title: Mechanisms of immunomodulation by glatiramer acetate.
abstract: OBJECTIVE
  To define the mechanism of action of glatiramer acetate (GA; formerly known as copolymer-1) as an immunomodulatory treatment for MS.
  
  
  BACKGROUND
  The proposed mechanisms of action of GA include 1) functional inhibition of myelin-reactive T cells by human leukocyte antigen (HLA) blocking, 2) T-cell receptor (TCR) antagonism, and 3) induction of T helper 2 (Th2) immunomodulatory cells. In this report, the authors examined the effects of GA on the functional activation of human T-cell clones (TCC) specific for myelin basic protein (MBP) and for foreign antigens. Several questions were addressed: Is the inhibitory effect of GA specific for autoantigens? Is it mediated by blocking the interaction between peptide and HLA molecule? Is GA a partial agonist or TCR antagonist, or does it induce anergy? Does it induce Th2 modulatory T cells?
  
  
  METHODS
  The effects of GA on antigen-induced activation of human TCC specific for MBP, influenza virus hemagglutinin, and Borrelia burgdorferi were studied by proliferation and cytokine measurements, TCR downmodulation, and anergy assays. GA-specific TCC were generated in vitro from the peripheral blood of patients and healthy controls by limiting dilution.
  
  
  RESULTS
  GA more strongly inhibited the proliferation of MBP, as compared with foreign antigen-specific TCC; in some MBP-specific TCC, the production of Th1-type cytokines was preferentially inhibited. In addition to HLA competition, the induction of anergy, but not direct TCR antagonism, was observed. Numerous GA-specific TCC were generated from the peripheral blood of both MS patients and normal controls, and a fraction of these showed a Th2 phenotype.
  
  
  CONCLUSIONS
  This study confirms a preferential inhibitory effect of GA on autoreactive TCC. With respect to cellular mechanisms, although HLA competition appears to play the most important role in functional inhibition in vitro, a direct effect on the TCR may be involved at least in some autoreactive T cells as shown by anergy induction. Although not confirmed at the clonal level, it is demonstrated further that GA induces T cells that crossreact with myelin proteins. GA-specific, Th2-modulatory cells may play an important role in mediating the effect of the drug in vivo.
authors: Cellular Immunology Section, Neuroimmunology Branch, NINDS, NIH, Bethesda, MD 20892, USA.
authors: B
authors: B
authors: Gran
authors: L R
authors: LR
authors: Tranquill
authors: M
authors: M
authors: Chen
authors: B
authors: B
authors: Bielekova
authors: W
authors: W
authors: Zhou
authors: S
authors: S
authors: Dhib-Jalbut
authors: R
authors: R
authors: Martin
mesh_terms: D000276:Adjuvants, Immunologic / Q000378:metabolism*; D005434:Flow Cytometry; D000068717:Glatiramer Acetate; D006801:Humans; D008285:Major Histocompatibility Complex / Q000276:immunology; D009103:Multiple Sclerosis / Q000097:blood / Q000276:immunology*; D010455:Peptides / Q000097:blood / Q000276:immunology*; D013601:T-Lymphocytes / Q000276:immunology
chemical_list: D000276:Adjuvants, Immunologic; D010455:Peptides; D000068717:Glatiramer Acetate