title: Increase in circulating Th17 cells during anti-TNF therapy is associated with ultrasonographic improvement of synovitis in rheumatoid arthritis.
abstract: Anti-TNF agents have revolutionised rheumatoid arthritis (RA) treatment; however, a third of patients fail to achieve therapeutic responses. Unexpectedly, studies in murine and human arthritis have indicated that anti-TNF treatment can increase circulating T helper 17 (Th17) cells, but the relationship to treatment response is unclear. To identify immune correlates of anti-TNF treatment response, we conducted a longitudinal study using clinical, ultrasound and T cell assessments.
  
  
  
  Patients with RA (n = 25) were studied at protocol visits during the initial 12 weeks of anti-TNF treatment. Improvement in the disease activity score of 28 joints (DAS28) >1.2 defined treatment responders (n = 16) and non-responders (n = 9). Changes in synovial thickening and vascularity of 10 metacarpophalangeal joints were quantitatively assessed by grey scale and power Doppler ultrasound. The frequency of circulating Th17 cells was determined by IL17 enzyme-linked immunospot assay (Elispot) and flow cytometry (fluorescence-activated cell sorting (FACS)).
  
  
  
  The frequency of circulating IL17-producing cells increased significantly 12 weeks after anti-TNF initiation (Elispot median (range) specific spot forming cells (spSFC)/106360 (280-645) vs 632 (367 - 1167), p = 0.003). The increase in CD4 + IL17+ cells at 12 weeks was confirmed by FACS (median (range) %, 0.7 (0.5-0.9) vs 1.05 (0.6-1.3); p = 0.01). The increase in circulating Th17 cells inversely correlated with reduction in synovial vascularity (r = -0.68, p = 0.007) and thickening (r = -0.39; p = 0.04). Higher frequencies of circulating Th17 cells at baseline were associated with poorer anti-TNF treatment response defined by ultrasonographic measures.
  
  
  
  These results demonstrate a link between changes in circulating Th17 cells with resolution of ultrasonographic features of synovial inflammation and vascularity during anti-TNF treatment. The findings may reflect redistribution of Th17 cells from inflamed joints or TNF-driven regulation of Th17 cell production.
  
  
  
  ClinicalTrials.gov: NCT01060098 . Registered 29 January 2010.
authors.affiliation: Department of Medicine, Imperial College London, London, UK.|Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK.
authors.forename: Dobrina N
authors.initials: DN
authors.lastname: Hull
authors.affiliation: Institute of Hepatology, The Foundation for Liver Research, 111 Coldharbour Lane, London, SE5 9NT, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Cooksley
authors.affiliation: Institute of Hepatology, The Foundation for Liver Research, 111 Coldharbour Lane, London, SE5 9NT, UK.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Chokshi
authors.affiliation: Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK.
authors.forename: Richard O
authors.initials: RO
authors.lastname: Williams
authors.affiliation: Department of Medicine, Imperial College London, London, UK.
authors.forename: Sonya
authors.initials: S
authors.lastname: Abraham
authors.affiliation: Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK. peter.taylor@kennedy.ox.ac.uk.
authors.forename: Peter C
authors.identifier: 0000-0001-7766-6167
authors.initials: PC
authors.lastname: Taylor
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000276:immunology*; D058501:Enzyme-Linked Immunospot Assay; D000068800:Etanercept; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013585:Synovitis / Q000000981:diagnostic imaging / Q000276:immunology*; D058504:Th17 Cells / Q000276:immunology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D000068800:Etanercept
keywords: Ankylosing spondylitis; Anti-TNF; Psoriatic arthritis; Rheumatoid arthritis; T cells