Helper T cells point the way to specific immunotherapy for autoimmune disease.

Autoimmune haemolytic anaemia (AIHA) is characterised by the production of autoantibodies that target determinants on red blood cells. Current treatments rely on generalised immunosupression or cytotoxic treatments that may have potentially harmful side effects. Whilst the underlying cause of disease remains unknown, recent advances in our understanding of CD4+ helper T cell (Th) subsets that drive and control the autoimmune response have important implications for the development of novel immunotherapy. The effector arm of the adaptive immune response is now known to include at least three Th subsets: Th1, Th2 and the recently described Th17. In human AIHA, the targets of the autoimmune response in most patients, the Rhesus (Rh) proteins, have been identified and sequenced, providing the opportunity to study antigen specific responses. The effector Th response is dominated by Th1 cells that are under the control of IL-10 dependent regulatory cells (Tr1). These Th1 responses can be suppressed, with synthetic peptides that are recognised by the Tr1 cells. Such specificity would provide an extremely potent tool in the treatment of autoimmune disease. This review discusses the recent advances in our understanding of helper T cell subsets and the implications for the development of specific immunotherapy in autoimmune disease, using the well characterised responses in AIHA as an example.