Furthermore, mouse analogues of these co-stimulatory-attenuated tolDC have been shown to prevent diabetes onset in non-obese diabetic (NOD) mice [79]. Ten million control DC or tolDC were injected intradermally into find protocol the abdominal wall once every 2 weeks for a total of four administrations, and patients were monitored subsequently for a period of 12 months. DC treatment was well tolerated without any adverse events. DC treatment did not increase or induce autoantibodies (e.g. insulinoma-associated protein-2 antibodies). Furthermore, despite the fact that serum levels of IL-10 and IL-4 were increased, patients did not

lose their capability to mount T cell responses to CT99021 supplier viral peptides or allogeneic cells, indicating that DC treatment did not result in systemic immunosuppression. The percentages of immune cell subsets in peripheral blood did not change after DC treatment, with the notable exception of B220+/CD11c– B cells. The proportions of this subset were increased significantly after DC treatment, although their levels returned to baseline after 6 months of treatment. This subset of B cells displayed suppressive activity in vitro and their proportional enhancement may be a beneficial effect

of DC treatment. Overall, there were no notable differences between treatment with control DC and tolDC. Control DC were immature and therefore in a tolerogenic state; thus, it is not surprising that both types of DC exerted similar, potentially

‘pro-tolerogenic’ effects, i.e. enhancing IL-4 and IL-10 and the proportion of regulatory B cells. However, as it cannot be excluded that immature DC may become immunogenic DC in vivo, treatment Thymidylate synthase with stable tolDC remains the preferred option. A Phase I study with autologous tolDC in patients with RA has been carried out by Ranjeny Thomas and colleagues at the University of Queensland. Preliminary data were reported at the European League against Rheumatism meeting (EULAR) in 2011 [77]. In this study tolDC were generated by treatment of monocyte-derived DC with an inhibitor of NFκB signalling, BAY 11–7082, shown previously to maintain mouse DC in a tolerogenic state by preventing DC maturation [54, 80]. BAY-treated tolDC are deficient for CD40 expression but express high levels of CD86 [80, 81]; thus, they are phenotypically different from the co-stimulation-attenuated tolDC developed by the Giannoukakis/Trucco team [79]. Furthermore, unlike the trial in type I diabetes, in which tolDC were not loaded with a relevant autoantigen, in this trial tolDC were pulsed with four citrullinated peptide antigens. The final, antigen-pulsed, tolDC product is referred to as ‘Rheumavax’.

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