Baricitinib-induced blockade of interferon gamma receptor and interleukin-6 receptor for the prevention and treatment of graft-versus-host disease

Leukemia. 2018 Nov;32(11):2483-2494. doi: 10.1038/s41375-018-0123-z. Epub 2018 Apr 2.

Abstract

The therapeutic benefits of allogeneic hematopoietic stem cell transplantation (allo-HSCT) are derived from the graft-versus-leukemia (GvL) effects of the procedure. There is a strong association between the GvL effects and graft-versus-host disease (GvHD), a major life-threatening complication of allo-HSCT. The limiting of GvHD while maintaining the GvL effect remains the goal of allo-HSCT. Therefore, identifying optimal therapeutic targets to selectively suppress GvHD while maintaining the GvL effects represents a significant unmet medical need. We demonstrate that the dual inhibition of interferon gamma receptor (IFNγR) and interleukin-6 receptor (IL6R) results in near-complete elimination of GvHD in a fully major histocompatibility complex-mismatched allo-HSCT model. Furthermore, baricitinib (an inhibitor of Janus kinases 1 and 2 (JAK1/JAK2) downstream of IFNγR/IL6R) completely prevented GvHD; expanded regulatory T cells by preserving JAK3-STAT5 signaling; downregulated CXCR3 and helper T cells 1 and 2 while preserving allogeneic antigen-presenting cell-stimulated T-cell proliferation; and suppressed the expression of major histocompatibility complex II (I-Ad), CD80/86, and PD-L1 on host antigen-presenting cells. Baricitinib also reversed established GvHD with 100% survival, thus demonstrating both preventive and therapeutic roles for this compound. Remarkably, baricitinib enhanced the GvL effects, possibly by downregulating tumor PD-L1 expression.

Publication types

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

MeSH terms

  • Animals
  • Antigen-Presenting Cells / drug effects
  • Antigen-Presenting Cells / metabolism
  • Azetidines / pharmacology*
  • B7-1 Antigen / metabolism
  • B7-2 Antigen / metabolism
  • B7-H1 Antigen / metabolism
  • Cell Proliferation / drug effects
  • Cells, Cultured
  • Graft vs Host Disease / metabolism*
  • Graft vs Host Disease / prevention & control*
  • Hematopoietic Stem Cell Transplantation / methods
  • Interferon gamma Receptor
  • Janus Kinase 1 / metabolism
  • Male
  • Mice
  • Purines
  • Pyrazoles
  • Receptors, Interferon / antagonists & inhibitors*
  • Receptors, Interleukin-6 / antagonists & inhibitors*
  • Signal Transduction / drug effects
  • Sulfonamides / pharmacology*
  • T-Lymphocytes, Regulatory / drug effects
  • T-Lymphocytes, Regulatory / metabolism
  • Transplantation, Homologous / methods

Substances

  • Azetidines
  • B7-1 Antigen
  • B7-2 Antigen
  • B7-H1 Antigen
  • Purines
  • Pyrazoles
  • Receptors, Interferon
  • Receptors, Interleukin-6
  • Sulfonamides
  • Janus Kinase 1
  • baricitinib