diseases. Most significantly, conclusive functional evidence for a major role for epitope spreading in the chronic pathogenesis of murine relapsing-remitting experimental autoimmune encephalomyelitis, a CD4⁺ T-cell-mediated model of multiple sclerosis, was forthcoming.     

Inheritance of susceptibility to multiple sclerosis

Inrecent years, epidemiological evidence supporting the genetic basis of multiple sclerosis has been extended and whole-genome linkage screening has advanced the mapping of the involved genes. Understanding of the known HLA associations has also improved and many candidate genes have been studied.     

Therapeutic potential of anti-IgE antibodies

Anti-IgE antibodies directed against the FcRI-binding region on IgE inhibit binding of IgE to IgE receptors without inducing mediator release from IgE sensitized cells. In mice these antibodies selectively reduce serum IgE, inhibit antigen induced skin reactions, cytokine production by lung Th2 cells, and pulmonary eosinophil infiltration. Clinical trials in humans reveal that such antibodies are well tolerated and reduce rhinitis symptoms and early and late phase bronchoconstriction responses. Thus interruption of the allergic cascade at the IgE antibody level with non-anaphylactogenic anti-IgE antibodies is effective and represents an attractive intervention for the treatment of allergic diseases.