Seven days of low-dose orally administered murine type I interferon does not cause priming in vivo.

In vivo, low-dose orally administered type I interferon (LDOA IFN) therapy has been shown to provide beneficial effects in a number of diseases. These diseases vary in nature (viral, autoimmune, and neoplastic), yet LDOA IFN therapy is able to provide effective treatment. Despite the growing knowledge of the efficacy of such treatment and ongoing human clinical trials, the mechanism by which LDOA IFN acts remains largely unknown. In this study, we examined the phenomenon known as "priming" as a potential mechanism by which LDOA IFN effects may be mediated. Priming is a phenomenon in which pretreatment of cells or entire organisms with type I IFN causes significantly enhanced IFN production after induction of the endogenous IFN system by virus or polyI:C. This phenomenon of priming has been exploited in commercial industry for the mass production of type I IFN for medical and research use. It was found that LDOA IFN treatment did not cause priming in vivo.     

Protective effect of low-dose interferon against neonatal murine cytomegalovirus infection.

Mice were injected with 10 to 5,000 reference units of interferon intraperitoneally or subcutaneously within 24 h of birth and reinoculated intraperitoneally 24 h later with 200 plaque-forming units of murine cytomegalovirus. Mock interferon and virus diluent were the control inocula. Infection of mock interferon-treated mice resulted in significant retardation of growth, accompanied by tissue injury and a depressed blastogenic response of splenic lymphocytes. Prophylactic administration of interferon prevented growth retardation and resulted in lower tissue viral titers and diminished injurious effects of the virus. Intraperitoneal inoculation of interferon was more protective than was subcutaneous, and 10 U of interferon was often as effective as 5,000 U. Accelerated maturation and enhanced activity of lymphoid elements were observed histologically in spleens and lymph nodes of interferon-treated mice; supportive of these findings was the greater incorporation of [3H]thymidine of splenocytes from interferon-treated mice. The protective effect of interferon may, therefore, be due to stimulation or accelerated maturation of cellular immune functions.     

Low-dose oral use of interferon inhibits virally induced myocarditis.

Cytomegalovirus (CMV) infection has been associated with the development of myocarditis in humans. Our established mouse model for CMV myocarditis allows detailed investigation of the immunopathogenic mechanisms and therapies for cardiovascular disease. The type I interferons (IFN-alpha/beta) are part of the innate immune response to CMV infections. Previously, we have reported that daily treatment with low doses of murine IFN-alpha/beta administered by the oral-mucosal route significantly reduces early virus replication of murine CMV in the spleen and liver of infected mice. The oral-mucosal route provides an alternate delivery system to the current modes of IFN administration and is associated with fewer side effects. Since prophylactic treatment with type 1 IFNs may result in both antiviral and immunomodulatory effects that may lessen the development of disease, we wished to study the effect of IFN-alpha/beta on the development of myocarditis. Low-dose oral use of type I IFN (10 IU/day for 7 days prior to virus infection) did not abrogate myocarditis but suppressed the inflammatory response in both the acute and chronic phase of the disease. Furthermore, low-dose oral use of IFN was as effective at inhibiting myocarditis as a single injection of a high dose of IFN (20,000 IU) on the day of virus infection. These findings indicate the need for evaluation of low-dose use of oral IFN in the development of improved clinical therapies for the treatment of cardiovascular disease.     

Upregulation of type I interferon receptor by IFN-gamma.

Type I interferon (IFN) receptor has a multichain structure composed of at least two distinct subunits, IFNAR-1 and IFNAR-2. In the present study, we demonstrated that IFN-gamma induced the expression of mRNA for IFNAR-1 and IFNAR-2 in a human hepatoma cell line, HepG2 cells. The induction was dose and time dependent. Because of this result, we examined the effect of combined treatment with type I IFN and IFN-gamma. The intracellular 2-5A-synthetase activity induced by combined treatment was significantly higher than that by type I IFN alone. This study suggests that combined treatment with type I IFN and IFN-gamma may be more effective than that of type I IFN alone and that the upregulation of type I IFN receptor may be one of the reasons. Our findings may have some relevance to the clinical use of IFN.     

The type I interferon response during viral infections: a "SWOT" analysis

The type I interferon (IFN) response is a strong and crucial moderator for the control of viral infections. The strength of this system is illustrated by the fact that, despite some temporary discomfort like a common cold or diarrhea, most viral infections will not cause major harm to the healthy immunocompetent host. To achieve this, the immune system is equipped with a wide array of pattern recognition receptors and the subsequent coordinated type I IFN response orchestrated by plasmacytoid dendritic cells (pDCs) and conventional dendritic cells (cDCs). The production of type I IFN subtypes by dendritic cells (DCs), but also other cells is crucial for the execution of many antiviral processes. Despite this coordinated response, morbidity and mortality are still common in viral disease due to the ability of viruses to exploit the weaknesses of the immune system. Viruses successfully evade immunity and infection can result in aberrant immune responses. However, these weaknesses also open opportunities for improvement via clinical interventions as can be seen in current vaccination and antiviral treatment programs. The application of IFNs, Toll-like receptor ligands, DCs, and antiviral proteins is now being investigated to further limit viral infections. Unfortunately, a common threat during stimulation of immunity is the possible initiation or aggravation of autoimmunity. Also the translation from animal models to the human situation remains difficult. With a Strengths-Weaknesses-Opportunities-Threats ("SWOT") analysis, we discuss the interaction between host and virus as well as (future) therapeutic options, related to the type I IFN system.     

Decreased type I interferon receptor-soluble isoform in antiretroviral-treated HIV-positive children.

We developed a real-time PCR assay to simultaneously measure the mRNA level of type I interferon (IFN) receptor (IFNAR) components in peripheral blood cells of children with chronic immune stimulation due to HIV infection. All patients were undergoing antiretroviral therapy and were divided into two groups on the basis of the induction of MxA mRNA, a marker of type I IFN bioactivity. We found that IFNAR-2 subunit mRNA was higher than that of the IFNAR-1 subunit, that the mRNA for the IFNAR-2.2 functional isoform was more expressed than that for the truncated IFNAR-2.1 isoform, and both were much more represented than that of the IFNAR-2.3 soluble isoform. We also demonstrated that soluble isoform mRNA was significantly diminished in the subgroup of patients with MxA mRNA below the cutoff value (determined as the 99th percentile of MxA measured in healthy controls). These results suggest that downregulation of the soluble receptor isoform, which would not compete with the functional isoform for binding to the target cytokine, would give type I IFN, eventually induced in these patients in the case of viral reactivation, the opportunity to promptly exert its antiviral activity.     

Controlled clinical trial of prophylactic human-leukocyte interferon in renal transplantation. Effects on cytomegalovirus and herpes simplex virus infections.

A double-blind, placebo-controlled trial of interferon prophylaxis against viral infections was conducted in renal-transplant recipients receiving standard immunosuprressive therapy with or without antithymocyte globulin. Interferon was administered for six weeks, beginning on the day of transplantation. Cytomegalovirus excretion began earlier and viremia was more frequent in placebo-treated than in interferon-treated patients. Cytomegalovirus viremia correlated with clinical syndromes was more frequent in recipients of antithymocyte globulin. In contrast, neither interferon nor antithymocyte globulin altered excretion of herpes simplex virus. Reversible leukopenia and thrombocytopenia occurred in seven interferon recipients. Patient and graft survival were comparable in interferon and placebo groups. There preliminary results suggest that a six-week course of prophylactic interferon delays shedding of cytomegalovirus and decreases the incidence of viremia after transplantation. In contrast, antithymocyte globulin appears to increase the severity of infection from cytomegalovirus among these patients.     

Acute cytomegalovirus infections in leukemic mice.

Mice infected with 2 x 10(3) plaque-forming units of mouse cytomegalovirus (MCMV) 3 days after receiving 300 to 400 spleen focus-forming units of Friend leukemia virus developed a more severe MCMV infection than did normal animals. Increased severity was demonstrated by the increased amounts of MCMV recoverable from the salivary glands of leukemic mice 1 to 5 weeks postinfection. In addition, the difference in the number of virus isolations from the kidneys, spleens, livers, and lungs of animals (74 to 120) coinfected with MCMV and Friend leukemia virus compared with animals (49 of 120) infected with MCMV alone was significant (P less than 0.01). Both the 50% lethal dose and 50% infectious dose of MCMV in leukemic mice were lower than in normal animals. MCMV and Friend leukemia virus appear to interact by suppressing the ability of infected spleen cells to respond to mitogen-induced stimulation. The observations of increased severity of MCMV infections in leukemic mice closely parallel the situation observed in human leukemia patients who are at an increased risk of disease due to human cytomegalovirus infections. This mouse model may be useful in assessing the effect of antiviral (cytomegalovirus) therapy.     

Immunosuppressive effects of lymphocyte (type II) and leucocyte (type I) interferon on primary antibody responses in vivo and in vitro.

We have tested the hypothesis that type II interferon (IF), released by immune lymphocytes after in vivo stimulation with tuberculin, has immunosuppressive effects. Mycobacterium bovis (BCG) infected mice injected with tuberculin showed a very intense suppression of antibody response to sheep erythrocytes. Sera containing lymphocyte IF strongly inhibited primary immune responses to sheep erythrocytes in cultures. Addition of macrophages could not counteract the in vitro immunosuppressive effects of lymphocyte IF, suggesting that the main effect is exerted directly on lymphocytes. Sendai virus-induced leucocyte (type I) IF was also shown to have suppressive effects in vivo and in vitro. However, lymphocyte IF was shown to be much more immunosuppressive than a preparation of type I interferon with equivalent antiviral potency. Thus type II IF, as a product of activated lymphocytes, may have a major immunoregulatory role.     

Janus-like effects of type I interferon in autoimmune diseases

In multiple sclerosis, type I interferon (IFN) is considered immune-modulatory, and recombinant forms of IFN-β are the most prescribed treatment for this disease. This is in contrast to most other autoimmune disorders, because type I IFN contributes to the pathologies. Even within the relapsing-remitting multiple sclerosis (RRMS) population, 30-50% of MS patients are non-responsive to this treatment, and it consistently worsens neuromyelitis optica, a disease similar to RRMS. In this article, we discuss the recent advances in the field of autoimmunity and introduce the theory explain how type I IFNs can be pro-inflammatory in disease that is predominantly driven by a Th17 response and are therapeutic when disease is predominantly Th1.     

Ingested type I interferon: a potential treatment for autoimmunity.

We have proposed a unifying hypothesis of the etiopathogenesis of autoimmunity that defines autoimmunity as a type I interferon (IFN) immunodeficiency syndrome. We have examined toxicity and potential efficacy in three phase I (type 1 diabetes, rheumatoid arthritis, multiple sclerosis) and one phase II clinical trials in multiple sclerosis (MS). In a phase I open-label trial in type 1 diabetes, ingested IFN-alpha preserved residual beta cell function in recent onset patients. In a second phase I trial, treatment of rheumatoid arthritis (RA) with ingested IFN-alpha reduced the secretion of interleukin-1 (IL-1), a proinflammatory cytokine. In a third phase I trial in MS, there was a significant decrease in peripheral blood mononuclear cell (PBMC) IL-2 and IFN-gamma production after ingesting IFN-alpha. In a phase II randomized, placebo-controlled, double-blind trial in MS, 10,000 IU ingested IFN-alpha significantly decreased gadolinium enhancements compared with the placebo group at month 5. Tumor necrosis factor-alpha (TNF-alpha) and IFN-gamma cytokine secretion in the 10,000 IU group at month 5 showed a significant decrease that corresponded with the effect of ingested IFN-alpha on decreasing gadolinium enhancements. Ingested IFN-alpha was not toxic in any of these clinical trials. These studies suggest that ingested IFN-alpha may have a potential role in the treatment of autoimmunity.     

The neglected role of type I interferon in the T-cell response: implications for its clinical use

Originally described as an antiviral substance, type I interferon (IFN) was subsequently shown to exert multiple biological effects and is now the most frequently used cytokine in the treatment of some viral and neoplastic diseases. Although early studies described various effects on the immune system, the role of type I IFN as an immunoregulatory molecule has long been neglected. Here, Filippo Belardelli and Ion Gresser summarize recent experimental results on the interactions of type I IFN with T cells, which may prove important in its use in patients.     

The type I interferon system in idiopathic inflammatory myopathies

Polymyositis (PM), dermatomyositis (DM) and inclusion body myositis (IBM) are chronic inflammatory diseases that are characterized by muscle weakness and inflammatory cells in muscle tissue. Autoantibodies are common, some of them are specific for myositis, the most frequent being the anti-Jo-1 antibody which is associated not only with myositis but also with interstitial lung disease and arthritis. A role of type I interferons in disease mechanisms of myositis was first supported by the reported onset of PM and DM during treatment with type I interferon. More recently an interferon signature has been reported in muscle tissue of DM and PM patients both as gene and protein expression, and type I IFN expression in peripheral blood cells seems to correlate with disease activity. Different mechanisms could induce type I interferon in PM and DM like viral infections or endogenous factors as suggested by the observation that sera from myositis patients with anti-Jo-1 antibodies as well as anti-SSA and anti-SSB antibodies have an interferon inducible capacity. Accumulating data indicate a role of the type I interferon in myositis, particularly in juvenile and adult DM and in anti-Jo-1 or anti-SSA positive PM.     

Fueling autoimmunity: type I interferon in autoimmune diseases

In recent years, active research using genomic, cellular and animal modeling approaches has revealed the fundamental forces driving the development of autoimmune diseases. Type I interferon imprints unique molecular signatures in a list of autoimmune diseases. Interferon is induced by diverse nucleic acid-containing complexes, which trigger innate immune activation of plasmacytoid dendritic cells. Interferon primes, activates or differentiates various leukocyte populations to promote autoimmunity. Accordingly, interferon signaling is essential for the initiation and/or progression of lupus in several experimental models. However, the heterogeneous nature of systemic lupus erythematosus requires better characterization on how interferon pathways are activated and subsequently promote the advancement of autoimmune diseases. Given the central role of type I interferon, various strategies are devised to target these cytokines or related pathways to curtail the progression of autoimmune diseases.     

Enhanced tumor development in mice lacking a functional type I interferon receptor.

The aim of this study was to investigate the contribution of endogenous - that is, without the addition of any interferon (IFN) inducer - type I IFN production in the defense against tumor development. To this purpose, the IFN-alpha receptor (IFNAR) knockout (KO)-induced mutation, resulting in the complete absence of IFN-alpha/beta activity, was introduced into a C3H genetic background by 10 backcross generations, followed by brother-sister matings for at least four generations. The resulting mice were inoculated either with syngeneic C3H melanoma K1735 cells, with allogeneic 3LL carcinoma cells, or with allogeneic B16F10 melanoma cells. With all three tumor cell lines, tumor development and ensuing mortality were enhanced in the IFNAR KO animals. This indicates that endogenous IFN-alpha/beta production is a mediator of natural immunity to tumor development.