Linomide (roquinimex) affects the balance between pro- and anti-inflammatory cytokines in vitro in multiple sclerosis

Objectives - Multiple sclerosis (MS) is characterized by high levels of circulating mononuclear cells (MNC) that respond to myelin proteins like myelin basic protein (MBP) in vitro by expressing mRNA of both pro-inflammatory cytokines, e.g. interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α) and lymphotoxin (LT) that may make MS worse, and anti-inflammatory cytokines like IL-4, IL-10 and transforming growth factor-β (TGF-β) that may act beneficially. Substances that down-regulate cytokines such as TNF-α or promote IL-10 or TGF-β can be anticipated to affect MS beneficially. Material and methods - In situ hybridization to detect and enumerate IFN-γ, TNF-α, LT, IL-4, IL-10 and TGF-β mRNA expressing blood MNC after stimulation with myelin basic protein (MBP), control antigens and without antigen in presence and absence of Linomide (roquinimex, LS-2616) was employed. In parallel, ELISPOT assay to detect MBP- and PHA-reactive IFN-γ secreting blood MNCLinomide was used. Results - Here we report that Linomide, a synthetic immunomodulator, at concentrations effective in vivo reduces the number of MBP-reactive TNF-a and increases MBP-reactive IL-10 and TGF-β mRNA expressing MNC from MS patients'blood when analysed in vitro. Compared to dexamethasone, Linomide up-regulated levels of blood MNC expressing mRNA of TGF-β after culture in presence of MBP. Conclusions - Changes of cytokine balance towards a production of anti-inflammatory cytokines could be a desirable effect to be evaluated in future drug studies of Linomide-like substances. At present, Linomide is not evaluable in MS clinical trials due to side-effects.