51
|
Gao S, Zhu H, Yang H, Zhang H, Li Q, Luo H. The role and mechanism of cathepsin G in dermatomyositis. Biomed Pharmacother 2017; 94:697-704. [PMID: 28797985 DOI: 10.1016/j.biopha.2017.07.088] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 11/20/2022] Open
Abstract
Dermatomyositis (DM) is an idiopathic inflammatory myopathy characterized by CD4+ T cells and B cells infiltration in perivascular and muscle tissue. Although the infiltration of inflammatory cells plays a key role in muscle damage, the exact mechanism is not clear. Cathepsin G (CTSG) is a member of the serine proteases family and can increase the permeability of vascular endothelial cells and the chemotaxis of inflammatory cells. In this study, we found that the expression of CTSG was increased in peripheral blood mononuclear cells and muscle tissues of DM patients. The activity of CTSG was significantly increased in DM patients and correlated with disease activity. Serum CTSG induced the expression of protease activated receptor 2 (PAR2) and altered the cytoskeleton of human dermal microvascular endothelial cells. Our studies indicate, for the first time, that CTSG may play an important role in muscle inflammatory cells infiltration by increasing the permeability of vascular endothelial cells.
Collapse
Affiliation(s)
- Siming Gao
- Department of Rheumatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, People's Republic of China
| | - Honglin Zhu
- Department of Rheumatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, People's Republic of China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, People's Republic of China
| | - Huali Zhang
- Department of Pathophysiology, Xiangya School of Medicine, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, People's Republic of China
| | - Qiuxiang Li
- Department of Neurology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, People's Republic of China
| | - Hui Luo
- Department of Rheumatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, People's Republic of China.
| |
Collapse
|
52
|
Sirotti S, Generali E, Ceribelli A, Isailovic N, De Santis M, Selmi C. Personalized medicine in rheumatology: the paradigm of serum autoantibodies. AUTOIMMUNITY HIGHLIGHTS 2017; 8:10. [PMID: 28702930 PMCID: PMC5507804 DOI: 10.1007/s13317-017-0098-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/04/2017] [Indexed: 02/08/2023]
Abstract
The sequencing of the human genome is now well recognized as the starting point of personalized medicine. Nonetheless, everyone is unique and can develop different phenotypes of the same disease, despite identical genotypes, as well illustrated by discordant monozygotic twins. To recognize these differences, one of the easiest and most familiar examples of biomarkers capable of identifying and predicting the outcome of patients is represented by serum autoantibodies. In this review, we will describe the concept of personalized medicine and discuss the predictive, prognostic and preventive role of antinuclear antibodies (ANA), anti-citrullinated peptide antibodies (ACPA), rare autoantibodies and anti-drug antibodies (ADA), to evaluate how these can help to identify different disease immune phenotypes and to choose the best option for treating and monitoring rheumatic patients in everyday practice. The importance of ANA resides in the prediction of clinical manifestations in systemic sclerosis and systemic lupus erythematosus and their association with malignancies. ACPA have a predictive role in rheumatoid arthritis, they are associated with the development of a more aggressive disease, extra-articular manifestations and premature mortality in RA patients; moreover, they are capable of predicting therapeutic response. Rare autoantibodies are associated with different disease manifestations and also with a greater incidence of cancer. The determination of ADA levels may be useful in patients where the clinical efficacy of TNF-α inhibitor has dropped, for the assessment of a right management. The resulting scenario supports serum autoantibodies as the cornerstone of personalized medicine in autoimmune diseases.
Collapse
Affiliation(s)
- Silvia Sirotti
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Elena Generali
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Angela Ceribelli
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Natasa Isailovic
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, Via A. Manzoni 56, Rozzano, 20089, Milan, Italy. .,BIOMETRA Department, University of Milan, Milan, Italy.
| |
Collapse
|
53
|
Shu X, Chen F, Peng Q, Lu X, Tian X, Wang Y, Wang G. Potential role of autophagy in T‑cell survival in polymyositis and dermatomyositis. Mol Med Rep 2017; 16:1180-1188. [PMID: 28586060 PMCID: PMC5562052 DOI: 10.3892/mmr.2017.6693] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 02/10/2017] [Indexed: 12/23/2022] Open
Abstract
Peripheral blood T lymphocytopenia has previously been identified in polymyositis/dermatomyositis (PM/DM) patients. Therefore, the present study aimed to examine the potential role of autophagy in peripheral blood T cell survival in PM/DM patients. Transmission electron microscopy was used to detect the formation of autophagosomes of peripheral blood cluster of differentiation (CD)3+ T cells obtained from 24 patients with PM/DM and 21 healthy controls. Protein and mRNA expression levels of autophagy‑related molecules were examined by western blot analysis and reverse transcription‑quantitative polymerase chain reaction, respectively. The number of peripheral blood CD3+ T cells decreased significantly in PM/DM patients. The median percentage of apoptosis of CD3+ T cells in PM/DM patients was significantly increased compared with healthy controls. Furthermore, the number of autophagosomes and the expression of the autophagy markers microtubule‑associated protein 1A/1B‑light chain 3 (LC3) and Beclin‑1 were significantly reduced in the circulating CD3+ T cells of PM/DM patients compared with those of healthy controls. LC3 and Beclin‑1 protein levels correlated negatively with apoptosis rates in circulating CD3+ T cells in patients with PM/DM. CD3+ T cells from PM/DM patients treated with rapamycin increased autophagy and decreased apoptosis compared with untreated cells (P<0.05). In conclusion, these results suggested that autophagy may serve a potential protective role in the peripheral blood T cells of patients with PM/DM.
Collapse
Affiliation(s)
- Xiaoming Shu
- Department of Rheumatology, China‑Japan Friendship Hospital, Chaoyang, Beijing 100029, P.R. China
| | - Fang Chen
- Department of Rheumatology, China‑Japan Friendship Hospital, Chaoyang, Beijing 100029, P.R. China
| | - Qinglin Peng
- Department of Rheumatology, China‑Japan Friendship Hospital, Chaoyang, Beijing 100029, P.R. China
| | - Xin Lu
- Department of Rheumatology, China‑Japan Friendship Hospital, Chaoyang, Beijing 100029, P.R. China
| | - Xiaolan Tian
- Department of Rheumatology, China‑Japan Friendship Hospital, Chaoyang, Beijing 100029, P.R. China
| | - Yan Wang
- Department of Rheumatology, China‑Japan Friendship Hospital, Chaoyang, Beijing 100029, P.R. China
| | - Guochun Wang
- Department of Rheumatology, China‑Japan Friendship Hospital, Chaoyang, Beijing 100029, P.R. China
| |
Collapse
|
54
|
Kashif M, Arya D, Niazi M, Khaja M. A Rare Case of Necrotizing Myopathy and Fibrinous and Organizing Pneumonia with Anti-EJ Antisynthetase Syndrome and SSA Antibodies. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:448-453. [PMID: 28439062 PMCID: PMC5410884 DOI: 10.12659/ajcr.903540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Patient: Male, 34 Final Diagnosis: Necrotizing myopathy • fibrinous • organizing pneumonia Symptoms: Short of breath • weakness in limbs Medication: — Clinical Procedure: — Specialty: Rheumatology
Collapse
Affiliation(s)
- Muhammad Kashif
- Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Divya Arya
- Department of Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Masooma Niazi
- Division of Pathology, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Misbahuddin Khaja
- Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| |
Collapse
|
55
|
Birtane M, Yavuz S, Taştekin N. Laboratory evaluation in rheumatic diseases. World J Methodol 2017; 7:1-8. [PMID: 28396844 PMCID: PMC5366934 DOI: 10.5662/wjm.v7.i1.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/21/2016] [Accepted: 01/18/2017] [Indexed: 02/06/2023] Open
Abstract
Autoantibodies can help clinicians to allow early detection of autoimmune diseases and their clinical manifestations, to determine effective monitoring of prognosis and the treatment response. From this point, they have a high impact in rheumatic disease management. When used carefully they allow rapid diagnosis and appropriate treatment. However, as they may be present in healthy population they may cause confusion for interpreting the situation. False positive test results may lead to wrong treatment and unnecessary anxiety for patients. Autoantibody positivity alone does not make a diagnosis. Similarly, the absence of autoantibodies alone does not exclude diagnosis. The success of the test is closely related to sensitivity, specificity and likelihood ratios. So, interpretation of these is very important for a proper laboratory evaluation. In conclusion, in spite of the remarkable advances in science and technology, a deeply investigated anamnesis and comprehensive physical examination still continue to be the best diagnostic method. The most correct approach is that clinicians apply laboratory tests to confirm or exclude preliminary diagnosis based on anamnesis and physical examination. This review will discuss these issues.
Collapse
|
56
|
Absence of calf muscle metabolism alterations in active cystic fibrosis adults with mild to moderate lung disease. J Cyst Fibros 2017; 16:98-106. [DOI: 10.1016/j.jcf.2016.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 11/19/2022]
|
57
|
Specific autoantibodies in dermatomyositis: a helpful tool to classify different clinical subsets. Arch Dermatol Res 2016; 309:87-95. [DOI: 10.1007/s00403-016-1704-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/10/2016] [Accepted: 11/30/2016] [Indexed: 10/20/2022]
|
58
|
Abstract
Dermatomyositis is a chronic systemic autoimmune disease characterized by inflammatory infiltrates in the skin and muscle. The wide variability in clinical and serologic presentation poses a diagnostic challenge for the internist. Appreciation of the clinical variants of dermatomyositis allows for expedient diagnosis and avoidance of diagnostic error. We illustrate these challenges with the case of a 51-year-old Vietnamese-American man who initially presented with fever of unknown origin in the absence of overt skin and muscle manifestations. The diagnosis of dermatomyositis was not evident on several clinical encounters due to the absence of these hallmark symptoms. We review the variable clinical manifestations of a subtype of dermatomyositis associated with an autoantibody against melanoma differentiation-associated protein 5 (anti-MDA5) and suggest consideration of dermatomyositis as a diagnosis in patients presenting with systemic illness and markedly elevated ferritin, even in the absence of elevated muscle enzymes and classic autoantibodies.
Collapse
|
59
|
Outcome and prognostic factors in a French cohort of patients with myositis-associated interstitial lung disease. Rheumatol Int 2016; 36:1727-1735. [DOI: 10.1007/s00296-016-3571-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 09/28/2016] [Indexed: 01/08/2023]
|
60
|
Musset L, Allenbach Y, Benveniste O, Boyer O, Bossuyt X, Bentow C, Phillips J, Mammen A, Van Damme P, Westhovens R, Ghirardello A, Doria A, Choi MY, Fritzler MJ, Schmeling H, Muro Y, García-De La Torre I, Ortiz-Villalvazo MA, Bizzaro N, Infantino M, Imbastaro T, Peng Q, Wang G, Vencovský J, Klein M, Krystufkova O, Franceschini F, Fredi M, Hue S, Belmondo T, Danko K, Mahler M. Anti-HMGCR antibodies as a biomarker for immune-mediated necrotizing myopathies: A history of statins and experience from a large international multi-center study. Autoimmun Rev 2016; 15:983-93. [DOI: 10.1016/j.autrev.2016.07.023] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/09/2016] [Indexed: 01/15/2023]
|
61
|
Maione F. Commentary: IL-17 in Chronic Inflammation: From Discovery to Targeting. Front Pharmacol 2016; 7:250. [PMID: 27561214 PMCID: PMC4980561 DOI: 10.3389/fphar.2016.00250] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 07/28/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Francesco Maione
- Department of Pharmacy, University of Naples Federico II Naples, Italy
| |
Collapse
|
62
|
Simon JP, Marie I, Jouen F, Boyer O, Martinet J. Autoimmune Myopathies: Where Do We Stand? Front Immunol 2016; 7:234. [PMID: 27379096 PMCID: PMC4905946 DOI: 10.3389/fimmu.2016.00234] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 05/31/2016] [Indexed: 11/28/2022] Open
Abstract
Autoimmune diseases (AIDs) as a whole represent a major health concern and remain a medical and scientific challenge. Some of them, such as multiple sclerosis or type 1 diabetes, have been actively investigated for many decades. Autoimmune myopathies (AIMs), also referred to as idiopathic inflammatory myopathies or myositis, represent a group of very severe AID for which we have a more limited pathophysiological knowledge. AIM encompass a group of, individually rare but collectively not so uncommon, diseases characterized by symmetrical proximal muscle weakness, increased serum muscle enzymes such as creatine kinase, myopathic changes on electromyography, and several typical histological patterns on muscle biopsy, including the presence of inflammatory cell infiltrates in muscle tissue. Importantly, some AIMs are strongly related to cancer. Here, we review the current knowledge on the most prevalent forms of AIM and, notably, the diagnostic contribution of autoantibodies.
Collapse
Affiliation(s)
- Jean-Philippe Simon
- Laboratory of Neuropathology, CHU Caen, Normandie University, UNICAEN, Caen, France; Normandie University, UNIROUEN, Pathophysiology and Biotherapy of Inflammatory and Autoimmune Diseases, INSERM, CHU Rouen, Rouen, France
| | - Isabelle Marie
- Normandie University, UNIROUEN, Pathophysiology and Biotherapy of Inflammatory and Autoimmune Diseases, INSERM, CHU Rouen , Rouen , France
| | - Fabienne Jouen
- Normandie University, UNIROUEN, Pathophysiology and Biotherapy of Inflammatory and Autoimmune Diseases, INSERM, CHU Rouen , Rouen , France
| | - Olivier Boyer
- Normandie University, UNIROUEN, Pathophysiology and Biotherapy of Inflammatory and Autoimmune Diseases, INSERM, CHU Rouen , Rouen , France
| | - Jérémie Martinet
- Normandie University, UNIROUEN, Pathophysiology and Biotherapy of Inflammatory and Autoimmune Diseases, INSERM, CHU Rouen , Rouen , France
| |
Collapse
|
63
|
Ngo LQ, Wu AG, Nguyen MA, McPherson LE, Gertner E. A case report of autoimmune necrotizing myositis presenting as dysphagia and neck swelling. BMC EAR, NOSE, AND THROAT DISORDERS 2016; 16:7. [PMID: 27190496 PMCID: PMC4869331 DOI: 10.1186/s12901-016-0027-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 05/10/2016] [Indexed: 12/21/2022]
Abstract
Background Severe dysphagia may occur in the immune mediated necrotizing myopathies (IMNM). Neck swelling and severe dysphagia as the initial symptoms upon presentation has not been previously described. Case presentation A 55-year-old male with a 4 week history of neck swelling, fatigue, dysphagia, myalgias, night sweats, and cough was admitted for an elevated CK. He underwent extensive infectious and inflammatory evaluation including neck imaging and muscle biopsy. Neck CT and MRI showed inflammation throughout his strap muscles, retropharyngeal soft tissues and deltoids. Infectious work up was negative. Deltoid muscle biopsy demonstrated evidence of IMNM. Lab tests revealed anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibodies confirming the diagnosis of HMGCR IMNM. Conclusions HMGCR IMNM is a rare and incompletely understood disease process. Awareness of HMGCR IMNM could potentially lead to earlier diagnosis, treatment and improved clinical outcomes as disease progression can be rapid and severe.
Collapse
Affiliation(s)
- Linh Q Ngo
- Division of Rheumatology, University of Minnesota Medical School, MMC 108 Mayo, 8108A, 420 Delaware St SE, Minneapolis, MN 55455 USA
| | - Andrew G Wu
- Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN USA
| | - Matthew A Nguyen
- Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN USA
| | - Lauren E McPherson
- Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN USA
| | - Elie Gertner
- Division of Rheumatology, University of Minnesota Medical School, MMC 108 Mayo, 8108A, 420 Delaware St SE, Minneapolis, MN 55455 USA ; Section of Rheumatology, Regions Hospital, Saint Paul, MN USA
| |
Collapse
|
64
|
Abstract
Histidyl-tRNA synthetase (HRS = Jo-1) represents a key autoantibody target in the anti-synthetase syndrome that is marked by myositis as well as extra-muscular organ complications including interstitial lung disease (ILD). Over the last 25 years, a wealth of clinical, epidemiological, genetic, and experimental data have collectively supported a role for Jo-1 in mediating deleterious cell-mediated, adaptive immune responses contributing to the disease phenotype of the anti-synthetase syndrome. Complementing these studies, more recent work suggests that unique, non-enzymatic functional properties of Jo-1 also endow this antigen with the capacity to activate components of the innate immune system, particularly cell surface as well as endosomal Toll-like receptors and their downstream signaling pathways. Combining these facets of Jo-1-mediated immunity now supports a more integrated model of disease pathogenesis that should lead to improved therapeutic targeting in the anti-synthetase syndrome and related subsets of idiopathic inflammatory myopathy.
Collapse
Affiliation(s)
- Dana P Ascherman
- Division of Rheumatology, Department of Medicine, Miller School of Medicine, University of Miami, RMSB, 7152, 1600 NW 10th Avenue, Miami, FL, 33136, USA,
| |
Collapse
|
65
|
Apiwattanakul M, Milone M, Pittock SJ, Kryzer TJ, Fryer JP, O'toole O, Mckeon A, Lennon VA. Signal recognition particle immunoglobulin g detected incidentally associates with autoimmune myopathy. Muscle Nerve 2016; 53:925-32. [PMID: 26561982 PMCID: PMC5067628 DOI: 10.1002/mus.24970] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 10/16/2015] [Accepted: 11/09/2015] [Indexed: 12/03/2022]
Abstract
Introduction: Paraneoplastic autoantibody screening of 150,000 patient sera by tissue‐based immunofluorescence incidentally revealed 170 with unsuspected signal recognition particle (SRP) immunoglobulin G (IgG), which is a recognized biomarker of autoimmune myopathy. Of the 77 patients with available information, 54 had myopathy. We describe the clinical/laboratory associations. Methods: Distinctive cytoplasm‐binding IgG (mouse tissue substrate) prompted western blot, enzyme‐linked immunoassay, and immunoprecipitation analyses. Available histories were reviewed. Results: The immunostaining pattern resembled rough endoplasmic reticulum, and mimicked Purkinje‐cell cytoplasmic antibody type 1 IgG/anti‐Yo. Immunoblotting revealed ribonucleoprotein reactivity. Recombinant antigens confirmed the following: SRP54 IgG specificity alone (17); SRP72 IgG specificity alone (3); both (32); or neither (2). Coexisting neural autoantibodies were identified in 28% (low titer). Electromyography revealed myopathy with fibrillation potentials; 78% of biopsies had active necrotizing myopathy with minimal inflammation, and 17% had inflammatory myopathy. Immunotherapy responsiveness was typically slow and incomplete, and relapses were frequent on withdrawal. Histologically confirmed cancers (17%) were primarily breast and hematologic, with some others. Conclusions: Autoimmune necrotizing SRP myopathy, both idiopathic and paraneoplastic, is underdiagnosed in neurological practice. Serological screening aids early diagnosis. Cancer surveillance and appropriate immunosuppressant therapy may improve outcome. Muscle Nerve53: 925–932, 2016
Collapse
Affiliation(s)
- Metha Apiwattanakul
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
| | | | - Sean J Pittock
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas J Kryzer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
| | - James P Fryer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
| | - Orna O'toole
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew Mckeon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vanda A Lennon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
66
|
|
67
|
Abstract
Necrotizing myopathy is defined by the predominant pathological feature of necrosis of muscle fibers in the absence of substantial lymphocytic inflammatory infiltrates. Most commonly necrotizing myopathies are divided into immune mediated (IMNM) and nonimmune mediated (NIMNM). IMNM has been associated with anti-signal recognition particle antibodies, connective tissue diseases, cancer, post-statin exposure with 3-hydroxy-3-methylglutaryl-coenzyme A antibodies, and viral infections including HIV and hepatitis C. NIMNM is linked to medications and toxic exposures. Both IMNM and NIMNM are typically characterized by proximal weakness, although the severity can vary substantially. Myalgias are reported by some, but not all, patients. Pathological findings on muscle biopsy include predominant fiber necrosis with little or no inflammatory infiltrate. In IMNM, there is variable evidence for the deposition of membrane attack complex on capillaries and muscle fibers, although membrane attack complex deposition on capillaries is typically less than is seen in dermatomyositis; class I major histocompatibility complex expression on muscle fibers is variable but typically less than is seen in polymyositis. Immunohistochemical abnormalities are not typically seen in NIMNM. Treatment of IMNM involves immunosuppressive therapy, although there are no controlled trials to guide particular treatment choices. Treatment of NIMNM involves removal of the toxic exposure.
Collapse
|
68
|
Abstract
Idiopathic inflammatory myopathies (IIMs) involve inflammation of the muscles and are classified by the patterns of presentation and immunohistopathologic features on skin and muscle biopsy into 4 categories: dermatomyositis, polymyositis, inclusion body myositis, and immune-mediated necrotizing myopathy. Systemic corticosteroid (CS) treatment is the standard of care for IIM with muscle and organ involvement. The extracutaneous features of systemic sclerosis are frequently treated with CS; however, high doses have been associated with scleroderma renal crisis in high-risk patients. Although CS can be effective first-line agents, their significant side effect profile encourages concomitant treatment with other immunosuppressive medications to enable timely tapering.
Collapse
Affiliation(s)
- Anna Postolova
- Division of Rheumatology and Immunology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Jennifer K Chen
- Department of Dermatology, Stanford Hospital and Clinics, 450 Broadway Street, Pavilion C, Suite 242, Redwood City, CA 94063, USA
| | - Lorinda Chung
- Division of Rheumatology and Immunology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA; Division of Rheumatology, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA.
| |
Collapse
|
69
|
Findlay AR, Goyal NA, Mozaffar T. An overview of polymyositis and dermatomyositis. Muscle Nerve 2015; 51:638-56. [PMID: 25641317 DOI: 10.1002/mus.24566] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 12/23/2022]
Abstract
Polymyositis and dermatomyositis are inflammatory myopathies that differ in their clinical features, histopathology, response to treatment, and prognosis. Although their clinical pictures differ, they both present with symmetrical, proximal muscle weakness. Treatment relies mainly upon empirical use of corticosteroids and immunosuppressive agents. A deeper understanding of the molecular pathways that drive pathogenesis, careful phenotyping, and accurate disease classification will aid clinical research and development of more efficacious treatments. In this review we address the current knowledge of the epidemiology, clinical characteristics, diagnostic evaluation, classification, pathogenesis, treatment, and prognosis of polymyositis and dermatomyositis.
Collapse
Affiliation(s)
- Andrew R Findlay
- Department of Neurology, University of California, Irvine UC Irvine, MDA ALS and Neuromuscular Center, 200 South Manchester Avenue, Suite 110, Orange, California, 92868, USA
| | | | | |
Collapse
|
70
|
Anti-PL7 antisynthetase syndrome: A rare cause of autoimmune-mediated interstitial lung disease. Allergol Immunopathol (Madr) 2015; 43:326-8. [PMID: 25092352 DOI: 10.1016/j.aller.2014.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 04/15/2014] [Accepted: 04/24/2014] [Indexed: 11/21/2022]
|
71
|
Sciorati C, Monno A, Ascherman DP, Seletti E, Manfredi AA, Rovere-Querini P. Required role of apoptotic myogenic precursors and toll-like receptor stimulation for the establishment of autoimmune myositis in experimental murine models. Arthritis Rheumatol 2015; 67:809-22. [PMID: 25504878 DOI: 10.1002/art.38985] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 12/02/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Muscle regeneration is a hallmark of the idiopathic inflammatory myopathies (IIMs), a group of autoimmune disorders that are characterized by leukocyte infiltration and dysfunction of the skeletal muscle. Despite detailed studies describing the clinical and histopathologic features of IIMs, the immunopathogenesis of these disorders remains undefined. The aim of this study was to investigate the immunopathologic processes of autoimmune myositis in experimental murine models. METHODS Expression of the autoantigen histidyl-transfer RNA synthetase (HisRS) was analyzed in mice with acutely injured or dystrophic muscles, in inflammatory leukocytes, and in purified satellite cells. Anti-HisRS antibodies and myositis induction were assessed in mice after muscle injury and immunization with apoptotic satellite cells or C2C12 myoblasts, in the presence or absence of the Toll-like receptor 7 (TLR-7) agonist R848. RESULTS Muscle necrosis, leukocyte infiltration, and myofiber regeneration induced by toxic agents (cardiotoxin or glycerol) or promoted by genetic disruption of the α-sarcoglycan/dystrophin complex in mice were uniformly associated with up-regulated expression of HisRS. Although regenerating myofibers and purified satellite cells are known to show increased expression of HisRS in these settings, anti-HisRS antibodies were not detectable. However, intramuscular immunization with ultraviolet B-irradiated, HisRS-expressing apoptotic myoblasts in the presence of R848 triggered the production of anti-HisRS IgG antibodies as well as persistent lymphocyte infiltration and prolonged/delayed muscle regeneration. Conversely, intramuscular administration of R848 alone or in combination with living or postapoptotic/necrotic myoblasts failed to generate this myositis phenotype. CONCLUSION In the presence of TLR/adjuvant signals and underlying muscle injury, apoptotic myogenic precursors expressing high levels of autoantigen can provoke autoantibody formation and lymphocytic infiltration of muscle tissue, effectively replicating the features of IIM.
Collapse
|
72
|
Ramanathan S, Langguth D, Hardy TA, Garg N, Bundell C, Rojana-Udomsart A, Dale RC, Robertson T, Mammen AL, Reddel SW. Clinical course and treatment of anti-HMGCR antibody-associated necrotizing autoimmune myopathy. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e96. [PMID: 25866831 PMCID: PMC4386794 DOI: 10.1212/nxi.0000000000000096] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 01/20/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We examined a cohort of Australian patients with statin exposure who developed a necrotizing autoimmune myopathy (NAM) associated with a novel autoantibody against 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) and describe the clinical and therapeutic challenges of managing these patients and an optimal therapeutic strategy. METHODS Clinical, laboratory, EMG, and histopathologic results and response to immunomodulation are reported in 6 Australian patients with previous statin exposure and antibodies targeting HMGCR. RESULTS All patients presented with painless proximal weakness following statin therapy, which persisted after statin cessation. Serum creatine kinase (CK) levels ranged from 2,700 to 16,200 IU/L. EMG was consistent with a myopathic picture. Muscle biopsies revealed a pauci-immune necrotizing myopathy. Detailed graphical representation of the clinical course of these patients showed a close association with rising CK and an increase in clinical weakness signifying relapses, particularly upon weaning or ceasing steroids. All 6 patients were responsive to initial steroid therapy, with 5 relapsing upon attempts to wean steroids. Both CK and clinical strength improved with the reinstitution of immunotherapy, in particular steroids and IV immunoglobulin (IVIg). All patients required treatment with varying multiagent immunosuppressive regimens to achieve clinical remission, including prednisone (n = 6), IVIg (n = 5), plasmapheresis (n = 2), and additional therapy including methotrexate (n = 6), cyclophosphamide (n = 2), rituximab (n = 2), azathioprine (n = 1), and cyclosporine (n = 1). CONCLUSIONS Recognition of HMGCR antibody-associated NAM is important because these patients are responsive to immunosuppression, and early multiagent therapy and a slow and cautious approach to withdrawing steroids may improve outcomes.
Collapse
Affiliation(s)
- Sudarshini Ramanathan
- Department of Neurology (S.R., T.A.H., N.G., S.W.R.), Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Neuroimmunology Group (S.R., R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, New South Wales, Australia; Department of Neurology (S.R.), Westmead Hospital, Sydney, New South Wales, Australia; Sullivan Nicolaides Pathology (D.L.), Brisbane, Queensland, Australia; Concord Clinical School (T.A.H., S.W.R.), University of Sydney, New South Wales, Australia; Clinical Immunology (C.B.), PathWest, QEII Medical Center, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine (C.B.), University of Western Australia, Nedlands, Western Australia, Australia; Australian Neuro-Muscular Research Institute (ANRI) and Centre for Neuromuscular and Neurological Disorders (CNND) (A.R.-U.), University of Western Australia, QEII Medical Centre, Nedlands, Western Australia, Australia; Pathology Queensland (T.R.), Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia; and National Institute of Arthritis and Musculoskeletal and Skin Diseases (A.L.M.), National Institutes of Health, Bethesda, MD
| | - Daman Langguth
- Department of Neurology (S.R., T.A.H., N.G., S.W.R.), Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Neuroimmunology Group (S.R., R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, New South Wales, Australia; Department of Neurology (S.R.), Westmead Hospital, Sydney, New South Wales, Australia; Sullivan Nicolaides Pathology (D.L.), Brisbane, Queensland, Australia; Concord Clinical School (T.A.H., S.W.R.), University of Sydney, New South Wales, Australia; Clinical Immunology (C.B.), PathWest, QEII Medical Center, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine (C.B.), University of Western Australia, Nedlands, Western Australia, Australia; Australian Neuro-Muscular Research Institute (ANRI) and Centre for Neuromuscular and Neurological Disorders (CNND) (A.R.-U.), University of Western Australia, QEII Medical Centre, Nedlands, Western Australia, Australia; Pathology Queensland (T.R.), Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia; and National Institute of Arthritis and Musculoskeletal and Skin Diseases (A.L.M.), National Institutes of Health, Bethesda, MD
| | - Todd A Hardy
- Department of Neurology (S.R., T.A.H., N.G., S.W.R.), Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Neuroimmunology Group (S.R., R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, New South Wales, Australia; Department of Neurology (S.R.), Westmead Hospital, Sydney, New South Wales, Australia; Sullivan Nicolaides Pathology (D.L.), Brisbane, Queensland, Australia; Concord Clinical School (T.A.H., S.W.R.), University of Sydney, New South Wales, Australia; Clinical Immunology (C.B.), PathWest, QEII Medical Center, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine (C.B.), University of Western Australia, Nedlands, Western Australia, Australia; Australian Neuro-Muscular Research Institute (ANRI) and Centre for Neuromuscular and Neurological Disorders (CNND) (A.R.-U.), University of Western Australia, QEII Medical Centre, Nedlands, Western Australia, Australia; Pathology Queensland (T.R.), Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia; and National Institute of Arthritis and Musculoskeletal and Skin Diseases (A.L.M.), National Institutes of Health, Bethesda, MD
| | - Nidhi Garg
- Department of Neurology (S.R., T.A.H., N.G., S.W.R.), Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Neuroimmunology Group (S.R., R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, New South Wales, Australia; Department of Neurology (S.R.), Westmead Hospital, Sydney, New South Wales, Australia; Sullivan Nicolaides Pathology (D.L.), Brisbane, Queensland, Australia; Concord Clinical School (T.A.H., S.W.R.), University of Sydney, New South Wales, Australia; Clinical Immunology (C.B.), PathWest, QEII Medical Center, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine (C.B.), University of Western Australia, Nedlands, Western Australia, Australia; Australian Neuro-Muscular Research Institute (ANRI) and Centre for Neuromuscular and Neurological Disorders (CNND) (A.R.-U.), University of Western Australia, QEII Medical Centre, Nedlands, Western Australia, Australia; Pathology Queensland (T.R.), Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia; and National Institute of Arthritis and Musculoskeletal and Skin Diseases (A.L.M.), National Institutes of Health, Bethesda, MD
| | - Chris Bundell
- Department of Neurology (S.R., T.A.H., N.G., S.W.R.), Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Neuroimmunology Group (S.R., R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, New South Wales, Australia; Department of Neurology (S.R.), Westmead Hospital, Sydney, New South Wales, Australia; Sullivan Nicolaides Pathology (D.L.), Brisbane, Queensland, Australia; Concord Clinical School (T.A.H., S.W.R.), University of Sydney, New South Wales, Australia; Clinical Immunology (C.B.), PathWest, QEII Medical Center, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine (C.B.), University of Western Australia, Nedlands, Western Australia, Australia; Australian Neuro-Muscular Research Institute (ANRI) and Centre for Neuromuscular and Neurological Disorders (CNND) (A.R.-U.), University of Western Australia, QEII Medical Centre, Nedlands, Western Australia, Australia; Pathology Queensland (T.R.), Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia; and National Institute of Arthritis and Musculoskeletal and Skin Diseases (A.L.M.), National Institutes of Health, Bethesda, MD
| | - Arada Rojana-Udomsart
- Department of Neurology (S.R., T.A.H., N.G., S.W.R.), Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Neuroimmunology Group (S.R., R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, New South Wales, Australia; Department of Neurology (S.R.), Westmead Hospital, Sydney, New South Wales, Australia; Sullivan Nicolaides Pathology (D.L.), Brisbane, Queensland, Australia; Concord Clinical School (T.A.H., S.W.R.), University of Sydney, New South Wales, Australia; Clinical Immunology (C.B.), PathWest, QEII Medical Center, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine (C.B.), University of Western Australia, Nedlands, Western Australia, Australia; Australian Neuro-Muscular Research Institute (ANRI) and Centre for Neuromuscular and Neurological Disorders (CNND) (A.R.-U.), University of Western Australia, QEII Medical Centre, Nedlands, Western Australia, Australia; Pathology Queensland (T.R.), Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia; and National Institute of Arthritis and Musculoskeletal and Skin Diseases (A.L.M.), National Institutes of Health, Bethesda, MD
| | - Russell C Dale
- Department of Neurology (S.R., T.A.H., N.G., S.W.R.), Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Neuroimmunology Group (S.R., R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, New South Wales, Australia; Department of Neurology (S.R.), Westmead Hospital, Sydney, New South Wales, Australia; Sullivan Nicolaides Pathology (D.L.), Brisbane, Queensland, Australia; Concord Clinical School (T.A.H., S.W.R.), University of Sydney, New South Wales, Australia; Clinical Immunology (C.B.), PathWest, QEII Medical Center, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine (C.B.), University of Western Australia, Nedlands, Western Australia, Australia; Australian Neuro-Muscular Research Institute (ANRI) and Centre for Neuromuscular and Neurological Disorders (CNND) (A.R.-U.), University of Western Australia, QEII Medical Centre, Nedlands, Western Australia, Australia; Pathology Queensland (T.R.), Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia; and National Institute of Arthritis and Musculoskeletal and Skin Diseases (A.L.M.), National Institutes of Health, Bethesda, MD
| | - Thomas Robertson
- Department of Neurology (S.R., T.A.H., N.G., S.W.R.), Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Neuroimmunology Group (S.R., R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, New South Wales, Australia; Department of Neurology (S.R.), Westmead Hospital, Sydney, New South Wales, Australia; Sullivan Nicolaides Pathology (D.L.), Brisbane, Queensland, Australia; Concord Clinical School (T.A.H., S.W.R.), University of Sydney, New South Wales, Australia; Clinical Immunology (C.B.), PathWest, QEII Medical Center, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine (C.B.), University of Western Australia, Nedlands, Western Australia, Australia; Australian Neuro-Muscular Research Institute (ANRI) and Centre for Neuromuscular and Neurological Disorders (CNND) (A.R.-U.), University of Western Australia, QEII Medical Centre, Nedlands, Western Australia, Australia; Pathology Queensland (T.R.), Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia; and National Institute of Arthritis and Musculoskeletal and Skin Diseases (A.L.M.), National Institutes of Health, Bethesda, MD
| | - Andrew L Mammen
- Department of Neurology (S.R., T.A.H., N.G., S.W.R.), Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Neuroimmunology Group (S.R., R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, New South Wales, Australia; Department of Neurology (S.R.), Westmead Hospital, Sydney, New South Wales, Australia; Sullivan Nicolaides Pathology (D.L.), Brisbane, Queensland, Australia; Concord Clinical School (T.A.H., S.W.R.), University of Sydney, New South Wales, Australia; Clinical Immunology (C.B.), PathWest, QEII Medical Center, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine (C.B.), University of Western Australia, Nedlands, Western Australia, Australia; Australian Neuro-Muscular Research Institute (ANRI) and Centre for Neuromuscular and Neurological Disorders (CNND) (A.R.-U.), University of Western Australia, QEII Medical Centre, Nedlands, Western Australia, Australia; Pathology Queensland (T.R.), Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia; and National Institute of Arthritis and Musculoskeletal and Skin Diseases (A.L.M.), National Institutes of Health, Bethesda, MD
| | - Stephen W Reddel
- Department of Neurology (S.R., T.A.H., N.G., S.W.R.), Concord Repatriation General Hospital, Sydney, New South Wales, Australia; Neuroimmunology Group (S.R., R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, New South Wales, Australia; Department of Neurology (S.R.), Westmead Hospital, Sydney, New South Wales, Australia; Sullivan Nicolaides Pathology (D.L.), Brisbane, Queensland, Australia; Concord Clinical School (T.A.H., S.W.R.), University of Sydney, New South Wales, Australia; Clinical Immunology (C.B.), PathWest, QEII Medical Center, Nedlands, Western Australia, Australia; School of Pathology and Laboratory Medicine (C.B.), University of Western Australia, Nedlands, Western Australia, Australia; Australian Neuro-Muscular Research Institute (ANRI) and Centre for Neuromuscular and Neurological Disorders (CNND) (A.R.-U.), University of Western Australia, QEII Medical Centre, Nedlands, Western Australia, Australia; Pathology Queensland (T.R.), Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia; and National Institute of Arthritis and Musculoskeletal and Skin Diseases (A.L.M.), National Institutes of Health, Bethesda, MD
| |
Collapse
|
73
|
|
74
|
Aouizerate J, De Antonio M, Bassez G, Gherardi RK, Berenbaum F, Guillevin L, Berezne A, Valeyre D, Maisonobe T, Dubourg O, Cosnes A, Benveniste O, Authier FJ. Myofiber HLA-DR expression is a distinctive biomarker for antisynthetase-associated myopathy. Acta Neuropathol Commun 2014; 2:154. [PMID: 25339355 PMCID: PMC4210467 DOI: 10.1186/s40478-014-0154-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 10/11/2014] [Indexed: 12/03/2022] Open
Abstract
Objectives To assess the value of major histocompatibility complex (MHC) class II antigen (HLA-DR) expression to distinguish anti-synthetase myopathy (ASM) from dermatomyositis (DM). Methods Muscle biopsies from patients with ASM (n = 33), DM without anti-synthetase antibodies (ASAb) (n = 17), and normal muscle biopsy (n = 10) were first reviewed. ASAb included anti-Jo1 (26/33), anti-PL12 (4/33), anti-PL7 (2/33), and anti-EJ (1/33). Immunohistochemistry was performed for MHC-I/HLA-ABC, MHC-II/HLA-DR, membrane attack complex (C5b-9), neural cell adhesion molecule (NCAM)/CD56 expression, and inflammatory cell subsets. Twenty-four ASM and 12 DM patients from another center were added for HLA-DR evaluation. Results Ubiquitous myofiber HLA-ABC expression was equally observed in ASM and DM (93.9% vs 100%, NS). In contrast, myofiber HLA-DR expression was found in 27/33 (81.8%) ASM (anti-Jo1: 23/26, 88.5%; others: 5/7, 71.4%) vs 4/17 (23.5%) DM patients (p < 0.001). HLA-DR was perifascicular in ASM, a pattern not observed in DM. In addition, C5b-9 deposition was observed on sarcolemma of non-necrotic perifascicular fibers in ASM, while, in DM, C5b-9was mainly detected in endomysial capillaries. CD8 cells were more abundant in ASM than in DM (p < 0.05), and electively located in perimysium or in perifascular endomysium. HLA-DR expression correlated positively with the CD8+ cells infiltrates. Strictly similar observations were made in the confirmatory study. Conclusion ASM is characterized by strong myofiber MHC-II/HLA-DR expression with a unique perifascicular pattern, not described so far. HLA-DR detection must be included for routine myopathological diagnosis of inflammatory/dysimmune myopathies. HLA-DR expression in ASM may indicate a specific immune mechanism, possibly involving IFNγ. Electronic supplementary material The online version of this article (doi:10.1186/s40478-014-0154-2) contains supplementary material, which is available to authorized users.
Collapse
|
75
|
Cortactin: A new target in autoimmune myositis and Myasthenia Gravis. Autoimmun Rev 2014; 13:1001-2. [DOI: 10.1016/j.autrev.2014.08.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/05/2014] [Indexed: 01/21/2023]
|
76
|
Labrador-Horrillo M, Martínez MA, Selva-O'Callaghan A, Trallero-Araguás E, Grau-Junyent JM, Vilardell-Tarrés M, Juarez C. Identification of a novel myositis-associated antibody directed against cortactin. Autoimmun Rev 2014; 13:1008-12. [DOI: 10.1016/j.autrev.2014.08.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2014] [Indexed: 02/06/2023]
|
77
|
Kim J, Watkins BA. Cannabinoid receptor antagonists and fatty acids alter endocannabinoid system gene expression and COX activity. J Nutr Biochem 2014; 25:815-23. [DOI: 10.1016/j.jnutbio.2014.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 12/21/2022]
|
78
|
Sharma K, Orbai AM, Desai D, Cingolani OH, Halushka MK, Christopher-Stine L, Mammen AL, Wu KC, Zakaria S. Brief report: antisynthetase syndrome-associated myocarditis. J Card Fail 2014; 20:939-45. [PMID: 25084215 DOI: 10.1016/j.cardfail.2014.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/23/2014] [Accepted: 07/23/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND The antisynthetase (AS) syndrome is characterized by autoimmune myopathy, interstitial lung disease, cutaneous involvement, arthritis, fever, and antibody specificity. We describe 2 patients with AS syndrome who also developed myocarditis, depressed biventricular function, and congestive heart failure. METHODS AND RESULTS Both patients were diagnosed with AS syndrome based on clinical manifestations, detection of serum AS antibodies, and myositis confirmation with the use of skeletal muscle magnetic resonance imaging and skeletal muscle biopsy. In addition, myocarditis resulting in heart failure was confirmed with the use of cardiac magnetic resonance imaging and from endomyocardial biopsy findings. After treatment for presumed AS syndrome-associated myocarditis, one patient recovered and the other patient died. CONCLUSIONS AS syndrome is a rare entity with morbidity and mortality typically attributed to myositis and lung involvement. This is the first report of AS syndrome-associated myocarditis leading to congestive heart failure in 2 patients. Given the potentially fatal consequences, myocarditis should be considered in patients with AS syndrome presenting with heart failure.
Collapse
Affiliation(s)
- Kavita Sharma
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Ana-Maria Orbai
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dipan Desai
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oscar H Cingolani
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marc K Halushka
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa Christopher-Stine
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew L Mammen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katherine C Wu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sammy Zakaria
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
79
|
Suárez-Calvet X, Gallardo E, Nogales-Gadea G, Querol L, Navas M, Díaz-Manera J, Rojas-Garcia R, Illa I. Altered RIG-I/DDX58-mediated innate immunity in dermatomyositis. J Pathol 2014; 233:258-68. [PMID: 24604766 DOI: 10.1002/path.4346] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 02/06/2014] [Accepted: 02/25/2014] [Indexed: 12/16/2023]
Abstract
We investigated the molecular mechanisms involved in the pathogenesis of three inflammatory myopathies, dermatomyositis (DM), polymyositis (PM) and inclusion body myositis (IBM). We performed microarray experiments(†) using microdissected pathological muscle fibres from 15 patients with these disorders and five controls. Differentially expressed candidate genes were validated by immunohistochemistry on muscle biopsies, and the altered pathways were analysed in human myotube cultures. Up-regulation of genes involved in viral and nucleic acid recognition were found in the three myopathies but not in controls. In DM, retinoic acid-inducible gene 1 (RIG-I, DDX58) and the novel antiviral factor DDX60, which promotes RIG-I-mediated signalling, were significantly up-regulated, followed by IFIH1 (MDA5) and TLR3. Immunohistochemistry confirmed over-expression of RIG-I in pathological muscle fibres in 5/5 DM, 0/5 PM and 0/5 IBM patients, and in 0/5 controls. Stimulation of human myotubes with a ligand of RIG-I produced a significant secretion of interferon-β (IFNβ; p < 0.05) and up-regulation of class I MHC, RIG-I and TLR3 (p < 0.05) by IFNβ-dependent and TLR3-independent mechanisms. RIG-I-mediated innate immunity, triggered by a viral or damage signal, plays a significant role in the pathogenesis of DM, but not in that of PM or IBM.
Collapse
Affiliation(s)
- Xavier Suárez-Calvet
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona and Institut de Recerca Sant Pau, Barcelona, Spain; Centro Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | | | | | | | | | | | | | | |
Collapse
|
80
|
Zhou JJ, Wang F, Xu Z, Lo WS, Lau CF, Chiang KP, Nangle LA, Ashlock MA, Mendlein JD, Yang XL, Zhang M, Schimmel P. Secreted histidyl-tRNA synthetase splice variants elaborate major epitopes for autoantibodies in inflammatory myositis. J Biol Chem 2014; 289:19269-75. [PMID: 24898250 DOI: 10.1074/jbc.c114.571026] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Inflammatory and debilitating myositis and interstitial lung disease are commonly associated with autoantibodies (anti-Jo-1 antibodies) to cytoplasmic histidyl-tRNA synthetase (HisRS). Anti-Jo-1 antibodies from different disease-afflicted patients react mostly with spatially separated epitopes in the three-dimensional structure of human HisRS. We noted that two HisRS splice variants (SVs) include these spatially separated regions, but each SV lacks the HisRS catalytic domain. Despite the large deletions, the two SVs cross-react with a substantial population of anti-Jo-l antibodies from myositis patients. Moreover, expression of at least one of the SVs is up-regulated in dermatomyositis patients, and cell-based experiments show that both SVs and HisRS can be secreted. We suggest that, in patients with inflammatory myositis, anti-Jo-1 antibodies may have extracellular activity.
Collapse
Affiliation(s)
- Jie J Zhou
- From the IAS HKUST-Scripps R&D Laboratory, Institute for Advanced Study, and Pangu BioPharma, Hong Kong, China
| | - Feng Wang
- From the IAS HKUST-Scripps R&D Laboratory, Institute for Advanced Study, and Pangu BioPharma, Hong Kong, China
| | - Zhiwen Xu
- From the IAS HKUST-Scripps R&D Laboratory, Institute for Advanced Study, and Pangu BioPharma, Hong Kong, China
| | - Wing-Sze Lo
- From the IAS HKUST-Scripps R&D Laboratory, Institute for Advanced Study, and Pangu BioPharma, Hong Kong, China
| | - Ching-Fun Lau
- From the IAS HKUST-Scripps R&D Laboratory, Institute for Advanced Study, and Pangu BioPharma, Hong Kong, China
| | | | | | | | | | - Xiang-Lei Yang
- From the IAS HKUST-Scripps R&D Laboratory, Institute for Advanced Study, and The Scripps Research Institute, La Jolla, California 92037, and
| | - Mingjie Zhang
- From the IAS HKUST-Scripps R&D Laboratory, Institute for Advanced Study, and Division of Life Science, State Key Laboratory of Molecular Neuroscience, Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, China
| | - Paul Schimmel
- From the IAS HKUST-Scripps R&D Laboratory, Institute for Advanced Study, and The Scripps Research Institute, La Jolla, California 92037, and Scripps Florida, Jupiter, Florida 33458
| |
Collapse
|
81
|
Bryant ND, Li K, Does MD, Barnes S, Gochberg DF, Yankeelov TE, Park JH, Damon BM. Multi-parametric MRI characterization of inflammation in murine skeletal muscle. NMR IN BIOMEDICINE 2014; 27:716-25. [PMID: 24777935 PMCID: PMC4134016 DOI: 10.1002/nbm.3113] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 02/10/2014] [Accepted: 03/13/2014] [Indexed: 05/15/2023]
Abstract
Myopathies often display a common set of complex pathologies that include muscle weakness, inflammation, compromised membrane integrity, fat deposition, and fibrosis. Multi-parametric, quantitative, non-invasive imaging approaches may be able to resolve these individual pathological components. The goal of this study was to use multi-parametric MRI to investigate inflammation as an isolated pathological feature. Proton relaxation, diffusion tensor imaging (DTI), quantitative magnetization transfer (qMT-MRI), and dynamic contrast enhanced (DCE-MRI) parameters were calculated from data acquired in a single imaging session conducted 6-8 hours following the injection of λ-carrageenan, a local inflammatory agent. T2 increased in the inflamed muscle and transitioned to bi-exponential behavior. In diffusion measurements, all three eigenvalues and the apparent diffusion coefficient increased, but λ3 had the largest relative change. Analysis of the qMT data revealed that the T1 of the free pool and the observed T1 both increased in the inflamed tissue, while the ratio of exchanging spins in the solid pool to those in the free water pool (the pool size ratio) significantly decreased. DCE-MRI data also supported observations of an increase in extracellular volume. These findings enriched the understanding of the relation between multiple quantitative MRI parameters and an isolated inflammatory pathology, and may potentially be employed for other single or complex myopathy models.
Collapse
Affiliation(s)
- Nathan D Bryant
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA
| | | | | | | | | | | | | | | |
Collapse
|
82
|
7-Tesla magnetic resonance imaging precisely and noninvasively reflects inflammation and remodeling of the skeletal muscle in a mouse model of antisynthetase syndrome. BIOMED RESEARCH INTERNATIONAL 2014; 2014:879703. [PMID: 24895622 PMCID: PMC4026959 DOI: 10.1155/2014/879703] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 04/04/2014] [Indexed: 01/28/2023]
Abstract
Inflammatory myopathies comprise heterogeneous disorders. Their etiopathogenesis is poorly understood, because of the paucity of informative experimental models and of approaches for the noninvasive study of inflamed tissues. Magnetic resonance imaging (MRI) provides information about the state of the skeletal muscle that reflects various facets of inflammation and remodeling. This technique has been scarcely used in experimental models of inflammatory myopathies. We characterized the performance of MRI in a well-established mouse model of myositis and the antisynthetase syndrome, based on the immunization of wild-type mice with the amino-terminal fragment of histidyl-tRNA synthetase (HisRS). Over an eight-week period following myositis induction, MRI enabled precise identification of pathological events taking place in muscle tissue. Areas of edema and of active inflammation identified by histopathology paralleled muscle modifications detected noninvasively by MRI. Muscles changes were chronologically associated with the establishment of autoimmunity, as reflected by the development of anti-HisRS antibodies in the blood of immunized mice. MR imaging easily appreciated muscle damage and remodeling even if actual disruption of myofiber integrity (as assessed by serum concentrations of creatinine phosphokinase) was limited. Thus, MR imaging represents an informative and noninvasive analytical tool for studying in vivo immune-mediated muscle involvement.
Collapse
|
83
|
Yokota M, Suzuki K, Tokoyoda K, Meguro K, Hosokawa J, Tanaka S, Ikeda K, Mikata T, Nakayama T, Kohsaka H, Nakajima H. Roles of mast cells in the pathogenesis of inflammatory myopathy. Arthritis Res Ther 2014; 16:R72. [PMID: 24636001 PMCID: PMC4060256 DOI: 10.1186/ar4512] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 03/05/2014] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION In addition to the pivotal roles of mast cells in allergic diseases, recent data suggest that mast cells play crucial roles in a variety of autoimmune responses. However, their roles in the pathogenesis of autoimmune skeletal muscle diseases have not been clarified despite their distribution in skeletal muscle. Therefore, the objective of this study is to determine the roles of mast cells in the development of autoimmune skeletal muscle diseases. METHODS The number of mast cells in the affected muscle was examined in patients with dermatomyositis (DM) or polymyositis (PM). The susceptibility of mast cell-deficient WBB6F1-Kit(W)/Kit(Wv) mice (W/W(v) mice) to a murine model of polymyositis, C protein-induced myositis (CIM), was compared with that of wild-type (WT) mice. The effect of mast cell reconstitution with bone marrow-derived mast cells (BMMCs) on the susceptibility of W/W(v) mice to CIM was also evaluated. RESULTS The number of mast cells in the affected muscle increased in patients with PM as compared with patients with DM. W/W(v) mice exhibited significantly reduced disease incidence and histological scores of CIM as compared with WT mice. The number of CD8⁺ T cells and macrophages in the skeletal muscles of CIM decreased in W/W(v) mice compared with WT mice. Engraftment of BMMCs restored the incidence and histological scores of CIM in W/W(v) mice. Vascular permeability in the skeletal muscle was elevated in WT mice but not in W/W(v) mice upon CIM induction. CONCLUSION Mast cells are involved in the pathogenesis of inflammatory myopathy.
Collapse
|
84
|
Chen FW, Zhou X, Egbert BM, Swetter SM, Sarin KY. Dermatomyositis associated with capecitabine in the setting of malignancy. J Am Acad Dermatol 2014; 70:e47-8. [PMID: 24438983 DOI: 10.1016/j.jaad.2013.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 10/12/2013] [Accepted: 10/15/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Frank W Chen
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Xiaolong Zhou
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Barbara M Egbert
- Pathology Service, VA Palo Alto Health Care System, Palo Alto, California
| | - Susan M Swetter
- Department of Dermatology, Stanford University School of Medicine, Stanford, California; Dermatology Service, VA Palo Alto Health Care System, Palo Alto, California
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University School of Medicine, Stanford, California.
| |
Collapse
|
85
|
Idiopathic inflammatory myopathies and the anti-synthetase syndrome: a comprehensive review. Autoimmun Rev 2014; 13:367-71. [PMID: 24424190 DOI: 10.1016/j.autrev.2014.01.022] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 01/30/2023]
Abstract
Autoantibodies are a hallmark in the diagnosis of many systemic autoimmune rheumatic diseases (SARD) including idiopathic inflammatory myopathies (IIM). Based on their specificity, autoantibodies in IIM are grouped into myositis specific (MSA) and myositis associated autoantibodies (MAA). Among the MSA, autoantibodies against aminoacyl-tRNA synthetases (ARS) represent the most common antibodies and can be detected in 25-35% of patients. The presence of ARS and other autoantibodies has become a key feature for classification and diagnosis of IIM and is increasingly used to define clinically distinguishable IIM subsets. For example, anti-ARS autoantibodies are the key features of what has become known as anti-synthetase syndrome (aSS), characterized by multiple organ involvement, primarily interstitial lung disease, often accompanied by myositis, non-erosive arthritis, Raynaud's phenomenon, fever, and "mechanic's hands". Autoantibodies directed to eight different ARS have been described: Jo-1 (histidyl), PL-7 (threonyl), PL-12 (alanyl), OJ (isoleucyl), EJ (glycyl), KS (asparaginyl), Zo (phenylalanyl) and Ha (tyrosyl). Each anti-ARS antibody seems to define a distinctive clinical phenotype. Although several research methods and commercial tests are available, routine testing for anti-ARS autoantibodies (other than anti-Jo-1/histidyl-tRNA synthetase) is not widely available, sometimes leading to delays in diagnosis and poor disease outcomes.
Collapse
|
86
|
Allenbach Y, Benveniste O. [Autoantibody profile in myositis]. Rev Med Interne 2014; 35:437-43. [PMID: 24387952 DOI: 10.1016/j.revmed.2013.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 12/02/2013] [Indexed: 12/31/2022]
Abstract
Patients suffering from muscular symptoms or with an increase of creatine kinase levels may present a myopathy. In such situations, clinicians have to confirm the existence of a myopathy and determine if it is an acquired or a genetic muscular disease. In the presence of an acquired myopathy after having ruled out an infectious, a toxic agent or an endocrine cause, physicians must identify which type of idiopathic myopathy the patient is presenting: either a myositis including polymyositis, dermatomyositis, and inclusion body myositis, or an immune-mediated necrotizing myopathy. Histopathology examination of a muscle biopsy is determinant but detection of autoantibody is now also crucial. The myositis-specific antibodies and myositis-associated antibodies lead to a serologic approach complementary to the histological classification, because strong associations of myositis-specific antibodies with clinical features and survival have been documented. The presence of anti-synthetase antibodies is associated with an original histopathologic pattern between polymyositis and dermatomyositis, and defines a syndrome where interstitial lung disease drives the prognosis. Anti-MDA-5 antibody are specifically associated with dermatomyositis, and define a skin-lung syndrome with a frequent severe disease course. Anti-TIF1-γ is also associated with dermatomyositis but its presence is frequently predictive of a cancer association whereas anti-MI2 is associated with the classical dermatomyositis. Two specific antibodies, anti-SRP and anti-HMGCR, are observed in patients with immune-mediated necrotizing myopathies and may be very useful to distinguish acquired myopathies from dystrophic muscular diseases in case of a slow onset and to allow the initiation of effective therapy.
Collapse
Affiliation(s)
- Y Allenbach
- Équipe Inserm U974, DHUI2B, UPMC, service de médecine interne, centre de référence des maladies neuromusculaires Paris Est, groupe hospitalier de la Pitié-Salpêtrière, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France.
| | - O Benveniste
- Équipe Inserm U974, DHUI2B, UPMC, service de médecine interne, centre de référence des maladies neuromusculaires Paris Est, groupe hospitalier de la Pitié-Salpêtrière, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| |
Collapse
|
87
|
Mizoguchi F, Takada K, Ishikawa K, Mizusawa H, Kohsaka H, Miyasaka N. A case of dermatomyositis with rhabdomyolysis, rescued by intravenous immunoglobulin. Mod Rheumatol 2013; 25:646-8. [PMID: 24252047 DOI: 10.3109/14397595.2013.843753] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We describe a case of severe dermatomyositis (DM) complicated by rhabdomyolysis, acute tubular necrosis, and hemophagocytosis. The case failed to respond to corticosteroids, but showed rapid and significant improvement after the addition of intravenous immunoglobulin (IVIG). While the prognosis of DM is poor when it is complicated by rhabdomyolysis, the early administration of IVIG has the potential to be the cornerstone of its management.
Collapse
Affiliation(s)
- Fumitaka Mizoguchi
- Department of Medicine and Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | | | | | | | | | | |
Collapse
|
88
|
Hall JC, Casciola-Rosen L, Samedy LA, Werner J, Owoyemi K, Danoff SK, Christopher-Stine L. Anti-melanoma differentiation-associated protein 5-associated dermatomyositis: expanding the clinical spectrum. Arthritis Care Res (Hoboken) 2013; 65:1307-15. [PMID: 23436757 DOI: 10.1002/acr.21992] [Citation(s) in RCA: 202] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 02/12/2013] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Autoantibodies against melanoma differentiation-associated protein 5 (MDA-5) have been described in several Asian dermatomyositis (DM) cohorts, often associated with amyopathic DM and rapidly progressive interstitial lung disease (ILD). A recent study of a DM cohort seen at a US dermatology clinic reports that MDA-5 autoantibodies are associated with a unique cutaneous phenotype. Given the widening spectrum of clinical findings, we evaluated the clinical features of anti-MDA-5-positive patients seen at a US myositis referral center. METHODS One hundred sixty DM patients were screened for MDA-5 autoantibodies by immunoprecipitation and antibody titers were analyzed in longitudinal serum samples. Anti-MDA-5-positive patients were evaluated for the presence of additional myositis autoantibodies. Patient clinical characteristics were compared by retrospective chart review. RESULTS MDA-5 was targeted in 11 (6.9%) of 160 patients with DM. Of these, 9 presented with a symmetric polyarthropathy, 6 demonstrated overt clinical myopathy, and 8 had ILD. Eight anti-MDA-5-positive patients exhibited the clinical attributes of the antisynthetase syndrome in the absence of Jo-1 or other antisynthetase autoantibodies. MDA-5 autoantibody titers did not correlate with clinical course. CONCLUSION MDA-5 autoantibodies are found in DM patients presenting with a symmetric polyarthritis, clinically similar to rheumatoid arthritis. These patients often have features of the antisynthetase syndrome, but in the absence of antisynthetase autoantibodies. Most anti-MDA-5-positive patients had overt clinical myopathy and ILD. The latter, while occasionally severe, typically resolved with immunosuppressive therapy. In this cohort, the MDA-5 phenotype is frequently a clinical mimic of the antisynthetase syndrome and is not associated with rapidly progressive ILD.
Collapse
Affiliation(s)
- John C Hall
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | | | | |
Collapse
|
89
|
De Bleecker JL, Lundberg IE, de Visser M. 193rd ENMC International workshop Pathology diagnosis of idiopathic inflammatory myopathies 30 November - 2 December 2012, Naarden, The Netherlands. Neuromuscul Disord 2013; 23:945-51. [PMID: 24011698 DOI: 10.1016/j.nmd.2013.07.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 07/12/2013] [Accepted: 07/18/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Jan L De Bleecker
- Department of Neurology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | | | | | | |
Collapse
|
90
|
Serum interleukin-6 expression level and its clinical significance in patients with dermatomyositis. Clin Dev Immunol 2013; 2013:717808. [PMID: 24082909 PMCID: PMC3776358 DOI: 10.1155/2013/717808] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 08/02/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To analyze serum interleukin-6 (IL-6) expression level and its clinical significance in patients with dermatomyositis. METHODS Blood samples from 23 adult patients with dermatomyositis (DM), 22 with systemic lupus erythematosus (SLE), 22 with rheumatoid arthritis (RA), 16 with Sjögren's syndrome (SS), and 20 healthy controls were collected. The IL-6 concentration was detected by chemiluminescence immunoassay. Correlations between IL-6 expression levels and clinical features or laboratory findings in patients with DM were investigated. RESULTS IL-6 expression level of DM patients was significantly higher than that of normal controls, significantly lower than that of RA patients, and slightly lower than that of SLE or SS patients with no significant differences. The incidence of fever was significantly higher in the IL-6 elevated group. Serum ferritin (SF) and C-reactive protein (CRP) were positively correlated with IL-6. CONCLUSIONS IL-6 plays a less important role in DM than in RA. IL-6 monoclonal antibodies may have poor effect in patients with DM.
Collapse
|
91
|
Liewluck T, Ernste FC, Tracy JA. Frequency and spectrum of myopathies in patients with psoriasis. Muscle Nerve 2013; 48:716-21. [PMID: 24037820 DOI: 10.1002/mus.23812] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2013] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Psoriasis is a T-cell-mediated skin disorder with uncommon extracutaneous manifestations. Rare patients with psoriasis and myopathy have been reported. METHODS We conducted a retrospective review of medical records of psoriasis patients seen at the Mayo Clinic during the period from January 1, 1996 to May 31, 2011. Patients who had pathologically confirmed myopathy or lymphocytic infiltrates in muscle were included. RESULTS Among 11,370 psoriasis patients, 13 had pathologically confirmed myopathies. Seventy percent were inflammatory myopathies, and 2 had focal inflammation in the muscle. Psoriasis preceded myopathy onset in two-thirds of the patients (median 14.7 years). Half of the patients had psoriatic arthritis; 60% had other autoimmune disorders. Patients who received anti-tumor necrosis factor-alpha (anti-TNF-α) therapy had a higher risk for developing myopathy or inflammation in muscle (odds ratio = 4.45). CONCLUSIONS Myopathy or inflammation in muscle affects an average of 1.32 of every 1000 psoriasis patients. Concomitant autoimmune disorders, psoriatic arthritis, and exposure to anti-TNF-α therapy may be associated with increased risk of developing myopathy in psoriasis patients.
Collapse
Affiliation(s)
- Teerin Liewluck
- Department of Neurology, University of Colorado Denver School of Medicine, Anschutz Medical Campus, 12631 East 17th Avenue, Aurora, Colorado, 80045, USA; Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | | | | |
Collapse
|
92
|
Abstract
A 59-year-old man presented with a history of dysphagia and generalized myalgia and muscle weakness and a rash on the face, neck, and upper arms. Serum muscle enzymes, myoglobin, C-reactive protein, and erythrocyte sedimentation rate were elevated and antinuclear antibodies positive. Electromyographic conduction studies showed pathological changes on arm and leg muscles and magnetic resonance imaging of the oral and neck muscles. A diagnosis of dermatomyositis with severe esophageal involvement was established. Treatment with prednisolone was started and methotrexate added. Enteral feeding with a percutaneous endoscopic gastrostomy was started and a therapy with intravenous immunoglobulin (IVIG) initiated, which caused a rapid improvement of the patient's ability to swallow. This case demonstrates a patient with polymyositis/dermatomyositis who showed steroid-resistant life-threatening esophageal impairment. IVIG resulted in a dramatic improvement of symptoms.
Collapse
|
93
|
Overexpression of MHC class I in muscle of lymphocyte-deficient mice causes a severe myopathy with induction of the unfolded protein response. THE AMERICAN JOURNAL OF PATHOLOGY 2013; 183:893-904. [PMID: 23850081 DOI: 10.1016/j.ajpath.2013.06.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 05/10/2013] [Accepted: 06/04/2013] [Indexed: 12/20/2022]
Abstract
Muscle fibers do not normally express major histocompatibility complex class I (MHC-I) molecules, and their reexpression is a hallmark of inflammatory myopathies. It has been shown in mice that overexpression of MHC-I induces a poorly inflammatory myositis accompanied by the unfolded protein response (UPR), but it is unclear whether it is attributable to T-cell-mediated MHC-I-dependent immune responses or to MHC-I forced expression per se. Indeed, besides presenting antigenic peptides to CD8(+) T cells, MHC-I may also possibly exert nonimmunologic, yet poorly understood pathogenic effects. Thus, we investigated the pathogenicity of MHC-I expression in muscle independently of its immune functions. HT transgenic mice that conditionally overexpress H-2K(b) in muscle were bred to an immunodeficient Rag2(-/-) background. The muscle proteome was analyzed by label-free high-resolution protein quantitation and Western blot. Despite the absence of adaptive immunity, HT Rag2(-/-) mice developed a very severe myopathy associated with the cytoplasmic accumulation of H-2K(b) molecules. The UPR was manifest by up-regulation of characteristic proteins. In humans, we found that HLA class I molecules not only were expressed at the sarcolemma but also could accumulate intracellularly in some patients with inclusion body myositis. Accordingly, the UPR was triggered as a function of the degree of HLA accumulation in myofibers. Hence, reexpression of MHC-I in normally negative myofibers exerts pathogenic effects independently of its immune function.
Collapse
|
94
|
Fernandez I, Harlow L, Zang Y, Liu-Bryan R, Ridgway WM, Clemens PR, Ascherman DP. Functional redundancy of MyD88-dependent signaling pathways in a murine model of histidyl-transfer RNA synthetase-induced myositis. THE JOURNAL OF IMMUNOLOGY 2013; 191:1865-72. [PMID: 23842751 DOI: 10.4049/jimmunol.1203070] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We have previously shown that i.m. administration of bacterially expressed murine histidyl-tRNA synthetase (HRS) triggers florid muscle inflammation (relative to appropriate control proteins) in various congenic strains of mice. Because severe disease develops even in the absence of adaptive immune responses to HRS, we sought to identify innate immune signaling components contributing to our model of HRS-induced myositis. In vitro stimulation assays demonstrated HRS-mediated activation of HEK293 cells transfected with either TLR2 or TLR4, revealing an excitatory capacity exceeding that of other bacterially expressed fusion proteins. Corresponding to this apparent functional redundancy of TLR signaling pathways, HRS immunization of B6.TLR2(-/-) and B6.TLR4(-/-) single-knockout mice yielded significant lymphocytic infiltration of muscle tissue comparable to that produced in C57BL/6 wild-type mice. In contrast, concomitant elimination of TLR2 and TLR4 signaling in B6.TLR2(-/-).TLR4(-/-) double-knockout mice markedly reduced the severity of HRS-induced muscle inflammation. Complementary subfragment analysis demonstrated that aa 60-90 of HRS were absolutely required for in vitro as well as in vivo signaling via these MyD88-dependent TLR pathways--effects mediated, in part, through preferential binding of exogenous ligands capable of activating specific TLRs. Collectively, these experiments indicate that multiple MyD88-dependent signaling cascades contribute to this model of HRS-induced myositis, underscoring the antigenic versatility of HRS and confirming the importance of innate immunity in this system.
Collapse
Affiliation(s)
- Irina Fernandez
- Division of Rheumatology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | | | | | | | | | | | | |
Collapse
|
95
|
Vij R, Strek ME. Diagnosis and treatment of connective tissue disease-associated interstitial lung disease. Chest 2013; 143:814-824. [PMID: 23460159 DOI: 10.1378/chest.12-0741] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Interstitial lung disease (ILD) is one of the most serious pulmonary complications associated with connective tissue diseases (CTDs), resulting in significant morbidity and mortality. Although the various CTDs associated with ILD often are considered together because of their shared autoimmune nature, there are substantial differences in the clinical presentations and management of ILD in each specific CTD. This heterogeneity and the cross-disciplinary nature of care have complicated the conduct of prospective multicenter treatment trials and hindered our understanding of the development of ILD in patients with CTD. In this update, we present new information regarding the diagnosis and treatment of patients with ILD secondary to systemic sclerosis, rheumatoid arthritis, dermatomyositis and polymyositis, and Sjögren syndrome. We review information on risk factors for the development of ILD in the setting of CTD. Diagnostic criteria for CTD are presented as well as elements of the clinical evaluation that increase suspicion for CTD-ILD. We review the use of medications in the treatment of CTD-ILD. Although a large, randomized study has examined the impact of immunosuppressive therapy for ILD secondary to systemic sclerosis, additional studies are needed to determine optimal treatment strategies for each distinct form of CTD-ILD. Finally, we review new information regarding the subgroup of patients with ILD who meet some, but not all, diagnostic criteria for a CTD. A careful and systematic approach to diagnosis in patients with ILD may reveal an unrecognized CTD or evidence of autoimmunity in those previously believed to have idiopathic ILD.
Collapse
Affiliation(s)
- Rekha Vij
- Section of Pulmonary and Critical Care, Department of Medicine, The University of Chicago, Chicago, IL.
| | - Mary E Strek
- Section of Pulmonary and Critical Care, Department of Medicine, The University of Chicago, Chicago, IL
| |
Collapse
|
96
|
Rider LG, Shah M, Mamyrova G, Huber AM, Rice MM, Targoff IN, Miller FW. The myositis autoantibody phenotypes of the juvenile idiopathic inflammatory myopathies. Medicine (Baltimore) 2013; 92:223-243. [PMID: 23877355 PMCID: PMC3721421 DOI: 10.1097/md.0b013e31829d08f9] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The juvenile idiopathic inflammatory myopathies (JIIM) are systemic autoimmune diseases characterized by skeletal muscle weakness, characteristic rashes, and other systemic features. In follow-up to our study defining the major clinical subgroup phenotypes of JIIM, we compared demographics, clinical features, laboratory measures, and outcomes among myositis-specific autoantibody (MSA) subgroups, as well as with published data on adult idiopathic inflammatory myopathy patients enrolled in a separate natural history study. In the present study, of 430 patients enrolled in a nationwide registry study who had serum tested for myositis autoantibodies, 374 had either a single specific MSA (n = 253) or no identified MSA (n = 121) and were the subject of the present report. Following univariate analysis, we used random forest classification and exact logistic regression modeling to compare autoantibody subgroups. Anti-p155/140 autoantibodies were the most frequent subgroup, present in 32% of patients with juvenile dermatomyositis (JDM) or overlap myositis with JDM, followed by anti-MJ autoantibodies, which were seen in 20% of JIIM patients, primarily in JDM. Other MSAs, including anti-synthetase, anti-signal recognition particle (SRP), and anti-Mi-2, were present in only 10% of JIIM patients. Features that characterized the anti-p155/140 autoantibody subgroup included Gottron papules, malar rash, "shawl-sign" rash, photosensitivity, cuticular overgrowth, lowest creatine kinase (CK) levels, and a predominantly chronic illness course. The features that differed for patients with anti-MJ antibodies included muscle cramps, dysphonia, intermediate CK levels, a high frequency of hospitalization, and a monocyclic disease course. Patients with anti-synthetase antibodies had higher frequencies of interstitial lung disease, arthralgia, and "mechanic's hands," and had an older age at diagnosis. The anti-SRP group, which had exclusively juvenile polymyositis, was characterized by high frequencies of black race, severe onset, distal weakness, falling episodes, Raynaud phenomenon, cardiac involvement, high CK levels, chronic disease course, frequent hospitalization, and wheelchair use. Characteristic features of the anti-Mi-2 subgroup included Hispanic ethnicity, classic dermatomyositis and malar rashes, high CK levels, and very low mortality. Finally, the most common features of patients without any currently defined MSA or myositis-associated autoantibodies included linear extensor erythema, arthralgia, and a monocyclic disease course. Several demographic and clinical features were shared between juvenile and adult idiopathic inflammatory myopathy subgroups, but with several important differences. We conclude that juvenile myositis is a heterogeneous group of illnesses with distinct autoantibody phenotypes defined by varying clinical and demographic characteristics, laboratory features, and outcomes.
Collapse
Affiliation(s)
- Lisa G Rider
- From Environmental Autoimmunity Group (LGR, MS, GM, FWM), Program of Clinical Research, National Institute of Environmental Health Sciences, National Institutes of Health, DHHS, Bethesda, Maryland; Department of Epidemiology and Biostatistics (MS, MMR) and Division of Rheumatology, Department of Medicine (GM), George Washington University School of Medicine, Washington, DC; Veteran's Affairs Medical Center (INT), University of Oklahoma Health Sciences Center, and Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, United States; and IWK Health Center and Dalhousie University (AMH), Halifax, Nova Scotia, Canada
| | | | | | | | | | | | | | | |
Collapse
|
97
|
Abstract
Statins are an extensively used class of drugs, and myopathy is an uncommon, but well-described side effect of statin therapy. Inflammatory myopathies, including polymyositis, dermatomyositis, and necrotizing autoimmune myopathy, are even more rare, but debilitating, side effects of statin therapy that are characterized by the persistence of symptoms even after discontinuation of the drug. It is important to differentiate statin-associated inflammatory myopathies from other self-limited myopathies, as the disease often requires multiple immunosuppressive therapies. Drug interactions increase the risk of statin-associated toxic myopathy, but no risk factors for statin-associated inflammatory myopathies have been established. Here we describe the case of a man, age 59 years, who had been treated with a combination of atorvastatin and gemfibrozil for approximately 5 years and developed polymyositis after treatment with omeprazole for 7 months. Symptoms did not resolve after discontinuation of the atorvastatin, gemfibrozil, and omeprazole. The patient was treated with prednisone and methotrexate followed by intravenous immunoglobulin, which resulted in normalization of creatinine kinase levels and resolution of symptoms after 14 weeks. It is unclear if polymyositis was triggered by interaction of the statin with omeprazole and/or gemfibrozil, or if it developed secondary to long-term use of atorvastatin only.
Collapse
Affiliation(s)
- Rajan Kanth
- Department of Internal Medicine, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
| | | | | |
Collapse
|
98
|
Paraneoplastic neurological syndromes: severe neurological symptoms resulting from relatively benign or occult tumours-two case reports. Case Rep Oncol Med 2013; 2013:458378. [PMID: 23691383 PMCID: PMC3638554 DOI: 10.1155/2013/458378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 03/12/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. Paraneoplastic syndromes represent rare symptom complexes resulting from the ability of tumour cells to disrupt the homeostatic processes of various bodily systems. Here we present two cases to demonstrate how such tumours may evade detection even after extensive investigation and how even relatively benign tumours can produce severe neurological symptoms. Case 1. A 69-year-old female was admitted with a subacute onset of dysarthria, ataxia, and cerebellar signs. Workup revealed a relatively benign Non-Hodgkin's Lymphoma. Case 2. A 64-year-old female was admitted with acute leg weakness, which progressed to quadriplegia and was eventually fatal over the ensuing months. Her Ca-125 was elevated, though three different CT views of her pelvis and surgical exploration failed to demonstrate any malignancy. Discussion. These cases highlight how even relatively benign or very small tumours may result in severe neurological symptoms. Suspecting and investigating paraneoplastic syndromes (PNSs) are crucial as up to 80% of patients present with PNS before there is any other indication of malignancy. A PET scan and regular surveillance may reveal occult malignancies better than CT or MRI. Neuromodulatory therapies and treatment of the underlying malignancy remain the best management options in these patients.
Collapse
|
99
|
Hamaguchi Y, Fujimoto M, Matsushita T, Kaji K, Komura K, Hasegawa M, Kodera M, Muroi E, Fujikawa K, Seishima M, Yamada H, Yamada R, Sato S, Takehara K, Kuwana M. Common and distinct clinical features in adult patients with anti-aminoacyl-tRNA synthetase antibodies: heterogeneity within the syndrome. PLoS One 2013; 8:e60442. [PMID: 23573256 PMCID: PMC3616126 DOI: 10.1371/journal.pone.0060442] [Citation(s) in RCA: 249] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 02/27/2013] [Indexed: 12/04/2022] Open
Abstract
Objective To identify similarities and differences in the clinical features of adult Japanese patients with individual anti-aminoacyl-tRNA synthetase antibodies (anti-ARS Abs). Methods This was a retrospective analysis of 166 adult Japanese patients with anti-ARS Abs detected by immunoprecipitation assays. These patients had visited Kanazawa University Hospital or collaborating medical centers from 2003 to 2009. Results Anti-ARS Ab specificity included anti-Jo-1 (36%), anti-EJ (23%), anti-PL-7 (18%), anti-PL-12 (11%), anti-KS (8%), and anti-OJ (5%). These anti-ARS Abs were mutually exclusive, except for one serum Ab that had both anti-PL-7 and PL-12 reactivity. Myositis was closely associated with anti-Jo-1, anti-EJ, and anti-PL-7, while interstitial lung disease (ILD) was correlated with all 6 anti-ARS Abs. Dermatomyositis (DM)-specific skin manifestations (heliotrope rash and Gottron’s sign) were frequently observed in patients with anti-Jo-1, anti-EJ, anti-PL-7, and anti-PL-12. Therefore, most clinical diagnoses were polymyositis or DM for anti-Jo-1, anti-EJ, and anti-PL-7; clinically amyopathic DM or ILD for anti-PL-12; and ILD for anti-KS and anti-OJ. Patients with anti-Jo-1, anti-EJ, and anti-PL-7 developed myositis later if they had ILD alone at the time of disease onset, and most patients with anti-ARS Abs eventually developed ILD if they did not have ILD at disease onset. Conclusion Patients with anti-ARS Abs are relatively homogeneous. However, the distribution and timing of myositis, ILD, and rashes differ among patients with individual anti-ARS Abs. Thus, identification of individual anti-ARS Abs is beneficial to define this rather homogeneous subset and to predict clinical outcomes within the “anti-synthetase syndrome.”
Collapse
Affiliation(s)
- Yasuhito Hamaguchi
- Department of Dermatology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
- * E-mail:
| | - Takashi Matsushita
- Department of Dermatology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kenzo Kaji
- Department of Dermatology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kazuhiro Komura
- Department of Dermatology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Minoru Hasegawa
- Department of Dermatology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Masanari Kodera
- Department of Dermatology, Social Insurance Chukyo Hospital, Nagoya, Japan
| | - Eiji Muroi
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keita Fujikawa
- Unit of Translational Medicine, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mariko Seishima
- Department of Dermatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hidehiro Yamada
- Division of Rheumatology, Department of Internal Medicine, and Allergy, St. Marianna University, Kawasaki, Japan
| | - Ryo Yamada
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Sato
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazuhiko Takehara
- Department of Dermatology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Masataka Kuwana
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
100
|
Werner JL, Christopher-Stine L, Ghazarian SR, Pak KS, Kus JE, Daya NR, Lloyd TE, Mammen AL. Antibody levels correlate with creatine kinase levels and strength in anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase-associated autoimmune myopathy. ACTA ACUST UNITED AC 2013; 64:4087-93. [PMID: 22933019 DOI: 10.1002/art.34673] [Citation(s) in RCA: 172] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 08/09/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Autoantibodies recognizing 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) are found in patients with statin-associated immune-mediated necrotizing myopathy and, less commonly, in statin-unexposed patients with autoimmune myopathy. The main objective of this study was to define the association of anti-HMGCR antibody levels with disease activity. METHODS Anti-HMGCR levels, creatine kinase (CK) levels, and strength were assessed in anti-HMGCR-positive patients. Associations of antibody level with CK level and strength at visit 1 were analyzed in 55 patients, 40 of whom were exposed to statins. In 12 statin-exposed and 5 statin-unexposed patients with serum from 5 serial visits, the evolution of antibody levels, CK levels, and strength was investigated. RESULTS Antibody levels were associated with CK levels (P < 0.001), arm strength (P < 0.05), and leg strength (P < 0.05) at visit 1, but these associations were only significant among statin-exposed patients in stratified analyses. With immunosuppressive treatment over 26.2 ± 12.6 months (mean ± SD), antibody levels declined (P < 0.05) and arm abduction strength improved (P < 0.05) in the 17 patients followed up longitudinally. The separate analysis showed that statin-exposed patients developed decreased antibody levels (P < 0.01), decreased CK levels (P < 0.001), improved arm strength (P < 0.05), and improved hip flexion strength (P < 0.05) with treatment. Anti-HMGCR antibody levels did not normalize in any patient. CONCLUSION In the entire cohort, initial anti-HMGCR levels correlated with indicators of disease activity; with immunosuppressive treatment, antibody levels declined and arm strength improved. Statin-exposed patients had significant improvements in CK levels and strength whereas statin-unexposed patients did not, suggesting a phenotypic difference between statin-exposed and statin-unexposed anti-HMGCR-positive patients.
Collapse
Affiliation(s)
- Jessie L Werner
- Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | | | | | | | | | | | | | | |
Collapse
|