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Abstract Number: 1036

Synergism Between GM-CSF and IL-17 Causes Enhanced Joint Pathology Via the Production of IL-6 and IL-23

Annemarie E.M. van Nieuwenhuijze1, Debbie M. Roeleveld2, Birgitte Walgreen2, Miranda Bennink1, Monique M. Helsen1, Liduine van den Bersselaar1, Ian P. Wicks3, Wim B. van den Berg1, Fons A. van de Loo1 and Marije I. Koenders1, 1Experimental Rheumatology, Radboud university medical center, Nijmegen, Netherlands, 2Experimentel Rheumatology, Radboud university medical center, Nijmegen, Netherlands, 3Inflammation, The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Animal models, cytokines, growth factors, interleukins (IL) and therapeutic targeting

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Session Information

Title: Cytokines, Mediators, Cell-cell Adhesion, Cell Trafficking and Angiogenesis

Session Type: Abstract Submissions (ACR)

Background/Purpose: T helper-17 (Th17) cells are important mediators of inflammatory diseases, and are the main pathogenic cell type in many animal models of autoimmunity. Recent studies highlight a surprising role for T-cell derived granulocyte-macrophage colony stimulating factor (GM-CSF) in the pathogenicity of Th17 cells. We examined the mechanism by which interleukin 17 (IL-17) and GM-CSF contribute to cartilage- and bone damage of synovial joints during experimental arthritis, and investigated their potential additive and synergistic effects to provide a rationale for combination therapy in auto-inflammatory conditions.

Methods: Collagen-induced arthritis (CIA) was elicited in DBA/1J mice. Neutralizing antibodies to IL-17 and/or GM-CSF were administered after onset of disease for 14 days. Arthritis progression was followed by macroscopic scoring of the paws (maximum score of 12 per mouse). In addition, the effect of local over-expression of IL-17 and/or GM-CSF was studied by adenoviral transfection in naïve knee joints. Joint pathology was studied by X-ray and histology, and Luminex and QPCR were performed to determine cytokine en chemokine expression.

Results:   Combined therapeutic treatment of mice early after the onset of CIA ameliorated disease progression. Macroscopic joint inflammation was significantly reduced, from a total score of 5.6±0.4 for mice treated with isotype control antibodies to 2±0.6 for mice treated with combination therapy. Treatment with anti-IL-17 or anti-GM-CSF alone resulted in scores of 3.4±0.5 and 3.5±0.4, respectively. Simultaneous blocking of GM-CSF and IL-17 was also the most effective treatment in the prevention of radiological bone damage and histological cartilage destruction.

To provide further insight in local additive or synergistic effects of IL-17 and GM-CSF, overexpression of IL-17, GM-CSF or the combination was achieved with adenoviral vectors. Inflammatory infiltrate and cartilage- and bone damage developed in all groups from day 1 after adenoviral transfer, with the most severe effect observed in the combination group. On day 7, partial destruction of joint architecture was apparent in knee joints after combined overexpression of IL-17 and GM-CSF. Overexpression of GM-CSF alone induced IL-1β, which production was elevated by IL-17. Interestingly, overexpression of IL-17 alone caused a clear increase in synovial IL-6 production (179±63pg/ml), which was dramatically enhanced in the co-presence of GM-CSF (1,9±0,4ng/ml). In addition,  a strong synergistic effect of combined overexpression was seen on the Th17 differentiation factor IL-23.

Conclusion:   Our results demonstrate that the combined presence of IL-17 and GM-CSF causes aggravated joint damage through synergistic effects on inflammatory mediators in the synovial joints. In view of the moderate success of therapeutic IL-17 or GM-CSF blockade in rheumatoid arthritis, combined inhibition of IL-17 and GM-CSF might be an interesting alternative option for RA patients that do not fully respond to inhibition of the separate cytokines.


Disclosure:

A. E. M. van Nieuwenhuijze,
None;

D. M. Roeleveld,
None;

B. Walgreen,
None;

M. Bennink,
None;

M. M. Helsen,
None;

L. van den Bersselaar,
None;

I. P. Wicks,
None;

W. B. van den Berg,
None;

F. A. van de Loo,
None;

M. I. Koenders,
None.

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