Peter Kelleher looks at a range of inflammatory conditions and considers the role that testing for anti-TNF drugs and neutralising antibodies can play in the care of patients with autoimmunity-related conditions.
Tumour necrosis factor alpha (TNFα) plays an important role in the development of acute inflammatory responses helping recruit white cells and host defence proteins to local sites of infection and inflammation. This cytokine (immune signalling protein) also acts on the liver to stimulate production of C-reactive protein (CRP) and other acute-phase proteins in response to tissue injury. Monocyte and macrophages are the main producers of TNFα; however, it can be secreted by almost all inflammatory immune cells (ie T cells, NK cells, neutrophils, mast cells and eosinophils). The physiological role of TNFα is therefore to protect the host against infection and injury. Elevated concentration of TNFα can, however, cause tissue injury and persistent inflammation.
Excess production of TNFα occurs in a number of inflammatory conditions including Crohn’s disease, ulcerative colitis, rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, and ocular inflammation in Behcet’s disease. Increased TNFα levels in joints have been linked to raised metalloproteinase synthesis, articular cartilage breakdown and synovial hypertrophy, which are typical of joint disease in patients with rheumatoid arthritis. The development of biological agents targeting the action of TNFα has led to significant clinical improvement in patients with these disorders, with the result that TNFα antagonists are among the best-selling prescribed drugs.
TNFα inhibitors
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