title: Down-regulation of leucocyte immunoglobulin-like receptor expression in the synovium of rheumatoid arthritis patients after treatment with disease-modifying anti-rheumatic drugs.
abstract: OBJECTIVE
  To compare the expression of leucocyte immunoglobulin-like receptors (LILRs) also known as ILTs and LIRs in rheumatoid arthritis (RA) synovial membrane before and after treatment with disease-modifying anti-rheumatic drugs (DMARDs) and investigate regulation of LILR-expression and function in vitro.
  
  
  METHODS
  A study was performed on serial synovial biopsies obtained from 10 RA patients before and after treatment with DMARDs. Expression of the activating LILRA2 (ILT1 or LIR-7) and inhibitory LILRB2 (ILT4 or LIR-2) and LILRB3 (ILT5 or LIR-3) was evaluated by immunohistochemical staining, and quantified by a validated scoring system. Peripheral blood mononuclear cells and in vitro derived macrophages were used to determine effects of DMARDs on expression and function of LILRs.
  
  
  RESULTS
  Abundant expression of LILRB2, B3 and A2 was found in synovial tissue of all patients before treatment. Number of inflammatory cells expressing both inhibitory and activating LILRs dramatically decreased in patients who responded to treatment, but remained high in those who did not. However, treatment of macrophages with DMARDs in vitro did not down-regulate LILR expression. On the other hand, reduction in LILR expression in RA synovia was associated with decreased inflammatory infiltrates in those who responded to treatment. Cross-linking of LILRA2 on macrophages caused substantial production of tumour necrosis factor (TNF-alpha) in a dose- and time-dependent manner that was strongly inhibited by dexamethasone.
  
  
  CONCLUSIONS
  We show that expression of LILRs in RA synovium was significantly reduced only in patients who responded to treatment. However, clinical responses may not be due to direct effects of DMARDs on LILR expression but due to partial inhibition of LIRA2-mediated TNF-alpha production by steroids leading to suppression of inflammation.
authors.affiliation: Inflammatory Diseases Research Unit, Wallace Wurth Building, University of New South Wales, Sydney 2052, Australia.
authors.forename: O A
authors.initials: OA
authors.lastname: Huynh
authors.forename: T
authors.initials: T
authors.lastname: Hampartzoumian
authors.forename: J P
authors.initials: JP
authors.lastname: Arm
authors.forename: J
authors.initials: J
authors.lastname: Hunt
authors.forename: L
authors.initials: L
authors.lastname: Borges
authors.forename: M
authors.initials: M
authors.lastname: Ahern
authors.forename: M
authors.initials: M
authors.lastname: Smith
authors.forename: C L
authors.initials: CL
authors.lastname: Geczy
authors.forename: H P
authors.initials: HP
authors.lastname: McNeil
authors.forename: N
authors.initials: N
authors.lastname: Tedla
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology*; D002478:Cells, Cultured; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D015536:Down-Regulation / Q000187:drug effects*; D005260:Female; D006801:Humans; D008262:Macrophage Activation; D008264:Macrophages / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008562:Membrane Glycoproteins / Q000378:metabolism*; D008875:Middle Aged; D011961:Receptors, Fc / Q000378:metabolism; D011971:Receptors, Immunologic / Q000378:metabolism*; D012720:Severity of Illness Index; D013583:Synovial Membrane / Q000276:immunology*; D015703:Antigens, CD
chemical_list: D018501:Antirheumatic Agents; D008562:Membrane Glycoproteins; D011961:Receptors, Fc; D011971:Receptors, Immunologic; C105298:LILRA2 protein, human; C491341:LILRB2 protein, human; C527699:LILRB3 protein, human; D015703:Antigens, CD