Combination treatment with anti-CD20 and oral anti-CD3 prevents and reverses autoimmune diabetes

Diabetes. 2013 Aug;62(8):2849-58. doi: 10.2337/db12-1175. Epub 2013 Feb 27.

Abstract

Type 1 diabetes (T1D) is a T cell-mediated autoimmune disease, although B cells also play an important role in T1D development. Both T cell- and B cell-directed immunotherapies have shown efficacy in the prevention and reversal of T1D. However, whether the combined strategy of targeting both T and B cells could further improve therapeutic efficacy remains to be explored. We show that combined treatment with intravenous antihuman CD20 (hCD20) and oral anti-CD3 significantly delays diabetes development in prediabetic hCD20 transgenic NOD mice. More importantly, the combined treatment reverses diabetes in >60% of mice newly diagnosed with diabetes. Further mechanistic studies demonstrated that the addition of oral anti-CD3 to the B-cell depletion therapy synergistically enhances the suppressive function of regulatory T cells. Of note, the oral anti-CD3 treatment induced a fraction of interleukin (IL)-10-producing CD4 T cells in the small intestine through IL-10- and IL-27-producing dendritic cells. Thus, the findings demonstrate that combining anti-CD20 and oral anti-CD3 is superior to anti-CD20 monotherapy for restoring normoglycemia in diabetic NOD mice, providing important preclinical evidence for the optimization of B cell-directed therapy for T1D.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antibodies, Monoclonal / pharmacology
  • Antibodies, Monoclonal / therapeutic use*
  • Antigens, CD20 / immunology*
  • B-Lymphocytes / drug effects
  • B-Lymphocytes / immunology
  • CD3 Complex / immunology*
  • CD4-Positive T-Lymphocytes / drug effects
  • CD4-Positive T-Lymphocytes / immunology
  • CD4-Positive T-Lymphocytes / metabolism
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Interleukin-10 / metabolism
  • Intestine, Small / drug effects
  • Intestine, Small / immunology
  • Intestine, Small / metabolism
  • Mice
  • Mice, Inbred NOD

Substances

  • Antibodies, Monoclonal
  • Antigens, CD20
  • CD3 Complex
  • Interleukin-10