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Azzouz DF, Martin GV, Arnoux F, Balandraud N, Martin T, Dubucquoi S, Hachulla E, Farge-Bancel D, Tiev K, Cabane J, Bardin N, Chiche L, Martin M, Caillet EC, Kanaan SB, Harlé JR, Granel B, Diot E, Roudier J, Auger I, Lambert NC. Anti-Ephrin Type-B Receptor 2 (EphB2) and Anti-Three Prime Histone mRNA EXonuclease 1 (THEX1) Autoantibodies in Scleroderma and Lupus. PLoS One 2016; 11:e0160283. [PMID: 27617966 PMCID: PMC5019431 DOI: 10.1371/journal.pone.0160283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/15/2016] [Indexed: 11/19/2022] Open
Abstract
In a pilot ProtoArray analysis, we identified 6 proteins out of 9483 recognized by autoantibodies (AAb) from patients with systemic sclerosis (SSc). We further investigated the 6 candidates by ELISA on hundreds of controls and patients, including patients with Systemic Lupus Erythematosus (SLE), known for high sera reactivity and overlapping AAb with SSc. Only 2 of the 6 candidates, Ephrin type-B receptor 2 (EphB2) and Three prime Histone mRNA EXonuclease 1 (THEX1), remained significantly recognized by sera samples from SSc compared to controls (healthy or with rheumatic diseases) with, respectively, 34% versus 14% (P = 2.10−4) and 60% versus 28% (P = 3.10−8). Above all, EphB2 and THEX1 revealed to be mainly recognized by SLE sera samples with respectively 56%, (P = 2.10−10) and 82% (P = 5.10−13). As anti-EphB2 and anti-THEX1 AAb were found in both diseases, an epitope mapping was realized on each protein to refine SSc and SLE diagnosis. A 15-mer peptide from EphB2 allowed to identify 35% of SLE sera samples (N = 48) versus only 5% of any other sera samples (N = 157), including SSc sera samples. AAb titers were significantly higher in SLE sera (P<0.0001) and correlated with disease activity (p<0.02). We could not find an epitope on EphB2 protein for SSc neither on THEX1 for SSc or SLE. We showed that patients with SSc or SLE have AAb against EphB2, a protein involved in angiogenesis, and THEX1, a 3’-5’ exoribonuclease involved in histone mRNA degradation. We have further identified a peptide from EphB2 as a specific and sensitive tool for SLE diagnosis.
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Affiliation(s)
- Doua F. Azzouz
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Aix Marseille Université, Marseille, France
| | - Gabriel V. Martin
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Aix Marseille Université, Marseille, France
| | - Fanny Arnoux
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Aix Marseille Université, Marseille, France
| | - Nathalie Balandraud
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Rhumatologie, IML, AP-HM, Hôpital Sainte Marguerite, Marseille, France
| | - Thierry Martin
- Service d'Immunologie Clinique, Hôpitaux universitaires de Strasbourg, Strasbourg, France
- UPR CNRS 3572, Strasbourg, France
| | - Sylvain Dubucquoi
- Institut d’Immunologie Centre Hospitalier Régional et Universitaire de Lille, Lille, France
- EA 2686, Université de Lille, Lille, France
| | - Eric Hachulla
- Service de Médecine Interne, Centre National de Référence de la Sclérodermie Systémique, Hôpital Claude Huriez, Lille, France
| | - Dominique Farge-Bancel
- Service de Médecine Interne et Pathologie Vasculaire, Hôpital St Louis, Paris, France
- INSERM U697, Hôpital St Louis, Paris, France
| | - Kiet Tiev
- Service de Médecine Interne, Hôpital St Antoine, Paris, France
| | - Jean Cabane
- Service de Médecine Interne, Hôpital St Antoine, Paris, France
| | - Nathalie Bardin
- UMR-S 1076 Endothélium, Pathologies Vasculaires et Cibles Thérapeutiques - Faculté de Pharmacie, Marseille, France
| | - Laurent Chiche
- AP-HM, Pôle de Médecine Interne, Centre de Compétence PACA Ouest pour la prise en charge des maladies auto-immunes systémiques, Marseille, France
- Aix-Marseille Université, Centre d'Immunologie de Marseille-Luminy (CIML), INSERM, CNRS UMR7280, Marseille, France
| | - Marielle Martin
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Aix Marseille Université, Marseille, France
| | - Eléonore C. Caillet
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Aix Marseille Université, Marseille, France
| | - Sami B. Kanaan
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Aix Marseille Université, Marseille, France
| | - Jean Robert Harlé
- AP-HM, Pôle de Médecine Interne, Centre de Compétence PACA Ouest pour la prise en charge des maladies auto-immunes systémiques, Marseille, France
| | - Brigitte Granel
- Aix Marseille Université, Marseille, France
- UMR-S 1076 Endothélium, Pathologies Vasculaires et Cibles Thérapeutiques - Faculté de Pharmacie, Marseille, France
- AP-HM, Pôle de Médecine Interne, Centre de Compétence PACA Ouest pour la prise en charge des maladies auto-immunes systémiques, Marseille, France
| | - Elisabeth Diot
- Service de Médecine Interne, CHU Bretonneau, Tours, France
| | - Jean Roudier
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Rhumatologie, IML, AP-HM, Hôpital Sainte Marguerite, Marseille, France
| | - Isabelle Auger
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Rhumatologie, IML, AP-HM, Hôpital Sainte Marguerite, Marseille, France
| | - Nathalie C. Lambert
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Aix Marseille Université, Marseille, France
- * E-mail:
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Kranenburg P, van den Hombergh WMT, Knaapen-Hans HKA, van den Hoogen FHJ, Fransen J, Vonk MC. Survival and organ involvement in patients with limited cutaneous systemic sclerosis and anti-topoisomerase-I antibodies: determined by skin subtype or auto-antibody subtype? A long-term follow-up study. Rheumatology (Oxford) 2016; 55:2001-2008. [DOI: 10.1093/rheumatology/kew298] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 07/07/2016] [Indexed: 11/14/2022] Open
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Fiorentino DF, Presby M, Baer AN, Petri M, Rieger KE, Soloski M, Rosen A, Mammen AL, Christopher-Stine L, Casciola-Rosen L. PUF60: a prominent new target of the autoimmune response in dermatomyositis and Sjögren's syndrome. Ann Rheum Dis 2016; 75:1145-51. [PMID: 26253095 PMCID: PMC4828328 DOI: 10.1136/annrheumdis-2015-207509] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 07/13/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Autoantibodies are used clinically to phenotype and subset patients with autoimmune rheumatic diseases. We detected a novel 60 kDa autoantibody specificity by immunoblotting using a dermatomyositis (DM) patient's serum. Our objective was to identify the targeted autoantigen and to evaluate disease specificity and clinical significance of this new autoantibody. METHODS A new 60 kDa specificity was detected by immunoblotting HeLa cell lysates. The targeted autoantigen was identified as poly(U)-binding-splicing factor 60 kDa (PUF60) using (i) a human protein array and (ii) two-dimensional gel electrophoresis and liquid chromatography tandem mass spectrometry peptide sequencing. Anti-PUF60 antibodies were assayed by ELISA using sera from patients with primary Sjögren's syndrome (SS; n=84), systemic lupus erythematosus (SLE; n=71), DM (n=267), polymyositis (n=45), inclusion body myositis (n=45) and healthy controls (n=38). RESULTS PUF60 was identified as a new autoantigen. Anti-PUF60 antibodies were present in 25/84 (30%) patients with SS, 6/71 (8.5%) patients with SLE and 2/38 (5.0%) control subjects (SS vs controls, p=0.002; SLE vs controls, p=0.711). Anti-PUF60 antibodies were present in 48/267 (18.0%) patients with DM versus 4/45 (8.9%) and 5/45 (11.1%) patients with inclusion body myositis and polymyositis, respectively. The antibody was significantly associated with anti-Ro52 antibodies, rheumatoid factor and hyperglobulinemia in the patients with primary SS. In patients with DM, the antibody was associated with anti-transcription intermediary factor 1 gamma seropositivity and Caucasian race. CONCLUSIONS PUF60 represents a novel autoantigen in patients with SS and DM. PUF60 antibodies are associated with distinct clinical features and different immune responses in different diseases.
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Affiliation(s)
- David F. Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Matthew Presby
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alan N. Baer
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michelle Petri
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kerri E. Rieger
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mark Soloski
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Andrew L. Mammen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Lisa Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Livia Casciola-Rosen
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Perosa F, Favoino E, Favia IE, Vettori S, Prete M, Corrado A, Cantatore FP, Valentini G. Subspecificities of anticentromeric protein A antibodies identify systemic sclerosis patients at higher risk of pulmonary vascular disease. Medicine (Baltimore) 2016; 95:e3931. [PMID: 27336883 PMCID: PMC4998321 DOI: 10.1097/md.0000000000003931] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Patients with systemic sclerosis (SSc) who express autoantibodies to centromeric proteins (CENPs) are at risk of developing pulmonary vascular disease and pulmonary arterial hypertension without fibrosis. Currently no biomarkers are available to predict these complications. We previously characterized the fine specificity of anti-CENP-A antibodies in SSc by screening a phage display library (expressing random 12-mer peptides), and identified phage clones whose peptides were differentially recognized by patients' autoantibodies. Here, we examined if subgroups of SSc patients with different anti-CENP-A antibody subspecificities also differ clinically, and if serum reactivity to phage-displayed peptides can predict pulmonary vascular disease.Clinical data and serum samples were collected from 84 anti-CENP-A-positive SSc patients. Indirect ELISAs were used to test serum reactivity. Pulmonary vascular disease was defined as high systolic pulmonary arterial pressure (sPAP) and low diffusing lung capacity for carbon monoxide (DLCO; percent of predicted values).Sera were screened for reactivity to peptides expressed by phage clones pc4.2 and pc14.1, confirming our earlier observation of differential specificities. Linear regression showed that the levels of antibodies specific for the 2 phage clones were associated with clinical features of pulmonary vascular disease, but in opposite ways: anti-pc4.2 antibodies were positively associated with sPAP and inversely associated with DLCO, whereas anti-pc14.1 antibodies were inversely associated with sPAP and positively associated with DLCO. Anti-pc4.2 and anti-pc14.1 antibody levels predicted sPAP independently of DLCO. These associations were confirmed by logistic regression using antibodies as predictors and dichotomized sPAP (cutoff, 45 mm Hg) as outcome. The ratio of the 2 antibody levels was a useful marker in predicting high sPAP.This study demonstrates that some SSc clinical features associate with subspecificities of anti-CENP-A antibodies. Moreover, it shows that a simple, inexpensive phage-based assay can predict which SSc patients have high sPAP and low DLCO, hence who are at greater risk of developing pulmonary arterial hypertension. The ability to identify these at-risk patients can contribute to clinical efficiency and effectiveness. Further research into the peptides expressed by the phage clones may reveal the molecular mechanisms that put some anti-CENP-A-positive patients at greater risk than others for pulmonary vascular disease.
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Affiliation(s)
- Federico Perosa
- Department of Biomedical Sciences and Human Oncology (DIMO), Systemic Rheumatic and Autoimmune Diseases Unit, University of Bari Medical School, Bari
| | - Elvira Favoino
- Department of Biomedical Sciences and Human Oncology (DIMO), Systemic Rheumatic and Autoimmune Diseases Unit, University of Bari Medical School, Bari
| | - Isabella Eleonora Favia
- Department of Biomedical Sciences and Human Oncology (DIMO), Systemic Rheumatic and Autoimmune Diseases Unit, University of Bari Medical School, Bari
| | - Serena Vettori
- Department of Clinical and Experimental Internal Medicine “F. Magrassi, A.Lanzara”-Rheumatology Section, Second University of Naples, Naples
| | - Marcella Prete
- Department of Biomedical Sciences and Human Oncology (DIMO), Systemic Rheumatic and Autoimmune Diseases Unit, University of Bari Medical School, Bari
| | - Addolorata Corrado
- Department of Medical and Surgery Sciences, Rheumatology Unit, University of Foggia, Foggia, Italy
| | | | - Gabriele Valentini
- Department of Clinical and Experimental Internal Medicine “F. Magrassi, A.Lanzara”-Rheumatology Section, Second University of Naples, Naples
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Maria ATJ, Maumus M, Le Quellec A, Jorgensen C, Noël D, Guilpain P. Adipose-Derived Mesenchymal Stem Cells in Autoimmune Disorders: State of the Art and Perspectives for Systemic Sclerosis. Clin Rev Allergy Immunol 2016; 52:234-259. [DOI: 10.1007/s12016-016-8552-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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106
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Castrini AI, Carubelli V, Lazzarini V, Bonadei I, Lombardi C, Metra M. Serelaxin a novel treatment for acute heart failure. Expert Rev Clin Pharmacol 2016; 8:549-57. [PMID: 26294074 DOI: 10.1586/17512433.2015.1073587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Acute heart failure (AHF) represents a major healthcare burden with a high risk of in-hospital and post-discharge mortality, which remained almost unchanged in the last few decades, underscoring the need of new treatments. Relaxin is a naturally occurring human peptide initially identified as a reproductive hormone and has been shown to play a key role in the maternal hemodynamic and renal adjustments that accommodate pregnancy. Recently, the new molecule serelaxin, a recombinant form of the naturally occurring hormone relaxin has been studied in patients hospitalized for AHF. In addition to vasodilation, serelaxin has anti-oxidative, anti-inflammatory and connective tissue regulating properties. In preclinical studies, it reduced both systemic and renal vascular resistance and, in the clinical trials Pre-RELAX-AHF and RELAX-AHF, it improved dyspnea and signs of congestion. In addition, serelaxin was associated with a reduction of 180-day mortality. The aim of this review is to summarize the pharmacological properties of serelaxin and the results of the preclinical and clinical studies.
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Affiliation(s)
- Anna Isotta Castrini
- a Department of Medical and Surgical Specialties, Cardiology, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Brescia, Italy
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Patterson KA, Roberts-Thomson PJ, Lester S, Tan JA, Hakendorf P, Rischmueller M, Zochling J, Sahhar J, Nash P, Roddy J, Hill C, Nikpour M, Stevens W, Proudman SM, Walker JG. Interpretation of an Extended Autoantibody Profile in a Well-Characterized Australian Systemic Sclerosis (Scleroderma) Cohort Using Principal Components Analysis. Arthritis Rheumatol 2016; 67:3234-44. [PMID: 26246178 DOI: 10.1002/art.39316] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/30/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine the relationships between systemic sclerosis (SSc)-related autoantibodies, as well as their clinical associations, in a well-characterized Australian patient cohort. METHODS Serum from 505 Australian SSc patients were analyzed with a commercial line immunoassay (EuroLine; Euroimmun) for autoantibodies to centromere proteins CENP-A and CENP-B, RNA polymerase III (RNAP III; epitopes 11 and 155), the 90-kd nucleolar protein NOR-90, fibrillarin, Th/To, PM/Scl-75, PM/Scl-100, Ku, topoisomerase I (topo I), tripartite motif-containing protein 21/Ro 52, and platelet-derived growth factor receptor. Patient subgroups were identified by hierarchical clustering of the first 2 dimensions of a principal components analysis of quantitative autoantibody scores. Results were compared with detailed clinical data. RESULTS A total of 449 of the 505 patients were positive for at least 1 autoantibody by immunoblotting. Heatmap visualization of autoantibody scores, along with principal components analysis clustering, demonstrated strong, mutually exclusive relationships between CENP, RNAP III, and topo I. Five patient clusters were identified: CENP, RNAP III strong, RNAP III weak, topo I, and other. Clinical features associated with CENP, RNAP III, and topo I were consistent with previously published reports concerning limited cutaneous and diffuse cutaneous SSc. A novel finding was the statistical separation of RNAP III into 2 clusters. Patients in the RNAP III strong cluster had an increased risk of gastric antral vascular ectasia, but a lower risk of esophageal dysmotility. Patients in the other cluster were more likely to be male and to have a history of smoking and a history of malignancy, but were less likely to have telangiectasia, Raynaud's phenomenon, and joint contractures. CONCLUSION Five major autoantibody clusters with specific clinical and serologic associations were identified in Australian SSc patients. Subclassification and disease stratification using autoantibodies may have clinical utility, particularly in early disease.
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Affiliation(s)
- K A Patterson
- Flinders University, Bedford Park, South Australia, and Commonwealth Scientific and Industrial Research Organization (CSIRO), Adelaide, South Australia, Australia
| | - P J Roberts-Thomson
- Flinders University and Flinders Medical Centre, Bedford Park, South Australia, and SA Pathology, Adelaide, South Australia, Australia
| | - S Lester
- Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - J A Tan
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - P Hakendorf
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - M Rischmueller
- University of Adelaide, Adelaide, South Australia, and Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - J Zochling
- Menzies Institute for Medical Research, Hobart, Tasmania, Australia
| | - J Sahhar
- Monash Health and Monash University, Melbourne, Victoria, Australia
| | - P Nash
- University of Queensland, Brisbane, Queensland, Australia
| | - J Roddy
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - C Hill
- University of Adelaide, Adelaide, South Australia, and Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - M Nikpour
- University of Melbourne and St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - W Stevens
- St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - S M Proudman
- University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - J G Walker
- Flinders University and Flinders Medical Centre, Bedford Park, South Australia, and Repatriation General Hospital, Daw Park, South Australia, Australia
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Pascoe VL, Fenves AZ, Wofford J, Jackson JM, Menter A, Kimball AB. The spectrum of nephrocutaneous diseases and associations. J Am Acad Dermatol 2016; 74:247-70; quiz 271-2. [DOI: 10.1016/j.jaad.2015.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 12/31/2022]
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Sobanski V, Giovannelli J, Lynch BM, Schreiber BE, Nihtyanova SI, Harvey J, Handler CE, Denton CP, Coghlan JG. Characteristics and Survival of Anti-U1 RNP Antibody-Positive Patients With Connective Tissue Disease-Associated Pulmonary Arterial Hypertension. Arthritis Rheumatol 2016; 68:484-93. [DOI: 10.1002/art.39432] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 09/08/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Vincent Sobanski
- Royal Free Hospital and University College London, London, UK, and Université de Lille, Centre National de Référence de la Sclérodermie Systémique, Hôpital Claude Huriez, EA2686, INSERM U995, Lille Inflammation Research International Centre, and Fédération Hospitalo-Universitaire Immune-Mediated Inflammatory Diseases and Targeted Therapies (IMMINeNT); Lille France
| | - Jonathan Giovannelli
- Université de Lille, Fédération Hospitalo-Universitaire IMMINeNT, and Centre Hospitalier Régional Universitaire de Lille; Lille France
| | | | | | | | - Jennifer Harvey
- Royal Free Hospital and University College London; London UK
| | | | | | - John G. Coghlan
- Royal Free Hospital and University College London; London UK
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Al Kindi MA, Colella AD, Chataway TK, Jackson MW, Wang JJ, Gordon TP. Secreted autoantibody repertoires in Sjögren's syndrome and systemic lupus erythematosus: A proteomic approach. Autoimmun Rev 2016; 15:405-10. [PMID: 26804757 DOI: 10.1016/j.autrev.2016.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/13/2016] [Indexed: 12/18/2022]
Abstract
The structures of epitopes bound by autoantibodies against RNA-protein complexes have been well-defined over several decades, but little is known of the clonality, immunoglobulin (Ig) variable (V) gene usage and mutational status of the autoantibodies themselves at the level of the secreted (serum) proteome. A novel proteomic workflow is presented based on affinity purification of specific Igs from serum, high-resolution two-dimensional gel electrophoresis, and de novo and database-driven sequencing of V-region proteins by mass spectrometry. Analysis of anti-Ro52/Ro60/La proteomes in primary Sjögren's syndrome (SS) and anti-Sm and anti-ribosomal P proteomes in systemic lupus erythematosus (SLE) has revealed that these antibody responses are dominated by restricted sets of public (shared) clonotypes, consistent with common pathways of production across unrelated individuals. The discovery of shared sets of specific V-region peptides can be exploited for diagnostic biomarkers in targeted mass spectrometry platforms and for tracking and removal of pathogenic clones.
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Affiliation(s)
- Mahmood A Al Kindi
- Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park, 5042, South Australia, Australia
| | - Alex D Colella
- Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park, 5042, South Australia, Australia; Flinders Proteomic Facility, Flinders University, Australia
| | - Tim K Chataway
- Flinders Proteomic Facility, Flinders University, Australia
| | - Michael W Jackson
- Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park, 5042, South Australia, Australia
| | - Jing J Wang
- Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park, 5042, South Australia, Australia.
| | - Tom P Gordon
- Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park, 5042, South Australia, Australia.
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Johnson ME, Grassetti AV, Taroni JN, Lyons SM, Schweppe D, Gordon JK, Spiera RF, Lafyatis R, Anderson PJ, Gerber SA, Whitfield ML. Stress granules and RNA processing bodies are novel autoantibody targets in systemic sclerosis. Arthritis Res Ther 2016; 18:27. [PMID: 26801089 PMCID: PMC4724133 DOI: 10.1186/s13075-016-0914-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/03/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Autoantibody profiles represent important patient stratification markers in systemic sclerosis (SSc). Here, we performed serum-immunoprecipitations with patient antibodies followed by mass spectrometry (LC-MS/MS) to obtain an unbiased view of all possible autoantibody targets and their associated molecular complexes recognized by SSc. METHODS HeLa whole cell lysates were immunoprecipitated (IP) using sera of patients with SSc clinically positive for autoantibodies against RNA polymerase III (RNAP3), topoisomerase 1 (TOP1), and centromere proteins (CENP). IP eluates were then analyzed by LC-MS/MS to identify novel proteins and complexes targeted in SSc. Target proteins were examined using a functional interaction network to identify major macromolecular complexes, with direct targets validated by IP-Western blots and immunofluorescence. RESULTS A wide range of peptides were detected across patients in each clinical autoantibody group. Each group contained peptides representing a broad spectrum of proteins in large macromolecular complexes, with significant overlap between groups. Network analyses revealed significant enrichment for proteins in RNA processing bodies (PB) and cytosolic stress granules (SG) across all SSc subtypes, which were confirmed by both Western blot and immunofluorescence. CONCLUSIONS While strong reactivity was observed against major SSc autoantigens, such as RNAP3 and TOP1, there was overlap between groups with widespread reactivity seen against multiple proteins. Identification of PB and SG as major targets of the humoral immune response represents a novel SSc autoantigen and suggests a model in which a combination of chronic and acute cellular stresses result in aberrant cell death, leading to autoantibody generation directed against macromolecular nucleic acid-protein complexes.
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Affiliation(s)
- Michael E Johnson
- Department of Genetics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Andrew V Grassetti
- Department of Genetics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Jaclyn N Taroni
- Department of Genetics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Shawn M Lyons
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
| | - Devin Schweppe
- Department of Genetics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Jessica K Gordon
- Department of Rheumatology, Hospital for Special Surgery, New York, NY, USA.
| | - Robert F Spiera
- Department of Rheumatology, Hospital for Special Surgery, New York, NY, USA.
| | | | - Paul J Anderson
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
| | - Scott A Gerber
- Department of Genetics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Michael L Whitfield
- Department of Genetics, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
- Dartmouth Medical School, Hinman Box 7400, Hanover, NH, 03755, USA.
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Desbois AC, Cacoub P. Systemic sclerosis: An update in 2016. Autoimmun Rev 2016; 15:417-26. [PMID: 26802722 DOI: 10.1016/j.autrev.2016.01.007] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/11/2016] [Indexed: 01/27/2023]
Abstract
Systemic sclerosis (SSc) is a chronic immune disorder of unknown origin, dominated by excessive fibrosis responsible for cutaneous and pulmonary fibrosis, and by vascular endothelial dysfunction at the origin of skin ischemia, renal and pulmonary artery lesions. Renal and pulmonary complications are mainly responsible for the severity of the disease. Recent advances led to a better understanding of pathological mechanisms and a more accurate classification of patients according to clinical and biological (auto-antibodies) phenotype. Recent trials provided interesting data on different therapeutic strategies, depending on organ involvement. These data are of particular importance in such disease, still characterized by increased mortality and morbidity rates. In this review, we aim to synthetize recent advances in diagnosis and prognosis leading to better classification of SSc patients, and in therapeutic management.
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Affiliation(s)
- Anne Claire Desbois
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, Paris, France; Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005 Paris, France; INSERM, UMR_S 959, F-75013 Paris, France; CNRS, FRE3632, F-75005 Paris, France
| | - Patrice Cacoub
- Sorbonne Universités, UPMC Université Paris 06, UMR 7211, Paris, France; Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005 Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, 83 boulevard de l'hôpital, F-75013 Paris, France.
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113
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Ferri C, Manfredi A, Sebastiani M, Colaci M, Giuggioli D, Vacchi C, Della Casa G, Cerri S, Torricelli P, Luppi F. Interstitial pneumonia with autoimmune features and undifferentiated connective tissue disease. Autoimmun Rev 2016; 15:61-70. [DOI: 10.1016/j.autrev.2015.09.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/08/2015] [Indexed: 12/30/2022]
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114
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Cantarini L, Rigante D, Vitale A, Napodano S, Sakkas LI, Bogdanos DP, Shoenfeld Y. Intravenous immunoglobulins (IVIG) in systemic sclerosis: a challenging yet promising future. Immunol Res 2015; 61:326-37. [PMID: 25550086 DOI: 10.1007/s12026-014-8615-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The etiology and pathogenesis of systemic sclerosis are still largely unknown, but a variety of humoral and cellular autoimmune phenomena have been documented. In addition, the rarity of the disease, the broad spectrum of clinical manifestations, and the relevant risk of severe complications as well as the highly variable disease course render its management a major challenge. Some immunomodulatory agents have been used, but no single agent has given a convincing proof of effectiveness, and treatment has remained largely symptomatic through recent years. Novel therapies are currently being tested and may have the potential of modifying the disease process and overall clinical outcome. Efficacy of intravenous immunoglobulins (IVIG) in different regimens (1-2 g/kg of body weight, administered over 2-5 consecutive days) has been described in a limited number of trials and small case series, showing benefits in skin, articular, and lung interstitial disease symptoms. However, studies on IVIG in systemic sclerosis still remain few, and further randomized controlled trials should be undertaken to assess their clinical effectiveness or define the optimal dosage and times of administration.
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Affiliation(s)
- Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy,
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Mendoza FA, Mansoor M, Jimenez SA. Treatment of Rapidly Progressive Systemic Sclerosis: Current and Futures Perspectives. Expert Opin Orphan Drugs 2015; 4:31-47. [PMID: 27812432 PMCID: PMC5087809 DOI: 10.1517/21678707.2016.1114454] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Systemic Sclerosis (SSc) is a systemic autoimmune disease characterized by severe and often progressive cutaneous, pulmonary, cardiac and gastrointestinal tract fibrosis, cellular and humoral immunologic alterations, and pronounced fibroproliferative vasculopathy. There is no effective SSc disease modifying therapy. Patients with rapidly progressive SSc have poor prognosis with frequent disability and very high mortality. AREAS COVERED This paper reviews currently available therapeutic approaches for rapidly progressive SSc and discuss novel drugs under study for SSc disease modification. EXPERT OPINION The extent, severity, and rate of progression of SSc skin and internal organ involvement determines the optimal therapeutic interventions for SSc. Cyclophosphamide for progressive SSc-associated interstitial lung disease and mycophenolate for rapidly progressive cutaneous involvement have shown effectiveness. Methotrexate has been used for less severe skin progression and for patients unable to tolerate mycophenolate. Rituximab was shown to induce improvement in SSc-cutaneous and lung involvement. Autologous bone marrow transplantation is reserved for selected cases in whom poor survival risk outweighs the high mortality rate of the procedure. Novel agents capable of modulating fibrotic and inflammatory pathways involved in SSc pathogenesis, including tocilizumab, pirfenidone, tyrosine kinase inhibitors, lipid lysophosphatidic acid 1, and NOX4 inhibitors are currently under development for the treatment of rapidly progressive SSc.
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Affiliation(s)
- Fabian A. Mendoza
- Department of Medicine, Division of Rheumatology, Thomas Jefferson University Philadelphia, PA 19107, USA
- Jefferson Institute of Molecular Medicine, and Scleroderma Center, Thomas Jefferson University Philadelphia, PA 19107, USA
| | - Maryah Mansoor
- Department of Medicine, Division of Rheumatology, Thomas Jefferson University Philadelphia, PA 19107, USA
| | - Sergio A. Jimenez
- Jefferson Institute of Molecular Medicine, and Scleroderma Center, Thomas Jefferson University Philadelphia, PA 19107, USA
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116
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Misra DP, Chowdhury AC, Phatak S, Agarwal V. Scleroderma: Not an orphan disease any more. World J Rheumatol 2015; 5:131-141. [DOI: 10.5499/wjr.v5.i3.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/24/2015] [Accepted: 07/14/2015] [Indexed: 02/06/2023] Open
Abstract
Scleroderma (or systemic sclerosis) is a rare disease associated with significant morbidity and mortality. Although previously thought to have a uniformly poor prognosis, the outlook has changed in recent years. We review recent insights into the pathogenesis, clinical features, assessment and management of scleroderma.
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Detection of anti-U3-RNP/fibrillarin IgG antibodies by line immunoblot assay has comparable clinical significance to immunoprecipitation testing in systemic sclerosis. Immunol Res 2015; 64:483-8. [DOI: 10.1007/s12026-015-8710-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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118
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Perosa F, Prete M, Di Lernia G, Ostuni C, Favoino E, Valentini G. Anti-centromere protein A antibodies in systemic sclerosis: Significance and origin. Autoimmun Rev 2015; 15:102-9. [PMID: 26455561 DOI: 10.1016/j.autrev.2015.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/04/2015] [Indexed: 02/03/2023]
Abstract
Systemic sclerosis (SSc) is systemic, autoimmune, connective tissue disorder characterized by vascular abnormalities, collagen deposition (fibrosis), and the production of autoantibodies to nuclear proteins. About 20%-40% of patients have antibodies to centromere protein (CENP)-A or -B. Despite the known association of anti-CENP antibodies with certain clinical features of SSc, the role of these antibodies in SSc physiopathology is still poorly understood. To better understand the clinical significance and origin of these antibodies, we and others have been studying the epitopic motifs (amino acid contact sites) on CENP-A with the aim of determining whether other proteins can prime or be targeted by them. Here, we review published and ongoing studies aimed at defining the fine specificity and origin of anti-CENP-A antibodies. We describe progress made in identifying the CENP-A epitopic motif amino acids, and the discovery of one of these motifs in forkhead box protein E3 (FOXE-3), a transcription factor previously studied only for its role in the development of lens fiber cells. Moreover, we discuss preliminary evidence for a possible role of FOXE-3 in SSc pathogenesis and for the association of different subsets of anti-CENP-A antibodies, heterogeneously expressed among SSc patients, with some clinical correlates.
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Affiliation(s)
- Federico Perosa
- Department of Biomedical Sciences and Human Oncology (DIMO), Section of Systemic Rheumatic and Autoimmune Diseases, University of Bari Medical School, Bari, Italy.
| | - Marcella Prete
- Department of Biomedical Sciences and Human Oncology (DIMO), Section of Internal Medicine, University of Bari Medical School, Bari, Italy
| | - Giuseppe Di Lernia
- Department of Biomedical Sciences and Human Oncology (DIMO), Section of Systemic Rheumatic and Autoimmune Diseases, University of Bari Medical School, Bari, Italy
| | - Carmela Ostuni
- Department of Biomedical Sciences and Human Oncology (DIMO), Section of Clinical Oncology, University of Bari Medical School, Bari, Italy
| | - Elvira Favoino
- Department of Biomedical Sciences and Human Oncology (DIMO), Section of Systemic Rheumatic and Autoimmune Diseases, University of Bari Medical School, Bari, Italy
| | - Gabriele Valentini
- Department of Clinical and Experimental Internal Medicine "F. Magrassi, A. Lanzara", Rheumatology Section, Second University of Naples, Naples, Italy
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Wodkowski M, Hudson M, Proudman S, Walker J, Stevens W, Nikpour M, Assassi S, Mayes MD, Tatibouet S, Wang M, Baron M, Fritzler MJ. Clinical correlates of monospecific anti-PM75 and anti-PM100 antibodies in a tri-nation cohort of 1574 systemic sclerosis subjects. Autoimmunity 2015; 48:542-51. [PMID: 26334795 DOI: 10.3109/08916934.2015.1077231] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Autoantibodies directed against the two principal antigens of the human exosome complex, PM75 and PM100, are present in systemic sclerosis (SSc) sera and have been associated with myositis and calcinosis. However, there is a paucity of data on the clinical correlates of these autoantibodies separately and in the absence of other SSc-specific antibodies. The aim of this study was to assess the clinical correlates of monospecific anti-PM75 and anti-PM100 in SSc. METHODS A tri-nation cohort of 1574 SSc subjects was formed, clinical variables were harmonized and sera were tested for anti-PM75 and anti-PM100 antibodies using a line immunoassay. RESULTS Forty-eight (3.0%) subjects had antibodies against PM75 and 18 (1.1%) against PM100. However, only 16 (1%) had monospecific anti-PM75 antibodies and 11 (0.7%) monospecific anti-PM100 antibodies (i.e. in isolation of each other and other SSc-specific antibodies). Monospecific profiles of each autoantibody included more calcinosis. An increased frequency of myositis was only seen in subjects positive for both anti-PM75 and anti-PM100 antibodies. Lung disease was only associated with anti-PM75 and subjects with anti-PM100 antibodies had better survival compared to other antibody subsets. CONCLUSION The prevalence of monospecific anti-PM75 and anti-PM100 antibodies in this large SSc cohort was low. Disease features associated with anti-PM/Scl antibodies may depend on particular and possibly multiple antigen specificities. However, due to the small samples, these results need to be interpreted with caution. International collaborations are key to understanding the clinical correlates of uncommon serological profiles in SSc.
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Affiliation(s)
- Michael Wodkowski
- a Department of Medicine , McGill University , Montréal , Quebec , Canada
| | - Marie Hudson
- a Department of Medicine , McGill University , Montréal , Quebec , Canada .,b Division of Rheumatology , Jewish General Hospital , Montréal , Quebec , Canada .,c Lady Davis Institute, Jewish General Hospital , Montréal , Quebec , Canada
| | - Susanna Proudman
- d Rheumatology Unit, Royal Adelaide Hospital , Adelaide , Australia .,e Discipline of Medicine, University of Adelaide , Bedford Park , Australia
| | - Jennifer Walker
- f Department of Allergy and Immunology , Flinders Medical Centre , Bedford Park , Australia
| | - Wendy Stevens
- g Department of Rheumatology , St. Vincent's Hospital Melbourne , Fitzroy , Victoria , Australia
| | - Mandana Nikpour
- g Department of Rheumatology , St. Vincent's Hospital Melbourne , Fitzroy , Victoria , Australia .,h Department of Medicine , The University of Melbourne at St. Vincent's Hospital , Melbourne , Victoria , Australia
| | - Shervin Assassi
- i Division of Rheumatology and Immunogenetics , University of Texas Health Science Centre at Houston , Houston , TX , USA , and
| | - Maureen D Mayes
- i Division of Rheumatology and Immunogenetics , University of Texas Health Science Centre at Houston , Houston , TX , USA , and
| | - Solène Tatibouet
- c Lady Davis Institute, Jewish General Hospital , Montréal , Quebec , Canada
| | - Mianbo Wang
- c Lady Davis Institute, Jewish General Hospital , Montréal , Quebec , Canada
| | | | | | | | - Murray Baron
- a Department of Medicine , McGill University , Montréal , Quebec , Canada .,b Division of Rheumatology , Jewish General Hospital , Montréal , Quebec , Canada .,c Lady Davis Institute, Jewish General Hospital , Montréal , Quebec , Canada
| | - Marvin J Fritzler
- j Faculty of Medicine, University of Calgary , Calgary , Alberta , Canada
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120
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Functional autoantibodies in systemic sclerosis. Semin Immunopathol 2015; 37:529-42. [DOI: 10.1007/s00281-015-0513-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 07/06/2015] [Indexed: 12/29/2022]
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121
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Chu H, Wu T, Wu W, Tu W, Jiang S, Chen S, Ma Y, Liu Q, Zhou X, Jin L, Wang J. Involvement of collagen-binding heat shock protein 47 in scleroderma-associated fibrosis. Protein Cell 2015; 6:589-598. [PMID: 26091621 PMCID: PMC4506285 DOI: 10.1007/s13238-015-0171-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/27/2015] [Indexed: 02/03/2023] Open
Abstract
Uncontrolled fibrosis of skin and internal organs is the main characteristic of scleroderma, and collagen is a major extracellular matrix protein that deposits in the fibrotic organs. As the chaperone of collagen, heat shock protein 47 (HSP47) is closely related with the development of fibrosis. To explore the potential function of HSP47 in the pathogenesis of scleroderma, the clinical, in vivo and in vitro studies were performed. In clinical, the increased mRNA level of HSP47 was observed in the skin fibroblasts and PBMC from scleroderma patients, and the enhanced protein level of HSP47 was also detected in the skin biopsy and plasma of the above patients. Unexpectedly, the enhanced levels of HSP47 were positively correlated with the presence of anti-centromere antibody in scleroderma patients. Moreover, a high expression of HSP47 was found in the skin lesion of BLM-induced scleroderma mouse model. Further in vitro studies demonstrated that HSP47 knockdown could block the intracellular and extracellular collagen over-productions induced by exogenous TGF-β. Therefore, the results in this study provide direct evidence that HSP47 is involved in the pathogenesis of scleroderma. The high expression of HSP47 can be detected in the circulatory system of scleroderma patients, indicating that HSP47 may become a pathological marker to assess the progression of scleroderma, and also explain the systemic fibrosis of scleroderma. Meanwhile, collagen over-expression is blocked by HSP47 knockdown, suggesting the possibility that HSP47 can be a potential therapeutic target for scleroderma.
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Affiliation(s)
- Haiyan Chu
- />Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, Shanghai, 200438 China
| | - Ting Wu
- />Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, Shanghai, 200438 China
| | - Wenyu Wu
- />Division of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040 China
- />Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, 20080 China
| | - Wenzhen Tu
- />Division of Rheumatology, Shanghai TCM-Integrated Hospital, Shanghai, 200082 China
| | - Shuai Jiang
- />Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, Shanghai, 200438 China
| | - Sidi Chen
- />Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, Shanghai, 200438 China
| | - Yanyun Ma
- />Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, Shanghai, 200438 China
| | - Qingmei Liu
- />Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, Shanghai, 200438 China
| | - Xiaodong Zhou
- />Division of Rheumatology, University of Texas Health Science Center at Houston, Houston, TX 77030 USA
| | - Li Jin
- />Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, Shanghai, 200438 China
| | - Jiucun Wang
- />Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, Shanghai, 200438 China
- />Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, 20080 China
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Chang WSJ, Schollum J, White DHN, Solanki KK. A cross-sectional study of autoantibody profiles in the Waikato systemic sclerosis cohort, New Zealand. Clin Rheumatol 2015; 34:1921-7. [PMID: 26022620 DOI: 10.1007/s10067-015-2981-3] [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] [Received: 10/16/2014] [Revised: 05/17/2015] [Accepted: 05/20/2015] [Indexed: 11/29/2022]
Abstract
The autoantibody profiles in New Zealand systemic sclerosis patients have not previously been reported. The aim of this study was to evaluate the autoantibody profiles of patients in the Waikato Hospital Systemic Sclerosis Clinic cohort. The EUROLINE (IgG) Systemic Sclerosis panel test kit (which tests for Scl-70, CENP-A, CENP-B, RP11, RP155, Fib, NOR90, Th/To, PM100, PM75, Ku, PDGFR and Ro-52) was selected for the purpose of this study. All patients attending the Waikato Hospital Systemic Sclerosis clinic were invited to participate. These patients were categorised by systemic sclerosis subtypes [1]. Results were compared with previously published data, including the EUSTAR database. Sixty patients (56 female) were recruited, with a median age of 61 years (range 29-81 years). Forty-one had limited cutaneous systemic sclerosis (lcSSc). Of these lcSSc patients, 31 (75.6%) were positive for CENP-A and CENP-B (anti-centromere) antibodies, 12 (29.3%) for Ro-52 antibodies, 5 (12.2%) for RP11 and RP155, 4 (9.8%) for Scl-70 and 1 (2.4%) each for anti-Fib and Th/To antibodies. Fifteen patients had diffuse cutaneous systemic sclerosis (dcSSc), of which 7 patients (47.6%) were positive for RP11 and RP155, 4 (26.7%) for Scl-70. Three dcSSc patients did not have either of these two major antibodies, but of these 15 dcSSc patients, 4 patients (26.7%) were positive also for Ro-52, 2 (13.3%) for anti-Ku, and 1 (6.7%) each for anti-Fib and NOR90. Four patients had overlap syndrome (OLS), 1 had CENP-A and CENP-B antibodies, 1 had Ro-52 autoantibodies 1 had anti-Ku antibodies. Three patients had no autoantibodies. This is the first study to look at the autoantibody profile of SSc patients in New Zealand. A higher prevalence of antibodies against centromere and RNA polymerase III was demonstrated in our group compared with the EUSTAR database suggesting that antibody prevalence may vary geographically.
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Affiliation(s)
- Winston S J Chang
- Rheumatology Department, Waikato Hospital, Pembroke Street, Hamilton, New Zealand
| | - Joanna Schollum
- Rheumatology Department, Waikato Hospital, Pembroke Street, Hamilton, New Zealand
| | - Douglas H N White
- Rheumatology Department, Waikato Hospital, Pembroke Street, Hamilton, New Zealand.,Waikato Clinical School, University of Auckland, Auckland, New Zealand
| | - Kamal K Solanki
- Rheumatology Department, Waikato Hospital, Pembroke Street, Hamilton, New Zealand. .,Waikato Clinical School, University of Auckland, Auckland, New Zealand.
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Uniphasic Blanching of the Fingers, Abnormal Capillaroscopy in Nonsymptomatic Digits, and Autoantibodies: Expanding Options to Increase the Level of Suspicion of Connective Tissue Diseases beyond the Classification of Raynaud's Phenomenon. J Immunol Res 2015; 2015:371960. [PMID: 26075287 PMCID: PMC4449942 DOI: 10.1155/2015/371960] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/02/2015] [Accepted: 05/04/2015] [Indexed: 11/17/2022] Open
Abstract
In patients with Raynaud's phenomenon (RP), the role of medical history, capillaroscopy, and autoantibodies in order to provide an early diagnosis of connective tissue disease (CTD) were examined. 115 consecutive adults with uni-, bi-, or triphasic colour changes of the fingers were studied. RP was bilateral in 92.7% of patients. The middle finger was significantly more affected. A lack of association between fingers affected by RP and fingers with capillary abnormalities was observed OR = 0.75 (0.34–1.66). RP with the cyanotic phase had a higher risk at capillaroscopy to have hemorrhages OR = 4.46 (1.50–13.30) and giant capillaries OR = 24.85 (1.48–417.44). The thumb and triphasic involvement have an OR of 1.477 and 1.845, respectively. RP secondary to systemic sclerosis (SSc) had greater value of VAS pain (p = 0.011). The presence of anti-centromere antibodies was significantly associated with a higher risk of SSc (p < 0.001). 44.3% of subjects had uniphasic blanching of the fingers, and among these, 27% was diagnosed as having an overt or suspected CTD. Markers of a potential development of CTDs include severe RP symptoms, positive autoantibodies, and capillary abnormalities. These data support the proposal to not discharge patients with uniphasic blanching of the fingers to avoid missing the opportunity of an early diagnosis.
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124
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Kayser C, Fritzler MJ. Autoantibodies in systemic sclerosis: unanswered questions. Front Immunol 2015; 6:167. [PMID: 25926833 PMCID: PMC4397862 DOI: 10.3389/fimmu.2015.00167] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 03/26/2015] [Indexed: 12/04/2022] Open
Abstract
Systemic sclerosis (SSc) is an autoimmune disease characterized by vascular abnormalities, and cutaneous and visceral fibrosis. Serum autoantibodies directed to multiple intracellular antigens are present in more than 95% of patients and are considered a hallmark of SSc. They are helpful biomarkers for the early diagnosis of SSc and are associated with distinctive clinical manifestations. With the advent of more sensitive, multiplexed immunoassays, new and old questions about the relevance of autoantibodies in SSc are emerging. In this review, we discuss the clinical relevance of autoantibodies in SSc emphasizing the more recently published data. Moreover, we will summarize recent advances regarding the stability of SSc autoantibodies over the course of disease, whether they are mutually exclusive and their potential roles in the disease pathogenesis.
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Affiliation(s)
- Cristiane Kayser
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo , São Paulo , Brazil
| | - Marvin J Fritzler
- Faculty of Medicine, Cumming School of Medicine, University of Calgary , Calgary, AB , Canada
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Thinking outside the box--The associations with cutaneous involvement and autoantibody status in systemic sclerosis are not always what we expect. Semin Arthritis Rheum 2015; 45:184-9. [PMID: 25959492 DOI: 10.1016/j.semarthrit.2015.04.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 03/24/2015] [Accepted: 04/06/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the clinical characteristics and survival of anti-topoisomerase antibody positive (ATA+) limited cutaneous systemic sclerosis (lcSSc) and anti-centromere antibody positive (ACA+) diffuse cutaneous systemic sclerosis (dcSSc) patients in a large, multicenter SSc cohort. METHODS Data from subjects in the Canadian Scleroderma Research Group (CSRG) cohort were extracted. Descriptive statistics were used to summarize the baseline characteristics, including sociodemographic, clinical and serological features of lcSSc and dcSSc, according to ATA+ and ACA+ subsets. Kaplan-Meier analysis was performed to investigate survival by subsets. RESULTS Of the 551 subjects included in this study, 52 (9.4%) had ATA+ lcSSc and 91 (16.5%) had ACA+ dcSSc. Demographic and visceral organ involvement (e.g., gastrointestinal symptoms, interstitial lung disease, pulmonary hypertension, and scleroderma renal crisis) was associated with serologic status more so than with skin subset. On the other hand, calcinosis, joint and peripheral vascular manifestations were associated with skin rather than antibody status. Survival was associated with both skin and autoantibody subsets, with ATA + dcSSc associated with the worse survival compared to ATA+ lcSSc (p = 0.0115), ACA+ lcSSc (p = 0.0216) and ACA+ dcSSc (p = 0.0313). CONCLUSION This study provides evidence that subsetting using antibody markers in addition to extent of skin involvement may predict clinical outcomes better than skin or serology alone in SSc. These findings can inform ongoing efforts to define more robust SSc subsets compared to those based on the extent of skin involvement or serology alone.
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126
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Sautereau N, Gabsi A, Daumas A, Bardin N, Granel B. [Is there a place of multiantigenes immunodot determination in systemic sclerosis patients without anti-centromeres or anti-Scl70 antibodies?]. Presse Med 2015; 44:547-9. [PMID: 25813097 DOI: 10.1016/j.lpm.2015.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 12/12/2014] [Accepted: 01/19/2015] [Indexed: 11/18/2022] Open
Affiliation(s)
- Nolwenn Sautereau
- AP-HM, hôpital Nord, service de médecine interne, 13915 Marseille, France; Aix Marseille université, 13284 Marseille, France
| | - Amira Gabsi
- Aix Marseille université, faculté pharmacie, UMRS1076, 13284 Marseille, France
| | - Aurélie Daumas
- AP-HM, hôpital Nord, service de médecine interne, 13915 Marseille, France; Aix Marseille université, 13284 Marseille, France
| | - Nathalie Bardin
- Aix Marseille université, faculté pharmacie, UMRS1076, 13284 Marseille, France; AP-HM, hôpital Conception, laboratoire d'immunologie, 13005 Marseille, France
| | - Brigitte Granel
- AP-HM, hôpital Nord, service de médecine interne, 13915 Marseille, France; Aix Marseille université, 13284 Marseille, France.
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Ghanadan A, Saghazadeh A, Jahanzad I, Rezaei N. Clinical aspects of indirect immunofluorescence for autoimmune diseases. Expert Rev Clin Immunol 2015; 11:597-616. [PMID: 25786676 DOI: 10.1586/1744666x.2015.1027152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Because the most common term used in conversations considering autoimmunity is autoantibodies, it is well-expected that the indirect immunofluorescence assay, which detects antibodies directed against various antigens, is one of our most impressive techniques for investigating autoimmune diseases (AIDs). Roughly speaking, the current literature corroborates that this immunopathologic investigation means that autoantibodies detection makes a considerable contribution to both diagnostic and prognostic aspects of AIDs in the clinical setting. However, it varies between different AIDs, autoantibodies, ethnicities or detection methodologies. Directly focusing on the indirect immunofluorescence assay, we present evidence to support this multidimensional variation regarding the subject via reviewing briefly the best-investigated autoantibodies in the well-documented AIDs, including vasculitis, inflammatory bowel disease, scleroderma, autoimmune hepatitis, primary biliary cirrhosis, systemic lupus erythematosus and Sjögren's syndrome.
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Affiliation(s)
- Alireza Ghanadan
- Department of Pathology, Imam Khomeini Complex Hospital, School of Medicine, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
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128
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Muro Y, Hosono Y, Sugiura K, Ogawa Y, Mimori T, Akiyama M. Anti-PM/Scl antibodies are found in Japanese patients with various systemic autoimmune conditions besides myositis and scleroderma. Arthritis Res Ther 2015; 17:57. [PMID: 25885224 PMCID: PMC4407870 DOI: 10.1186/s13075-015-0573-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 02/20/2015] [Indexed: 01/09/2023] Open
Abstract
Introduction Anti-PM/Scl antibodies are associated with polymyositis (PM)/systemic scleroderma (SSc) overlap syndromes and are also found in other systemic autoimmune diseases. Although anti-PM/Scl reactivity is found in 3-11% of PM or SSc patients and in approximately 25% of PM/SSc overlap patients, previous large studies of Japanese patients with scleroderma reported that anti-PM/Scl are not found in Japanese patients at all. The PM/Scl autoantigen complex comprises 11–16 different polypeptides; ELISA with PM1-α peptide, which is a major epitope of the PM/Scl complex, has frequently been used for the detection of these antibodies in recent studies. However, no ELISA kit is commercially available in Japan. Methods In this study, we developed an immunoassay for measuring antibodies against recombinant PM/Scl-100 and PM/Scl-75 polypeptides, which are the two major targets of the complex, and we investigated their presence in 600 Japanese patients with various systemic autoimmune conditions. Immunoprecipitation analysis using the recombinants in addition to traditional radiolabeled cell extracts were also applied to ELISA-positive sera. Results In ELISA, 11 patients were positive for anti-PM/Scl-100 antibodies and 7 of these 11 patients were also positive for anti-PM/Scl-75 antibodies. Immunoprecipitation analysis using the recombinants in addition to traditional radiolabeled cell extracts confirmed that 9 out of these 11 patients immunoprecipitated the typical sets of PM/Scl proteins. In total, 4/16 (25%) undifferentiated connective tissue disease (UCTD) patients, 3/126 (2.4%) dermatomyositis patients, 1/223 (0.4%) SSc patients, 1/88 (1.1%) Sjögren’s syndrome patients, 0/123 patients with systemic lupus erythematosus, 0/17 patients with overlap syndrome and 0/7 patients with PM were judged to be positive for anti-PM/Scl antibodies. Conclusions This is the first report of Japanese autoimmune patients with anti-PM/Scl antibodies. In Japanese patients, anti-PM/Scl antibodies are only very rarely found, and they are not always specific for dermatomyositis (DM) or SSc; they are also present in various autoimmune conditions with the highest prevalence being in UCTD. All anti-PM/Scl-positive DM cases are complicated with interstitial lung disease and/or cancer, while no life-threatening involvement was found in other anti-PM/Scl-positive cases. Further studies on larger cohorts are necessary to define the clinical significance of anti-PM/Scl antibodies in autoimmune diseases.
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Affiliation(s)
- Yoshinao Muro
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. .,Division of Connective Tissue Disease and Autoimmunity, Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yuji Hosono
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Kazumitsu Sugiura
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yasushi Ogawa
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Masashi Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
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129
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Mahler M, Fritzler MJ, Satoh M. Autoantibodies to the mitochondrial RNA processing (MRP) complex also known as Th/To autoantigen. Autoimmun Rev 2015; 14:254-7. [DOI: 10.1016/j.autrev.2014.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 11/11/2014] [Indexed: 02/06/2023]
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130
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Vogelpoel LTC, Baeten DLP, de Jong EC, den Dunnen J. Control of cytokine production by human fc gamma receptors: implications for pathogen defense and autoimmunity. Front Immunol 2015; 6:79. [PMID: 25759693 PMCID: PMC4338787 DOI: 10.3389/fimmu.2015.00079] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/10/2015] [Indexed: 01/21/2023] Open
Abstract
Control of cytokine production by immune cells is pivotal for counteracting infections via orchestration of local and systemic inflammation. Although their contribution has long been underexposed, it has recently become clear that human Fc gamma receptors (FcγRs), which are receptors for the Fc region of immunoglobulin G (IgG) antibodies, play a critical role in this process by controlling tissue- and pathogen-specific cytokine production. Whereas individual stimulation of FcγRs does not evoke cytokine production, FcγRs cell-type specifically interact with various other receptors for selective amplification or inhibition of particular cytokines, thereby tailoring cytokine responses to the immunological context. The physiological function of FcγR-mediated control of cytokine production is to counteract infections with various classes of pathogens. Upon IgG opsonization, pathogens are simultaneously recognized by FcγRs as well as by various pathogen-sensing receptors, leading to the induction of pathogen class-specific immune responses. However, when erroneously activated, the same mechanism also contributes to the development of autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus. In this review, we discuss control of cytokine production as a novel function of FcγRs in human innate immune cells in the context of homeostasis, infection, and autoimmunity and address the possibilities for future therapeutic exploitation.
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Affiliation(s)
- Lisa T C Vogelpoel
- Department of Cell Biology and Histology, Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands
| | - Dominique L P Baeten
- Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands
| | - Esther C de Jong
- Department of Cell Biology and Histology, Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands
| | - Jeroen den Dunnen
- Department of Cell Biology and Histology, Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands
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131
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Iudici M, Moroncini G, Cipriani P, Giacomelli R, Gabrielli A, Valentini G. Where are we going in the management of interstitial lung disease in patients with systemic sclerosis? Autoimmun Rev 2015; 14:575-8. [PMID: 25709096 DOI: 10.1016/j.autrev.2015.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 02/02/2015] [Indexed: 11/28/2022]
Abstract
Interstitial lung disease (ILD) affects about 90% of patients with systemic sclerosis (SSc). It is associated with a restrictive lung disease in only 30% of patients and is progressive in an even lower percentage. A low forced vital capacity at presentation, an extent of lung fibrosis >20% as detected by lung high-resolution computed tomography, high serum interleukin-6 levels, anti-topoisomerase I antibody positivity and diffuse cutaneous SSc are each associated with SSc-ILD progression. However, no such association is absolute. Treating patients with a recent deterioration of lung function may allow to capture those with active disease. To date, cyclophosphamide (CYC) is the only drug found to stabilize or improve lung function in randomized clinical trials, but its small beneficial effect is short lived. Therefore, immunosuppressive maintenance therapy after CYC treatment is warranted. At present, however, the best therapeutical strategy after CYC therapy both in responders and in non-responders to CYC is still controversial. Based on a review of the literature, we suggest an approach to the management of SSc-ILD.
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Affiliation(s)
- Michele Iudici
- Department of Clinical and Experimental Medicine, Rheumatology Section, Second University of Naples, Naples, Italy.
| | - Gianluca Moroncini
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
| | - Paola Cipriani
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy.
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila, L'Aquila, Italy.
| | - Armando Gabrielli
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
| | - Gabriele Valentini
- Department of Clinical and Experimental Medicine, Rheumatology Section, Second University of Naples, Naples, Italy.
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132
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Marie I, Leroi AM, Menard JF, Levesque H, Quillard M, Ducrotte P. Fecal calprotectin in systemic sclerosis and review of the literature. Autoimmun Rev 2015; 14:547-54. [PMID: 25661980 DOI: 10.1016/j.autrev.2015.01.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 12/14/2022]
Abstract
Fecal calprotectin (FC) is a simple, non-invasive and reproducible test, which has been described to be highly elevated in patients with active inflammatory bowel diseases. Recently, few authors have reported increased levels of FC in SSc patients, although the relationship between FC levels and the degree of gastrointestinal involvement has not yet been determined in patients with SSc. Thus, this prospective study aimed to: 1) determine the prevalence of increased fecal calprotectin (FC) levels in unselected patients with systemic sclerosis (SSc); 2) make prediction about which SSc patients exhibit increased levels of FC; and 3) evaluate the correlation between increased levels of FC and digestive symptoms, and gastrointestinal involvement, including the presence of small intestinal bacterial overgrowth (SIBO) using glucose H2/CH4 breath test. 125 consecutive patients with SSc underwent FC levels and glucose H2/CH4 breath test. All of the patients with SSc also completed a questionnaire on digestive symptoms, and a global symptom score (GSS) was calculated. 93 (74.4%) patients had abnormal levels of FC (>50 μg/g); 68 patients (54.4%) exhibited highly elevated levels of FC (>200 μg/g). A marked correlation was found between abnormal FC levels and GSS score of digestive symptoms, esophageal involvement and delayed gastric emptying. Moreover, we found a strong association between abnormal levels of FC and the presence of SIBO on glucose H2/CH4 breath test, with the higher correlation between the presence of SIBO and the level of FC ≥275 μg/g with an area under the receiver operating characteristic curve of 0.97 ± 0.001 (CI: 0.93-0.99; p<10(-6)); the sensitivity of FC level ≥275 μg/g for predicting SIBO was as high as 0.93, while the specificity was 0.95. Finally, eradication of SIBO was obtained in 52.4% of the SSc patients with a significant improvement of intestinal symptoms. Finally, after 3 months of rotating courses of alternative antibiotic therapy, eradication of SIBO was associated with significant decrease of FC levels in SSc patients. The current study underscores that abnormal FC levels were correlated with gastrointestinal impairment, especially SIBO. Because FC levels ≥275 μg/g were markedly associated with the presence of SIBO, our findings suggest that FC may be a helpful test in identifying the group of SSc patients at high risk for SIBO requiring glucose breath test to detect SIBO. Finally, we also suggest that FC levels may be helpful in SSc patients to assess SIBO eradication, as long-term antibiotic therapy is costly and carries risks such as the onset of pseudo-membranous colitis and SIBO-related antibiotic resistance.
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Affiliation(s)
- I Marie
- Department of Internal Medicine, CHU Rouen, INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France.
| | - A-M Leroi
- Department of Digestive Physiology, CHU Rouen, INSERM UMR 1073, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | - J-F Menard
- Department of Biostatistics, CHU Rouen, Rouen, France
| | - H Levesque
- Department of Internal Medicine, CHU Rouen, INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | - M Quillard
- Laboratory of Biochemistry, CHU Rouen, Rouen, France
| | - P Ducrotte
- Department of Gastroenterology, CHU Rouen, INSERM UMR 1073, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
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133
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Damoiseaux J, Andrade LE, Fritzler MJ, Shoenfeld Y. Autoantibodies 2015: From diagnostic biomarkers toward prediction, prognosis and prevention. Autoimmun Rev 2015; 14:555-63. [PMID: 25661979 DOI: 10.1016/j.autrev.2015.01.017] [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: 01/20/2015] [Accepted: 01/28/2015] [Indexed: 12/29/2022]
Abstract
At the 12th International Workshop on Autoantibodies and Autoimmunity (IWAA), organized in August 2014 in Sao Paulo, Brazil, more than 300 autoimmunologists gathered to discuss the status of many novel autoantibodies in clinical practice, and to envisage additional value of autoantibodies in terms of prediction, prognosis and prevention of autoimmune diseases. Two separate workshops were dedicated to standardization and harmonization of autoantibody testing and nomenclature: International Autoantibody Standardization (IAS) and International Consensus on ANA Patterns (ICAP). It was apparent to all in attendance that the discovery and elucidation of novel autoantibodies did not slow down, but that multiple challenges lay ahead of us in order to apply these discoveries to effective and efficient clinical practice. Importantly, this requires optimal bidirectional communication between clinicians and laboratory specialists, as well as close collaboration with the diagnostic industry. This paper is a report on the 12th IWAA in combination with a review of the recent developments in the field of autoantibodies.
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Affiliation(s)
- Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Luis E Andrade
- Rheumatology Division, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Immunology Division, Fleury Medicine and Health Laboratories, Sao Paulo, Brazil
| | - Marvin J Fritzler
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yehuda Shoenfeld
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
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134
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Vascular biomarkers and correlation with peripheral vasculopathy in systemic sclerosis. Autoimmun Rev 2014; 14:314-22. [PMID: 25485941 DOI: 10.1016/j.autrev.2014.12.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 12/01/2014] [Indexed: 01/12/2023]
Abstract
Vascular disease is a hallmark of systemic sclerosis (SSc). It is present in every patient, being responsible both for the earliest clinical manifestations and the major life-threatening complications of the disease, and thus determining important morbidity and mortality. In SSc, progressive vascular injury leads to vascular tone dysfunction and reduced capillary blood flow, with consequent tissue ischemia and chronic hypoxia. These phenomena are often accompanied by abnormal levels of vascular factors. Microangiopathy in SSc may be easily assessed by nailfold videocapillaroscopy. The variety of derangements detected in the nailfold capillaries is accompanied by abnormal levels of different vascular mediators and appears to be the best evaluable predictor of the development of peripheral vascular complications, such as digital ulcers. The purpose of this review is to summarize in SSc the most relevant vascular biomarkers and the main associations between vascular biomarkers and capillaroscopic parameters and/or the presence of digital ulcers. Vascular biomarkers could become useful predictive factors of vascular damage in SSc, allowing an earlier management of vascular complications.
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135
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Valentini G. Undifferentiated Connective Tissue Disease at risk for systemic sclerosis (SSc) (so far referred to as very early/early SSc or pre-SSc). Autoimmun Rev 2014; 14:210-3. [PMID: 25461837 DOI: 10.1016/j.autrev.2014.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
Abstract
In the last few years, a number of studies have been published on a condition characterized by Raynaud's phenomenon (RP) associated with systemic sclerosis (SSc) marker autoantibodies and/or scleroderma-type capillaroscopic abnormalities and referred to as very early/early SSc. The present review is devoted to analyze pathophysiologic, clinical, and evolutive aspects of the condition that would induce to label it as Undifferentiated Connective Tissue Disease at risk for SSc and to split it into 3 subsets (i.e. RP associated to marker autoantibodies and scleroderma-type capillaroscopic abnormalities; RP associated to marker autoantibodies in the absence of scleroderma-type capillaroscopic abnormalities; and RP associated to scleroderma-type capillaroscopic abnormalities without any detectable marker autoantibody), which have been shown to carry different degrees of risk, but not the certainty, to develop overt SSc over time. This nosographic approach is instrumental to plan future studies devoted to investigate validated biomarkers heralding the development of major vascular disease manifestations as well as skin and/or organ fibrosis in patients at risk.
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136
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Wang Y, Shu Y, Xiao Y, Wang Q, Kanekura T, Li Y, Wang J, Zhao M, Lu Q, Xiao R. Hypomethylation and overexpression of ITGAL (CD11a) in CD4(+) T cells in systemic sclerosis. Clin Epigenetics 2014; 6:25. [PMID: 25414732 PMCID: PMC4237764 DOI: 10.1186/1868-7083-6-25] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/24/2014] [Indexed: 12/17/2022] Open
Abstract
Background The pathogenesis and etiology of systemic sclerosis (SSc) are complex and poorly understood. To date, several studies have demonstrated that the activation of the immune system undoubtedly plays a pivotal role in SSc pathogenesis. Activated immune effector T cells contribute to the release of various pro-inflammatory cytokines and drive the SSc-specific autoantibody responses. This, and a profibrotic environment, are all-important components of abnormal active immune responses that can lead to pathological disorders of SSc. CD11a is essential to inflammatory and immune responses, regulating adhesive and co-stimulatory interactions between CD4+ T cells and other cells. Although CD11a is overexpressed in SSc patients, the mechanisms leading to this overexpression and its consequences remain unclear. DNA methylation, a main epigenetic modification, plays an important role in the regulation of gene expression and is involved in the pathogenesis of autoimmune diseases. This work aims to investigate the effect of DNA demethylation on CD11a expression in SSc CD4+ T cells and to determine its functional significance. CD11a expression was measured using RT-PCR and flow cytometry. Bisulfite sequencing was used to determine the methylation status of the CD11a regulatory region. CD4+ T cells were co-cultured with antigen-presenting cells, B cells, or fibroblasts with and without anti-CD11a, and proliferation of CD4+ T cells, IgG production by B cells, and expression levels of COL1A2 mRNA by fibroblasts were evaluated. Results Elevated CD11a expression levels were observed in CD4+ T cells from SSc patients; these levels were found to be positively correlated with disease activity. The methylation levels of the CD11a regulatory sequences were lower in SSc patients than in controls and inversely correlated with CD11a mRNA expression. Treatment of CD4+ T cells with 5-azacytidine (5-azaC) decreased CD11a promoter methylation and caused CD11a overexpression. SSc CD4+ T cells and 5-azaC-treated CD4+ T cells showed increased proliferation of CD4+ T cells, increased production of IgG by co-cultured B cells, and induced expression of COL1A2 mRNA by co-cultured fibroblasts. These stimulatory effects were abrogated by anti-CD11a. Conclusions Demethylation of CD11a regulatory elements and subsequent CD11a overexpression in CD4+ T cells may mediate immunological abnormalities and fibrotic processes in SSc.
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Affiliation(s)
- YaoYao Wang
- Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011 China ; Department of Dermatology, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016 China
| | - Ye Shu
- Department of Dermatology, Hunan Children's Hospital, 86 Zi-Yuan Road, Changsha, 410007 China
| | - YangFan Xiao
- Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011 China
| | - Qing Wang
- Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011 China
| | - Takuro Kanekura
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan
| | - YaPing Li
- Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011 China
| | - JiuCun Wang
- Ministry of Education (MOE) Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, 220 Handan Road, 200433 Shanghai, China
| | - Ming Zhao
- Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011 China ; Hunan Key Laboratory of Medical Epigenomics, 139 Ren-Min Road, Changsha, 410011 China
| | - QianJin Lu
- Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011 China ; Hunan Key Laboratory of Medical Epigenomics, 139 Ren-Min Road, Changsha, 410011 China
| | - Rong Xiao
- Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011 China
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Silva I, Almeida J, Vasconcelos C. A PRISMA-driven systematic review for predictive risk factors of digital ulcers in systemic sclerosis patients. Autoimmun Rev 2014; 14:140-52. [PMID: 25449678 DOI: 10.1016/j.autrev.2014.10.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/04/2014] [Indexed: 01/20/2023]
Abstract
Vasculopathy has a major role in the pathogenesis and tissue injury in systemic sclerosis (SSc). Raynaud's phenomenon (RP) is frequently the first clinical manifestation of SSc preceding by years other clinical manifestations. RP in SSc patients is frequent, often very severe and long lasting. The repeated bouts of RP lead to prolonged digital ischemia that may progress to digital ulceration or in extreme to critical digital ischemia with gangrene. Digital ulcers (DU) are a true burden for all patients. They are very painful, with a long and slow healing course, have high risk of infection and are extremely disabling. In adults, up to 40-50% of patients will experience at least one DU in the course of the disease and of these 31-71% will have recurrent ulcers. In order to try to identify predictive risk factors for DU in SSc patients, an extensive literature review was conducted, according to the guidelines proposed at the PRISMA statement. MEDLINE database (PubMed) and Thomson Reuters Web of Knowledge platform were searched for articles published in peer-reviewed journals since 1990 with the last search run on June 2014 and published in English language. The keyword search terms included: digital ulcer/s, systemic sclerosis, scleroderma, digital scars, ischemic complications, autoantibodies, biomarkers, endothelium dysfunction, endothelin-1, vascular endothelial growth factor (VEGF), endostatin, ADMA, endoglin, angiostatin, and capillaroscopy. The following criteria were included: (1) cohorts of SSc patients including patients with DU, (2) endothelium dysfunction and angiogenesis biomarkers compared with a healthy control group, (3) autoantibodies, capillary morphology and distribution, endothelium dysfunction and angiogenesis biomarkers compared between patients with and without digital ulcers, (4) detailed description of the statistical methods used to conclude for predictive factors, and (5) English language. Our search provided a total of 376 citations. Of these, 297 studies were discarded for not meeting the criteria proposed.
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Affiliation(s)
- I Silva
- Angiology and Vascular Surgery and Clinical Imunology Unit, Hospital Santo António, Centro Hospitalar do Porto, Portugal.
| | - J Almeida
- Internal Medicine Service, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - C Vasconcelos
- Clinical Imunology Unit, Hospital Santo António, Centro Hospitalar do Porto, Portugal; UMIB, ICBAS, Universidade do Porto, Portugal
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138
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Diab S, Dostrovsky N, Hudson M, Tatibouet S, Fritzler MJ, Baron M, Khalidi N. Systemic Sclerosis Sine Scleroderma: A Multicenter Study of 1417 Subjects. J Rheumatol 2014; 41:2179-85. [DOI: 10.3899/jrheum.140236] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To describe the clinical and serological features of systemic sclerosis sine scleroderma (ssSSc) in a multicentered SSc cohort.Methods.Data from 1417 subjects in the Canadian Scleroderma Research Group registry were extracted to identify subjects with ssSSc, defined as SSc diagnosed by an expert rheumatologist, but without any sclerodactyly or skin involvement prior to baseline study visit or during followup. Clinical and serological features of ssSSc subjects were compared to limited (lcSSc) and diffuse cutaneous SSc (dcSSc) subjects.Results.At the first registry visit, only 57 subjects (4.0%) were identified as having ssSSc. Of these, 30 (2.1%) were reclassified as lcSSc within 1.9 years. Thus, only 27 ssSSc subjects (1.9%) remained, with mean followup of 2.4 years. Clinical profiles of ssSSc were generally similar or milder compared to lcSSc, and milder than dcSSc, including rates of interstitial lung disease (25.9% ssSSc, 25.4% lcSSc, 40.3% dcSSc). Patients with ssSSc had serological profiles similar to those with lcSSc, including high rates of anticentromere antibodies (50.0% ssSSc, 47.5% lcSSc, 12.1% dcSSc), and low rates of antitopoisomerase I (16.7% ssSSc, 7.0% lcSSc, 21.8% dcSSc) and anti-RNA polymerase III (0 ssSSc, 11.1% lcSSc, 34.9% dcSSc).Conclusion.The condition ssSSc is rare and resembles lcSSc. These observations suggest that ssSSc is most likely a forme fruste of lcSSc, and that the absence of skin involvement may in part be related to misclassification arising from early or subtle skin involvement. There is little evidence to consider ssSSc as a distinct clinical or serological subset of SSc.
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139
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Trad S, Nosbaum A, Musset L, Ghillani-Dalbin P, Launay D, Costedoat-Chalumeau N, Saadoun D, Cabane J, Hachulla E, Hanslik T, Frances C. Systemic sclerosis and prevalence of monoclonal immunoglobulin. Autoimmun Rev 2014; 13:1189-94. [PMID: 25151977 DOI: 10.1016/j.autrev.2014.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 07/07/2014] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The purpose of this study was to estimate the prevalence of monoclonal immunoglobulin (MIg) among patients with systemic sclerosis (SSc) according to the capillary electrophoresis or immunofixation method of detection and to search for any related clinical correlations. PATIENTS AND METHODS Retrospective multicenter comparison of capillary electrophoresis and immunofixation results in SSc patients and of the characteristics of patients with and without MIg. RESULTS The study included 244 SSc patients (216 women and 28 men, mean age: 55±14 years). Median time since SSc diagnosis was 51 months [0-320]; disease was diffuse in 48% of cases. Ten percent of patients had cancer, including Waldenström macroglobulinemia (n=1) and multiple myeloma (n=3). Capillary electrophoresis showed a γ-globulin anomaly in 41% of cases, and immunofixation in 18%: MIg (13.5%) and restriction of heterogeneity (4.5%). Capillary electrophoresis failed to detect 60% of the 33 MIg patients. Measurable MIg concentrations were obtained from 7 patients. MIg patients were significantly older at SSc diagnosis than those without MIg (p=0.002), had a lower diffusing capacity (p=0.002), a higher prevalence of pulmonary hypertension and cancer (p=0.002) and were more frequently positive for anti-mitochondrial and anti-beta2-glycoprotein-I antibodies (p=0.03 and p=0.02, respectively). Multivariate analyses showed that only age at test [hazard ratio 1.03 (95% CI, 1.00-1.07, p=0.04)] and presence of cancer [hazard ratio 4.46 (95% CI, 1.6-12.4, p=0.004)] were associated with MIg. CONCLUSION Immunofixation detected a high prevalence of MIg among SSc patients especially in patients aged 50-years or older. MIg was not detected by the standard capillary electrophoresis in 60% of cases and was significantly associated with cancer.
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Affiliation(s)
- Salim Trad
- AP-HP, Internal Medicine Department 2, Groupe Hospitalier Pitié Salpêtrière, 75013 Paris, France.
| | - Audrey Nosbaum
- AP-HP, Internal Medicine Department, Hôpital Saint-Antoine, 75012 Paris, France
| | - Lucile Musset
- AP-HP, Immunochemistry Laboratory, Groupe Hospitalier Pitié Salpêtrière, 75013 Paris, France
| | - Pascale Ghillani-Dalbin
- AP-HP, Immunochemistry Laboratory, Groupe Hospitalier Pitié Salpêtrière, 75013 Paris, France
| | - David Launay
- Internal Medicine Department, Hôpital Claude Huriez, CHRU, 59000 Lille, France; University Hospital, Lille, 75013 Paris, France
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Internal Medicine Department 2, Groupe Hospitalier Pitié Salpêtrière, 75013 Paris, France; Université Pierre et Marie Curie, Paris 6, 75013 Paris, France
| | - David Saadoun
- AP-HP, Internal Medicine Department 2, Groupe Hospitalier Pitié Salpêtrière, 75013 Paris, France; Université Pierre et Marie Curie, Paris 6, 75013 Paris, France
| | - Jean Cabane
- AP-HP, Internal Medicine Department, Hôpital Saint-Antoine, 75012 Paris, France; Université Pierre et Marie Curie, Paris 6, 75013 Paris, France
| | - Eric Hachulla
- Internal Medicine Department, Hôpital Claude Huriez, CHRU, 59000 Lille, France; University Hospital, Lille, 75013 Paris, France
| | - Thomas Hanslik
- AP-HP, Internal Medicine Department 2, Groupe Hospitalier Pitié Salpêtrière, 75013 Paris, France; Versailles-Saint-Quentin-en-Yvelines University, 78000 Versailles, France
| | - Camille Frances
- Université Pierre et Marie Curie, Paris 6, 75013 Paris, France; AP-HP, Service de Dermatologie-Allergologie, Hôpital Tenon, 75020 Paris, France
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Ferri C, Sebastiani M, Lo Monaco A, Iudici M, Giuggioli D, Furini F, Manfredi A, Cuomo G, Spinella A, Colaci M, Govoni M, Valentini G. Systemic sclerosis evolution of disease pathomorphosis and survival. Our experience on Italian patients' population and review of the literature. Autoimmun Rev 2014; 13:1026-34. [PMID: 25182204 DOI: 10.1016/j.autrev.2014.08.029] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 05/31/2014] [Indexed: 01/12/2023]
Abstract
The clinical spectrum and prognosis of systemic sclerosis (SSc) seem to vary among patients' populations recruited during different time periods. In order to verify this possible evolution we investigated the clinico-serological and survival rate in a large Italian SSc series (821 patients; 746 females, 75 males; mean age 53.7±13.9SD years) recruited between 2000 and 2011. The observed findings were compared with previous studies of the world literature.Compared to older Italian SSc series, the present patients' population showed a significantly increased prevalence of limited cutaneous SSc (from 72 to 87.5%; p ≤.0001) and serum anti-centromere antibodies (from 39 to 47,4%; p ≤.001), with a significant reduction of lung (from 81 to 63.7%; p ≤.0001), heart (from 35 to 20.5%; p ≤.0001), and renal involvement (from 10 to 3.8%; p ≤.0001), and skin ulcers (from 54 to 16.5%; p ≤.0001). Cumulative 10th-year survival showed a clear-cut increase (80.7%) compared to our previous series (69.2%). These findings were mirrored by the results of survival studies published during the last five decades, grouped according to the time periods of patients'' recruitment at the referral centers. A clear progression of 10th-year survival rates was detectable, from the 54% median survival of the oldest studies (1935-1974) to 74% and 83.5% of the more recent SSc series, 1976-1999 and after 1999, respectively. In conclusion, the favorable evolution of SSc pathomorphosis and prognosis during the last decades might be related to more diffuse physician/patient awareness of this harmful disease and availability of diagnostic tools, the consequent wider recruitment of patients in the early stages of the disease, as well as to the improved therapeutic strategies.
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Affiliation(s)
- Clodoveo Ferri
- Rheumatology Unit, Policlinico di Modena, University of Modena & Reggio E., Modena, Italy.
| | - Marco Sebastiani
- Rheumatology Unit, Policlinico di Modena, University of Modena & Reggio E., Modena, Italy
| | - Andrea Lo Monaco
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Michele Iudici
- Rheumatology Unit, II University of Napoli, Napoli, Italy
| | - Dilia Giuggioli
- Rheumatology Unit, Policlinico di Modena, University of Modena & Reggio E., Modena, Italy
| | - Federica Furini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Andreina Manfredi
- Rheumatology Unit, Policlinico di Modena, University of Modena & Reggio E., Modena, Italy
| | - Giovanna Cuomo
- Rheumatology Unit, II University of Napoli, Napoli, Italy
| | - Amelia Spinella
- Rheumatology Unit, Policlinico di Modena, University of Modena & Reggio E., Modena, Italy
| | - Michele Colaci
- Rheumatology Unit, Policlinico di Modena, University of Modena & Reggio E., Modena, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Stem Cell Therapy in Autoimmune Rheumatic Diseases: a Comprehensive Review. Clin Rev Allergy Immunol 2014; 47:244-57. [DOI: 10.1007/s12016-014-8445-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
BACKGROUND Many aspects of autoimmune disease are not well understood, including the specificities of autoimmune targets, and patterns of co-morbidity and cross-heritability across diseases. Prior work has provided evidence that somatic mutation caused by gene conversion and deletion at segmentally duplicated loci is relevant to several diseases. Simple tandem repeat (STR) sequence is highly mutable, both somatically and in the germ-line, and somatic STR mutations are observed under inflammation. RESULTS Protein-coding genes spanning STRs having markers of mutability, including germ-line variability, high total length, repeat count and/or repeat similarity, are evaluated in the context of autoimmunity. For the initiation of autoimmune disease, antigens whose autoantibodies are the first observed in a disease, termed primary autoantigens, are informative. Three primary autoantigens, thyroid peroxidase (TPO), phogrin (PTPRN2) and filaggrin (FLG), include STRs that are among the eleven longest STRs spanned by protein-coding genes. This association of primary autoantigens with long STR sequence is highly significant (p<3.0x10(-7)). Long STRs occur within twenty genes that are associated with sixteen common autoimmune diseases and atherosclerosis. The repeat within the TTC34 gene is an outlier in terms of length and a link with systemic lupus erythematosus is proposed. CONCLUSIONS The results support the hypothesis that many autoimmune diseases are triggered by immune responses to proteins whose DNA sequence mutates somatically in a coherent, consistent fashion. Other autoimmune diseases may be caused by coherent somatic mutations in immune cells. The coherent somatic mutation hypothesis has the potential to be a comprehensive explanation for the initiation of many autoimmune diseases.
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Affiliation(s)
- Kenneth Andrew Ross
- Department of Computer Science, Columbia University, New York, New York, United States of America
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Mahler M, Satoh M, Hudson M, Baron M, Chan JYF, Chan EKL, Wick J, Fritzler MJ. Autoantibodies to the Rpp25 component of the Th/To complex are the most common antibodies in patients with systemic sclerosis without antibodies detectable by widely available commercial tests. J Rheumatol 2014; 41:1334-43. [PMID: 24931955 DOI: 10.3899/jrheum.131450] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Antinuclear antibodies (ANA) occur in up to 95% of patients with systemic sclerosis (SSc). In most, SSc-associated antibodies are detected (i.e., centromere, topoisomerase I, RNA polymerase III, PM/Scl, Ro52/TRIM21, and U1RNP). Ribonuclease P protein subunit p25, (Rpp25) is an autoantigenic component of the Th/To complex. The contribution of anti-Th/To and anti-Rpp25 antibodies to ANA positivity in patients with SSc remains unknown. METHODS Sera from 873 patients with SSc were tested for ANA, and SSc-associated antibodies were measured. Samples without antibodies to extractable nuclear antigens (ENA; n = 53, ANA+/ENA-), were analyzed by immunoprecipitation (IP) and metabolically labeled proteins and for anti-Rpp25 antibodies (n = 50) by a chemiluminescent immunoassay (CLIA) and Rpp25 ELISA. RESULTS Anti-Th/To antibodies occurred in 19/53 (36%), as determined by IP, and were the most common autoantibody in ANA+/ENA- SSc. Of those samples, 50/53 were available for additional testing by CLIA and ELISA. Anti-Rpp25 antibodies were detected in 12 (24% CLIA) or 10 (20% ELISA) of 50 patients. Receiver-operating characteristic curve analysis showed similar discrimination between Th/To IP-positive (n = 19) and -negative samples (n = 31) by CLIA and ELISA (area under the curve 0.90 vs 0.87; p = 0.6691). The positive percent agreement between IP and CLIA or ELISA was 12/19 (63.2%, 95% CI 38.4-83.7%) or 10/19 (52.6%, 95% CI 73.3-94.2%), respectively. Negative percent agreement was 100% for both assays. CONCLUSION Autoantibodies to the Th/To autoantigen are important in patients with SSc who have been considered negative for SSc-specific or SSc-associated antibodies by widely available commercial assays. Rpp25 can be considered a major target of anti-Th/To antibodies. Assays detecting anti-Th/To and anti-Rpp25 antibodies may be important in SSc.
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Affiliation(s)
- Michael Mahler
- From INOVA Diagnostics Inc., San Diego, California, USA; the Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan; Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, and the Department of Oral Biology, University of Florida, Gainesville, Florida, USA; Department of Medicine, McGill University; the Division of Rheumatology and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec; the Department of Medicine, University of Calgary, Calgary, Alberta, Canada.M. Mahler, PhD, INOVA Diagnostics Inc.; M. Satoh, MD, PhD, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida; M. Hudson, MD, Department of Medicine, McGill University, Division of Rheumatology and Lady Davis Institute, Jewish General Hospital; M. Baron, MD, Department of Medicine, McGill University, and Division of Rheumatology, Jewish General Hospital; J.Y.F. Chan; E.K.L. Chan, PhD, Department of Oral Biology, University of Florida; J. Wick, BSc; M.J. Fritzler, MD, PhD, Department of Medicine, University of Calgary.
| | - Minoru Satoh
- From INOVA Diagnostics Inc., San Diego, California, USA; the Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan; Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, and the Department of Oral Biology, University of Florida, Gainesville, Florida, USA; Department of Medicine, McGill University; the Division of Rheumatology and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec; the Department of Medicine, University of Calgary, Calgary, Alberta, Canada.M. Mahler, PhD, INOVA Diagnostics Inc.; M. Satoh, MD, PhD, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida; M. Hudson, MD, Department of Medicine, McGill University, Division of Rheumatology and Lady Davis Institute, Jewish General Hospital; M. Baron, MD, Department of Medicine, McGill University, and Division of Rheumatology, Jewish General Hospital; J.Y.F. Chan; E.K.L. Chan, PhD, Department of Oral Biology, University of Florida; J. Wick, BSc; M.J. Fritzler, MD, PhD, Department of Medicine, University of Calgary
| | - Marie Hudson
- From INOVA Diagnostics Inc., San Diego, California, USA; the Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan; Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, and the Department of Oral Biology, University of Florida, Gainesville, Florida, USA; Department of Medicine, McGill University; the Division of Rheumatology and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec; the Department of Medicine, University of Calgary, Calgary, Alberta, Canada.M. Mahler, PhD, INOVA Diagnostics Inc.; M. Satoh, MD, PhD, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida; M. Hudson, MD, Department of Medicine, McGill University, Division of Rheumatology and Lady Davis Institute, Jewish General Hospital; M. Baron, MD, Department of Medicine, McGill University, and Division of Rheumatology, Jewish General Hospital; J.Y.F. Chan; E.K.L. Chan, PhD, Department of Oral Biology, University of Florida; J. Wick, BSc; M.J. Fritzler, MD, PhD, Department of Medicine, University of Calgary
| | - Murray Baron
- From INOVA Diagnostics Inc., San Diego, California, USA; the Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan; Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, and the Department of Oral Biology, University of Florida, Gainesville, Florida, USA; Department of Medicine, McGill University; the Division of Rheumatology and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec; the Department of Medicine, University of Calgary, Calgary, Alberta, Canada.M. Mahler, PhD, INOVA Diagnostics Inc.; M. Satoh, MD, PhD, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida; M. Hudson, MD, Department of Medicine, McGill University, Division of Rheumatology and Lady Davis Institute, Jewish General Hospital; M. Baron, MD, Department of Medicine, McGill University, and Division of Rheumatology, Jewish General Hospital; J.Y.F. Chan; E.K.L. Chan, PhD, Department of Oral Biology, University of Florida; J. Wick, BSc; M.J. Fritzler, MD, PhD, Department of Medicine, University of Calgary
| | - Jason Y F Chan
- From INOVA Diagnostics Inc., San Diego, California, USA; the Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan; Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, and the Department of Oral Biology, University of Florida, Gainesville, Florida, USA; Department of Medicine, McGill University; the Division of Rheumatology and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec; the Department of Medicine, University of Calgary, Calgary, Alberta, Canada.M. Mahler, PhD, INOVA Diagnostics Inc.; M. Satoh, MD, PhD, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida; M. Hudson, MD, Department of Medicine, McGill University, Division of Rheumatology and Lady Davis Institute, Jewish General Hospital; M. Baron, MD, Department of Medicine, McGill University, and Division of Rheumatology, Jewish General Hospital; J.Y.F. Chan; E.K.L. Chan, PhD, Department of Oral Biology, University of Florida; J. Wick, BSc; M.J. Fritzler, MD, PhD, Department of Medicine, University of Calgary
| | - Edward K L Chan
- From INOVA Diagnostics Inc., San Diego, California, USA; the Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan; Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, and the Department of Oral Biology, University of Florida, Gainesville, Florida, USA; Department of Medicine, McGill University; the Division of Rheumatology and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec; the Department of Medicine, University of Calgary, Calgary, Alberta, Canada.M. Mahler, PhD, INOVA Diagnostics Inc.; M. Satoh, MD, PhD, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida; M. Hudson, MD, Department of Medicine, McGill University, Division of Rheumatology and Lady Davis Institute, Jewish General Hospital; M. Baron, MD, Department of Medicine, McGill University, and Division of Rheumatology, Jewish General Hospital; J.Y.F. Chan; E.K.L. Chan, PhD, Department of Oral Biology, University of Florida; J. Wick, BSc; M.J. Fritzler, MD, PhD, Department of Medicine, University of Calgary
| | - James Wick
- From INOVA Diagnostics Inc., San Diego, California, USA; the Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan; Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, and the Department of Oral Biology, University of Florida, Gainesville, Florida, USA; Department of Medicine, McGill University; the Division of Rheumatology and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec; the Department of Medicine, University of Calgary, Calgary, Alberta, Canada.M. Mahler, PhD, INOVA Diagnostics Inc.; M. Satoh, MD, PhD, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida; M. Hudson, MD, Department of Medicine, McGill University, Division of Rheumatology and Lady Davis Institute, Jewish General Hospital; M. Baron, MD, Department of Medicine, McGill University, and Division of Rheumatology, Jewish General Hospital; J.Y.F. Chan; E.K.L. Chan, PhD, Department of Oral Biology, University of Florida; J. Wick, BSc; M.J. Fritzler, MD, PhD, Department of Medicine, University of Calgary
| | - Marvin J Fritzler
- From INOVA Diagnostics Inc., San Diego, California, USA; the Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan; Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, and the Department of Oral Biology, University of Florida, Gainesville, Florida, USA; Department of Medicine, McGill University; the Division of Rheumatology and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec; the Department of Medicine, University of Calgary, Calgary, Alberta, Canada.M. Mahler, PhD, INOVA Diagnostics Inc.; M. Satoh, MD, PhD, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida; M. Hudson, MD, Department of Medicine, McGill University, Division of Rheumatology and Lady Davis Institute, Jewish General Hospital; M. Baron, MD, Department of Medicine, McGill University, and Division of Rheumatology, Jewish General Hospital; J.Y.F. Chan; E.K.L. Chan, PhD, Department of Oral Biology, University of Florida; J. Wick, BSc; M.J. Fritzler, MD, PhD, Department of Medicine, University of Calgary
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Sobanski V, Dauchet L, Lefèvre G, Lambert M, Morell-Dubois S, Sy T, Hachulla E, Hatron PY, Launay D, Dubucquoi S. Prevalence of anti-RNA polymerase III antibodies in systemic sclerosis: New data from a French cohort and a systematic review and meta-analysis. Arthritis Rheumatol 2014; 66:407-17. [PMID: 24504813 DOI: 10.1002/art.38219] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 09/26/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Studies assessing the prevalence of anti-RNA polymerase III (anti-RNAP III) antibodies in systemic sclerosis (SSc) have yielded a wide range of results. The aim of the present study was to describe a new SSc cohort tested for presence of anti-RNAP III and perform a systematic review and meta-analysis to assess the prevalence of anti-RNAP III in patients worldwide and the potential factors of variability. METHODS Seropositivity for anti-RNAP III was evaluated in a French cohort of SSc patients. A systematic review of the literature was carried out in PubMed and EMBase. Meta-analysis was performed using available data on prevalence, clinical characteristics of SSc patients, and the types of assays used for anti-RNAP III testing. RESULTS One hundred thirty-three French SSc patients were tested for anti-RNAP III, and a prevalence of 6-9% was found in these patients. Thirty studies representing a total population of 8,437 SSc patients were included in the meta-analysis. Prevalence of anti-RNAP III in this population was highly variable (range 0-41%). The overall pooled prevalence of anti-RNAP III was 11% (95% confidence interval 8-14), but heterogeneity was high among studies (I(2) = 93%, P < 0.0001). Geographic factors such as continent or country of study origin partially explained this heterogeneity and correlated with the prevalence. No other baseline SSc characteristics were significantly correlated with the prevalence of anti-RNAP III. CONCLUSION Data on our new cohort and our meta-analysis of the literature confirmed that anti-RNAP III prevalence in SSc varies among centers. Geographic factors were significantly associated with prevalence, which underscores the probable implication that genetic background and environmental factors play a role. Heterogeneity among studies remained largely unexplained.
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Affiliation(s)
- Vincent Sobanski
- Université Lille Nord de France, EA 2686, IMPRT IFR 114, Centre National de Référence de la Sclérodermie Systémique, and Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
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Clinical and Serologic Correlates of Anti-PM/Scl Antibodies in Systemic Sclerosis: A Multicenter Study of 763 Patients. Arthritis Rheumatol 2014; 66:1608-15. [DOI: 10.1002/art.38428] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 02/13/2014] [Indexed: 12/12/2022]
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146
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Abel L, Kutschki S, Turewicz M, Eisenacher M, Stoutjesdijk J, Meyer HE, Woitalla D, May C. Autoimmune profiling with protein microarrays in clinical applications. BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2014; 1844:977-87. [PMID: 24607371 DOI: 10.1016/j.bbapap.2014.02.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 02/18/2014] [Accepted: 02/27/2014] [Indexed: 02/05/2023]
Abstract
In recent years, knowledge about immune-related disorders has substantially increased, especially in the field of central nervous system (CNS) disorders. Recent innovations in protein-related microarray technology have enabled the analysis of interactions between numerous samples and up to 20,000 targets. Antibodies directed against ion channels, receptors and other synaptic proteins have been identified, and their causative roles in different disorders have been identified. Knowledge about immunological disorders is likely to expand further as more antibody targets are discovered. Therefore, protein microarrays may become an established tool for routine diagnostic procedures in the future. The identification of relevant target proteins requires the development of new strategies to handle and process vast quantities of data so that these data can be evaluated and correlated with relevant clinical issues, such as disease progression, clinical manifestations and prognostic factors. This review will mainly focus on new protein array technologies, which allow the processing of a large number of samples, and their various applications with a deeper insight into their potential use as diagnostic tools in neurodegenerative diseases and other diseases. This article is part of a Special Issue entitled: Biomarkers: A Proteomic Challenge.
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Affiliation(s)
- Laura Abel
- Department of Medical Proteomics/Bioanalytics, Medizinisches Proteom-Center, Ruhr-Universität Bochum, 44801 Bochum, Germany
| | - Simone Kutschki
- Department of Medical Proteomics/Bioanalytics, Medizinisches Proteom-Center, Ruhr-Universität Bochum, 44801 Bochum, Germany
| | - Michael Turewicz
- Department of Medical Proteomics/Bioanalytics, Medizinisches Proteom-Center, Ruhr-Universität Bochum, 44801 Bochum, Germany
| | - Martin Eisenacher
- Department of Medical Proteomics/Bioanalytics, Medizinisches Proteom-Center, Ruhr-Universität Bochum, 44801 Bochum, Germany
| | - Jale Stoutjesdijk
- Department of Medical Proteomics/Bioanalytics, Medizinisches Proteom-Center, Ruhr-Universität Bochum, 44801 Bochum, Germany
| | - Helmut E Meyer
- Department of Medical Proteomics/Bioanalytics, Medizinisches Proteom-Center, Ruhr-Universität Bochum, 44801 Bochum, Germany; Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V., Dortmund, Germany
| | - Dirk Woitalla
- S. Josef Hospital, Ruhr-University Bochum, 44780 Bochum, Germany; St. Josef-Krankenhaus Kupferdreh, Heidbergweg 22-24, 45257 Essen, Germany
| | - Caroline May
- Department of Medical Proteomics/Bioanalytics, Medizinisches Proteom-Center, Ruhr-Universität Bochum, 44801 Bochum, Germany.
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Sujau I, Ng CT, Sthaneshwar P, Sockalingam S, Cheah TE, Yahya F, Jasmin R. Clinical and autoantibody profile in systemic sclerosis: baseline characteristics from a West Malaysian cohort. Int J Rheum Dis 2014; 18:459-65. [DOI: 10.1111/1756-185x.12322] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ibrahim Sujau
- Division of Rheumatology; Department of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Chin Teck Ng
- Division of Rheumatology; Department of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Pavai Sthaneshwar
- Division of Laboratory Medicine; Department of Pathology; University of Malaya; Kuala Lumpur Malaysia
| | - Sargunan Sockalingam
- Division of Rheumatology; Department of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Tien Eang Cheah
- Division of Rheumatology; Department of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Fariz Yahya
- Division of Rheumatology; Department of Medicine; University of Malaya; Kuala Lumpur Malaysia
| | - Raja Jasmin
- Division of Rheumatology; Department of Medicine; University of Malaya; Kuala Lumpur Malaysia
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Idiopathic inflammatory myopathies and the anti-synthetase syndrome: a comprehensive review. Autoimmun Rev 2014; 13:367-71. [PMID: 24424190 DOI: 10.1016/j.autrev.2014.01.022] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 01/30/2023]
Abstract
Autoantibodies are a hallmark in the diagnosis of many systemic autoimmune rheumatic diseases (SARD) including idiopathic inflammatory myopathies (IIM). Based on their specificity, autoantibodies in IIM are grouped into myositis specific (MSA) and myositis associated autoantibodies (MAA). Among the MSA, autoantibodies against aminoacyl-tRNA synthetases (ARS) represent the most common antibodies and can be detected in 25-35% of patients. The presence of ARS and other autoantibodies has become a key feature for classification and diagnosis of IIM and is increasingly used to define clinically distinguishable IIM subsets. For example, anti-ARS autoantibodies are the key features of what has become known as anti-synthetase syndrome (aSS), characterized by multiple organ involvement, primarily interstitial lung disease, often accompanied by myositis, non-erosive arthritis, Raynaud's phenomenon, fever, and "mechanic's hands". Autoantibodies directed to eight different ARS have been described: Jo-1 (histidyl), PL-7 (threonyl), PL-12 (alanyl), OJ (isoleucyl), EJ (glycyl), KS (asparaginyl), Zo (phenylalanyl) and Ha (tyrosyl). Each anti-ARS antibody seems to define a distinctive clinical phenotype. Although several research methods and commercial tests are available, routine testing for anti-ARS autoantibodies (other than anti-Jo-1/histidyl-tRNA synthetase) is not widely available, sometimes leading to delays in diagnosis and poor disease outcomes.
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149
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Prete M, Fatone MC, Favoino E, Perosa F. Raynaud's phenomenon: from molecular pathogenesis to therapy. Autoimmun Rev 2014; 13:655-67. [PMID: 24418302 DOI: 10.1016/j.autrev.2013.12.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/24/2013] [Indexed: 01/01/2023]
Abstract
Raynaud's phenomenon (RP) is a well defined clinical syndrome characterized by recurrent episodes of digital vasospasm triggered by exposure to physical/chemical or emotional stress. RP has been classified as primary or secondary, depending on whether it occurs as an isolated condition (pRP) or is associated to an underlying disease, mainly a connective tissue disease (CTD-RP). In both cases, it manifests with unique "triple" (pallor, cyanosis and erythema), or "double" color changes. pRP is usually a benign condition, while sRP can evolve and be complicated by acral digital ulcers and gangrene, which may require surgical treatment. The pathogenesis of RP has not yet been entirely clarified, nor is it known whether autoantibodies have a role in RP. Even so, recent advances in our understanding of the pathophysiology have highlighted novel potential therapeutic targets. The aim of this review is to discuss the etiology, epidemiology, risk factors, clinical manifestations, recently disclosed pathogenic mechanisms underlying RP and their correlation with the available therapeutic options, focusing primarily on pRP and CTD-RP.
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Affiliation(s)
- Marcella Prete
- Internal Medicine, University of Bari Medical School, I-70124 Bari, Italy
| | | | - Elvira Favoino
- Rheumatological and Autoimmune Systemic Diseases Units, University of Bari Medical School, I-70124 Bari, Italy
| | - Federico Perosa
- Rheumatological and Autoimmune Systemic Diseases Units, University of Bari Medical School, I-70124 Bari, Italy.
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150
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Liberal R, Grant CR, Sakkas L, Bizzaro N, Bogdanos DP. Diagnostic and clinical significance of anti-centromere antibodies in primary biliary cirrhosis. Clin Res Hepatol Gastroenterol 2013; 37:572-85. [PMID: 23876351 DOI: 10.1016/j.clinre.2013.04.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 03/31/2013] [Accepted: 04/23/2013] [Indexed: 02/04/2023]
Abstract
Primary biliary cirrhosis (PBC) is an autoimmune disease of the liver characterised by biochemical evidence of cholestasis, elevated alkaline phosphatase levels and the presence of the highly disease specific anti-mitochondrial autoantibodies. Extra-hepatic autoimmune manifestations are common, including rheumatic disorders, such as systemic sclerosis (SSc). Notably, PBC is the most frequent autoimmune liver disease in SSc patients. Based on skin lesion extension, two major SSc disease subgroups are recognised: limited cutaneous SSc (lSSc) and diffuse cutaneous SSc. Anti-centromere antibody (ACA) positivity is highly characteristic of SSc, with up to 90% prevalence in lSSc patients. ACA has also been found in up to 30% of PBC patients and 80% of patients with a PBC/SSc overlap syndrome. The diagnostic and clinical significance of ACA positivity in patients with PBC without SSc has recently been under investigation, with several studies highlighting links to severe bile duct injury and portal hypertension. This review discusses the diagnostic and clinical relevance of ACA in patients with PBC, with or without SSc.
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Affiliation(s)
- Rodrigo Liberal
- Institute of Liver Studies, King's College London School of Medicine at King's College Hospital, Denmark Hill Campus, London SE5 9RS, UK; Faculty of Medicine, University of Porto, Porto, Portugal.
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