AntiTNF-alpha agents in the treatment of inflammation

Tumour necrosis factor/cachecin (TNF-alpha) and lymphotoxin (LTalpha / TNF-alpha), 2 members of the TNF family of cytokines, have numerous biological functions, such as induction of apoptosis, cytotoxicity, inflammation, immunoregulation, proliferation and antiviral responses. Although TNF-alpha is produced by many cell types, the majority comes from activated macrophages. The related molecule, LT-alpha is produced mainly by activated lymphocytes and shares many of TNF's properties. TNF-alpha is active in both of its molecular forms, a secreted 17 kDa mature form and a transmembrane 26 kDa precursor. It induces activity by stimulating 2 distinct receptor subtypes, TNFR1 (55 kDa) and TNFR2 (75 kDa). The activation of TNFR1 is generally thought to trigger the majority of inflammatory and apoptotic effects, although TNFR2 has recently been shown to play more of a role in signal transduction than was initially thought. TNF-alpha is responsible for the induction of apoptosis in certain cell types, where it plays a pivotal role in the induction of cytotoxicity, killing of neoplastic cells and deletion of autoreactive T-cell clones. This cytokine, and in particular, its overproduction, has been implicated in the pathogenesis of a variety of immunologically mediated inflammatory diseases, including endotoxic shock, inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA). Currently, there is an intense effort underway to regulate TNF-alpha production and activity, in order to treat diseases where TNF-alpha is thought to be pathologically indicated. To achieve this goal, the pharmaceutical industry is currently pursuing a 2 pronged strategy: a) testing biological agents such as antibodies against TNF-alpha or soluble TNF-alpha receptor constructs, and b) identifying small molecular inhibitors directed against targets such as phosphodiesterase-IV (PDE-IV) and TNF-alpha converting enzyme (TACE), a subgroup of the matrix metalloproteinases (MMP). The main difficulties in the clinical implementation of the biological agents are: development of immunogenicity, lack of oral availability and the high cost of production. The currently available small molecular compounds exhibit poor bio-availability and low selectivity, resulting in unacceptable side effects and a low therapeutic index. Despite these hurdles, numerous companies are actively pursuing agents that inhibit TNF-alpha.