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Yeung RSM, Albani S, Feldman BM, Mellins E, Prakken B, Wedderburn LR. Enhancing translational research in paediatric rheumatology through standardization. Nat Rev Rheumatol 2016; 12:684-690. [PMID: 27652504 DOI: 10.1038/nrrheum.2016.156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The past decade has seen many successes in translational rheumatology, from dramatic improvements in outcomes brought about by novel biologic therapies, to the discovery of new monogenic inflammatory disorders. Advances in molecular medicine, combined with progress towards precision care, provide an excellent opportunity to accelerate the translation of biological understanding to the bedside. However, although the field of rheumatology is a leader in the standardization of data collection and measures of disease activity, it lags behind in standardization of biological sample collection and assay performance. Uniform approaches are necessary for robust collaborative research, particularly in rare diseases. Standardization is also critical to increase reproducibility between centres, a prerequisite for clinical implementation of translational research. This Perspectives article emphasizes the need for standardization and implementation of best practices, presented in the context of lessons learned from international biorepository networks.
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Affiliation(s)
- Rae S M Yeung
- Department of Paediatrics, Division of Rheumatology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; and at the Department of Immunology and the Institute of Medical Science, University of Toronto Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
| | - Salvatore Albani
- Duke-National University of Singapore Graduate Medical School, 8 College Road, 169857, Singapore
| | - Brian M Feldman
- Department of Paediatrics and Institute of Medical Science, University of Toronto Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; the Division of Rheumatology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; and at the Institute of Health Policy Management and Evaluation, The Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
| | - Elizabeth Mellins
- Department of Pediatrics and the Stanford Program in Immunology, Stanford University, 300 Pasteur Drive, Stanford, California 94305, USA
| | - Berent Prakken
- Department of Immunology, University Medical Centre, Heidelberglaan 100, 3584 CX Utrecht, Netherlands
| | - Lucy R Wedderburn
- Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
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Lavric M, Miranda-García MA, Holzinger D, Foell D, Wittkowski H. Alarmins firing arthritis: Helpful diagnostic tools and promising therapeutic targets. Joint Bone Spine 2016; 84:401-410. [PMID: 27659403 DOI: 10.1016/j.jbspin.2016.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/22/2016] [Indexed: 12/11/2022]
Abstract
Alarmins are endogenous molecules with homeostatic roles that have reached the focus of research in inflammatory arthritis in the last two decades, mostly due to their ability to indicate tissue related damage after active or passive release from injured cells. From HMGB1, S100A8/A9 and S100A12 proteins, over heat-shock proteins (HSPs) and purine metabolites (e.g. uric acid, ATP) to altered matrix proteins and interleukin-33 (IL-33), a number of alarmins have been determined until now as having a role in rheumatoid arthritis, psoriatic and juvenile idiopathic arthritis, as well as spondyloarthritis and gout. Although formerly being linked to initiation and chronification of inflammatory arthritis, driving auto- and paracrine inflammatory loops, more recent research has also unraveled the alarmins' role in the crosstalk between innate and adaptive immunity and in resolution of inflammation. Providing a state-of-the-art overview of known alarmins, this review lists the known modes of action and pathologic contribution of alarmins to inflammatory arthritis, as well as biomarker potential of alarmins in the clinical setting for tracking disease severity. Based upon research on animal experimental models (CIA, AIA) and clinical trials, a look is made into potentially viable strategies for modifying alarmin secretion and their target receptor (e.g. TLR, RAGE) interaction with the purpose of attenuating arthritic disease.
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Affiliation(s)
- Miha Lavric
- Department of Paediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany
| | | | - Dirk Holzinger
- Department of Paediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany.
| | - Helmut Wittkowski
- Department of Paediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany
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Alberdi-Saugstrup M, Nielsen S, Mathiessen P, Nielsen CH, Müller K. Low pretreatment levels of myeloid-related protein-8/14 and C-reactive protein predict poor adherence to treatment with tumor necrosis factor inhibitors in juvenile idiopathic arthritis. Clin Rheumatol 2016; 36:67-75. [PMID: 27562034 DOI: 10.1007/s10067-016-3375-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/25/2022]
Abstract
Two thirds of patients with juvenile idiopathic arthritis (JIA) treated with tumor necrosis factor (TNF)-alpha inhibitors respond initially, but only about one third of patients achieve clinical remission at follow-up. We evaluated the 1-year response and long-term treatment adherence to TNF inhibitor treatment in JIA patients naive to biologics and investigated if baseline myeloid-related protein (MRP)-8/14 and C-reactive protein (CRP) were predictive of treatment response. One hundred fifty-two patients were included in a unicenter observational, prospective study from 2002 to 2015, excluding patients with systemic-onset JIA. One-year treatment response was evaluated by American College of Rheumatology-pediatric (ACR-ped) and by the number of patients achieving inactive disease (ID). Medical charts were reviewed for reasons of treatment withdrawal. After one year of treatment ACR-ped 30, 50, 70, and 90 were achieved by 61, 55, 38, and 10 % of the patients, and 23 % achieved a status of ID. Treatment adherence: 51 % withdrew from treatment due to lack of clinical effect, while 32 % continued treatment or withdrew due to disease remission. Increased MRP-8/14 concentrations at treatment initiation was associated with ID after 1 year (OR 1.55, CI 1.06-2.25, p = 0.02). Treatment withdrawal due to lack of effect was associated with low baseline levels of both MRP-8/14 (685 vs. 1235 ng/ml, p < 0.001) and CRP (0.75 vs. 2.73 mg/l, p < 0.001), verified by multivariable logistic regression analysis (OR 0.51, CI 0.34-0.77/OR 0.63, CI 0.48-0.83). In conclusion, an association was found between ID after 1 year of treatment and increased baseline levels of MRP-8/14. Furthermore, low baseline MRP-8/14 and CRP concentrations were associated with treatment withdrawal due to lack of clinical effect.
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Affiliation(s)
- Mikel Alberdi-Saugstrup
- Department of Pediatrics, Naestved Hospital, Naestved, Denmark.
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
- Institute for Inflammation Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Susan Nielsen
- Department of Pediatrics, Naestved Hospital, Naestved, Denmark
| | - Pernille Mathiessen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claus Henrik Nielsen
- Institute for Inflammation Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Klaus Müller
- Department of Pediatrics, Naestved Hospital, Naestved, Denmark
- Institute for Inflammation Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Giancane G, Consolaro A, Lanni S, Davì S, Schiappapietra B, Ravelli A. Juvenile Idiopathic Arthritis: Diagnosis and Treatment. Rheumatol Ther 2016; 3:187-207. [PMID: 27747582 PMCID: PMC5127964 DOI: 10.1007/s40744-016-0040-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Indexed: 12/20/2022] Open
Abstract
Juvenile idiopathic arthritis is a broad term that describes a clinically heterogeneous group of arthritides of unknown cause, which begin before 16 years of age. This term encompasses several disease categories, each of which has distinct presentation, clinical manifestations, and, presumably, genetic background and etiopathogenesis. Although none of the available drugs has curative potential, prognosis has greatly improved as a result of substantial progresses in disease management. The most important new development has been the introduction of the biologic medications, which constitute a valuable treatment option for patients who are resistant to conventional antirheumatic agents. Further insights into the disease pathogenesis and treatment will be provided by the continuous advances in understanding of the mechanisms related to the immune response and inflammatory process, and by the development of new drugs that are capable of selectively inhibiting single molecules or pathways.
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Affiliation(s)
- Gabriella Giancane
- Istituto Giannina Gaslini, Genoa, Italy.,Università degli Studi di Genova, Genoa, Italy
| | - Alessandro Consolaro
- Istituto Giannina Gaslini, Genoa, Italy.,Università degli Studi di Genova, Genoa, Italy
| | | | | | | | - Angelo Ravelli
- Istituto Giannina Gaslini, Genoa, Italy. .,Università degli Studi di Genova, Genoa, Italy.
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Pruenster M, Vogl T, Roth J, Sperandio M. S100A8/A9: From basic science to clinical application. Pharmacol Ther 2016; 167:120-131. [PMID: 27492899 DOI: 10.1016/j.pharmthera.2016.07.015] [Citation(s) in RCA: 251] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 07/20/2016] [Indexed: 12/15/2022]
Abstract
Neutrophils and monocytes belong to the first line of immune defence cells and are recruited to sites of inflammation during infection or sterile injury. Both cells contain huge amounts of the heterodimeric protein S100A8/A9 in their cytoplasm. S100A8/A9 belongs to the Ca2+ binding S100 protein family and has recently gained a lot of interest as a critical alarmin modulating the inflammatory response after its release (extracellular S100A8/A9) from neutrophils and monocytes. Extracellular S100A8/A9 interacts with the pattern recognition receptors Toll-like receptor 4 (TLR4) and Receptor for Advanced Glycation Endproducts (RAGE) promoting cell activation and recruitment. Besides its biological function, S100A8/A9 (also known as myeloid related protein 8/14, MRP8/14) was identified as interesting biomarker to monitor disease activity in chronic inflammatory disorders including inflammatory bowel disease and rheumatoid arthritis. Furthermore, S100A8/A9 has been tested successfully in pre-clinical imaging studies to localize sites of infection or sterile injury. Finally, recent evidence using small molecule inhibitors for S100A8/A9 also suggests that blocking S100A8/A9 activity exerts beneficial effects on disease activity in animal models of autoimmune diseases including multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis and inflammatory bowel disease. This review will provide a comprehensive and detailed overview into the structure and biological function of S100A8/A9 and also will give an outlook in terms of diagnostic and therapeutic applications targeting S100A8/A9.
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Affiliation(s)
- Monika Pruenster
- Walter Brendel Center of Experimental Medicine, Ludwig-Maximilians Universität, Munich, Germany
| | - Thomas Vogl
- Institute of Immunology, University of Muenster, Muenster, Germany
| | - Johannes Roth
- Institute of Immunology, University of Muenster, Muenster, Germany
| | - Markus Sperandio
- Walter Brendel Center of Experimental Medicine, Ludwig-Maximilians Universität, Munich, Germany.
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Gohar F, Kessel C, Lavric M, Holzinger D, Foell D. Review of biomarkers in systemic juvenile idiopathic arthritis: helpful tools or just playing tricks? Arthritis Res Ther 2016; 18:163. [PMID: 27411444 PMCID: PMC4944486 DOI: 10.1186/s13075-016-1069-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 06/29/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Diagnosing systemic juvenile idiopathic arthritis (SJIA) can be extremely challenging if typical arthritis is lacking. A variety of biomarkers have been described for the diagnosis and management of SJIA. However, very few markers have been well-validated. In addition, increasing numbers of biomarkers are identified by high throughput or multi-marker panels. METHOD We identified diagnostic or prognostic biomarkers by systematic literature review, evaluating each according to a predefined level of verification, validation or clinical utility. Diagnostic biomarkers were those identifying SJIA versus (1) non-SJIA conditions or healthy controls (HC) or (2) other non-systemic JIA subtypes. Prognostic biomarkers were those specifically tested for the prediction of (1) disease flare, (2) increased disease activity +/- discrimination of active versus inactive disease, or (3) macrophage activation syndrome (MAS). RESULTS Fifty-five studies fulfilled the inclusion criteria identifying 68 unique biomarkers, of which 50/68 (74 %) were investigated by only a single research group. Candidate marker verification and clinical utility was evaluated according to whether markers were readily and reliably measurable, investigated by independent study groups, discovered by more than one method (i.e. verified markers) and validated in independent cohorts. This evaluation revealed diagnostic biomarkers of high interest for further evaluation in the diagnostic approach to SJIA that included heme oxygenase-1, interleukin-6 (IL-6), IL-12, IL-18, osteoprotegerin, S100 calcium-binding protein A12 (S100A12) and S100A8/A9. CONCLUSION In summary, a number of biomarkers were identified, though most had limited evidence for their use. However, our findings combined with the identified studies could inform validation studies, whether in single or multi-marker assays, which are urgently needed.
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Affiliation(s)
- Faekah Gohar
- Department of Paediatric Rheumatology and Immunology, University of Münster, Domagkstraße 3, D-48149, Münster, Germany
| | - Christoph Kessel
- Department of Paediatric Rheumatology and Immunology, University of Münster, Domagkstraße 3, D-48149, Münster, Germany
| | - Miha Lavric
- Department of Paediatric Rheumatology and Immunology, University of Münster, Domagkstraße 3, D-48149, Münster, Germany
| | - Dirk Holzinger
- Department of Paediatric Rheumatology and Immunology, University of Münster, Domagkstraße 3, D-48149, Münster, Germany
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, University of Münster, Domagkstraße 3, D-48149, Münster, Germany.
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Soliman AF, Elnady BM, Shaker RHM, Mansour AI. Potential role of calprotectin as a monitoring biomarker for clinical and sonographic activity and treatment outcome in recent-onset rheumatoid arthritis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2016. [DOI: 10.4103/1110-161x.189824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Draibe JB, Fulladosa X, Cruzado JM, Torras J, Salama AD. Current and novel biomarkers in anti-neutrophil cytoplasm-associated vasculitis. Clin Kidney J 2016; 9:547-51. [PMID: 27478594 PMCID: PMC4957731 DOI: 10.1093/ckj/sfw056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 05/31/2016] [Indexed: 12/15/2022] Open
Abstract
Anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) is characterized by a variable disease course, with up to 50% of patients having one relapse within 5 years and many progressing to end-stage organ damage despite modern treatment strategies. Moreover, complications arising from treatment dominate the causes of mortality and morbidity both early and late during disease, especially in the elderly and those with severe renal involvement, and there is additional uncertainty as to how long treatment should be continued. There is, therefore, an urgent clinical need to identify robust biomarkers to better predict treatment responses, risk of disease relapse and eventual complete clinical and immunological quiescence. To date, no such biomarkers exist, but better understanding of disease pathogenesis and the underlying immune dysfunction has provided some potential candidates linked to the discovery of new antibodies, different leukocyte activation states, the role of the alternative complement pathway and markers of vascular activation. With all promising new biomarkers, there is the need to rapidly replicate and validate early findings using large biobanks of samples that could be brought together by leaders in the field.
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Affiliation(s)
| | - Xavier Fulladosa
- Nephrology Department , Hospital Universitari de Bellvitge , Barcelona , Spain
| | - Josep Maria Cruzado
- Nephrology Department , Hospital Universitari de Bellvitge , Barcelona , Spain
| | - Joan Torras
- Nephrology Department , Hospital Universitari de Bellvitge , Barcelona , Spain
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Kahn R, Berthold E, Gullstrand B, Schmidt T, Kahn F, Geborek P, Saxne T, Bengtsson AA, Månsson B. Circulating complexes between tumour necrosis factor-alpha and etanercept predict long-term efficacy of etanercept in juvenile idiopathic arthritis. Acta Paediatr 2016; 105:427-32. [PMID: 26707699 PMCID: PMC5066673 DOI: 10.1111/apa.13319] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 11/24/2015] [Accepted: 12/18/2015] [Indexed: 01/17/2023]
Abstract
Aim The relationship between tumour necrosis factor‐alpha (TNF‐α) and drug survival had not been studied in juvenile idiopathic arthritis (JIA), and there were no laboratory tests to predict the long‐term efficacy of biological drugs for JIA. We studied whether serum levels of TNF‐α, free or bound to etanercept, could predict long‐term efficacy of etanercept in children with JIA. Methods We included 41 biologic‐naïve patients with JIA who started treatment with etanercept at Skåne University Hospital between 1999 and 2010. Serum taken at the start of treatment and at the six‐week follow‐up were analysed for TNF‐α and the long‐term efficacy of etanercept was assessed using the drug survival time. Results Levels of TNF‐α increased significantly at the six‐week follow‐up, and this was almost exclusively comprised of TNF‐α in complex with etanercept. The increase in TNF‐α showed a dose‐dependent correlation to long‐term drug survival (p < 0.01). Conclusion Increasing levels of circulating TNF‐α at treatment initiation predicted long‐term efficacy of etanercept in children with JIA, which may have been due to different pathophysiological mechanisms of inflammation. Our result may provide a helpful clinical tool, as high levels of circulating TNF‐α/etanercept complexes could be used as a marker for the long‐term efficacy of etanercept.
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Affiliation(s)
- Robin Kahn
- Department of Pediatrics Clinical Sciences Lund Lund University and Skåne University Hospital Lund Sweden
| | - Elisabet Berthold
- Department of Rheumatology Clinical Sciences Lund Lund University and Skåne University Hospital Lund Sweden
| | - Birgitta Gullstrand
- Department of Rheumatology Clinical Sciences Lund Lund University and Skåne University Hospital Lund Sweden
| | - Tobias Schmidt
- Department of Pediatrics Clinical Sciences Lund Lund University and Skåne University Hospital Lund Sweden
| | - Fredrik Kahn
- Department of Infection Medicine Clinical Sciences Lund Lund University and Skåne University Hospital Lund Sweden
| | - Pierre Geborek
- Department of Rheumatology Clinical Sciences Lund Lund University and Skåne University Hospital Lund Sweden
| | - Tore Saxne
- Department of Rheumatology Clinical Sciences Lund Lund University and Skåne University Hospital Lund Sweden
| | - Anders A. Bengtsson
- Department of Rheumatology Clinical Sciences Lund Lund University and Skåne University Hospital Lund Sweden
| | - Bengt Månsson
- Department of Rheumatology Clinical Sciences Lund Lund University and Skåne University Hospital Lund Sweden
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Nair SC, Welsing PMJ, Choi IYK, Roth J, Holzinger D, Bijlsma JWJ, van Laar JM, Gerlag DM, Lafeber FPJG, Tak PP. A Personalized Approach to Biological Therapy Using Prediction of Clinical Response Based on MRP8/14 Serum Complex Levels in Rheumatoid Arthritis Patients. PLoS One 2016; 11:e0152362. [PMID: 27029006 PMCID: PMC4814133 DOI: 10.1371/journal.pone.0152362] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/13/2016] [Indexed: 02/02/2023] Open
Abstract
Objectives Measurement of MRP8/14 serum levels has shown potential in predicting clinical response to different biological agents in rheumatoid arthritis (RA). We aimed to develop a treatment algorithm based on a prediction score using MRP8/14 measurements and clinical parameters predictive for response to different biological agents. Methods Baseline serum levels of MRP8/14 were measured in 170 patients starting treatment with infliximab, adalimumab or rituximab. We used logistic regression analysis to develop a predictive score for clinical response at 16 weeks. MRP8/14 levels along with clinical variables at baseline were investigated. We also investigated how the predictive effect of MRP8/14 was modified by drug type. A treatment algorithm was developed based on categorizing the expected response per drug type as high, intermediate or low for each patient and optimal treatment was defined. Finally, we present the utility of using this treatment algorithm in clinical practice. Results The probability of response increased with higher baseline MRP8/14 complex levels (OR = 1.39), differentially between the TNF-blockers and rituximab (OR of interaction term = 0.78), and also increased with higher DAS28 at baseline (OR = 1.28). Rheumatoid factor positivity, functional disability (a higher HAQ), and previous use of a TNF-inhibitor decreased the probability of response. Based on the treatment algorithm 80 patients would have been recommended for anti-TNF treatment, 8 for rituximab, 13 for another biological treatment (other than TNFi or rituximab) and for 69 no recommendation was made. The predicted response rates matched the observed response in the cohort well. On group level the predicted response based on the algorithm resulted in a modest 10% higher response rate in our cohort with much higher differences in response probability in individual patients treated contrary to treatment recommendation. Conclusions Prediction of response using MRP8/14 levels along with clinical predictors has potential in personalizing treatment for RA patients starting biological anti-rheumatic treatment, and might increase cost-effectiveness.
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Affiliation(s)
- S. C. Nair
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands
- * E-mail:
| | - P. M. J. Welsing
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands
| | - I. Y. K. Choi
- Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - J. Roth
- Institute of Immunology, University Hospital Muenster, Muenster, Germany
| | - D. Holzinger
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany
| | - J. W. J. Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands
| | - J. M. van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands
| | - D. M. Gerlag
- Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - F. P. J. G. Lafeber
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands
| | - P. P. Tak
- Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
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Patro PS, Singh A, Misra R, Aggarwal A. Myeloid-related Protein 8/14 Levels in Rheumatoid Arthritis: Marker of Disease Activity and Response to Methotrexate. J Rheumatol 2016; 43:731-7. [DOI: 10.3899/jrheum.150998] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2015] [Indexed: 12/25/2022]
Abstract
Objective.Myeloid-related proteins (MRP) 8/14 belong to a family of calcium-binding proteins produced by myeloid cells. Baseline serum levels of MRP8/14 have been shown to predict response to biologicals in rheumatoid arthritis (RA). Because methotrexate (MTX) is the first-line therapy in RA, we studied whether MRP8/14 levels can predict response to MTX.Methods.Patients with active RA disease who were naive to disease-modifying antirheumatic drugs were enrolled. All patients were treated with MTX only, to a maximum of 25 mg/week or the maximal tolerated dose. At 4 months, the European League Against Rheumatism response was assessed. All patients who needed rescue therapy after 2 months or who did not respond at 4 months were classified as nonresponders.Results.Ninety patients were enrolled, of whom 3 discontinued MTX within 4–6 weeks, so 87 patients were analyzed [74 women, median (interquartile range; IQR) for the Disease Activity Score at 28 joints (DAS28) was 4.43 (4.1–5.1)]. The median (IQR) serum MRP8/14 level at baseline was 19.95 µg/ml (11.49–39.06). The serum MRP8/14 had good correlation with DAS28-C-reactive protein (CRP; r = 0.35, p = 0.001). The MRP8/14 levels fell significantly after 4 months of treatment (10.28 µg/ml, 5.95–16.05, p < 0.001). Among 87 patients, 69 were responders. The median (IQR) baseline level of MRP8/14 was higher among responders compared with nonresponders: 23.99 µg/ml (15.39–42.75) versus 9.58 µg/ml (6.11–24.93, p = 0.00250). The levels declined in the responders, from 23.99 µg/ml (15.39–42.75) to 10.41 µg/ml (5.83–15.61, p < 0.001), but not in the nonresponders, from 9.58 µg/ml (6.11–24.93) to 9.19 µg/ml (7.74–21.96, p = 0.687). Receiver-operation characteristic analysis showed that MRP8/14 was a better predictor of response than CRP and erythrocyte sedimentation rate, especially with early disease onset (< 1-yr duration).Conclusion.MRP8/14 is a good marker of disease activity in RA, and higher levels predict response to MTX.
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Lippitz K, Waldkirch J, Kessel C, Varga G, Foell D. [Translational research in pediatric rheumatology. Current research approaches to the innate immune system]. Z Rheumatol 2016; 75:276-83. [PMID: 26800663 DOI: 10.1007/s00393-015-0040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Translational research aims at closely linking basic research and clinical observations so that important mechanistic insights identified in one field should trigger progress in the other. Particularly in the field of pediatric rheumatology this approach has significantly improved the understanding and therapy of several diseases in recent years. One focus of our research in this respect is on the structure, release mechanisms and function of damage associated molecular patterns (DAMP), particularly S100 proteins. Due to their huge potential as inflammation biomarkers for more specific diagnostics these proteins are of particular clinical interest. Overactivated cells of the innate immune system play a crucial role in the development of rheumatic diseases. Innate mechanisms, such as the generation of neutrophil extracellular traps (NETosis) were linked to the pathogenesis of inflammatory diseases, such as systemic lupus erythematosus and rheumatoid arthritis. Furthermore, it became increasingly more evident that various excessive sterile inflammatory mechanisms and reactions significantly contribute to an activation of adaptive immune responses and thus to the development of autoimmunity. Studying such potentially DAMP-dependent pathways at the interface between innate and adaptive immunity can provide a better understanding of autoinflammatory conditions in pediatric rheumatology and to identify novel targets for optimization of therapy.
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Affiliation(s)
- K Lippitz
- Klinik für Pädiatrische Rheumatologie und Immunologie, Universitätsklinikum Münster, Domagkstraße 3, 48149, Münster, Deutschland
| | - J Waldkirch
- Klinik für Pädiatrische Rheumatologie und Immunologie, Universitätsklinikum Münster, Domagkstraße 3, 48149, Münster, Deutschland
| | - C Kessel
- Klinik für Pädiatrische Rheumatologie und Immunologie, Universitätsklinikum Münster, Domagkstraße 3, 48149, Münster, Deutschland
| | - G Varga
- Klinik für Pädiatrische Rheumatologie und Immunologie, Universitätsklinikum Münster, Domagkstraße 3, 48149, Münster, Deutschland
| | - D Foell
- Klinik für Pädiatrische Rheumatologie und Immunologie, Universitätsklinikum Münster, Domagkstraße 3, 48149, Münster, Deutschland.
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Hügle B, Horneff G. The role of synthetic drugs in the biologic era: therapeutic strategies for treating juvenile idiopathic arthritis. Expert Opin Pharmacother 2016; 17:703-14. [PMID: 26678914 DOI: 10.1517/14656566.2016.1133592] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Juvenile idiopathic arthritis is the most frequent chronic rheumatic disease in childhood. Synthetic disease modifying drugs (DMARDs) have been used in its treatment since the 1980s and have led to substantial improvement of quality of life and disease outcome. Recent pharmacological research has focused on newer medications, especially biologic agents. AREAS COVERED Synthetic DMARDS, especially methotrexate, rightfully remain the first-line treatment of most categories of juvenile arthritis, as attested by several international guidelines. A substantial body of evidence supports these medications, and recent research tries to clarify their optimal use in the clinical setting, both as monotherapy and in combination with biologics. In addition, new forms of synthetic DMARDs are in the research pipeline, or are already used for rheumatoid arthritis. EXPERT OPINION Methotrexate remains the preferred first-line medication for polyarticular arthritis, with leflunomide as a viable alternative in case of intolerance or toxicity, despite lack of approval in Europe and the US. Sulfasalazine and hydroxychloroquine are used only rarely in clinical practice, considered in combination with methotrexate if biologics are not available. New synthetic DMARDS are in the research pipeline for JIA, in the form of small molecules.
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Affiliation(s)
- Boris Hügle
- a German Center for Pediatric Rheumatology , Garmisch-Partenkirchen , Germany
| | - Gerd Horneff
- b Department of Pediatrics , Asklepios Clinic Sankt Augustin , Sankt Augustin , Germany
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Funk RS, Becker ML. Disease modifying anti-rheumatic drugs in juvenile idiopathic arthritis: striving for individualized therapy. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016. [DOI: 10.1080/23808993.2016.1133234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ward TM, Yuwen W, Voss J, Foell D, Gohar F, Ringold S. Sleep Fragmentation and Biomarkers in Juvenile Idiopathic Arthritis. Biol Res Nurs 2015; 18:299-306. [PMID: 26512051 DOI: 10.1177/1099800415609997] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES (1) To compare sleep (nighttime sleep duration and sleep efficiency) and sleep fragmentation (movement and fragmentation index), as measured by actigraphy, and symptoms (pain and fatigue) in 8- to 14-year-old children with polyarticular and extended oligoarticular juvenile idiopathic arthritis (JIA) and (2) to examine the associations between sleep fragmentation (movement and fragmentation index) and the calcium-binding protein biomarkers S100A12 and myeloid-related protein (MRP8/14). METHOD Participants included 40 children with extended oligoarticular (n = 15) or polyarticular (n = 25) JIA and their parents. Serum protein samples were obtained during routine rheumatology clinic visits. Children completed the PedsQL Multidimensional Fatigue Scale and daily pain and sleep diaries and wore actigraphy monitors for 9 consecutive days. Parents completed the Children's Sleep Habits Questionnaire (CSHQ). RESULTS Of the 40 children, 68% scored above the CSHQ clinical cutoff score for sleep disturbances. Mean nighttime sleep duration was 7.5 hr, and mean sleep efficiency was 85.3%. Group differences were not found for nighttime sleep duration, sleep efficiency, movement and fragmentation index, or S100A12 and MRP8/14 protein concentrations. In a stepwise regression, medications, joint count, and movement and fragmentation index explained 21% of the variance in MRP8/14 concentration. CONCLUSION Decreased nighttime sleep duration, poor sleep efficiency, and fragmented sleep were observed in our sample, regardless of JIA category. Sleep fragmentation was a significant predictor of MRP8/14 protein concentration. Additional research is needed to understand the interrelations among sleep fragmentation, effects of medication, and S100A12 and MRP8/14 protein biomarkers in JIA.
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Affiliation(s)
- Teresa M Ward
- Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Weichao Yuwen
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Joachim Voss
- Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA, USA
| | - Dirk Foell
- Pediatric Rheumatology and Immunology, University Children's Hospital, Muenster, Germany
| | - Faekah Gohar
- Pediatric Rheumatology and Immunology, University Children's Hospital, Muenster, Germany
| | - Sarah Ringold
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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Hurnakova J, Zavada J, Hanova P, Hulejova H, Klein M, Mann H, Sleglova O, Olejarova M, Forejtova S, Ruzickova O, Komarc M, Vencovsky J, Pavelka K, Senolt L. Serum calprotectin (S100A8/9): an independent predictor of ultrasound synovitis in patients with rheumatoid arthritis. Arthritis Res Ther 2015; 17:252. [PMID: 26373925 PMCID: PMC4572609 DOI: 10.1186/s13075-015-0764-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 08/24/2015] [Indexed: 11/10/2022] Open
Abstract
Introduction Calprotectin, a heterodimeric complex of S100A8/9 (MRP8/14), has been proposed as an important serum biomarker that reflects disease activity and structural joint damage in rheumatoid arthritis (RA). The objective of this cross-sectional study was to test the hypothesis that calprotectin is associated with clinical and ultrasound-determined disease activity in patients with RA. Methods A total of 37 patients with RA (including 24 females, a mean disease duration of 20 months) underwent a clinical examination and 7-joint ultrasound score (German US-7) of the clinically dominant hand and foot to assess synovitis by grey-scale (GS) and synovial vascularity by power Doppler (PD) ultrasound using semiquantitative 0–3 grading. The levels of serum calprotectin and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were determined at the time of the ultrasound assessment. We analysed the relationship between serum calprotectin level, traditional inflammatory markers, and ultrasound-determined synovitis. Results The levels of serum calprotectin were significantly correlated with swollen joint count (r = 0.465, p < 0.005), DAS28-ESR (r = 0.430, p < 0.01), ESR (r = 0.370, p < 0.05) and, in particular, CRP (r = 0.629, p < 0.001). Calprotectin was significantly associated with GS (r = 0.359, p < 0.05) and PD synovitis scores (r = 0.497, p < 0.005). Using multivariate regression analysis, calprotectin, adjusted for age and sex, was a better predictor of PD synovitis score (R2 = 0.765, p < 0.001) than CRP (R2 = 0.496, p < 0.001). Conclusions The serum levels of calprotectin are significantly associated with clinical, laboratory and ultrasound assessments of RA disease activity. These results suggest that calprotectin might be superior to CRP for monitoring ultrasound-determined synovial inflammation in RA patients.
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Affiliation(s)
- Jana Hurnakova
- Institute of Rheumatology, Na Slupi 4, 128 05, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jakub Zavada
- Institute of Rheumatology, Na Slupi 4, 128 05, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petra Hanova
- Institute of Rheumatology, Na Slupi 4, 128 05, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Hulejova
- Institute of Rheumatology, Na Slupi 4, 128 05, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Klein
- Institute of Rheumatology, Na Slupi 4, 128 05, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Herman Mann
- Institute of Rheumatology, Na Slupi 4, 128 05, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Olga Sleglova
- Institute of Rheumatology, Na Slupi 4, 128 05, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marta Olejarova
- Institute of Rheumatology, Na Slupi 4, 128 05, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Sarka Forejtova
- Institute of Rheumatology, Na Slupi 4, 128 05, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Olga Ruzickova
- Institute of Rheumatology, Na Slupi 4, 128 05, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Komarc
- Institute of biophysics and informatics, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Vencovsky
- Institute of Rheumatology, Na Slupi 4, 128 05, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Na Slupi 4, 128 05, Prague 2, Czech Republic.,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Senolt
- Institute of Rheumatology, Na Slupi 4, 128 05, Prague 2, Czech Republic. .,Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
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Abstract
PURPOSE OF REVIEW To review recent advances in the management strategies of polyarticular course juvenile idiopathic arthritis (JIA) and identify unanswered questions and avenues for further research. RECENT FINDINGS There is evidence for an early, aggressive, treat-to-target approach for polyarticular JIA. Clinical disease activity criteria have been recently defined and validated, including criteria for inactive disease and the juvenile arthritis disease activity score (JADAS). There is a need for evidence-based, defined disease targets and biomarkers for prediction of response, including targets for remission induction, and guidelines on drug withdrawal. Recent treatment consensus plans and guidelines are discussed and compared, including the 2015 NHS England clinical policy statement, the 2014 Childhood Arthritis and Rheumatology Research Alliance (CARRA) treatment plans and the 2011 American College of Rheumatology (ACR) guidelines. Evidence for new agents such as tocilizumab, rituximab, golimumab, ustekinumab, certolizumab and tofacitinib is promising: the recent clinical trials are summarized here. Stratification of individual patient treatment remains a goal, and predictive biomarkers have been shown to predict success in the withdrawal of methotrexate therapy. SUMMARY There are promising advances in the treatment approaches, disease activity criteria, clinical guidelines, pharmaceutical choices and individually stratified therapy choices for polyarticular JIA.
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Affiliation(s)
- Kate Webb
- aDivision of Medicine, Arthritis Research UK Centre for Adolescent Rheumatology at UCL, UCLH, and GOSH, University College London bInstitute of Child Health UCL, University College London, London, UK
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Anink J, Van Suijlekom-Smit LWA, Otten MH, Prince FHM, van Rossum MAJ, Dolman KM, Hoppenreijs EPAH, ten Cate R, Ursu S, Wedderburn LR, Horneff G, Frosch M, Vogl T, Gohar F, Foell D, Roth J, Holzinger D. MRP8/14 serum levels as a predictor of response to starting and stopping anti-TNF treatment in juvenile idiopathic arthritis. Arthritis Res Ther 2015; 17:200. [PMID: 26249667 PMCID: PMC4528380 DOI: 10.1186/s13075-015-0723-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 07/23/2015] [Indexed: 12/02/2022] Open
Abstract
Introduction Approximately 30 % of juvenile idiopathic arthritis (JIA) patients fail to respond to anti-TNF treatment. When clinical remission is induced, some patients relapse after treatment has been stopped. We tested the predictive value of MRP8/14 serum levels to identify responders to treatment and relapse after discontinuation of therapy. Methods Samples from 88 non-systemic JIA patients who started and 26 patients who discontinued TNF-blockers were analyzed. MRP8/14 serum levels were measured by in-house MRP8/14 ELISA and by Bühlmann Calprotectin ELISA at start of anti-TNF treatment, within 6 months after start and at discontinuation of etanercept in clinical remission. Patients were categorized into responders (ACRpedi ≥ 50 and/or inactive disease) and non-responders (ACRpedi < 50) within six months after start, response was evaluated by change in JADAS-10. Disease activity was assessed within six months after discontinuation. Results Baseline MRP8/14 levels were higher in responders (median MRP8/14 of 1466 ng/ml (IQR 1045–3170)) compared to non-responders (median MRP8/14 of 812 (IQR 570–1178), p < 0.001). Levels decreased after start of treatment only in responders (p < 0.001). Change in JADAS-10 was correlated with baseline MRP8/14 levels (Spearman’s rho 0.361, p = 0.001). Patients who flared within 6 months after treatment discontinuation had higher MRP8/14 levels (p = 0.031, median 1025 ng/ml (IQR 588–1288)) compared to patients with stable remission (505 ng/ml (IQR 346–778)). Results were confirmed by Bühlmann ELISA with high reproducibility but different overall levels. Conclusion High levels of baseline MRP8/14 are associated with good response to anti-TNF treatment, whereas elevated MRP8/14 levels at discontinuation of etanercept are associated with higher chance to flare. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0723-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Janneke Anink
- Department of Pediatrics/ Pediatric Rheumatology, Erasmus MC Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands.
| | - Lisette W A Van Suijlekom-Smit
- Department of Pediatrics/ Pediatric Rheumatology, Erasmus MC Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands.
| | - Marieke H Otten
- Department of Pediatrics/ Pediatric Rheumatology, Erasmus MC Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands.
| | - Femke H M Prince
- Department of Pediatrics/ Pediatric Rheumatology, Erasmus MC Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands.
| | - Marion A J van Rossum
- Department of Pediatrics/ Pediatric Rheumatology Academic Medical Centre Emma Children's Hospital and Reade location Jan van Breemen, Amsterdam, The Netherlands.
| | - Koert M Dolman
- Sint Lucas Andreas Hospital and Reade location Jan van Breemen, Amsterdam, The Netherlands.
| | | | | | - Simona Ursu
- Infection, Immunity, Inflammation and Physiological Medicine Programme UCL Institute of Child Health, University College London, London, UK.
| | - Lucy R Wedderburn
- Infection, Immunity, Inflammation and Physiological Medicine Programme UCL Institute of Child Health, University College London, London, UK.
| | - Gerd Horneff
- Centre of Pediatric Rheumatology, Department of General Pediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany.
| | - Michael Frosch
- German Pediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.
| | - Thomas Vogl
- Institute of Immunology, University Hospital Muenster and Interdisciplinary Centre for Clinical Research IZKF, University Hospital Muenster, Muenster, Germany.
| | - Faekah Gohar
- Interdisciplinary Centre for Clinical Research IZKF, University Hospital Muenster, Muenster and Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany.
| | - Dirk Foell
- Interdisciplinary Centre for Clinical Research IZKF, University Hospital Muenster, Muenster and Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany.
| | - Johannes Roth
- Institute of Immunology, University Hospital Muenster and Interdisciplinary Centre for Clinical Research IZKF, University Hospital Muenster, Muenster, Germany.
| | - Dirk Holzinger
- Interdisciplinary Centre for Clinical Research IZKF, University Hospital Muenster, Muenster and Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, Germany.
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Lerman MA, Lewen MD, Kempen JH, Mills MD. Uveitis Reactivation in Children Treated With Tumor Necrosis Factor Alpha Inhibitors. Am J Ophthalmol 2015; 160:193-200.e1. [PMID: 25892124 DOI: 10.1016/j.ajo.2015.04.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate reactivation of pediatric uveitis during/following treatment with tumor necrosis factor alpha inhibition (anti-TNFα). DESIGN Retrospective cohort study. METHODS We assessed the incidence of uveitis reactivation in children ≤18 years who had achieved uveitis quiescence under anti-TNFα. Survival analysis was used to calculate reactivation rates while still on (primary outcome), and following discontinuation of (secondary outcome), anti-TNFα. Potential predictive factors were assessed. RESULTS Among 50 children observed to develop quiescence of uveitis under anti-TNFα, 39 met criteria to be "at risk" of the primary (19 for the secondary) outcome. 60% were female, ∼half had juvenile idiopathic arthritis, and most were treated with infliximab. Overall, the estimated proportion relapsing within 12 months was 27.8% (95% confidence interval [CI]: 15.9%-45.8%); the estimated probability of reactivation was higher following (63.8% [95% CI: 38.9%-87.7%]) vs before (21.6% [95% CI: 10.8%-40.2%]) anti-TNFα discontinuation. Among those who discontinued anti-TNFα, the likelihood of reactivation was higher for those treated with adalimumab vs infliximab (hazard ratio [HR] 13.4, P = .01, 95% CI: 2.2-82.5) and those with older age at uveitis onset (HR 1.3, P = .09, 95% CI: 1.0-1.7). The duration of suppression, on medication, did not significantly affect the likelihood of reactivation when quiescence was maintained for ≥1.5 years. CONCLUSIONS Approximately 75% of children remaining on anti-TNFα following achievement of uveitis quiescence remain quiescent at 1 year. However, most reactivate following anti-TNFα discontinuation. These results suggest that infliximab more often is followed by remission, off medication, than adalimumab. The data do not suggest that maintenance of suppression for more than 1.5 years decreases the reactivation risk.
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Chang CY, Meyer RML, Reiff AO. Impact of medication withdrawal method on flare-free survival in patients with juvenile idiopathic arthritis on combination therapy. Arthritis Care Res (Hoboken) 2015; 67:658-66. [PMID: 25220674 DOI: 10.1002/acr.22477] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/05/2014] [Accepted: 09/09/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine whether order of medication withdrawal in children with juvenile idiopathic arthritis (JIA) taking methotrexate (MTX) and tumor necrosis factor inhibitor (TNFi) combination therapy (CBT) affects flare-free survival (FFS). METHODS This retrospective observational study of 335 patients with polyarticular JIA or enthesitis-related arthritis analyzed FFS off medications in 4 withdrawal arms: 1) TNFi plus MTX, off MTX first, 2) TNFi plus MTX, off TNFi first, 3) MTX monotherapy, or 4) TNFi monotherapy. Outcomes were evaluated based on order of medication withdrawal, clinical presentation, serologic parameters, and duration of clinically inactive disease (CID) while taking medications. RESULTS Sixty-four percent of all patients achieved CID. However, 89% of patients on CBT who withdrew TNFi first flared within 12 months despite continuing MTX, compared to 12% of those who withdrew MTX and continued TNFi (P < 0.0005). Twenty-seven percent of patients discontinued all medications, but 63% flared within 12 months, and only 49% of these regained CID within 12 months of restarting therapy. Patients on MTX monotherapy had the best FFS after medication withdrawal. FFS was independent of disease subtype, rheumatoid factor status, initial erythrocyte sedimentation rate, initial joint count, corticosteroid exposure, time in CID, and method of medication discontinuation. CONCLUSION This study confirms that flare rates in JIA are high, and discontinuing medications is challenging. Withdrawal of TNFi from CBT first carries a significantly higher risk of disease flare than withdrawing MTX first. The high relapse rate after discontinuation of TNFi suggests that these medications may not modify the underlying disease process.
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From bench to bedside and back again: translational research in autoinflammation. Nat Rev Rheumatol 2015; 11:573-85. [PMID: 26077920 DOI: 10.1038/nrrheum.2015.79] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Translational research approaches brought major changes to the understanding and treatment options of autoinflammatory diseases. Patients with common complex multifactorial diseases such as systemic-onset juvenile idiopathic arthritis (sJIA), and particularly those with rare monogenic autoinflammatory diseases such as cryopyrin-associated periodic syndromes (CAPS) or TNF receptor-associated periodic syndrome (TRAPS), benefited from a deeper understanding of the pathophysiological mechanisms and new treatment options emerging from preclinical studies. The study of IL-1 and IL-6 in this context led to novel therapies by forward translation. Conversely, effective treatment of sJIA and TRAPS with IL-1 blockade stimulated reverse translational efforts to study the pathophysiology of these cytokines in autoinflammatory diseases. These translational efforts led to the discovery of biomarkers such as S100 proteins, IL-18 or serum amyloid A, which are components of the inflammatory process, support diagnosis and allow for monitoring of disease activity, helping to predict patient outcomes. The ongoing characterization of autoinflammatory diseases in individual patients has led to classification into heterogeneous subgroups. Further characterization of relevant subgroups and the design of tailored treatment regimens, as well as the identification of new therapeutic targets and treatment options, are the major future challenges in the field of autoinflammatory diseases, particularly for paediatric rheumatologists.
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Guzman J, Oen K, Huber AM, Watanabe Duffy K, Boire G, Shiff N, Berard RA, Levy DM, Stringer E, Scuccimarri R, Morishita K, Johnson N, Cabral DA, Rosenberg AM, Larché M, Dancey P, Petty RE, Laxer RM, Silverman E, Miettunen P, Chetaille AL, Haddad E, Houghton K, Spiegel L, Turvey SE, Schmeling H, Lang B, Ellsworth J, Ramsey SE, Bruns A, Roth J, Campillo S, Benseler S, Chédeville G, Schneider R, Tse SML, Bolaria R, Gross K, Feldman B, Feldman D, Cameron B, Jurencak R, Dorval J, LeBlanc C, St Cyr C, Gibbon M, Yeung RSM, Duffy CM, Tucker LB. The risk and nature of flares in juvenile idiopathic arthritis: results from the ReACCh-Out cohort. Ann Rheum Dis 2015; 75:1092-8. [PMID: 25985972 DOI: 10.1136/annrheumdis-2014-207164] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/01/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe probabilities and characteristics of disease flares in children with juvenile idiopathic arthritis (JIA) and to identify clinical features associated with an increased risk of flare. METHODS We studied children in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) prospective inception cohort. A flare was defined as a recurrence of disease manifestations after attaining inactive disease and was called significant if it required intensification of treatment. Probability of first flare was calculated with Kaplan-Meier methods, and associated features were identified using Cox regression. RESULTS 1146 children were followed up a median of 24 months after attaining inactive disease. We observed 627 first flares (54.7% of patients) with median active joint count of 1, physician global assessment (PGA) of 12 mm and duration of 27 weeks. Within a year after attaining inactive disease, the probability of flare was 42.5% (95% CI 39% to 46%) for any flare and 26.6% (24% to 30%) for a significant flare. Within a year after stopping treatment, it was 31.7% (28% to 36%) and 25.0% (21% to 29%), respectively. A maximum PGA >30 mm, maximum active joint count >4, rheumatoid factor (RF)-positive polyarthritis, antinuclear antibodies (ANA) and receiving disease-modifying antirheumatic drugs (DMARDs) or biological agents before attaining inactive disease were associated with increased risk of flare. Systemic JIA was associated with the lowest risk of flare. CONCLUSIONS In this real-practice JIA cohort, flares were frequent, usually involved a few swollen joints for an average of 6 months and 60% led to treatment intensification. Children with a severe disease course had an increased risk of flare.
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Affiliation(s)
- Jaime Guzman
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Kiem Oen
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karen Watanabe Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Gilles Boire
- Centre Hospitalier Universitaire de Sherbrooke and Departments of Medicine and Pediatrics, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Natalie Shiff
- Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Roberta A Berard
- London Health Sciences Centre and Western University, London, Ontario, Canada
| | - Deborah M Levy
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Stringer
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rosie Scuccimarri
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Kimberly Morishita
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Johnson
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - David A Cabral
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Alan M Rosenberg
- Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Maggie Larché
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland, Canada
| | - Ross E Petty
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Ronald M Laxer
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Earl Silverman
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Paivi Miettunen
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Anne-Laure Chetaille
- Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Québec, Canada
| | - Elie Haddad
- Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Québec, Canada
| | - Kristin Houghton
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Lynn Spiegel
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Stuart E Turvey
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Heinrike Schmeling
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janet Ellsworth
- Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada
| | - Suzanne E Ramsey
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alessandra Bruns
- Centre Hospitalier Universitaire de Sherbrooke and Departments of Medicine and Pediatrics, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Johannes Roth
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Campillo
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Susanne Benseler
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Gaëlle Chédeville
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Rayfel Schneider
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Shirley M L Tse
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Roxana Bolaria
- Department of Pediatrics University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Gross
- Department of Pediatrics University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Feldman
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | | | - Bonnie Cameron
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Roman Jurencak
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Jean Dorval
- Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Québec, Canada
| | - Claire LeBlanc
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Claire St Cyr
- Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Québec, Canada
| | - Michele Gibbon
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Rae S M Yeung
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Ciarán M Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Lori B Tucker
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
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Niehues T. Optimizing treatment in paediatric rheumatology--lessons from oncology. Nat Rev Rheumatol 2015; 11:493-9. [PMID: 25900208 DOI: 10.1038/nrrheum.2015.50] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Treatment of children with cancer, in particular with acute lymphoblastic leukaemia (ALL), has been highly successful in the past two decades owing to the implementation of treatment optimization studies. Study centres appointed by scientific societies design treatment optimization study protocols (TOSPs) that address an investigator-initiated research question and detail treatment procedures according to these aims. Nearly all children with malignant diseases are treated within TOSPs, whereas children with juvenile idiopathic arthritis (JIA) and other common paediatric rheumatic diseases are mostly treated outside TOSPs and clinical trials. Despite the differences in natural course and prognosis between malignant and inflammatory diseases, aiming for the recruitment of all children with defined rheumatic diseases into TOSPs or similar protocols would enable the longitudinal collection of crucial clinical data and improve evidence-based approaches. Successful research networks already exist in paediatric rheumatology that could facilitate the implementation of this approach. Paediatric rheumatic diseases have a considerable impact on patients and their families; thus, I propose that research networks in paediatric rheumatology should recruit most--if not all--children with rheumatic diseases into study protocols with standardized treatment and outcome measures.
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Affiliation(s)
- Tim Niehues
- HELIOS Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
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126
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Bulatović Ćalasan M, Vastert SJ, Scholman RC, Verweij F, Klein M, Wulffraat NM, Prakken BJ, van Wijk F. Methotrexate treatment affects effector but not regulatory T cells in juvenile idiopathic arthritis. Rheumatology (Oxford) 2015; 54:1724-34. [PMID: 25877908 DOI: 10.1093/rheumatology/kev101] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The balance between Treg and effector T cells (Teff) is crucial for immune regulation in JIA. How MTX, the cornerstone treatment in JIA, influences this balance in vivo is poorly elucidated. The aim of this study was to investigate quantitative and qualitative effects of MTX on Treg and Teff in JIA patients during MTX treatment. METHODS Peripheral blood samples were obtained from JIA patients at the start of MTX and 3 and 6 months thereafter. Treg numbers and phenotypes were determined by flow cytometry and suppressive function in allogeneic suppression assays. Teff proliferation upon stimulation with anti-CD3, activation status and intracellular cytokine production were determined by flow cytometry. Effector cell responsiveness to suppression was investigated in autologous suppression assays. Effector cell cytokines in supernatants of proliferation and suppression assays and in plasma were measured by cytokine multiplex assay. RESULTS MTX treatment in JIA did not affect Treg phenotype and function. Instead, MTX treatment enhanced, rather than diminished, CD4(+) and CD8(+) T cell proliferation of JIA patients after 6 months of therapy, independent of clinical response. Effector cells during MTX treatment were equally responsive to Treg-mediated suppression. MTX treatment did not attenuate Teff activation status and their capacity to produce IL-13, IL-17, TNF-α and IFN-γ. Similarly to Teff proliferation, plasma IFN-γ concentrations after 6 months were increased. CONCLUSION This study provides the novel insight that MTX treatment in JIA does not attenuate Teff function but, conversely, enhances T cell proliferation and IFN-γ plasma concentrations in JIA patients.
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Affiliation(s)
- Maja Bulatović Ćalasan
- Center for Molecular and Cellular Intervention, Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sebastiaan J Vastert
- Center for Molecular and Cellular Intervention, Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Rianne C Scholman
- Center for Molecular and Cellular Intervention, Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Frederik Verweij
- Center for Molecular and Cellular Intervention, Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mark Klein
- Center for Molecular and Cellular Intervention, Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Nico M Wulffraat
- Center for Molecular and Cellular Intervention, Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Berent J Prakken
- Center for Molecular and Cellular Intervention, Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Femke van Wijk
- Center for Molecular and Cellular Intervention, Department of Pediatric Immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
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127
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Biomarker für chronisch-entzündliche Erkrankungen. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-014-3265-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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128
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Becker A, Große Hokamp N, Zenker S, Flores-Borja F, Barzcyk K, Varga G, Roth J, Geyer C, Heindel W, Bremer C, Vogl T, Eisenblaetter M. Optical in vivo imaging of the alarmin S100A9 in tumor lesions allows for estimation of the individual malignant potential by evaluation of tumor-host cell interaction. J Nucl Med 2015; 56:450-6. [PMID: 25678492 DOI: 10.2967/jnumed.114.146688] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
UNLABELLED Tumors recruit and reprogram immune cells to support tumor development and spread, the most prominent among them being of monocytic origin such as tumor-associated macrophages (TAM) or myeloid-derived suppressor cells (MDSC). The alarmin S100A8/A9 has been implicated in the induction of TAM and MDSC. We assessed S100A9 as a molecular imaging marker for the activity of tumor-associated immune cells in a syngeneic murine breast cancer model. S100A9 could serve as a surrogate marker for tumor immune crosstalk as a function of malignancy, providing a tool with the potential for both basic research in tumor immunology and clinical stratification of patients. METHODS BALB/c mice were inoculated with murine breast cancer cells of common origin but different metastatic capability. At different times during tumor development, optical imaging was performed using a S100A9-specific probe to visualize activated monocytes. To further explore the impact of tumor-educated monocytes, splenic myeloid cells were isolated from either healthy or tumor-bearing animals and injected into tumor-bearing mice. We analyzed the effect of the cell transfer on immune cell activity and tumor development. RESULTS We could prove S100A9-driven imaging to sensitively and specifically reflect monocyte activity in primary tumor lesions. The imaging results were corroborated by histology and fluorescence-activated cell sorting analyses. In a prospective experiment, S100A9 imaging proved indicative of the individual tumor growth, with excellent correlation. Moreover, we could show that the monocyte activity as depicted by S100A9 activity in the primary tumor lesion mirrored the tumor's metastatic behavior. Treatment with tumor-primed splenic monocytes induced increased tumor growth, accompanied by an augmented infiltration of activated myeloid cells (MDSC and TAM) into the tumor. The consecutive S100A9 expression as depicted by in vivo imaging was significantly increased. CONCLUSION S100A9 proved to be a sensitive and specific marker for the activity of tumor-associated immune cells. To our knowledge, S100A9 imaging represents a first in vivo imaging approach for the estimation of recruitment and activity of tumor-associated myeloid immune cells. We demonstrated the potential value of this imaging approach for prediction of local and systemic tumor development.
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Affiliation(s)
- Anne Becker
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Nils Große Hokamp
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Stefanie Zenker
- Institute of Immunology, University Hospital Münster, Münster, Germany
| | - Fabian Flores-Borja
- Richard Dimbleby Department of Cancer Research, King's College London, London, United Kingdom Breakthrough Breastcancer Unit, Guy's and St. Thomas' NHS Hospital Trust, London, United Kingdom
| | - Katarzyna Barzcyk
- Institute of Immunology, University Hospital Münster, Münster, Germany
| | - Georg Varga
- Department of Paediatric Rheumatology and Immunology, University Hospital Münster, Münster, Germany
| | - Johannes Roth
- Institute of Immunology, University Hospital Münster, Münster, Germany Interdisciplinary Center for Clinical Research, Münster University, Münster, Germany
| | - Christiane Geyer
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany Interdisciplinary Center for Clinical Research, Münster University, Münster, Germany
| | - Walter Heindel
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Christoph Bremer
- Interdisciplinary Center for Clinical Research, Münster University, Münster, Germany Department of Radiology, St. Franziskus Hospital GmbH Münster, Münster, Germany; and
| | - Thomas Vogl
- Institute of Immunology, University Hospital Münster, Münster, Germany Interdisciplinary Center for Clinical Research, Münster University, Münster, Germany
| | - Michel Eisenblaetter
- Department of Clinical Radiology, University Hospital Münster, Münster, Germany Richard Dimbleby Department of Cancer Research, King's College London, London, United Kingdom Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
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Heiligenhaus A, Minden K, Föll D, Pleyer U. Uveitis in juvenile idiopathic arthritis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:92-100, i. [PMID: 25721436 PMCID: PMC4349966 DOI: 10.3238/arztebl.2015.0092] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/30/2014] [Accepted: 10/30/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is the most common systemic disease causing uveitis in childhood, with a prevalence of 10 per 100 000 persons. JIA often takes a severe inflammatory course, and its complications often endanger vision. METHODS This review is based on pertinent articles retrieved by a selective literature search up to 18 August 2014 and on the current interdisciplinary S2k guideline on the diagnostic evaluation and anti-inflammatory treatment of juvenile idiopathic uveitis. RESULTS Uveitis arises in roughly 1 in 10 patients with JIA. Regular eye check-ups should be performed starting as soon as JIA is diagnosed. 75-80% of patients are girls; antinuclear antibodies are found in 70-90%. The risk to vision is higher if JIA begins in the preschool years. As for treatment, only a single, small-scale randomized controlled trial (RCT) and a small number of prospective trials have been published to date. Topical corticosteroids should be given as the initial treatment. Systemic immunosuppression is needed if irritation persists despite topical corticosteroids, if new complications arise, or if the topical steroids have to be given in excessively high doses or have unacceptable side effects. If the therapeutic effect remains inadequate, conventional and biological immune modulators can be given as add-on (escalation) therapy. Treatment lowers the risk of uveitis and its complications and thereby improves the prognosis for good visual function. CONCLUSION Severely affected patients should be treated in competence centers to optimize their long-term outcome. Multidisciplinary, individualized treatment is needed because of the chronic course of active inflammation and the ensuing high risk of complications that can endanger vision. Future improvements in therapy will be aided by prospective, population-based registries and by basic research on biomarkers for the prediction of disease onset, prognosis, tissue damage, and therapeutic response.
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Affiliation(s)
- Arnd Heiligenhaus
- Department of Ophthalmology, St. Franziskus Hospital, Uveitis Center, University of Duisburg-Essen
| | - Kirsten Minden
- German Rheumatism Research Centre Berlin (DRFZ), University Medicine, Berlin
| | - Dirk Föll
- Department of Pediatric Rheumatology and Immunology, University Children’s Hospital Münster
| | - Uwe Pleyer
- Department of Ophthalmology, Charité – Universitätsmedizin Berlin
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Hinze C, Gohar F, Foell D. Management of juvenile idiopathic arthritis: hitting the target. Nat Rev Rheumatol 2015; 11:290-300. [DOI: 10.1038/nrrheum.2014.212] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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131
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Prakken B, Martini A. Digging deeper for greater precision and more impact in JIA. Nat Rev Rheumatol 2015; 11:70-2. [DOI: 10.1038/nrrheum.2014.224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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133
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Clinical features of juvenile idiopathic arthritis. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
The search for biomarkers in paediatric rheumatic diseases, particularly juvenile idiopathic arthritis (JIA), childhood lupus nephritis (LN), and juvenile idiopathic inflammatory myopathies (JIIMs) is attracting increased interest. In JIA, a number of biomarkers have shown potential for predicting clinical phenotype, disease activity and severity, clinical remission and relapse, response to treatment, and disease course over time. In systemic JIA, measurement of biomarkers that reflect the degree of activation and expansion of T cells and macrophages might be helpful for detecting subclinical macrophage activation syndrome. Urine biomarkers for childhood LN hold promise for facilitating early diagnosis and improving disease monitoring and assessment of response to therapy. Myositis-specific autoantibodies define distinct serological subgroups of JIIMs, albeit with similar clinical features, responses to therapy, and prognoses. Use of biomarkers may potentially help to avoid invasive procedures, such as renal biopsy in systemic lupus erythematosus and muscle biopsy in juvenile dermatomyositis. Incorporation of effective and reliable biomarkers into routine practice might facilitate adoption of a stratified approach to investigation and management, foster the implementation of research into the design of personalized and targeted therapies, and ultimately lead to more rational and effective clinical care.
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van Dijkhuizen EHP, Wulffraat NM. Prediction of methotrexate efficacy and adverse events in patients with juvenile idiopathic arthritis: a systematic literature review. Pediatr Rheumatol Online J 2014; 12:51. [PMID: 25525416 PMCID: PMC4269851 DOI: 10.1186/1546-0096-12-51] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/03/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Methotrexate (MTX) is the cornerstone disease-modifying anti-rheumatic drug in juvenile idiopathic arthritis (JIA). In JIA, it is important to start effective treatment early to avoid long-term sequelae, such as joint damage. To accomplish this goal, it is crucial to know beforehand who is going to respond well to MTX. In addition, MTX adverse effects such as MTX intolerance occur frequently, potentially hindering its efficacy. To avoid inefficacy of an otherwise effective drug, the physician should be timely aware of these adverse events. Consequently, to optimise treatment of JIA patients with MTX, predictors for efficacy and adverse events should be used in daily clinical practice. The aim of this study was to summarise the existing knowledge about such predictors. METHODS A systematic literature search was performed in PubMed, Embase and The Cochrane Library, and 1,331 articles were identified. These were selected based on their relevance to the topic and critically appraised according to pre-defined criteria. Predictors for MTX efficacy and adverse events were extracted from the literature and tabulated. RESULTS Twenty articles were selected. The overall quality of the studies was good. For MTX efficacy, candidate predictors were antinuclear antibody positivity, the childhood health assessment questionnaire score, the myeloid-related protein 8/14 level, long-chain MTX polyglutamates, bilateral wrist involvement and some single nucleotide polymorphisms (SNPs) in the adenosine triphosphate binding cassette and solute carrier transporter gene families. For MTX adverse events, potential predictors were alanine aminotransferase and thrombocyte level and two SNPs in the γ-glutamyl hydrolase and methylenetetrahydrofolate reductase genes. However, validation of most predictors in independent cohorts was still lacking. CONCLUSIONS Interesting candidate predictors were found, especially for MTX efficacy. However, most of these were not validated. This should be the goal of future efforts. A clinically relevant way to validate the predictors is by means of creating a clinical prediction model.
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Affiliation(s)
- EH Pieter van Dijkhuizen
- Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands ,Pediatria II, Reumatologia, IRCCS G. Gaslini, Largo Gaslini, 5, 16147 Genova, Italy
| | - Nico M Wulffraat
- Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
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Fassl SK, Austermann J, Papantonopoulou O, Riemenschneider M, Xue J, Bertheloot D, Freise N, Spiekermann C, Witten A, Viemann D, Kirschnek S, Stoll M, Latz E, Schultze JL, Roth J, Vogl T. Transcriptome Assessment Reveals a Dominant Role for TLR4 in the Activation of Human Monocytes by the Alarmin MRP8. THE JOURNAL OF IMMUNOLOGY 2014; 194:575-83. [DOI: 10.4049/jimmunol.1401085] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
Use of biomarkers in clinical practice has proved extremely valuable and is a rapidly expanding field. However, despite the huge potential of biomarkers, for juvenile idiopathic arthritis (JIA) there are currently no validated paediatric biomarkers available to help with setting up a more tailored approach on which drug choice could be based, to achieve remission early in the course of disease. Early remission reduces burden of disease, limits side effects from toxic and unnecessary medication, and, most importantly, enhances quality of life. Several studies have suggested promising biomarkers: these may be a protein, cellular component, mRNA, or genetic component, for example a single nucleotide polymorphism (SNP). Here we describe recent developments in the use of biomarkers for JIA and their potential to assist in management of disease by predicting disease phenotype, severity, progression, and response to treatment, and determining when patients have reached stable remission and can safely discontinue treatment.
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138
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Wallace CA, Ringold S, Bohnsack J, Spalding SJ, Brunner HI, Milojevic D, Schanberg LE, Higgins GC, O'Neil KM, Gottlieb BS, Hsu J, Punaro MG, Kimura Y, Hendrickson A. Extension study of participants from the trial of early aggressive therapy in juvenile idiopathic arthritis. J Rheumatol 2014; 41:2459-65. [PMID: 25179849 DOI: 10.3899/jrheum.140347] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To follow children with juvenile idiopathic arthritis (JIA) who had completed at least 6 months of the TRial of Early Aggressive Therapy (TREAT) clinical study for an additional 2 years, describing safety of early aggressive treatment, disease activity, function, and duration of clinical inactive disease (CID) during followup. METHODS Children were treated as per provider's discretion. Physician, patient/parent, and laboratory measures of disease status as well as safety information were collected at clinic visits every 3 months for up to 2 years. RESULTS Forty-eight children were followed for a mean of 28 months (range 12-42) beyond the end of the TREAT study. Half of patients were in CID for > 50% of their followup time. Overall, 88% of patients achieved CID at > 1 study visit and 54% achieved clinical remission while taking medication. Six patients were in CID for the duration of the study, and, of those, 2 achieved a full year of clinical remission while not taking medication. Active disease was mild: mean physician's global assessment 2.4, active joint count 3.5, parent global evaluation 2.4, Childhood Health Assessment Questionnaire 0.32, erythrocyte sedimentation rate 19 mm/h, and morning stiffness 23 min. There were no serious adverse events or adverse events reported at grade 3 or higher of Common Terminology Criteria for Adverse Events. CONCLUSION Early aggressive therapy in this cohort of patients with polyarticular JIA who had high initial disease activity was associated with prolonged periods of CID in the majority of patients during followup. Those not in CID had low levels of disease activity.
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Affiliation(s)
- Carol A Wallace
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute.
| | - Sarah Ringold
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - John Bohnsack
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Steven J Spalding
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Hermine I Brunner
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Diana Milojevic
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Laura E Schanberg
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Gloria C Higgins
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Kathleen M O'Neil
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Beth S Gottlieb
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Joyce Hsu
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Marilynn G Punaro
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Yukiko Kimura
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Audrey Hendrickson
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
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Update on research and clinical translation on specific clinical areas: From bench to bedside: How insight in immune pathogenesis can lead to precision medicine of severe juvenile idiopathic arthritis. Best Pract Res Clin Rheumatol 2014; 28:229-46. [PMID: 24974060 DOI: 10.1016/j.berh.2014.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Despite the enormous progress in the treatment of juvenile idiopathic arthritis (JIA), innovations based on true bench-to-bedside research, performed in JIA patients, are still scarce. This chapter describes novel developments in which clinical innovations go hand in hand with basic discoveries. For the purpose of this review, we will mainly focus on developments in severe forms of JIA, most notably systemic JIA and polyarticular JIA. However, also in less severe forms of JIA, such as oligoarticular JIA, better insight will help to improve diagnosis and treatment. Facilitating the transition from bench to bedside will prove crucial for addressing the major challenges in JIA management. If successful, it will set new standards for a safe, targeted and personalized therapeutic approach for children with JIA.
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Abstract
The treatment of juvenile idiopathic arthritis (JIA) has substantially evolved over the past two decades. Research has been conducted and is ongoing on how therapies can best be utilized either as monotherapy or in combination for enhanced efficacy. The introduction of biologic therapies that selectively target specific cytokines has changed the acceptable clinical course of childhood arthritis. In addition to the development and utilization of new therapeutic agents, the pediatric rheumatology community has made vital progress toward defining disease activity, developing validated outcome measures, and establishing collaborative networks to assess both clinical outcomes and the long-term side effects related to therapeutics for juvenile arthritis. In this chapter, we will discuss the therapeutic evolution in JIA over the past two decades. Although the largest strides have been made with biologic agents, and these newer drugs have more rigorous data to support their use, select commonly used non-biologic therapies are included, with the discussion focused on more recent updated literature.
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Affiliation(s)
- Elizabeth A Kessler
- Division of Rheumatology, Department of Pediatrics, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | - Mara L Becker
- Division of Rheumatology, Department of Pediatrics, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA.
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141
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Vogl T, Eisenblätter M, Völler T, Zenker S, Hermann S, van Lent P, Faust A, Geyer C, Petersen B, Roebrock K, Schäfers M, Bremer C, Roth J. Alarmin S100A8/S100A9 as a biomarker for molecular imaging of local inflammatory activity. Nat Commun 2014; 5:4593. [PMID: 25098555 PMCID: PMC4143994 DOI: 10.1038/ncomms5593] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/03/2014] [Indexed: 12/19/2022] Open
Abstract
Inflammation has a key role in the pathogenesis of various human diseases. The early detection, localization and monitoring of inflammation are crucial for tailoring individual therapies. However, reliable biomarkers to detect local inflammatory activities and to predict disease outcome are still missing. Alarmins, which are locally released during cellular stress, are early amplifiers of inflammation. Here, using optical molecular imaging, we demonstrate that the alarmin S100A8/S100A9 serves as a sensitive local and systemic marker for the detection of even sub-clinical disease activity in inflammatory and immunological processes like irritative and allergic contact dermatitis. In a model of collagen-induced arthritis, we use S100A8/S100A9 imaging to predict the development of disease activity. Furthermore, S100A8/S100A9 can act as a very early and sensitive biomarker in experimental leishmaniasis for phagocyte activation linked to an effective Th1-response. In conclusion, the alarmin S100A8/S100A9 is a valuable and sensitive molecular target for novel imaging approaches to monitor clinically relevant inflammatory disorders on a molecular level.
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Affiliation(s)
- Thomas Vogl
- Institute of Immunology, University of Münster, 48149 Münster, Germany
- Interdisciplinary Centre for Clinical Research, University of Münster, 48149 Münster, Germany
- These authors contributed equally to this work
| | - Michel Eisenblätter
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London SE1 7EH, UK
- Department of Clinical Radiology, University of Münster, 48149 Münster, Germany
- These authors contributed equally to this work
| | - Tom Völler
- Institute of Immunology, University of Münster, 48149 Münster, Germany
| | - Stefanie Zenker
- Institute of Immunology, University of Münster, 48149 Münster, Germany
| | - Sven Hermann
- Interdisciplinary Centre for Clinical Research, University of Münster, 48149 Münster, Germany
- European Institute for Molecular Imaging, University of Münster, 48149 Münster, Germany
| | - Peter van Lent
- Department of Rheumatology, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands
| | - Andreas Faust
- European Institute for Molecular Imaging, University of Münster, 48149 Münster, Germany
| | - Christiane Geyer
- Interdisciplinary Centre for Clinical Research, University of Münster, 48149 Münster, Germany
- Department of Clinical Radiology, University of Münster, 48149 Münster, Germany
| | - Beatrix Petersen
- Institute of Immunology, University of Münster, 48149 Münster, Germany
| | - Kirsten Roebrock
- Institute of Immunology, University of Münster, 48149 Münster, Germany
- Interdisciplinary Centre for Clinical Research, University of Münster, 48149 Münster, Germany
| | - Michael Schäfers
- European Institute for Molecular Imaging, University of Münster, 48149 Münster, Germany
- Cluster of Excellence EXC 1003 ‘Cells in Motion - CiM’, University of Münster, 48149 Münster, Germany
| | - Christoph Bremer
- Interdisciplinary Centre for Clinical Research, University of Münster, 48149 Münster, Germany
- Department of Radiology, St Franziskus Hospital Münster, 48145 Münster, Germany
| | - Johannes Roth
- Institute of Immunology, University of Münster, 48149 Münster, Germany
- Interdisciplinary Centre for Clinical Research, University of Münster, 48149 Münster, Germany
- Cluster of Excellence EXC 1003 ‘Cells in Motion - CiM’, University of Münster, 48149 Münster, Germany
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van Dijkhuizen EHP, Wulffraat NM. Early predictors of prognosis in juvenile idiopathic arthritis: a systematic literature review. Ann Rheum Dis 2014; 74:1996-2005. [DOI: 10.1136/annrheumdis-2014-205265] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 05/25/2014] [Indexed: 11/04/2022]
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143
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Rothmund F, Gerss J, Ruperto N, Däbritz J, Wittkowski H, Frosch M, Wulffraat NM, Wedderburn LR, Holzinger D, Gohar F, Vastert SJ, Brik R, Job Deslandre C, Melo-Gomes JA, Saad Magalhães C, Barcellona R, Russo R, Gattorno M, Martini A, Roth J, Foell D. Validation of Relapse Risk Biomarkers for Routine Use in Patients With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2014; 66:949-55. [DOI: 10.1002/acr.22248] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 11/04/2013] [Accepted: 11/26/2013] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Nicolino Ruperto
- Istituto Giannina Gaslini, Paediatric Rheumatology International Trials Organisation; Genoa Italy
| | - Jan Däbritz
- University Children's Hospital; Munster Germany
| | | | | | | | | | - Dirk Holzinger
- University Children's Hospital and University of Munster; Munster Germany
| | | | | | | | - Chantal Job Deslandre
- Hôpital Cochin Centre de Référence National pour les Arthrites Juvéniles; Paris France
| | | | | | | | - Ricardo Russo
- Hospital de Pediatria Juan P. Garrahan; Buenos Aires Argentina
| | - Marco Gattorno
- Istituto Giannina Gaslini, Paediatric Rheumatology International Trials Organisation; Genoa Italy
| | - Alberto Martini
- Istituto Giannina Gaslini, Paediatric Rheumatology International Trials Organisation, and Università di Genova; Genoa Italy
| | | | - Dirk Foell
- University Children's Hospital and University of Munster; Munster Germany
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Bulatović Ćalasan M, Wulffraat NM. Methotrexate in juvenile idiopathic arthritis: towards tailor-made treatment. Expert Rev Clin Immunol 2014; 10:843-54. [DOI: 10.1586/1744666x.2014.916617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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145
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Holzinger D, Nippe N, Vogl T, Marketon K, Mysore V, Weinhage T, Dalbeth N, Pool B, Merriman T, Baeten D, Ives A, Busso N, Foell D, Bas S, Gabay C, Roth J. Myeloid-Related Proteins 8 and 14 Contribute to Monosodium Urate Monohydrate Crystal-Induced Inflammation in Gout. Arthritis Rheumatol 2014; 66:1327-39. [DOI: 10.1002/art.38369] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 01/14/2014] [Indexed: 12/28/2022]
Affiliation(s)
- Dirk Holzinger
- University Hospital Muenster and University Children's Hospital Muenster; Muenster Germany
| | - Nadine Nippe
- University Hospital Muenster and University of Muenster; Muenster Germany
| | - Thomas Vogl
- University Hospital Muenster; Muenster Germany
| | | | | | - Toni Weinhage
- University Children's Hospital Muenster; Muenster Germany
| | | | | | | | - Dominique Baeten
- Academic Medical Center and University of Amsterdam; Amsterdam The Netherlands
| | | | | | - Dirk Foell
- University Children's Hospital Muenster; Muenster Germany
| | - Sylvette Bas
- University Hospitals of Geneva; Geneva Switzerland
| | - Cem Gabay
- University Hospitals of Geneva; Geneva Switzerland
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Varkas G, Van Praet L, Cypers H, Elewaut D. Spondyloarthritis and inflammatory bowel disease. Comorbidity and treatment implications. Z Rheumatol 2014; 72:524-9. [PMID: 23756592 DOI: 10.1007/s00393-012-1114-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Spondyloarthritides (SpA) and inflammatory bowel disease (IBD) are chronic, idiopathic inflammatory disorders of the axial and peripheral joints and the intestinal tract, respectively, affecting up to 1 % of the population. There is clinical and genetic evidence supporting some degree of overlap between the pathogenesis of these two entities. Nevertheless, their treatment is at times conflicting. NSAIDs, although useful in SpA, are considered to be possible risk factors for flares in IBD. Moreover, etanercept, a soluble TNF receptor blocker used in SpA, is ineffective in IBD. As patients with SpA often develop microscopic gut inflammation, it is important to understand the impact on disease progression or even therapeutic response. Further research is mandatory in this regard.
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Affiliation(s)
- G Varkas
- Laboratory for Molecular Immunology and Inflammation, Department of Rheumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
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147
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Hashkes PJ, Becker ML, Cabral DA, Laxer RM, Paller AS, Rabinovich CE, Turner D, Zulian F. Methotrexate: new uses for an old drug. J Pediatr 2014; 164:231-6. [PMID: 24286573 DOI: 10.1016/j.jpeds.2013.10.029] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 09/09/2013] [Accepted: 10/11/2013] [Indexed: 02/04/2023]
Affiliation(s)
- Philip J Hashkes
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Mara L Becker
- Division of Pediatric Rheumatology, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - David A Cabral
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Ronald M Laxer
- Division of Rheumatology, The Hospital for Sick Children, Departments of Pediatrics and Medicine, University of Toronto, Toronto, ON, Canada
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Dan Turner
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
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148
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Kang KY, Woo JW, Park SH. S100A8/A9 as a biomarker for synovial inflammation and joint damage in patients with rheumatoid arthritis. Korean J Intern Med 2014; 29:12-9. [PMID: 24574827 PMCID: PMC3932383 DOI: 10.3904/kjim.2014.29.1.12] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 12/14/2013] [Indexed: 11/27/2022] Open
Abstract
S100A8 and S100A9 are major leukocyte proteins, known as damage-associated molecular patterns, found at high concentrations in the synovial fluid of patients with rheumatoid arthritis (RA). A heterodimeric complex of S100A8/A9 is secreted by activated leukocytes and binds to Toll-like receptor 4, which mediates downstream signaling and promotes inflammation and autoimmunity. Serum and synovial fluid levels of S100A8/A9 are markedly higher in patients with RA than in patients with osteoarthritis or miscellaneous inflammatory arthritis. Serum levels of S100A8/A9 are significantly correlated with clinical and laboratory markers of inflammation, such as C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor, and the Disease Activity Score for 28 joints. Significant correlations have also been found between S100A8/A9 and radiographic and clinical assessments of joint damage, such as hand radiographs and the Rheumatoid Arthritis Articular Damage score. In addition, among known inflammatory markers, S100A8/A9 has the strongest correlation with total sum scores of ultrasonography assessment. Furthermore, baseline levels of S100A8/A9 are independently associated with progression of joint destruction in longitudinal studies and are responsive to change during conventional and biologic treatments. These findings suggest S100A8/A9 to be a valuable diagnostic and prognostic biomarker for RA.
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Affiliation(s)
- Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Jung-Won Woo
- Department of Convergent Research Consortium for Immunologic Disease, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
- Business Development, Genexine Inc., Seongnam, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
- Department of Convergent Research Consortium for Immunologic Disease, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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149
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Choi IY, Gerlag DM, Herenius MJ, Thurlings RM, Wijbrandts CA, Foell D, Vogl T, Roth J, Tak PP, Holzinger D. MRP8/14 serum levels as a strong predictor of response to biological treatments in patients with rheumatoid arthritis. Ann Rheum Dis 2013; 74:499-505. [DOI: 10.1136/annrheumdis-2013-203923] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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150
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Ćalasan MB, den Boer E, de Rotte MCFJ, Vastert SJ, Kamphuis S, de Jonge R, Wulffraat NM. Methotrexate polyglutamates in erythrocytes are associated with lower disease activity in juvenile idiopathic arthritis patients. Ann Rheum Dis 2013; 74:402-7. [PMID: 24288013 DOI: 10.1136/annrheumdis-2013-203723] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine association of erythrocyte methotrexate polyglutamates (MTX-PG) with disease activity and adverse effects in a prospective juvenile idiopathic arthritis (JIA) cohort. METHODS One hundred and thirteen JIA patients were followed from MTX start until 12 months. Erythrocyte MTX-PGs with 1-5 glutamate residues were measured at 3 months with tandem mass spectrometry. The outcomes were Juvenile Arthritis Disease Activity Score (JADAS)-27 and adverse effects. To determine associations of MTX-PGs with JADAS-27 at 3 months and during 1 year of MTX treatment, linear regression and linear mixed-model analyses were used. To determine associations of MTX-PGs with adverse effects during 1 year of MTX treatment, logistic regression was used. Analyses were corrected for JADAS-27 at baseline and co-medication. RESULTS Median JADAS-27 decreased from 12.7 (IQR: 7.8-18.2) at baseline to 2.9 (IQR: 0.1-6.5) at 12 months. Higher concentrations of MTX-PG3 (β: -0.006, p=0.005), MTX-PG4 (β: -0.015, p=0.004), MTX-PG5 (β: -0.051, p=0.011) and MTX-PG3-5 (β: -0.004, p=0.003) were associated with lower disease activity at 3 months. Higher concentrations of MTX-PG3 (β: -0.005, p=0.028), MTX-PG4 (β: -0.014, p=0.014), MTX-PG5 (β: -0.049, p=0.023) and MTX-PG3-5 (β: -0.004, p=0.018) were associated with lower disease activity over 1 year. None of the MTX-PGs was associated with adverse effects. CONCLUSIONS In the first prospective study in JIA, long-chain MTX-PGs were associated with lower JADAS-27 at 3 months and during 1 year of MTX treatment. Erythrocyte MTX-PG could be a plausible candidate for therapeutic drug monitoring of MTX in JIA.
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Affiliation(s)
- Maja Bulatović Ćalasan
- Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Ethan den Boer
- Department of Clinical Chemistry, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maurits C F J de Rotte
- Department of Clinical Chemistry, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sebastiaan J Vastert
- Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Erasmus University Medical Centre Rotterdam, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Robert de Jonge
- Department of Clinical Chemistry, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nico M Wulffraat
- Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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