To determine whether IL-4 is therapeutic in treating established
experimental arthritis, a recombinant adenovirus carrying the gene that encodes
murine IL-4 (Ad-mIL-4) was used for periarticular injection into the ankle
joints into mice with established collagen-induced arthritis (CIA).
Periarticular injection of Ad-mIL-4 resulted in a reduction in the severity of
arthritis and joint swelling compared with saline- and adenoviral control
groups. Local expression of IL-4 also reduced macroscopic signs of joint
inflammation and bone erosion. Moreover, injection of Ad-mIL-4 into the hind
ankle joints resulted in a decrease in disease severity in the untreated front
paws. Systemic delivery of murine IL-4 by intravenous injection of Ad-mIL-4
resulted in a significant reduction in the severity of early-stage
arthritis.
Introduction:
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease
that is characterized by joint inflammation, and progressive cartilage and bone
erosion. Recent research has identified certain biologic agents that appear
more able than conventional therapies to halt effectively the progression of
disease, as well as ameliorate disease symptoms. One potential problem with the
use of biologic agents for arthritis therapy is the need for daily or weekly
repeat dosing. The transfer of genes directly to the synovial lining can
theoretically circumvent the need for repeat dosing and reduce potential
systemic side effects [1,2].
However, although many genes have been effective in treating murine CIA if
administrated at a time before disease onset, local intra-articular or
periarticular gene transfer has not been highly effective in halting the
progression of established disease. IL-4, similar to tumor necrosis factor
(TNF)-α and IL-1 inhibitors, has been shown be therapeutic for the
treatment of murine CIA when administered intravenously as a recombinant
protein, either alone or in combination with IL-10. IL-4 can downregulate the
production of proinflammatory and T-helper (Th)1-type cytokines by inducing
mRNA degradation and upregulating the expression of inhibitors of
proinflammatory cytokines such as IL-1 receptor antagonist (IL-1Ra) [3,4]. IL-4 is able to inhibit IL-2 and
IFN-γ production by Th1 cells, resulting in suppression of macrophage
activation and the production of the proinflammatory cytokines IL-1, IL-6,
IL-8, and TNF-α by monocytes and macrophages [4,5,6,7,8,9].
Objective:
In order to examine the therapeutic effects of local and systemic
IL-4 expression in established CIA, an adenoviral vector carrying the gene for
murine IL-4 (Ad-mIL-4) was generated. The ability of Ad-mIL-4 to treat
established CIA was evaluated by local periarticular and systemic intravenous
injection of Ad-mIL-4 into mice at various times after disease onset.
Materials and methods:
Male DBA/1 lacJ (H-2q) mice, aged 7-8 weeks,
were purchased from The Jackson Laboratory (Bar Harbor, ME, USA). The mice were
immunized intradermally at the base of tail with 100 μ g bovine type II
collagen. On day 21 after priming, mice received a boost injection
(intradermally) with 100 μ g type II collagen in incomplete adjuvant. For
the synchronous onset of arthritis, 40 μ g lipopolysaccharide (Sigma, St
Louis, MO, USA) was injected intraperitoneally on day 28. Ad-mIL-4 was injected
periarticularly into the hind ankle joints of mice on day 32 or intravenously
by tail vein injection on day 29. Disease severity was monitored every other
day using an established macroscopic scoring system ranging from 0 to 4: 0,
normal; 1, detectable arthritis with erythma; 2, significant swelling and
redness; 3, severe swelling and redness from joint to digit; and 4, maximal
swelling with ankylosis. The average of macroscopic score was expressed as a
cumulative value for all paws, with a maximum possible score of 16 per mouse.
Cytokine production by joint tissue or serum were assessed using enzyme-linked
immunosorbent assay (ELISA; R&D Systems, Minneapolis, MN, USA).
Results:
To examine the therapeutic effects of IL-4 gene transfer in a
murine model of arthritis, 5×108 particles of Ad-mIL-4 and
enhanced green fluorescent protein (Ad-eGFP) were administered by periarticular
injection into the ankle joints of mice with established disease 4 days after
lipopolysaccharide injection. All mice had established disease at time of
injection. As shown in Figure 1, the severity of
arthritis (Fig. 1a), paw thickness (Fig. 1b), and the number of arthritic paws (Fig. 1c) were all significantly reduced in the Ad-mIL-4 group,
compared with the saline- and Ad-eGFP-treated groups. Analysis of the bones in
the ankle joints of control arthritic mice showed evidence of erosion with an
associated monocytic infiltrate around the joint space compared with the
Ad-mIL-4-treated and nonarthritic control joints. In addition, injection of the
ankle joints in the hind legs resulted in a therapeutic effect in the front
paws. A similar contralateral effect has been observed with adenoviral-mediated
delivery of viral (v)-IL-10. Interestingly, a high level of murine IL-10 also
was detected from the joint lysates of Ad-mIL-4-treated naïve and
arthritic mice, with the production of endogenous IL-10 correlating with the
dose of Ad-mIL-4. The administration of recombinant IL-4 protein systemically
has been shown to be therapeutic in murine CIA models if given before disease
onset. To examine the effect of systemic IL-4 delivered by gene transfer,
1×109 particles of Ad-mIL-4 were injected via the tail vein of
collagen-immunized mice the day after lipopolysaccharide injection. Whereas the
immunized control mice, injected with Ad-eGFP, showed disease onset on day 3
after lipopolysaccharide injection, Ad-mIL-4-treated mice showed a delay in
disease onset and as a reduction in the total number of arthritic paws. Also,
systemic injection of Ad-mIL-4 suppressed the severity of arthritis in CIA mice
according to arthritis index.
Discussion:
Gene therapy represents a novel approach for delivery of
therapeutic agents to joints in order to treat the pathologies associated with
RA and osteoarthritis, as well as other disorders of the joints. In the present
study we examined the ability of local periarticular and systemic gene transfer
of IL-4 to treat established and early-stage murine CIA, respectively. We have
demonstrated that both local and systemic administration of Ad-mIL-4 resulted
in a reduction in the severity of arthritis, as well as in the number of
arthritic paws. In addition, the local gene transfer of IL-4 reduced histologic
signs of inflammation and of bone erosion. Interestingly, local delivery of
Ad-mIL-4 was able to confer a therapeutic effect to the untreated, front paws
through a currently unknown mechanism. In addition, both local and systemic
expression of IL-4 resulted in an increase in the level of endogenous IL-10, as
well as of IL-1Ra (data not shown). Previous experiments have shown that gene
transfer of IL-10 and IL-1 and TNF inhibitors at the time of disease initiation
(day 28) is therapeutic. However, delivery of these agents after disease onset
appeared to have only limited therapeutic effect. In contrast, the present
results demonstrate that IL-4, resulting from local periarticular and systemic
injection of Ad-mIL-4, was able partially to reverse progression of established
and early-stage disease, respectively. These results, as well as those of
others, support the potential application of IL-4 gene therapy for the clinical
treatment of RA.