Autoimmune Disease: Treatment


In recent years, substantial progress has been made in understanding the mechanisms of inflammation and autoimmunity, providing new targets for the development of new treatment principles. Tumour necrosis factor α (TNFα) antagonists have been proven as a major progress in the treatment of different rheumatic and chronic inflammatory bowel diseases. The interleukin 1 (IL‐1) receptor antagonist has considerably improved our medication for the systemic juvenile arthritis and periodic fever syndromes, an anti‐IL‐6 receptor monoclonal antibody might be of value as well as abatacept, a cytotoxity lymphocyte‐associated antigen 4Ig (CTLA‐4Ig) fusion protein for the treatment of patients with rheumatic diseases who do not respond to TNF antagonists. The same is true for rituximab, a chimeric anti‐CD20 antibody.

Key concepts

  • Mode of action and indications for the treatment with traditional and new (cyclooxygenase II, COX‐II, inhibitors), Nonsteroidal anti‐inflammatory drugs (NSAIDs).

  • Mode of action and indications of steroids for the treatment of autoimmune and chronic inflammatory diseases.

  • Disease modifying and immunosuppressive drugs, there are different modes of action.

  • The limitation of surgical approaches in the treatment of autoimmune and chronic inflammatory diseases such as thymectomy, splenectomy and synovectomy.

  • The limitation of radiotherapy and total lymphoid irradiation for the treatment of autoimmune diseases.

  • The limitation of plasmapheresis and leucapheresis as treatment principles for autoimmune diseases.

  • Cellular and juvenile targets for immune intervention in autoimmune and chronic inflammatory diseases.

  • Biologics for the treatment of autoimmune and chronic inflammatory diseases, modes of actions.

  • Monoclonal antibodies and fusion proteins for targeting T cells, B cells, cytokines and adhesion molecules.

  • Mechanisms that could help to reestablish self‐tolerance as well as the ultimate therapeutic goal in autoimmune diseases.

Keywords: immunomodulatory therapy; autoimmune disease; monoclonal antibody therapy; cytokine antagonism; tolerance induction; modulation of T cells

Figure 1.

Potential therapeutic effects of monoclonal antibodies directed to proteins expressed on the cell surface of T cells: (1) induction of cytotoxic effects upon interaction of the Fc part of the antibody with Fc receptors on phagocytes; (2) activation of the complement cascade leading to the formation of the cytolytic membrane attack complex and to chemoattraction of phagocytes; (3) interference with T‐cell activation by blocking of T‐cell receptor costimulation; (4) modulation of the T‐cell response by alteration of the costimulatory signals. The modulated costimulation may give rise to a shift of cytokine release from a TH1‐dominated profile (IFNγ, IL‐12) towards a TH2 pattern (IL‐4, IL‐10).

Figure 2.

Immunomodulatory strategies targeting pro‐inflammatory cytokines: (1) blocking of the respective cytokine by the application of neutralizing monoclonal antibodies; (2) administration of a recombinant receptor antagonist that can bind to the receptor molecule but will not trigger the signalling cascade that is usually activated by the cytokine; (3) neutralization of the cytokine by recombinant soluble cytokine‐receptor constructs. All the strategies prevent the cytokine (e.g. IL‐1 or TNFα) from engaging with its respective cell surface receptor.


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Kalden, Joachim R, and Burkhardt, Harald(Mar 2009) Autoimmune Disease: Treatment. In: eLS. John Wiley & Sons Ltd, Chichester. [doi: 10.1002/9780470015902.a0001437.pub2]