151
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Rider LG, Aggarwal R, Machado PM, Hogrel JY, Reed AM, Christopher-Stine L, Ruperto N. Update on outcome assessment in myositis. Nat Rev Rheumatol 2018; 14:303-318. [PMID: 29651119 PMCID: PMC6702032 DOI: 10.1038/nrrheum.2018.33] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The adult and juvenile myositis syndromes, commonly referred to collectively as idiopathic inflammatory myopathies (IIMs), are systemic autoimmune diseases with the hallmarks of muscle weakness and inflammation. Validated, well-standardized measures to assess disease activity, known as core set measures, were developed by international networks of myositis researchers for use in clinical trials. Composite response criteria using weighted changes in the core set measures of disease activity were developed and validated for adult and juvenile patients with dermatomyositis and adult patients with polymyositis, with different thresholds for minimal, moderate and major improvement in adults and juveniles. Additional measures of muscle strength and function are being validated to improve content validity and sensitivity to change. A health-related quality of life measure, which incorporates patient input, is being developed for adult patients with IIM. Disease state criteria, including criteria for inactive disease and remission, are being used as secondary end points in clinical trials. MRI of muscle and immunological biomarkers are promising approaches to discriminate between disease activity and damage and might provide much-needed objective outcome measures. These advances in the assessment of outcomes for myositis treatment, along with collaborations between international networks, should facilitate further development of new therapies for patients with IIM.
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Affiliation(s)
- Lisa G. Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD
| | - Rohit Aggarwal
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA
| | - Pedro M. Machado
- Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | | | - Ann M. Reed
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Lisa Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nicolino Ruperto
- Istituto Giannina Gaslini, Clinica Pediatria e Reumatologia, PRINTO, Genoa, Italy
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153
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Radke J, Koll R, Preuße C, Pehl D, Todorova K, Schönemann C, Allenbach Y, Aronica E, de Visser M, Heppner FL, Weis J, Doostkam S, Maisonobe T, Benveniste O, Goebel HH, Stenzel W. Architectural B-cell organization in skeletal muscle identifies subtypes of dermatomyositis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018. [PMID: 29520367 PMCID: PMC5840889 DOI: 10.1212/nxi.0000000000000451] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective To study the B-cell content, organization, and existence of distinct B-cell subpopulations in relation to the expression of type 1 interferon signature related genes in dermatomyositis (DM). Methods Evaluation of skeletal muscle biopsies from patients with adult DM (aDM) and juvenile DM (jDM) by histology, immunohistochemistry, electron microscopy, and quantitative reverse-transcription PCR. Results We defined 3 aDM subgroups—classic (containing occasional B cells without clusters), B-cell–rich, and follicle-like aDM—further elucidating IM B-lymphocyte maturation and immunity. The quantity of B cells and formation of ectopic lymphoid structures in a subset of patients with aDM were associated with a specific profile of cytokines and chemokines involved in lymphoid neogenesis. Levels of type 1 interferon signature related gene expression paralleled B-cell content and architectural organization and link B-cell immunity to the interferon type I signature. Conclusion These data corroborate the important role of B cells in DM, highlighting the direct link between humoral mechanisms as key players in B-cell immunity and the role of type I interferon–related immunity.
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Affiliation(s)
- Josefine Radke
- Author affiliations are provided at the end of the article
| | - Randi Koll
- Author affiliations are provided at the end of the article
| | - Corinna Preuße
- Author affiliations are provided at the end of the article
| | - Debora Pehl
- Author affiliations are provided at the end of the article
| | | | | | - Yves Allenbach
- Author affiliations are provided at the end of the article
| | | | | | | | - Joachim Weis
- Author affiliations are provided at the end of the article
| | | | | | | | | | - Werner Stenzel
- Author affiliations are provided at the end of the article
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154
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Smith JA. Regulation of Cytokine Production by the Unfolded Protein Response; Implications for Infection and Autoimmunity. Front Immunol 2018; 9:422. [PMID: 29556237 PMCID: PMC5844972 DOI: 10.3389/fimmu.2018.00422] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/16/2018] [Indexed: 12/14/2022] Open
Abstract
Protein folding in the endoplasmic reticulum (ER) is an essential cell function. To safeguard this process in the face of environmental threats and internal stressors, cells mount an evolutionarily conserved response known as the unfolded protein response (UPR). Invading pathogens induce cellular stress that impacts protein folding, thus the UPR is well situated to sense danger and contribute to immune responses. Cytokines (inflammatory cytokines and interferons) critically mediate host defense against pathogens, but when aberrantly produced, may also drive pathologic inflammation. The UPR influences cytokine production on multiple levels, from stimulation of pattern recognition receptors, to modulation of inflammatory signaling pathways, and the regulation of cytokine transcription factors. This review will focus on the mechanisms underlying cytokine regulation by the UPR, and the repercussions of this relationship for infection and autoimmune/autoinflammatory diseases. Interrogation of viral and bacterial infections has revealed increasing numbers of examples where pathogens induce or modulate the UPR and implicated UPR-modulated cytokines in host response. The flip side of this coin, the UPR/ER stress responses have been increasingly recognized in a variety of autoimmune and inflammatory diseases. Examples include monogenic disorders of ER function, diseases linked to misfolding protein (HLA-B27 and spondyloarthritis), diseases directly implicating UPR and autophagy genes (inflammatory bowel disease), and autoimmune diseases targeting highly secretory cells (e.g., diabetes). Given the burgeoning interest in pharmacologically targeting the UPR, greater discernment is needed regarding how the UPR regulates cytokine production during specific infections and autoimmune processes, and the relative place of this interaction in pathogenesis.
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Affiliation(s)
- Judith A Smith
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States.,Department of Medical Microbiology and Immunology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
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155
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Abstract
PURPOSE OF REVIEW This article provides guidelines for diagnosing and treating the different subtypes of autoimmune myopathies. RECENT FINDINGS The most common subtypes of autoimmune myopathies are dermatomyositis, immune-mediated necrotizing myopathy, antisynthetase syndrome, and overlap syndromes; isolated polymyositis is an exceptionally rare disease. Specific autoantibodies are associated with unique clinical phenotypes and may be used for diagnostic and prognostic purposes, such as to assess the risk of coexisting malignancy. SUMMARY Diagnosing the specific subtype of autoimmune myopathy can be achieved by combining relevant features of the history, neuromuscular examination, muscle biopsy, and serologic studies.
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156
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Sen P, Kemppainen E, Orešič M. Perspectives on Systems Modeling of Human Peripheral Blood Mononuclear Cells. Front Mol Biosci 2018; 4:96. [PMID: 29376056 PMCID: PMC5767226 DOI: 10.3389/fmolb.2017.00096] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 12/21/2017] [Indexed: 12/12/2022] Open
Abstract
Human peripheral blood mononuclear cells (PBMCs) are the key drivers of the immune responses. These cells undergo activation, proliferation and differentiation into various subsets. During these processes they initiate metabolic reprogramming, which is coordinated by specific gene and protein activities. PBMCs as a model system have been widely used to study metabolic and autoimmune diseases. Herein we review various omics and systems-based approaches such as transcriptomics, epigenomics, proteomics, and metabolomics as applied to PBMCs, particularly T helper subsets, that unveiled disease markers and the underlying mechanisms. We also discuss and emphasize several aspects of T cell metabolic modeling in healthy and disease states using genome-scale metabolic models.
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Affiliation(s)
- Partho Sen
- Turku Centre for Biotechnology, University of Turku and Åbo Akademi University, Turku, Finland
| | - Esko Kemppainen
- Turku Centre for Biotechnology, University of Turku and Åbo Akademi University, Turku, Finland
| | - Matej Orešič
- Turku Centre for Biotechnology, University of Turku and Åbo Akademi University, Turku, Finland.,School of Medical Sciences, Örebro University, Örebro, Sweden
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157
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Role of the chemokine receptors CXCR3, CXCR4 and CCR7 in the intramuscular recruitment of plasmacytoid dendritic cells in dermatomyositis. J Neuroimmunol 2018; 319:142-148. [PMID: 29366593 DOI: 10.1016/j.jneuroim.2018.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 10/13/2017] [Accepted: 01/08/2018] [Indexed: 12/18/2022]
Abstract
To explore the possible mechanism implicated in the recruitment of plasmacytoid dendritic cells (pDCs), we investigated the expression of the chemokine receptors CXCR3, CXCR4, and CCR7 on intramuscular and circulating pDCs from patients with dermatomyositis (DM). Using immunohistochemistry, preferential expression of CXCR3, CXCR4 and CCR7 was identified in the perivascular inflammatory infiltrates within the perimysium in DM muscle. Western-blot analysis showed marked up-regulation of expression of CXCR3, CXCR4 and CCR7 in muscle homogenate from patients with DM compared with that in non-diseased controls. Co-localization of CD303+ pDCs with these chemokine receptors was further examined by double immunofluorescence staining, which showed extensive co-localization of CD303 with CXCR3/CXCR4/CCR7 in DM biopsies. Flow cytometry was then used to investigate the proportion of pDCs among the total PBMCs and the expression of CXCR3, CXCR4 and CCR7 on circulating pDCs. The proportion of CD123+CD303+ pDCs in peripheral blood from DM patients was markedly decreased compared to that from polymyositis (PM) patients and normal controls. Significantly increased expression of CXCR3, but not CXCR4 or CCR7, was further identified on circulating pDCs in DM. Correlation analysis showed that the expression of CXCR3 correlated inversely with the frequency of pDCs in peripheral blood. Our findings indicate that the chemokine receptors, CXCR3, CXCR4 and CCR7 may be involved in the recruitment of pDCs from peripheral blood to muscle tissues in DM via different mechanisms, and in which CXCR3 may play an important role under DM conditions.
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158
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Parperis K, Kiyani A. Clinically amyopathic dermatomyositis associated with anti-MDA5 antibody. BMJ Case Rep 2018; 2018:bcr-2017-222060. [PMID: 29301801 DOI: 10.1136/bcr-2017-222060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Clinically amyopathic dermatomyositis (CADM) is a rare entity that presents with cutaneous manifestations of classic dermatomyositis but without muscle weakness or abnormal muscle enzymes. It is more common in young white and Asian females. A subset of patients with CADM has a specific antibody known as anti-MDA5. These patients have a more aggressive course with distinct cutaneous features, pulmonary involvement and early death. Here, we present the case of a 64-year-old Caucasian male with no significant medical history who was admitted with marked weight loss and a painful rash for 6 months. Patient had no muscle weakness and his rash was characteristic of classic dermatomyositis. Skin biopsy was suggestive of dermatomyositis but muscle enzymes were normal. His serum was positive for anti-MDA5 antibody. Extensive workup failed to detect any malignancy but he did show non-specific interstitial pneumonia. He was treated with prednisone and mycophenolate with good clinical response.
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Affiliation(s)
- Konstantinos Parperis
- Department of Medicine, Maricopa Medical Center and University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Amirali Kiyani
- Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
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159
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Gitiaux C, Latroche C, Weiss‐Gayet M, Rodero MP, Duffy D, Bader‐Meunier B, Glorion C, Nusbaum P, Bodemer C, Mouchiroud G, Chelly J, Germain S, Desguerre I, Chazaud B. Myogenic Progenitor Cells Exhibit Type I Interferon–Driven Proangiogenic Properties and Molecular Signature During Juvenile Dermatomyositis. Arthritis Rheumatol 2017; 70:134-145. [DOI: 10.1002/art.40328] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 09/15/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Cyril Gitiaux
- Département de Neurophysiologie Clinique Hôpital Necker‐Enfants Malades, AP‐HP, Centre de Référence pour les Maladies Neuromusculaires, Garches‐Necker‐Mondor‐Hendaye, AP‐HP, FILNEMUS, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes Paris France
| | - Claire Latroche
- Institut Cochin INSERM U1016, CNRS UMR 8104, Université Paris Descartes Paris France
| | - Michèle Weiss‐Gayet
- Institut NeuroMyoGène Université Claude Bernard Lyon 1, CNRS UMR 5310, INSERM U1217 Villeurbanne France
| | - Mathieu P. Rodero
- Laboratory of Neurogenetics and Neuroinflammation INSERM UMR1163, Institut Imagine Paris France
| | - Darragh Duffy
- Immunobiology of Dendritic Cells INSERM U1223, Institut Pasteur Paris France
| | - Brigitte Bader‐Meunier
- Département de Rhumatologie Pédiatrique Hôpital Necker Enfants Malades, AP‐HP Paris France
| | - Christophe Glorion
- Département de Chirurgie Orthopédique Hôpital Necker Enfants Malades, AP‐HP Paris France
| | - Patrick Nusbaum
- Service de Biochimie et de Génétique Moléculaire Hôpital Cochin, AP‐HP Paris France
| | - Christine Bodemer
- Département de Dermatologie Hôpital Necker Enfants Malades, AP‐HP Paris France
| | - Guy Mouchiroud
- Institut NeuroMyoGène Université Claude Bernard Lyon 1, CNRS UMR 5310, INSERM U1217 Villeurbanne France
| | - Jamel Chelly
- Institut Cochin INSERM U1016, CNRS UMR 8104, Université Paris Descartes Paris France
| | - Stéphane Germain
- Center for Interdisciplinary Research in Biology Collège de France, INSERM, CNRS, PSL Research University Paris France
| | - Isabelle Desguerre
- Centre de Référence pour les Maladies Neuromusculaires, Garches‐Necker‐Mondor‐Hendaye, AP‐HP, FILNEMUS Paris France
| | - Bénédicte Chazaud
- Institut NeuroMyoGène Université Claude Bernard Lyon 1, CNRS UMR 5310, INSERM U1217 Villeurbanne France
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160
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Cerbelli B, Pisano A, Colafrancesco S, Pignataro MG, Biffoni M, Berni S, De Luca A, Riccieri V, Priori R, Valesini G, d'Amati G, Giordano C. Anti-aminoacyl-tRNA synthetase-related myositis and dermatomyositis: clues for differential diagnosis on muscle biopsy. Virchows Arch 2017; 472:477-487. [PMID: 29147923 DOI: 10.1007/s00428-017-2269-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/19/2017] [Accepted: 11/12/2017] [Indexed: 12/19/2022]
Abstract
Anti-synthetase syndrome is an autoimmune disease characterized by autoantibodies toward amino acyl-tRNA synthetases (ARS), anti-Jo 1 being the most commonly detected. Muscle damage develops in up to 90% of ARS-positive patients, characterized by a necrotizing myositis restricted to the perifascicular region. This topographic distribution of muscle damage may lead to a misdiagnosis of dermatomyositis (DM) at muscle biopsy. We compared morphological, immunohistochemical, and histoenzymatic features of muscle from ARS-positive patients (n = 11) with those of DM (n = 7) providing clues for their differential diagnosis. In addition, we evaluated markers of mitochondrial damage to provide a further distinction between these two entities. Necrosis occurred in the majority of ARS patients, mainly located in the perifascicular region. It was often limited to small foci of fibers, always associated with myocyte regeneration. This last often overwhelmed necrosis, representing occasionally the main finding. In DM, necrosis/regeneration was scarce while the peculiar feature was a diffuse atrophy of perifascicular fibers. These last showed decreased cytochrome c oxidase (COX) stain and mitochondrial DNA depletion, consistent with mitochondrial dysfunction. In contrast to DM, ARS displayed scattered COX-deficient fibers, not restricted to the perifascicular region. This feature occurred in up to 91% of patients, being prominent only in two.
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Affiliation(s)
- Bruna Cerbelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy
| | - Annalinda Pisano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy
| | - Serena Colafrancesco
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, 00161, Rome, Italy
| | - Maria Gemma Pignataro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy
| | - Marco Biffoni
- Department of Surgical Science, Sapienza University of Rome, 00161, Rome, Italy
| | - Silvia Berni
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy
| | - Antonia De Luca
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy
| | - Valeria Riccieri
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, 00161, Rome, Italy
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, 00161, Rome, Italy
| | - Guido Valesini
- Department of Internal Medicine and Medical Specialties, Rheumatology Unit, Sapienza University of Rome, 00161, Rome, Italy
| | - Giulia d'Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy
| | - Carla Giordano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy.
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161
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Uruha A, Suzuki S, Nishino I. Diagnosis of dermatomyositis: Autoantibody profile and muscle pathology. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/cen3.12419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Akinori Uruha
- Pierre and Marie Curie University - Paris VI; National Institute of Health and Medical Research (INSERM); Mixed Research Unit 974; Center of Research in Myology; Institute of Myology; Pitié-Salpêtrière University Hospital; Paris France
| | - Shigeaki Suzuki
- Department of Neurology; Keio University School of Medicine; Tokyo Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research; National Institute of Neuroscience; Tokyo Japan
- Department of Genome Medicine Development; Medical Genome Center; National Center of Neurology and Psychiatry; Tokyo Japan
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162
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IFN-β-induced reactive oxygen species and mitochondrial damage contribute to muscle impairment and inflammation maintenance in dermatomyositis. Acta Neuropathol 2017. [PMID: 28623559 DOI: 10.1007/s00401-017-1731-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Dermatomyositis (DM) is an autoimmune disease associated with enhanced type I interferon (IFN) signalling in skeletal muscle, but the mechanisms underlying muscle dysfunction and inflammation perpetuation remain unknown. Transcriptomic analysis of early untreated DM muscles revealed that the main cluster of down-regulated genes was mitochondria-related. Histochemical, electron microscopy, and in situ oxygraphy analysis showed mitochondrial abnormalities, including increased reactive oxygen species (ROS) production and decreased respiration, which was correlated with low exercise capacities and a type I IFN signature. Moreover, IFN-β induced ROS production in human myotubes was found to contribute to mitochondrial malfunctions. Importantly, the ROS scavenger N-acetyl cysteine (NAC) prevented mitochondrial dysfunctions, type I IFN-stimulated transcript levels, inflammatory cell infiltrate, and muscle weakness in an experimental autoimmune myositis mouse model. Thus, these data highlight a central role of mitochondria and ROS in DM. Mitochondrial dysfunctions, mediated by IFN-β induced-ROS, contribute to poor exercise capacity. In addition, mitochondrial dysfunctions increase ROS production that drive type I IFN-inducible gene expression and muscle inflammation, and may thus self-sustain the disease. Given that current DM treatments only induce partial recovery and expose to serious adverse events (including muscular toxicity), protecting mitochondria from dysfunctions may open new therapeutic avenues for DM.
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163
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Boor PPC, de Ruiter PE, Asmawidjaja PS, Lubberts E, van der Laan LJW, Kwekkeboom J. JAK-inhibitor tofacitinib suppresses interferon alfa production by plasmacytoid dendritic cells and inhibits arthrogenic and antiviral effects of interferon alfa. Transl Res 2017; 188:67-79. [PMID: 27931982 DOI: 10.1016/j.trsl.2016.11.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 10/14/2016] [Accepted: 11/13/2016] [Indexed: 12/30/2022]
Abstract
Tofacitinib is an oral Janus kinase inhibitor that is effective for the treatment of rheumatoid arthritis and shows encouraging therapeutic effects in several other autoimmune diseases. A prominent adverse effect of tofacitinib therapy is the increased risk of viral infections. Despite its advanced stage of clinical development, the modes of action that mediate the beneficial and adverse effects of tofacitinib in autoimmune diseases remain unclear. Interferon alfa (IFNα) produced by plasmacytoid dendritic cells (PDCs) is critically involved in the pathogenesis of many systemic autoimmune diseases and in immunity to viral infections. Using in vitro culture models with human cells, we studied the effects of tofacitinib on PDC survival and IFNα production, and on arthrogenic and antiviral effects of IFNα. Tofacitinib inhibited the expression of antiapoptotic BCL-A1 and BCL-XL in human PDC and induced PDC apoptosis. TLR7 stimulation upregulated the levels of antiapoptotic Bcl-2 family members and prevented the induction of PDC apoptosis by tofacitinib. However, tofacitinib robustly inhibited the production of IFNα by toll like receptor-stimulated PDC. In addition, tofacitinib profoundly suppressed IFNα-induced upregulation of TLR3 on synovial fibroblasts, thereby inhibiting their cytokine and protease production in response to TLR3 ligation. Finally, tofacitinib counteracted the suppressive effects of IFNα on viral replication. Tofacitinib inhibits PDC survival and IFNα production and suppresses arthrogenic and antiviral effects of IFNα signaling. Inhibition of the IFNα pathway at 2 levels may contribute to the beneficial effects of tofacitinib in autoimmune diseases and explain the increased viral infection rates observed during tofacitinib treatment.
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Affiliation(s)
- Patrick P C Boor
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands.
| | - Petra E de Ruiter
- Department of Surgery, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands
| | - Patrick S Asmawidjaja
- Department of Rheumatology, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands
| | - Erik Lubberts
- Department of Rheumatology, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands
| | - Luc J W van der Laan
- Department of Surgery, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands
| | - Jaap Kwekkeboom
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands
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164
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165
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Aussy A, Boyer O, Cordel N. Dermatomyositis and Immune-Mediated Necrotizing Myopathies: A Window on Autoimmunity and Cancer. Front Immunol 2017; 8:992. [PMID: 28871260 PMCID: PMC5566616 DOI: 10.3389/fimmu.2017.00992] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/03/2017] [Indexed: 12/21/2022] Open
Abstract
Autoimmune myopathies (myositides) are strongly associated with malignancy. The link between myositis and cancer, originally noticed by Bohan and Peter in their classification in 1975 (1), has been evidenced by large population-based cohort studies and a recent meta-analysis. The numerous reports of cases in which the clinical course of myositis reflects that of cancer and the short delay between myositis and cancer onset support the notion that myositis may be an authentic paraneoplastic disorder. Thus, cancer-associated myositis raises the question of cancer as a cause rather than a consequence of autoimmunity. Among myositides, dermatomyositis and more recently, although to a lesser extent, immune-mediated necrotizing myopathies are the most documented forms associated with cancer. Interestingly, the current diagnostic approach for myositis is based on the identification of specific antibodies where each antibody determines specific clinical features and outcomes. Recent findings have shown that the autoantibodies anti-TIF1γ, anti-NXP2 and anti-HMGCR are associated with cancers in the course of myositis. Herein, we highlight the fact that the targets of these three autoantibodies involve cellular pathways that intervene in tumor promotion and we discuss the role of cancer mutations as autoimmunity triggers in adult myositis.
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Affiliation(s)
- Audrey Aussy
- Normandie University, UNIROUEN, INSERM, U1234, Rouen University Hospital, Department of Immunology, Rouen, France
| | - Olivier Boyer
- Normandie University, UNIROUEN, INSERM, U1234, Rouen University Hospital, Department of Immunology, Rouen, France
| | - Nadège Cordel
- Normandie University, UNIROUEN, INSERM, U1234, Rouen University Hospital, Department of Immunology, Rouen, France.,Unit of Dermatology and Internal Medicine, Pointe-à-Pitre University Hospital, University of the French West Indies, Fouillole, Pointe-à-Pitre, Guadeloupe
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166
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De Luna N, Suárez-Calvet X, Lleixà C, Diaz-Manera J, Olivé M, Illa I, Gallardo E. Hypoxia triggers IFN-I production in muscle: Implications in dermatomyositis. Sci Rep 2017; 7:8595. [PMID: 28819164 PMCID: PMC5561123 DOI: 10.1038/s41598-017-09309-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/25/2017] [Indexed: 12/21/2022] Open
Abstract
Dermatomyositis is an inflammatory myopathy characterized by symmetrical proximal muscle weakness and skin changes. Muscle biopsy hallmarks include perifascicular atrophy, loss of intramuscular capillaries, perivascular and perimysial inflammation and the overexpression of IFN-inducible genes. Among them, the retinoic-acid inducible gene 1 (RIG-I) is specifically overexpressed in perifascicular areas of dermatomyositis muscle. The aim of this work was to study if RIG-I expression may be modulated by hypoxia using an in vitro approach. We identified putative hypoxia response elements (HRE) in RIG-I regulatory regions and luciferase assays confirmed that RIG-I is a new HIF-inducible gene. We observed an increase expression of RIG-I both by Real time PCR and Western blot in hypoxic conditions in human muscle cells. Cell transfection with a constitutive RIG-I expression vector increased levels of phospho-IRF-3, indicating that RIG-I promotes binding of transcription factors to the enhancer sequence of IFN. Moreover, release of IFN-β was observed in hypoxic conditions. Finally, HIF-1α overexpression was confirmed in the muscle biopsies and in some RIG-I positive perifascicular muscle fibres but not in controls. Our results indicate that hypoxia triggers the production of IFN-I in vitro, and may contribute to the pathogenesis of DM together with other inflammatory factors.
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Affiliation(s)
- Noemí De Luna
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Institut de Recerca Sant Pau, (Barcelona) and Biomedical Network Research Centre on Rare Diseases (CIBERER), Sant Pau, Spain
| | - Xavier Suárez-Calvet
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Institut de Recerca Sant Pau, (Barcelona) and Biomedical Network Research Centre on Rare Diseases (CIBERER), Sant Pau, Spain
| | - Cinta Lleixà
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Institut de Recerca Sant Pau, (Barcelona) and Biomedical Network Research Centre on Rare Diseases (CIBERER), Sant Pau, Spain
| | - Jordi Diaz-Manera
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Institut de Recerca Sant Pau, (Barcelona) and Biomedical Network Research Centre on Rare Diseases (CIBERER), Sant Pau, Spain
| | - Montse Olivé
- Department of Pathology and Neuromuscular Unit, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - Isabel Illa
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Institut de Recerca Sant Pau, (Barcelona) and Biomedical Network Research Centre on Rare Diseases (CIBERER), Sant Pau, Spain.
| | - Eduard Gallardo
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Institut de Recerca Sant Pau, (Barcelona) and Biomedical Network Research Centre on Rare Diseases (CIBERER), Sant Pau, Spain.
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167
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Suárez-Calvet X, Gallardo E, Pinal-Fernandez I, De Luna N, Lleixà C, Díaz-Manera J, Rojas-García R, Castellví I, Martínez MA, Grau JM, Selva-O'Callaghan A, Illa I. RIG-I expression in perifascicular myofibers is a reliable biomarker of dermatomyositis. Arthritis Res Ther 2017; 19:174. [PMID: 28738907 PMCID: PMC5525343 DOI: 10.1186/s13075-017-1383-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/06/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dermatomyositis (DM) is inflammatory myopathy or myositis characterized by muscle weakness and skin manifestations. In the differential diagnosis of DM the evaluation of the muscle biopsy is of importance among other parameters. Perifascicular atrophy in the muscle biopsy is considered a hallmark of DM. However, perifascicular atrophy is not observed in all patients with DM and, conversely, perifascicular atrophy can be observed in other myositis such as antisynthetase syndrome (ASS), complicating DM diagnosis. Retinoic acid inducible-gene I (RIG-I), a receptor of innate immunity that promotes type I interferon, was observed in perifascicular areas in DM. We compared the value of RIG-I expression with perifascicular atrophy as a biomarker of DM. METHODS We studied by immunohistochemical analysis the expression of RIG-I and the presence of perifascicular atrophy in 115 coded muscle biopsies: 44 patients with DM, 18 with myositis with overlap, 8 with ASS, 27 with non-DM inflammatory myopathy (16 with polymyositis, 6 with inclusion body myositis, 5 with immune-mediated necrotizing myopathy), 8 with muscular dystrophy (4 with dysferlinopathy, 4 with fascioscapulohumeral muscle dystrophy) and 10 healthy controls. RESULTS We found RIG-I-positive fibers in 50% of DM samples vs 11% in non-DM samples (p < 0.001). Interestingly, RIG-I staining identified 32% of DM patients without perifascicular atrophy (p = 0.007). RIG-I sensitivity was higher than perifascicular atrophy (p < 0.001). No differences in specificity between perifascicular atrophy and RIG-I staining were found (92% vs 88%). RIG-I staining was more reproducible than perifascicular atrophy (κ coefficient 0.52 vs 0.37). CONCLUSIONS The perifascicular pattern of RIG-I expression supports the diagnosis of DM. Of importance for clinical and therapeutic studies, the inclusion of RIG-I in the routine pathological staining of samples in inflammatory myopathy will allow us to gather more homogeneous subgroups of patients in terms of immunopathogenesis.
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Affiliation(s)
- Xavier Suárez-Calvet
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau and Institut de Recerca Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret 167, 08025, Barcelona, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain
| | - Eduard Gallardo
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau and Institut de Recerca Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret 167, 08025, Barcelona, Spain.
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain.
| | - Iago Pinal-Fernandez
- Autoimmune Systemic Diseases Unit, Department of Internal Medicine, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Noemi De Luna
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau and Institut de Recerca Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret 167, 08025, Barcelona, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain
| | - Cinta Lleixà
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau and Institut de Recerca Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret 167, 08025, Barcelona, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain
| | - Jordi Díaz-Manera
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau and Institut de Recerca Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret 167, 08025, Barcelona, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain
| | - Ricardo Rojas-García
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau and Institut de Recerca Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret 167, 08025, Barcelona, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain
| | - Ivan Castellví
- Rheumatology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Angeles Martínez
- Immunology Department, Hospital de La Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Josep M Grau
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain
- Muscle Research Unit, Internal Medicine Service, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Albert Selva-O'Callaghan
- Autoimmune Systemic Diseases Unit, Department of Internal Medicine, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Illa
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau and Institut de Recerca Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret 167, 08025, Barcelona, Spain.
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain.
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168
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Mavragani CP, Sagalovskiy I, Guo Q, Nezos A, Kapsogeorgou EK, Lu P, Liang Zhou J, Kirou KA, Seshan SV, Moutsopoulos HM, Crow MK. Expression of Long Interspersed Nuclear Element 1 Retroelements and Induction of Type I Interferon in Patients With Systemic Autoimmune Disease. Arthritis Rheumatol 2017; 68:2686-2696. [PMID: 27338297 DOI: 10.1002/art.39795] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/16/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Increased expression of type I interferon (IFN) and a broad signature of type I IFN-induced gene transcripts are observed in patients with systemic lupus erythematosus (SLE) and other systemic autoimmune diseases. To identify disease-relevant triggers of the type I IFN pathway, this study sought to investigate whether endogenous virus-like genomic repeat elements, normally silent, are expressed in patients with systemic autoimmune disease, and whether these retroelements could activate an innate immune response and induce type I IFN. METHODS Expression of type I IFN and long interspersed nuclear element 1 (LINE-1; L1) was studied by polymerase chain reaction, Western blotting, and immunohistochemistry in samples of kidney tissue from patients with lupus nephritis and minor salivary gland (MSG) tissue from patients with primary Sjögren's syndrome (SS). Induction of type I IFN by L1 was investigated by transfection of plasmacytoid dendritic cells (PDCs) or monocytes with an L1-encoding plasmid or L1 RNA. Involvement of innate immune pathways and altered L1 methylation were assessed. RESULTS Levels of L1 messenger RNA transcripts were increased in lupus nephritis kidneys and in MSG tissue from patients with SS. Transcript expression correlated with the expression of type I IFN and L1 DNA demethylation. L1 open-reading frame 1/p40 protein and IFNβ were expressed in MSG ductal epithelial cells and in lupus nephritis kidneys, and IFNα was detected in infiltrating PDCs. Transfection of PDCs or monocytes with L1-encoding DNA or RNA induced type I IFN. Inhibition of Toll-like receptor 7 (TLR-7)/TLR-8 reduced the induction of IFNα by L1 in PDCs, and an inhibitor of IKKε/TANK-binding kinase 1 abrogated the induction of type I IFN by L1 RNA in monocytes. CONCLUSION L1 genomic repeat elements represent endogenous nucleic acid triggers of the type I IFN pathway in SLE and SS and may contribute to initiation or amplification of autoimmune disease.
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Affiliation(s)
- Clio P Mavragani
- Hospital for Special Surgery, New York, New York, and National and Kapodistrian University of Athens, Athens, Greece
| | | | - Qiu Guo
- Hospital for Special Surgery, New York, New York
| | - Adrianos Nezos
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - Pin Lu
- Hospital for Special Surgery, New York, New York
| | | | | | | | | | - Mary K Crow
- Hospital for Special Surgery, New York, New York.
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169
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Integrated Diagnosis Project for Inflammatory Myopathies: An association between autoantibodies and muscle pathology. Autoimmun Rev 2017; 16:693-700. [DOI: 10.1016/j.autrev.2017.05.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/25/2017] [Indexed: 01/30/2023]
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170
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Thompson C, Piguet V, Choy E. The pathogenesis of dermatomyositis. Br J Dermatol 2017; 179:1256-1262. [DOI: 10.1111/bjd.15607] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- C. Thompson
- Department of Infection and Immunity; Cardiff University; Cardiff U.K
- Department of Rheumatology; University Hospital of Wales; Cardiff U.K
| | - V. Piguet
- Department of Infection and Immunity; Cardiff University; Cardiff U.K
- Department of Dermatology; University Hospital of Wales; Cardiff U.K
| | - E. Choy
- Department of Rheumatology; University Hospital of Wales; Cardiff U.K
- Department of Dermatology; University Hospital of Wales; Cardiff U.K
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171
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Xu D, Kacha-Ochana A, Morgan GA, Huang CC, Pachman LM. Endothelial progenitor cell number is not decreased in 34 children with Juvenile Dermatomyositis: a pilot study. Pediatr Rheumatol Online J 2017; 15:42. [PMID: 28514969 PMCID: PMC5436461 DOI: 10.1186/s12969-017-0171-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/09/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE A pilot study to determine endothelial progenitor cells (EPC) number in children with Juvenile Dermatomyositis (JDM). METHODS After obtaining informed consent, the EPC number from 34 fasting children with definite/probable JDM at various stages of therapy-initially untreated, active disease on medication and clinically inactive, off medication-was compared with 13 healthy fasting pediatric controls. The EPC number was determined by fluorescence activated cell sorting (FACS), CD34+/VEGFR2+/CD45dim-, and assessed in conjunction with clinical variables: disease activity scores (DAS), duration of untreated disease (DUD), TNF-α allelic polymorphism (A/G) at the promoter region of -308, number of nailfold capillary end row loop (ERL) and von Willebrand factor antigen (vWF:Ag). Correlations of the EPC numbers with the clinical and demographic variables, including DAS Skin (DAS SK), DAS Weakness (DAS WK), DAS Total Score, DUD, Cholesterol, triglycerides, High-Density Lipoprotein (HDL) and Low-Density Lipoprotein (LDL), and ERL were calculated using the Pearson correlation coefficient. Tests of associations of EPC with gender (boy vs girl), TNF-α-308A allele (GA/AA vs GG), vWF:Ag (categorized by specific ABO type) as normal/abnormal were performed, using two-sample T- tests. RESULTS The EPC number for JDM was not significantly different from the healthy controls and was not associated with any of the clinical or cardiovascular risk factors tested. CONCLUSION The EPC for JDM were in the normal range, similar to adults with DM. These data support the concept that the normal EPC numbers in DM/JDM, irrespective of age, differs from adult PM, where they are decreased, perhaps reflecting a different pathophysiology.
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Affiliation(s)
- Dong Xu
- 0000 0004 0388 2248grid.413808.6Cure JM Program of Excellence in Juvenile Myositis Research at Stanley Manne Children’s Research Institute of Ann and Robert H., Lurie Children’s Hospital of Chicago, Chicago, IL USA ,0000 0004 0388 2248grid.413808.6Department of Pediatrics, Division of Rheumatology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Akadia Kacha-Ochana
- 0000 0004 0388 2248grid.413808.6Cure JM Program of Excellence in Juvenile Myositis Research at Stanley Manne Children’s Research Institute of Ann and Robert H., Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Gabrielle A. Morgan
- 0000 0004 0388 2248grid.413808.6Cure JM Program of Excellence in Juvenile Myositis Research at Stanley Manne Children’s Research Institute of Ann and Robert H., Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Chiang-Ching Huang
- 0000 0001 0695 7223grid.267468.9Zilber School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI USA
| | - Lauren M. Pachman
- 0000 0004 0388 2248grid.413808.6Cure JM Program of Excellence in Juvenile Myositis Research at Stanley Manne Children’s Research Institute of Ann and Robert H., Lurie Children’s Hospital of Chicago, Chicago, IL USA ,0000 0004 0388 2248grid.413808.6Department of Pediatrics, Division of Rheumatology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL USA
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Rodero MP, Decalf J, Bondet V, Hunt D, Rice GI, Werneke S, McGlasson SL, Alyanakian MA, Bader-Meunier B, Barnerias C, Bellon N, Belot A, Bodemer C, Briggs TA, Desguerre I, Frémond ML, Hully M, van den Maagdenberg AM, Melki I, Meyts I, Musset L, Pelzer N, Quartier P, Terwindt GM, Wardlaw J, Wiseman S, Rieux-Laucat F, Rose Y, Neven B, Hertel C, Hayday A, Albert ML, Rozenberg F, Crow YJ, Duffy D. Detection of interferon alpha protein reveals differential levels and cellular sources in disease. J Exp Med 2017; 214:1547-1555. [PMID: 28420733 PMCID: PMC5413335 DOI: 10.1084/jem.20161451] [Citation(s) in RCA: 243] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/15/2016] [Accepted: 03/02/2017] [Indexed: 12/20/2022] Open
Abstract
Type I interferons (IFNs) are essential mediators of antiviral responses. These cytokines have been implicated in the pathogenesis of autoimmunity, most notably systemic lupus erythematosus (SLE), diabetes mellitus, and dermatomyositis, as well as monogenic type I interferonopathies. Despite a fundamental role in health and disease, the direct quantification of type I IFNs has been challenging. Using single-molecule array (Simoa) digital ELISA technology, we recorded attomolar concentrations of IFNα in healthy donors, viral infection, and complex and monogenic interferonopathies. IFNα protein correlated well with functional activity and IFN-stimulated gene expression. High circulating IFNα levels were associated with increased clinical severity in SLE patients, and a study of the cellular source of IFNα protein indicated disease-specific mechanisms. Measurement of IFNα attomolar concentrations by digital ELISA will enhance our understanding of IFN biology and potentially improve the diagnosis and stratification of pathologies associated with IFN dysregulation.
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Affiliation(s)
- Mathieu P. Rodero
- Laboratory of Neurogenetics and Neuroinflammation, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR1163, Institut Imagine, 75015 Paris, France
| | - Jérémie Decalf
- Immunobiology of Dendritic Cells, Institut Pasteur, 75015 Paris, France
- INSERM U1223, 75015 Paris, France
| | - Vincent Bondet
- Immunobiology of Dendritic Cells, Institut Pasteur, 75015 Paris, France
- INSERM U1223, 75015 Paris, France
| | - David Hunt
- Medical Research Council (MRC) Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH8 9YL, Scotland, UK
- Centre for Clinical Brain Sciences (CCBS), University of Edinburgh, Edinburgh EH8 9YL, Scotland, UK
| | - Gillian I. Rice
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9NT, England, UK
| | - Scott Werneke
- Immunobiology of Dendritic Cells, Institut Pasteur, 75015 Paris, France
- INSERM U1223, 75015 Paris, France
| | - Sarah L. McGlasson
- Medical Research Council (MRC) Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH8 9YL, Scotland, UK
- Centre for Clinical Brain Sciences (CCBS), University of Edinburgh, Edinburgh EH8 9YL, Scotland, UK
| | - Marie-Alexandra Alyanakian
- Laboratoire d’Immunologie Biologique, Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, 75015 Paris, France
| | - Brigitte Bader-Meunier
- Pediatric Immunology-Hematology and Rheumatology Unit, Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, 75015 Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmunity, INSERM UMR 1163, 75015 Paris, France
| | - Christine Barnerias
- Department of Paediatric Neurology, Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, 75015 Paris, France
| | - Nathalia Bellon
- Department of Paediatric Dermatology, Reference Centre for Rare Skin Disorders (MAGEC), Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, 75015 Paris, France
| | - Alexandre Belot
- Department of Paediatric Rheumatology, Hospices Civils de Lyon, INSERM U1111, 69007 Lyon, France
| | - Christine Bodemer
- Université Paris Descartes, Université Sorbonne Paris Cité, Institut Imagine, 75015 Paris, France
- Department of Paediatric Dermatology, Reference Centre for Rare Skin Disorders (MAGEC), Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, 75015 Paris, France
| | - Tracy A. Briggs
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9NT, England, UK
- Manchester Centre for Genomic Medicine, St Mary’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9NT, England, UK
| | - Isabelle Desguerre
- Department of Paediatric Neurology, Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, 75015 Paris, France
| | - Marie-Louise Frémond
- Laboratory of Neurogenetics and Neuroinflammation, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR1163, Institut Imagine, 75015 Paris, France
| | - Marie Hully
- Department of Paediatric Neurology, Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, 75015 Paris, France
| | - Arn M.J.M. van den Maagdenberg
- Department of Neurology, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
- Department of Human Genetics, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - Isabelle Melki
- Laboratory of Neurogenetics and Neuroinflammation, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR1163, Institut Imagine, 75015 Paris, France
- Pediatric Immunology-Hematology and Rheumatology Unit, Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, 75015 Paris, France
- General Paediatrics, Infectious Disease and Internal Medicine Department, Assistance Publique–Hôpitaux de Paris, Robert-Debré Hospital, 75019 Paris, France
| | - Isabelle Meyts
- Department of Pediatrics, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Microbiology and Immunology, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
| | - Lucile Musset
- Department of Immunology, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Nadine Pelzer
- Department of Neurology, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - Pierre Quartier
- Université Paris Descartes, Université Sorbonne Paris Cité, Institut Imagine, 75015 Paris, France
- Pediatric Immunology-Hematology and Rheumatology Unit, Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, 75015 Paris, France
| | - Gisela M. Terwindt
- Department of Neurology, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences (CCBS), University of Edinburgh, Edinburgh EH8 9YL, Scotland, UK
| | - Stewart Wiseman
- Centre for Clinical Brain Sciences (CCBS), University of Edinburgh, Edinburgh EH8 9YL, Scotland, UK
| | - Frédéric Rieux-Laucat
- Université Paris Descartes, Université Sorbonne Paris Cité, Institut Imagine, 75015 Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmunity, INSERM UMR 1163, 75015 Paris, France
| | - Yoann Rose
- Laboratory of Neurogenetics and Neuroinflammation, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR1163, Institut Imagine, 75015 Paris, France
| | - Bénédicte Neven
- Université Paris Descartes, Université Sorbonne Paris Cité, Institut Imagine, 75015 Paris, France
- Pediatric Immunology-Hematology and Rheumatology Unit, Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, 75015 Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmunity, INSERM UMR 1163, 75015 Paris, France
| | | | - Adrian Hayday
- Peter Gorer Department of Immunobiology, King’s College, Guy’s Hospital, London SE1 9RT, England, UK
- Francis Crick Institute, London NW1 1BF, England, UK
| | - Matthew L. Albert
- Immunobiology of Dendritic Cells, Institut Pasteur, 75015 Paris, France
- Centre for Translational Research, Institut Pasteur, 75015 Paris, France
- INSERM U1223, 75015 Paris, France
| | - Flore Rozenberg
- Service de Virologie, Université Paris Descartes, Université Sorbonne Paris Cité, Assistance–Publique Hôpitaux de Paris, Groupe Hospitalier Universitaire Paris Centre, 75014 Paris, France
| | - Yanick J. Crow
- Laboratory of Neurogenetics and Neuroinflammation, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR1163, Institut Imagine, 75015 Paris, France
- Université Paris Descartes, Université Sorbonne Paris Cité, Institut Imagine, 75015 Paris, France
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9NT, England, UK
- Département de Génétique, Assistance Publique–Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, 75015 Paris, France
| | - Darragh Duffy
- Immunobiology of Dendritic Cells, Institut Pasteur, 75015 Paris, France
- Centre for Translational Research, Institut Pasteur, 75015 Paris, France
- INSERM U1223, 75015 Paris, France
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Retraction notice. Muscle Nerve 2017; 55:766. [DOI: 10.1002/mus.21394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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174
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Meyer A, Lannes B, Goetz J, Echaniz-Laguna A, Lipsker D, Arnaud L, Martin T, Gottenberg JE, Geny B, Sibilia J. Inflammatory myopathies: A new landscape. Joint Bone Spine 2017; 85:23-33. [PMID: 28343013 DOI: 10.1016/j.jbspin.2017.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 02/07/2023]
Abstract
Greater accuracy in clinical descriptions combined with advances in muscle histology and immunology have established that inflammatory myopathies (IMs), similarly to inflammatory rheumatic diseases, constitute a highly heterogeneous group of conditions. The topographic distribution, severity, and tempo of onset of the myopathy vary widely, and the histological findings distinguish at least five different profiles, which may reflect different pathophysiological processes. Most IMs are connective tissue diseases that can affect multiple organs, among which the most common targets are the skin, joints, and lungs. The extramuscular manifestations may antedate the muscular involvement and should therefore suggest a diagnosis of IM even in the absence of obvious muscle disease. About 20 different autoantibodies have been identified in patients with IM. Some are mutually exclusive and associated with specific combinations of clinical manifestations. Following the model of antisynthetase syndrome, about 10 syndromes associated with autoantibodies specific of IM have been identified. Thus, polymyositis is now emerging as a rare entity that is often mistaken for more recently described patterns of IM. No consensus exists to date about the classification of IMs. Nevertheless, the clinical manifestations, autoantibody profile, and muscle histology can be used to distinguish patient subgroups with fairly homogeneous patterns of complications, treatment responses, and outcomes. These subgroups are also characterized by specific genetic and environmental factors. The advances made in the nosology of IMs have benefited the diagnosis, personalization of treatment strategies, and understanding of pathophysiological mechanisms. They can be expected to assist in the development of specific treatments.
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Affiliation(s)
- Alain Meyer
- Service de physiologie et d'explorations fonctionnelles, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Service de rhumatologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Centre de référence des maladies auto-immunes rares, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Fédération de médecine translationnelle de Strasbourg, université de Strasbourg, 67000 Strasbourg, France.
| | - Béatrice Lannes
- Fédération de médecine translationnelle de Strasbourg, université de Strasbourg, 67000 Strasbourg, France; Département de pathologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - Joëlle Goetz
- Laboratoire d'immunologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - Andoni Echaniz-Laguna
- Service de neurologie, centre de référence des maladies neuromusculaires, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - Dan Lipsker
- Clinique dermatologique, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - Laurent Arnaud
- Service de rhumatologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Centre de référence des maladies auto-immunes rares, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Fédération de médecine translationnelle de Strasbourg, université de Strasbourg, 67000 Strasbourg, France
| | - Thierry Martin
- Centre de référence des maladies auto-immunes rares, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Fédération de médecine translationnelle de Strasbourg, université de Strasbourg, 67000 Strasbourg, France; Service d'immunologie clinique, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - Jacques Eric Gottenberg
- Service de rhumatologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Centre de référence des maladies auto-immunes rares, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Fédération de médecine translationnelle de Strasbourg, université de Strasbourg, 67000 Strasbourg, France
| | - Bernard Geny
- Service de physiologie et d'explorations fonctionnelles, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Centre de référence des maladies auto-immunes rares, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Fédération de médecine translationnelle de Strasbourg, université de Strasbourg, 67000 Strasbourg, France
| | - Jean Sibilia
- Service de rhumatologie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Centre de référence des maladies auto-immunes rares, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France; Fédération de médecine translationnelle de Strasbourg, université de Strasbourg, 67000 Strasbourg, France
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175
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Allenbach Y, Benveniste O, Goebel HH, Stenzel W. Integrated classification of inflammatory myopathies. Neuropathol Appl Neurobiol 2017; 43:62-81. [DOI: 10.1111/nan.12380] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 01/04/2017] [Accepted: 01/11/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Y. Allenbach
- Department of Internal Medicine and Clinical Immunology; Pitié-Salpêtrière Hospital; DHU I2B; AP-HP; Paris France
- INSERM U974; UPMC Sorbonne Universities; Paris France
| | - O. Benveniste
- Department of Internal Medicine and Clinical Immunology; Pitié-Salpêtrière Hospital; DHU I2B; AP-HP; Paris France
- INSERM U974; UPMC Sorbonne Universities; Paris France
| | - H-H. Goebel
- Department of Neuropathology; Charité - Universitätsmedizin; Berlin Germany
| | - W. Stenzel
- Department of Neuropathology; Charité - Universitätsmedizin; Berlin Germany
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176
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Huard C, Gullà S, Bennett D, Coyle A, Vleugels R, Greenberg S. Correlation of cutaneous disease activity with type 1 interferon gene signature and interferon β in dermatomyositis. Br J Dermatol 2017; 176:1224-1230. [DOI: 10.1111/bjd.15006] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 01/19/2023]
Affiliation(s)
- C. Huard
- Pfizer Inc.; Centers for Therapeutic Innovation; Boston MA U.S.A
| | - S.V. Gullà
- Pfizer Inc.; Centers for Therapeutic Innovation; Boston MA U.S.A
| | - D.V. Bennett
- Pfizer Inc.; Pharma Therapeutics; Precision Medicine; Cambridge MA U.S.A
| | - A.J. Coyle
- Pfizer Inc.; Centers for Therapeutic Innovation; Boston MA U.S.A
| | - R.A. Vleugels
- Department of Dermatology; Brigham and Women's Hospital; Boston MA U.S.A
| | - S.A. Greenberg
- Department of Neurology; Brigham and Women's Hospital; Harvard Medical School; Boston MA U.S.A
- Children's Hospital Informatics Program; Boston Children's Hospital; Boston MA U.S.A
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177
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Yin X, Han GC, Jiang XW, Shi Q, Pu CQ. Increased Expression of the NOD-like Receptor Family, Pyrin Domain Containing 3 Inflammasome in Dermatomyositis and Polymyositis is a Potential Contributor to Their Pathogenesis. Chin Med J (Engl) 2017; 129:1047-52. [PMID: 27098789 PMCID: PMC4852671 DOI: 10.4103/0366-6999.180528] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Dermatomyositis (DM) and polymyositis (PM) are common inflammatory myopathies whose immunopathogenic mechanisms remain poorly understood. The NOD-like receptor family, pyrin domain containing 3 (NLRP3) inflammasome is a type of cytoplasmic multiprotein inflammasome and is responsible for the activation of inflammatory reactivations. Responding to a wide range of exogenous and endogenous microbial or sterile stimuli, NLRP3 inflammasomes can cleave pro-caspase-1 into active caspase-1, which processes the pro-inflammatory cytokines pro-interleukin (IL)-1β and pro-IL-18 into active and secreted IL-1β and IL-18. The NLRP3 inflammasome is implicated in infectious and sterile inflammatory diseases. However, it remains unclear whether it is involved in the pathogenesis of DM/PM, which we aim to address in our research. Methods: In this study, 22 DM/PM patients and 24 controls were recruited. The protein and RNA expression of IL-1β, IL-18, NLRP3, and caspase-1 in serum and muscle samples were tested and compared between the two groups. Results: The serum IL-1β and IL-18 levels were significantly higher in DM/PM patients than those in the controls by enzyme linked immunosorbent assay (ELISA, DM vs. control, 25.02 ± 8.29 ng/ml vs. 16.49 ± 3.30 ng/ml, P < 0.001; PM vs. control, 26.49 ± 7.79 ng/ml vs. 16.49 ± 3.30 ng/ml, P < 0.001). Moreover, the real-time quantitative reverse transcription-polymerase chain reaction (qRT-PCR) showed that DM/PM patients exhibited higher RNA expression of IL-1β, IL-18, and NLRP3 in the muscle (for IL-1β, DM vs. control, P = 0.0012, PM vs. control, P = 0.0021; for IL-18, DM vs. control, P = 0.0045, PM vs. control, P = 0.0031; for NLRP3, DM vs. control, P = 0.0017, PM vs. control, P = 0.0006). Moreover, the protein expression of NLRP3 and caspase-1 in muscle samples of DM/PM patients were also significantly elevated compared to that in the muscles of the controls. Conclusions: Our findings demonstrate that the NLRP3 inflammasome is implicated in the pathogenesis of DM/PM. High NLRP3 expression led to elevated levels of IL-1β and IL-18 and could be one of the factors promoting disease progress.
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Affiliation(s)
| | | | | | | | - Chuan-Qiang Pu
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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178
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The host defense peptide LL-37 a possible inducer of the type I interferon system in patients with polymyositis and dermatomyositis. J Autoimmun 2017; 78:46-56. [DOI: 10.1016/j.jaut.2016.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/01/2016] [Accepted: 12/06/2016] [Indexed: 11/22/2022]
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179
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Ceribelli A, De Santis M, Isailovic N, Gershwin ME, Selmi C. The Immune Response and the Pathogenesis of Idiopathic Inflammatory Myositis: a Critical Review. Clin Rev Allergy Immunol 2017; 52:58-70. [PMID: 26780034 DOI: 10.1007/s12016-016-8527-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The pathogenesis of idiopathic inflammatory myositis (IIMs, including polymyositis and dermatomyositis) remains largely enigmatic, despite advances in the study of the role played by innate immunity, adaptive immunity, genetic predisposition, and environmental factors in an orchestrated response. Several factors are involved in the inflammatory state that characterizes the different forms of IIMs which share features and mechanisms but are clearly different with respect to the involved sites and characteristics of the inflammation. Cellular and non-cellular mechanisms of both the immune and non-immune systems have been identified as key regulators of inflammation in polymyositis/dermatomyositis, particularly at different stages of disease, leading to the fibrotic state that characterizes the end stage. Among these, a special role is played by an interferon signature and complement cascade with different mechanisms in polymyositis and dermatomyositis; these differences can be identified also histologically in muscle biopsies. Numerous cellular components of the adaptive and innate immune response are present in the site of tissue inflammation, and the complexity of idiopathic inflammatory myositis is further supported by the involvement of non-immune mechanisms such as hypoxia and autophagy. The aim of this comprehensive review is to describe the major pathogenic mechanisms involved in the onset of idiopathic inflammatory myositis and to report on the major working hypothesis with therapeutic implications.
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Affiliation(s)
- Angela Ceribelli
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, via A. Manzoni 56, 20089, Rozzano, MI, Italy
- BIOMETRA Department, University of Milan, Milan, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, via A. Manzoni 56, 20089, Rozzano, MI, Italy
| | - Natasa Isailovic
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, via A. Manzoni 56, 20089, Rozzano, MI, Italy
| | - M Eric Gershwin
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California Davis, Davis, CA, USA
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, via A. Manzoni 56, 20089, Rozzano, MI, Italy.
- BIOMETRA Department, University of Milan, Milan, Italy.
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180
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Moghadam-Kia S, Oddis CV, Aggarwal R. Modern Therapies for Idiopathic Inflammatory Myopathies (IIMs): Role of Biologics. Clin Rev Allergy Immunol 2017; 52:81-87. [PMID: 26767526 DOI: 10.1007/s12016-016-8530-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the lack of placebo-controlled trials, glucocorticoids are considered the mainstay of initial treatment for idiopathic inflammatory myopathy (IIMs) and myositis-associated ILD (MA-ILD). Glucocorticoid-sparing agents are often given concomitantly with other immunosuppressive agents, particularly in patients with moderate or severe disease. As treatment of refractory cases of idiopathic inflammatory myopathies has been challenging, there is growing interest in evaluating newer therapies including biologics that target various pathways involved in the pathogenesis of IIMs. In a large clinical trial of rituximab in adult and juvenile myositis, the primary outcome was not met, but the definition of improvement was met by most of this refractory group of myositis patients. Rituximab use was also associated with a significant glucocorticoid-sparing effect. Intravenous immune globulin (IVIg) can be used for refractory IIMs or those with severe dysphagia or concomitant infections. Anti-tumor necrosis factor (anti-TNF) utility in IIMs is generally limited by previous negative studies along with recent reports suggesting their potential for inducing myositis. Further research is required to assess the role of new therapies such as tocilizumab (anti-IL6), ACTH gel, sifalimumab (anti-IFNα), and abatacept (inhibition of T cell co-stimulation) given their biological plausibility and encouraging small case series results. Other potential novel therapies include alemtuzumab (a humanized monoclonal antibody which binds CD52 on B and T lymphocytes), fingolimod (a sphingosine 1-phosphate receptor modulator that traps T lymphocytes in the lymphoid organs), eculizumab, and basiliximab. The future investigations in IIMs will depend on well-designed controlled clinical trials using validated consensus core set measures and improvements in myositis classification schemes based on serologic and histopathologic features.
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Affiliation(s)
- Siamak Moghadam-Kia
- Department of Medicine, Myositis Center and Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, 3601 5th Avenue, Suite 2B, Pittsburgh, PA, 15261, USA
| | - Chester V Oddis
- Department of Medicine, Myositis Center and Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, 3601 5th Avenue, Suite 2B, Pittsburgh, PA, 15261, USA
| | - Rohit Aggarwal
- Department of Medicine, Myositis Center and Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, 3601 5th Avenue, Suite 2B, Pittsburgh, PA, 15261, USA.
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181
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Ekholm L, Vosslamber S, Tjärnlund A, de Jong TD, Betteridge Z, McHugh N, Plestilova L, Klein M, Padyukov L, Voskuyl AE, Bultink IEM, Michiel Pegtel D, Mavragani CP, Crow MK, Vencovsky J, Lundberg IE, Verweij CL. Autoantibody Specificities and Type I Interferon Pathway Activation in Idiopathic Inflammatory Myopathies. Scand J Immunol 2017; 84:100-9. [PMID: 27173897 DOI: 10.1111/sji.12449] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/08/2016] [Indexed: 11/29/2022]
Abstract
Myositis is a heterogeneous group of autoimmune diseases, with different pathogenic mechanisms contributing to the different subsets of disease. The aim of this study was to test whether the autoantibody profile in patients with myositis is associated with a type I interferon (IFN) signature, as in patients with systemic lupus erythematous (SLE). Patients with myositis were prospectively enrolled in the study and compared to healthy controls and to patients with SLE. Autoantibody status was analysed using an immunoassay system and immunoprecipitation. Type I IFN activity in whole blood was determined using direct gene expression analysis. Serum IFN-inducing activity was tested using peripheral blood cells from healthy donors. Blocking experiments were performed by neutralizing anti-IFNAR or anti-IFN-α antibodies. Patients were categorized into IFN high and IFN low based on an IFN score. Patients with autoantibodies against RNA-binding proteins had a higher IFN score compared to patients without these antibodies, and the IFN score was related to autoantibody multispecificity. Patients with dermatomyositis (DM) and inclusion body myositis (IBM) had a higher IFN score compared to the other subgroups. Serum type I IFN bioactivity was blocked by neutralizing anti-IFNAR or anti-IFN-α antibodies. To conclude, a high IFN score was not only associated with DM, as previously reported, and IBM, but also with autoantibody monospecificity against several RNA-binding proteins and with autoantibody multispecificity. These studies identify IFN-α in sera as a trigger for activation of the type I IFN pathway in peripheral blood and support IFN-α as a possible target for therapy in these patients.
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Affiliation(s)
- L Ekholm
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - S Vosslamber
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - A Tjärnlund
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - T D de Jong
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Z Betteridge
- Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - N McHugh
- Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - L Plestilova
- Institute of Rheumatology, Prague, Czech Republic
| | - M Klein
- Institute of Rheumatology, Prague, Czech Republic
| | - L Padyukov
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - A E Voskuyl
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, VU University Medical Center, Amsterdam, the Netherlands
| | - I E M Bultink
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, VU University Medical Center, Amsterdam, the Netherlands
| | - D Michiel Pegtel
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - C P Mavragani
- Mary Kirkland Center for Lupus Research, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA.,Department of Experimental Physiology, University of Athens, Athens, Greece
| | - M K Crow
- Mary Kirkland Center for Lupus Research, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA
| | - J Vencovsky
- Institute of Rheumatology, Prague, Czech Republic
| | - I E Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - C L Verweij
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands.,Department of Rheumatology, Amsterdam Rheumatology and immunology Center, VU University Medical Center, Amsterdam, the Netherlands
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182
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De Paepe B. Vascular changes and perifascicular muscle fiber damage in dermatomyositis: another question of the chicken or the egg that is on our mind. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:22. [PMID: 28164107 DOI: 10.21037/atm.2016.12.68] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Boel De Paepe
- Neuromuscular Reference Center & Neurology Department, Ghent University Hospital, Ghent, Belgium
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183
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Uruha A, Nishikawa A, Tsuburaya RS, Hamanaka K, Kuwana M, Watanabe Y, Suzuki S, Suzuki N, Nishino I. Sarcoplasmic MxA expression. Neurology 2016; 88:493-500. [DOI: 10.1212/wnl.0000000000003568] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/27/2016] [Indexed: 01/11/2023] Open
Abstract
Objective:To evaluate the diagnostic value of myxovirus resistance A (MxA) expression in the cytoplasm of myofibers in the diagnosis of dermatomyositis (DM).Methods:We assessed the sensitivity and specificity of the sarcoplasmic expression of MxA in muscles with DM by immunohistochemistry in consecutive cases of DM (n = 34) and other idiopathic inflammatory myopathies (n = 120: 8 with polymyositis, 16 with anti–tRNA-synthetase antibody–associated myositis, 46 with immune-mediated necrotizing myopathy, and 50 with inclusion body myositis) and compared them with conventional pathologic hallmarks of DM, including perifascicular atrophy (PFA) and membrane attack complex (MAC) deposition on endomysial capillaries.Results:The sensitivity and specificity of sarcoplasmic MxA expression were 71% and 98%, respectively. While the specificity was almost comparable to that of PFA and capillary MAC deposition, the sensitivity was higher, with PFA showing 47% sensitivity and 98% specificity and capillary MAC deposition showing 35% sensitivity and 93% specificity. Of note, in patients with DM with typical skin rash but no PFA, 44% of the samples showed sarcoplasmic MxA expression, which was higher than the 17% sensitivity of capillary MAC deposition in the population.Conclusions:Sarcoplasmic MxA expression detected by immunohistochemistry is a more sensitive marker of DM than the conventional hallmarks, indicating its practical utility in the diagnosis of DM. It may well be included in the routine immunohistochemistry panel for myositis.Classification of evidence:This study provides Class II evidence that immunohistochemistry-detected sarcoplasmic MxA expression accurately identifies patients with dermatomyositis.
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184
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Assessment of Type I Interferon Signaling in Pediatric Inflammatory Disease. J Clin Immunol 2016; 37:123-132. [PMID: 27943079 PMCID: PMC5325846 DOI: 10.1007/s10875-016-0359-1] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/21/2016] [Indexed: 12/22/2022]
Abstract
Purpose Increased type I interferon is considered relevant to the pathology of a number of monogenic and complex disorders spanning pediatric rheumatology, neurology, and dermatology. However, no test exists in routine clinical practice to identify enhanced interferon signaling, thus limiting the ability to diagnose and monitor treatment of these diseases. Here, we set out to investigate the use of an assay measuring the expression of a panel of interferon-stimulated genes (ISGs) in children affected by a range of inflammatory diseases. Design, Setting, and Participants A cohort study was conducted between 2011 and 2016 at the University of Manchester, UK, and the Institut Imagine, Paris, France. RNA PAXgene blood samples and clinical data were collected from controls and symptomatic patients with a genetically confirmed or clinically well-defined inflammatory phenotype. The expression of six ISGs was measured by quantitative polymerase chain reaction, and the median fold change was used to calculate an interferon score (IS) for each subject compared to a previously derived panel of 29 controls (where +2 SD of the control data, an IS of >2.466, is considered as abnormal). Results were correlated with genetic and clinical data. Results Nine hundred ninety-two samples were analyzed from 630 individuals comprising symptomatic patients across 24 inflammatory genotypes/phenotypes, unaffected heterozygous carriers, and controls. A consistent upregulation of ISG expression was seen in 13 monogenic conditions (455 samples, 265 patients; median IS 10.73, interquartile range (IQR) 5.90–18.41), juvenile systemic lupus erythematosus (78 samples, 55 patients; median IS 10.60, IQR 3.99–17.27), and juvenile dermatomyositis (101 samples, 59 patients; median IS 9.02, IQR 2.51–21.73) compared to controls (78 samples, 65 subjects; median IS 0.688, IQR 0.427–1.196), heterozygous mutation carriers (89 samples, 76 subjects; median IS 0.862, IQR 0.493–1.942), and individuals with non-molecularly defined autoinflammation (89 samples, 69 patients; median IS 1.07, IQR 0.491–3.74). Conclusions and Relevance An assessment of six ISGs can be used to define a spectrum of inflammatory diseases related to enhanced type I interferon signaling. If future studies demonstrate that the IS is a reactive biomarker, this measure may prove useful both in the diagnosis and the assessment of treatment efficacy. Electronic supplementary material The online version of this article (doi:10.1007/s10875-016-0359-1) contains supplementary material, which is available to authorized users.
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185
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López De Padilla CM, Crowson CS, Hein MS, Pendegraft RS, Strausbauch MA, Niewold TB, Ernste FC, Peterson E, Baechler EC, Reed AM. Gene Expression Profiling in Blood and Affected Muscle Tissues Reveals Differential Activation Pathways in Patients with New-onset Juvenile and Adult Dermatomyositis. J Rheumatol 2016; 44:117-124. [PMID: 27803134 DOI: 10.3899/jrheum.160293] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To identify shared and differential molecular pathways in blood and affected muscle between adult dermatomyositis (DM) and juvenile DM, and their association with clinical disease activity measures. METHODS Gene expression of transcription factors and cytokines involved in differentiation and effector function of T cell subsets, regulatory T cells and follicular Th cells, were analyzed in the blood from 21 newly diagnosed adult and 26 juvenile DM subjects and in 15 muscle specimens (7 adult and 8 juvenile DM) using a custom RT2 Profiler PCR Array. Disease activity was determined and measured by established disease activity tools. RESULTS The most prominent finding was the higher blood expression of Th17-related cytokines [retinoic acid-related orphan receptor-γ, interferon regulatory factor 4, interleukin (IL)-23A, IL-6, IL-17F, and IL-21] in juvenile DM at baseline. In contrast, adult patients with DM showed increased blood levels of STAT3 and BCL6 compared with juvenile DM. In muscle, GATA3, IL-13, and STAT5B were found at higher levels in juvenile patients with DM compared with adult DM. Among 25 patients (11 adult and 14 juvenile DM) who had blood samples at baseline and at 6 months, increased expression of IL-1β, STAT3, STAT6, STAT5B, and BCL6 was associated with an improvement in global extramuscular disease activity. CONCLUSION We observed differences in gene expression profiling in blood and muscle between new-onset adult and juvenile DM. Cytokine expression in the blood of juvenile patients with new-onset DM was dominated by Th17-related cytokines compared with adult patients with DM. This may reflect the activation of different Th pathways between muscle and blood.
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Affiliation(s)
- Consuelo M López De Padilla
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Cynthia S Crowson
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Molly S Hein
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Richard S Pendegraft
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Michael A Strausbauch
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Timothy B Niewold
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Floranne C Ernste
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Erik Peterson
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Emily C Baechler
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Ann M Reed
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA. .,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center.
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186
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Dysregulated innate immune function in the aetiopathogenesis of idiopathic inflammatory myopathies. Autoimmun Rev 2016; 16:87-95. [PMID: 27666811 DOI: 10.1016/j.autrev.2016.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 09/08/2016] [Indexed: 12/20/2022]
Abstract
The idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of systemic muscle conditions that are believed to be autoimmune in nature. They have distinct pathological features, but the aetiopathogenesis of each subtype remains largely unknown. Recently, there has been increased interest in the complex role the innate immune system plays in initiating and perpetuating these conditions, and how this may differ between subtypes. This article summarises the traditional paradigms of IIM pathogenesis and reviews the accumulating evidence for disturbances in innate immune processes in these rare, but debilitating chronic conditions.
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187
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Transcriptomic profiling of long non-coding RNAs in dermatomyositis by microarray analysis. Sci Rep 2016; 6:32818. [PMID: 27605457 PMCID: PMC5015085 DOI: 10.1038/srep32818] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/15/2016] [Indexed: 12/22/2022] Open
Abstract
Long non-coding RNAs (lncRNAs) are prevalently transcribed in the genome and have been found to be of functional importance. However, the potential roles of lncRNAs in dermatomyositis (DM) remain unknown. In this study, a lncRNA + mRNA microarray analysis was performed to profile lncRNAs and mRNAs from 15 treatment-naive DM patients and 5 healthy controls. We revealed a total of 1198 lncRNAs (322 up-regulated and 876 down-regulated) and 1213 mRNAs (665 up-regulated and 548 down-regulated) were significantly differentially expressed in DM patients compared with the healthy controls (fold change>2, P < 0.05). Subgrouping DM patients according to the presence of interstitial lung disease and anti-Jo-1 antibody revealed different expression patterns of the lncRNAs. Pathway and gene ontology analysis for the differentially expressed mRNAs confirmed that type 1 interferon signaling was the most significantly dysregulated pathway in all DM subgroups. In addition, distinct pathways that uniquely associated with DM subgroup were also identified. Bioinformatics prediction suggested that linc-DGCR6-1 may be a lncRNA that regulates type 1 interferon-inducible gene USP18, which was found highly expressed in the perifascicular areas of the muscle fibers of DM patients. Our findings provide an overview of aberrantly expressed lncRNAs in DM muscle and further broaden the understanding of DM pathogenesis.
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188
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Ekholm L, Kahlenberg JM, Barbasso Helmers S, Tjärnlund A, Yalavarthi S, Zhao W, Seto N, Betteridge Z, Lundberg IE, Kaplan MJ. Dysfunction of endothelial progenitor cells is associated with the type I IFN pathway in patients with polymyositis and dermatomyositis. Rheumatology (Oxford) 2016; 55:1987-1992. [PMID: 27498356 DOI: 10.1093/rheumatology/kew288] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/26/2016] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Alterations in phenotype and function of endothelial progenitor cells (EPCs) have been associated with poor vascular outcomes and impaired vascular repair in various conditions. Our hypothesis was that patients with PM and DM have dysregulation of EPCs driven by type I IFN and IL-18 similar to other autoimmune diseases. METHODS Quantification of circulating EPCs was performed by flow cytometry in patients with PM/DM and matched healthy controls. The ability of EPCs to differentiate into mature endothelial cells was investigated by light and fluorescence microscopy quantification in the presence or absence of PM/DM or control serum, neutralizing antibodies to type I IFN receptor or IL-18. Serum type I IFN activity was quantified by induction of type I IFN-inducible genes in HeLa cells. Circulating IL-18 concentrations were assessed by ELISA. RESULTS Circulating EPCs were significantly lower in PM/DM patients compared with controls. PM/DM EPCs displayed a decreased capacity to differentiate into mature endothelial cells and PM/DM serum significantly inhibited differentiation of control EPCs. This effect was reversed in the majority of samples with neutralizing antibodies to IL-18 or to type I IFN receptor or by a combination of these antibodies. Patients with associated impairments in EPC function had higher type I IFN serum activity. CONCLUSION PM/DM is associated with dysregulation of EPC phenotype and function that may be attributed, at least in part, to aberrant IL-18 and type I IFN pathways. The implication of these vasculopathic findings for disease prognosis and complications remains to be determined.
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Affiliation(s)
- Louise Ekholm
- Department of Medicine, Rheumatology Unit, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - J Michelle Kahlenberg
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Sevim Barbasso Helmers
- Department of Medicine, Rheumatology Unit, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - Anna Tjärnlund
- Department of Medicine, Rheumatology Unit, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - Srilakshmi Yalavarthi
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Wenpu Zhao
- Systemic Autoimmunity Branch, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, NIH, Bethesda, MD, USA
| | - Nickie Seto
- Systemic Autoimmunity Branch, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, NIH, Bethesda, MD, USA
| | | | - Ingrid E Lundberg
- Department of Medicine, Rheumatology Unit, Karolinska University Hospital, Karolinska Institutet, Solna, Sweden
| | - Mariana J Kaplan
- Systemic Autoimmunity Branch, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, NIH, Bethesda, MD, USA
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189
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Benveniste O, Rider LG. 213th ENMC International Workshop: Outcome measures and clinical trial readiness in idiopathic inflammatory myopathies, Heemskerk, The Netherlands, 18-20 September 2015. Neuromuscul Disord 2016; 26:523-34. [PMID: 27312023 PMCID: PMC5118225 DOI: 10.1016/j.nmd.2016.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 05/19/2016] [Accepted: 05/23/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Olivier Benveniste
- Département de Médecine Interne et Immunologie Clinique, Hôpital Pitié-Salpêtrière, DHU I2B, AP-HP, Paris, France; INSERM U974, UPMC Sorbonne Universités, Paris, France.
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA.
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190
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Auerbach SS. In vivo Signatures of Genotoxic and Non-genotoxic Chemicals. TOXICOGENOMICS IN PREDICTIVE CARCINOGENICITY 2016. [DOI: 10.1039/9781782624059-00113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This chapter reviews the findings from a broad array of in vivo genomic studies with the goal of identifying a general signature of genotoxicity (GSG) that is indicative of exposure to genotoxic agents (i.e. agents that are active in either the bacterial mutagenesis and/or the in vivo micronucleus test). While the GSG has largely emerged from systematic studies of rat and mouse liver, its response is evident across a broad collection of genotoxic treatments that cover a variety of tissues and species. Pathway-based characterization of the GSG indicates that it is enriched with genes that are regulated by p53. In addition to the GSG, another pan-tissue signature related to bone marrow suppression (a common effect of genotoxic agent exposure) is reviewed. Overall, these signatures are quite effective in identifying genotoxic agents; however, there are situations where false positive findings can occur, for example when necrotizing doses of non-genotoxic soft electrophiles (e.g. thioacetamide) are used. For this reason specific suggestions for best practices for generating for use in the creation and application of in vivo genomic signatures are reviewed.
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Affiliation(s)
- Scott S. Auerbach
- Toxicoinformatic Group, Biomolecular Screening Branch, Division of the National Toxicology Program, National Institute of Environmental Health Sciences PO Box 12233 MD K2-17 Research Triangle Park NC 27709 USA
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Abstract
The management of patients with idiopathic inflammatory myopathy (IIM) remains a challenge given the systemic features beyond active myositis. That is, recognizing the inflammatory arthropathy, varying dermatomyositis rashes, and overt and occult features of interstitial lung disease in addition to myositis adds to the complexity of diagnosis and treatment of IIM. However, clinicians now have available many more immunosuppressive drugs as well as biologic agents for use in patients with myositis and other autoimmune diseases. Here, the use of these agents is reviewed and support based on available published literature is provided even though many studies have been small and results somewhat anecdotal. Glucocorticoids remain the initial treatment of choice in most instances and methotrexate and azathioprine are often used early in the treatment course. These agents are followed by other immunosuppressive drugs, for example mycophenolate mofetil, tacrolimus, cyclosporine and cyclophosphamide, some of which are used alone while combinations of these agents also provide an effective option. There is more rationale for the use of biologic agents such as rituximab from a mechanistic perspective and, given the incorporation of validated core set measures in assessing myositis patients, we can look forward to better designed clinical trials in the future.
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Affiliation(s)
- C V Oddis
- Myositis Center, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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192
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Yan W, Fan W, Chen C, Wu Y, Fan Z, Chen J, Chen Z, Chen H. IL-15 up-regulates the MMP-9 expression levels and induces inflammatory infiltration of macrophages in polymyositis through regulating the NF-kB pathway. Gene 2016; 591:137-147. [PMID: 27374114 DOI: 10.1016/j.gene.2016.06.055] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/15/2016] [Accepted: 06/28/2016] [Indexed: 02/04/2023]
Abstract
This study was aimed to research the effects of IL-15 on inducing inflammatory infiltration of macrophages in polymyositis (PM) through the NF-kB pathway, and whether IL-15 was able to further regulate MMP-9 expression levels. Prepared PM cells, collected from the patients suffering from PM, were administered to SD rats. Also, a group of healthy SD rats was undergoing the same treatment as the control group. The test animals were treated with either anti-IL-15, IL-15, MMP-9 siRNA or ERK1/2 inhibitor. The blood toxicological parameters creatine kinase (CK) and CD163 were tested by using ELISA and immunohistochemistry assay. In addition, NF-kB expression in macrophages was measured by immunocytochemical assay. To measure the degree of cell infiltration the Transwell assay was performed. Lastly, western blot and zymography were carried out to compare MMP-9 and ERK expression levels between the two groups, both in vivo and in vitro. The results showed that S-CK, IL-15 and IL-15Rα levels increased rapidly after the conventional treatment was introduced to the PM infected SD rats. The PM model establishment and IL-15 treatment significantly increased the expressions of IL-15Rα, MMP-9, p-ERK and p-IKBα. However, the same effect can be suppressed by using anti-IL-15, MMP-9 siRNA or ERK1/2 inhibitor (P < 0.05). In addition, IL-15 is proved to increase cell migration and nucleus expression of NF-kB in the macrophages. IL-15 is able to significantly regulate the inflammatory infiltration of macrophages in PM patients through affecting the NF-kB pathway and MMP-9 expression levels.
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Affiliation(s)
- Wang Yan
- Department of Neurological Internal Medicine, Ningbo No.2 Hospital, Ningbo, Zhejiang, 315000, China
| | - Weinv Fan
- Department of Neurological Internal Medicine, Ningbo No.2 Hospital, Ningbo, Zhejiang, 315000, China
| | - Caijing Chen
- Department of Neurological Internal Medicine, Ningbo No.2 Hospital, Ningbo, Zhejiang, 315000, China
| | - Yunqin Wu
- Department of Neurological Internal Medicine, Ningbo No.2 Hospital, Ningbo, Zhejiang, 315000, China
| | - Zhenyi Fan
- Department of Neurological Internal Medicine, Ningbo No.2 Hospital, Ningbo, Zhejiang, 315000, China
| | - Jiaqi Chen
- Department of Neurological Internal Medicine, Ningbo No.2 Hospital, Ningbo, Zhejiang, 315000, China
| | - Zhaoying Chen
- Department of Neurological Internal Medicine, Ningbo No.2 Hospital, Ningbo, Zhejiang, 315000, China
| | - Huimin Chen
- Department of Neurological Internal Medicine, Ningbo No.2 Hospital, Ningbo, Zhejiang, 315000, China.
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193
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Porter BF, Ambrus A, Storts RW. Immunohistochemical Evaluation of Mx Protein Expression in Canine Encephalitides. Vet Pathol 2016; 43:981-7. [PMID: 17099155 DOI: 10.1354/vp.43-6-981] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Mx proteins are a group of interferon-induced GTPases whose expression has been demonstrated in a number of human viral infections and in some idiopathic inflammatory diseases. In this study, the expression of Mx protein was evaluated in known viral, nonviral, and idiopathic encephalitides in the dog via immunohistochemistry using an antibody against human MxA. All 12 cases of confirmed viral encephalitis, including 7 cases of canine distemper, 4 cases of canine herpesvirus, and 1 case of rabies, were Mx positive. In canine distemper cases, staining was particularly strong and a variety of cell types were positive, including astrocytes, macrophages/microglia, and neurons. Immunoreactivity for Mx protein was evident in a few cases of nonviral infectious encephalitis, including neosporosis (1/1), Chagas disease (2/3), aspergillosis (1/2), and encephalitozoonosis (1/1). Consistent staining was observed in most cases of idiopathic encephalitis, including granulomatous meningoencephalomyelitis (7/7), necrotizing meningoencephalitis of pug dogs (6/7), and necrotizing encephalitis of the Yorkshire Terrier (3/3) and Maltese (1/1) breeds. Mx staining was negative in 5 normal dog brains; 3 cases of cryptococcosis; and single cases of blastomycosis, protothecosis, and bacterial meningitis.
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Affiliation(s)
- B F Porter
- Texas A and M University, College of Veterinary Medicine and Biomedical Sciences, Department of Pathobiology, College Station, TX 77843-4467, USA.
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194
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Simon JP, Marie I, Jouen F, Boyer O, Martinet J. Autoimmune Myopathies: Where Do We Stand? Front Immunol 2016; 7:234. [PMID: 27379096 PMCID: PMC4905946 DOI: 10.3389/fimmu.2016.00234] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 05/31/2016] [Indexed: 11/28/2022] Open
Abstract
Autoimmune diseases (AIDs) as a whole represent a major health concern and remain a medical and scientific challenge. Some of them, such as multiple sclerosis or type 1 diabetes, have been actively investigated for many decades. Autoimmune myopathies (AIMs), also referred to as idiopathic inflammatory myopathies or myositis, represent a group of very severe AID for which we have a more limited pathophysiological knowledge. AIM encompass a group of, individually rare but collectively not so uncommon, diseases characterized by symmetrical proximal muscle weakness, increased serum muscle enzymes such as creatine kinase, myopathic changes on electromyography, and several typical histological patterns on muscle biopsy, including the presence of inflammatory cell infiltrates in muscle tissue. Importantly, some AIMs are strongly related to cancer. Here, we review the current knowledge on the most prevalent forms of AIM and, notably, the diagnostic contribution of autoantibodies.
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Affiliation(s)
- Jean-Philippe Simon
- Laboratory of Neuropathology, CHU Caen, Normandie University, UNICAEN, Caen, France; Normandie University, UNIROUEN, Pathophysiology and Biotherapy of Inflammatory and Autoimmune Diseases, INSERM, CHU Rouen, Rouen, France
| | - Isabelle Marie
- Normandie University, UNIROUEN, Pathophysiology and Biotherapy of Inflammatory and Autoimmune Diseases, INSERM, CHU Rouen , Rouen , France
| | - Fabienne Jouen
- Normandie University, UNIROUEN, Pathophysiology and Biotherapy of Inflammatory and Autoimmune Diseases, INSERM, CHU Rouen , Rouen , France
| | - Olivier Boyer
- Normandie University, UNIROUEN, Pathophysiology and Biotherapy of Inflammatory and Autoimmune Diseases, INSERM, CHU Rouen , Rouen , France
| | - Jérémie Martinet
- Normandie University, UNIROUEN, Pathophysiology and Biotherapy of Inflammatory and Autoimmune Diseases, INSERM, CHU Rouen , Rouen , France
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Malik A, Hayat G, Kalia JS, Guzman MA. Idiopathic Inflammatory Myopathies: Clinical Approach and Management. Front Neurol 2016; 7:64. [PMID: 27242652 PMCID: PMC4873503 DOI: 10.3389/fneur.2016.00064] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/12/2016] [Indexed: 01/30/2023] Open
Abstract
Idiopathic inflammatory myopathies (IIM) are a group of chronic, autoimmune conditions affecting primarily the proximal muscles. The most common types are dermatomyositis (DM), polymyositis (PM), necrotizing autoimmune myopathy (NAM), and sporadic inclusion body myositis (sIBM). Patients typically present with sub-acute to chronic onset of proximal weakness manifested by difficulty with rising from a chair, climbing stairs, lifting objects, and combing hair. They are uniquely identified by their clinical presentation consisting of muscular and extramuscular manifestations. Laboratory investigations, including increased serum creatine kinase (CK) and myositis specific antibodies (MSA) may help in differentiating clinical phenotype and to confirm the diagnosis. However, muscle biopsy remains the gold standard for diagnosis. These disorders are potentially treatable with proper diagnosis and initiation of therapy. Goals of treatment are to eliminate inflammation, restore muscle performance, reduce morbidity, and improve quality of life. This review aims to provide a basic diagnostic approach to patients with suspected IIM, summarize current therapeutic strategies, and provide an insight into future prospective therapies.
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Affiliation(s)
- Asma Malik
- Neurology, Saint Louis University, Saint Louis, MO, USA
| | - Ghazala Hayat
- Neurology, Saint Louis University, Saint Louis, MO, USA
| | - Junaid S. Kalia
- Department of Neurology and Neurotherapeutics, The University of Texas Southwestern, Dallas, TX, USA
| | - Miguel A. Guzman
- Department of Pathology, Saint Louis University, Saint Louis, MO, USA
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Lahoria R, Selcen D, Engel AG. Microvascular alterations and the role of complement in dermatomyositis. Brain 2016; 139:1891-903. [DOI: 10.1093/brain/aww122] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/07/2016] [Indexed: 12/21/2022] Open
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197
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Differential roles of hypoxia and innate immunity in juvenile and adult dermatomyositis. Acta Neuropathol Commun 2016; 4:45. [PMID: 27121733 PMCID: PMC4847347 DOI: 10.1186/s40478-016-0308-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 04/06/2016] [Indexed: 12/13/2022] Open
Abstract
Dermatomyositis (DM) can occur in both adults and juveniles with considerable clinical differences. The links between immune-mediated mechanisms and vasculopathy with respect to development of perifascicular pathology are incompletely understood. We investigated skeletal muscle from newly diagnosed, treatment-naïve juvenile (jDM) and adult dermatomyositis (aDM) patients focusing on hypoxia-related pathomechanisms, vessel pathology, and immune mechanisms especially in the perifascicular region. Therefore, we assessed the skeletal muscle biopsies from 21 aDM, and 15 jDM patients by immunohistochemistry and electron microscopy. Transcriptional analyses of genes involved in hypoxia, as well as in innate and adaptive immunity were performed by quantitative Polymerase chain reaction (qPCR) of whole tissue cross sections including perifascicular muscle fibers.Through these analysis, we found that basic features of DM, like perifascicular atrophy and inflammatory infiltrates, were present at similar levels in jDM and aDM patients. However, jDM was characterized by predominantly hypoxia-driven pathology in perifascicular small fibers and by macrophages expressing markers of hypoxia. A more pronounced regional loss of capillaries, but no relevant activation of type-1 Interferon (IFN)-associated pathways was noted. Conversely, in aDM, IFN-related genes were expressed at significantly elevated levels, and Interferon-stimulated gene (ISG)15 was strongly positive in small perifascicular fibers whereas hypoxia-related mechanisms did not play a significant role.In our study we could provide new molecular data suggesting a conspicuous pathophysiological 'dichotomy' between jDM and aDM: In jDM, perifascicular atrophy is tightly linked to hypoxia-related pathology, and poorly to innate immunity. In aDM, perifascicular atrophy is prominently associated with molecules driving innate immunity, while hypoxia-related mechanisms seem to be less relevant.
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198
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Allenbach Y, Leroux G, Suárez-Calvet X, Preusse C, Gallardo E, Hervier B, Rigolet A, Hie M, Pehl D, Limal N, Hufnagl P, Zerbe N, Meyer A, Aouizerate J, Uzunhan Y, Maisonobe T, Goebel HH, Benveniste O, Stenzel W, Hot A, Grados A, Schleinitz N, Gallet L, Streichenberger N, Petiot P, Hachulla E, Launay D, Devilliers H, Hamidou M, Cornec D, Bienvenu B, Langlois V, Levesque H, Delluc A, Drouot L, Charuel JL, Jouen F, Romero N, Dubourg O, Leonard-Louis S, Behin A, Laforet P, Stojkovic T, Eymard B, Costedoat-Chalumeau N, Campana-Salort E, Tournadre A, Musset L, Bader-Meunier B, Kone-Paut I, Sibilia J, Servais L, Fain O, Larroche C, Diot E, Terrier B, De Paz R, Dossier A, Menard D, Morati C, Roux M, Ferrer X, Martinet J, Besnard S, Bellance R, Cacoub P, Saadoun D, Arnaud L, Grosbois B, Herson S, Boyer O. Dermatomyositis With or Without Anti-Melanoma Differentiation-Associated Gene 5 Antibodies. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 186:691-700. [DOI: 10.1016/j.ajpath.2015.11.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/19/2015] [Accepted: 11/16/2015] [Indexed: 12/18/2022]
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199
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Rosen A, Casciola-Rosen L. Autoantigens as Partners in Initiation and Propagation of Autoimmune Rheumatic Diseases. Annu Rev Immunol 2016; 34:395-420. [PMID: 26907212 DOI: 10.1146/annurev-immunol-032414-112205] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Systemic autoimmune diseases are characterized by specific targeting of a limited group of ubiquitously expressed autoantigens by the immune system. This review examines the mechanisms underlying their selection as immune targets. Initiation of autoimmune responses likely reflects the presentation of antigens with a distinct structure not previously encountered by the immune system, in a proimmune context (injury, malignancy, or infection). Causes of modified structure include somatic mutation and posttranslational modifications (including citrullination and proteolysis). Many autoantigens are components of multimolecular complexes, and some of the other components may provide adjuvant activity. Propagation of autoimmune responses appears to reflect a bidirectional interaction between the immune response and the target tissues in a mutually reinforcing cycle: Immune effector pathways generate additional autoantigen, which feeds further immune response. We propose that this resonance may be a critical principle underlying disease propagation, with specific autoantigens functioning as the hubs around which amplification occurs.
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Affiliation(s)
- Antony Rosen
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224; ,
| | - Livia Casciola-Rosen
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224; ,
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Comment to "Role of Toll-like receptors and retinoic acid inducible gene I in endogenous production of type I interferon in dermatomyositis". J Neuroimmunol 2016; 291:125. [PMID: 26723487 DOI: 10.1016/j.jneuroim.2015.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 11/24/2022]
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