Maren Lindner, Béatrice Pignolet, David Brassat, Petra Hundehege, Maria Eveslage, Melanie Eschborn, Johanna Breuer, Luisa Klotz, Karin Loser, Andreas Schulte-Mecklenbeck, Sven G. Meuth, Judith Austermann, Catharina C. Gross, Nicole Freise, Karin B. Busch, Nicholas Schwab, Giulia Nebel, Tilman Schneider-Hohendorf, Timothy J. Turner, Vilmos Posevitz, Heinz Wiendl, Marie Liebmann, Amit Bar-Or, Martin Herold, Shirin Glander, Belén Torres Garrido, Johannes Roth, Claudia Janoschka, Timo Wirth, Graham R. Campbell, Don J. Mahad, Monika Stoll, Biochemie, RS: FHML MaCSBio, RS: CARIM - R1 - Thrombosis and haemostasis, RS: Carim - B01 Blood proteins & engineering, University Hospital Münster - Universitaetsklinikum Muenster [Germany] (UKM), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), University of Edinburgh, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University [Maastricht], Sanofi Genzyme, Perelman School of Medicine, University of Pennsylvania, The University of Sydney, and Pistre, Karine
International audience; Interference with immune cell proliferation represents a successful treatment strategy in T cell-mediated autoimmune diseases such as rheumatoid arthritis and multiple sclerosis (MS). One prominent example is pharmacological inhibition of dihydroorotate dehydrogenase (DHODH), which mediates de novo pyrimidine synthesis in actively proliferating T and B lymphocytes. Within the TERIDYNAMIC clinical study, we observed that the DHODH inhibitor teriflunomide caused selective changes in T cell subset composition and T cell receptor repertoire diversity in patients with relapsing-remitting MS (RRMS). In a preclinical antigen-specific setup, DHODH inhibition preferentially suppressed the proliferation of high-affinity T cells. Mechanistically, DHODH inhibition interferes with oxidative phosphorylation (OXPHOS) and aerobic glycolysis in activated T cells via functional inhibition of complex III of the respiratory chain. The affinity-dependent effects of DHODH inhibition were closely linked to differences in T cell metabolism. High-affinity T cells preferentially use OXPHOS during early activation, which explains their increased susceptibility toward DHODH inhibition. In a mouse model of MS, DHODH inhibitory treatment resulted in preferential inhibition of high-affinity autoreactive T cell clones. Compared to T cells from healthy controls, T cells from patients with RRMS exhibited increased OXPHOS and glycolysis, which were reduced with teriflunomide treatment. Together, these data point to a mechanism of action where DHODH inhibition corrects metabolic disturbances in T cells, which primarily affects profoundly metabolically active high-affinity T cell clones. Hence, DHODH inhibition may promote recovery of an altered T cell receptor repertoire in autoimmunity.