Myelin basic protein-reactive T cells in multiple sclerosis: pathologic relevance and therapeutic targeting

Autoreactive T cells specific for myelin proteins, such as myelin basic protein (MBP), are thought to play an important role in the pathogenesis of multiple sclerosis (MS). In MS, these MBP-reactive T cells are activated and clonally expanded in vivo and found to accumulate in the brain compartment, suggesting their pathologic role in the disease. There is experimental evidence supporting the beliefs that MBP-reactive T cells are regulated in vivo by the clonotypic regulatory network. This concept has led to the paradigm of T cell vaccination where attenuated MBP-reactive T cells are used as vaccines to effectively prevent and treat experimental autoimmune encephalomyelitis, an animal model for MS. In this paper, the recent evidence regarding the pathologic relevance of MBP-reactive T cell in MS is reviewed. In particular, we discuss our recent clinical trial in which patients with MS were vaccinated with inactivated autologous MBP-reactive T cell clones to investigate the nature of clonotypic responses in vivo, and whether the responses are effective in depleting circulating MBP-reactive T cells in patients with MS. Our study presented in this paper demonstrated the successful depletion of MBP-reactive T cells by T cell vaccination and touched upon important issues related to the clinical application of T cell vaccination in humans. This review provides new insights into the current development in designing effective therapeutic strategies, such as T cell vaccination, to treat patients with MS and other autoimmune diseases.