Therapeutic potential of Tregs to treat rheumatoid arthritis

There is accumulating evidence for regulatory T cell defects in rheumatoid arthritis and that some biologic interventions, in particular anti-TNF, can target this population. Despite the challenges in defining regulatory T cells in patients, there are a number of approaches currently being developed to utilise their potent immunosuppressive properties. Through genetic manipulation Tregs can be generated ex vivo or in vivo that target antigens present in the inflamed joint. Here we discuss these approaches, their refinement to restore tolerance in patients with rheumatoid arthritis, and strategies to prevent their conversion towards a Th17 phenotype.

► Tregs from RA patients are unable to suppress inflammatory cytokines.
► Anti-TNF treated RA patient Tregs regain suppressive ability.
► Tregs are implicated in current/potential RA therapies.
► Joint-specific Tregs localise and suppress model arthritis in Ag-dependent manner.
► Despite promise of Tregs to treat RA no focused Treg therapies are available.