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Furie R, Morand EF, Bruce IN, Isenberg D, van Vollenhoven R, Abreu G, Pineda L, Tummala R. What Does It Mean to Be a British Isles Lupus Assessment Group-Based Composite Lupus Assessment Responder? Post Hoc Analysis of Two Phase III Trials. Arthritis Rheumatol 2021; 73:2059-2068. [PMID: 33913260 PMCID: PMC8596929 DOI: 10.1002/art.41778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The British Isles Lupus Assessment Group-based Composite Lupus Assessment (BICLA) is a validated global measure of treatment response in systemic lupus erythematosus (SLE) clinical trials. To understand the relevance of BICLA in clinical practice, we investigated relationships between BICLA response and routine SLE assessments, patient-reported outcomes (PROs), and medical resource utilization. METHODS This was a post hoc analysis of pooled data from the phase III, randomized, placebo-controlled, 52-week TULIP-1 (ClinicalTrials.gov identifier: NCT02446912; n = 457) and TULIP-2 (ClinicalTrials.gov identifier: NCT02446899; n = 362) trials of intravenous anifrolumab (150/300 mg once every 4 weeks) in patients with moderate-to-severe SLE. Changes from baseline to week 52 in clinical assessments, PROs, and medical resource use were compared in BICLA responders versus nonresponders, regardless of treatment assignment. RESULTS BICLA responders (n = 318) achieved significantly improved outcomes compared with nonresponders (n = 501), including lower flare rates, higher rates of attainment of sustained oral glucocorticoid taper to ≤7.5 mg/day, greater improvements in PROs (Functional Assessment of Chronic Illness Therapy-Fatigue, Short Form 36 Health Survey), and fewer SLE-related hospitalizations/emergency department visits (all nominal P < 0.001). Compared with nonresponders, BICLA responders had greater improvements in global and organ-specific disease activity (Physician's Global Assessment, SLE Disease Activity Index 2000, Cutaneous Lupus Erythematosus Disease Area and Severity Index Activity, and joint counts; all nominal P < 0.001). BICLA responders had fewer lupus-related serious adverse events than nonresponders. CONCLUSION BICLA response is associated with clinical benefit in SLE assessments, PROs, and medical resource utilization, confirming its value as a clinical trial end point that is associated with measures important to patient care.
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Affiliation(s)
- Richard Furie
- Zucker School of Medicine at Hofstra/NorthwellGreat NeckNew York
| | | | - Ian N. Bruce
- University of ManchesterNIHR Manchester Biomedical Research CentreManchester University Hospitals NHS Foundation TrustManchester Academic Health Science CentreManchesterUK
| | - David Isenberg
- University College London and University College HospitalLondonUK
| | | | | | - Lilia Pineda
- BioPharmaceuticals R&D, AstraZenecaGaithersburgMaryland
| | - Raj Tummala
- BioPharmaceuticals R&D, AstraZenecaGaithersburgMaryland
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52
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Connelly K, Vettivel J, Golder V, Kandane-Rathnayake R, Morand EF. Measurement of specific organ domains in lupus randomised controlled trials: a scoping review. Rheumatology (Oxford) 2021; 61:1341-1353. [PMID: 34664636 DOI: 10.1093/rheumatology/keab777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Randomised controlled trials (RCTs) in systemic lupus erythematosus (SLE, lupus) typically adopt composite responder definitions as primary efficacy endpoints, however outcomes within individual organ domains are also important to understand. The aim of this scoping review was to evaluate how organ-specific disease activity and therapeutic responses have been measured and reported in lupus RCTs. METHODS We searched MEDLINE, EMBASE, Cochrane registry and clinicaltrials.gov. Eligible studies were RCTs investigating efficacy of an immune-directed drug therapy in active SLE, published January 2000-March 2021, excluding studies limited to lupus nephritis. Data were extracted independently in duplicate into a template and summarised descriptively. RESULTS Thirty-four RCTs were included, of which 32 (94%) reported activity and/or responses in at least one organ domain. Study populations had a high, although variable, frequency of baseline musculoskeletal and mucocutaneous activity and low but also variable representation of other domains. Definitions of organ-specific responses were inconsistent, even within individual instruments. Response in most organ domains were evaluated using BILAG and SLEDAI components but meaningful comparison between treatment arms was limited by small subgroups analysed in a post hoc fashion. Specific mucocutaneous and arthritis instruments were also used, including within pre-specified organ-specific endpoints, which discriminated between treatment arms in some studies. CONCLUSION Mucocutaneous and musculoskeletal manifestations predominate in SLE RCTs. Organ-specific outcome measures are commonly reported, but definitions of involvement and response are inconsistent. Research into the development of new outcome measures for key organ domains, and validation and comparison of response definitions using existing instruments, is needed.
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Affiliation(s)
- Kathryn Connelly
- School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia.,Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia
| | - Jeevan Vettivel
- School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia
| | - Vera Golder
- School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia.,Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia
| | | | - Eric F Morand
- School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia.,Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia
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53
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Connelly K, Morand EF. Systemic lupus erythematosus: a clinical update. Intern Med J 2021; 51:1219-1228. [PMID: 34423550 DOI: 10.1111/imj.15448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/11/2021] [Accepted: 04/25/2021] [Indexed: 12/21/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease known for its complexity and heterogeneity. Striking diversity can be observed between individual patients, in terms of clinical manifestations, serological abnormalities, disease progression and response to therapy. Furthermore, dysfunction of a broad range of immune pathways underlies disease development and expression. An appreciation of this diversity is vital in order to diagnose accurately and appropriately treat patients with SLE as there is no one-size-fits-all diagnostic test or treatment. Optimal management involves identifying affected organs, assessing severity, differentiating activity from irreversible damage and tailoring immunosuppressive treatment accordingly. Non-pharmacological interventions, attention to disease and treatment-related comorbidities and addressing the significant impact on health-related quality of life are also crucial to maximising patient outcomes.
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Affiliation(s)
- Kathryn Connelly
- Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia.,School for Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric F Morand
- Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia.,School for Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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54
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Connelly K, Golder V, Kandane-Rathnayake R, Morand EF. Clinician-reported outcome measures in lupus trials: a problem worth solving. Lancet Rheumatol 2021; 3:e595-e603. [PMID: 38287623 DOI: 10.1016/s2665-9913(21)00119-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 02/08/2023]
Abstract
Systemic lupus erythematosus (SLE) remains a disease of high unmet clinical need. Because of substantial patient heterogeneity, the execution of clinical trials that successfully determine the efficacy of novel therapeutics compared with placebo is a continuous challenge. Clinician-reported outcome measures of treatment response used in SLE trials have evolved from the use of individual disease activity indices, including the SLE Disease Activity Index (SLEDAI) and British Isles Lupus Assessment Group (BILAG), to composite responder definitions such as the SLE Responder Index (SRI) and BILAG-Based Composite Lupus Assessment (BICLA), which are based on these indices. However, these approaches have notable drawbacks and defining the optimal clinical trial outcome measure for SLE remains a research goal. In this Viewpoint, we explore the strengths and limitations of existing indices and composite assessments, illustrating features which should be investigated in future analysis of trial data. Further, we provide a platform from which to advance new approaches to endpoint design, which is crucial to improve the interpretability and success of subsequent clinical trials in SLE.
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Affiliation(s)
- Kathryn Connelly
- School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; Department of Rheumatology, Monash Health, Monash University, Clayton, VIC 3168, Australia
| | - Vera Golder
- School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; Department of Rheumatology, Monash Health, Monash University, Clayton, VIC 3168, Australia
| | | | - Eric F Morand
- School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia; Department of Rheumatology, Monash Health, Monash University, Clayton, VIC 3168, Australia.
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55
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Valentin R, Wong C, Alharbi AS, Pradeloux S, Morros MP, Lennox KA, Ellyard JI, Garcin AJ, Ullah TR, Kusuma GD, Pépin G, Li HM, Pearson JS, Ferrand J, Lim R, Veedu RN, Morand EF, Vinuesa CG, Behlke MA, Gantier MP. Sequence-dependent inhibition of cGAS and TLR9 DNA sensing by 2'-O-methyl gapmer oligonucleotides. Nucleic Acids Res 2021; 49:6082-6099. [PMID: 34057477 PMCID: PMC8216285 DOI: 10.1093/nar/gkab451] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 12/26/2022] Open
Abstract
Oligonucleotide-based therapeutics have the capacity to engage with nucleic acid immune sensors to activate or block their response, but a detailed understanding of these immunomodulatory effects is currently lacking. We recently showed that 2′-O-methyl (2′OMe) gapmer antisense oligonucleotides (ASOs) exhibited sequence-dependent inhibition of sensing by the RNA sensor Toll-Like Receptor (TLR) 7. Here we discovered that 2′OMe ASOs can also display sequence-dependent inhibitory effects on two major sensors of DNA, namely cyclic GMP-AMP synthase (cGAS) and TLR9. Through a screen of 80 2′OMe ASOs and sequence mutants, we characterized key features within the 20-mer ASOs regulating cGAS and TLR9 inhibition, and identified a highly potent cGAS inhibitor. Importantly, we show that the features of ASOs inhibiting TLR9 differ from those inhibiting cGAS, with only a few sequences inhibiting both pathways. Together with our previous studies, our work reveals a complex pattern of immunomodulation where 95% of the ASOs tested inhibited at least one of TLR7, TLR9 or cGAS by ≥30%, which may confound interpretation of their in vivo functions. Our studies constitute the broadest analysis of the immunomodulatory effect of 2′OMe ASOs on nucleic acid sensing to date and will support refinement of their therapeutic development.
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Affiliation(s)
- Roxane Valentin
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, Victoria 3800, Australia
| | - Christophe Wong
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, Victoria 3800, Australia
| | - Arwaf S Alharbi
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, Victoria 3800, Australia.,The Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Turabah 29179, Saudi Arabia
| | - Solène Pradeloux
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, Victoria 3800, Australia
| | - Makala P Morros
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, Victoria 3800, Australia
| | - Kim A Lennox
- Integrated DNA Technologies Inc., Coralville, IA 52241, USA
| | - Julia I Ellyard
- Department of Immunology and Infectious Diseases, John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia.,Centre for Personalised Immunology, John Curtin School of Medical Research, Australian National University, Canberra, ACT, 2601, Australia
| | - Aurélie J Garcin
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, Victoria 3800, Australia
| | - Tomalika R Ullah
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, Victoria 3800, Australia
| | - Gina D Kusuma
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3800, Australia
| | - Geneviève Pépin
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, Victoria 3800, Australia
| | - Hong-Mei Li
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, Victoria 3800, Australia
| | - Jaclyn S Pearson
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, Victoria 3800, Australia
| | - Jonathan Ferrand
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, Victoria 3800, Australia
| | - Rebecca Lim
- Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3800, Australia.,Australian Regenerative Medicine Institute, Monash University, Clayton, Victoria 3800, Australia
| | - Rakesh N Veedu
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, Western Australia 6150, Australia.,Perron Institute for Neurological and Translational Science, Perth, Western Australia 6150, Australia
| | - Eric F Morand
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria 3168, Australia
| | - Carola G Vinuesa
- Department of Immunology and Infectious Diseases, John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia.,Centre for Personalised Immunology, John Curtin School of Medical Research, Australian National University, Canberra, ACT, 2601, Australia
| | - Mark A Behlke
- Integrated DNA Technologies Inc., Coralville, IA 52241, USA
| | - Michael P Gantier
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, Victoria 3800, Australia
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56
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Mok CC, Hamijoyo L, Kasitanon N, Chen DY, Chen S, Yamaoka K, Oku K, Li MT, Zamora L, Bae SC, Navarra S, Morand EF, Tanaka Y. The Asia-Pacific League of Associations for Rheumatology consensus statements on the management of systemic lupus erythematosus. Lancet Rheumatol 2021; 3:e517-e531. [PMID: 38279404 DOI: 10.1016/s2665-9913(21)00009-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
Systemic lupus erythematosus (SLE) is prevalent in Asia and carries a variable prognosis among patients across the Asia-Pacific region, which could relate to access to health care, tolerability of medications, and adherence to therapies. Because many aspects of SLE are unique among patients from this region, the Asia-Pacific League of Associations for Rheumatology developed the first set of consensus recommendations on the management of SLE. A core panel of 13 rheumatologists drafted a set of statements through face-to-face meeting and teleconferences. A literature review was done for each statement to grade the quality of evidence and strength of recommendation. 29 independent specialists and three patients with SLE were then recruited for a modified Delphi process to establish consensus on the statements through an online voting platform. A total of 34 consensus recommendations were developed. Panellists agreed that patients with SLE should be referred to a specialist for the formulation of a treatment plan through shared decision making between patients and physicians. Remission was agreed to be the goal of therapy, but when it cannot be achieved, a low disease activity state should be aimed for. Patients should be screened for renal disease, and hydroxychloroquine is recommended for all Asian people with SLE. Major organ manifestations of SLE should be treated with induction immunosuppression and subsequently maintenance; options include cyclophosphamide, mycophenolate mofetil, azathioprine, and calcineurin inhibitors, in combination with glucocorticoids. Biologics, combination regimens, plasma exchange, and intravenous immunoglobulins should be reserved for cases of refractory or life-threatening disease. Anticoagulation therapy with warfarin is preferred to the direct oral anticoagulants for thromboembolic SLE manifestations associated with a high-risk antiphospholipid antibody profile.
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Affiliation(s)
- Chi Chiu Mok
- Division of Rheumatology, Department of Medicine, Tuen Mun Hospital, Hong Kong Special Administrative Region, China.
| | - Laniyati Hamijoyo
- Rheumatology Division, Department of Internal Medicine, Padjadjaran University, Jawa Barat, Indonesia
| | - Nuntana Kasitanon
- Division of Rheumatology, Department of Internal Medicine, Chiang Mai University, Thailand
| | - Der Yuan Chen
- Rheumatology and Immunology Centre, China Medical University, Taichung, Taiwan
| | - Sheng Chen
- Department of Rheumatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kunihiro Yamaoka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kenji Oku
- Department of Rheumatology, Endocrinology and Nephrology Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Meng Tao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China; Chinese Academy of Medical Science, National Clinical Research Centre for Dermatological and Immunological Diseases, Beijing, China
| | - Leonid Zamora
- Section of Rheumatology, University of Santo Tomas, Manila, Philippines
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Sandra Navarra
- Section of Rheumatology, University of Santo Tomas, Manila, Philippines
| | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University School of Clinical Sciences, Monash Medical Centre, Melbourne, Australia
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Abstract
The recent updates on treatment recommendations for the management of systemic lupus erythematous have provided greater clarity in the way existing anti-inflammatory and immunomodulatory drugs are used, in treating disease activity, preventing flares, and reducing irreversible organ damage and toxicity arising from the treatments themselves. Novel therapies will provide more options in the armamentarium for treating this complex disease, but ongoing studies are needed to improve understanding of the optimal treatment algorithm to maintain quality of life and improve survival for patients.
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Affiliation(s)
- Alberta Y Hoi
- Centre for Inflammatory Diseases, Monash University, Victoria, Australia; Department of Rheumatology, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University, Victoria, Australia; Department of Rheumatology, Monash Health, 246 Clayton Road, Clayton, Victoria 3168, Australia.
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58
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Furie R, Morand EF, Askanase AD, Vital EM, Merrill JT, Kalyani RN, Abreu G, Pineda L, Tummala R. Anifrolumab reduces flare rates in patients with moderate to severe systemic lupus erythematosus. Lupus 2021; 30:1254-1263. [PMID: 33977796 DOI: 10.1177/09612033211014267] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) management objectives include preventing disease flares while minimizing glucocorticoid exposure. Pooled data from the phase 3 TULIP-1 and TULIP-2 trials in patients with moderate to severe SLE were analyzed to determine anifrolumab's effect on flares, including those arising with glucocorticoid taper. METHODS TULIP-1 and TULIP-2 were randomized, placebo-controlled, 52-week trials of intravenous anifrolumab (300 mg every 4 weeks for 48 weeks). For patients receiving baseline glucocorticoid ≥10 mg/day, attempted taper to ≤7.5 mg/day prednisone or equivalent from Weeks 8-40 was required and defined as sustained reduction when maintained through Week 52. Flares were defined as ≥1 new BILAG-2004 A or ≥2 new BILAG-2004 B scores versus the previous visit. Flare assessments were compared for patients receiving anifrolumab versus placebo. RESULTS Compared with placebo (n = 366), anifrolumab (n = 360) was associated with lower annualized flare rates (rate ratio 0.75, 95% confidence interval [CI] 0.60-0.95), prolonged time to first flare (hazard ratio 0.70, 95% CI 0.55-0.89), and fewer patients with ≥1 flare (difference -9.3%, 95% CI -16.3 to -2.3), as well as flares in organ domains commonly active at baseline (musculoskeletal, mucocutaneous). Fewer BILAG-based Composite Lupus Assessment responders had ≥1 flare with anifrolumab (21.1%, 36/171) versus placebo (30.4%, 34/112). Of patients who achieved sustained glucocorticoid reductions from ≥10 mg/day at baseline, more remained flare free with anifrolumab (40.0%, 76/190) versus placebo (17.3%, 32/185). CONCLUSIONS Analyses of pooled TULIP-1 and TULIP-2 data support that anifrolumab reduces flares while permitting glucocorticoid taper in patients with SLE.ClinicalTrials.gov identifiersTULIP-1 NCT02446912 (clinicaltrials.gov/ct2/show/NCT02446912);TULIP-2 NCT02446899 (clinicaltrials.gov/ct2/show/NCT02446899).
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Affiliation(s)
- Richard Furie
- Division of Rheumatology, Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Eric F Morand
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Anca D Askanase
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Edward M Vital
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Joan T Merrill
- Clinical Pharmacology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | | | - Gabriel Abreu
- BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Lilia Pineda
- BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Raj Tummala
- BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
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59
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Vincent FB, Kandane-Rathnayake R, Koelmeyer R, Harris J, Hoi AY, Mackay F, Morand EF. Associations of serum soluble Fas and Fas ligand (FasL) with outcomes in systemic lupus erythematosus. Lupus Sci Med 2021; 7:7/1/e000375. [PMID: 32546562 PMCID: PMC7299016 DOI: 10.1136/lupus-2019-000375] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/24/2020] [Accepted: 05/13/2020] [Indexed: 01/11/2023]
Abstract
Objective Fas/Fas ligand (FasL) and B cell-activating factor (BAFF) signalling have pivotal roles in SLE pathogenesis. We investigated the clinical associations of serum concentrations of soluble Fas (sFas) and soluble FasL (sFasL) in SLE and their relationship with BAFF. Methods Serum sFas and sFasL were quantified by multiplex assay, and BAFF by ELISA, in 118 patients with SLE and 17 healthy controls (HC). SLE disease activity and organ damage were assessed using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and the Systemic Lupus International Collaborating Clinics Damage Index. Results sFas, sFasL and BAFF were detectable in all samples. Serum sFas and sFasL were significantly higher in SLE compared with HC. In univariable regression analyses, patients with active renal disease and those with flare had significantly higher levels of sFas compared with those without. High serum BAFF in patients with SLE was associated with increased sFas but not sFasL. The association between sFas and renal disease remained significant after adjusting for BAFF, but the association with flare attenuated. High sFas levels were associated with increased time-adjusted mean SLEDAI-2K, even after adjusting for BAFF, and with higher odds of flare over time. In contrast, high sFasL was associated with reduced organ damage over time. Serum sFasL/sFas ratio was negatively associated with active overall disease, flare and organ damage. Conclusions Serum sFas is associated with active renal SLE, and active disease and flare over time, while sFasL/sFas ratio is negatively associated with disease activity and organ damage accrual. Treatments correcting abnormal levels of sFas/FasL may be worthy of evaluation in SLE.
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Affiliation(s)
- Fabien B Vincent
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Rangi Kandane-Rathnayake
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Rachel Koelmeyer
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - James Harris
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Alberta Y Hoi
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Fabienne Mackay
- Department of Immunology and Pathology, Monash University, Central Clinical School, Alfred Medical Research and Education Precinct (AMREP), Melbourne, Victoria, Australia.,Department of Microbiology and Immunology, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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60
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Northcott M, Gearing LJ, Nim HT, Nataraja C, Hertzog P, Jones SA, Morand EF. Glucocorticoid gene signatures in systemic lupus erythematosus and the effects of type I interferon: a cross-sectional and in-vitro study. Lancet Rheumatol 2021; 3:e357-e370. [PMID: 38279391 DOI: 10.1016/s2665-9913(21)00006-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/14/2020] [Accepted: 01/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Glucocorticoids, used as a therapy in systemic lupus erythematosus (SLE), interact with the cytoplasmic glucocorticoid receptor to modulate gene transcription. Minimising the use of glucocorticoids is a goal in SLE; however, pharmacological measures to support clinical guidelines are scarce. We evaluated glucocorticoid-regulated genes for their potential use as biomarkers of glucocorticoid exposure in SLE. We examined interactions between changes in gene expression that are induced by glucocorticoids and type I interferon. METHODS Genes regulated by glucocorticoids and type I interferon were analysed in relation to glucocorticoid exposure in adult patients meeting the American College of Rheumatology criteria for SLE from three cross-sectional cohorts: a local cohort from a tertiary hospital in Melbourne, VIC, Australia, and two public datasets (GSE49454, Hospital de la Conception, Marseille, France, and GSE88884, patients enrolled in a large, multicentre clinical trial). RNA sequencing was done using RNA from healthy donor leucocytes treated with the glucocorticoid dexamethasone, or type I interferon, or both. FINDINGS Glucocorticoid-regulated genes were analysed in a local SLE cohort (n=18) and public dataset GSE49454 (n=62). Five genes correlated with glucocorticoid dose in both cohorts and were combined to make a glucocorticoid gene signature. Validity of the glucocorticoid gene signature was tested in the public dataset GSE88884 (n=1756). A dose-dependent association was observed with glucocorticoid dose (p<0·0001), and the glucocorticoid gene signature had moderate ability to identify patients taking high-dose glucocorticoid (area under the curve [AUC]=0·77) although was less discriminatory when including all doses (AUC=0·69). We saw no effect of glucocorticoid dose on type I interferon -regulated gene expression. Patients with a high type I interferon gene signature had reduced glucocorticoid gene signature expression compared with patients with a low type I interferon gene signature matched for glucocorticoid dose, suggesting type I interferon inhibits glucocorticoid-stimulated gene expression. In RNA sequencing experiments, type I interferon impaired the expression of glucocorticoid-induced genes, whereas dexamethasone had minimal effect on the expression of type I interferon-stimulated genes. We identified genes regulated by dexamethasone but not affected by type I interferon; combined signatures using these genes also showed moderate ability to distinguish patients taking glucocorticoids. INTERPRETATION A gene signature for glucocorticoid exposure was identified, but the substantial effect of type I interferon on glucocorticoid-induced genes might limit its application in SLE. These data confirm the insensitivity of type I interferon-regulated genes to glucocorticoids, and together support the concept that type I interferon has a role in glucocorticoid resistance in SLE. FUNDING Lupus Research Alliance and Australian National Health and Medical Research Council.
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Affiliation(s)
- Melissa Northcott
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
| | - Linden J Gearing
- Department of Molecular and Translational Science, Monash University, Clayton, VIC, Australia; Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Hieu T Nim
- Australian Regenerative Medicine Institute, Monash University, Clayton, VIC, Australia; Systems Biology Laboratory, Monash University, Clayton, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Champa Nataraja
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
| | - Paul Hertzog
- Department of Molecular and Translational Science, Monash University, Clayton, VIC, Australia; Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Sarah A Jones
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia.
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Nataraja C, Dankers W, Flynn J, Lee JPW, Zhu W, Vincent FB, Gearing LJ, Ooi J, Pervin M, Cristofaro MA, Sherlock R, Hasnat MA, Harris J, Morand EF, Jones SA. GILZ Regulates the Expression of Pro-Inflammatory Cytokines and Protects Against End-Organ Damage in a Model of Lupus. Front Immunol 2021; 12:652800. [PMID: 33889157 PMCID: PMC8056982 DOI: 10.3389/fimmu.2021.652800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/15/2021] [Indexed: 12/21/2022] Open
Abstract
Glucocorticoid-induced leucine zipper (GILZ) mimics many of the anti-inflammatory effects of glucocorticoids, suggesting it as a point of therapeutic intervention that could bypass GC adverse effects. We previously reported that GILZ down-regulation is a feature of human SLE, and loss of GILZ permits the development of autoantibodies and lupus-like autoimmunity in mice. To further query the contribution of GILZ to protection against autoimmune inflammation, we studied the development of the lupus phenotype in Lyn-deficient (Lyn-/-) mice in which GILZ expression was genetically ablated. In Lyn-/- mice, splenomegaly, glomerulonephritis, anti-dsDNA antibody titres and cytokine expression were exacerbated by GILZ deficiency, while other autoantibody titres and glomerular immune complex deposition were unaffected. Likewise, in patients with SLE, GILZ was inversely correlated with IL23A, and in SLE patients not taking glucocorticoids, GILZ was also inversely correlated with BAFF and IL18. This suggests that at the onset of autoimmunity, GILZ protects against tissue injury by modulating pro-inflammatory pathways, downstream of antibodies, to regulate the cycle of inflammation in SLE.
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Affiliation(s)
- Champa Nataraja
- Monash University Centre for Inflammatory Disease, School of Clinical Sciences at Monash Health, Melbourne, VIC, Australia
| | - Wendy Dankers
- Monash University Centre for Inflammatory Disease, School of Clinical Sciences at Monash Health, Melbourne, VIC, Australia
| | - Jacqueline Flynn
- Monash University Centre for Inflammatory Disease, School of Clinical Sciences at Monash Health, Melbourne, VIC, Australia
| | - Jacinta P W Lee
- Monash University Centre for Inflammatory Disease, School of Clinical Sciences at Monash Health, Melbourne, VIC, Australia
| | - Wendy Zhu
- Monash University Centre for Inflammatory Disease, School of Clinical Sciences at Monash Health, Melbourne, VIC, Australia
| | - Fabien B Vincent
- Monash University Centre for Inflammatory Disease, School of Clinical Sciences at Monash Health, Melbourne, VIC, Australia
| | - Linden J Gearing
- Centre for Innate Immunity and Infectious Diseases, Department of Molecular and Translational Science, Hudson Institute, Melbourne, VIC, Australia
| | - Joshua Ooi
- Monash University Centre for Inflammatory Disease, School of Clinical Sciences at Monash Health, Melbourne, VIC, Australia
| | - Mehnaz Pervin
- Monash University Centre for Inflammatory Disease, School of Clinical Sciences at Monash Health, Melbourne, VIC, Australia
| | - Megan A Cristofaro
- Monash University Centre for Inflammatory Disease, School of Clinical Sciences at Monash Health, Melbourne, VIC, Australia
| | - Rochelle Sherlock
- Monash University Centre for Inflammatory Disease, School of Clinical Sciences at Monash Health, Melbourne, VIC, Australia
| | - Md Abul Hasnat
- Monash University Centre for Inflammatory Disease, School of Clinical Sciences at Monash Health, Melbourne, VIC, Australia
| | - James Harris
- Monash University Centre for Inflammatory Disease, School of Clinical Sciences at Monash Health, Melbourne, VIC, Australia
| | - Eric F Morand
- Monash University Centre for Inflammatory Disease, School of Clinical Sciences at Monash Health, Melbourne, VIC, Australia
| | - Sarah A Jones
- Monash University Centre for Inflammatory Disease, School of Clinical Sciences at Monash Health, Melbourne, VIC, Australia
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Tse K, Sangodkar S, Bloch L, Arntsen K, Bae SC, Bruce IN, Connolly-Strong E, Costenbader KH, Dickerson B, Dörner T, Evans S, Kalunian K, Kao AH, Manzi S, Morand EF, Raymond SC, Rovin BH, Schanberg LE, Von Feldt JM, Werth VP, Williams Derricott A, Zook D, Franson T, Getz K, Peña Y, Hanrahan LM. The ALPHA Project: Establishing consensus and prioritisation of global community recommendations to address major challenges in lupus diagnosis, care, treatment and research. Lupus Sci Med 2021; 8:8/1/e000433. [PMID: 33563729 PMCID: PMC7875256 DOI: 10.1136/lupus-2020-000433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/15/2022]
Abstract
The Addressing Lupus Pillars for Health Advancement (ALPHA) Project is a global consensus effort to identify, prioritise and address top barriers in lupus impacting diagnosis, care, treatment and research. To conduct this process, the ALPHA Project convened a multistakeholder Global Advisory Committee (GAC) of lupus experts and collected input from global audiences, including patients. In phase I, the ALPHA Project used expert interviews and a global survey of lupus experts to identify and categorise barriers into three overarching pillars: drug development, clinical care and access to care. In phase II, reported here, the GAC developed recommended actionable solutions to address these previously identified barriers through an in-person stakeholder meeting, followed by a two-round scoring process. Recommendations were assessed for feasibility, impact and timeline for implementation (FIT), where potential FIT component values were between 1 and 3 and total scores were between 3 and 9. Higher scores represented higher achievability based on the composite of the three criteria. Simplifying and standardising outcomes measures, including steroid sparing as an outcome (drug development) and defining the lupus spectrum (clinical care) ranked as the highest two priority solutions during the GAC meeting and received high FIT scores (7.67 and 7.44, respectively). Leveraging social media (access to care) received the highest FIT score across all pillars (7.86). Cross-cutting themes of many solutions include leveraging digital technology and applying specific considerations for special populations, including paediatrics. Implementing the recommendations to address key barriers to drug development, clinical care and access to care is essential to improving the quality of life of adults and children with lupus. Multistakeholder collaboration and guidance across existing efforts globally is warranted.
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Affiliation(s)
- Karin Tse
- Research, Lupus Foundation of America Inc, Washington, District of Columbia, USA
| | - Sanjyot Sangodkar
- Faegre Drinker Consulting, Faegre Drinker Biddle and Reath LLP, Washington, DC, USA
| | - Lauren Bloch
- Faegre Drinker Consulting, Faegre Drinker Biddle and Reath LLP, Washington, DC, USA
| | - Kathleen Arntsen
- Lupus and Allied Diseases Association, Inc, Verona, New York, USA
| | - Sang-Cheol Bae
- Rheumatology, Hanyang University Seoul Hospital, Seongdong-gu, Seoul, South Korea
| | - Ian N Bruce
- NIHR Manchester Biomedical Research Centre, Manchester, UK.,Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
| | - Erin Connolly-Strong
- Autoimmune and Rare Disease Division, Mallinckrodt Pharmaceuticals Specialty Brands, Bedminster, New Jersey, USA
| | | | | | - Thomas Dörner
- Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany
| | - Sydney Evans
- Patient Representative, Riverdale, Maryland, USA
| | - Kenneth Kalunian
- Medical Center, University of California San Diego, La Jolla, California, USA
| | - Amy H Kao
- EMD Serono Research and Development Institute, Billerica, Massachusetts, USA
| | - Susan Manzi
- Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Eric F Morand
- Rheumatology, Monash University, Clayton, Victoria, Australia
| | - Sandra C Raymond
- Research, Lupus Foundation of America Inc, Washington, District of Columbia, USA
| | - Brad H Rovin
- Internal Medicine/Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | | | - Victoria P Werth
- Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | | | - David Zook
- Faegre Drinker Consulting, Faegre Drinker Biddle and Reath LLP, Washington, DC, USA
| | - Timothy Franson
- Faegre Drinker Consulting, Faegre Drinker Biddle and Reath LLP, Indianapolis, Indiana, USA
| | - Kenneth Getz
- Center for the Study of Drug Development, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Yaritza Peña
- Center for the Study of Drug Development, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Leslie M Hanrahan
- Research, Lupus Foundation of America Inc, Washington, District of Columbia, USA
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Tummala R, Abreu G, Pineda L, Michaels MA, Kalyani RN, Furie RA, Morand EF. Safety profile of anifrolumab in patients with active SLE: an integrated analysis of phase II and III trials. Lupus Sci Med 2021; 8:e000464. [PMID: 33597205 PMCID: PMC7893670 DOI: 10.1136/lupus-2020-000464] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE In phase II and III trials, anifrolumab, a human monoclonal antibody that binds type I interferon receptor subunit 1, has shown efficacy in adults with moderate to severe SLE. We evaluated the safety and tolerability of anifrolumab using data pooled from these trials to more precisely estimate the rate and severity of adverse events (AEs). METHODS Data were pooled from patients receiving monthly intravenous anifrolumab 300 mg or placebo in MUSE, TULIP-1 and TULIP-2. Key safety endpoints included percentages and exposure-adjusted incidence rates (EAIRs) of patients who experienced AEs, serious AEs (SAEs), AEs leading to discontinuation and AEs of special interest. RESULTS During treatment, 86.9% of patients receiving anifrolumab 300 mg (n=459) experienced AEs (≥1) versus 79.4% receiving placebo (n=466), and 4.1% versus 5.2% experienced an AE leading to discontinuation of investigational product. SAEs (≥1) were experienced by 11.8% and 16.7% of patients receiving anifrolumab and placebo, respectively (EAIR risk difference (95% CI) -7.2 (-12.5 to -1.9)), including lupus exacerbations classified as SAEs (1.5% and 3%, respectively). Infections occurred in 69.7% and 55.4% of patients receiving anifrolumab and placebo, respectively; difference in reported rates was driven by herpes zoster (HZ) and mild and moderate respiratory (excluding pneumonia) infections. The risk of HZ was increased with anifrolumab versus placebo (6.1% vs 1.3%, respectively; EAIR risk difference (95% CI) 5.4 (2.8 to 8.4)); most HZ events were mild or moderate, cutaneous and resolved without treatment discontinuation. Serious infections occurred in 4.8% and 5.6% of patients receiving anifrolumab and placebo, respectively. CONCLUSIONS In this pooled analysis of 925 patients with moderate to severe SLE, monthly intravenous anifrolumab 300 mg was generally well tolerated over 52 weeks with an acceptable safety profile. Anifrolumab was associated with an increased incidence of HZ and respiratory tract infections and lower reported rate of SLE worsening as SAEs.
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Affiliation(s)
- Raj Tummala
- Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Gabriel Abreu
- BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Lilia Pineda
- Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - M Alex Michaels
- Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Rubana N Kalyani
- Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Richard A Furie
- Division of Rheumatology, Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA
| | - Eric F Morand
- Centre for Inflammatory Disease, Monash University, Melbourne, Victoria, Australia
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Stuart RL, Zhu W, Morand EF, Stripp A. Breaking the chain of transmission within a tertiary health service: An approach to contact tracing during the COVID-19 pandemic. Infect Dis Health 2020; 26:118-122. [PMID: 33281108 PMCID: PMC7670898 DOI: 10.1016/j.idh.2020.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/07/2020] [Accepted: 11/08/2020] [Indexed: 11/02/2022]
Abstract
BACKGROUND Tertiary referral health service. INTERVENTION(S) An approach to hospital based contact tracing is described along with tools employed to streamline the process and including the development of an outbreak management team (OMT) for each contact trace. RESULTS Forty-one OMTs occurred, involving 23 HCW and 18 patient index cases. The total furloughed HCWs arising from these contact traces was 383, with individual contact traces furloughing a mean (range) of 10 (0-80) HCWs. Importantly, 15 furloughed HCWs subsequently became COVID-19 positive during their 14-day isolation period, showing the importance of the contact tracing process and the ability to remove workers from the workplace before they become infectious. CONCLUSIONS A standardised, streamlined contact tracing procedure in healthcare settings ensures any impacts of COVID-19 positive cases are consistently managed. This response framework may be of use to other health services and help reduce the transmission of COVID-19 in the workplace.
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Affiliation(s)
- Rhonda L Stuart
- Monash Health, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | - Wendy Zhu
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric F Morand
- Monash Health, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Andrew Stripp
- Monash Health, Melbourne, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Morand EF, Isenberg DA, Wallace DJ, Kao AH, Vazquez-Mateo C, Chang P, Pudota K, Aranow C, Merrill JT. Attainment of treat-to-target endpoints in SLE patients with high disease activity in the atacicept phase 2b ADDRESS II study. Rheumatology (Oxford) 2020; 59:2930-2938. [PMID: 32107560 PMCID: PMC7516108 DOI: 10.1093/rheumatology/keaa029] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/16/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Low disease activity (LDA) and remission are emerging treat-to-target (T2T) endpoints in SLE. However, the rates at which these endpoints are met in patients with high disease activity (HDA) are unknown. Atacicept, which targets B lymphocyte stimulator and a proliferation-inducing ligand, improved disease outcomes in SLE patients with HDA (SLEDAI-2K ≥10) at baseline in the phase 2b ADDRESS II study. This is a post hoc analysis of T2T endpoints in these patients. METHODS Patients received weekly atacicept (75 or 150 mg s.c.) or placebo for 24 weeks (1:1:1 randomization). Attainment of three T2T endpoints, LDA (SLEDAI-2K ≤ 2), Lupus Low Disease Activity State (LLDAS) and remission (clinical SLEDAI-2K = 0, prednisone-equivalent ≤5mg/day and Physician's Global Assessment <0.5), was assessed and compared with SLE Responder Index (SRI)-4 and SRI-6 response. RESULTS Of 306 randomized patients, 158 (51.6%) had baseline HDA. At week 24, 37 (23.4%) HDA patients attained LDA, 25 (15.8%) LLDAS and 17 (10.8%) remission. Each of these endpoints was more stringent than SRI-4 (n = 87; 55.1%) and SRI-6 (n = 67; 42.4%). Compared with placebo (n = 52), at week 24, patients treated with atacicept 150 mg (n = 51) were more likely to attain LDA [odds ratio (OR) 3.82 (95% CI: 1.44, 10.15), P = 0.007], LLDAS [OR 5.03 (95% CI: 1.32, 19.06), P = 0.018] or remission [OR 3.98 (95% CI: 0.78, 20.15), P = 0.095]. CONCLUSION At week 24, LDA, LLDAS and remission were more stringent than SRI-4 and SRI-6 response, were attainable in the HDA population and discriminated between treatment with atacicept 150 mg and placebo. These results suggest that T2T endpoints are robust outcome measures in SLE clinical trials and support further evaluation of atacicept in SLE. TRAIL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, NCT01972568.
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Affiliation(s)
- Eric F Morand
- Centre for Inflammatory Disease, Monash University, Melbourne, Australia
| | | | - Daniel J Wallace
- Division of Rheumatology, Cedars-Sinai Medical Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Amy H Kao
- EMD Serono Research & Development Institute, Inc. (A Business of Merck KGaA, Darmstadt, Germany), Billerica, MA, USA
| | - Cristina Vazquez-Mateo
- EMD Serono Research & Development Institute, Inc. (A Business of Merck KGaA, Darmstadt, Germany), Billerica, MA, USA
| | - Peter Chang
- EMD Serono Research & Development Institute, Inc. (A Business of Merck KGaA, Darmstadt, Germany), Billerica, MA, USA
| | - Kishore Pudota
- EMD Serono Research & Development Institute, Inc. (A Business of Merck KGaA, Darmstadt, Germany), Billerica, MA, USA
| | - Cynthia Aranow
- Institute of Molecular Medicine, Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Joan T Merrill
- Clinical Pharmacology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
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Yeo AL, Koelmeyer R, Kandane‐Rathnayake R, Golder V, Hoi A, Huq M, Hammond E, Nab H, Nikpour M, Morand EF. Lupus Low Disease Activity State and Reduced Direct Health Care Costs in Patients With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 72:1289-1295. [DOI: 10.1002/acr.24023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 07/02/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Ai Li Yeo
- Monash University and Monash Health Clayton Victoria Australia
| | | | | | - Vera Golder
- Monash University and Monash Health Clayton Victoria Australia
| | - Alberta Hoi
- Monash University and Monash Health Clayton Victoria Australia
| | - Molla Huq
- University of Melbourne, Parkville, Monash University, Clayton, and St Vincent’s Hospital Melbourne Fitzroy Victoria Australia
| | - Edward Hammond
- AstraZeneca, Gaithersburg, Maryland, and AstraZeneca Cambridge UK
| | - Henk Nab
- AstraZeneca, Gaithersburg, Maryland, and AstraZeneca Cambridge UK
| | - Mandana Nikpour
- University of Melbourne, Parkville, and St Vincent’s Hospital Melbourne Fitzroy Victoria Australia
| | - Eric F. Morand
- Monash University and Monash Health Clayton Victoria Australia
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Dankers W, Hasnat MA, Swann V, Alharbi A, Lee JP, Cristofaro MA, Gantier MP, Jones SA, Morand EF, Flynn JK, Harris J. Necrotic cell death increases the release of macrophage migration inhibitory factor by monocytes/macrophages. Immunol Cell Biol 2020; 98:782-790. [PMID: 32654231 DOI: 10.1111/imcb.12376] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/16/2020] [Accepted: 07/09/2020] [Indexed: 12/01/2022]
Abstract
Macrophage migration inhibitory factor (MIF) is a pleiotropic inflammatory molecule with both cytokine and noncytokine activity. MIF is constitutively released from multiple cell types via an unconventional secretory pathway that is not well defined. Here, we looked at MIF release from human and mouse monocytes/macrophages in response to different stimuli. While MIF release was not significantly altered in response to lipopolysaccharide or heat-killed Escherichia coli, cytotoxic stimuli strongly promoted release of MIF. MIF release was highly upregulated in cells undergoing necrosis, necroptosis and NLRP3 inflammasome-dependent pyroptosis. Our data suggest that cell death represents a major route for MIF release from myeloid cells. The functional significance of these findings and their potential importance in the context of autoimmune and inflammatory diseases warrant further investigation.
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Affiliation(s)
- Wendy Dankers
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Md Abul Hasnat
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Vanesa Swann
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Arwaf Alharbi
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute for Medical Research, Clayton, VIC, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, VIC, Australia
| | - Jacinta Pw Lee
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Megan A Cristofaro
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Michael P Gantier
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute for Medical Research, Clayton, VIC, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, VIC, Australia
| | - Sarah A Jones
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Eric F Morand
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Jacqueline K Flynn
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - James Harris
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
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Northcott M, Morand EF. Interferon blockade in systemic lupus erythematosus: Light at the end of the tunnel for novel therapies for lupus? Int J Rheum Dis 2020. [DOI: 10.1111/1756-185x.13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Melissa Northcott
- Centre for Inflammatory Diseases School of Clinical Sciences Monash University Melbourne Australia
| | - Eric F. Morand
- Centre for Inflammatory Diseases School of Clinical Sciences Monash University Melbourne Australia
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Yeo AL, Le S, Ong J, Connelly K, Ojaimi S, Nim H, Morand EF, Leech M. Utility of repeated antinuclear antibody tests: a retrospective database study. Lancet Rheumatol 2020; 2:e412-e417. [PMID: 38273605 DOI: 10.1016/s2665-9913(20)30084-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/15/2020] [Accepted: 03/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Anti-nuclear antibody (ANA) testing is frequently used as a diagnostic or screening test in patients with inflammatory or musculoskeletal symptoms. The value of repeat testing is unclear. We sought to evaluate the frequency, utility, and cost of repeat ANA testing. The main objective was to assess the positive predictive value of a repeat ANA test for the diagnosis of rheumatological conditions associated with ANA. METHODS In this retrospective cohort study, we analysed data from a single, multisite tertiary health network in Australia across a 7-year period. ANA and other autoimmune test results were obtained from the hospital pathology system with a positive ANA titre cutoff set at 1:160. Clinical information was sourced from clinical information systems on any patient who had a change in ANA result from negative to positive on repeat testing. The cost of repeated ANA testing was calculated using the Australian Government Medicare Benefits Schedule. FINDINGS From March 19, 2011, to July 23, 2018, a total of 36 715 ANA tests were done in 28 840 patients at a total cost of US$675 029 (2018 equivalent). 14 058 (38·3%) of these ANA tests were positive. 7875 (21·4%) of the ordered tests were repeats in 4887 (16·9%) of the patients, among whom 2683 (54·9%) had initially negative tests, and 2204 (45·1%) had initially positive tests. 511 (19·0%) of the 2683 patients with initially negative tests had a positive result on at least one repeat test, with a median time to first positive result of 1·74 years (IQR 0·54-3·60). A change from negative to positive ANA was associated with a new diagnosis in only five (1·1%) of the 451 patients with clinical information available and no previous diagnosis of an ANA-associated rheumatological condition, yielding a positive predictive value of 1·1% (95% CI 0·4-2·7). INTERPRETATION Repeat ANA testing after a negative result has low utility and results in high cost. FUNDING Monash Health.
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Affiliation(s)
- Ai Li Yeo
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Department of Rheumatology, Monash Health, Clayton, VIC, Australia
| | - Suong Le
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
| | - Jason Ong
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia
| | - Kathryn Connelly
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Department of Rheumatology, Monash Health, Clayton, VIC, Australia
| | - Samar Ojaimi
- Department of Immunology, Monash Health, Clayton, VIC, Australia
| | - Hieu Nim
- School of Biological Sciences, Monash University, Clayton, VIC, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Department of Rheumatology, Monash Health, Clayton, VIC, Australia.
| | - Michelle Leech
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Department of Rheumatology, Monash Health, Clayton, VIC, Australia
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Askanase A, Oon S, Huq M, Calderone A, Morand EF, Nikpour M, Aranow C. Response to: 'Physician global assessment in systemic lupus erythematosus: can we rely on its reliability?' by Chessa et al. Ann Rheum Dis 2020; 81:e80. [PMID: 32461205 DOI: 10.1136/annrheumdis-2020-217692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Anca Askanase
- Rheumatology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Shereen Oon
- Rheumatology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Molla Huq
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Alicia Calderone
- Rheumatology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Eric F Morand
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Mandana Nikpour
- Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
| | - Cynthia Aranow
- The Feinstein Institute for Medical Research, Manhasset, New York, USA
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71
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Askanase A, Oon S, Huq M, Calderone A, Morand EF, Nikpour M, Aranow C. Response to: 'Phsician's global assessment is often useful in SLE, but not always: the case of clinical remission' by Zen et al. Ann Rheum Dis 2020; 81:e78. [PMID: 32434819 DOI: 10.1136/annrheumdis-2020-217687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Anca Askanase
- Department of Rheumatology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Shereen Oon
- Rheumatology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Molla Huq
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Alicia Calderone
- Rheumatology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Eric F Morand
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Mandana Nikpour
- Rheumatology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Cynthia Aranow
- The Feinstein Institute for Medical Research, Manhasset, New York, USA
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72
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Vago JP, Galvão I, Negreiros-Lima GL, Teixeira LCR, Lima KM, Sugimoto MA, Moreira IZ, Jones SA, Lang T, Riccardi C, Teixeira MM, Harris J, Morand EF, Sousa LP. Glucocorticoid-induced leucine zipper modulates macrophage polarization and apoptotic cell clearance. Pharmacol Res 2020; 158:104842. [PMID: 32413484 DOI: 10.1016/j.phrs.2020.104842] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023]
Abstract
Macrophages are professional phagocytes that display remarkable plasticity, with a range of phenotypes that can be broadly characterized by the M1/M2 dichotomy. Glucocorticoid (GC)-induced leucine zipper (GILZ) is a protein known to mediate anti-inflammatory and some pro-resolving actions, including as neutrophil apoptosis. However, the role of GILZ in key macrophage function is not well understood. Here, we investigated the role of GILZ on macrophage reprogramming and efferocytosis. Using murine bone-marrow-derived macrophages (BMDMs), we found that GILZ was expressed in naive BMDMs and exhibited increased expression in M2-like macrophages (IL4-differentiated). M1-like macrophages (IFN/LPS-differentiated) from GILZ-/- mice showed higher expression of the M1 markers CD86, MHC class II, iNOS, IL-6 and TNF-α, associated with increased levels of phosphorylated STAT1 and lower IL-10 levels, compared to M1-differentiated cells from WT mice. There were no changes in the M2 markers CD206 and arginase-1 in macrophages from GILZ-/- mice differentiated with IL-4, compared to cells from WT animals. Treatment of M1-like macrophages with TAT-GILZ, a cell-permeable GILZ fusion protein, decreased the levels of CD86 and MHC class II in M1-like macrophages without modifying CD206 levels in M2-like macrophages. In line with the in vitro data, increased numbers of M1-like macrophages were found into the pleural cavity of GILZ-/- mice after LPS-injection, compared to WT mice. Moreover, efferocytosis was defective in the context of GILZ deficiency, both in vitro and in vivo. Conversely, treatment of LPS-injected mice with TAT-GILZ promoted inflammation resolution, associated with lower numbers of M1-like macrophages and increased efferocytosis. Collectively, these data indicate that GILZ is a regulator of important macrophage functions, contributing to macrophage reprogramming and efferocytosis, both key steps for the resolution of inflammation.
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Affiliation(s)
- Juliana P Vago
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Rheumatology Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Izabela Galvão
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Graziele L Negreiros-Lima
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lívia C R Teixeira
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kátia M Lima
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Michelle A Sugimoto
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Isabella Z Moreira
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sarah A Jones
- Rheumatology Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Tali Lang
- Rheumatology Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Carlo Riccardi
- Departament of Medicine, Section of Pharmacology, University of Perugia, Perugia, Italy
| | - Mauro M Teixeira
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - James Harris
- Rheumatology Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Eric F Morand
- Rheumatology Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Lirlândia P Sousa
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Aranow C, Askanase A, Oon S, Huq M, Calderone A, Morand EF, Nikpour M. Laboratory investigation results influence Physician’s Global Assessment (PGA) of disease activity in SLE. Ann Rheum Dis 2020; 79:787-792. [DOI: 10.1136/annrheumdis-2019-216753] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/19/2020] [Accepted: 03/06/2020] [Indexed: 11/04/2022]
Abstract
ObjectiveTo evaluate the impact of laboratory results on scoring of the Physician Global Assessment (PGA) of disease activity in systemic lupus erythematosus.MethodsFifty clinical vignettes were presented via an online survey to a group of international lupus experts. For each case, respondents scored the PGA pre and post knowledge of laboratory test results (pre-lab and post-lab PGAs). Agreement between individual assessors and relationships between pre-lab and post-lab PGAs, and PGAs and Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) were determined. Respondents were also asked about factors they incorporate into their PGA determinations.ResultsSixty surveys were completed. The inter-rater PGA reliability was excellent (pre-lab intraclass correlation coefficient (ICC) 0.98; post-lab ICC 0.99). Post-lab PGAs were higher than pre-lab PGAs: median (IQR) pre-lab PGA 0.5 (1.05), post-lab PGA 1 (1.3) (p<0.001), with a median (IQR) difference of 0.2 (0.45). In general, all abnormal labs including elevated anti-double stranded DNA antibody level (dsDNA) and low complement impacted PGA assessment. Cases with weakest correlations between pre-lab and post-lab PGA were characterised by laboratory results revealing nephritis and/or haematological manifestations. Both pre-lab and post-lab PGAs correlated with SLEDAI-2K. However, a significantly stronger correlation was observed between post-lab PGA and SLEDAI-2K. Multiple factors influenced PGA determinations. Some factors were considered by an overwhelming majority of lupus experts, with less agreement on others.ConclusionsWe found excellent inter-rater reliability for PGAs in a group of international lupus experts. Post-lab PGA scores were higher than pre-lab PGA scores, with a significantly stronger correlation with the SLEDAI-2K. Our findings indicate that PGA scoring should be performed with knowledge of pertinent laboratory results.
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74
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Zhan Y, Kong I, Chopin M, Macri C, Zhang JG, Xie J, Nutt SL, O'Keeffe M, Hawkins ED, Morand EF, Lew AM. Plasmacytoid dendritic cells from parent strains of the NZB/W F1 lupus mouse contribute different characteristics to autoimmune propensity. Immunol Cell Biol 2020; 98:203-214. [PMID: 31916630 DOI: 10.1111/imcb.12313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/30/2022]
Abstract
The NZB/W F1 (F1) mice develop severe disease that is similar to human systemic lupus erythematosus. By contrast, each parent strain, NZB or NZW, has limited autoimmunity, suggesting traits of both strains contribute to pathogenesis. Although many of the contributing genes have been identified, the contributing cellular abnormality associated with each parent strain remains unresolved. Given that plasmacytoid dendritic cells (pDCs) are key to the pathogenesis of lupus, we investigated the properties of pDCs from NZB and NZW mice. We found that NZB mouse had higher numbers of pDCs, with much of the increase being contributed by a more abundant CD8+ pDC subset. This was associated with prolonged survival and stronger proliferation of CD4+ T cells. By contrast, NZW pDCs had heightened capacity to produce interferon-α (IFNα) and IFNλ, and promoted stronger B-cell proliferation upon CpG stimulation. Thus, our data reveal the different functional and numerical characteristics of pDCs from NZW and NZB mouse.
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Affiliation(s)
- Yifan Zhan
- The Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Isabella Kong
- The Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Michael Chopin
- The Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Christophe Macri
- Infection and Immunity Program, Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Jian-Guo Zhang
- The Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Jiaying Xie
- College of Life Sciences, Nankai University, Tianjin, China
| | - Stephen L Nutt
- The Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Meredith O'Keeffe
- Infection and Immunity Program, Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Edwin D Hawkins
- The Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University, Melbourne, VIC, Australia
| | - Andrew M Lew
- The Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.,Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, VIC, Australia
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Pépin G, De Nardo D, Rootes CL, Ullah TR, Al-Asmari SS, Balka KR, Li HM, Quinn KM, Moghaddas F, Chappaz S, Kile BT, Morand EF, Masters SL, Stewart CR, Williams BRG, Gantier MP. Connexin-Dependent Transfer of cGAMP to Phagocytes Modulates Antiviral Responses. mBio 2020; 11:e03187-19. [PMID: 31992625 PMCID: PMC6989113 DOI: 10.1128/mbio.03187-19] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/12/2019] [Indexed: 12/19/2022] Open
Abstract
Activation of cyclic GMP-AMP (cGAMP) synthase (cGAS) plays a critical role in antiviral responses to many DNA viruses. Sensing of cytosolic DNA by cGAS results in synthesis of the endogenous second messenger cGAMP that activates stimulator of interferon genes (STING) in infected cells. Critically, cGAMP can also propagate antiviral responses to uninfected cells through intercellular transfer, although the modalities of this transfer between epithelial and immune cells remain poorly defined. We demonstrate here that cGAMP-producing epithelial cells can transactivate STING in cocultured macrophages through direct cGAMP transfer. cGAMP transfer was reliant upon connexin expression by epithelial cells and pharmacological inhibition of connexins blunted STING-dependent transactivation of the macrophage compartment. Macrophage transactivation by cGAMP contributed to a positive-feedback loop amplifying antiviral responses, significantly protecting uninfected epithelial cells against viral infection. Collectively, our findings constitute the first direct evidence of a connexin-dependent cGAMP transfer to macrophages by epithelial cells, to amplify antiviral responses.IMPORTANCE Recent studies suggest that extracellular cGAMP can be taken up by macrophages to engage STING through several mechanisms. Our work demonstrates that connexin-dependent communication between epithelial cells and macrophages plays a significant role in the amplification of antiviral responses mediated by cGAMP and suggests that pharmacological strategies aimed at modulating connexins may have therapeutic applications to control antiviral responses in humans.
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Affiliation(s)
- Geneviève Pépin
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
| | - Dominic De Nardo
- The Walter and Eliza Hall Institute of Medical Research, Inflammation Division, Parkville, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Christina L Rootes
- Australian Animal Health Laboratory, Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, Geelong, Victoria, Australia
| | - Tomalika R Ullah
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
| | - Sumaiah S Al-Asmari
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
| | - Katherine R Balka
- The Walter and Eliza Hall Institute of Medical Research, Inflammation Division, Parkville, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Hong-Mei Li
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
| | - Kylie M Quinn
- Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Department of Microbiology and Immunology, The Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, Victoria, Australia
| | - Fiona Moghaddas
- The Walter and Eliza Hall Institute of Medical Research, Inflammation Division, Parkville, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
| | - Stephane Chappaz
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Benjamin T Kile
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Eric F Morand
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Seth L Masters
- The Walter and Eliza Hall Institute of Medical Research, Inflammation Division, Parkville, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
| | - Cameron R Stewart
- Australian Animal Health Laboratory, Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, Geelong, Victoria, Australia
| | - Bryan R G Williams
- Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
- Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Michael P Gantier
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
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Morand EF, Furie R, Tanaka Y, Bruce IN, Askanase AD, Richez C, Bae SC, Brohawn PZ, Pineda L, Berglind A, Tummala R. Trial of Anifrolumab in Active Systemic Lupus Erythematosus. N Engl J Med 2020; 382:211-221. [PMID: 31851795 DOI: 10.1056/nejmoa1912196] [Citation(s) in RCA: 611] [Impact Index Per Article: 152.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anifrolumab, a human monoclonal antibody to type I interferon receptor subunit 1 investigated for the treatment of systemic lupus erythematosus (SLE), did not have a significant effect on the primary end point in a previous phase 3 trial. The current phase 3 trial used a secondary end point from that trial as the primary end point. METHODS We randomly assigned patients in a 1:1 ratio to receive intravenous anifrolumab (300 mg) or placebo every 4 weeks for 48 weeks. The primary end point of this trial was a response at week 52 defined with the use of the British Isles Lupus Assessment Group (BILAG)-based Composite Lupus Assessment (BICLA). A BICLA response requires reduction in any moderate-to-severe baseline disease activity and no worsening in any of nine organ systems in the BILAG index, no worsening on the Systemic Lupus Erythematosus Disease Activity Index, no increase of 0.3 points or more in the score on the Physician Global Assessment of disease activity (on a scale from 0 [no disease activity] to 3 [severe disease]), no discontinuation of the trial intervention, and no use of medications restricted by the protocol. Secondary end points included a BICLA response in patients with a high interferon gene signature at baseline; reductions in the glucocorticoid dose, in the severity of skin disease, and in counts of swollen and tender joints; and the annualized flare rate. RESULTS A total of 362 patients received the randomized intervention: 180 received anifrolumab and 182 received placebo. The percentage of patients who had a BICLA response was 47.8% in the anifrolumab group and 31.5% in the placebo group (difference, 16.3 percentage points; 95% confidence interval, 6.3 to 26.3; P = 0.001). Among patients with a high interferon gene signature, the percentage with a response was 48.0% in the anifrolumab group and 30.7% in the placebo group; among patients with a low interferon gene signature, the percentage was 46.7% and 35.5%, respectively. Secondary end points with respect to the glucocorticoid dose and the severity of skin disease, but not counts of swollen and tender joints and the annualized flare rate, also showed a significant benefit with anifrolumab. Herpes zoster and bronchitis occurred in 7.2% and 12.2% of the patients, respectively, who received anifrolumab. There was one death from pneumonia in the anifrolumab group. CONCLUSIONS Monthly administration of anifrolumab resulted in a higher percentage of patients with a response (as defined by a composite end point) at week 52 than did placebo, in contrast to the findings of a similar phase 3 trial involving patients with SLE that had a different primary end point. The frequency of herpes zoster was higher with anifrolumab than with placebo. (Funded by AstraZeneca; ClinicalTrials.gov number, NCT02446899.).
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Affiliation(s)
- Eric F Morand
- From the Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia (E.F.M.); the Division of Rheumatology, Zucker School of Medicine at Hofstra-Northwell, Great Neck (R.F.), and the Department of Medicine, Division of Rheumatology, Columbia University College of Physicians and Surgeons, New York (A.D.A.) - both in New York; the First Department of Internal Medicine and Graduate School of Medical Science, University of Occupational and Environmental Health Japan, Kitakyushu (Y.T.); the Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine, and Health, University of Manchester and National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (I.N.B.); the Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux-Groupe Hospitalier Pellegrin, and Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, Bordeaux University, Bordeaux, France (C.R.); the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea (S.-C.B.); AstraZeneca, Gaithersburg, MD (P.Z.B., L.P., R.T.); and AstraZeneca, Gothenburg, Sweden (A.B.)
| | - Richard Furie
- From the Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia (E.F.M.); the Division of Rheumatology, Zucker School of Medicine at Hofstra-Northwell, Great Neck (R.F.), and the Department of Medicine, Division of Rheumatology, Columbia University College of Physicians and Surgeons, New York (A.D.A.) - both in New York; the First Department of Internal Medicine and Graduate School of Medical Science, University of Occupational and Environmental Health Japan, Kitakyushu (Y.T.); the Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine, and Health, University of Manchester and National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (I.N.B.); the Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux-Groupe Hospitalier Pellegrin, and Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, Bordeaux University, Bordeaux, France (C.R.); the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea (S.-C.B.); AstraZeneca, Gaithersburg, MD (P.Z.B., L.P., R.T.); and AstraZeneca, Gothenburg, Sweden (A.B.)
| | - Yoshiya Tanaka
- From the Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia (E.F.M.); the Division of Rheumatology, Zucker School of Medicine at Hofstra-Northwell, Great Neck (R.F.), and the Department of Medicine, Division of Rheumatology, Columbia University College of Physicians and Surgeons, New York (A.D.A.) - both in New York; the First Department of Internal Medicine and Graduate School of Medical Science, University of Occupational and Environmental Health Japan, Kitakyushu (Y.T.); the Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine, and Health, University of Manchester and National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (I.N.B.); the Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux-Groupe Hospitalier Pellegrin, and Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, Bordeaux University, Bordeaux, France (C.R.); the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea (S.-C.B.); AstraZeneca, Gaithersburg, MD (P.Z.B., L.P., R.T.); and AstraZeneca, Gothenburg, Sweden (A.B.)
| | - Ian N Bruce
- From the Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia (E.F.M.); the Division of Rheumatology, Zucker School of Medicine at Hofstra-Northwell, Great Neck (R.F.), and the Department of Medicine, Division of Rheumatology, Columbia University College of Physicians and Surgeons, New York (A.D.A.) - both in New York; the First Department of Internal Medicine and Graduate School of Medical Science, University of Occupational and Environmental Health Japan, Kitakyushu (Y.T.); the Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine, and Health, University of Manchester and National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (I.N.B.); the Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux-Groupe Hospitalier Pellegrin, and Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, Bordeaux University, Bordeaux, France (C.R.); the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea (S.-C.B.); AstraZeneca, Gaithersburg, MD (P.Z.B., L.P., R.T.); and AstraZeneca, Gothenburg, Sweden (A.B.)
| | - Anca D Askanase
- From the Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia (E.F.M.); the Division of Rheumatology, Zucker School of Medicine at Hofstra-Northwell, Great Neck (R.F.), and the Department of Medicine, Division of Rheumatology, Columbia University College of Physicians and Surgeons, New York (A.D.A.) - both in New York; the First Department of Internal Medicine and Graduate School of Medical Science, University of Occupational and Environmental Health Japan, Kitakyushu (Y.T.); the Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine, and Health, University of Manchester and National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (I.N.B.); the Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux-Groupe Hospitalier Pellegrin, and Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, Bordeaux University, Bordeaux, France (C.R.); the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea (S.-C.B.); AstraZeneca, Gaithersburg, MD (P.Z.B., L.P., R.T.); and AstraZeneca, Gothenburg, Sweden (A.B.)
| | - Christophe Richez
- From the Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia (E.F.M.); the Division of Rheumatology, Zucker School of Medicine at Hofstra-Northwell, Great Neck (R.F.), and the Department of Medicine, Division of Rheumatology, Columbia University College of Physicians and Surgeons, New York (A.D.A.) - both in New York; the First Department of Internal Medicine and Graduate School of Medical Science, University of Occupational and Environmental Health Japan, Kitakyushu (Y.T.); the Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine, and Health, University of Manchester and National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (I.N.B.); the Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux-Groupe Hospitalier Pellegrin, and Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, Bordeaux University, Bordeaux, France (C.R.); the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea (S.-C.B.); AstraZeneca, Gaithersburg, MD (P.Z.B., L.P., R.T.); and AstraZeneca, Gothenburg, Sweden (A.B.)
| | - Sang-Cheol Bae
- From the Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia (E.F.M.); the Division of Rheumatology, Zucker School of Medicine at Hofstra-Northwell, Great Neck (R.F.), and the Department of Medicine, Division of Rheumatology, Columbia University College of Physicians and Surgeons, New York (A.D.A.) - both in New York; the First Department of Internal Medicine and Graduate School of Medical Science, University of Occupational and Environmental Health Japan, Kitakyushu (Y.T.); the Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine, and Health, University of Manchester and National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (I.N.B.); the Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux-Groupe Hospitalier Pellegrin, and Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, Bordeaux University, Bordeaux, France (C.R.); the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea (S.-C.B.); AstraZeneca, Gaithersburg, MD (P.Z.B., L.P., R.T.); and AstraZeneca, Gothenburg, Sweden (A.B.)
| | - Philip Z Brohawn
- From the Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia (E.F.M.); the Division of Rheumatology, Zucker School of Medicine at Hofstra-Northwell, Great Neck (R.F.), and the Department of Medicine, Division of Rheumatology, Columbia University College of Physicians and Surgeons, New York (A.D.A.) - both in New York; the First Department of Internal Medicine and Graduate School of Medical Science, University of Occupational and Environmental Health Japan, Kitakyushu (Y.T.); the Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine, and Health, University of Manchester and National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (I.N.B.); the Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux-Groupe Hospitalier Pellegrin, and Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, Bordeaux University, Bordeaux, France (C.R.); the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea (S.-C.B.); AstraZeneca, Gaithersburg, MD (P.Z.B., L.P., R.T.); and AstraZeneca, Gothenburg, Sweden (A.B.)
| | - Lilia Pineda
- From the Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia (E.F.M.); the Division of Rheumatology, Zucker School of Medicine at Hofstra-Northwell, Great Neck (R.F.), and the Department of Medicine, Division of Rheumatology, Columbia University College of Physicians and Surgeons, New York (A.D.A.) - both in New York; the First Department of Internal Medicine and Graduate School of Medical Science, University of Occupational and Environmental Health Japan, Kitakyushu (Y.T.); the Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine, and Health, University of Manchester and National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (I.N.B.); the Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux-Groupe Hospitalier Pellegrin, and Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, Bordeaux University, Bordeaux, France (C.R.); the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea (S.-C.B.); AstraZeneca, Gaithersburg, MD (P.Z.B., L.P., R.T.); and AstraZeneca, Gothenburg, Sweden (A.B.)
| | - Anna Berglind
- From the Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia (E.F.M.); the Division of Rheumatology, Zucker School of Medicine at Hofstra-Northwell, Great Neck (R.F.), and the Department of Medicine, Division of Rheumatology, Columbia University College of Physicians and Surgeons, New York (A.D.A.) - both in New York; the First Department of Internal Medicine and Graduate School of Medical Science, University of Occupational and Environmental Health Japan, Kitakyushu (Y.T.); the Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine, and Health, University of Manchester and National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (I.N.B.); the Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux-Groupe Hospitalier Pellegrin, and Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, Bordeaux University, Bordeaux, France (C.R.); the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea (S.-C.B.); AstraZeneca, Gaithersburg, MD (P.Z.B., L.P., R.T.); and AstraZeneca, Gothenburg, Sweden (A.B.)
| | - Raj Tummala
- From the Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia (E.F.M.); the Division of Rheumatology, Zucker School of Medicine at Hofstra-Northwell, Great Neck (R.F.), and the Department of Medicine, Division of Rheumatology, Columbia University College of Physicians and Surgeons, New York (A.D.A.) - both in New York; the First Department of Internal Medicine and Graduate School of Medical Science, University of Occupational and Environmental Health Japan, Kitakyushu (Y.T.); the Arthritis Research UK Centre for Epidemiology, Faculty of Biology, Medicine, and Health, University of Manchester and National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom (I.N.B.); the Rheumatology Department, Centre Hospitalier Universitaire de Bordeaux-Groupe Hospitalier Pellegrin, and Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5164, Bordeaux University, Bordeaux, France (C.R.); the Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea (S.-C.B.); AstraZeneca, Gaithersburg, MD (P.Z.B., L.P., R.T.); and AstraZeneca, Gothenburg, Sweden (A.B.)
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Abstract
Cell death is a vital process for maintaining tissue homeostasis and removing potentially harmful cells. Cell death can be both programmed and non-programmed and is commonly divided into two main forms, termed apoptotic and necrotic death modes. In this chapter cell death is classified into apoptosis, primary necrosis, pyroptosis, and necroptosis. This chapter outlines the measurement of these different types of cell death and the relationship of measuring MIF release in these assays.
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Affiliation(s)
- Shahrzad Zamani
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia
| | - Eric F Morand
- Rheumatology Group, Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Monash Medical Centre, Clayton, VIC, Australia.
| | - Jacqueline K Flynn
- Rheumatology Group, Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Monash Medical Centre, Clayton, VIC, Australia
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78
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Figgett WA, Monaghan K, Ng M, Alhamdoosh M, Maraskovsky E, Wilson NJ, Hoi AY, Morand EF, Mackay F. Machine learning applied to whole-blood RNA-sequencing data uncovers distinct subsets of patients with systemic lupus erythematosus. Clin Transl Immunology 2019; 8:e01093. [PMID: 31921420 PMCID: PMC6946916 DOI: 10.1002/cti2.1093] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/25/2019] [Accepted: 10/29/2019] [Indexed: 12/19/2022] Open
Abstract
Objectives Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease that is difficult to treat. There is currently no optimal stratification of patients with SLE, and thus, responses to available treatments are unpredictable. Here, we developed a new stratification scheme for patients with SLE, based on the computational analysis of patients’ whole‐blood transcriptomes. Methods We applied machine learning approaches to RNA‐sequencing (RNA‐seq) data sets to stratify patients with SLE into four distinct clusters based on their gene expression profiles. A meta‐analysis on three recently published whole‐blood RNA‐seq data sets was carried out, and an additional similar data set of 30 patients with SLE and 29 healthy donors was incorporated in this study; a total of 161 patients with SLE and 57 healthy donors were analysed. Results Examination of SLE clusters, as opposed to unstratified SLE patients, revealed underappreciated differences in the pattern of expression of disease‐related genes relative to clinical presentation. Moreover, gene signatures correlated with flare activity were successfully identified. Conclusion Given that SLE disease heterogeneity is a key challenge hindering the design of optimal clinical trials and the adequate management of patients, our approach opens a new possible avenue addressing this limitation via a greater understanding of SLE heterogeneity in humans. Stratification of patients based on gene expression signatures may be a valuable strategy allowing the identification of separate molecular mechanisms underpinning disease in SLE. Further, this approach may have a use in understanding the variability in responsiveness to therapeutics, thereby improving the design of clinical trials and advancing personalised therapy.
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Affiliation(s)
- William A Figgett
- Department of Microbiology and Immunology University of Melbourne at the Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia
| | | | | | | | | | | | - Alberta Y Hoi
- Centre for Inflammatory Diseases School of Clinical Sciences Monash University Clayton VIC Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases School of Clinical Sciences Monash University Clayton VIC Australia
| | - Fabienne Mackay
- Department of Microbiology and Immunology University of Melbourne at the Peter Doherty Institute for Infection and Immunity Melbourne VIC Australia.,Department of Immunology and Pathology Central Clinical School Monash University Melbourne VIC Australia
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79
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Furie RA, Morand EF, Bruce IN, Manzi S, Kalunian KC, Vital EM, Lawrence Ford T, Gupta R, Hiepe F, Santiago M, Brohawn PZ, Berglind A, Tummala R. Type I interferon inhibitor anifrolumab in active systemic lupus erythematosus (TULIP-1): a randomised, controlled, phase 3 trial. Lancet Rheumatol 2019; 1:e208-e219. [PMID: 38229377 DOI: 10.1016/s2665-9913(19)30076-1] [Citation(s) in RCA: 218] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Type I interferons are involved in systemic lupus erythematosus (SLE) pathogenesis. In a phase 2 trial, anifrolumab, a human monoclonal antibody to type I interferon receptor subunit 1, suppressed interferon gene signatures and substantially reduced SLE disease activity. Here, we sought to confirm the efficacy of anifrolumab versus placebo in a phase 3 trial of adult patients with SLE and moderate-to-severe disease activity despite standard-of-care treatment. METHODS TULIP-1 was a double-blind, randomised, controlled, phase 3 trial done at 123 sites in 18 countries. Included patients were aged 18-70 years, with moderate-to-severe SLE, and ongoing stable treatment with either prednisone or equivalent, an antimalarial, azathioprine, mizoribine, mycophenolate mofetil or mycophenolic acid, or methotrexate. Patients were randomly assigned (2:1:2) to receive placebo, anifrolumab 150 mg, or anifrolumab 300 mg intravenously every 4 weeks for 48 weeks. Stable standard-of-care treatment continued except for mandatory attempts at oral corticosteroid tapering for patients receiving prednisone or equivalent of 10 mg/day or more at baseline. The primary outcome was the difference between the proportion of patients who achieved an SLE responder index-4 (SRI-4) response at week 52 with anifrolumab 300 mg versus with placebo. Key secondary outcomes were the difference between the anifrolumab 300 mg group and the placebo group in: proportion of patients in the interferon gene signature test-high subgroup who achieved SRI-4 at week 52; proportion of patients on 10 mg/day or more corticosteroids at baseline who achieved a sustained dose reduction to 7·5 mg/day or less from week 40 to 52; proportion of patients with a cutaneous lupus erythematosus disease area and severity index (CLASI) activity score of 10 or higher at baseline who achieved a 50% or more reduction in CLASI score by week 12; proportion of patients who achieved SRI-4 at week 24; and annualised flare rate through week 52. Other measures of disease activity were also assessed at week 52, including the British Isles Lupus Assessment Group-based composite lupus assessment (BICLA). Safety was also assessed. Efficacy and safety analyses were done in the population of patients who received at least one dose of study drug. This trial was registered at ClinicalTrials.gov (NCT02446912). FINDINGS Between June 9, 2015, and June 16, 2017, 457 patients were randomly assigned to the anifrolumab 300 mg group (n=180), the anifrolumab 150 mg group (n=93), or the placebo group (n=184). The proportion of patients at week 52 with an SRI-4 response was similar between anifrolumab 300 mg (65 [36%] of 180) and placebo (74 [40%] of 184; difference -4·2 [95% CI -14·2 to 5·8], p=0·41). Similarly, proportions of patients with an SRI-4 response at week 24, and at week 52 in patients in the interferon gene signature test-high subgroup, did not differ between the anifrolumab and placebo groups. In patients with baseline oral corticosteroids of at least 10 mg/day, sustained dose reduction to 7·5 mg/day or less was achieved by 42 (41%) of 103 patients in the anifrolumab 300 mg group and 33 (32%) of 102 patients in the placebo group (difference 8·9 [95% CI -4·1 to 21·9]). In patients with CLASI activity score of at least 10 at baseline, at least 50% reduction by week 12 was achieved by 24 (42%) of 58 patients in the anifrolumab 300 mg group and 14 (25%) of 54 in the placebo group (difference 17·0 [95% CI -0·3 to 34·3]). Annualised flare rates were 0·60 for anifrolumab and 0·72 for placebo (rate ratio 0·83 [95% CI 0·60 to 1·14]). BICLA response was achieved by 67 (37%) of 180 patients receiving anifrolumab 300 mg versus 49 (27%) of 184 receiving placebo (difference 10·1 [95% CI 0·6 to 19·7]). Anifrolumab's safety profile was similar to that observed in phase 2, with similar proportions of patients having a serious adverse event between groups (25 [14%] of 180 for anifrolumab 300 mg, ten [11%] of 93 for anifrolumab 150 mg, and 30 [16%] of 184 for placebo). INTERPRETATION The primary endpoint was not reached. However, several secondary endpoints, including reduction in oral corticosteroid dose, CLASI responses, and BICLA responses, suggest clinical benefit of anifrolumab compared with placebo. Conclusive evidence for the efficacy of anifrolumab awaits further phase 3 trial data. Despite the inherent limitations of a 1-year phase 3 study, such as incomplete knowledge of applicability to the general population and scarce detection of rare safety signals, in addition to complications from prespecified restricted medication rules, our results suggest that anifrolumab might have the potential to provide a treatment option for patients who have active SLE while receiving standard therapy. FUNDING AstraZeneca.
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Affiliation(s)
- Richard A Furie
- Division of Rheumatology, Zucker School of Medicine at Hofstra/Northwell Health, Great Neck, NY, USA.
| | - Eric F Morand
- Centre for Inflammatory Disease, Monash University, Melbourne, VIC, Australia
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Susan Manzi
- Lupus Center of Excellence, Autoimmunity Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Edward M Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Ramesh Gupta
- Baptist Memorial Hospital-Memphis, Memphis, TN, USA
| | - Falk Hiepe
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mittermayer Santiago
- Bahiana School of Medicine and Public Health, Science Development Foundation of Bahia, Graça, Brazil
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80
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Morand EF, Golder V. Defining remission in systemic lupus erythematosus: still elusive? Lancet Rheumatol 2019; 1:e137-e138. [PMID: 38229386 DOI: 10.1016/s2665-9913(19)30065-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 01/18/2024]
Affiliation(s)
- Eric F Morand
- Monash University School of Clinical Sciences, Monash Medical Centre, Melbourne, VIC 3168, Australia.
| | - Vera Golder
- Monash University School of Clinical Sciences, Monash Medical Centre, Melbourne, VIC 3168, Australia
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81
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Golder V, Kandane-Rathnayake R, Huq M, Nim HT, Louthrenoo W, Luo SF, Wu YJJ, Lateef A, Sockalingam S, Navarra SV, Zamora L, Hamijoyo L, Katsumata Y, Harigai M, Chan M, O'Neill S, Goldblatt F, Lau CS, Li ZG, Hoi A, Nikpour M, Morand EF. Lupus low disease activity state as a treatment endpoint for systemic lupus erythematosus: a prospective validation study. Lancet Rheumatol 2019; 1:e95-e102. [PMID: 38229349 DOI: 10.1016/s2665-9913(19)30037-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/11/2019] [Accepted: 07/22/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treat-to-target strategies have improved outcomes in single-organ diseases with simple clinical or laboratory endpoints. A lack of validated endpoints has prevented adoption of treat to target for complex multiorgan conditions, such as systemic lupus erythematosus (SLE). We report the first prospective study undertaken to specifically validate a treat-to-target endpoint for SLE. METHODS In this prospective cohort study, patients aged 18 years or older with SLE were recruited from 13 centres in eight countries and followed prospectively. Patients with at least two visits over the study period no more than 6 months apart were included in the longitudinal analysis. Patients with no visits in the final year of the study were censored from their last visit. Attainment of the lupus low disease activity state (LLDAS) was assessed at each visit. The primary outcome measure was accrual of irreversible end-organ damage, defined as at least a 1-point increase in the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. We used time-dependent hazard regression models and generalised linear models to measure the association between LLDAS (attainment at any timepoint, cumulative time in LLDAS, and sustained LLDAS) with accrual of irreversible end-organ damage or flare (key secondary outcome). This study is registered with ClinicalTrials.gov, NCT03138941. FINDINGS Between May 1, 2013, and Dec 31, 2016, 1707 patients were recruited and followed for a mean of 2·2 years (SD 0·9), totalling 12 689 visits. Attainment of LLDAS at any timepoint was associated with reduction in damage accrual (hazard ratio 0·59, 0·45-0·76; p<0·0001) and subsequent flare (0·65, 95% CI 0·56-0·75; p<0·0001). Cumulative time in LLDAS was associated with improved outcomes: compared with patients with less than 50% of observed time in LLDAS, those with at least 50% of observed time in LLDAS had reduced risk of damage accrual (0·54, 0·42-0·70; p<0·0001) and flare (0·41, 0·35-0·48; p<0·0001). Similarly, increased durations of sustained LLDAS were associated with incremental reductions in the risk of damage accrual. The association of LLDAS with reduced damage accrual was observed regardless of pre-existing damage or disease activity at study entry. INTERPRETATION LLDAS attainment is associated with significant protection against flare and damage accrual in SLE. These findings validate LLDAS as an endpoint for clinical studies in SLE. FUNDING The Asia Pacific Lupus Collaboration received project support grants from UCB Pharma, GlaxoSmithKline, Janssen, Bristol-Myers Squibb, and AstraZeneca.
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Affiliation(s)
- Vera Golder
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.
| | | | - Molla Huq
- Department of Rheumatology, The University of Melbourne, Melbourne, VIC, Australia
| | - Hieu T Nim
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Worawit Louthrenoo
- Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Shue Fen Luo
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Guishan Township, Taiwan
| | - Yeong-Jian Jan Wu
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Guishan Township, Taiwan
| | - Aisha Lateef
- Rheumatology Division, National University Hospital, Singapore
| | | | - Sandra V Navarra
- Joint and Bone Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Leonid Zamora
- Joint and Bone Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Laniyati Hamijoyo
- Department of Internal Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Yasuhiro Katsumata
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayoshi Harigai
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Madelynn Chan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Sean O'Neill
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Fiona Goldblatt
- Department of Rheumatology, Royal Adelaide Hospital, Adelaide, SA, Australia; Department of Rheumatology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Zhan Guo Li
- Department of Rheumatology and Immunology, People's Hospital Peking University Health Sciences Centre, Beijing, China
| | - Alberta Hoi
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Mandana Nikpour
- Department of Rheumatology, The University of Melbourne, Melbourne, VIC, Australia
| | - Eric F Morand
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
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Golder V, Kandane-Rathnayake R, Huq M, Louthrenoo W, Luo SF, Wu YJJ, Lateef A, Sockalingam S, Navarra SV, Zamora L, Hamijoyo L, Katsumata Y, Harigai M, Chan M, O'Neill S, Goldblatt F, Lau CS, Li ZG, Hoi A, Nikpour M, Morand EF. Evaluation of remission definitions for systemic lupus erythematosus: a prospective cohort study. Lancet Rheumatol 2019; 1:e103-e110. [PMID: 38229337 DOI: 10.1016/s2665-9913(19)30048-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Validated outcome measures are needed from which to derive treatment strategies for systemic lupus erythematosus (SLE). However, no definition of remission for SLE has been widely adopted. The Definitions of Remission in Systemic Lupus Erythematosus (DORIS) group has proposed a framework with multiple potential definitions of remission. In this study, we aimed to assess the attainability and effect on disease outcomes of the DORIS definitions of remission, compared with the lupus low disease activity state (LLDAS), in patients with SLE. METHODS In this prospective cohort study, we enrolled patients with SLE from 13 international centres that are part of the Asia Pacific Lupus Collaboration. Eligible patients were older than 18 years and fulfilled one of two classification criteria for SLE (1997 American College of Rheumatology criteria or the 2012 Systemic Lupus International Collaborating Clinics criteria). Visits were according to clinical need, with a minimum frequency of one visit per 6 months. We assessed attainment of remission on the basis of the eight DORIS definitions of remission, which varied in terms of serological activity, glucocorticoid use, and use of immunosuppresive agents; attainment of LLDAS; and disease flares at each visit. Irreversible organ damage accrual was recorded annually. Our primary aim was to assess exposure of patients to each of the remission definitions or LLDAS, and the respective association of these states with accrual of irreversible organ damage as the primary outcome measure. Occurrence of disease flares was the key secondary outcome. We used time-dependent Cox proportional hazards models and generalised linear models to assess DORIS definitions of remission and LLDAS in terms of their association with damage accrual and disease flares. FINDINGS Between May 1, 2013, and Dec 31, 2016, 1707 patients with SLE were recruited and followed for a mean of 2·2 years (SD 0·9), totalling 12 689 visits. Remission, depending on DORIS definition, was achieved in 581 (4·6%) to 4546 (35·8%) of 12 689 visits. Spending 50% or more of observed time in any remission state was associated with a significant reduction in damage accrual, except for the two most stringent remission definitions, for which the frequency of attainment was lowest. Remission definitions disallowing serological activity were associated with the greatest reductions in disease flares. LLDAS was more attainable than any remission definition and was associated with a similar magnitude of protection from damage accrual and disease flares. Sustained remission and LLDAS were associated with a wider spread of effect sizes for reduction in risk of damage. By analysing patients who met the definition for LLDAS but not remission, we found that LLDAS was significantly associated with reduction in damage accrual, independent of all definitions of remission, except the least stringent. INTERPRETATION Attainment of remission was associated with significant reductions in damage accrual and disease flares. LLDAS was more achievable than remission based on the DORIS criteria, but was similarly protective. Remission definitions with less stringency might be insufficiently distinct from LLDAS to substantially affect outcome measures, and further studies are needed to distinguish the protective effects of the various remission definitions. FUNDING UCB, GlaxoSmithKline, Janssen, Bristol-Myers Squibb, and AstraZeneca.
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Affiliation(s)
- Vera Golder
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.
| | | | - Molla Huq
- Department of Rheumatology, The University of Melbourne, Melbourne, VIC, Australia
| | - Worawit Louthrenoo
- Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Shue Fen Luo
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Guishan Township, Taiwan
| | - Yeong-Jian Jan Wu
- Department of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Guishan Township, Taiwan
| | - Aisha Lateef
- Rheumatology Division, National University Hospital, Singapore
| | | | - Sandra V Navarra
- Joint and Bone Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Leonid Zamora
- Joint and Bone Center, University of Santo Tomas Hospital, Manila, Philippines
| | - Laniyati Hamijoyo
- Department of Internal Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Yasuhiro Katsumata
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayoshi Harigai
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Madelynn Chan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Sean O'Neill
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Fiona Goldblatt
- Department of Rheumatology, Royal Adelaide Hospital, Adelaide, SA, Australia; Department of Rheumatology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Zhan Guo Li
- Department of Rheumatology and Immunology, People's Hospital Peking University Health Sciences Centre, Beijing, China
| | - Alberta Hoi
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Mandana Nikpour
- Department of Rheumatology, The University of Melbourne, Melbourne, VIC, Australia
| | - Eric F Morand
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
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83
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Nim HT, Connelly K, Vincent FB, Petitjean F, Hoi A, Koelmeyer R, Boyd SE, Morand EF. Novel Methods of Incorporating Time in Longitudinal Multivariate Analysis Reveals Hidden Associations With Disease Activity in Systemic Lupus Erythematosus. Front Immunol 2019; 10:1649. [PMID: 31379847 PMCID: PMC6653068 DOI: 10.3389/fimmu.2019.01649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/02/2019] [Indexed: 12/27/2022] Open
Abstract
Objective: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease. SLE is characterized by high inter-patient variability, including fluctuations over time, a factor which most biomarker studies omit from consideration. We investigated relationships between disease activity and biomarker expression in SLE, using novel methods to control for time-dependent variability, in a proof-of-concept study to evaluate whether doing so revealed additional information. Methods: We measured 4 serum biomarkers (MIF, CCL2, CCL19, and CXCL10) and 13 routine clinical laboratory parameters, alongside disease activity measured by the SLE disease activity index-2k (SLEDAI-2k), collected longitudinally. We analyzed these data with unsupervised learning methods via ensemble clustering, incorporating temporal relationships using dynamic time warping for distance metric calculation. Results: Data from 843 visits in 110 patients (median age 47, 83% female) demonstrated highly heterogeneous time-dependent relationships between disease activity and biomarkers. Unbiased magnitude-based hierarchical clustering of biomarker expression levels isolated a patient subset (n = 9) with distinctively heterogeneous expression of the 17 biological parameters, and who had MIF, CCL2, CCL19, and CXCL10 levels that were higher and more strongly associated with disease activity, based on leave-one-out cross-validated regression analysis. In the remaining subgroup, a time-dependent regression model revealed significantly stronger predictive power of biomarkers for disease activity, compared to a time-agnostic regression model. Despite no significant difference in simple magnitude, using dynamic time warping analysis to align longitudinal profiles revealed a large subset (n = 69) with significantly stronger associations between biological parameters and disease activity. This subgroup had significantly lower flare rates, disease activity and damage scores, suggesting this clustering is clinically meaningful. Conclusions: These results suggest associations between biological parameters and disease activity in SLE exist in a multi-dimensional time-dependent pattern, with implications for the analysis of biomarkers in SLE often used to identify therapeutic targets. Novel methods to analyse high-dimensional data and control for time-dependent variability may have broad utility in the study complex relationships between clinical and biological parameters.
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Affiliation(s)
- Hieu T Nim
- Data Science & AI, Faculty of Information Technology, Monash University, Clayton, VIC, Australia.,Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Kathryn Connelly
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Fabien B Vincent
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - François Petitjean
- Data Science & AI, Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Alberta Hoi
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Rachel Koelmeyer
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Sarah E Boyd
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
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84
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Abstract
Glucocorticoids (GC) are used globally to treat autoimmune and inflammatory disorders. Their anti-inflammatory actions are mainly mediated via binding to the glucocorticoid receptor (GR), creating a GC/GR complex, which acts in both the cytoplasm and nucleus to regulate the transcription of a host of target genes. As a result, signaling pathways such as NF-κB and AP-1 are inhibited, and cell activation, differentiation and survival and cytokine and chemokine production are suppressed. However, the gene regulation by GC can also cause severe side effects in patients. Systemic lupus erythematosus (SLE or lupus) is a multisystem autoimmune disease, characterized by a poorly regulated immune response leading to chronic inflammation and dysfunction of multiple organs, for which GC is the major current therapy. Long-term GC use, however, can cause debilitating adverse consequences for patients including diabetes, cardiovascular disease and osteoporosis and contributes to irreversible organ damage. To date, there is no alternative treatment which can replicate the rapid effects of GC across multiple immune cell functions, effecting disease control during disease flares. Research efforts have focused on finding alternatives to GC, which display similar immunoregulatory actions, without the devastating adverse metabolic effects. One potential candidate is the glucocorticoid-induced leucine zipper (GILZ). GILZ is induced by low concentrations of GC and is shown to mimic the action of GC in several inflammatory processes, reducing immunity and inflammation in in vitro and in vivo studies. Additionally, GILZ has, similar to the GC-GR complex, the ability to bind to both NF-κB and AP-1 as well as DNA directly, to regulate immune cell function, while potentially lacking the GC-related side effects. Importantly, in SLE patients GILZ is under-expressed and correlates negatively with disease activity, suggesting an important regulatory role of GILZ in SLE. Here we provide an overview of the actions and use of GC in lupus, and discuss whether the regulatory mechanisms of GILZ could lead to the development of a novel therapeutic for lupus. Increased understanding of the mechanisms of action of GILZ, and its ability to regulate immune events leading to lupus disease activity has important clinical implications for the development of safer anti-inflammatory therapies.
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Affiliation(s)
- Jacqueline K Flynn
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Wendy Dankers
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Eric F Morand
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
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85
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Vincent FB, Bubicich M, Downie-Doyle S, Mackay F, Morand EF, Rischmueller M. Serum soluble Fas and Fas ligand (FasL) in primary Sjögren's syndrome. Clin Exp Rheumatol 2019; 37 Suppl 118:254-256. [PMID: 30789150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Fabien B Vincent
- Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Australia.
| | - Melissa Bubicich
- Rheumatology Department, The Queen Elizabeth Hospital, Woodville, Australia
| | - Sarah Downie-Doyle
- Rheumatology Department, The Queen Elizabeth Hospital, Woodville, Australia
| | - Fabienne Mackay
- Dept. of Immunology and Pathology, Monash Univ., Alfred Medical Research and Education Precinct (AMREP); and Dept. of Microbiology and Immunology, School of Biomedical Sciences, Dentistry & Health Sciences, Univ. of Melbourne, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Australia
| | - Maureen Rischmueller
- Rheumatology Department, The Queen Elizabeth Hospital, Woodville, and Discipline of Medicine, University of Adelaide, Australia
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86
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Harris J, VanPatten S, Deen NS, Al-Abed Y, Morand EF. Rediscovering MIF: New Tricks for an Old Cytokine. Trends Immunol 2019; 40:447-462. [DOI: 10.1016/j.it.2019.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 12/14/2022]
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87
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Vincent FB, Lang T, Kandane-Rathnayake R, Downie-Doyle S, Morand EF, Rischmueller M. Serum and urinary macrophage migration inhibitory factor (MIF) in primary Sjögren's syndrome. Joint Bone Spine 2019; 86:393-395. [DOI: 10.1016/j.jbspin.2018.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
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88
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Vincent FB, Kandane-Rathnayake R, Koelmeyer R, Hoi AY, Harris J, Mackay F, Morand EF. Analysis of serum B cell-activating factor from the tumor necrosis factor family (BAFF) and its soluble receptors in systemic lupus erythematosus. Clin Transl Immunology 2019; 8:e01047. [PMID: 31024730 PMCID: PMC6475618 DOI: 10.1002/cti2.1047] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 12/28/2022] Open
Abstract
Objectives To determine the presence and clinical associations of the soluble receptors of B cell-activating factor from the tumor necrosis factor family (BAFF) in serum of patients with systemic lupus erythematosus (SLE). Methods Serum BAFF and soluble BAFF receptor (sBAFF-R) were quantified using ELISA, and soluble B cell maturation antigen (sBCMA) and transmembrane activator and cyclophilin ligand interactor (sTACI) by Luminex, in 87 SLE patients and 17 healthy controls (HC). Disease activity and organ damage were assessed using SLE Disease Activity Index 2000 (SLEDAI-2K) and Systemic Lupus International Collaborating Clinics (SLICC) SLE Damage Index (SDI), respectively. Results BAFF and all receptors were detectable in all serum samples. Serum sBCMA and sTACI, but not sBAFF-R, were significantly higher in SLE than in HC. Serum BAFF was also increased in SLE, but this association was attenuated after adjusting for age and ethnicity. Increased serum BAFF was associated with flare and organ damage. Increased serum sBCMA was associated with the presence of anti-dsDNA, but not with overall or organ-specific disease activity, flare or organ damage. Neither sTACI nor sBAFF-R was associated with any SLE clinical parameters in multivariable analysis. While serum BAFF correlated negatively with sBAFF-R in HC, no statistically significant correlations were observed between BAFF and its receptors in SLE patients. Conclusion Serum BAFF was associated with flare and organ damage independent of the presence of its soluble receptors. While sBCMA was associated with anti-dsDNA positivity, other soluble BAFF receptors were not associated with SLE clinical indicators.
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Affiliation(s)
- Fabien B Vincent
- Rheumatology Research Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Rangi Kandane-Rathnayake
- Rheumatology Research Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Rachel Koelmeyer
- Rheumatology Research Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Alberta Y Hoi
- Rheumatology Research Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - James Harris
- Rheumatology Research Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Fabienne Mackay
- Department of Immunology and Pathology Central Clinical School Alfred Medical Research and Education Precinct (AMREP) Monash University Melbourne VIC Australia.,Department of Microbiology and Immunology School of Biomedical Sciences Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne Melbourne VIC Australia
| | - Eric F Morand
- Rheumatology Research Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
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89
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Lin E, Vincent FB, Sahhar J, Ngian GS, Kandane-Rathnayake R, Mende R, Morand EF, Lang T, Harris J. Analysis of serum interleukin(IL)-1α, IL-1β and IL-18 in patients with systemic sclerosis. Clin Transl Immunology 2019; 8:e1045. [PMID: 30997045 PMCID: PMC6451750 DOI: 10.1002/cti2.1045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 12/17/2022] Open
Abstract
Objectives Systemic sclerosis (SSc) is an autoimmune disease characterised by fibrosis, vascular dysfunction and immune dysregulation. The pathogenesis of SSc remains poorly understood, although studies have indicated a role for the innate immune response. Methods Here, we measured serum interleukin (IL)‐1α, IL‐1β and IL‐18 levels in 105 SSc patients and 47 healthy controls (HC) and analysed them with respect to multiple clinical parameters. Results Serum IL‐18 concentrations were significantly higher in SSc patients than in HC, while no significant differences in concentrations of IL‐1α and IL‐1β were observed between SSc and HC. In both SSc and HC serum, IL‐1α and IL‐1β were positively correlated, while in SSc, both cytokines negatively correlated with IL‐18. Serum IL‐18 was significantly negatively correlated with both carbon monoxide transfer coefficient (KCO) and diffusing capacity of the lungs for carbon monoxide (DLCO). Serum IL‐1β was positively correlated with the modified Rodnan skin score (mRSS), particularly in patients with limited subtype. DLCO, KCO and tricuspid regurgitation (TR) velocity were significantly higher in patients with high serum IL‐1β. Serum IL‐1α was significantly lower in SSc patients with low KCO and positively correlated with KCO. SSc patients with high serum IL‐1α concentrations were more likely to have digital ulcers. Conclusions Our data suggest that these IL‐1 family cytokines may have different roles in the pathogenesis of SSc fibrotic complications.
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Affiliation(s)
- Emily Lin
- Rheumatology Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Fabien B Vincent
- Rheumatology Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Joanne Sahhar
- Department of Rheumatology Monash Health & Monash University Clayton VIC Australia
| | - Gene-Siew Ngian
- Department of Rheumatology Monash Health & Monash University Clayton VIC Australia
| | - Rangi Kandane-Rathnayake
- Rheumatology Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Rachel Mende
- Rheumatology Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Eric F Morand
- Rheumatology Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia.,Department of Rheumatology Monash Health & Monash University Clayton VIC Australia
| | - Tali Lang
- Rheumatology Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia.,Present address: Tali Lang, The Szalmuk Family Department of Medical Oncology Cabrini Institute Malvern VIC 3144 Australia
| | - James Harris
- Rheumatology Group Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
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90
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Oon S, Huq M, Golder V, Ong PX, Morand EF, Nikpour M. Lupus Low Disease Activity State (LLDAS) discriminates responders in the BLISS-52 and BLISS-76 phase III trials of belimumab in systemic lupus erythematosus. Ann Rheum Dis 2019; 78:629-633. [PMID: 30679152 DOI: 10.1136/annrheumdis-2018-214427] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/17/2018] [Accepted: 01/03/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE We evaluated the discriminant capacity of the Lupus Low Disease Activity State (LLDAS) in post-hoc analysis of data from the BLISS-52 and BLISS-76 trials of belimumab in systemic lupus erythematosus (SLE). METHODS LLDAS attainment, discrimination between belimumab and placebo arms, and the effects in subgroups with high disease activity at recruitment were evaluated at week 52 using appropriate descriptive statistics, χ2 test and logistic regression. RESULTS At week 52, for belimumab 10 mg/kg, 17.0% and 19.3% of patients who achieved a Systemic Lupus Erythematosus Responder Index-4 also attained LLDAS in BLISS-52 and BLISS-76, respectively. Significantly more patients attained LLDAS on belimumab 10 mg/kg compared with placebo (12.5% vs 5.8%, OR 2.32, p=0.02 for BLISS-52; 14.4% vs 7.8%, OR 1.98, p=0.04 for BLISS-76). In a subgroup analysis, the difference in week 52 LLDAS attainment between belimumab 10 mg/kg and placebo was greater in patients who had higher disease activity at baseline, compared with the overall group. CONCLUSIONS LLDAS was able to discriminate belimumab 10 mg/kg from placebo in the BLISS-52 and BLISS-76 trials. Our findings support the validity of LLDAS as an outcome measure in SLE clinical trials.
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Affiliation(s)
- Shereen Oon
- Rheumatology, St Vincent's Hospital, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Molla Huq
- Rheumatology, St Vincent's Hospital, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Vera Golder
- Monash University, Melbourne, Victoria, Australia
| | - Pei Xuan Ong
- Monash University, Melbourne, Victoria, Australia
| | | | - Mandana Nikpour
- Rheumatology, St Vincent's Hospital, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
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91
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Vincent FB, Lin E, Sahhar J, Ngian GS, Kandane-Rathnayake R, Mende R, Hoi AY, Morand EF, Lang T, Harris J. Analysis of serum macrophage migration inhibitory factor and D-dopachrome tautomerase in systemic sclerosis. Clin Transl Immunology 2018; 7:e1042. [PMID: 30546906 PMCID: PMC6283235 DOI: 10.1002/cti2.1042] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 12/25/2022] Open
Abstract
Objectives Macrophage migration inhibitory factor (MIF) and D‐dopachrome tautomerase (DDT), members of the same cytokine superfamily, are linked to the pathogenesis of a number of inflammatory diseases. The aim of this study was to investigate their clinical relevance in systemic sclerosis (SSc). Methods Serum MIF and DDT were quantified in 105 SSc patients by ELISA and levels compared to healthy controls (HC) (47) and patients with systemic lupus erythematosus (SLE) (184). Clinical parameters included organ involvement, serum laboratory markers and results of pulmonary function tests, and overall disease activity assessed using the European Scleroderma Trials and Research group (EUSTAR) activity index. Results There was no significant difference in serum DDT concentrations between patients with SSc and HC. However, serum MIF was significantly increased in SSc compared to both HC and SLE cohorts. Serum MIF was increased in SSc patients with low forced vital capacity (FVC) and was also associated with the use of angiotensin II receptor blockers and beta blockers in SSc, confirmed after adjusting for the presence of systemic hypertension and low FVC. Serum DDT was significantly higher in SSc patients with low FEV1 and negatively correlated with EUSTAR score, particularly in patients with limited disease. Conclusion Although not significantly linked to specific clinical parameters, serum MIF was significantly higher in SSc patients than in HC and SLE patients, suggesting a fundamental role for MIF in SSc. DDT, while closely related to MIF, did not show a similar expression profile, suggesting functional differences between these molecules.
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Affiliation(s)
- Fabien B Vincent
- Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Emily Lin
- Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Joanne Sahhar
- Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia.,Department of Rheumatology Monash Health Clayton VIC Australia
| | - Gene-Siew Ngian
- Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia.,Department of Rheumatology Monash Health Clayton VIC Australia
| | - Rangi Kandane-Rathnayake
- Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Rachel Mende
- Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Alberta Y Hoi
- Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia.,Department of Rheumatology Monash Health Clayton VIC Australia
| | - Tali Lang
- Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia.,Present address: The Szalmuk Family Department of Medical Oncology Cabrini Institute Malvern VIC 3144 Australia
| | - James Harris
- Centre for Inflammatory Diseases School of Clinical Sciences at Monash Health Monash University Clayton VIC Australia
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92
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Dendle C, Baulch J, Pellicano R, Hay M, Lichtwark I, Ayoub S, Clarke DM, Morand EF, Kumar A, Leech M, Horne K. Medical student psychological distress and academic performance. Med Teach 2018; 40:1257-1263. [PMID: 29355074 DOI: 10.1080/0142159x.2018.1427222] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The impact of medical student psychological distress on academic performance has not been systematically examined. This study provided an opportunity to closely examine the potential impacts of workplace and study related stress factors on student's psychological distress and their academic performance during their first clinical year. METHODS This one-year prospective cohort study was performed at a tertiary hospital based medical school in Melbourne, Australia. Students completed a questionnaire at three time points during the year. The questionnaire included the validated Kessler psychological distress scale (K10) and the General Health Questionnaire-28 (GHQ-28), as well as items about sources of workplace stress. Academic outcome scores were aggregated and correlated with questionnaire results. RESULTS One hundred and twenty six students participated; 126 (94.7%), 102 (76.7%), and 99 (74.4%) at time points one, two, and three, respectively. 33.1% reported psychological distress at time point one, increasing to 47.4% at time point three. There was no correlation between the K10 scores and academic performance. There was weak negative correlation between the GHQ-28 at time point three and academic performance. Keeping up to date with knowledge, need to do well and fear of negative feedback were the most common workplace stress factors. CONCLUSIONS Poor correlation was noted between psychological distress and academic performance.
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Affiliation(s)
- Claire Dendle
- a School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
- b Monash Infectious Diseases, Monash Health , Clayton , Australia
| | - Julie Baulch
- a School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
| | - Rebecca Pellicano
- a School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
- c Nephrology Monash Health , Clayton , Australia
| | - Margaret Hay
- d Faculty of Medicine and Health Sciences , Monash Institute for Health and Clinical Education (MIHCE), Monash University , Melbourne , Australia
| | - Irene Lichtwark
- d Faculty of Medicine and Health Sciences , Monash Institute for Health and Clinical Education (MIHCE), Monash University , Melbourne , Australia
| | - Sally Ayoub
- a School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
| | - David M Clarke
- a School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
| | - Eric F Morand
- a School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
| | - Arunaz Kumar
- a School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
- e Department of Obstetrics and Gynaecology , Monash Health , Clayton , Australia
| | - Michelle Leech
- f Faculty of Medicine, Nursing and Health Sciences , Monash University , Clayton , Australia
| | - Kylie Horne
- a School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
- b Monash Infectious Diseases, Monash Health , Clayton , Australia
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93
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Kandane‐Rathnayake R, Golder V, Louthrenoo W, Luo S, Jan Wu Y, Li Z, An Y, Lateef A, Sockalingam S, Navarra SV, Zamora L, Hamijoyo L, Katsumata Y, Harigai M, Chan M, O’Neill S, Goldblatt F, Hao Y, Zhang Z, Al‐Saleh J, Khamashta M, Takeuchi T, Tanaka Y, Bae S, Lau CS, Hoi A, Nikpour M, Morand EF. Development of the Asia Pacific Lupus Collaboration cohort. Int J Rheum Dis 2018; 22:425-433. [PMID: 30398013 DOI: 10.1111/1756-185x.13431] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/27/2018] [Accepted: 10/04/2018] [Indexed: 12/20/2022]
Affiliation(s)
| | - Vera Golder
- School of Clinical Sciences at Monash HealthMonash University Melbourne Victoria Australia
| | | | - Shue‐Fen Luo
- Chang Gung Memorial Hospital Taipei Taiwan
- Chang Gung Memorial Hospital Keelung Taiwan
| | - Yeong‐Jian Jan Wu
- Chang Gung Memorial Hospital Taipei Taiwan
- Chang Gung Memorial Hospital Keelung Taiwan
| | - Zhanguo Li
- People's Hospital, Peking University Health Science Center Beijing China
| | - Yuan An
- People's Hospital, Peking University Health Science Center Beijing China
| | - Aisha Lateef
- National University Hospital Singapore Singapore
| | | | | | - Leonid Zamora
- University of Santo Tomas Hospital Manila Philippines
| | | | | | | | | | - Sean O’Neill
- Rheumatology Liverpool Hospital, SWS Clinical SchoolUNSW and The Ingham Institute for Applied Medical Research Liverpool New South Wales Australia
| | - Fiona Goldblatt
- Royal Adelaide Hospital Adelaide New South Wales Australia
- Flinders Medical Centre Adelaide New South Wales Australia
| | - Yanjie Hao
- Peking University First Hospital Beijing China
| | | | | | | | | | - Yoshiya Tanaka
- University of Occupational and Environmental Health Kitakyushu Japan
| | - Sang‐Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases Seoul South Korea
| | | | - Alberta Hoi
- School of Clinical Sciences at Monash HealthMonash University Melbourne Victoria Australia
| | | | - Eric F. Morand
- School of Clinical Sciences at Monash HealthMonash University Melbourne Victoria Australia
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94
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Morand EF, Trasieva T, Berglind A, Illei G, Tummala R. Response to: 'Comment on: 'Lupus Low Disease Activity State(LLDAS) attainment discriminates responders in a systemic lupus erythematosus trial: post-hocanalysis of the Phase IIb MUSE trial of anifrolumab' by Eric Morand et al' by Isenberg. Ann Rheum Dis 2018; 78:e122. [PMID: 30373881 DOI: 10.1136/annrheumdis-2018-214487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/02/2018] [Accepted: 10/06/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Eric F Morand
- School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | | | | | - Gabor Illei
- Clinical Development, Respiratory, Inflammation and Autoimmunity, MedImmune, Gaithersburg, Maryland, USA
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95
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Vincent FB, Slavin L, Hoi AY, Kitching AR, Mackay F, Harris J, Kandane-Rathnayake R, Morand EF. Analysis of urinary macrophage migration inhibitory factor in systemic lupus erythematosus. Lupus Sci Med 2018; 5:e000277. [PMID: 30397495 PMCID: PMC6203042 DOI: 10.1136/lupus-2018-000277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/20/2018] [Accepted: 08/27/2018] [Indexed: 01/02/2023]
Abstract
Objective To characterise the clinical relevance of urinary macrophage migration inhibitory factor (uMIF) concentrations in patients with systemic lupus erythematosus (SLE). Methods MIF, adjusted for urine creatinine, was quantified by ELISA in urine samples from 64 prospectively recruited patients with SLE. Serum MIF and urinary monocyte chemoattractant protein 1 (uMCP-1) were quantified by ELISA in a subset of patients (n = 39). Disease activity was assessed using the SLE Disease Activity Index-2000 (SLEDAI-2K) score. Results uMIF was detectable in all patients with SLE. uMIF was positively correlated with overall SLEDAI-2K, was significantly higher in patients with SLE with high disease activity (SLEDAI-2K≥10) compared with those with inactive disease (SLEDAI-2K<4), and this association remained significant after adjusting for ethnicity, flare and use of immunosuppressants. uMIF was also significantly higher in SLE patients with flare of disease, although not confirmed in multivariable analysis. No significant differences in uMIF levels were observed according to the presence of renal disease activity, as assessed by renal SLEDAI-2K or biopsy-confirmed lupus nephritis. In contrast, uMCP-1 was significantly higher in SLE patients with active renal disease. uMIF expression was not associated with irreversible organ damage accrual or glucocorticoid use. Conclusions These data suggest uMIF as a potential overall but not renal-specific SLE biomarker, whereas uMCP-1 is a renal-specific SLE biomarker.
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Affiliation(s)
- Fabien B Vincent
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Laura Slavin
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Alberta Y Hoi
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Arthur Richard Kitching
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Fabienne Mackay
- Department of Microbiology and Immunology, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - James Harris
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Rangi Kandane-Rathnayake
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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96
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Vincent FB, Kandane-Rathnayake R, Hoi AY, Slavin L, Godsell JD, Kitching AR, Harris J, Nelson CL, Jenkins AJ, Chrysostomou A, Hibbs ML, Kerr PG, Rischmueller M, Mackay F, Morand EF. Urinary B-cell-activating factor of the tumour necrosis factor family (BAFF) in systemic lupus erythematosus. Lupus 2018; 27:2029-2040. [PMID: 30301439 DOI: 10.1177/0961203318804885] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION We examined the clinical relevance of urinary concentrations of B-cell-activating factor of the tumour necrosis factor family (BAFF) and a proliferation-inducing ligand (APRIL) in systemic lupus erythematosus (SLE). METHODS We quantified urinary BAFF (uBAFF) by enzyme-linked immunosorbent assay in 85 SLE, 28 primary Sjögren syndrome (pSS), 40 immunoglobulin A nephropathy (IgAN) patients and 36 healthy controls (HCs). Urinary APRIL (uAPRIL) and monocyte chemoattractant protein 1 (uMCP-1) were also quantified. Overall and renal SLE disease activity were assessed using the Systemic Lupus Erythematosus Disease Activity Index 2000. RESULTS uBAFF was detected in 12% (10/85) of SLE patients, but was undetectable in HCs, IgAN and pSS patients. uBAFF was detectable in 28% (5/18) of SLE patients with active nephritis vs 5/67 (7%) of those without ( p = 0.03), and uBAFF was significantly higher in active renal patients ( p = 0.02) and more likely to be detected in patients with persistently active renal disease. In comparison, uAPRIL and uMCP-1 were detected in 32% (25/77) and 46% (22/48) of SLE patients, respectively. While no difference in proportion of samples with detectable uAPRIL was observed between SLE, HCs and IgAN patients, both uAPRIL and uMCP-1 were significantly detectable in higher proportions of patients with active renal disease. CONCLUSIONS uBAFF was detectable in a small but a significant proportion of SLE patients but not in other groups tested, and was higher in SLE patients with active renal disease.
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Affiliation(s)
- F B Vincent
- 1 Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
| | - R Kandane-Rathnayake
- 1 Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
| | - A Y Hoi
- 1 Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
| | - L Slavin
- 1 Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
| | - J D Godsell
- 1 Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
| | - A R Kitching
- 1 Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia.,2 Department of Nephrology, Monash Health, and Monash University, Clayton, Victoria, Australia
| | - J Harris
- 1 Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
| | - C L Nelson
- 3 Western Health, Department of Nephrology, St Albans, Victoria, Australia.,4 The Department of Medicine, Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - A J Jenkins
- 5 National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - A Chrysostomou
- 6 The Renal Unit, The Alfred Hospital, Prahran, Victoria, Australia
| | - M L Hibbs
- 7 Department of Immunology and Pathology, Monash University, Central Clinical School, Melbourne, Victoria, Australia
| | - P G Kerr
- 2 Department of Nephrology, Monash Health, and Monash University, Clayton, Victoria, Australia
| | - M Rischmueller
- 8 Rheumatology Department, The Queen Elizabeth Hospital, and Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - F Mackay
- 7 Department of Immunology and Pathology, Monash University, Central Clinical School, Melbourne, Victoria, Australia.,9 Department of Microbiology and Immunology, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - E F Morand
- 1 Centre for Inflammatory Diseases, Monash University School of Clinical Sciences at Monash Health, Melbourne, Victoria, Australia
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97
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La HM, Chan AL, Legrand JMD, Rossello FJ, Gangemi CG, Papa A, Cheng Q, Morand EF, Hobbs RM. GILZ-dependent modulation of mTORC1 regulates spermatogonial maintenance. Development 2018; 145:dev.165324. [PMID: 30126904 DOI: 10.1242/dev.165324] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/06/2018] [Indexed: 12/15/2022]
Abstract
Male fertility is dependent on spermatogonial stem cells (SSCs) that self-renew and produce differentiating germ cells. Growth factors produced within the testis are essential for SSC maintenance but intrinsic factors that dictate the SSC response to these stimuli are poorly characterised. Here, we have studied the role of GILZ, a TSC22D family protein and spermatogenesis regulator, in spermatogonial function and signalling. Although broadly expressed in the germline, GILZ was prominent in undifferentiated spermatogonia and Gilz deletion in adults resulted in exhaustion of the GFRα1+ SSC-containing population and germline degeneration. GILZ loss was associated with mTORC1 activation, suggesting enhanced growth factor signalling. Expression of deubiquitylase USP9X, an mTORC1 modulator required for spermatogenesis, was disrupted in Gilz mutants. Treatment with an mTOR inhibitor rescued GFRα1+ spermatogonial failure, indicating that GILZ-dependent mTORC1 inhibition is crucial for SSC maintenance. Analysis of cultured undifferentiated spermatogonia lacking GILZ confirmed aberrant activation of ERK MAPK upstream mTORC1 plus USP9X downregulation and interaction of GILZ with TSC22D proteins. Our data indicate an essential role for GILZ-TSC22D complexes in ensuring the appropriate response of undifferentiated spermatogonia to growth factors via distinct inputs to mTORC1.
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Affiliation(s)
- Hue M La
- Australian Regenerative Medicine Institute, Monash University, Melbourne, Victoria 3800, Australia.,Development and Stem Cells Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia
| | - Ai-Leen Chan
- Australian Regenerative Medicine Institute, Monash University, Melbourne, Victoria 3800, Australia.,Development and Stem Cells Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia
| | - Julien M D Legrand
- Australian Regenerative Medicine Institute, Monash University, Melbourne, Victoria 3800, Australia.,Development and Stem Cells Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia
| | - Fernando J Rossello
- Australian Regenerative Medicine Institute, Monash University, Melbourne, Victoria 3800, Australia.,Development and Stem Cells Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia
| | - Christina G Gangemi
- Australian Regenerative Medicine Institute, Monash University, Melbourne, Victoria 3800, Australia.,Development and Stem Cells Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia
| | - Antonella Papa
- Cancer Program, Monash Biomedicine Discovery Institute and Department of Biochemistry and Molecular Biology, Monash University, Melbourne, Victoria 3800, Australia
| | - Qiang Cheng
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria 3800, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria 3800, Australia
| | - Robin M Hobbs
- Australian Regenerative Medicine Institute, Monash University, Melbourne, Victoria 3800, Australia .,Development and Stem Cells Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia
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98
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O'Neill S, Morand EF, Hoi A. The Australian Lupus Registry and Biobank: a timely initiative. Med J Aust 2018; 206:194-195. [PMID: 28301780 DOI: 10.5694/mja16.01282] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 01/23/2017] [Indexed: 12/16/2022]
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99
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Mende R, Vincent FB, Kandane-Rathnayake R, Koelmeyer R, Lin E, Chang J, Hoi AY, Morand EF, Harris J, Lang T. Analysis of Serum Interleukin (IL)-1β and IL-18 in Systemic Lupus Erythematosus. Front Immunol 2018; 9:1250. [PMID: 29930551 PMCID: PMC5999794 DOI: 10.3389/fimmu.2018.01250] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/18/2018] [Indexed: 12/13/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease characterized by biological and clinical heterogeneity. The interleukin (IL)-1 superfamily is a group of innate cytokines that contribute to pathogenesis in many autoimmune diseases. IL-1β and IL-18 are two members that have been shown to play a role in murine lupus-like models, but their role in human SLE remains poorly understood. Here, IL-1β and IL-18 were quantified by enzyme-linked immunosorbent assay in the serum of healthy controls (HCs) and SLE patients from a prospectively followed cohort. Disease activity and organ damage were assessed using SLE disease activity index 2000 (SLEDAI-2K) and SLE damage index scores (SDI), respectively. 184 SLE patients (mean age 44.9 years, 91% female, 56% double-stranded deoxyribonucleic acid positive) were compared to 52 HC. SLE patients had median [IQR] SLEDAI-2K of 4 [2,6], and SDI of 1 [0–2]. Serum IL-18 levels were statistically significantly higher in SLE patients compared to HCs. Univariable linear regression analyses showed that patients with active renal disease or irreversible organ damage had statistically significantly elevated serum IL-18 levels. The association between serum IL-18 and active renal disease was confirmed in multivariable analysis after adjusting for ethnicity and organ damage. High baseline serum IL-18 levels were associated with organ damage at the subsequent visit. Serum IL-1β levels were not significantly elevated in SLE patients when compared to HCs and had no association with overall or organ-specific disease activity or organ damage in cross-sectional and longitudinal analyses. Our data suggest that serum IL-18 and IL-1β have different clinical implications in SLE, with IL-18 being potentially associated with active renal disease.
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Affiliation(s)
- Rachel Mende
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Fabien B Vincent
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Rangi Kandane-Rathnayake
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Rachel Koelmeyer
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Emily Lin
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Janet Chang
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Alberta Y Hoi
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Eric F Morand
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - James Harris
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Tali Lang
- Rheumatology Research Group, Centre for Inflammatory Diseases, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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100
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Qin CX, Finlayson SB, Al-Sharea A, Tate M, De Blasio MJ, Deo M, Rosli S, Prakoso D, Thomas CJ, Kiriazis H, Gould E, Yang YH, Morand EF, Perretti M, Murphy AJ, Du XJ, Gao XM, Ritchie RH. Author Correction: Endogenous Annexin-A1 Regulates Haematopoietic Stem Cell Mobilisation and Inflammatory Response Post Myocardial Infarction in Mice In Vivo. Sci Rep 2018; 8:7185. [PMID: 29720616 PMCID: PMC5932007 DOI: 10.1038/s41598-018-24994-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.
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Affiliation(s)
- Cheng Xue Qin
- Baker Heart & Diabetes Institute, Melbourne, 3004, Australia. .,Dept of Pharmacology and Therapeutics, University of Melbourne, Parkville, 3010, Australia.
| | - Siobhan B Finlayson
- Baker Heart & Diabetes Institute, Melbourne, 3004, Australia.,Dept of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, 3086, Australia.,Dept of Medicine, Central Clinical School, Monash University, Melbourne, 3004, Australia
| | - Annas Al-Sharea
- Baker Heart & Diabetes Institute, Melbourne, 3004, Australia.,Dept of Medicine, Central Clinical School, Monash University, Melbourne, 3004, Australia
| | - Mitchel Tate
- Baker Heart & Diabetes Institute, Melbourne, 3004, Australia
| | - Miles J De Blasio
- Baker Heart & Diabetes Institute, Melbourne, 3004, Australia.,School of Biosciences, University of Melbourne, Parkville, 3010, Australia
| | - Minh Deo
- Baker Heart & Diabetes Institute, Melbourne, 3004, Australia
| | - Sarah Rosli
- Baker Heart & Diabetes Institute, Melbourne, 3004, Australia.,Centre for Inflammatory Diseases, Monash University, Clayton, 3168, VIC, Australia
| | - Darnel Prakoso
- Baker Heart & Diabetes Institute, Melbourne, 3004, Australia.,School of Biosciences, University of Melbourne, Parkville, 3010, Australia
| | - Colleen J Thomas
- Dept of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, 3086, Australia
| | - Helen Kiriazis
- Baker Heart & Diabetes Institute, Melbourne, 3004, Australia
| | - Eleanor Gould
- Baker Heart & Diabetes Institute, Melbourne, 3004, Australia
| | - Yuan H Yang
- Centre for Inflammatory Diseases, Monash University, Clayton, 3168, VIC, Australia
| | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University, Clayton, 3168, VIC, Australia
| | - Mauro Perretti
- William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Andrew J Murphy
- Baker Heart & Diabetes Institute, Melbourne, 3004, Australia.,Department of Immunology, Monash University, Melbourne, 3004, VIC, Australia
| | - Xiao-Jun Du
- Baker Heart & Diabetes Institute, Melbourne, 3004, Australia.,Dept of Medicine, Central Clinical School, Monash University, Melbourne, 3004, Australia
| | - Xiao-Ming Gao
- Baker Heart & Diabetes Institute, Melbourne, 3004, Australia
| | - Rebecca H Ritchie
- Baker Heart & Diabetes Institute, Melbourne, 3004, Australia. .,Dept of Pharmacology and Therapeutics, University of Melbourne, Parkville, 3010, Australia. .,Dept of Medicine, Central Clinical School, Monash University, Melbourne, 3004, Australia.
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