Th17 and Th1 T-cell responses in giant cell arteritis.
BACKGROUND
In giant cell arteritis (GCA), vasculitic damage of the aorta and its branches is combined with a syndrome of intense systemic inflammation. Therapeutically, glucocorticoids remain the gold standard because they promptly and effectively suppress acute manifestations; however, they fail to eradicate vessel wall infiltrates. The effects of glucocorticoids on the systemic and vascular components of GCA are not understood.


RESULTS
The immunoprofile of untreated and glucocorticoid-treated GCA was examined in peripheral blood and temporal artery biopsies with protein quantification assays, flow cytometry, quantitative real-time polymerase chain reaction, and immunohistochemistry. Plasma interferon-gamma and interleukin (IL)-17 and frequencies of interferon-gamma-producing and IL-17-producing T cells were markedly elevated before therapy. Glucocorticoid treatment suppressed the Th17 but not the Th1 arm in the blood and the vascular lesions. Analysis of monocytes/macrophages in the circulation and in temporal arteries revealed glucocorticoid-mediated suppression of Th17-promoting cytokines (IL-1beta, IL-6, and IL-23) but sparing of Th1-promoting cytokines (IL-12). In human artery-severe combined immunodeficiency mouse chimeras, in which patient-derived T cells cause inflammation of engrafted human temporal arteries, glucocorticoids were similarly selective in inhibiting Th17 cells and leaving Th1 cells unaffected.


CONCLUSIONS
Two pathogenic pathways mediated by Th17 and Th1 cells contribute to the systemic and vascular manifestations of GCA. IL-17-producing Th17 cells are sensitive to glucocorticoid-mediated suppression, but interferon-gamma-producing Th1 responses persist in treated patients. Targeting steroid-resistant Th1 responses will be necessary to resolve chronic smoldering vasculitis. Monitoring Th17 and Th1 frequencies can aid in assessing disease activity in GCA.
Division of Immunology and Rheumatology, Stanford University School of Medicine, 269 W Campus Dr, Stanford, CA 94305, USA.
Jiusheng
J
Deng
Brian R
BR
Younge
Richard A
RA
Olshen
Jörg J
JJ
Goronzy
Cornelia M
CM
Weyand
D000818:Animals; D002678:Chimera / Q000097:blood / Q000276:immunology; D004195:Disease Models, Animal; D013700:Giant Cell Arteritis / Q000097:blood / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D005938:Glucocorticoids / Q000494:pharmacology; D006801:Humans; D007371:Interferon-gamma / Q000097:blood / Q000276:immunology; D020381:Interleukin-17 / Q000097:blood / Q000276:immunology*; D051379:Mice; D018417:Th1 Cells / Q000276:immunology*
D005938:Glucocorticoids; D020381:Interleukin-17; D007371:Interferon-gamma