In vivo regulation of interleukin 1beta in patients with cryopyrin-associated periodic syndromes

J Exp Med. 2009 May 11;206(5):1029-36. doi: 10.1084/jem.20082481. Epub 2009 Apr 13.

Abstract

The investigation of interleukin 1beta (IL-1beta) in human inflammatory diseases is hampered by the fact that it is virtually undetectable in human plasma. We demonstrate that by administering the anti-human IL-1beta antibody canakinumab (ACZ885) to humans, the resulting formation of IL-1beta-antibody complexes allowed the detection of in vivo-produced IL-1beta. A two-compartment mathematical model was generated that predicted a constitutive production rate of 6 ng/d IL-1beta in healthy subjects. In contrast, patients with cryopyrin-associated periodic syndromes (CAPS), a rare monogenetic disease driven by uncontrolled caspase-1 activity and IL-1 production, produced a mean of 31 ng/d. Treatment with canakinumab not only induced long-lasting complete clinical response but also reduced the production rate of IL-1beta to normal levels within 8 wk of treatment, suggesting that IL-1beta production in these patients was mainly IL-1beta driven. The model further indicated that IL-1beta is the only cytokine driving disease severity and duration of response to canakinumab. A correction for natural IL-1 antagonists was not required to fit the data. Together, the study allowed new insights into the production and regulation of IL-1beta in man. It also indicated that CAPS is entirely mediated by IL-1beta and that canakinumab treatment restores physiological IL-1beta production.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Monoclonal / therapeutic use*
  • Autoimmune Diseases / drug therapy
  • Autoimmune Diseases / genetics*
  • Autoimmune Diseases / immunology
  • C-Reactive Protein / metabolism
  • Carrier Proteins / genetics*
  • Familial Mediterranean Fever / blood
  • Familial Mediterranean Fever / drug therapy
  • Familial Mediterranean Fever / genetics*
  • Familial Mediterranean Fever / immunology
  • Homeostasis
  • Humans
  • Interleukin 1 Receptor Antagonist Protein / therapeutic use
  • Interleukin-1beta / immunology*
  • Interleukin-6 / blood
  • NLR Family, Pyrin Domain-Containing 3 Protein
  • Receptors, Interleukin-1 / blood
  • Serum Amyloid A Protein / metabolism
  • Urticaria / blood
  • Urticaria / drug therapy
  • Urticaria / genetics*
  • Urticaria / immunology

Substances

  • Antibodies, Monoclonal
  • Carrier Proteins
  • Interleukin 1 Receptor Antagonist Protein
  • Interleukin-1beta
  • Interleukin-6
  • NLR Family, Pyrin Domain-Containing 3 Protein
  • NLRP3 protein, human
  • Receptors, Interleukin-1
  • Serum Amyloid A Protein
  • C-Reactive Protein