Investigation of the prognostic value of TNF-alpha gene polymorphism among patients treated with infliximab, and the effects of infliximab therapy on TNF-alpha production and apoptosis

Objectives: Infliximab, a chimeric anti-tumor necrosis factor (TNF) antibody, is highly effective for the treatment of Crohn's disease ( CD) and rheumatoid arthritis ( RA). Our experiments focused on RA and CD patients receiving infliximab. Since cytokine production is largely determined by genetic factors, the promoter polymorphisms of TNF-alpha were examined among these patients. Additionally, the changes caused by infliximab in the TNF-alpha-producing ability and apoptosis of peripheral blood mononuclear cells (PBMCs) were investigated. Methods: The TNF-alpha genotypes were analyzed by PCR-RFLP. The in vitro TNF-alpha production of the PBMCs was detected by flow cytometric analysis. The TNF-alpha concentration in the supernatant was measured by bioassay. Apoptosis was detected by annexin V-fluorescein isothiocyanate labeling. Results and Conclusions: 8 of the 12 nonresponder patients carried the TNF A allele associated with high TNF-alpha production. We suggest that the determination of TNF polymorphism may help identify more suitable candidates for infliximab treatment. Although in vitro infliximab treatment for 48 h resulted in significant (44.2 +/- 1.17%) apoptosis in PBMCs, in ex vivo samples from RA patients who received infliximab, apoptosis was only 13.3 +/- 1.6%. Furthermore, infliximab did not result in irreversible inhibition of the TNF-alpha-producing ability or in the significant apoptosis of PBMCs. Copyright (C) 2004 S. Karger AG, Basel.