EXTENDED REPORT

Chemokine blockade and chronic inflammatory disease: proof of concept in patients with rheumatoid arthritis

J J Haringman¹, M C Kraan¹, T J M Smeets¹, K H Zwinderman², P P Tak¹

¹ Division of Clinical Immunology and Rheumatology, Academic Medical Centre/University of Amsterdam, The Netherlands
² Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre/University of Amsterdam, The Netherlands

Correspondence to:
Correspondence to:
Professor P P Tak, Division of Clinical Immunology and Rheumatology F4–218, Department of Internal Medicine, Academic Medical Centre/University of Amsterdam, Meibergdreef 9, NL-1105 AZ Amsterdam, The Netherlands;
p.p.tak{at}amc.uva.nl

Background: Chemokines and their receptors are considered important contributors in cell migration and inflammation in chronic inflammatory disorders. Chemokines affecting monocytes/macrophages are considered potential therapeutic targets, but no studies of the effects of blocking the chemokine repertoire in humans with a chronic inflammatory disease have been reported.

Objective: To carry out a double blind, placebo controlled, phase Ib clinical trial with a specific, oral CCR1 antagonist.

Methods: 16 patients with active rheumatoid arthritis (RA) were randomised 3:1 to active:placebo treatment for 14 days. Synovial biopsy specimens were obtained on days 1 and 15. Immunohistochemistry was used to detect the presence of various cell types before and after treatment and the results measured by digital image analysis. Results before and after treatment were compared by paired t test, and a two sample t test was used to compare the changes from baseline in the two groups.

Results: All patients completed the study. A significant reduction in the number of macrophages (p=0.016), intimal macrophages (p=0.026), and CCR1+cells (p=0.049) in patients treated with the chemokine antagonist compared with the placebo group occurred in the synovium. Significant decreases in overall cellularity, intimal lining layer cellularity, CD4+ T cells, and CD8+ T cells also occurred in treated patients. Cells lacking CCR1 were not affected. Trends towards clinical improvement were seen in the treated patients but not in the placebo group. Severe side effects were not reported.

Conclusion: Specific chemokine receptor blockade can result in relevant biological effects in patients with active RA.

Keywords: rheumatoid arthritis; CCR1; chemokine blockade; synovium

Abbreviations: ACR, American College of Rheumatology; DAS, disease activity score; DMARDs, disease modifying antirheumatic drugs; HAQ, Health Assessment Questionnaire; OPC, oral powder for constitution; RA, rheumatoid arthritis; SF, synovial fluid; ST, synovial tissue

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