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Ah Kioon MD, Laurent P, Chaudhary V, Du Y, Crow MK, Barrat FJ. Modulation of plasmacytoid dendritic cells response in inflammation and autoimmunity. Immunol Rev 2024; 323:241-256. [PMID: 38553621 DOI: 10.1111/imr.13331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
The discovery of toll-like receptors (TLRs) and the subsequent recognition that endogenous nucleic acids (NAs) could serve as TLR ligands have led to essential insights into mechanisms of healthy immune responses as well as pathogenic mechanisms relevant to systemic autoimmune and inflammatory diseases. In systemic lupus erythematosus, systemic sclerosis, and rheumatoid arthritis, NA-containing immune complexes serve as TLR ligands, with distinct implications depending on the additional immune stimuli available. Plasmacytoid dendritic cells (pDCs), the robust producers of type I interferon (IFN-I), are providing critical insights relevant to TLR-mediated healthy immune responses and tissue repair, as well as generation of inflammation, autoimmunity and fibrosis, processes central to the pathogenesis of many autoimmune diseases. In this review, we describe recent data characterizing the role of platelets and NA-binding chemokines in modulation of TLR signaling in pDCs, as well as implications for how the IFN-I products of pDCs contribute to the generation of inflammation and wound healing responses by monocyte/macrophages. Chemokine modulators of TLR-mediated B cell tolerance mechanisms and interactions between TLR signaling and metabolic pathways are also considered. The modulators of TLR signaling and their contribution to the pathogenesis of systemic autoimmune diseases suggest new opportunities for identification of novel therapeutic targets.
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Affiliation(s)
| | - Paôline Laurent
- HSS Research Institute, Hospital for Special Surgery, New York, New York, USA
- Department of Microbiology and Immunology, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Vidyanath Chaudhary
- HSS Research Institute, Hospital for Special Surgery, New York, New York, USA
- Department of Microbiology and Immunology, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Yong Du
- HSS Research Institute, Hospital for Special Surgery, New York, New York, USA
- Department of Microbiology and Immunology, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Mary K Crow
- HSS Research Institute, Hospital for Special Surgery, New York, New York, USA
- Mary Kirkland Center for Lupus Research, Hospital for Special Surgery, New York, New York, USA
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Franck J Barrat
- HSS Research Institute, Hospital for Special Surgery, New York, New York, USA
- Department of Microbiology and Immunology, Weill Cornell Medical College of Cornell University, New York, New York, USA
- David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, New York, USA
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2
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Ritter J, Menger M, Herath SC, Histing T, Kolbenschlag J, Daigeler A, Heinzel JC, Prahm C. Translational evaluation of gait behavior in rodent models of arthritic disorders with the CatWalk device - a narrative review. Front Med (Lausanne) 2023; 10:1255215. [PMID: 37869169 PMCID: PMC10587608 DOI: 10.3389/fmed.2023.1255215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Arthritic disorders have become one of the main contributors to the global burden of disease. Today, they are one of the leading causes of chronic pain and disability worldwide. Current therapies are incapable of treating pain sufficiently and preventing disease progression. The lack of understanding basic mechanisms underlying the initiation, maintenance and progression of arthritic disorders and related symptoms represent the major obstacle in the search for adequate treatments. For a long time, histological evaluation of joint pathology was the predominant outcome parameter in preclinical arthritis models. Nevertheless, quantification of pain and functional limitations analogs to arthritis related symptoms in humans is essential to enable bench to bedside translation and to evaluate the effectiveness of new treatment strategies. As the experience of pain and functional deficits are often associated with altered gait behavior, in the last decades, automated gait analysis has become a well-established tool for the quantitative evaluation of the sequalae of arthritic disorders in animal models. The purpose of this review is to provide a detailed overview on the current literature on the use of the CatWalk gait analysis system in rodent models of arthritic disorders, e.g., Osteoarthritis, Monoarthritis and Rheumatoid Arthritis. Special focus is put on the assessment and monitoring of pain-related behavior during the course of the disease. The capability of evaluating the effect of distinct treatment strategies and the future potential for the application of the CatWalk in rodent models of arthritic disorders is also addressed in this review. Finally, we discuss important consideration and provide recommendations on the use of the CatWalk in preclinical models of arthritic diseases.
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Affiliation(s)
- Jana Ritter
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Maximilian Menger
- Department of Trauma and Reconstructive Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Steven C Herath
- Department of Trauma and Reconstructive Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Tina Histing
- Department of Trauma and Reconstructive Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Jonas Kolbenschlag
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Adrien Daigeler
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Germany
| | - Johannes C Heinzel
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Germany
- Ludwig Boltzmann Institute for Traumatology - The Research Center in Cooperation with AUVA, Vienna, Austria
- Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Cosima Prahm
- Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, University of Tuebingen, Tuebingen, Germany
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Aripova N, Duryee MJ, England BR, Hunter CD, Mordeson JE, Ryan EM, Daubach EC, Romberger DJ, Thiele GM, Mikuls TR. Citrullinated and malondialdehyde-acetaldehyde modified fibrinogen activates macrophages and promotes an aggressive synovial fibroblast phenotype in patients with rheumatoid arthritis. Front Immunol 2023; 14:1203548. [PMID: 37654483 PMCID: PMC10467288 DOI: 10.3389/fimmu.2023.1203548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Objective Post-translational protein modifications with malondialdehyde-acetaldehyde (MAA) and citrulline (CIT) are implicated in the pathogenesis of rheumatoid arthritis (RA). Although precise mechanisms have not been elucidated, macrophage-fibroblast interactions have been proposed to play a central role in the development and progression of RA. The purpose of our study was to evaluate the downstream effects of macrophage released soluble mediators, following stimulation with fibrinogen (FIB) modified antigens, on human fibroblast-like synoviocytes (HFLS). Methods PMA-treated U-937 monocytes (Mϕ) and macrophage-differentiated peripheral blood mononuclear cells (MP) were stimulated with FIB, FIB-MAA, FIB-CIT, or FIB-MAA-CIT. HFLS-RA cells were stimulated directly with FIB antigens or with supernatants (SN) from macrophages (Mϕ-SN or MP-SN) stimulated with FIB antigens. Genes associated with an aggressive HFLS phenotype, extracellular matrix proteins, and activated signaling pathways were evaluated. Results HFLS-RA cells treated with Mϕ-SNFIB-CIT and Mϕ-SNFIB-MAA-CIT demonstrated significant increases in mRNA expression of genes associated with an aggressive phenotype at 24-h as compared to direct stimulation with the same antigens. Similar results were obtained using MP-SN. Cellular morphology was altered and protein expression of vimentin (p<0.0001 vs. Mϕ-SNFIB) and type II collagen (p<0.0001) were significantly increased in HFLS-RA cells treated with any of the Mϕ-SN generated following stimulation with modified antigens. Phosphorylation of JNK, Erk1/2, and Akt were increased most substantially in HFLS-RA treated with Mϕ-SNFIB-MAA-CIT (p<0.05 vs Mϕ-SNFIB). These and other data suggested the presence of PDGF-BB in Mϕ-SN. Mϕ-SNFIB-MAA-CIT contained the highest concentration of PDGF-BB (p<0.0001 vs. Mϕ-SNFIB) followed by Mϕ-SNFIB-CIT then Mϕ-SNFIB-MAA. HFLS-RA cells treated with PDGF-BB showed similar cellular morphology to the Mϕ-SN generated following stimulation with modified FIB, as well as the increased expression of vimentin, type II collagen, and the phosphorylation of JNK, Erk1/2 and Akt signaling molecules. Conclusion Together, these findings support the hypothesis that in response to MAA-modified and/or citrullinated fibrinogen, macrophages release soluble factors including PDGF-BB that induce fibroblast activation and promote an aggressive fibroblast phenotype. These cellular responses were most robust following macrophage activation with dually modified fibrinogen, compared to single modification alone, providing novel insights into the combined role of multiple post-translational protein modifications in the development of RA.
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Affiliation(s)
- Nozima Aripova
- Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Michael J. Duryee
- Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Research Services 151, Veteran Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, United States
| | - Bryant R. England
- Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Research Services 151, Veteran Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, United States
| | - Carlos D. Hunter
- Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Research Services 151, Veteran Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, United States
| | - Jack E. Mordeson
- Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Evan M. Ryan
- Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Eric C. Daubach
- Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Debra J. Romberger
- Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Omaha, NE, United States
| | - Geoffrey M. Thiele
- Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Research Services 151, Veteran Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, United States
| | - Ted R. Mikuls
- Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Research Services 151, Veteran Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, United States
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4
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Wang J, He L, Li W, Lv S. A Role of IL-17 in Rheumatoid Arthritis Patients Complicated With Atherosclerosis. Front Pharmacol 2022; 13:828933. [PMID: 35211020 PMCID: PMC8861488 DOI: 10.3389/fphar.2022.828933] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/19/2022] [Indexed: 12/14/2022] Open
Abstract
Rheumatoid arthritis (RA) is mainly caused by joint inflammation. RA significantly increases the probability of cardiovascular disease. Although the progress of RA has been well controlled recently, the mortality of patients with RA complicated with cardiovascular disease is 1.5–3 times higher than that of patients with RA alone. The number of people with atherosclerosis in patients with RA is much higher than that in the general population, and atherosclerotic lesions develop more rapidly in patients with RA, which has become one of the primary factors resulting in the death of patients with RA. The rapid development of atherosclerosis in RA is induced by inflammation-related factors. Recent studies have reported that the expression of IL-17 is significantly upregulated in patients with RA and atherosclerosis. Simultaneously, there is evidence that IL-17 can regulate the proliferation, migration, and apoptosis of vascular endothelial cells and vascular smooth muscle cells through various ways and promote the secretion of several cytokines leading to the occurrence and development of atherosclerosis. Presently, there is no clear prevention or treatment plan for atherosclerosis in patients with RA. Therefore, this paper explores the mechanism of IL-17 in RA complicated with atherosclerosis and shows the reasons for the high incidence of atherosclerosis in patients with RA. It is hoped that the occurrence and development of atherosclerosis in patients with RA can be diagnosed or prevented in time in the early stage of lesions, and the prevention and treatment of cardiovascular complications in patients with RA can be enhanced to reduce mortality.
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Affiliation(s)
- Jiexin Wang
- Basic Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Linxi He
- Basic Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Weihong Li
- Basic Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shangbin Lv
- Basic Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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5
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Fiechter RH, Bolt JW, van de Sande MGH, Aalbers CJ, Landewé RBM, Maas M, Tas SW, van Baarsen LGM. Ultrasound-guided lymph node biopsy sampling to study the immunopathogenesis of rheumatoid arthritis: a well-tolerated valuable research tool. Arthritis Res Ther 2022; 24:36. [PMID: 35115042 PMCID: PMC8812012 DOI: 10.1186/s13075-022-02728-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background Analyses of lymphoid organs are required to further elucidate the pathogenesis of inflammatory diseases like rheumatoid arthritis (RA). Yet, invasive tissue collection methods are scarcely applied, because they are often considered burdensome, although patients do not always consider invasive methods as a high burden. We aimed to investigate the perspectives of study participants undergoing ultrasound-guided inguinal lymph node (LN) needle biopsy sampling and determine the molecular and cellular quantity and quality of LN biopsies. Methods Together with patient research partners, questionnaires were developed to evaluate the motives, expectations, and experiences of participants undergoing a LN biopsy. Healthy controls and RA(-risk) patients were asked to complete these questionnaires before and after the procedure. RNA and lymphocyte yields from obtained LN biopsies were also calculated. Results We included 50 individuals, of which 43 (86%) reported their pre- and post-procedure experiences. The median reported pain on a 5-point Likert scale (1 not to 5 very painful) was 1. Interestingly, almost all (n = 32; 74%) study participants would undergo a second procedure and more than half (n = 23; 54%) would encourage others to take part in the LN biopsy study. Motives for current and future participation were mostly altruistic. Inguinal hematoma occurred frequently, but no other significant or unexpected complications ensued. The LN biopsies yielded sufficient and high-quality RNA and lymphocyte numbers. Conclusions Ultrasound-guided inguinal LN biopsy sampling is well-tolerated, safe, and provides sufficient material for further molecular and cellular analyses. Our participants’ positive experiences endorse the application of this research tool to further elucidate the pathogenesis of RA and other inflammatory diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02728-7.
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Affiliation(s)
- Renée H Fiechter
- Department of Rheumatology and Clinical Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rheumatology and Immunology Center (ARC), EULAR & FOCIS Center of Excellence, Amsterdam UMC, Location Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Janne W Bolt
- Department of Rheumatology and Clinical Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rheumatology and Immunology Center (ARC), EULAR & FOCIS Center of Excellence, Amsterdam UMC, Location Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marleen G H van de Sande
- Department of Rheumatology and Clinical Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rheumatology and Immunology Center (ARC), EULAR & FOCIS Center of Excellence, Amsterdam UMC, Location Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Caroline J Aalbers
- Department of Rheumatology and Clinical Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rheumatology and Immunology Center (ARC), EULAR & FOCIS Center of Excellence, Amsterdam UMC, Location Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Robert B M Landewé
- Department of Rheumatology and Clinical Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Rheumatology and Immunology Center (ARC), EULAR & FOCIS Center of Excellence, Amsterdam UMC, Location Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mario Maas
- Department of Radiology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. .,Amsterdam Rheumatology and Immunology Center (ARC), EULAR & FOCIS Center of Excellence, Amsterdam UMC, Location Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Lisa G M van Baarsen
- Department of Rheumatology and Clinical Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. .,Amsterdam Rheumatology and Immunology Center (ARC), EULAR & FOCIS Center of Excellence, Amsterdam UMC, Location Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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6
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Li Yim AYF, Ferrero E, Maratou K, Lewis HD, Royal G, Tough DF, Larminie C, Mannens MMAM, Henneman P, de Jonge WJ, van de Sande MGH, Gerlag DM, Prinjha RK, Tak PP. Novel Insights Into Rheumatoid Arthritis Through Characterization of Concordant Changes in DNA Methylation and Gene Expression in Synovial Biopsies of Patients With Differing Numbers of Swollen Joints. Front Immunol 2021; 12:651475. [PMID: 33968050 PMCID: PMC8100206 DOI: 10.3389/fimmu.2021.651475] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/25/2021] [Indexed: 12/26/2022] Open
Abstract
In this study, we sought to characterize synovial tissue obtained from individuals with arthralgia and disease-specific auto-antibodies and patients with established rheumatoid arthritis (RA), by applying an integrative multi-omics approach where we investigated differences at the level of DNA methylation and gene expression in relation to disease pathogenesis. We performed concurrent whole-genome bisulphite sequencing and RNA-Sequencing on synovial tissue obtained from the knee and ankle from 4 auto-antibody positive arthralgia patients and thirteen RA patients. Through multi-omics factor analysis we observed that the latent factor explaining the variance in gene expression and DNA methylation was associated with Swollen Joint Count 66 (SJC66), with patients with SJC66 of 9 or more displaying separation from the rest. Interrogating these observed differences revealed activation of the immune response as well as dysregulation of cell adhesion pathways at the level of both DNA methylation and gene expression. We observed differences for 59 genes in particular at the level of both transcript expression and DNA methylation. Our results highlight the utility of genome-wide multi-omics profiling of synovial samples for improved understanding of changes associated with disease spread in arthralgia and RA patients, and point to novel candidate targets for the treatment of the disease.
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Affiliation(s)
- Andrew Y. F. Li Yim
- R&D GlaxoSmithKline, Stevenage, United Kingdom
- Department of Clinical Genetics, Genome Diagnostics Laboratory, Amsterdam Reproduction & Development, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | | | | | | | | | | | - Marcel M. A. M. Mannens
- Department of Clinical Genetics, Genome Diagnostics Laboratory, Amsterdam Reproduction & Development, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Henneman
- Department of Clinical Genetics, Genome Diagnostics Laboratory, Amsterdam Reproduction & Development, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Wouter J. de Jonge
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology & Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Department of Surgery, University Clinic of Bonn, Bonn, Germany
| | - Marleen G. H. van de Sande
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Department of Experimental Immunology, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Paul P. Tak
- R&D GlaxoSmithKline, Stevenage, United Kingdom
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam Institute for Infection & Immunity, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Department of Rheumatology, Ghent University, Ghent, Belgium
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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Orr CK, Vieira-Sousa E, Fonseca JE, Veale D. Arthroscopic Guided Synovial Biopsies. Front Med (Lausanne) 2021; 7:604582. [PMID: 33681237 PMCID: PMC7928330 DOI: 10.3389/fmed.2020.604582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/23/2020] [Indexed: 01/23/2023] Open
Abstract
Synovial tissue can be safely and reliably collected for research and clinical purposes using arthroscopy. This technique offers the obvious advantage of allowing direct visualization, and targeted biopsy of specific areas of interest within the joint, as well as for the collection of tissue which will include a lining layer. Much has been learnt by studying the synovium retrieved using this technique concerning the pathobiology of inflammatory arthritis. Furthermore, recent evidence suggests that the tissue retrieved may enable the identification of unique pathotypes that will allow for a precise approach to treatment selection in individual patients. Although ultrasound guided techniques for sampling synovial tissue have gained in popularity over the last decade, both methodologies are expected to compliment each other, each having unique benefits and drawbacks. We present here a detailed description of the arthroscopy technique reporting on our collective experience at two centers in Europe.
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Affiliation(s)
- Carl Kieran Orr
- Centre for Arthritis and Rheumatic Diseases, Saint Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Elsa Vieira-Sousa
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal.,Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal.,Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisbon, Portugal
| | - Douglas Veale
- Centre for Arthritis and Rheumatic Diseases, Saint Vincent's University Hospital, University College Dublin, Dublin, Ireland
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Gessl I, Popescu M, Schimpl V, Supp G, Deimel T, Durechova M, Hucke M, Loiskandl M, Studenic P, Zauner M, Smolen JS, Aletaha D, Mandl P. Role of joint damage, malalignment and inflammation in articular tenderness in rheumatoid arthritis, psoriatic arthritis and osteoarthritis. Ann Rheum Dis 2021; 80:884-890. [PMID: 33436384 DOI: 10.1136/annrheumdis-2020-218744] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine whether clinical tenderness can be considered a sign of inflammatory joint activity in patients with rheumatoid arthritis (RA), osteoarthritis (OA) or psoriatic arthritis (PsA) and to assess other possible factors associated with tenderness. METHODS Patients diagnosed with RA, PsA and OA underwent clinical and ultrasound examination of wrists and finger joints. Radiographs of the hands were scored for erosions, joint space narrowing (JSN), osteophytes and malalignment. A binary damage score (positive if ≥1 erosion, JSN and/or presence of malalignment) was calculated. Differences in grey scale signs of synovitis and power Doppler (PD) between tender non-swollen (TNS) versus non-tender non-swollen (NTNS) joints were calculated. Disease duration was assessed,<2 years was regarded as early and >5 years as long-standing arthritis. RESULTS In total, 34 patients (9 early and 14 long-standing) from patients with RA, 31 patients (7 early and 15 long-standing) with PsA and 30 with OA were included. We found equal frequencies of PD signal between TNS and NTNS joints in RA (p=0.18), PsA (p=0.59) or OA (p=0.96). However, PD had a significant association with tenderness in early arthritis both in RA (p=0.02) and in PsA (p=0.02). The radiographic damage score showed significant association with tenderness in RA (p<0.01), PsA (p<0.01) and OA (p=0.04). CONCLUSION Tenderness might not always be a sign of active inflammation in RA, PsA and OA. While tenderness in early arthritis may be more related to inflammation, established disease is better explained by joint damage and malalignment.
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Affiliation(s)
- Irina Gessl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Mihaela Popescu
- Department of Rheumatology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Victoria Schimpl
- Department of Pediatric and Adolescent Medicine, Klinik Donaustadt, Vienna, Austria
| | - Gabriela Supp
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Thomas Deimel
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Martina Durechova
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Miriam Hucke
- Department of Internal Medicine and Gastroenterology, Hepatology, Endocrinology, Rheumatology and Nephrology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Kärnten, Austria
| | - Michaela Loiskandl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Paul Studenic
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Michael Zauner
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Josef S Smolen
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Peter Mandl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
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9
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Huang QQ, Doyle R, Chen SY, Sheng Q, Misharin AV, Mao Q, Winter DR, Pope RM. Critical role of synovial tissue-resident macrophage niche in joint homeostasis and suppression of chronic inflammation. SCIENCE ADVANCES 2021; 7:7/2/eabd0515. [PMID: 33523968 PMCID: PMC7787490 DOI: 10.1126/sciadv.abd0515] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/17/2020] [Indexed: 05/30/2023]
Abstract
Little is known about the mechanisms regulating the transition of circulating monocytes into pro- or anti-inflammatory macrophages in chronic inflammation. Here, we took advantage of our novel mouse model of rheumatoid arthritis, in which Flip is deleted under the control of a CD11c promoter (HUPO mice). During synovial tissue homeostasis, both monocyte-derived F4/80int and self-renewing F4/80hi tissue-resident, macrophage populations were identified. However, in HUPO mice, decreased synovial tissue-resident macrophages preceded chronic arthritis, opened a niche permitting the influx of activated monocytes, with impaired ability to differentiate into F4/80hi tissue-resident macrophages. In contrast, Flip-replete monocytes entered the vacated niche and differentiated into tissue-resident macrophages, which suppressed arthritis. Genes important in macrophage tissue residency were reduced in HUPO F4/80hi macrophages and in leukocyte-rich rheumatoid arthritis synovial tissue monocytes. Our observations demonstrate that the macrophage tissue-resident niche is necessary for suppression of chronic inflammation and may contribute to the pathogenesis of rheumatoid arthritis.
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Affiliation(s)
- Qi-Quan Huang
- Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Renee Doyle
- Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Shang-Yang Chen
- Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Qicong Sheng
- Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Alexander V Misharin
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Qinwen Mao
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Deborah R Winter
- Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
| | - Richard M Pope
- Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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10
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Ultrasonography in Early Rheumatoid Arthritis of Hand and Wrist Joints: Comparison with Magnetic Resonance Imaging. Indian J Orthop 2020; 54:695-703. [PMID: 32850035 PMCID: PMC7429602 DOI: 10.1007/s43465-020-00178-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/19/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of the study was to evaluate the use of ultrasonography (USG) including power Doppler in detecting hand and wrist joint changes in early rheumatoid arthritis (RA) and to compare USG findings with magnetic resonance imaging (MRI). MATERIALS AND METHODS Thirty-four patients diagnosed as RA by 2010 ACR/EULAR criteria; with the onset of symptoms within last one year, were included in the study after institute ethical clearance and informed consent to undergo USG and contrast-enhanced MRI of the dominant affected hand. Second to fifth metacarpophalangeal (MCP) joints, second to fifth proximal interphalangeal (PIP) joints and wrist joints (total nine joints) were evaluated for synovitis, erosions along with tenosynovitis. USG and MRI features were compared; agreement on the two imaging modalities as well as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of ultrasonography compared to MRI (gold standard) was calculated. RESULTS One hundred thirty-six MCP, 136 PIP and 34 wrist joints (total 306 joints) and 136 flexor tendons were evaluated. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of USG for diagnosing synovitis was 78.6%, 91.1%, 86.1%, 85.8%, 86.3%; for erosions 67.2%, 97.5%, 84.8%, 90.5%, 91.5%; for tenosynovitis 86.5%, 100%, 100%, 92.3% and 94.8% respectively. The overall agreement between USG and MRI for detection of synovitis was achieved in 83% joints and for erosions in 89.5% joints. CONCLUSION In early RA, USG was nearly as effective in diagnosing features of joint and tendon sheath involvement, with relatively better performance of USG for tenosynovitis. The performance of USG in diagnosing erosions was limited likely due to difficult access of three-dimensional joint structure.
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11
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de Groot M, Patel N, Manavaki R, Janiczek RL, Bergstrom M, Östör A, Gerlag D, Roberts A, Graves MJ, Karkera Y, Fernando D, Mistry P, Walker A, Wisniacki N, Fryer TD, Jimenez-Royo P. Quantifying disease activity in rheumatoid arthritis with the TSPO PET ligand 18F-GE-180 and comparison with 18F-FDG and DCE-MRI. EJNMMI Res 2019; 9:113. [PMID: 31858293 PMCID: PMC6923307 DOI: 10.1186/s13550-019-0576-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/15/2019] [Indexed: 02/14/2023] Open
Abstract
Purpose While the aetiology of rheumatoid arthritis (RA) remains unclear, many of the inflammatory components are well characterised. For diagnosis and therapy evaluation, in vivo insight into these processes would be valuable. Various imaging probes have shown value including dynamic contrast-enhanced (DCE) MRI and PET/CT using 18F-fluorodeoxyglucose (18F-FDG) or tracers targeting the translocator protein (TSPO). To evaluate 18F-GE-180, a novel TSPO PET tracer, for detecting and quantifying disease activity in RA, we compared 18F-GE-180 uptake with that of 18F-FDG and DCE-MRI measures of inflammation. Methods Eight RA patients with moderate-to-high, stable disease activity and active disease in at least one wrist were included in this study (NCT02350426). Participants underwent PET/CT examinations with 18F-GE-180 and 18F-FDG on separate visits, covering the shoulders and from the pelvis to the feet, including hands and wrists. DCE-MRI was performed on one affected hand. Uptake was compared visually between tracers as judged by an experienced radiologist and quantitatively using the maximum standardised uptake value (SUVmax). Uptake for both tracers was correlated with DCE-MRI parameters of inflammation, including the volume transfer coefficient Ktrans using Pearson correlation (r). Results PET/CT imaging with 18F-GE-180 in RA patients showed marked extra-synovial uptake around the affected joints. Overall sensitivity for detecting clinically affected joints was low (14%). 18F-GE-180 uptake did not or only weakly correlate with DCE-MRI parameters in the wrist (r = 0.09–0.31). 18F-FDG showed higher sensitivity for detecting symptomatic joints (34%), as well as strong positive correlation with DCE-MRI parameters (SUVmax vs. Ktrans: r = 0.92 for wrist; r = 0.68 for metacarpophalangeal joints). Conclusions The correlations between DCE-MRI parameters and 18F-FDG uptake support use of this PET tracer for quantification of inflammatory burden in RA. The TSPO tracer 18F-GE-180, however, has shown limited use for the investigation of RA due to its poor sensitivity and ability to quantify disease activity in RA.
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Affiliation(s)
- Marius de Groot
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, UK.,Department of Radiology, University of Cambridge, Cambridge, UK
| | - Neel Patel
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, UK
| | - Roido Manavaki
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Robert L Janiczek
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, UK
| | - Mats Bergstrom
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, UK
| | - Andrew Östör
- Monash University, Cabrini Medical Centre, Melbourne, Australia
| | | | - Alexandra Roberts
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, UK
| | - Martin J Graves
- Department of Radiology, University of Cambridge, Cambridge, UK
| | | | - Disala Fernando
- Clinical Unit Cambridge (CUC), GlaxoSmithKline R&D, Addenbrooke's Hospital, Cambridge, UK
| | | | - Adam Walker
- Clinical Unit Cambridge (CUC), GlaxoSmithKline R&D, Addenbrooke's Hospital, Cambridge, UK
| | - Nicolas Wisniacki
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, UK
| | - Tim D Fryer
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Pilar Jimenez-Royo
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline R&D, Gunnels Wood Road, Stevenage, UK.
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12
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Imaging disease activity of rheumatoid arthritis by macrophage targeting using second generation translocator protein positron emission tomography tracers. PLoS One 2019; 14:e0222844. [PMID: 31553762 PMCID: PMC6760780 DOI: 10.1371/journal.pone.0222844] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 09/09/2019] [Indexed: 11/19/2022] Open
Abstract
Background Positron emission tomography (PET) imaging of macrophages using the translocator protein (TSPO) tracer (R)-[11C]PK11195 has shown the promise to image rheumatoid arthritis (RA). To further improve TSPO PET for RA imaging, second generation TSPO tracers [11C]DPA-713 and [18F]DPA-714 have recently been evaluated pre-clinically showing better imaging characteristics. Objective A clinical proof of concept study to evaluate [11C]DPA-713 and [18F]DPA-714 to visualize arthritis in RA patients. Methods RA patients (n = 13) with at least two active hand joints were included. PET/CT scans of the hands were obtained after injection of [18F]DPA-714, [11C]DPA-713 and/or (R)-[11C]PK11195 (max. 2 tracers pp). Standardized uptake values (SUVs) and target-to-background (T/B) ratios were determined. Imaging data of the 3 different tracers were compared by pooled post-hoc testing, and by a head to head comparison. Results Clinically active arthritis was present in 110 hand joints (2–17 pp). Arthritic joints were visualized with both [11C]DPA-713 and [18F]DPA-714. Visual tracer uptake corresponded with clinical signs of arthritis in 80% of the joints. Mean absolute uptake in PET-positive joints was significantly higher for [11C]DPA-713 than for [18F]DPA-714, the latter being not significantly different from (R)-[11C]PK11195 uptake. Background uptake was lower for both DPA tracers compared with that of (R)-[11C]PK11195. Higher absolute uptake and lower background resulted in two-fold higher T/B ratios for [11C]DPA-713. Conclusions [11C]DPA-713 and [18F]DPA-714 visualize arthritic joints in active RA patients and most optimal arthritis imaging results were obtained for [11C]DPA-713. Second generation TSPO macrophage PET provides new opportunities for both early diagnosis and therapy monitoring of RA.
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13
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14
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Humby FC. Synovial Tissue Sampling in Rheumatological Practice-Past Developments and Future Perspectives. Front Med (Lausanne) 2019; 6:4. [PMID: 30761301 PMCID: PMC6361834 DOI: 10.3389/fmed.2019.00004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/09/2019] [Indexed: 11/21/2022] Open
Abstract
Synovial biopsies are performed in routine clinical care in order to refine diagnosis as well as within a research setting. Progress in the development of minimally invasive synovial sampling methods in the last century has accelerated and facilitated novel insights into disease pathogenesis. This review discusses the development of synovial biopsy techniques as well as examining the three currently most commonly used approaches: arthroscopic, blind needle biopsy and ultrasound guided approaches. It also highlights major research advances driven through synovial research and considers future developments.
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Affiliation(s)
- Frances C Humby
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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15
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Orr CK, Najm A, Young F, McGarry T, Biniecka M, Fearon U, Veale DJ. The Utility and Limitations of CRP, ESR and DAS28-CRP in Appraising Disease Activity in Rheumatoid Arthritis. Front Med (Lausanne) 2018; 5:185. [PMID: 30123796 PMCID: PMC6085449 DOI: 10.3389/fmed.2018.00185] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/06/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction: Identifying and quantifying inflammatory disease activity in rheumatoid arthritis remains a challenge. Many studies have suggested that a large proportion of patients may have active inflammation, but normal inflammatory markers. Although various disease activity scores have been validated, most rely to a large degree on biomarkers such as CRP and ESR. In this study, we examine the utility and limitations of these biomarkers, as well as the DAS28-CRP in appraising disease activity in RA. Methods: Two hundred and twenty three consecutive rheumatoid arthritis reporting knee arthralgia underwent synovial sampling of the affected knee via needle arthroscopy. The synovium was examined by microscopy with H+E staining as well as immunohistochemistry, and related to the ESR, CRP and DAS28-CRP on blood samples taken immediately before arthroscopy. Results: Although a statistically significant positive correlation was observed between CRP and the level of inflammation in the biopsy retrieved (n = 197, rho = 0.43, CI 0.30–0.54, p < 0.0001), there was histological evidence of inflammation in the synovium in 49.4% of the patients who had a normal CRP. A positive correlation was also observed between ESR and the level of inflammation in the biopsy retrieved (n = 188, rho = 0.29, CI 0.15–0.42 p < 0.0001). A statistically significant but weak positive correlation was observed between the DAS28-CRP and synovial inflammation (n = 189, rho = 0.23, CI 0.09–0.37, p = 0.0011). Only the CD19 infiltrate in the synovium correlated with serum CRP (n = 70, rho = 0.32, CI 0.08–0.52, p = 0.0068). Conclusion: CRP has a moderately strong relationship with disease activity, but there are significant pitfalls in the use of this biomarker in RA, and therefore a need interpret CRP results judiciously. The results of this study underline the heterogeneity of RA, and the need to develop improved panels of biomarkers, to better stratify RA, and to identify the cohort for whom inflammatory activity cannot be measured accurately with CRP.
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Affiliation(s)
- Carl K Orr
- Dublin Academic Medical Centre, Centre for Arthritis and Rheumatic Diseases, University College Dublin, Dublin, Ireland
| | - Aurelie Najm
- Dublin Academic Medical Centre, Centre for Arthritis and Rheumatic Diseases, University College Dublin, Dublin, Ireland
| | - Francis Young
- Dublin Academic Medical Centre, Centre for Arthritis and Rheumatic Diseases, University College Dublin, Dublin, Ireland
| | - Trudy McGarry
- Molecular Rheumatology Research Group, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
| | - Monika Biniecka
- Dublin Academic Medical Centre, Centre for Arthritis and Rheumatic Diseases, University College Dublin, Dublin, Ireland
| | - Ursula Fearon
- Molecular Rheumatology Research Group, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
| | - Douglas J Veale
- Dublin Academic Medical Centre, Centre for Arthritis and Rheumatic Diseases, University College Dublin, Dublin, Ireland
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16
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Krüger JP, Enz A, Hondke S, Wichelhaus A, Endres M, Mittlmeier T. Proliferation, migration and differentiation potential of human mesenchymal progenitor cells derived from osteoarthritic subchondral cancellous bone. J Stem Cells Regen Med 2018. [PMID: 30018472 PMCID: PMC6043655 DOI: 10.46582/jsrm.1401006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background: For regenerative therapies in the orthopedic field, one prerequisite for therapeutic success in the treatment of cartilage defects is the potential of body's own cells to migrate, proliferate and differentiate into functional cells. While this has been demonstrated for mesenchymal stem and progenitor cells (MPC) from healthy tissue sources, the potential of cells from degenerative conditions is unclear. In this study the regenerative potential of MPC derived from subchondral cancellous bone with diagnosed osteoarthritis is evaluated in vitro. Methods: OaMPC isolated from bone chips of three individual patients with Kellgren grade 3 osteoarthritis were characterized by analysis of cell surface antigen pattern. Cell proliferation was evaluated by doubling time and population doubling rate. Cell migration was assessed using a multi-well migration assay. Multi-lineage potential was evaluated by histological staining of adipogenic, osteogenic and chondrogenic markers. In addition, chondrogenic differentiation was verified by qPCR. Results: OaMPC showed a stable proliferation and a typical surface antigen pattern known from mesenchymal stem cells. Cell migration of oaMPC can be induced by human blood serum. OaMPC were capable of adipogenic, osteogenic and chondrogenic differentiation comparable to MPC derived from healthy conditions. Conclusion: OaMPC derived from knee joints affected by osteoarthritic conditions showed regeneration potential regarding migration, proliferation and chondrogenic differentiation. This suggests that oaMPC are able to contribute to cartilage repair tissue formation.
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Affiliation(s)
- Jan Philipp Krüger
- TransTissue Technologies GmbH, 10117 Berlin, Germany.,Authors contributed equally to the work
| | - Andreas Enz
- Department of Trauma, Hand and Reconstructive Surgery, Universitätsmedizin Rostock, 18057 Rostock, Germany.,Authors contributed equally to the work
| | - Sylvia Hondke
- TransTissue Technologies GmbH, 10117 Berlin, Germany
| | - Alice Wichelhaus
- Department of Trauma, Hand and Reconstructive Surgery, Universitätsmedizin Rostock, 18057 Rostock, Germany
| | | | - Thomas Mittlmeier
- Department of Trauma, Hand and Reconstructive Surgery, Universitätsmedizin Rostock, 18057 Rostock, Germany
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Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, Kavanaugh A, McInnes IB, Solomon DH, Strand V, Yamamoto K. Rheumatoid arthritis. Nat Rev Dis Primers 2018; 4:18001. [PMID: 29417936 DOI: 10.1038/nrdp.2018.1] [Citation(s) in RCA: 1330] [Impact Index Per Article: 221.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic, inflammatory, autoimmune disease that primarily affects the joints and is associated with autoantibodies that target various molecules including modified self-epitopes. The identification of novel autoantibodies has improved diagnostic accuracy, and newly developed classification criteria facilitate the recognition and study of the disease early in its course. New clinical assessment tools are able to better characterize disease activity states, which are correlated with progression of damage and disability, and permit improved follow-up. In addition, better understanding of the pathogenesis of RA through recognition of key cells and cytokines has led to the development of targeted disease-modifying antirheumatic drugs. Altogether, the improved understanding of the pathogenetic processes involved, rational use of established drugs and development of new drugs and reliable assessment tools have drastically altered the lives of individuals with RA over the past 2 decades. Current strategies strive for early referral, early diagnosis and early start of effective therapy aimed at remission or, at the least, low disease activity, with rapid adaptation of treatment if this target is not reached. This treat-to-target approach prevents progression of joint damage and optimizes physical functioning, work and social participation. In this Primer, we discuss the epidemiology, pathophysiology, diagnosis and management of RA.
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Anne Barton
- Arthritis Research UK Centre for Genetics and Genomics and NIHR Manchester Biomedical Research Centre, Manchester Academic Health Sciences Centre, The University of Manchester and Central Manchester Foundation Trust, Manchester, UK
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Gary S Firestein
- Division of Rheumatology, Allergy and Immunology, University of California-San Diego School of Medicine, La Jolla, CA, USA
| | - Arthur Kavanaugh
- Division of Rheumatology, Allergy and Immunology, University of California-San Diego School of Medicine, La Jolla, CA, USA
| | - Iain B McInnes
- Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Daniel H Solomon
- Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA
| | - Vibeke Strand
- Division of Immunology and Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Kazuhiko Yamamoto
- Laboratory for Autoimmune Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
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18
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Najm A, Orr C, Gallagher L, Biniecka M, Gaigneux E, Le Goff B, Fearon U, Veale DJ. Knee joint synovitis: study of correlations and diagnostic performances of ultrasonography compared with histopathology. RMD Open 2018. [PMID: 29531789 PMCID: PMC5845411 DOI: 10.1136/rmdopen-2017-000616] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives Ultrasonography (US) is a fast, available and low-cost imaging tool used for detecting knee synovitis. Our aims were to assess the relationship between US and histology findings in appraising levels of inflammation and vascularity in the knee joint in subjects with inflammatory arthropathies; to determine whether differences exist in the appraisal between varying knee compartments and to compare US performances compared with gold standard histology for knee synovitis detection. Methods Subjects with actively inflamed knee joint having crystal arthropathies, rheumatoid arthritis, psoriatic arthritis or ostoearthritis were prospectively recruited from rheumatology clinics after giving their written consent between May and October 2015. Study was approved by the institutional ethics committee. The knee was divided into three compartments (medial, lateral, superior). Patients had a knee US followed by a knee arthroscopy with biopsies retrieval from each compartment. Biopsies were blindly scored for lining layer hyperplasia, inflammation, vascularity, CD68 and factor VIII staining. Correlation was determined using the Spearman’s correlation test. Results 26 patients with active arthritis in a knee joint and recent onset of disease were prospectively included. Strong correlations were observed between US synovitis grade and histological inflammation score (r=0.63; P=0.002), US Doppler grade and histological score for vascularity (r=0.68; P<0.001); US measured synovial thickness and lining layer hyperplasia (r=0.61; P=0.002). Moderate correlation was found between US synovitis grade and CD68 score (r=0.49; P=0.02). Conclusion US findings correlate with histological inflammation and vascularity scores in actively inflamed knee joints. US accurately describes knee synovitis.
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Affiliation(s)
- Aurélie Najm
- Rheumatology Department, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France.,The Centre for Arthritis and Rheumatic Diseases, Saint Vincent's University Hospital and Dublin Academic Medical Centre, University College Dublin, Dublin, Ireland
| | - Carl Orr
- The Centre for Arthritis and Rheumatic Diseases, Saint Vincent's University Hospital and Dublin Academic Medical Centre, University College Dublin, Dublin, Ireland
| | - Lorna Gallagher
- Department of Molecular Rheumatology, Trinity College Dublin, Dublin, Ireland
| | - Monika Biniecka
- The Centre for Arthritis and Rheumatic Diseases, Saint Vincent's University Hospital and Dublin Academic Medical Centre, University College Dublin, Dublin, Ireland
| | - Emeline Gaigneux
- Rheumatology Department, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Benoit Le Goff
- Rheumatology Department, Centre Hospitalier Universitaire de Nantes, Nantes, Pays de la Loire, France
| | - Ursula Fearon
- Department of Molecular Rheumatology, Trinity College Dublin, Dublin, Ireland
| | - Douglas J Veale
- The Centre for Arthritis and Rheumatic Diseases, Saint Vincent's University Hospital and Dublin Academic Medical Centre, University College Dublin, Dublin, Ireland
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19
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Hunt L, Eugénio G, Grainger AJ. Magnetic resonance imaging in individuals at risk of rheumatoid arthritis. Best Pract Res Clin Rheumatol 2017; 31:80-89. [PMID: 29221601 DOI: 10.1016/j.berh.2017.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 07/06/2017] [Accepted: 08/18/2017] [Indexed: 01/07/2023]
Abstract
Individuals with rheumatoid arthritis (RA) benefit from early diagnosis and initiation of therapy. There can be delays in both due to diagnostic uncertainties. Imaging modalities, including magnetic resonance imaging (MRI), can detect inflammation earlier than clinical examination alone in early RA patients. Furthermore, the predictive role of MRI for the future development of RA has recently been explored in 'at-risk' individuals. This review details the use of MRI in early and undifferentiated arthritis and summarises the studies to date in individuals at risk of RA.
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Affiliation(s)
- Laura Hunt
- Leeds Biomedical Research Centre, Chapel Allerton Hospital Leeds, LS7 4SA, UK.
| | - Gisela Eugénio
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Andrew J Grainger
- Leeds Biomedical Research Centre, Chapel Allerton Hospital Leeds, LS7 4SA, UK
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20
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Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune disease affecting multiple joints. It remains unclear which factors in the circulation are associated with the systemic spread of the disease. Fibrocytes are pluripotent mesenchymal stem cells present in the circulation of RA patients. Our earlier findings implicated activated fibrocytes in the etiology of onset and pathogenesis of RA. Elevated levels of interleukin-34 (IL-34) in the serum and synovial fluid of RA patients are associated with rheumatoid factor and anticyclic citrullinated peptide antibodies, indicators of RA. Moreover, IL-34 levels are independent predictors of radiographic progression in RA patients. We provide evidence of simultaneous elevated levels of IL-34 and increased numbers of activated fibrocytes in the circulation of mice induced to develop arthritis. In vitro, IL-34 treatment induced the proliferation of fibrocytes, mediated by activation of cognate CSF-R1s on fibrocytes. Taken together, we infer that IL-34 has a role in stimulating fibrocyte proliferation and activation during arthritis, thereby contributing to both onset of RA and systemic spread of disease.
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Affiliation(s)
- Carole L Galligan
- 1 Division of Advanced Diagnostics, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada
| | - Eleanor N Fish
- 1 Division of Advanced Diagnostics, Toronto General Hospital Research Institute, University Health Network , Toronto, Canada .,2 Department of Immunology, University of Toronto , Toronto, Canada
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21
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Tak PP, Doorenspleet ME, de Hair MJH, Klarenbeek PL, van Beers-Tas MH, van Kampen AHC, van Schaardenburg D, Gerlag DM, Baas F, de Vries N. Dominant B cell receptor clones in peripheral blood predict onset of arthritis in individuals at risk for rheumatoid arthritis. Ann Rheum Dis 2017; 76:1924-1930. [PMID: 28790026 PMCID: PMC5705849 DOI: 10.1136/annrheumdis-2017-211351] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/15/2017] [Accepted: 07/18/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The onset of seropositive rheumatoid arthritis (RA) is preceded by the presence of specific autoantibodies in the absence of synovial inflammation. Only a subset of these at-risk individuals will develop clinical disease. This impedes efforts to implement early interventions that may prevent onset of clinically manifest disease. Here we analyse whether clonal changes in the B cell receptor (BCR) repertoire can reliably predict onset of signs and symptoms. METHODS In a prospective cohort study in 21 individuals at risk for RA based on the presence of autoantibodies, the BCR repertoire of paired peripheral blood and synovial tissue samples was analysed using next-generation BCR sequencing. BCR clones that were expanded beyond 0.5% of the total repertoire were labelled dominant. The relative risk (RR) for onset of arthritis was assessed using the presence of ≥5 dominant BCR clones as cut-off. Findings in peripheral blood were validated in an independent prospective cohort of 50 at-risk individuals. Based on the test cohort, individuals in the validation cohort were considered positive if peripheral blood at study entry showed ≥5 dominant BCR clones. FINDINGS Both in the test and validation cohort, the presence of ≥5 dominant BCR clones in peripheral blood was significantly associated with arthritis development after follow-up (validation cohort RR 6.3, 95% CI 2.7 to 15, p<1×10-4). Even when adjusted for a recently described clinical prediction rule the association remained intact (RR 5.0, 95% CI 1.2 to 20, p=0.024). When individuals developed arthritis, dominant BCR clones disappeared from peripheral blood and appeared in synovial tissue, suggesting a direct role of these clones in disease pathogenesis. INTERPRETATION Dominant BCR clones in peripheral blood predict onset of clinical signs and symptoms of RA in at-risk individuals with high accuracy. Our data suggest that during onset of RA these clones shift from peripheral blood to the target tissue.
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Affiliation(s)
- Paul P Tak
- Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke E Doorenspleet
- Amsterdam Rheumatology and Immunology Center, Academic Medical Center, Amsterdam, The Netherlands.,Department of Genome Analysis, Academic Medical Center, Amsterdam, The Netherlands
| | - Maria J H de Hair
- Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul L Klarenbeek
- Amsterdam Rheumatology and Immunology Center, Academic Medical Center, Amsterdam, The Netherlands.,Department of Genome Analysis, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Antoine H C van Kampen
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Danielle M Gerlag
- Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank Baas
- Department of Genome Analysis, Academic Medical Center, Amsterdam, The Netherlands
| | - Niek de Vries
- Amsterdam Rheumatology and Immunology Center, Academic Medical Center, Amsterdam, The Netherlands
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Kim YJ, Shin JM, Shin SH, Kim JH, Sohn KY, Kim HJ, Kang JK, Yoon SY, Kim JW. 1-palmitoyl-2-linoleoyl-3-acetyl-rac-glycerol ameliorates arthritic joints through reducing neutrophil infiltration mediated by IL-6/STAT3 and MIP-2 activation. Oncotarget 2017; 8:96636-96648. [PMID: 29228558 PMCID: PMC5722510 DOI: 10.18632/oncotarget.19384] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 07/06/2017] [Indexed: 12/24/2022] Open
Abstract
The pathogenesis of rheumatoid arthritis (RA) has been implicated neutrophil extracellular traps (NETs) formation which could generate autoantigen. Neutrophil contributes to initiate and maintain the inflammatory process in the joint. In this study, we show that 1-palmitoyl-2-linoleoyl-3-acetyl-rac-glycerol (PLAG) decreases neutrophil migration by regulating the activity of STAT3, a regulator of IL-6 and MIP-2 expression. PLAG caused a decrease in IL-6 production in the RAW264.7 macrophage cell line and in rheumatoid arthritis–fibroblast-like synoviocytes via the regulation of STAT3 signaling without affecting NF-κB signaling. In a mouse model of collagen-induced arthritis (CIA), arthritic symptoms were recapitulated, with increased IL-6 level in the synovium, and PLAG treatment restored IL-6 to a level comparable to that achieved with commercial therapeutics (such as Remicade or methotrexate). Staining of joint tissue with neutrophil-specific antibody showed that PLAG significantly reduced the infiltration of neutrophils into the joint synovium of CIA mice. The inhibitory effect of PLAG on IL-6/STAT3 or MIP-2 signaling also reduced the migration of differentiated neutrophils in vitro. Therefore, PLAG inhibits the infiltration of destructive neutrophils into inflammatory sites, and can be utilized as a potent therapeutic agent for the treatment of sustained inflammation and joint destruction.
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Affiliation(s)
- Young-Jun Kim
- Cell Factory Research Center, Division of Systems Biology and Bioengineering, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
| | - Jae Min Shin
- Cell Factory Research Center, Division of Systems Biology and Bioengineering, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
| | - Su-Hyun Shin
- Cell Factory Research Center, Division of Systems Biology and Bioengineering, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
| | - Joo Heon Kim
- Department of Pathology, EulJi University School of Medicine, Daejeon, Republic of Korea
| | | | | | - Jong-Koo Kang
- Department of Laboratory Animal medicine, College of Veterinary medicine, Chungbuk National University, Cheongju, Republic of Korea
| | | | - Jae Wha Kim
- Cell Factory Research Center, Division of Systems Biology and Bioengineering, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
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24
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Sultana F, Neog MK, Rasool M. Withaferin-A, a steroidal lactone encapsulated mannose decorated liposomes ameliorates rheumatoid arthritis by intriguing the macrophage repolarization in adjuvant-induced arthritic rats. Colloids Surf B Biointerfaces 2017; 155:349-365. [PMID: 28454064 DOI: 10.1016/j.colsurfb.2017.04.046] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 03/31/2017] [Accepted: 04/19/2017] [Indexed: 02/07/2023]
Abstract
In order to develop a better therapeutic approach for the treatment of rheumatoid arthritis (RA), withaferin-A; a steroidal lactone incorporated with mannosylated liposomes (ML-WA) was administered to adjuvant induced arthritic rats in intent to target the synovial macrophages. The confocal microscopy studies showed a successful internalization of ML-WA in the primarily isolated synovial macrophages. Consequently, targeting synovial macrophages via ML-WA reduced the oxidative stress (ROS and NO), and paw edema, however, a progressive gain in the body weight was observed in AIA rats. ML-WA treatment upregulated the production of osteoprotegerin (OPG) and downregulated the release of receptor activator of nuclear factor-κB ligand (RANKL), favoring osteoclastogenesis negatively. Correspondingly, the ankle joints were found intact with no bone erosion and cartilage degradation in ML-WA treated AIA rats as evidenced by histopathological analysis. Also, synovial macrophage assessment showed that the concentration and the gene amplification of M1 macrophage mediated pro-inflammatory mediators (TNF-α, IL-1β, IL-6, MCP-1 and VEGF) were curtailed in ML-WA treated AIA rats. In contrast, anti-inflammatory cytokine (IL-10) was found abundantly released. Furthermore, the mRNA expression of the M1 surface marker (CD86) was found down regulated, whereas, M2 marker (CD163) was highly amplified in ML-WA treated synovial macrophages of arthritic rats. Cumulatively, our result signified that targeted delivery of ML-WA ameliorated the severity of inflammation and bone resorption in AIA rats via M1 to M2 macrophage repolarization.
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Affiliation(s)
- Farhath Sultana
- Immunopathology Lab, School of Bio Sciences and Technology, VIT University, Vellore, 632 014, Tamil Nadu, India
| | - Manoj Kumar Neog
- Immunopathology Lab, School of Bio Sciences and Technology, VIT University, Vellore, 632 014, Tamil Nadu, India
| | - MahaboobKhan Rasool
- Immunopathology Lab, School of Bio Sciences and Technology, VIT University, Vellore, 632 014, Tamil Nadu, India.
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He H, Ghosh S, Yang H. Nanomedicines for dysfunctional macrophage-associated diseases. J Control Release 2017; 247:106-126. [PMID: 28057522 PMCID: PMC5360184 DOI: 10.1016/j.jconrel.2016.12.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 12/28/2016] [Indexed: 12/13/2022]
Abstract
Macrophages play vital functions in host inflammatory reaction, tissue repair, homeostasis and immunity. Dysfunctional macrophages have significant pathophysiological impacts on diseases such as cancer, inflammatory diseases (rheumatoid arthritis and inflammatory bowel disease), metabolic diseases (atherosclerosis, diabetes and obesity) and major infections like human immunodeficiency virus infection. In view of this common etiology in these diseases, targeting the recruitment, activation and regulation of dysfunctional macrophages represents a promising therapeutic strategy. With the advancement of nanotechnology, development of nanomedicines to efficiently target dysfunctional macrophages can strengthen the effectiveness of therapeutics and improve clinical outcomes. This review discusses the specific roles of dysfunctional macrophages in various diseases and summarizes the latest advances in nanomedicine-based therapeutics and theranostics for treating diseases associated with dysfunctional macrophages.
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Affiliation(s)
- Hongliang He
- Department of Chemical and Life Science Engineering, Virginia Commonwealth University, Richmond, VA 23219, United States
| | - Shobha Ghosh
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA 23298, United States.
| | - Hu Yang
- Department of Chemical and Life Science Engineering, Virginia Commonwealth University, Richmond, VA 23219, United States; Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA 23298, United States; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298, United States.
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26
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Development of Diagnostic Techniques for Early Rheumatoid Arthritis Using Positron Emission Tomography with [11C]PK11195 and [11C]Ketoprofen Tracers. Mol Imaging Biol 2017; 19:746-753. [DOI: 10.1007/s11307-016-1039-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Haanstra KG, Jonker M, 't Hart BA. An Evaluation of 20 Years of EU Framework Programme-Funded Immune-Mediated Inflammatory Translational Research in Non-Human Primates. Front Immunol 2016; 7:462. [PMID: 27872622 PMCID: PMC5098224 DOI: 10.3389/fimmu.2016.00462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/17/2016] [Indexed: 12/26/2022] Open
Abstract
Aging western societies are facing an increasing prevalence of chronic inflammatory and degenerative diseases for which often no effective treatments exist, resulting in increasing health-care expenditure. Despite high investments in drug development, the number of promising new drug candidates decreases. We propose that preclinical research in non-human primates can help to bridge the gap between drug discovery and drug prescription. Translational research covers various stages of drug development of which preclinical efficacy tests in valid animal models is usually the last stage. Preclinical research in non-human primates may be essential in the evaluation of new drugs or therapies when a relevant rodent model is not available. Non-human primate models for life-threatening or severely debilitating diseases in humans are available at the Biomedical Primate Research Centre (BPRC). These have been instrumental in translational research for several decades. In order to stimulate European health research and innovation from bench to bedside, the European Commission has invested heavily in access to non-human primate research for more than 20 years. BPRC has hosted European users in a series of transnational access programs covering a wide range of research areas with the common theme being immune-mediated inflammatory disorders. We present an overview of the results and give an account of the studies performed as part of European Union Framework Programme (EU FP)-funded translational non-human primate research performed at the BPRC. These data illustrate the value of translational non-human primate research for the development of new therapies and emphasize the importance of EU FP funding in drug development.
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Affiliation(s)
- Krista G Haanstra
- Department of Immunobiology, Biomedical Primate Research Centre , Rijswijk , Netherlands
| | - Margreet Jonker
- Department of Immunobiology, Biomedical Primate Research Centre, Rijswijk, Netherlands; Department of Immunohematology, Leiden University Medical Center, Leiden, Netherlands
| | - Bert A 't Hart
- Department of Immunobiology, Biomedical Primate Research Centre, Rijswijk, Netherlands; Department of Neuroscience, University Medical Center, University of Groningen, Groningen, Netherlands
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28
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Abstract
Rheumatoid arthritis is a chronic inflammatory joint disease, which can cause cartilage and bone damage as well as disability. Early diagnosis is key to optimal therapeutic success, particularly in patients with well-characterised risk factors for poor outcomes such as high disease activity, presence of autoantibodies, and early joint damage. Treatment algorithms involve measuring disease activity with composite indices, applying a treatment-to-target strategy, and use of conventional, biological, and newz non-biological disease-modifying antirheumatic drugs. After the treatment target of stringent remission (or at least low disease activity) is maintained, dose reduction should be attempted. Although the prospects for most patients are now favourable, many still do not respond to current therapies. Accordingly, new therapies are urgently required. In this Seminar, we describe current insights into genetics and aetiology, pathophysiology, epidemiology, assessment, therapeutic agents, and treatment strategies together with unmet needs of patients with rheumatoid arthritis.
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria; 2nd Department of Medicine, Hietzing Hospital Vienna, Vienna, Austria.
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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29
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High prevalence of tenosynovial inflammation before onset of rheumatoid arthritis and its link to progression to RA—A combined MRI/CT study. Semin Arthritis Rheum 2016; 46:143-150. [DOI: 10.1016/j.semarthrit.2016.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/08/2016] [Accepted: 05/12/2016] [Indexed: 01/05/2023]
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30
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Cope FO, Abbruzzese B, Sanders J, Metz W, Sturms K, Ralph D, Blue M, Zhang J, Bracci P, Bshara W, Behr S, Maurer T, Williams K, Walker J, Beverly A, Blay B, Damughatla A, Larsen M, Mountain C, Neylon E, Parcel K, Raghuraman K, Ricks K, Rose L, Sivakumar A, Streck N, Wang B, Wasco C, Schlesinger LS, Azad A, Rajaram MVS, Jarjour W, Young N, Rosol T, Williams A, McGrath M. The inextricable axis of targeted diagnostic imaging and therapy: An immunological natural history approach. Nucl Med Biol 2016; 43:215-25. [PMID: 26924502 PMCID: PMC4794336 DOI: 10.1016/j.nucmedbio.2015.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 12/30/2022]
Abstract
In considering the challenges of approaches to clinical imaging, we are faced with choices that sometimes are impacted by rather dogmatic notions about what is a better or worse technology to achieve the most useful diagnostic image for the patient. For example, is PET or SPECT most useful in imaging any particular disease dissemination? The dictatorial approach would be to choose PET, all other matters being equal. But is such a totalitarian attitude toward imaging selection still valid? In the face of new receptor targeted SPECT agents one must consider the remarkable specificity and sensitivity of these agents. (99m)Tc-Tilmanocept is one of the newest of these agents, now approved for guiding sentinel node biopsy (SLNB) in several solid tumors. Tilmanocept has a Kd of 3×10(-11)M, and it specificity for the CD206 receptor is unlike any other agent to date. This coupled with a number of facts, that specific disease-associated macrophages express this receptor (100 to 150 thousand receptors), that the receptor has multiple binding sites for tilmanocept (>2 sites per receptor) and that these receptors are recycled every 15 min to bind more tilmanocept (acting as intracellular "drug compilers" of tilmanocept into non-degraded vesicles), gives serious pause as to how we select our approaches to diagnostic imaging. Clinically, the size of SLNs varies greatly, some, anatomically, below the machine resolution of SPECT. Yet, with tilmanocept targeting, the SLNs are highly visible with macrophages stably accruing adequate (99m)Tc-tilmanocept counting statistics, as high target-to-background ratios can compensate for spatial resolution blurring. Importantly, it may be targeted imaging agents per se, again such as tilmanocept, which may significantly shrink any perceived chasm between the imaging technologies and anchor the diagnostic considerations in the targeting and specificity of the agent rather than any lingering dogma about the hardware as the basis for imaging approaches. Beyond the elements of imaging applications of these agents is their evolution to therapeutic agents as well, and even in the neo-logical realm of theranostics. Characteristics of agents such as tilmanocept that exploit the natural history of diseases with remarkably high specificity are the expectations for the future of patient- and disease-centered diagnosis and therapy.
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Affiliation(s)
- Frederick O Cope
- Navidea Biopharmaceuticals, Drug Development, 5600 Blazer Parkway, Dublin, OH 43017.
| | - Bonnie Abbruzzese
- Navidea Biopharmaceuticals, Drug Development, 5600 Blazer Parkway, Dublin, OH 43017
| | - James Sanders
- Navidea Biopharmaceuticals, Drug Development, 5600 Blazer Parkway, Dublin, OH 43017
| | - Wendy Metz
- Navidea Biopharmaceuticals, Drug Development, 5600 Blazer Parkway, Dublin, OH 43017
| | - Kristyn Sturms
- Navidea Biopharmaceuticals, Drug Development, 5600 Blazer Parkway, Dublin, OH 43017
| | - David Ralph
- Navidea Biopharmaceuticals, Drug Development, 5600 Blazer Parkway, Dublin, OH 43017
| | - Michael Blue
- Navidea Biopharmaceuticals, Drug Development, 5600 Blazer Parkway, Dublin, OH 43017
| | - Jane Zhang
- The University of California San Francisco and the San Francisco General Hospital, AIDS and Cancer Specimen Resource Center, The Department of Pathology, 1001 Potrero Ave, Bldg. 3, Rm 207 San Francisco, CA 94110
| | - Paige Bracci
- The University of California San Francisco and the San Francisco General Hospital, AIDS and Cancer Specimen Resource Center, The Department of Pathology, 1001 Potrero Ave, Bldg. 3, Rm 207 San Francisco, CA 94110
| | - Wiam Bshara
- Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263
| | - Spencer Behr
- Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263
| | - Toby Maurer
- Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263
| | - Kenneth Williams
- Boston College, Department of Biology, 14 Commonwealth Ave, Chestnut Hill, Massachusetts 02467
| | - Joshua Walker
- Boston College, Department of Biology, 14 Commonwealth Ave, Chestnut Hill, Massachusetts 02467
| | - Allison Beverly
- Navidea Biopharmaceuticals Drug Development Internship Program, 5600 Blazer Parkway, Dublin, OH 43017
| | - Brooke Blay
- Navidea Biopharmaceuticals Drug Development Internship Program, 5600 Blazer Parkway, Dublin, OH 43017
| | - Anirudh Damughatla
- Navidea Biopharmaceuticals Drug Development Internship Program, 5600 Blazer Parkway, Dublin, OH 43017
| | - Mark Larsen
- Navidea Biopharmaceuticals Drug Development Internship Program, 5600 Blazer Parkway, Dublin, OH 43017
| | - Courtney Mountain
- Navidea Biopharmaceuticals Drug Development Internship Program, 5600 Blazer Parkway, Dublin, OH 43017
| | - Erin Neylon
- Navidea Biopharmaceuticals Drug Development Internship Program, 5600 Blazer Parkway, Dublin, OH 43017
| | - Kaeli Parcel
- Navidea Biopharmaceuticals Drug Development Internship Program, 5600 Blazer Parkway, Dublin, OH 43017
| | - Kapil Raghuraman
- Navidea Biopharmaceuticals Drug Development Internship Program, 5600 Blazer Parkway, Dublin, OH 43017
| | - Kevin Ricks
- Navidea Biopharmaceuticals Drug Development Internship Program, 5600 Blazer Parkway, Dublin, OH 43017
| | - Lucas Rose
- Navidea Biopharmaceuticals Drug Development Internship Program, 5600 Blazer Parkway, Dublin, OH 43017
| | - Akhilesh Sivakumar
- Navidea Biopharmaceuticals Drug Development Internship Program, 5600 Blazer Parkway, Dublin, OH 43017
| | - Nicholas Streck
- Navidea Biopharmaceuticals Drug Development Internship Program, 5600 Blazer Parkway, Dublin, OH 43017
| | - Bryan Wang
- Navidea Biopharmaceuticals Drug Development Internship Program, 5600 Blazer Parkway, Dublin, OH 43017
| | - Christopher Wasco
- Navidea Biopharmaceuticals Drug Development Internship Program, 5600 Blazer Parkway, Dublin, OH 43017
| | | | | | | | | | | | | | - Amifred Williams
- Navidea Biopharmaceuticals Drug Development Internship Program, 5600 Blazer Parkway, Dublin, OH 43017
| | - Michael McGrath
- The University of California San Francisco and the San Francisco General Hospital, AIDS and Cancer Specimen Resource Center, The Department of Pathology, 1001 Potrero Ave, Bldg. 3, Rm 207 San Francisco, CA 94110
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31
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Vierboom MPM, Breedveld E, Kap YS, Mary C, Poirier N, 't Hart BA, Vanhove B. Clinical efficacy of a new CD28-targeting antagonist of T cell co-stimulation in a non-human primate model of collagen-induced arthritis. Clin Exp Immunol 2015; 183:405-18. [PMID: 26540618 DOI: 10.1111/cei.12739] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 01/13/2023] Open
Abstract
T cells have a central pathogenic role in the aetiopathogenesis of rheumatoid arthritis (RA), and are therefore a favoured target of immunotherapy aiming at physical or functional elimination. Here we report an efficacy test of FR104, a new co-stimulation inhibitor directly targeting CD28 on T cells, in a translationally relevant model, the rhesus monkey model of collagen-induced arthritis (CIA). As a relevant comparator we used abatacept [cytotoxic T lymphocyte antigen immunoglobulin (CTLA Ig)], an antagonist of CTLA-4 binding to CD80/86 clinically approved for treatment of RA. Treatment with either compound was started at the day of CIA induction. Although FR104 previously demonstrated a higher control of T cell responses in vitro than abatacept, both compounds were equally potent in the suppression of CIA symptoms and biomarkers, such as the production of C-reactive protein (CRP) and interleukin (IL)-6 and anti-collagen type II (CII) serum antibody (IgM/IgG). However, in contrast to abatacept, FR104 showed effective suppression of CII-induced peripheral blood mononuclear cell (PBMC) proliferation. The current study demonstrates a strong potential of the new selective CD28 antagonist FR104 for treatment of RA.
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Affiliation(s)
- M P M Vierboom
- Department of Immunobiology, Biomedical Primate Research Centre, Rijswijk, the Netherlands
| | - E Breedveld
- Department of Immunobiology, Biomedical Primate Research Centre, Rijswijk, the Netherlands
| | - Y S Kap
- Department of Immunobiology, Biomedical Primate Research Centre, Rijswijk, the Netherlands
| | - C Mary
- Institut National De La Santé Et De La Recherche Médicale, Université De Nantes, Effimune SA, Nantes, France
| | - N Poirier
- Institut National De La Santé Et De La Recherche Médicale, Université De Nantes, Effimune SA, Nantes, France
| | - B A 't Hart
- Department of Immunobiology, Biomedical Primate Research Centre, Rijswijk, the Netherlands.,Department Neuroscience, University of Groningen, University Medical Center, Groningen, the Netherlands
| | - B Vanhove
- Institut National De La Santé Et De La Recherche Médicale, Université De Nantes, Effimune SA, Nantes, France
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Abstract
PURPOSE OF REVIEW Rheumatoid arthritis (RA) is a heterogeneous chronic immune-mediated inflammatory disease, associated with significant morbidity and reduced life expectancy. Here, we review recent discoveries; particularly those which have attempted to integrate genome-wide association studies (GWAS) with biological pathways and cell types known to play a role in disease pathology in order to expand our current understanding of the pathogenesis of RA. As the role of stromal cells in the pathogenesis of RA has been reviewed in detail in Current Opinions in Rheumatology, this area will not be covered in this review. RECENT FINDINGS Although our understandings of the pathogenic processes that drive disease in RA remain incomplete, remarkable advances over the past year can be highlighted. GWAS have raised awareness of important new risk loci with genes that either are the targets of approved therapies for RA, or involve pathways for drugs that could be repurposed from other disease indications such as cancer. Furthermore, promising strides have been made in predicting the likelihood of developing RA in those at risk using human leukocyte antigen (HLA), smoking, and autoantibody status prediction models. These findings give a fresh insight into RA pathogenesis and help identify new, or repurpose known therapeutic targets from other disease areas. SUMMARY The findings discussed in this review underscore the progress made to date and the need for future studies, investigating disease mechanisms in RA, with particular interest in at-risk RA gene loci, their function in immune and stromal cells within the synovium, and how they interact with environmental factors to initiate and perpetuate disease.
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33
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Maijer KI, Neumann E, Müller-Ladner U, Drop DACAD, Ramwadhdoebe TH, Choi IYK, Gerlag DM, de Hair MJH, Tak PP. Serum Vaspin Levels Are Associated with the Development of Clinically Manifest Arthritis in Autoantibody-Positive Individuals. PLoS One 2015; 10:e0144932. [PMID: 26670468 PMCID: PMC4682927 DOI: 10.1371/journal.pone.0144932] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/25/2015] [Indexed: 12/26/2022] Open
Abstract
Objectives We have previously shown that overweight may increase the risk of developing rheumatoid arthritis (RA) in autoantibody positive individuals. Adipose tissue could contribute to the development of RA by production of various bioactive peptides. Therefore, we examined levels of adipokines in serum and synovial tissue of subjects at risk of RA. Methods Fifty-one individuals positive for immunoglobulin M rheumatoid factor (IgM-RF) and/or anti-citrullinated protein antibodies (ACPA), without arthritis, were included in this prospective study. Levels of adiponectin, vaspin, resistin, leptin, chemerin and omentin were determined in baseline fasting serum samples (n = 27). Synovial tissue was obtained by arthroscopy at baseline and we examined the expression of adiponectin, resistin and visfatin by immunohistochemistry. Results The development of clinically manifest arthritis after follow-up was associated with baseline serum vaspin levels (HR1.5 (95% CI 1.1 to 2.2); p = 0.020), also after adjustment for overweight (HR1.7 (95% CI 1.1 to 2.5); p = 0.016). This association was not seen for other adipokines. Various serum adipokine levels correlated with BMI (adiponectin r = -0.538, leptin r = 0.664; chemerin r = 0.529) and systemic markers of inflammation such as CRP levels at baseline (adiponectin r = -0.449, omentin r = -0.557, leptin r = 0.635, chemerin r = 0.619, resistin r = 0.520) and ESR (leptin r = 0.512, chemerin r = 0.708), p-value<0.05. Synovial expression of adiponectin, resistin and visfatin was not associated with development of clinically manifest arthritis. Conclusions In this exploratory study, serum adipokines were associated with an increased inflammatory state in autoantibody-positive individuals at risk of developing RA. Furthermore, serum vaspin levels may assist in predicting the development of arthritis in these individuals.
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Affiliation(s)
- Karen I. Maijer
- Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Elena Neumann
- Department of Internal Medicine and Rheumatology, University of Giessen, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Ulf Müller-Ladner
- Department of Internal Medicine and Rheumatology, University of Giessen, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Daniël A. C. A. D. Drop
- Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Tamara H. Ramwadhdoebe
- Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Ivy Y. K. Choi
- Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Daniëlle M. Gerlag
- Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Maria J. H. de Hair
- Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Paul P. Tak
- Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, the Netherlands
- * E-mail:
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van Beers-Tas MH, Turk SA, van Schaardenburg D. How does established rheumatoid arthritis develop, and are there possibilities for prevention? Best Pract Res Clin Rheumatol 2015; 29:527-42. [PMID: 26697764 DOI: 10.1016/j.berh.2015.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Established rheumatoid arthritis (RA) is a chronic state with more or less joint damage and inflammation, which persists after a phase of early arthritis. Autoimmunity is the main determinant of persistence. Although the autoimmune response is already fully developed in the phase of early arthritis, targeted treatment within the first months produces better results than delayed treatment. Prevention of established RA currently depends on the success of remission-targeted treatment of early disease. Early recognition is aided by the new criteria for RA. Further improvement may be possible by even earlier recognition and treatment in the at-risk phase. This requires the improvement of prediction models and strategies, and more intervention studies. Such interventions should also be directed at modifiable risk factors such as smoking and obesity. The incidence of RA has declined for decades in parallel with the decrease of smoking rates; however, a recent increase has occurred that is associated with obesity.
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Affiliation(s)
- Marian H van Beers-Tas
- Amsterdam Rheumatology and Immunology Center, Reade, Doctor Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands.
| | - Samina A Turk
- Amsterdam Rheumatology and Immunology Center, Reade, Doctor Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands.
| | - Dirkjan van Schaardenburg
- Amsterdam Rheumatology and Immunology Center, Reade and Academic Medical Center, Amsterdam, The Netherlands.
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Gerlag DM, Norris JM, Tak PP. Towards prevention of autoantibody-positive rheumatoid arthritis: from lifestyle modification to preventive treatment. Rheumatology (Oxford) 2015; 55:607-14. [PMID: 26374913 PMCID: PMC4795536 DOI: 10.1093/rheumatology/kev347] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Indexed: 01/02/2023] Open
Abstract
Recent advances in research into the earliest phases of RA have provided additional insights into the processes leading from the healthy to the diseased state. These insights have opened the way for the development of preventive strategies for RA, which represents a significant paradigm shift from treatment to prevention and will have major implications for patients as well as society. It would be a huge step forward if clinical signs and symptoms, disability, impaired quality of life and the need for chronic immunosuppressive treatment could be prevented. RA can be seen as a prototypic autoimmune disease, and discoveries about the preclinical diseased state for RA could potentially facilitate research into prevention of other immune-mediated inflammatory diseases such as type 1 diabetes, SLE and multiple sclerosis. This review focuses on the current knowledge of factors contributing to the development of RA and discusses the opportunities for intervention.
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Affiliation(s)
| | - Jill M Norris
- Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Paul P Tak
- Department of Rheumatology, University of Ghent, Ghent, Belgium, Department of Medicine, University of Cambridge, Cambridge and Research and Development, GlaxoSmithKline, Stevenage, UK
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Rheumatoid arthritis therapy reappraisal: strategies, opportunities and challenges. Nat Rev Rheumatol 2015; 11:276-89. [PMID: 25687177 DOI: 10.1038/nrrheum.2015.8] [Citation(s) in RCA: 310] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Rheumatoid arthritis (RA) is considered a chronic disease that cannot be cured. Biologic agents have enabled good therapeutic successes; however, the response to biologic therapy depends on treatment history and, especially, disease duration. In general, the more drug-experienced the patients, the lower the response rates, although this limitation can be overcome by promptly adjusting or switching treatment in a treat-to-target approach. Another challenge is the question of how long therapy should be continued once the treatment target, which should be remission or at least a state of low disease activity, has been reached. The data available suggest that, in most patients with established disease, cessation of biologic therapy will be followed by disease flares, whereas a reduction of dose or an increase in the interval between doses enables maintenance of treatment success. Induction therapy very early in the disease course followed by withdrawal of the biologic agent might also be a feasible approach to attain sustained good outcomes, but currently available data are not strong enough to allow for such a conclusion to be reached. Taken together, this underscores the importance of research into the cause(s) of RA so that curative therapies can be developed.
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Anandarajah A, Thiele R, Giampoli E, Monu J, Seo GS, Feng C, Ritchlin CT. Patients with rheumatoid arthritis in clinical remission manifest persistent joint inflammation on histology and imaging studies. J Rheumatol 2014; 41:2153-60. [PMID: 25274900 DOI: 10.3899/jrheum.140411] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of our study was to test the hypothesis that synovitis on magnetic resonance imaging (MRI) and ultrasound (US) observed in patients with rheumatoid arthritis (RA) who meet remission criteria reflects active inflammation on histopathology. METHODS We analyzed 15 synovial specimens obtained during surgical procedures from 14 patients with RA in clinical remission as defined by the American College of Rheumatology criteria. Histological specimens were scored for hyperplasia of synovial lining and synovial stroma, inflammation, lymphoid follicles, and vascularity. The histology scores were classified as minimal, mild, moderate, or severe disease activity. US and MRI performed within a 4-month period of surgery were scored for disease activity. The correlation between histology and imaging scores was examined. RESULTS Four of 14 patients were receiving anti-tumor necrosis factor (TNF) therapy, 4 were receiving methotrexate (MTX) alone, 4 were taking MTX and hydroxychloroquine (HCQ), and 1 was taking HCQ and sulfasalazine. Four specimens had severe, 6 moderate, 3 mild, and 2 minimal disease activity on histology. Three of 4 specimens with minimal and mild histology were observed in subjects receiving anti-TNF therapy. Synovitis was noted on greyscale in 80% of joints and Doppler signal in 60%. MRI demonstrated synovitis and bone marrow edema in 86% of images. Positive but not significant correlations were noted between histology and synovitis scores on US. CONCLUSION Despite clinical remission, histology and imaging studies documented a persistently active disease state that may explain the mechanism for radiographic progression.
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Affiliation(s)
- Allen Anandarajah
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester.
| | - Ralf Thiele
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
| | - Ellen Giampoli
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
| | - Johnny Monu
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
| | - Gwy-Suk Seo
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
| | - Changyong Feng
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
| | - Christopher T Ritchlin
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
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Abstract
There exists a preclinical phase to the disease progression of rheumatoid arthritis, in which there is evidence of autoimmunity but no overt clinical arthritis. Identifying patients in this phase would allow for early treatment, to potentially halt manifestation of the disease. Imaging, because it is noninvasive, provides an appealing alternative to gold-standard synovial biopsies for identification of these preclinical patients. Ultrasonography, magnetic resonance imaging, and positron emission tomography all have their advantages and disadvantages as imaging modalities in this regard. Further research into alternative imaging modalities with larger cohorts is required to determine the most effective technique.
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Affiliation(s)
- Daniel P Marcusa
- Department of Medicine, Hospital for Special Surgery, 535 E70th Street, New York City, NY 10021, USA
| | - Lisa A Mandl
- Department of Medicine, Hospital for Special Surgery, 535 E70th Street, New York City, NY 10021, USA.
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Nandagudi AC, Kelly S. Ultrasound Detection of Salmonella Septic Arthritis in a Rheumatoid Arthritis Patient on Anti-TNF Treatment. J Investig Med High Impact Case Rep 2014; 2:2324709614532799. [PMID: 26425605 PMCID: PMC4528892 DOI: 10.1177/2324709614532799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a case of Salmonella septic arthritis detected by ultrasound in a 40-year-old man with rheumatoid arthritis while he was on anti–tumor necrosis factor-α monoclonal antibody certolizumab. An aspirate of his left elbow joint showed Salmonella enteritidis infection that was sensitive to ceftraixone. This was preceded by a brief episode of loose stools following a visit to the Far East. He was treated with antibiotics and made a good recovery. There have only been a few case reports of Salmonella septic arthritis in a rheumatoid arthritis patient on anti–tumor necrosis factor treatment but none previously in association with certolizumab.
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Sewerin P, Buchbender C, Vordenbäumen S, Scherer A, Miese F, Brinks R, Wittsack HJ, Klein S, Schneider M, Antoch G, Ostendorf B. Advantages of a combined rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for hand and feet: does the RAMRIS of the hand alone underestimate disease activity and progression? BMC Musculoskelet Disord 2014; 15:104. [PMID: 24669889 PMCID: PMC3974414 DOI: 10.1186/1471-2474-15-104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/21/2014] [Indexed: 12/03/2022] Open
Abstract
Background To evaluate a combined rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for hand and foot (HaF-score) in rheumatoid arthritis (RA). Methods Magnetic resonance imaging (MRI, 0.2 Tesla) of the dominant hand and foot of 26 ACPA positive RA patients before and 6 months after initiation of methotrexate was obtained. RAMRIS of the hand was complemented by corresponding scoring of the foot (MTP I-V; HaF-score). Disease Activity Score 28 (DAS28) and a tender and swollen joint count (JC) of the joints scored in MRI were recorded. Changes in these scores (Δ) were assessed. Results ΔHaF-score correlated significantly with ΔDAS28 (r = 0.820, 95%-CI 0.633-0.916). Correlations to ΔDAS28 were best for changes in the synovitis subscore (0.648) and bone marrow edema (0.703). Correlations to ΔDAS28 were significantly better for of the ΔHaF-score than ΔRAMRIS (0.499, 0.139-0.743, p = 0.0368). All patients with at least moderate response (EULAR criteria, n = 11) had continuing disease activity on MRI, including five cases with new erosions, three of them at the feet. Improvements of the hand JC or foot JC were seen in 16 and 15 cases, respectively. However, MRI of the hand or feet improved in only 10 and 9 cases, respectively. No patient fulfilled SDAI remission criteria. Conclusions The HaF-score identifies patients with continuing disease activity despite clinical response that would have been missed by consideration of the traditional RAMRIS or the DAS28 alone. Response as opposed to remission may be an insufficient goal in RA as all patients showed continuing disease activity, especially at the feet.
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Affiliation(s)
- Philipp Sewerin
- Department of Rheumatology, Univ Duesseldorf, Medical Faculty, Moorenstrasse 5, Duesseldorf D-40225, Germany.
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Pottier G, Bernards N, Dollé F, Boisgard R. [¹⁸F]DPA-714 as a biomarker for positron emission tomography imaging of rheumatoid arthritis in an animal model. Arthritis Res Ther 2014; 16:R69. [PMID: 24621017 PMCID: PMC4060384 DOI: 10.1186/ar4508] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 02/17/2014] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic disease, affecting 0.5 to 1% of adults in industrialized countries, in which systemic inflammation and synovitis drive joint destruction. [¹⁸F]DPA-714 is a specific tracer of the 18 kDa translocator protein (TSPO), which is overexpressed on activated macrophages, and proposed as a biomarker of neuroinflammation. Today, diagnosis of patients with early inflammatory arthritis is limited by poor sensitivity and specificity. The present study aims to investigate the potential of [¹⁸F]DPA-714 to monitor in vivo inflammatory processes at a preclinical stage via positron emission tomography (PET). METHODS RA was induced in Dark Agouti rats by subcutaneous injection of inactivated Mycobacterium tuberculosis. Development of arthritis clinical signs was investigated daily and the severity of the disease evaluated. Animals were imaged at the peak of inflammation using [¹⁸F]DPA-714 and a small-animal PET-CT tomograph. RESULTS The first clinical signs appeared at 10 days post-injection, with a peak of inflammation at 20 days. At this time, PET-analyses showed a clear uptake of [¹⁸F]DPA-714 in swollen ankles, with mean values of 0.52 ± 0.18% injected dose (ID/cc) for treated (n = 11) and 0.19 ± 0.09 for non-treated (n = 6) rats. A good correlation between [¹⁸F]DPA-714's uptake and swelling was also found. Immunohistochemistry showed an enhanced TSPO expression in hind paws, mainly co-localized with the macrophages specific antigen CD68 expressing cells. CONCLUSION These preliminary results demonstrate that the TSPO 18 kDa specific radioligand [¹⁸F]DPA-714 is adapted for the study and follow-up of inflammation linked to RA in our experimental model, suggesting also a strong potential for clinical imaging of peripheral inflammation.
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de Hair MJH, van de Sande MGH, Ramwadhdoebe TH, van der Leij C, Maas M, Hansson M, Klareskog L, Landewé R, Serre G, van Schaardenburg D, Gerlag DM, van Baarsen LGM, Tak PP. Reply: To PMID 24574210. Arthritis Rheumatol 2014; 66:1683-4. [PMID: 24577836 DOI: 10.1002/art.38411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Brunner J, Kern PM, Gaipl US, Munoz LE, Voll RE, Kalden JR, Wiesenhutter CW, Herrmann M. The low-throughput protein A adsorber: an immune modulatory device. Hypothesis for the mechanism of action in the treatment of rheumatoid arthritis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-004-0366-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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van Steenbergen HW, Huizinga TWJ, van der Helm-van Mil AHM. The preclinical phase of rheumatoid arthritis: what is acknowledged and what needs to be assessed? ACTA ACUST UNITED AC 2013; 65:2219-32. [PMID: 23686440 DOI: 10.1002/art.38013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 05/06/2013] [Indexed: 12/17/2022]
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Abstract
PURPOSE OF REVIEW To critically appraise the literature related to the pathophysiology of rheumatoid arthritis (RA) focusing on the contribution of synovial tissue pathology (synovitis) in determining diverse clinical outcome/therapeutic response. RECENT FINDINGS RA synovitis is highly heterogeneous with diverse cellular and molecular signatures (pathotypes) emerging as potential taxonomic classifiers of disease phenotypes.The challenge is to understand mechanistically the sophisticated interplay between systemic disease 'initiators' and joint-specific 'localizing/perpetuating' factors leading to disparate coupling of inflammation/tissue-destructive pathways and disease outcome. Synovial tissue analysis has been instrumental in enhancing understanding of R0A pathogenesis and developing targeted DMARD-biologic therapies. The next step is to elucidate the relationship of different synovial pathotypes/molecular signatures with therapeutic response/resistance in randomized clinical trials in order to develop effective therapies for 'resistant' patients. The development of ultrasound-guided synovial biopsy as a rapid, safe and well tolerated procedure that enables synovial tissue collection from most joints/patients will facilitate such studies. SUMMARY RA is a heterogeneous clinical and pathobiological entity. Specific pathways within synovial tissues are emerging as associated with diverse clinical evolution and therapeutic response/resistance that, if confirmed in randomized clinical trials, may lead to the development of synovial tissue analysis as a potential clinical tool for patient stratification.
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Prieto-Potín I, Roman-Blas JA, Martínez-Calatrava MJ, Gómez R, Largo R, Herrero-Beaumont G. Hypercholesterolemia boosts joint destruction in chronic arthritis. An experimental model aggravated by foam macrophage infiltration. Arthritis Res Ther 2013; 15:R81. [PMID: 23941259 PMCID: PMC3978700 DOI: 10.1186/ar4261] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 08/13/2013] [Indexed: 02/06/2023] Open
Abstract
Objective The aim of this study was to determine whether hypercholesterolemia increases articular damage in a rabbit model of chronic arthritis. Methods Hypercholesterolemia was induced in 18 rabbits by administrating a high-fat diet (HFD). Fifteen rabbits were fed normal chow as controls. Chronic antigen-induced arthritis (AIA) was induced in half of the HFD and control rabbits, previously immunized, by intra-articular injections of ovalbumin. After sacrifice, lipid and systemic inflammation markers were analyzed in blood serum. Synovium was analyzed by Krenn score, multinucleated cell counting, immunohistochemistry of RAM11 and CD31, and TNF-α and macrophage chemoattractant protein-1 (MCP-1) gene expression. Active bone resorption was assessed by protein expression of receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG) and quantification of cathepsin K, contact surface and the invasive area of pannus into bone. Results Rabbits receiving the HFD showed higher total serum cholesterol, HDL, triglycerides and CRP levels than rabbits fed a normal diet. Synovitis score was increased in HFD, and particularly in AIA and AIA + HFD groups. AIA + HFD synovium was characterized by a massive infiltration of RAM11+ cells, higher presence of multinucleated foam cells and bigger vascularization than AIA. Cathepsin K+ osteoclasts and the contact surface of bone resorbing pannus were also increased in rabbits with AIA + HFD compared with AIA alone. Synovial TNF-α and MCP-1 gene expression was increased in AIA and HFD rabbits compared with healthy animals. RANKL protein expression in AIA and AIA + HFD groups was higher compared with either HFD or normal groups. Conclusions This experimental model demonstrates that hypercholesterolemia increments joint tissue damage in chronic arthritis, with foam macrophages being key players in this process.
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Kleyer A, Finzel S, Rech J, Manger B, Krieter M, Faustini F, Araujo E, Hueber AJ, Harre U, Engelke K, Schett G. Bone loss before the clinical onset of rheumatoid arthritis in subjects with anticitrullinated protein antibodies. Ann Rheum Dis 2013; 73:854-60. [DOI: 10.1136/annrheumdis-2012-202958] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Vierboom M, Breedveld E, Kondova I, 't Hart BA. The significance of non-human primates as preclinical models of human arthritic disease. Expert Opin Drug Discov 2013; 3:299-310. [PMID: 23480265 DOI: 10.1517/17460441.3.3.299] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The broad immunological gap between inbred SPF-raised strains of mice and rats and the diverse rheumatoid arthritis (RA) patient population limits the predictive value of the existing disease models for clinical success of new therapies, in particular for those using highly specific biologicals. OBJECTIVE This review argues that because of their closer immunological and physiological proximity to patients, disease models in non-human primates (NHPs) may bridge this gap and help reduce the failure of many (± 80%) new therapies in clinical trials. In various research areas, NHPs are an accepted intermediate between disease models in rodents and the ultimate introduction for clinical use in patients. However, with the exception of transplantation, this is not the case for immune-mediated inflammatory disorders, such as RA, although useful preclinical models are being developed. METHOD The validity and use of the rhesus monkey model of collagen-induced arthritis as a preclinical RA model is reviewed. The discussion comprises present genetic and immunological aspects, biomarkers, and an overview of published preclinical therapy evaluations. CONCLUSION It is time to consider the use of NHPs with a greater evolutionary proximity to humans as models for preclinical evaluation of new human-specific drugs for arthritic disease.
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Affiliation(s)
- Michel Vierboom
- Biomedical Primate Research Centre, Department of Immunobiology, PO Box 3306, 2280 GH Rijswijk, The Netherlands +31 15 284 2500 ; +31 15 284 2600 ;
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Evaluation of the novel folate receptor ligand [18F]fluoro-PEG-folate for macrophage targeting in a rat model of arthritis. Arthritis Res Ther 2013; 15:R37. [PMID: 23452511 PMCID: PMC3672671 DOI: 10.1186/ar4191] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 02/20/2013] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Detection of (subclinical) synovitis is relevant for both early diagnosis and monitoring of therapy of rheumatoid arthritis (RA). Previously, the potential of imaging (sub)clinical arthritis was demonstrated by targeting the translocator protein in activated macrophages using (R)-[11C]PK11195 and positron emission tomography (PET). Images, however, also showed significant peri-articular background activity. The folate receptor (FR)-β is a potential alternative target for imaging activated macrophages. Therefore, the PET tracer [18F]fluoro-PEG-folate was synthesized and evaluated in both in vitro and ex vivo studies using a methylated BSA induced arthritis model. METHODS [18F]fluoro-PEG-folate was synthesized in a two-step procedure. Relative binding affinities of non-radioactive fluoro-PEG-folate, folic acid and naturally circulating 5-methyltetrahydrofolate (5-Me-THF) to FR were determined using KB cells with high expression of FR. Both in vivo [18F]fluoro-PEG-folate PET and ex vivo tissue distribution studies were performed in arthritic and normal rats and results were compared with those of the established macrophage tracer (R)-[11C]PK11195. RESULTS [18F]fluoro-PEG-folate was synthesized with a purity >97%, a yield of 300 to 1,700 MBq and a specific activity between 40 and 70 GBq/µmol. Relative in vitro binding affinity for FR of F-PEG-folate was 1.8-fold lower than that of folic acid, but 3-fold higher than that of 5-Me-THF. In the rat model, [18F]fluoro-PEG-folate uptake in arthritic knees was increased compared with both contralateral knees and knees of normal rats. Uptake in arthritic knees could be blocked by an excess of glucosamine-folate, consistent with [18F]fluoro-PEG-folate being specifically bound to FR. Arthritic knee-to-bone and arthritic knee-to-blood ratios of [18F]fluoro-PEG-folate were increased compared with those of (R)-[11C]PK11195. Reduction of 5-Me-THF levels in rat plasma to those mimicking human levels increased absolute [18F]fluoro-PEG-folate uptake in arthritic joints, but without improving target-to-background ratios. CONCLUSIONS The novel PET tracer [18F]fluoro-PEG-folate, designed to target FR on activated macrophages provided improved contrast in a rat model of arthritis compared with the accepted macrophage tracer (R)-[11C]PK11195. These results warrant further exploration of [18F]fluoro-PEG-folate as a putative PET tracer for imaging (sub)clinical arthritis in RA patients.
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Krabben A, Stomp W, van der Heijde DMFM, van Nies JAB, Bloem JL, Huizinga TWJ, Reijnierse M, van der Helm-van Mil AHM. MRI of hand and foot joints of patients with anticitrullinated peptide antibody positive arthralgia without clinical arthritis. Ann Rheum Dis 2013; 72:1540-4. [PMID: 23334211 DOI: 10.1136/annrheumdis-2012-202628] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Anticitrullinated peptide antibodies (ACPA) and acute phase reactants may be increased before arthritis becomes clinically detectable, suggesting that the processes underlying rheumatoid arthritis (RA) start preclinically. Whether local inflammation occurs in the preclinical phase is unknown. Therefore, we studied the small joints of ACPA positive arthralgia patients for local subclinical inflammation. METHODS Imaging was performed using 1.5 T extremity MRI. Painful hand or foot joints of 21 ACPA positive arthralgia patients without clinical arthritis were imaged. For comparison, hand and foot joints of 22 ACPA positive RA patients and 19 symptom free controls were studied. Within ACPA positive arthralgia patients, painful and symptom free joint regions were imaged. Scoring was performed according to the Outcome Measures in Rheumatology Clinical Trials (OMERACT) Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) method. Analyses were performed on joint region level and focused on inflammation (synovitis plus bone marrow oedema). RESULTS The mean combined inflammation scores of the metacarpophalangeal/proximal interphalangeal joints of controls, painful joints of ACPA positive arthralgia patients and ACPA positive RA patients were 0.1, 0.7 and 3.7, respectively (p<0.001). Likewise, the mean combined inflammation scores of the wrist were 0.9, 2.3 and 10.3, respectively (p<0.001) and that of the metatarsophalangeal joints 0.5, 0.9 and 3.8, respectively (p=0.10). At the MCP joints, the combined inflammation score was significantly correlated with C reactive protein and erythrocyte sedimentation rate levels (rs=0.83 and rs=0.78, respectively) CONCLUSIONS The present data suggest that local subclinical inflammation occurs in ACPA positive arthralgia patients.
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Affiliation(s)
- Annemarie Krabben
- Department of Rheumatology, Leiden University Medical Center, , Leiden, The Netherlands.
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