ARTHRITIS
May 10, 2004

New RA Therapy: Immune Reeducation vs. Immunosuppression

A promising new treatment may be able to reeducate the body's immune system to stop it from attacking healthy joint tissue.
The immune system is our chief protector from disease. In people with rheumatoid arthritis, or RA, however, the immune system turns traitor and attacks the body instead.

If the immune system of RA patients could be altered, T cells might be less likely to cause chronic inflammation.

Though there is no cure for RA, its symptoms are usually treated with immunosuppressants, but these medicines can, themselves, produce dangerous side effects. Now, however, a promising new treatment may be able to reeducate the body's immune system to stop it from attacking healthy joint tissue.

Affecting an estimated 2.1 million Americans, RA causes chronic joint inflammation and destruction, disability and even death. While its precise cause is unknown, researchers believe that RA has to do with an immune system overreaction, in certain genetically susceptible individuals, to something in the environment.

The new treatment, called immune-modulation therapy, was developed by Salvatore Albani, M.D., Ph.D., UC San Diego professor of medicine and pediatrics, from his work on the immune system's T cells, which trigger inflammation to kill and clear infections from the body. Albani reasoned that if the immune system of RA patients could be altered, T cells might be less likely to cause chronic inflammation.

To prevent T cells from attacking the body, Albani sought to develop a vaccine therapy that could "reeducate" the diseased immune system in RA patients to prevent rampant inflammation. He focused on a protein called dnaJP1 that is used by T cells to help initiate the inflammation process. "We believed that if we could administer dnaJP1 as a vaccine to patients with early RA, it would affect the autoimmune inflammation," Albani said.

"In essence, we reeducated the immune system T cells in RA patients to be tolerant of the dnaJP1 amino acid sequence that would usually trigger inflammation," Albani said. This immune modulation, rather than immune suppression, prevented a T cell attack against the body's own tissue.

Asked for comment, TheDoctor's RA expert Dr. Peter Barland, Professor of Medicine Emeritus at the Albert Einstein College of Medicine in New York, said, "Oral immunotherapy as a potential treatment for RA is an idea with obvious potential. So far, however, the data is much too preliminary to judge its safety and effectiveness. While oral antigens have been shown to shift autoimmune excitation to immune tolerance, e.g., myelin basic protein in multiple sclerosis, their clinical trials have been very disappointing."

The new treatment is currently being studied in clinical trials at the UC San Diego School of Medicine and several other schools. These are expected to be completed by the end of 2004.
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