Vaccine against autoimmune disease: antigen-specific immunotherapy

Recent interest in testing whether the success of antigen-specific immunotherapy (ASIT) for autoimmune diseases in mice can be translated to humans has highlighted the need for better tools to study and understand human autoimmunity. Clinical development of ASIT for allergy has been instructive, but limited understanding of CD4 T cell epitope/determinant hierarchies hampers the rational design and monitoring of ASIT. Definitive identification of pathogenic T cell epitopes as is now known in celiac disease and recent initiatives to optimize immune monitoring will facilitate rational design, monitoring and mechanistic understanding of ASIT for human autoimmune diseases.

► Epitope hierarchies for pathogenic T cells enable ASIT/ESIT design and monitoring.
► Epitope-specific immunotherapy (ESIT) utilizes immunodominant peptides.
► Dose, route and regimen influence the immunological outcomes of ASIT.
► Monitoring T cell responses in fresh blood are essential for clinical development.
► Celiac disease provides a unique opportunity for the development of ESIT.