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Eur J Immunol. 2016 Dec;46(12):2862-2870. doi: 10.1002/eji.201646375. Epub 2016 Oct 5.

Increased autophagy in CD4+ T cells of rheumatoid arthritis patients results in T-cell hyperactivation and apoptosis resistance.

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Translational Research Laboratory, Inflammatory and Infectious Disease Center, Sanford-Burnham Medical Research Institute, La Jolla, USA.
Eureka Institute for Translational Medicine, Siracusa, Italy.
Division of Pediatrics, University Medical Center, Utrecht, The Netherlands.
Center for Molecular Medicine, University Medical Center, Utrecht, The Netherlands.
SingHealth Translational Immunology and Inflammation Centre, Duke-NUS Graduate Medical School, Singapore, Singapore.
Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, USA.
Division of Rheumatology, Scripps Clinic, San Diego, USA.


Rheumatoid arthritis (RA) is an autoimmune disease hallmarked by aberrant cellular homeostasis, resulting in hyperactive CD4+ T cells that are more resistant to apoptosis. Both hyperactivation and resistance to apoptosis may contribute to the pathogenicity of CD4+ T cells in the autoimmune process. A better knowledge of the mechanisms determining such impaired homeostasis could contribute significantly to both the understanding and the treatment of the disease. Here we investigated whether autophagy, is dysregulated in CD4+ T cells of RA patients, resulting in disturbed T-cell homeostasis. We demonstrate that the rate of autophagy is significantly increased in CD4+ T cells from RA patients, and that increased autophagy is also a feature of in vitro activated CD4+ T cells. The increased apoptosis resistance observed in CD4+ T cells from RA patients was significantly reversed upon autophagy inhibition. These mechanisms may contribute to RA pathogenesis, as autophagy inhibition reduced both arthritis incidence and disease severity in a mouse collagen induced arthritis mouse model. Conversely, in Atg5flox/flox -CD4-Cre+ mice, in which all T cells are autophagy deficient, T cells showed impaired activation and proliferation. These data provide novel insight into the pathogenesis of RA and underscore the relevance of autophagy as a promising therapeutic target.


Activation; Apoptosis resistance; Autophagy; Rheumatoid arthritis; T cells

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