TNF-α–induced protein 3 (TNFAIP3) /A20 acts as a master switch in TNF-α blockade–driven IL-17A expression

摘要

BackgroundAnti-TNF inhibitors successfully improve the quality of life of patients with inflammatory disease. Unfortunately, not all patients respond to anti-TNF therapy, and some patients show paradoxical immune side effects, which are poorly understood. Surprisingly, anti-TNF agents were shown to promote IL-17A production with as yet unknown clinical implications.ObjectiveWe sought to investigate the molecular mechanism underlying anti-TNFdriven IL-17A expression and the clinical implications of this phenomenon.MethodsFluorescence-activated cell sorting, RNA sequencing, quantitative real-time PCR, Western blotting, small interfering RNA interference, and kinase inhibitors were used to study the molecular mechanisms in isolated human CD4+T cells from healthy donors. The clinical implication was studied in blood samples of patients with inflammatory bowel disease (IBD) receiving anti-TNF therapy.ResultsHere we show that anti-TNF treatment results in inhibition of the anti-inflammatory molecule TNF-?induced protein 3(TNFAIP3)/A20 in memory CD4+T cells. We found an inverse relationship betweenTNFAIP3/A20 expression levels and IL-17A production. Inhibition ofTNFAIP3/A20 promotes kinase activity of p38 mitogen-activated protein kinase and protein kinase C, which drives IL-17A expression. Regulation ofTNFAIP3/A20 expression and cognate IL-17A production in T cells are specifically mediated through TNF receptor 2 signaling.Ex爒ivo, in patients with IBD treated with anti-TNF, we found further evidence for an inverse relationship betweenTNFAIP3/A20 expression levels and IL-17Aproducing T cells.ConclusionAnti-TNF treatment interferes in theTNFAIP3/A20-mediated anti-inflammatory feedback loop in CD4+T cells and promotes kinase activity. This putsTNFAIP3/A20, combined with IL-17A expression, on the map as a potential tool for predicting therapy responsiveness or side effects of anti-TNF therapy. Moreover, it provides novel targets related toTNFAIP3/A20 activity for superior therapeutic regimens in patients with IBD.