0:03
Hi everyone, Peter Nash reporting from ACR Convergence Orlando 2026.
0:09
And this is a little bit esoteric, but I think it represents a possible major advance in therapy in axSpA in particular and I'm hoping PsA as well.
0:23
We're talking about the pathogenesis of axSpA and a new line of potential therapy.
0:28
Gut bacterial infection produces pathogenic peptides.
0:33
Then that becomes antigenic presentation on your dendritic cells and those patients are HLA-B27 positive.
0:43
Those abnormal peptides get put in the MHC binding groove and then they get presented to TEC cells.
0:56
Now 80% of these TEC cells carry a T-cell receptor called TRBV9 plus, and that particular receptor has two chains — an alpha chain and a beta chain — and TRBV9 sits on the beta chain and TRAV sits on the alpha chain.
1:16
And now companies are busy making monoclonal antibodies to block that T-cell receptor at the TRBV9 or TRAV stage and get rid of those TEC cell clones that drive axSpA.
1:32
And what's nice about it is they're only 4% of the TEC cells.
1:36
So you eliminate that clone, you leave all the other T-cell repertoire alone.
1:41
So at this meeting there was a late breaker which talked about a T-cell engager that binds to CD3 — so picks up T-cells — and binds specifically to TRBV9, and it's been tested in non-human primates, not in humans.
2:00
And then Atul Diiodar did another presentation where he's talking about a very clever bispecific which picks up TRBV9 but also binds to IL-17A.
2:12
So you can imagine that's going to be very effective as a monoclonal antibody in PsA.
2:18
And these two T-cell engagers can get rid of this T-cell clone for an extended period of time.
2:30
So the three takeaways from this early, early research, which shows a lot of promise for a completely new way of treating axSpA and potentially PsA — and remember it's only in B27-positive patients, so that's most of the radiographic axSpA and maybe 30–40% of PsA are potential.
2:50
So you've got a promise in these diseases, you've got very limited immune suppression, and you might even have a targeted reset and a very new treatment approach.
3:02
So those are the three features, and I'm going to write a little article about it with pictures so it's much easier to see than to explain.
3:14
Peter Nash, RheumNow, ACR Convergence Orlando 2026.
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