RA Vaccines and Other New Immune Treatments

When you have rheumatoid arthritis (RA), you face more than sore and swollen joints. The autoimmune disease can affect your whole body, including your organs, and make you feel lousy all over. Fortunately, today’s drugs go a long way to help control the disease and its symptoms. They can, though, have serious side effects. In the future, an RA “vaccine” and other drugs that affect your immune system may be an option.

Research to develop this vaccine has been going on for years. Unlike those for other serious conditions, an RA vaccine wouldn’t prevent you from getting the disease. Instead, it would control RA in a different way than biologics or disease-modifying antirheumatic drugs (DMARDs) like methotrexate.

An RA vaccine and other immune system drugs are likely years away from approval for use in humans. But several types are in clinical trials or earlier phases of research. So far, they show real promise.

Targeting T Cells

Most biologic drugs for RA target a single substance that causes inflammation, like TNF-alpha. Etanercept and infliximab are examples of anti-TNF drugs used for RA. Scientists at Rush University Medical Center in Chicago are working on a vaccine that targets T cells. These are cells that make several substances involved in RA inflammation. That means this vaccine may be able to attack RA on more than one front.

The drug is known as CEL-4000 (previously DerG-PG70). Because it isn’t a biologic, researchers say it may cost less and be easier to make than biologics. They also say it likely won’t weaken your immune system the way current biologics can. But for now, these are just theories. CEL-4000 hasn’t been tested in humans.

Progress Down Under

A few years ago in Australia, researchers tested an RA vaccine called Rheumavax on 18 people. Doctors took samples of their blood and separated out certain cells called dendritic cells. These are inflammatory cells of the immune system. Those cells were "tolerized." That means they were modified in a lab to react differently to anti-CCP (a substance that can trigger RA). Then, the tolerized dendritic cells, or tolDC, were injected back into the patients.

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A single shot proved safe and effective. Now the Australians are conducting the first human trial of DEN-181. The tolDC treatment -- a first-in-class immunotherapy for RA -- will be given to people with RA who have anti-CCP in their bodies and take the drug methotrexate.

Australian researchers aren’t the only ones testing tolDC therapy for RA. In the U.K., researchers found tolDC to be a safe, acceptable treatment option for knee symptoms in a group of people with inflammatory arthritis.

Designer Cells

Scientists at several U.S. institutions have collaborated on research that transforms stem cells into RA fighters. Using the gene editing tool CRISPR/Cas9, they created smart cells that could:

  • Fight inflammation
  • Deliver biologic drug therapy
  • Turn on and off as needed

To do this, they removed a gene involved in RA’s inflammatory process. Then, they added a gene that releases a biologic drug. The modified cells could even create cartilage tissue.

Researchers call this a regenerative medicine approach. They say it could one day provide an effective vaccine for a range of diseases, not just RA.

WebMD Medical Reference Reviewed by David Zelman, MD on October 11, 2019

Sources

SOURCES:

Johns Hopkins Arthritis Center: “Rheumatoid Arthritis.” 

Stem Cell Reports: “Genome Engineering of Stem Cells for Autonomously Regulated, Closed-Loop Delivery of Biologic Drugs.” 

Katalin Mikecz, MD, PhD, professor, department of orthopedic surgery, Rush Medical College, Chicago. 

Biomedical Reports: “TNF Inhibitor therapy for rheumatoid arthritis.”

Vaccine: “An epitope-specific DerG-PG70 LEAPS vaccine modulates T cell responses and suppresses arthritis progression in two related murine models of rheumatoid arthritis.”

Expert Review of Vaccines: “Rheumatoid arthritis vaccine therapies: perspectives and lessons from therapeutic ligand epitope antigen presentation system vaccines for models of rheumatoid arthritis."

Science Translational Medicine: “Citrullinated peptide dendritic cell immunotherapy in HLA risk genotype-positive rheumatoid arthritis patients.”

Annals of the Rheumatic Diseases: “Autologous tolerogenic dendritic cells for rheumatoid and inflammatory arthritis.”

 

 

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