Chemokines and leukocyte trafficking in rheumatoid arthritis
Section snippets
Leukocyte migration
A key step in the development of an inflammatory process, including autoimmune diseases like RA, is the recruitment of leukocytes to the site of inflammation. This involves multiple regulatory steps initially proposed in the multi-step models of Springer [1] and Butcher and co-workers [2]. This process involves: (1) leukocyte rolling; (2) rapid activation of leukocyte integrins and subsequent adhesion to endothelial ligands (firm adhesion); (3) transendothelial migration (diapedesis); and (4)
Chemokines and chemokine receptors
Chemokines are small, structurally related peptides of 8–10 kD that function to upregulate integrin adhesiveness and promote leukocyte migration into tissues [5], [9]. The chemokine system is extensive with an estimated 50 chemokine ligands and 20 receptors. Chemokines are secreted from a wide variety of cells, and are involved in both innate and adaptive immune responses. They are similar in amino acid sequence and bind to receptors containing seven transmembrane spanning helices. They are
Regulation of leukocyte trafficking to inflamed synovium
Organ-specific leukocyte trafficking can occur at many different points and is highly regulated. Increased cell recruitment occurs by upregulating selectin or integrin adhesion molecule expression on the cell surface or by increasing leukocyte migration and activation through differential chemokine production. The resulting infiltrate consists of many leukocyte subsets including granulocytes, T cells, B cells, monocytes, macrophages, dendritic cells and mast cells, each contributing in unique
Therapeutic considerations
Inhibitors to adhesion molecules have had some success in animal models of inflammatory arthritis. A P-selectin glycoprotein ligand (rPSGL-1Ig) fusion protein was able to ameliorate established CIA in mice, partially through decreased production of TNF-α [116]. VCAM-1 blockade with neutralizing antibodies increases circulating B cells and is able to reduce clinical severity but not incidence of CIA [85]. A recently generated monoether derivative of probucil, compound 4ad (AGIX-4207), which has
Conclusions
Although anti-TNF-α therapies have provided considerable benefit to numerous patients with RA, there are still those who obtain only partial benefit or are unable to tolerate these drugs. Consequently, there is still a need for additional therapies that can be used either in conjunction with anti-TNF-α drugs or to act as solo agents. Leukocyte trafficking to sites of inflammation is a highly regulated process and may be a potential therapeutic target in chronic autoimmune diseases like RA.
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This paper was part of the Rheumatoid Special Issue, See Pathophysiology 12/3.