Selective estrogen receptor modulators (SERMs) are tissue- and context-specific regulators of estrogen receptor (ER) signaling, originally developed to treat breast cancer and osteoporosis. Increasing recognition of the roles of ERα and ERβ in modulation of immune cell development, tolerance, inflammation and antiviral defense has led to growing interest in SERMs as potential therapies for autoimmune disease. This review summarizes current mechanistic, preclinical, and clinical evidence on SERMs and related ER-directed agents across autoimmune and immune-mediated conditions. Preclinical studies demonstrated that select SERMs can generate anti-inflammatory or tissue-protective effects of endogenous estrogen without negatively impacting reproductive tissue. In inflammatory arthritis, SERMs reduced synovial inflammation, modulated Th17-associated responses, and protected against bone loss in murine models. In systemic lupus erythematosus (SLE), where estrogen signaling contributes to disease susceptibility and activity, SERMs and SERDs showed variable but encouraging findings: raloxifene improved bone mineral density without increasing lupus flares, bazedoxifene preserved trabecular bone in lupus-prone mice, and fulvestrant reduced disease activity and T-cell activation markers in a randomized trial. In multiple sclerosis, ERα-dependent mechanisms mediate estradiol's protective effects in experimental autoimmune encephalomyelitis (EAE), illustrating the broader immunologic relevance of estrogen pathways. Given the high burden of glucocorticoid exposure, premature ovarian insufficiency, and osteoporosis among individuals with autoimmune diseases, SERMs may offer dual benefit as both immunomodulatory and bone-protective agents. However, available human studies remain small and short-term. Future work should define cell-specific ER signaling in human immunity and autoimmunity, identify patient subgroups most likely to benefit, and evaluate long-term safety in adequately powered clinical trials.
Cyclopia, a rare genetic anomaly and birth defect, was recently observed in our nonhuman primate study. A newborn rhesus macaque, delivered via cesarean section, exhibited facial abnormalities, including a single eye in the middle of the forehead. This macaque was born to a dam who had been inoculated with SIV in the first trimester and received antiretroviral therapy (ART) in the early third trimester of pregnancy. Prenatal ultrasound detected fetal defects, including the fusion of the thalami and absence of third ventricle during the third trimester of fetal development. Remarkably, the newborn macaque was diagnosed with severe alobar holoprosencephaly, characterized by a single eye located on the facial midline and proboscises positioned above and below the eye. This condition was accompanied by the absence of a nose, mouth, mandible, maxilla, nasal and oral cavities, tongue, as well as the esophagus. Subsequent genetic screening identified a significant down-regulation of craniofacial development-associated genes, although genetic mutations in the sonic hedgehog gene (SHH) were not present. As the fetal defects were identified prior to the initiation of antiretroviral therapy, it is possible that other environmental factors may have contributed to the development of cyclopia in this rhesus case. However, the etiology of this congenital HPE case remains essentially unknown.
Recognition of abnormal glycosylation in virtually any cancer type has raised a great interest in the glycan-based tumor biomarkers. Our team explored carbohydrate microarrays as a broad-spectrum immunoassay to probe the immunologically potent tumor glycan targets. This effort has led to the identification of a blood group precursor antigen SSEA-0 as a conserved breast cancer (BCA) marker. Since this immunogenic O-core glycan is normally hidden as a cryptic antigen but becomes overexpressed and surface-exposed by metastatic breast cancer cells (MBCA), its potential as a novel immunological target for precision immunotherapy against tumor metastasis warrants a focused investigation.
Type 2 airway diseases including chronic rhinosinusitis, allergic rhinitis, and asthma remain a major health concern. These disorders are largely characterized by an uncontrolled type 2 immune response with elevated cytokines of IL-4, IL-5 and IL-13, eosinophilic inflammation, goblet cell hyperplasia as well as tissue remodeling. In the last few decades, critical potential roles of innate lymphoid cells (ILCs) in type 2 human diseases have emerged. Unlike their lymphocyte counterpart T cells, ILCs lack antigen-specific receptors and are largely tissue resident. Specifically, group 2 innate lymphoid cells (ILC2s) respond to airway epithelium-derived alarmins (TSLP, IL-33) and secrete high levels of type 2 cytokines. ILC2 responses can bypass the activation of T cells as well as develop corticosteroid-resistance. Currently approved biologics targeting the alarmin thymic stromal lymphopoietin (TSLP) or the IL-4/IL-13 receptor may reduce ILC2 activation, though novel treatments of type 2 airway diseases remain needed. In this review, we briefly discuss the pathogenesis of ILC2-mediated airway diseases followed by their current and potential treatments.
Our innate immune systems are evolved to provide the first line of immune defense against microbial infections. A key effector component is the adenosine deaminase acting on the RNA-1 (ADAR-1)/interferon (IFN) pathway of the innate cytoplasmic immunity that mounts rapid responses to many viral pathogens. As an RNA-editing enzyme, ADAR-1 targets viral RNA intermediates in the cytoplasmic compartment to interfere with the infection. However, ADAR-1 may also edit characteristic RNA structures of certain host genes, notably, the 5-hydroxytryptamine (serotonin) receptor 2C (5-HT2CR). Dysfunction of 5-HT2CR has been linked to the pathology of several human mental conditions, such as Schizophrenia, anxiety, bipolar disorder, major depression, and the mental illnesses of substance use disorders (SUD). Thus, the ADAR-1-mediated RNA editing may be either beneficial or harmful; these effects need to be tightly modulated to sustain innate antiviral immunity while restricting undesired off-target self-reactivity. In this communication, we discuss ideas and tools to identify the orphan drug candidates, including small molecules and biologics that may serve as effective modulators of the ADAR-1/IFN innate immunity and are thereby promising for use in treating or preventing SUD- and/or viral infection-associated mental illnesses.
