TY - JOUR A1 - Mahmood, Zafar A1 - Schmalzing, Marc A1 - Dörner, Thomas A1 - Tony, Hans-Peter A1 - Muhammad, Khalid T1 - Therapeutic Cytokine Inhibition Modulates Activation and Homing Receptors of Peripheral Memory B Cell Subsets in Rheumatoid Arthritis Patients JF - Frontiers in Immunology N2 - Memory B cells have known to play an important role in the pathogenesis of rheumatoid arthritis (RA). With the emergence of B cell-targeted therapies, the modulation of memory B cells appears to be a key therapeutic target. Human peripheral memory B cells can be distinguished based on the phenotypic expression of CD27 and IgD, characterizing the three major B cell subpopulations: CD27+IgD+ pre-switch, CD27+IgD- post-switch, and CD27-IgD- double-negative memory B cells. We evaluated different memory cell populations for activation markers (CD95 and Ki-67) and chemokine receptors (CXCR3 and 4) expressing B cells in active RA, as well as under IL6-R blockade by tocilizumab (TCZ) and TNF-α blockade by adalimumab (ADA). Memory B cells were phenotypically analyzed from RA patients at baseline, week 12, and week 24 under TCZ or ADA treatment, respectively. Using flow cytometry, surface expression of CD95, intracellular Ki-67, and surface expressions of CXCR3 and CXCR4 were determined. Compared with healthy donors (n = 40), the phenotypic analysis of RA patients (n = 80) demonstrated that all three types of memory B cells were activated in RA patients. Surface and intracellular staining of B cells showed a significantly higher percentage of CD95+ (p < 0.0001) and Ki-67+ (p < 0.0001) cells, with numerically altered CXCR3+ and CXCR4+ cells in RA. CD95 and Ki-67 expressions were highest in post-switch memory B cells, whereas CD19+CXCR3+ and CD19+CXCR4+ expressing cells were substantially higher in the pre-switch compartment. In all subsets of the memory B cells, in vivo IL-6R, and TNF-α blockade significantly reduced the enhanced expressions of CD95 and Ki-67. Based on our findings, we conclude that the three major peripheral memory B cell populations, pre-, post-switch, and double-negative B cells, are activated in RA, demonstrating enhanced CD95 and Ki-67 expressions, and varied expression of CXCR3 and CXCR4 chemokine receptors when compared with healthy individuals. This activation can be efficaciously modulated under cytokine inhibition in vivo. KW - B cells KW - inflammation KW - adalimumab KW - tocilizumab (IL-6 inhibitor) KW - memory B cells KW - rheumatoid arhritis Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-212380 SN - 1664-3224 VL - 11 ER - TY - JOUR A1 - Kirsten, Natalia A1 - Ohm, Frenz A1 - Gehrdau, Kathrin A1 - Girbig, Gefion A1 - Stephan, Brigitte A1 - Ben-Anaya, Nesrine A1 - Pinter, Andreas A1 - Bechara, Falk G. A1 - Presser, Dagmar A1 - Zouboulis, Christos C. A1 - Augustin, Matthias T1 - Switching from adalimumab originator to biosimilar in patients with hidradenitis suppurativa results in losses of response — data from the German HS registry HSBest JF - Life N2 - Since 2021, adalimumab biosimilar ABP 501 can be used alternatively to adalimumab originator (ADAO) in the treatment of hidradenitis suppurativa (HS). Effectiveness and safety data remain scarce. We investigated the impact of switching from ADAO to ABP 501 on disease severity and the occurrence of adverse events (AEs) in patients with HS. We analyzed clinical data on patients enrolled in the German HSBest registry. Evaluation outcomes were assessed at three time points (baseline of originator (t0), prior to switching to biosimilar (t1) and 12 to 14 weeks after switching (t2)) and included patient-reported AEs and disease severity using the International Hidradenitis Suppurativa Severity Score System (IHS4) score. In total, 94 patients were switched from ADAO to ABP 501. Overall, 33.3% (n = 31/94) of the patients developed AEs and/or loss of response (LoR) within 12 to 14 weeks after switching. Of these, 61.3% (n = 19/31) experienced LoR but no AEs, 22.6% (n = 7/31) LoR combined with AEs and 16.1% (n = 5/31) AEs only. Our study showed that switching HS patients from ADAO to ABP 501 does significantly affect treatment effectiveness. Switching patients who are on remission maintenance therapy should be viewed critically. KW - hidradenitis suppurativa KW - biologics KW - TNF alpha KW - adverse drug reaction KW - biosimilar KW - drug effectiveness KW - switching KW - adalimumab KW - registry Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-288213 SN - 2075-1729 VL - 12 IS - 10 ER - TY - JOUR A1 - Kleinert, Stefan A1 - Tony, Hans-Peter A1 - Krause, Andreas A1 - Feuchtenberger, Martin A1 - Wassenberg, Siegfried A1 - Richter, Constanze A1 - Räther, Ekkehard A1 - Spieler, Wolfgang A1 - Gnann, Holger A1 - Wittig, Bianca M. T1 - Impact of patient and disease characteristics on therapeutic success during adalimumab treatment of patients with rheumatoid arthritis: data from a German noninterventional observational study JF - Rheumatology International N2 - The objective of this study was to use data from a noninterventional study to evaluate the effectiveness of adalimumab in rheumatoid arthritis (RA) patients during routine clinical practice and to explore the potential impact of patient and disease characteristics in response to adalimumab therapy. A total of 2,625 RA patients with specified data at baseline (prior to initiating adalimumab treatment) and 12 months entered this study between April 2003 and March 2009. We evaluated response to adalimumab therapy and conducted stepwise regression and subgroup analyses of factors influencing therapeutic response. During the 1-year adalimumab treatment period, disease activity decreased from a baseline mean disease activity score-28 joints (DAS28) of 5.9–3.9, while functional capacity improved from 59.0 to 68.4 Funktionsfragebogen Hannover (FFbH) percentage points. In multivariate regression models, high baseline DAS28 was the strongest positive predictor for decrease in disease activity, and high baseline functional capacity was associated with reduced gains in functional capacity. Male gender was a positive predictor of therapeutic response for both disease activity and functional capacity, while older age and multiple previous biologics were associated with a reduced therapeutic response. Subset analyses provided further support for the impact of baseline DAS28, FFbH, and prior biologic therapy on therapeutic response during treatment. We conclude that treatment with adalimumab leads to decreased disease activity and improved function during routine clinical practice. Patients with high disease activity and low functional capacity are particularly benefitted by adalimumab therapy. KW - antirheumatic agents KW - arthritis KW - adalimumab KW - rheumatoid KW - treatment outcome KW - regression analysis Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-125118 VL - 32 IS - 9 ER - TY - JOUR A1 - Kleinert, Stefan A1 - Tony, Hans-Peter A1 - Krause, Andreas A1 - Feuchtenberger, Martin A1 - Wassenberg, Siegfried A1 - Richter, Constanze A1 - Röther, Ekkehard A1 - Spieler, Wolfgang A1 - Gnann, Holger A1 - Wittig, Bianca M. T1 - Impact of patient and disease characteristics on therapeutic success during adalimumab treatment of patients with rheumatoid arthritis: data from a German JF - Rheumatology International N2 - The objective of this study was to use data from a noninterventional study to evaluate the effectiveness of adalimumab in rheumatoid arthritis (RA) patients during routine clinical practice and to explore the potential impact of patient and disease characteristics in response to adalimumab therapy. A total of 2,625 RA patients with specified data at baseline (prior to initiating adalimumab treatment) and 12 months entered this study between April 2003 and March 2009. We evaluated response to adalimumab therapy and conducted stepwise regression and subgroup analyses of factors influencing therapeutic response. During the 1-year adalimumab treatment period, disease activity decreased from a baseline mean disease activity score-28 joints (DAS28) of 5.9–3.9, while functional capacity improved from 59.0 to 68.4 Funktionsfragebogen Hannover (FFbH) percentage points. In multivariate regression models, high baseline DAS28 was the strongest positive predictor for decrease in disease activity, and high baseline functional capacity was associated with reduced gains in functional capacity. Male gender was a positive predictor of therapeutic response for both disease activity and functional capacity, while older age and multiple previous biologics were associated with a reduced therapeutic response. Subset analyses provided further support for the impact of baseline DAS28, FFbH, and prior biologic therapy on therapeutic response during treatment. We conclude that treatment with adalimumab leads to decreased disease activity and improved function during routine clinical practice. Patients with high disease activity and low functional capacity are particularly benefitted by adalimumab therapy. KW - antirheumatic agents KW - adalimumab KW - rheumatoid arthritis KW - treatment outcome KW - regression analysis Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-126220 VL - 32 IS - 9 ER - TY - THES A1 - Hell, Dennis T1 - Development of self-adjusting cytokine neutralizer cells as a closed-loop delivery system of anti-inflammatory biologicals T1 - Entwicklung von selbstregulierenden Zytokin-Neutralisierer-Zellen als Closed-Loop Abgabesystem von anti-inflammatorischen Biologikals N2 - The current treatment strategies for diseases are assessed on the basis of diagnosed phenotypic changes due to an accumulation of asymptomatic events in physiological processes. Since a diagnosis can only be established at advanced stages of the disease, mainly due to insufficient early detection possibilities of physiological disorders, doctors are forced to treat diseases rather than prevent them. Therefore, it is desirable to link future therapeutic interventions to the early detection of physiological changes. So-called sensor-effector systems are designed to recognise disease-specific biomarkers and coordinate the production and delivery of therapeutic factors in an autonomous and automated manner. Such approaches and their development are being researched and promoted by the discipline of synthetic biology, among others. Against this background, this paper focuses on the in vitro design of cytokine-neutralizing sensor-effector cells designed for the potential treatment of recurrent autoimmune diseases, especially rheumatoid arthritis. The precise control of inducible gene expression was successfully generated in human cells. At first, a NF-κB-dependent promoter was developed, based on HIV-1 derived DNA-binding motives. The activation of this triggerable promoter was investigated using several inducers including the physiologically important NF-κB inducers tumor necrosis factor alpha (TNFα) and interleukin 1 beta (IL-1β). The activation strength of the NF-κB-triggered promoter was doubled by integrating a non-coding RNA. The latter combined expressed RNA structures, which mimic DNA by double stranded RNAs and have been demonstrated to bind to p50 or p65 by previous publications. The sensitivity was investigated for TNFα and IL-1β. The detection limit and the EC50 values were in in the lower picomolar range. Besides the sensitivity, the reversibility and dynamic of the inducible system were characterized. Hereby a close correlation between pulse times and expression profile was shown. The optimized NF-κB-dependent promoter was then coupled to established TNFα- and IL-1-blocking biologicals to develop sensor-effector systems with anti-inflammatory activity, and thus potential use against autoimmune diseases such as rheumatoid arthritis. The biologicals were differentiated between ligand-blocking and receptor-blocking biologicals and different variants were selected: Adalimumab, etanercept and anakinra. The non-coding RNA improved again the activation strength of NF-κB-dependent expressed biologicals, indicating its universal benefit. Furthermore, it was shown that the TNFα-induced expression of NF-κB-regulated TNFα-blocking biologics led to an extracellular negative feedback loop. Interestingly, the integration of the non-coding RNA and this negative feedback loop has increased the dynamics and reversibility of the NF-κB-regulated gene expression. The controllability of drug release can also be extended by the use of inhibitors of classical NF-κB signalling such as TPCA-1. The efficacy of the expressed biologicals was detected through neutralization of the cytokines using different experiments. For future in vivo trials, first alginate encapsulations of the cells were performed. Furthermore, the activation of NF-κB-dependent promoter was demonstrated using co-cultures with human plasma samples or using synovial liquids. With this generated sensor-effector system we have developed self-adjusting cytokine neutralizer cells as a closed-loop delivery system for anit-inflammatory biologics. N2 - Die derzeitig üblichen Behandlungsstrategien von Krankheiten werden auf Basis diagnostizierter phänotypischer Veränderungen erhoben, die auf eine Ansammlung asymptomatischer Ereignisse in physiologischen Vorgängen zurückzuführen sind. Da die Feststellung einer Diagnose bislang erst in fortgeschrittenen Krankheitsstadien, vor allem aufgrund unzureichender Früherkennungsmöglichkeiten von physiologischen Störungen, erfolgen kann, sehen sich Ärzte gezwungen, Krankheiten vornehmlich zu behandeln anstatt ihnen vorzubeugen. Daher ist es erstrebenswert, wenn zukünftige therapeutische Interventionen bereits an die Früherkennung von physiologischen Veränderungen gekoppelt werden könnten. Sogenannte Sensor-Effektor Systeme sollen krankheitsspezifische Biomarker erkennen und die Produktion und Bereitstellung von therapeutischen Faktoren in einer selbstständigen und automatisierten Art und Weise koordinieren. Solche Ansätze und deren Entwicklung werden unter anderem durch die Disziplin der synthetischen Biologie erforscht und vorangetrieben. Die vorliegende Arbeit konzentriert sich vor diesem Hintergrund auf das in vitro Design von Zytokin-neutralisierenden Sensor-Effektor Zellen, die für die potentielle Behandlung wiederkehrender Autoimmunerkrankungen, insbesondere der rheumatoiden Arthritis, konstruiert wurden. Die gezielte Ansteuerung zur induzierbaren Genexpression konnte in humanen Zellen erfolgreich generiert werden. In der vorliegenden Arbeit wurde zunächst ein NF-κB abhängiger Promoter zur induzierbaren Genexpression auf der Grundlage von HIV-1 abgleitenden DNA-Bindemotiven entwickelt. Die Aktivierbarkeit dieses Promoters wurde durch verschiedene Induktoren, insbesondere auch durch die physiologisch wichtigen NF-κB Aktivatoren Tumornekrosefaktor alpha (TNFα) und Interleukin 1 beta (IL-1β) überprüft. Die Aktivierungsstärke des NF-κB abhängigen Promoters wurde durch die Integration einer nicht-kodierenden RNA verdoppelt. Diese RNA kombiniert Strukturelemente, die im RNA-Doppelstrang DNA-Strukturen imitieren, und für die in Vorarbeiten die Bindung an p50 oder p65 nachgewiesen werden konnten. Für TNFα und IL-1β lagen das Detektionslimit und die EC50 Werte der NF-κB getriggerten Genexpression im unteren pikomolaren Bereich. Neben der Sensitivität wurde das induzierbare System bezüglich seiner Reversibilität und Dynamik charakterisiert. Dabei konnte eine enge Korrelation zwischen Pulszeiten und Expressionsmustern aufgezeigt werden. Ferner wurde der NF-κB abhängige Promoter an etablierte TNFα- und IL-1-blockierende Biologicals gekoppelt, um Sensor-Effektor Systeme mit anti-entzündlicher Aktivität zu erhalten, die potentiell zur Behandlung von Autoimmunerkrankungen, wie beispielsweise der rheumatoiden Arthritis, eingesetzt werden könnten. Bei den Biologicals wurde zwischen Ligand-blockierenden und Rezeptor-blockierenden Biologicals differenziert und unterschiedliche Varianten ausgewählt: Adalimumab, Etanercept und Anakinra. Erneut verbesserte die zusätzliche Integration der nicht-kodierenden RNA die Aktivierungsstärke der NF-κB abhängig exprimierten Biologicals, das die universelle Nutzbarkeit des hier entwickelten optimierten NF-κB-Promoters unterstreicht. Ferner wurde gezeigt, dass die TNFα-induzierte Expression von NF-κB-regulierten TNFα-blockierenden Biologika zu einem extrazellulären negativen Feedback Loop führte. Interessanterweise hat die Integration der nicht-kodierender RNA und dieser negative Feedback Loop die Dynamik und Reversibilität der NF-κB-regulierten Genexpression erhöht. Die Kontrollierbarkeit der Wirkstoffabgabe kann zudem durch den Einsatz von Inhibitoren der klassischen NF-κB-Signalisierung wie z.B. TPCA-1 erweitert werden. Die Wirksamkeit der exprimierten Biologicals wurde durch Neutralisation der Zytokine in verschiedenen Experimenten nachgewiesen. Für zukünftige in vivo Versuche konnten erste Alginat-Verkapselungen der Zellen durchgeführt werden. Die Aktivierbarkeit des NF-κB abhängigen Promoters wurde ferner durch Ko-Kultivierung mit humanen Plasmaproben und Synovialflüssigkeiten nachgewiesen. Mit diesem generierten Sensor-Effektor-System haben wir selbstregulierende Zytokin-Neutralisierer-Zellen als Closed-Loop Abgabesystem von anit-inflammatorischen Biologikals entwickelt. KW - cell therapy KW - synthetic biology KW - designer cell KW - suppressor cells KW - closed-loop systems KW - autoimmune disease KW - rheumatoid arthritis KW - gene network KW - adalimumab KW - enbrel KW - etanercept KW - anakinra KW - Biologika KW - Autoaggressionskrankheit KW - Cytokine KW - in vitro Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-175381 ER -