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Banko A, Cirkovic A, Miskovic R, Jeremic I, Grk M, Basaric M, Lazarevic I, Raskovic S, Despotovic A, Miljanovic D. Epstein-Barr virus infection as potential indicator of the occurrence and clinical presentation of systemic lupus erythematosus. Front Immunol 2023; 14:1307589. [PMID: 38146370 PMCID: PMC10749334 DOI: 10.3389/fimmu.2023.1307589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023] Open
Abstract
Introduction The relationship between Systemic lupus erythematosus (SLE) and Epstein-Barr virus (EBV) infection has been suggested for decades, but the underlying mechanism of the EBV influence on SLE development remains to be elucidated. Methods The goals of this research, which included 103 SLE patients and 99 controls, were to investigate the association of the parameters of EBV infection and SLE, to explore whether pooled demographic, clinical and EBV markers achieve a more significant effect on SLE development than each of them individually, and to evaluate EBV nuclear antigen 1 (EBNA1) and latent membrane protein 1 (LMP1) gene polymorphisms in isolates from SLE patients. Results Comprehensive results related to serological, molecular and sequence markers of EBV infection in SLE patients demonstrated even 24 times higher possibility of having SLE if there is the presence of anti-EBV-EA(D) (early antigen) IgG antibodies (OR=24.086 95%CI OR=2.86-216.07, p=0.004). There was the same distribution of glucocorticoids (p=0.130), antimalarials (p=0.213), and immunosuppressives (p=0.712) in anti-EBV-EA(D) IgG positive and negative SLE patients. Further, higher anti-EBV-EA(D) IgG antibodies titers were identified as independent factors associated with lymphopenia, hematological SLE manifestation (OR=1.041, 95%CI OR=1.01-1.08, p=0.025, while a higher titer of anti-CA (viral capsid antigen) IgG antibodies (OR=1.015, 95%CI OR=1.01-1.03, p=0.019) and positive RF (rheumatoid factors) (OR=4.871, 95%CI OR=1.52-15.61, p=0.008) were identified as independent factors associated with alopecia within SLE. Finally, novel data on EBV EBNA1 and LMP1 gene polymorphisms in lupus are reported. Conclusion The results support further investigation targeting EBV as a prognostic marker and therapeutic goal for lupus.
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Affiliation(s)
- Ana Banko
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andja Cirkovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Rada Miskovic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivica Jeremic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milka Grk
- Institute of Human Genetics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Basaric
- Institute of Rheumatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Lazarevic
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanvila Raskovic
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksa Despotovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danijela Miljanovic
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Vojdani A, Vojdani E, Saidara E, Maes M. Persistent SARS-CoV-2 Infection, EBV, HHV-6 and Other Factors May Contribute to Inflammation and Autoimmunity in Long COVID. Viruses 2023; 15:v15020400. [PMID: 36851614 PMCID: PMC9967513 DOI: 10.3390/v15020400] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
A novel syndrome called long-haul COVID or long COVID is increasingly recognized in a significant percentage of individuals within a few months after infection with SARS-CoV-2. This disorder is characterized by a wide range of persisting, returning or even new but related symptoms that involve different tissues and organs, including respiratory, cardiac, vascular, gastrointestinal, musculo-skeletal, neurological, endocrine and systemic. Some overlapping symptomatologies exist between long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Very much like with long ME/CFS, infections with herpes family viruses, immune dysregulation, and the persistence of inflammation have been reported as the most common pattern for the development of long COVID. This review describes several factors and determinants of long COVID that have been proposed, elaborating mainly on viral persistence, reactivation of latent viruses such as Epstein-Barr virus and human herpesvirus 6 which are also associated with the pathology of ME/CFS, viral superantigen activation of the immune system, disturbance in the gut microbiome, and multiple tissue damage and autoimmunity. Based on these factors, we propose diagnostic strategies such as the measurement of IgG and IgM antibodies against SARS-CoV-2, EBV, HHV-6, viral superantigens, gut microbiota, and biomarkers of autoimmunity to better understand and manage this multi-factorial disorder that continues to affect millions of people in the world.
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Affiliation(s)
- Aristo Vojdani
- Immunosciences Lab, Inc., Los Angeles, CA 90035, USA
- Cyrex Laboratories, LLC, Phoenix, AZ 85034, USA
- Correspondence: ; Tel.: +1-310-657-1077
| | | | - Evan Saidara
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok 10330, Thailand
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3
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Altered Immune Response to the Epstein-Barr Virus as a Prerequisite for Multiple Sclerosis. Cells 2022; 11:cells11172757. [PMID: 36078165 PMCID: PMC9454695 DOI: 10.3390/cells11172757] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
Strong epidemiologic evidence links Epstein–Barr virus (EBV) infection and its altered immune control to multiple sclerosis (MS) development. Clinical MS onset occurs years after primary EBV infection and the mechanisms linking them remain largely unclear. This review summarizes the epidemiological evidence for this association and how the EBV specific immune control is altered in MS patients. The two main possibilities of mechanisms for this association are further discussed. Firstly, immune responses that are induced during a symptomatic primary EBV infection, namely infectious mononucleosis, might be amplified during the following years to finally cause central nervous system (CNS) inflammation and demyelination. Secondly, genetic predisposition and environmental factors might not allow for an efficient immune control of the EBV-infected B cells that might drive autoimmune T cell stimulation or CNS inflammation. These two main hypotheses for explaining the association of the EBV with MS would implicate opposite therapeutic interventions, namely either dampening CNS inflammatory EBV-reactive immune responses or strengthening them to eliminate the autoimmunity stimulating EBV-infected B cell compartment. Nevertheless, recent findings suggest that EBV is an important puzzle piece in the pathogenesis of MS, and understanding its contribution could open new treatment possibilities for this autoimmune disease.
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Frazzei G, van Vollenhoven RF, de Jong BA, Siegelaar SE, van Schaardenburg D. Preclinical Autoimmune Disease: a Comparison of Rheumatoid Arthritis, Systemic Lupus Erythematosus, Multiple Sclerosis and Type 1 Diabetes. Front Immunol 2022; 13:899372. [PMID: 35844538 PMCID: PMC9281565 DOI: 10.3389/fimmu.2022.899372] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/30/2022] [Indexed: 12/16/2022] Open
Abstract
The preclinical phase of autoimmune disorders is characterized by an initial asymptomatic phase of varying length followed by nonspecific signs and symptoms. A variety of autoimmune and inflammatory manifestations can be present and tend to increase in the last months to years before a clinical diagnosis can be made. The phenotype of an autoimmune disease depends on the involved organs, the underlying genetic susceptibility and pathophysiological processes. There are different as well as shared genetic or environmental risk factors and pathophysiological mechanisms between separate diseases. To shed more light on this, in this narrative review we compare the preclinical disease course of four important autoimmune diseases with distinct phenotypes: rheumatoid arthritis (RA), Systemic Lupus Erythematosus (SLE), multiple sclerosis (MS) and type 1 diabetes (T1D). In general, we observed some notable similarities such as a North-South gradient of decreasing prevalence, a female preponderance (except for T1D), major genetic risk factors at the HLA level, partly overlapping cytokine profiles and lifestyle risk factors such as obesity, smoking and stress. The latter risk factors are known to produce a state of chronic systemic low grade inflammation. A central characteristic of all four diseases is an on average lengthy prodromal phase with no or minor symptoms which can last many years, suggesting a gradually evolving interaction between the genetic profile and the environment. Part of the abnormalities may be present in unaffected family members, and autoimmune diseases can also cluster in families. In conclusion, a promising strategy for prevention of autoimmune diseases might be to address adverse life style factors by public health measures at the population level.
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Affiliation(s)
- Giulia Frazzei
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Centre, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Giulia Frazzei,
| | - Ronald F. van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Centre, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Rheumatology Center, Amsterdam, Netherlands
| | - Brigit A. de Jong
- Department of Neurology, MS Center Amsterdam, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Sarah E. Siegelaar
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Dirkjan van Schaardenburg
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Centre, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
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5
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Enfrein A, Hamidou M. Epstein-Barr Virus et lupus systémique : quels liens ? Rev Med Interne 2022; 43:487-493. [DOI: 10.1016/j.revmed.2022.03.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
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Das P, Minz RW, Saikia B, Sharma A, Anand S, Singh H, Singh S. Association of Human Leucocyte Antigen Class II, with viral load and immune response to Epstein-Barr virus in adult and pediatric Systemic lupus erythematosus patients. Lupus 2022; 31:1054-1066. [PMID: 35607991 DOI: 10.1177/09612033221100156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease, which is known to be associated with HLA-DRB1 and Epstein-Barr virus (EBV) infection. In the Indian subcontinent where there is high seroendemicity of EBV, we postulated that the association of this virus in adult SLE (aSLE) and pediatric SLE (pSLE) patients would be different and differentially associate with the HLA-DRB1 susceptibility and protective genes. METHODS A total of 109 aSLE, 52 pSLE, 215 adult healthy and 63 pediatric healthy controls were recruited. HLA-DRB1 genotyping by PCR-SSP, EBV load estimation by real-time PCR and antibody profiling (IgG & IgM) to EBV antigens by line blot assay were performed. RESULTS DRB1*15 was found predominant in pSLE patients and DRB1*03 in aSLE patients. DRB1*15/X heterozygous was predominant in overall SLE patients, although disease severity, like hypocomplementemia, higher autoantibody levels and more organ involvement was observed in *15/*15 homozygous state. EBV strongly associated with pSLE patients showing higher percent of EA-D IgG (p < 0.0001) and p22 IgG (p = 0.035) along with higher viral load (p = 0.001) as compared to healthy controls. In addition, the higher EBV DNA load significantly associated with anti-EA-D IgG (p = 0.013) and DRB1*15/*15 (p = 0.007) in pSLE patients as compared to aSLE patients. CONCLUSIONS This study therefore indicates that different HLA-DRB1 allotypes confer susceptibility to SLE in children and adults and disease may be triggered by increased EBV reactivation.
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Affiliation(s)
- Prabir Das
- Department of Immunopathology, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjana W Minz
- Department of Immunopathology, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Biman Saikia
- Department of Immunopathology, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shashi Anand
- Department of Immunopathology, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Heera Singh
- Department of Immunopathology, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Advanced Pediatric Centre, 29751Post Graduate Institute of Medical Education and Research, Chandigarh, India
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7
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Laurynenka V, Ding L, Kaufman KM, James JA, Harley JB. A High Prevalence of Anti-EBNA1 Heteroantibodies in Systemic Lupus Erythematosus (SLE) Supports Anti-EBNA1 as an Origin for SLE Autoantibodies. Front Immunol 2022; 13:830993. [PMID: 35251022 PMCID: PMC8892314 DOI: 10.3389/fimmu.2022.830993] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background That Epstein–Barr virus (EBV) infection is associated with systemic lupus erythematosus (SLE) is established. The challenge is to explain mechanistic roles EBV has in SLE pathogenesis. Previous studies identify four examples of autoantibody cross-reactions between SLE autoantigens and Epstein–Barr nuclear antigen 1 (EBNA1). For two of these examples, the earliest detected autoantibody specifically cross-reacts with EBNA1; thereby, defined EBNA1 epitopes induce a robust autoantibody response in animals. These results suggest that the autoantibodies initiating the process leading to SLE may emerge from the anti-EBNA1 heteroimmune response. If this hypothesis is true, then anti-EBNA1 responses would be more frequent in EBV-infected SLE patients than in EBV-infected controls. We tested this prediction. Methods We evaluated published East Asian data by selecting those with a positive anti-viral capsid antigen (VCA) antibody immunoglobulin G (IgG) test and determining whether anti-EBNA1 was more common among the EBV-infected SLE cases than among matched EBV-infected controls with conditional logistic regression analysis. Results All the qualifying SLE patients (100%) in this dataset were EBV-infected compared to age- and sex-matched controls (92.2%) [odds ratio (OR) = 28.6, 95% CI 6.4–∞, p = 8.83 × 10-8], confirming the known close association of EBV infection with SLE. Furthermore, virtually all the SLE cases have both anti-VCA IgG and anti-EBNA1 IgG antibodies [124 of 125 (99.2%)], which are more frequently present than in age- and sex-matched EBV-infected controls [232 of 250 (93.2%)] (OR = 9.7, 95% CI 1.5–414, p = 0.0078) for an 89.7% SLE attributable risk from anti-EBNA1, which is in addition to the 100% SLE risk attributable to EBV infection in these data. Conclusions The association of EBV infection with SLE is reconfirmed. The prediction that anti-EBNA1 is more frequent in these SLE cases than in EBV-infected controls is true, consistent with the hypothesis that anti-EBNA1 contributes to SLE. This second EBV-dependent risk factor is consistent with a molecular mimicry model for the generation of SLE, starting with EBV infection, progressing to anti-EBNA1 response; then molecular mimicry leads to anti-EBNA1 antibodies cross-reacting with an SLE autoantigen, causing autoantibody epitope spreading, and culminating in clinical SLE. These results support the anti-EBNA1 heteroimmune response being a foundation from which pathogenic SLE autoimmunity emerges.
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Affiliation(s)
- Viktoryia Laurynenka
- Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Kenneth M Kaufman
- Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Research Service, US Department of Veterans Affairs Medical Center, Cincinnati, OH, United States
| | - Judith A James
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States.,Department of Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK, United States.,Department of Pathology, University of Oklahoma Health Science Center, Oklahoma City, OK, United States
| | - John B Harley
- Research Service, US Department of Veterans Affairs Medical Center, Cincinnati, OH, United States.,Cincinnati Education and Research for Veterans Foundation, Cincinnati, OH, United States
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8
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Iwata S, Tanaka Y. Association of Viral Infection With the Development and Pathogenesis of Systemic Lupus Erythematosus. Front Med (Lausanne) 2022; 9:849120. [PMID: 35280878 PMCID: PMC8914279 DOI: 10.3389/fmed.2022.849120] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/03/2022] [Indexed: 12/27/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that causes multiple organ damage in women of childbearing age and has a relapsing-remitting course. SLE is caused by the interaction between genetic and environmental factors, however, its underlying triggers remain unknown. Among the environmental factors, the involvement of infections as a trigger for SLE, especially those of viral etiology, has been widely reported. Human endogenous retroviruses (HERVs) may put patients at a genetic predisposition to SLE, while the Epstein-Barr virus (EBV) may play a role as an environmental factor that triggers the development of SLE. It has been suggested that EBV-infected B-cells may become resistant to apoptosis, resulting in the activation, proliferation, and antibody production of autoreactive B-cells, which cause tissue damage in SLE. However, the interaction between the virus and immune cells, as well as the impact of the virus on the differentiation and dysfunction of immune cells, remain unclear. In this review, we focus on the relationship between the development and pathogenesis of SLE and viral infections, as well as the mechanism of SLE exacerbation via activation of immune cells, such as B-cells, based on the latest findings.
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9
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Wood RA, Guthridge L, Thurmond E, Guthridge CJ, Kheir JM, Bourn RL, Wagner CA, Chen H, DeJager W, Macwana SR, Kamp S, Lu R, Arriens C, Chakravarty EF, Thanou A, Merrill JT, Guthridge JM, James JA. Serologic markers of Epstein-Barr virus reactivation are associated with increased disease activity, inflammation, and interferon pathway activation in patients with systemic lupus erythematosus. J Transl Autoimmun 2022; 4:100117. [PMID: 35005588 PMCID: PMC8716608 DOI: 10.1016/j.jtauto.2021.100117] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 12/27/2022] Open
Abstract
SLE is a clinically heterogeneous disease characterized by an unpredictable relapsing-remitting disease course. Although the etiology and mechanisms of SLE flares remain elusive, Epstein-Barr virus (EBV) reactivation is implicated in SLE pathogenesis. This study examined the relationships between serological measures of EBV reactivation, disease activity, and interferon (IFN)-associated immune pathways in SLE patients. Sera from adult SLE patients (n = 175) and matched unaffected controls (n = 47) were collected and tested for antibodies against EBV-viral capsid antigen (EBV-VCA; IgG and IgA), EBV-early antigen (EBV-EA; IgG), cytomegalovirus (CMV; IgG), and herpes simplex virus (HSV-1; IgG). Serological evidence of EBV reactivation was more common in SLE patients compared to controls as demonstrated by seropositivity to EBV-EA IgG (39% vs 13%; p = 0.0011) and EBV-VCA IgA (37% vs 17%; p = 0.018). EBV-VCA, CMV1, and HSV-1 IgG seropositivity rates did not differ between SLE patients and controls. Furthermore, concentrations of EBV-VCA (IgG and IgA) and EBV-EA (IgG) were higher in SLE patients. SLE patients with high disease activity had increased concentrations of EBV-VCA IgA (mean ISR 1.34 vs. 0.97; p = 0.041) and EBV-EA IgG levels (mean ISR 1.38 vs. 0.90; p = 0.007) compared with those with lower disease activity. EBV reactivation was associated with enhanced levels of the IFN-associated molecule IP-10 (p < 0.001) and the soluble mediators BLyS (p < 0.001) and IL-10 (p = 0.0011). In addition, EBV-EA IgG responses were enriched in two previously defined patient clusters with robust expression of IFN and inflammatory or lymphoid and monocyte responses. Patients in these clusters were also more likely to have major organ involvement, such as renal disease. This study supports a possible role for EBV reactivation in SLE disease activity. Serologic markers of EBV reactivation are more common in SLE patients. Elevated EBV reactivation is associated with higher SLE disease activity. EBV serologic reactivation correlates with elevated IP-10, IL-10, and BLyS levels. EBV reactivation occurs in SLE clusters with robust inflammatory and IFN responses.
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Affiliation(s)
- Rebecca A Wood
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Lauren Guthridge
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Emma Thurmond
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Carla J Guthridge
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Joseph M Kheir
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Rebecka L Bourn
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Catriona A Wagner
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Hua Chen
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Wade DeJager
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Susan R Macwana
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Stan Kamp
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Rufei Lu
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA.,Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Cristina Arriens
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Eliza F Chakravarty
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Aikaterini Thanou
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Joan T Merrill
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA
| | - Joel M Guthridge
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA.,Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Judith A James
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 73104, USA.,Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
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10
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Afrasiabi A, Keane JT, Ong LTC, Alinejad-Rokny H, Fewings NL, Booth DR, Parnell GP, Swaminathan S. Genetic and transcriptomic analyses support a switch to lytic phase in Epstein Barr virus infection as an important driver in developing Systemic Lupus Erythematosus. J Autoimmun 2021; 127:102781. [PMID: 34952359 DOI: 10.1016/j.jaut.2021.102781] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/04/2021] [Accepted: 12/10/2021] [Indexed: 12/20/2022]
Abstract
To investigate the molecular mechanisms through which Epstein-Barr virus (EBV) may contribute to Systemic Lupus Erythematosus (SLE) pathogenesis, we interrogated SLE genetic risk loci for signatures of EBV infection. We first compared the gene expression profile of SLE risk genes across 459 different cell/tissue types. EBV-infected B cells (LCLs) had the strongest representation of highly expressed SLE risk genes. By determining an SLE risk allele effect on gene expression (expression quantitative trait loci, eQTL) in LCLs and 16 other immune cell types, we identified 79 SLE risk locus:gene pairs putatively interacting with EBV infection. A total of 10 SLE risk genes from this list (CD40, LYST, JAZF1, IRF5, BLK, IKZF2, IL12RB2, FAM167A, PTPRC and SLC15A) were targeted by the EBV transcription factor, EBNA2, differentially expressed between LCLs and B cells, and the majority were also associated with EBV DNA copy number, and expression level of EBV encoded genes. Our final gene network model based on these genes is suggestive of a nexus involving SLE risk loci and EBV latency III and B cell proliferation signalling pathways. Collectively, our findings provide further evidence to support the interaction between SLE risk loci and EBV infection that is in part mediated by EBNA2. This interplay may increase the tendency towards EBV lytic switching dependent on the presence of SLE risk alleles. These results support further investigation into targeting EBV as a therapeutic strategy for SLE.
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Affiliation(s)
- Ali Afrasiabi
- EBV Molecular Lab, Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia; BioMedical Machine Learning Lab (BML), The Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia
| | - Jeremy Thomas Keane
- EBV Molecular Lab, Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Lawrence T C Ong
- EBV Molecular Lab, Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Hamid Alinejad-Rokny
- BioMedical Machine Learning Lab (BML), The Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia; Health Data Analytics Program Leader, AI-enabled Processes (AIP) Research Centre, Macquarie University, Sydney, 2109, Australia; Core Member of UNSW Data Science Hub, The University of New South Wales (UNSW Sydney), Sydney, NSW, 2052, Australia
| | - Nicole Louise Fewings
- EBV Molecular Lab, Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia; Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - David Richmond Booth
- EBV Molecular Lab, Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Grant Peter Parnell
- EBV Molecular Lab, Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia; Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Sanjay Swaminathan
- EBV Molecular Lab, Centre for Immunology and Allergy Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia; Department of Medicine, Western Sydney University, Sydney, NSW, Australia.
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11
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Knight JS, Caricchio R, Casanova JL, Combes AJ, Diamond B, Fox SE, Hanauer DA, James JA, Kanthi Y, Ladd V, Mehta P, Ring AM, Sanz I, Selmi C, Tracy RP, Utz PJ, Wagner CA, Wang JY, McCune WJ. The intersection of COVID-19 and autoimmunity. J Clin Invest 2021; 131:e154886. [PMID: 34710063 PMCID: PMC8670833 DOI: 10.1172/jci154886] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Acute COVID-19, caused by SARS-CoV-2, is characterized by diverse clinical presentations, ranging from asymptomatic infection to fatal respiratory failure, and often associated with varied longer-term sequelae. Over the past 18 months, it has become apparent that inappropriate immune responses contribute to the pathogenesis of severe COVID-19. Researchers working at the intersection of COVID-19 and autoimmunity recently gathered at an American Autoimmune Related Diseases Association Noel R. Rose Colloquium to address the current state of knowledge regarding two important questions: Does established autoimmunity predispose to severe COVID-19? And, at the same time, can SARS-CoV-2 infection trigger de novo autoimmunity? Indeed, work to date has demonstrated that 10% to 15% of patients with critical COVID-19 pneumonia exhibit autoantibodies against type I interferons, suggesting that preexisting autoimmunity underlies severe disease in some patients. Other studies have identified functional autoantibodies following infection with SARS-CoV-2, such as those that promote thrombosis or antagonize cytokine signaling. These autoantibodies may arise from a predominantly extrafollicular B cell response that is more prone to generating autoantibody-secreting B cells. This Review highlights the current understanding, evolving concepts, and unanswered questions provided by this unique opportunity to determine mechanisms by which a viral infection can be exacerbated by, and even trigger, autoimmunity. The potential role of autoimmunity in post-acute sequelae of COVID-19 is also discussed.
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Affiliation(s)
- Jason S. Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Roberto Caricchio
- Section of Rheumatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, New York, New York, USA
- Howard Hughes Medical Institute, New York, New York, USA
- Laboratory of Human Genetics of Infectious Diseases, INSERM, Necker Hospital for Sick Children, Paris, France
- Imagine Institute, University of Paris, Paris, France
| | - Alexis J. Combes
- Department of Pathology, ImmunoX Initiative, UCSF Immunoprofiler Initiative, UCSF CoLabs, UCSF, San Francisco, California, USA
| | - Betty Diamond
- Center for Autoimmune and Musculoskeletal Diseases, Northwell Health’s Feinstein Institute for Medical Research, New York, New York, USA
| | - Sharon E. Fox
- Pathology and Laboratory Medicine Service, Southeast Louisiana Veterans Healthcare System, New Orleans, Louisiana, USA
- Department of Pathology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - David A. Hanauer
- Department of Pediatrics and School of Information, University of Michigan, Ann Arbor, Michigan, USA
| | - Judith A. James
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Yogendra Kanthi
- National Heart, Lung, and Blood Institute Division of Intramural Research, Bethesda, Maryland, USA
| | - Virginia Ladd
- American Autoimmune Related Diseases Association Inc., Eastpointe, Michigan, USA
| | - Puja Mehta
- Centre for Inflammation and Tissue Repair, University College London, London, United Kingdom
| | - Aaron M. Ring
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ignacio Sanz
- Division of Rheumatology, Emory University, Atlanta, Georgia, USA
| | - Carlo Selmi
- Rheumatology and Clinical Immunology, Humanitas Research Hospital–Scientific Institute for Research, Hospitalization and Healthcare, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Russell P. Tracy
- Department of Pathology and Laboratory Medicine and Department of Biochemistry, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Paul J. Utz
- Division of Immunology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Catriona A. Wagner
- American Autoimmune Related Diseases Association Inc., Eastpointe, Michigan, USA
| | | | - William J. McCune
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
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12
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Mizukawa Y, Aoyama Y, Takahashi H, Takahashi R, Shiohara T. Risk of progression to autoimmune disease in severe drug eruption: risk factors and the factor-guided stratification. J Invest Dermatol 2021; 142:960-968.e9. [PMID: 34808234 DOI: 10.1016/j.jid.2021.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 10/23/2021] [Accepted: 11/02/2021] [Indexed: 12/17/2022]
Abstract
The identification of risk factors is key not only to uncover the pathogenesis of autoimmune disease but also to predict progression to autoimmune disease. Drug-induced hypersensitivity syndrome (DiHS)/ drug reaction with eosinophilia and systemic symptoms (DRESS) is likely the best prototypic example for analyzing the sequential events. We conducted a retrospective study of 55 patients with DiHS/DRESS followed for the possibility of later development of autoimmune disease ∼18 years after resolution. Nine patients progressed to autoimmune sequelae regardless of treatment. The generation of autoantibodies preceded by 8 years in 8 of the 9 patients. The combination of increases in lymphocyte counts, severe liver damage, a rebound increase in globulin, persistent reactivations of Epstein-Barr virus and human herpesvirus-6, and low interleukin (IL)-2 and IL-4 at the acute/subacute phases, were significant risk factors for the future development of autoimmune disease. Based on these factors, we established a scoring system that can identify high-risk patients. When stratified these patients into three risk categories (low/intermediate/high), occurrence of autoimmune disease was exclusively detected in the high group. Our data represent the new scoring system to identify patients at high-risk of developing autoimmune disease, although a larger study is required to validate the scoring system.
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Affiliation(s)
- Yoshiko Mizukawa
- Department of Dermatology, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan.
| | - Yumi Aoyama
- Department of Dermatology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, Japan
| | - Hayato Takahashi
- Department of Dermatology, Keio University School of Medicine, Shinjuku, Tokyo 160-8582, Japan
| | - Ryo Takahashi
- Flow Cytometry Core Facility, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan
| | - Tetsuo Shiohara
- Department of Dermatology, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan
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13
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Läderach F, Münz C. Epstein Barr Virus Exploits Genetic Susceptibility to Increase Multiple Sclerosis Risk. Microorganisms 2021; 9:2191. [PMID: 34835317 PMCID: PMC8625064 DOI: 10.3390/microorganisms9112191] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 02/06/2023] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) for which both genetic and environmental risk factors have been identified. The strongest synergy among them exists between the MHC class II haplotype and infection with the Epstein Barr virus (EBV), especially symptomatic primary EBV infection (infectious mononucleosis) and elevated EBV-specific antibodies. In this review, we will summarize the epidemiological evidence that EBV infection is a prerequisite for MS development, describe altered EBV specific immune responses in MS patients, and speculate about possible pathogenic mechanisms for the synergy between EBV infection and the MS-associated MHC class II haplotype. We will also discuss how at least one of these mechanisms might explain the recent success of B cell-depleting therapies for MS. While a better mechanistic understanding of the role of EBV infection and its immune control during MS pathogenesis is required and calls for the development of innovative experimental systems to test the proposed mechanisms, therapies targeting EBV-infected B cells are already starting to be explored in MS patients.
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Affiliation(s)
| | - Christian Münz
- Viral Immunobiology, Institute of Experimental Immunology, University of Zurich, 8057 Zurich, Switzerland; or
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14
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Trendelenburg M. Autoantibodies against complement component C1q in systemic lupus erythematosus. Clin Transl Immunology 2021; 10:e1279. [PMID: 33968409 PMCID: PMC8082710 DOI: 10.1002/cti2.1279] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/19/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is the archetype of a systemic autoimmune disease, but the multifaceted pathogenic mechanisms leading to inflammation and organ damage are not fully understood. Homozygous deficiency of complement C1q, the first component of the classical pathway of complement, is strongly associated with the development of SLE, thus pointing at a primarily protective role of C1q. However, while most SLE patients do not have hereditary C1q deficiency, there is indirect evidence for the importance of C1q in the inflammatory processes of the disease, including hypocomplementemia as a result of activation via the classical pathway, deposition of C1q in affected tissues and the occurrence of autoantibodies against C1q (anti‐C1q). The growing body of knowledge on anti‐C1q led to the establishment of a biomarker that is used in the routine clinical care of SLE patients. Exploring the binding characteristics of anti‐C1q allows to understand the mechanisms, that lead to the expression of relevant autoantigenic structures and the role of genetic as well as environmental factors. Lastly, the analysis of the pathophysiological consequences of anti‐C1q is of importance because C1q, the target of anti‐C1q, is a highly functional molecule whose downstream effects are altered by the binding of the autoantibody. This review summarises current study data on anti‐C1q and their implications for the understanding of SLE.
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Affiliation(s)
- Marten Trendelenburg
- Division of Internal Medicine University Hospital Basel Basel Switzerland.,Clinical Immunology Department of Biomedicine University of Basel Basel Switzerland
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15
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Human osteoclastogenesis in Epstein-Barr virus-induced erosive arthritis in humanized NOD/Shi-scid/IL-2Rγnull mice. PLoS One 2021; 16:e0249340. [PMID: 33793647 PMCID: PMC8029598 DOI: 10.1371/journal.pone.0249340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 03/16/2021] [Indexed: 11/25/2022] Open
Abstract
Many human viruses, including Epstein-Barr virus (EBV), do not infect mice, which
is challenging for biomedical research. We have previously reported that EBV
infection induces erosive arthritis, which histologically resembles rheumatoid
arthritis, in humanized NOD/Shi-scid/IL-2Rγnull
(hu-NOG) mice; however, the underlying mechanisms are not known. Osteoclast-like
multinucleated cells were observed during bone erosion in this mouse model, and
therefore, we aimed to determine whether the human or mouse immune system
activated bone erosion and analyzed the characteristics and origin of the
multinucleated cells in hu-NOG mice. Sections of the mice knee joint tissues
were immunostained with anti-human antibodies against certain osteoclast
markers, including cathepsin K and matrix metalloproteinase-9 (MMP-9).
Multinucleated cells observed during bone erosion stained positively for human
cathepsin K and MMP-9. These results indicate that human osteoclasts primarily
induce erosive arthritis during EBV infections. Human osteoclast development
from hematopoietic stem cells transplanted in hu-NOG mice remains unclear. To
confirm their differentiation potential into human osteoclasts, we cultured bone
marrow cells of EBV-infected hu-NOG mice and analyzed their characteristics.
Multinucleated cells cultured from the bone marrow cells stained positive for
human cathepsin K and human MMP-9, indicating that bone marrow cells of hu-NOG
mice could differentiate from human osteoclast progenitor cells into human
osteoclasts. These results indicate that the human immune response to EBV
infection may induce human osteoclast activation and cause erosive arthritis in
this mouse model. Moreover, this study is the first, to our knowledge, to
demonstrate human osteoclastogenesis in humanized mice. We consider that this
model is useful for studying associations of EBV infections with rheumatoid
arthritis and human bone metabolism.
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16
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Viral Infections and Systemic Lupus Erythematosus: New Players in an Old Story. Viruses 2021; 13:v13020277. [PMID: 33670195 PMCID: PMC7916951 DOI: 10.3390/v13020277] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 02/07/2023] Open
Abstract
A causal link between viral infections and autoimmunity has been studied for a long time and the role of some viruses in the induction or exacerbation of systemic lupus erythematosus (SLE) in genetically predisposed patients has been proved. The strength of the association between different viral agents and SLE is variable. Epstein-Barr virus (EBV), parvovirus B19 (B19V), and human endogenous retroviruses (HERVs) are involved in SLE pathogenesis, whereas other viruses such as Cytomegalovirus (CMV) probably play a less prominent role. However, the mechanisms of viral-host interactions and the impact of viruses on disease course have yet to be elucidated. In addition to classical mechanisms of viral-triggered autoimmunity, such as molecular mimicry and epitope spreading, there has been a growing appreciation of the role of direct activation of innate response by viral nucleic acids and epigenetic modulation of interferon-related immune response. The latter is especially important for HERVs, which may represent the molecular link between environmental triggers and critical immune genes. Virus-specific proteins modulating interaction with the host immune system have been characterized especially for Epstein-Barr virus and explain immune evasion, persistent infection and self-reactive B-cell "immortalization". Knowledge has also been expanding on key viral proteins of B19-V and CMV and their possible association with specific phenotypes such as antiphospholipid syndrome. This progress may pave the way to new therapeutic perspectives, including the use of known or new antiviral drugs, postviral immune response modulation and innate immunity inhibition. We herein describe the state-of-the-art knowledge on the role of viral infections in SLE, with a focus on their mechanisms of action and potential therapeutic targets.
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Gugliesi F, Pasquero S, Griffante G, Scutera S, Albano C, Pacheco SFC, Riva G, Dell’Oste V, Biolatti M. Human Cytomegalovirus and Autoimmune Diseases: Where Are We? Viruses 2021; 13:260. [PMID: 33567734 PMCID: PMC7914970 DOI: 10.3390/v13020260] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/14/2022] Open
Abstract
Human cytomegalovirus (HCMV) is a ubiquitous double-stranded DNA virus belonging to the β-subgroup of the herpesvirus family. After the initial infection, the virus establishes latency in poorly differentiated myeloid precursors from where it can reactivate at later times to cause recurrences. In immunocompetent subjects, primary HCMV infection is usually asymptomatic, while in immunocompromised patients, HCMV infection can lead to severe, life-threatening diseases, whose clinical severity parallels the degree of immunosuppression. The existence of a strict interplay between HCMV and the immune system has led many to hypothesize that HCMV could also be involved in autoimmune diseases (ADs). Indeed, signs of active viral infection were later found in a variety of different ADs, such as rheumatological, neurological, enteric disorders, and metabolic diseases. In addition, HCMV infection has been frequently linked to increased production of autoantibodies, which play a driving role in AD progression, as observed in systemic lupus erythematosus (SLE) patients. Documented mechanisms of HCMV-associated autoimmunity include molecular mimicry, inflammation, and nonspecific B-cell activation. In this review, we summarize the available literature on the various ADs arising from or exacerbating upon HCMV infection, focusing on the potential role of HCMV-mediated immune activation at disease onset.
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Affiliation(s)
- Francesca Gugliesi
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy; (F.G.); (S.P.); (S.S.); (C.A.); (S.F.C.P.); (V.D.)
| | - Selina Pasquero
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy; (F.G.); (S.P.); (S.S.); (C.A.); (S.F.C.P.); (V.D.)
| | - Gloria Griffante
- Department of Translational Medicine, Molecular Virology Unit, University of Piemonte Orientale Medical School, 28100 Novara, Italy;
| | - Sara Scutera
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy; (F.G.); (S.P.); (S.S.); (C.A.); (S.F.C.P.); (V.D.)
| | - Camilla Albano
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy; (F.G.); (S.P.); (S.S.); (C.A.); (S.F.C.P.); (V.D.)
| | - Sergio Fernando Castillo Pacheco
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy; (F.G.); (S.P.); (S.S.); (C.A.); (S.F.C.P.); (V.D.)
| | - Giuseppe Riva
- Otorhinolaryngology Division, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| | - Valentina Dell’Oste
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy; (F.G.); (S.P.); (S.S.); (C.A.); (S.F.C.P.); (V.D.)
| | - Matteo Biolatti
- Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy; (F.G.); (S.P.); (S.S.); (C.A.); (S.F.C.P.); (V.D.)
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18
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Munroe ME, Anderson JR, Gross TF, Stunz LL, Bishop GA, James JA. Epstein-Barr Functional Mimicry: Pathogenicity of Oncogenic Latent Membrane Protein-1 in Systemic Lupus Erythematosus and Autoimmunity. Front Immunol 2021; 11:606936. [PMID: 33613527 PMCID: PMC7886997 DOI: 10.3389/fimmu.2020.606936] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022] Open
Abstract
Systemic lupus erythematosus (SLE) and other autoimmune diseases are propelled by immune dysregulation and pathogenic, disease-specific autoantibodies. Autoimmunity against the lupus autoantigen Sm is associated with cross-reactivity to Epstein-Barr virus (EBV) nuclear antigen 1 (EBNA-1). Additionally, EBV latent membrane protein-1 (LMP1), initially noted for its oncogenic activity, is an aberrantly active functional mimic of the B cell co-stimulatory molecule CD40. Mice expressing a transgene (Tg) for the mCD40-LMP1 hybrid molecule (containing the cytoplasmic tail of LMP1) have mild autoantibody production and other features of immune dysregulation by 2-3 months of age, but no overt autoimmune disease. This study evaluates whether exposure to the EBV molecular mimic, EBNA-1, stimulates antigen-specific and concurrently-reactive humoral and cellular immunity, as well as lupus-like features. After immunization with EBNA-1, mCD40-LMP1 Tg mice exhibited enhanced, antigen-specific, cellular and humoral responses compared to immunized WT congenic mice. EBNA-1 specific proliferative and inflammatory cytokine responses, including IL-17 and IFN-γ, were significantly increased (p<0.0001) in mCD40-LMP1 Tg mice, as well as antibody responses to amino- and carboxy-domains of EBNA-1. Of particular interest was the ability of mCD40-LMP1 to drive EBNA-1 associated molecular mimicry with the lupus-associated autoantigen, Sm. EBNA-1 immunized mCD40-LMP1 Tg mice exhibited enhanced proliferative and cytokine cellular responses (p<0.0001) to the EBNA-1 homologous epitope PPPGRRP and the Sm B/B' cross-reactive sequence PPPGMRPP. When immunized with the SLE autoantigen Sm, mCD40-LMP1 Tg mice again exhibited enhanced cellular and humoral immune responses to both Sm and EBNA-1. Cellular immune dysregulation with EBNA-1 immunization in mCD40-LMP1 Tg mice was accompanied by enhanced splenomegaly, increased serum blood urea nitrogen (BUN) and creatinine levels, and elevated anti-dsDNA and antinuclear antibody (ANA) levels (p<0.0001 compared to mCD40 WT mice). However, no evidence of immune-complex glomerulonephritis pathology was noted, suggesting that a combination of EBV and genetic factors may be required to drive lupus-associated renal disease. These data support that the expression of LMP1 in the context of EBNA-1 may interact to increase immune dysregulation that leads to pathogenic, autoantigen-specific lupus inflammation.
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Affiliation(s)
- Melissa E. Munroe
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Jourdan R. Anderson
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Timothy F. Gross
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
| | - Laura L. Stunz
- Department of Microbiology & Immunology, The University of Iowa, Iowa City, IA, United States
| | - Gail A. Bishop
- Department of Microbiology & Immunology, The University of Iowa, Iowa City, IA, United States
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, United States
- Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, United States
- Iowa City VA Medical Center, Iowa City, IA, United States
| | - Judith A. James
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
- Department of Medicine and Pathology, Oklahoma University Health Sciences Center, Oklahoma City, OK, United States
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19
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Aygun D, Kuskucu MA, Sahin S, Adrovic A, Barut K, Yıldız M, Sharifova S, Midilli K, Cokugras H, Camcıoglu Y, Kasapcopur O. Epstein-Barr virus, cytomegalovirus and BK polyomavirus burden in juvenile systemic lupus erythematosus: correlation with clinical and laboratory indices of disease activity. Lupus 2020; 29:1263-1269. [PMID: 32646294 DOI: 10.1177/0961203320940029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Clinical and laboratory investigations have revealed that Epstein-Barr virus (EBV) is involved in altered immunological response of systemic lupus erythematosus (SLE). Higher seroprevalence rates of anti-EBV antibodies and increased viral load are demonstrated in adult SLE patients. The prevalence of BK polyomavirus (BKV) reactivation is also suggested to be higher in SLE. Herein, we aimed to evaluate the immune response of children with SLE to EBV antigens in addition to EBV and BKV DNA. We also tried to evaluate whether these serological results differ from another connective tissue disease - juvenile systemic sclerosis (jSS) - and healthy individuals. METHODS Serum levels of EBV early antigen diffuse (EA-D) IgG, EBV nuclear antigen-1 IgG, EBV viral capsid antigen (VCA), cytomegalovirus (CMV) IgG, EBV DNA, CMV DNA and urinary BKV DNA were evaluated in healthy controls and in patients with a diagnosis of juvenile SLE (jSLE) and jSS. RESULTS A total of 70 jSLE patients, 14 jSS patients and 44 sex-matched healthy individuals were involved in the study. EBV VCA was positive in 84.2% of jSLE patients, 85.7% of jSS patients and 36.3% of healthy controls. EBV EA-D IgG positivity was significantly higher in jSLE patients compared to jSS patients and healthy controls (20% vs. 7.1% and 0%, p = 0.005). EBV VCA positivity was associated with malar rash and immunological disorder, but there was no statistical significance in other antibody positivity in terms of clinical and haemogram findings and autoantibody positivity. CMV DNA positivity was present in only 2.8% of jSLE patients. None of the jSS patients or the healthy controls had CMV DNA positivity. EBV DNA and BKV DNA were also negative in all three groups. CONCLUSION The results of our study assume a relationship between SLE and EBV, but we could not demonstrate an association between CMV and BKV. The negative DNA results in contrast to serological positivity can be interpreted as an altered and impaired immune system and increased viral susceptibility. These results suggest that EBV contributes to disease continuity, even if it does not directly cause development.
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Affiliation(s)
- Deniz Aygun
- Department of Pediatric Infectious Disease, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Mert Ahmet Kuskucu
- Department of Microbiology and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Sezgin Sahin
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Kenan Barut
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Mehmet Yıldız
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Sabina Sharifova
- Department of Pediatric Infectious Disease, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Kenan Midilli
- Department of Microbiology and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Haluk Cokugras
- Department of Pediatric Infectious Disease, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Yıldız Camcıoglu
- Department of Pediatric Infectious Disease, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
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20
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Marcucci SB, Obeidat AZ. EBNA1, EBNA2, and EBNA3 link Epstein-Barr virus and hypovitaminosis D in multiple sclerosis pathogenesis. J Neuroimmunol 2019; 339:577116. [PMID: 31805475 DOI: 10.1016/j.jneuroim.2019.577116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 01/12/2023]
Abstract
A strong north-to-south gradient is observed in the distribution of multiple sclerosis (MS), hinting toward an environmental etiology. Vitamin D has been associated with a decreased incidence of MS and may explain, in part, the lower prevalence in tropical climates. However, the existence of MS epidemics implies the possibility of an infectious etiology. Epstein-Barr virus (EBV) infection precedes MS presentation in nearly all affected individuals. While the individual contribution of EBV, vitamin D deficiency, and specific risk genes to MS etiology is possible, their potential interaction is of great interest and may have a synergistic effect on the development of MS.
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Affiliation(s)
- Samuel B Marcucci
- University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, United States of America.
| | - Ahmed Z Obeidat
- Department of Neurology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, United States of America.
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21
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Csorba K, Schirmbeck LA, Tuncer E, Ribi C, Roux-Lombard P, Chizzolini C, Huynh-Do U, Vanhecke D, Trendelenburg M. Anti-C1q Antibodies as Occurring in Systemic Lupus Erythematosus Could Be Induced by an Epstein-Barr Virus-Derived Antigenic Site. Front Immunol 2019; 10:2619. [PMID: 31787984 PMCID: PMC6853867 DOI: 10.3389/fimmu.2019.02619] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 10/21/2019] [Indexed: 01/08/2023] Open
Abstract
Previous infection with Epstein-Barr virus (EBV) is believed to trigger autoimmunity and to drive autoantibody generation as occurring in patients with systemic lupus erythematosus (SLE). Complement C1q and autoantibodies targeting it (anti-C1q) are also considered to be involved in the pathogenesis of SLE, independently of the impact of environmental insults. Still, the circumstances under which these autoantibodies arise remain elusive. By studying a major antigenic site of C1q targeted by anti-C1q (A08), we aimed to determine environmental factors and possible mechanisms leading to the development of anti-C1q. First, we determined antigenic residues of A08 that were critical for the binding of anti-C1q; importantly, we found the binding to depend on amino-acid-identity. Anti-C1q of SLE patients targeting these critical antigenic residues specifically cross-reacted with the EBV-related EBNA-1 (Epstein-Barr virus nuclear antigen 1)-derived peptide EBNA348. In a cohort of 180 SLE patients we confirmed that patients that were seropositive for EBV and recognized the EBNA348 peptide had increased levels of anti-A08 and anti-C1q, respectively. The correlation of anti-EBNA348 with anti-A08 levels was stronger in SLE patients than in matched healthy controls. Finally, EBNA348 peptide-immunization of C1q−/− mice induced the generation of cross-reactive antibodies which recognized both the A08 epitope of C1q and intact C1q. These findings suggest that anti-C1q in SLE patients could be induced by an EBV-derived epitope through molecular mimicry, thereby further supporting the pathogenic role of EBV in the development of SLE. Considering the role of C1q and anti-C1q, modifying the anti-EBV response might be a promising strategy to improve the course of the disease.
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Affiliation(s)
- Kinga Csorba
- Clinical Immunology, Department of Biomedicine and Division of Internal Medicine, University and University Hospital Basel, Basel, Switzerland
| | - Lucia A Schirmbeck
- Clinical Immunology, Department of Biomedicine and Division of Internal Medicine, University and University Hospital Basel, Basel, Switzerland
| | - Eylul Tuncer
- Clinical Immunology, Department of Biomedicine and Division of Internal Medicine, University and University Hospital Basel, Basel, Switzerland
| | - Camillo Ribi
- Immunology and Allergy, Department of Internal Medicine, University Hospital Lausanne, Lausanne, Switzerland
| | - Pascale Roux-Lombard
- Division of Immunology and Allergy, Department of Medicine, University Hospital and University of Geneva, Geneva, Switzerland
| | - Carlo Chizzolini
- Division of Immunology and Allergy, Department of Medicine, University Hospital and University of Geneva, Geneva, Switzerland
| | - Uyen Huynh-Do
- Division of Nephrology and Hypertension, University Hospital Bern, Bern, Switzerland
| | - Dominique Vanhecke
- Clinical Immunology, Department of Biomedicine and Division of Internal Medicine, University and University Hospital Basel, Basel, Switzerland
| | - Marten Trendelenburg
- Clinical Immunology, Department of Biomedicine and Division of Internal Medicine, University and University Hospital Basel, Basel, Switzerland
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Gonzalez-Quintial R, Mayeux JM, Kono DH, Theofilopoulos AN, Pollard KM, Baccala R. Silica exposure and chronic virus infection synergistically promote lupus-like systemic autoimmunity in mice with low genetic predisposition. Clin Immunol 2019; 205:75-82. [PMID: 31175964 DOI: 10.1016/j.clim.2019.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 12/11/2022]
Abstract
Considerable evidence indicates that autoimmune disease expression depends on both genetic and environmental factors. Among potential environmental triggers, occupational airway exposure to crystalline silica and virus infections have been linked to lupus and other autoimmune diseases in both humans and mouse models. Here, we hypothesized that combined silica and virus exposures synergize and induce autoimmune manifestations more effectively than single exposure to either of these factors, particularly in individuals with low genetic predisposition. Accordingly, infection with the model murine pathogen lymphocytic choriomenigitis virus (LCMV) in early life, followed by airway exposure to crystalline silica in adult life, induced lupus-like autoantibodies to several nuclear self-antigens including chromatin, RNP and Sm, concurrent with kidney lesions, in non-autoimmune C57BL/6 (B6) mice. In contrast, given individually, LCMV or silica were largely ineffectual in this strain. These results support a multihit model of autoimmunity, where exposure to different environmental factors acting on distinct immunostimulatory pathways complements limited genetic predisposition and increases the risk of autoimmunity above a critical threshold.
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Affiliation(s)
| | - Jessica M Mayeux
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - Dwight H Kono
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | | | - Kenneth M Pollard
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - Roberto Baccala
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA.
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Hussein HM, Rahal EA. The role of viral infections in the development of autoimmune diseases. Crit Rev Microbiol 2019; 45:394-412. [PMID: 31145640 DOI: 10.1080/1040841x.2019.1614904] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The exact aetiology of most autoimmune diseases remains unknown, nonetheless, several factors contributing to the induction or exacerbation of autoimmune reactions have been suggested. These include the genetic profile and lifestyle of the affected individual in addition to environmental triggers such as bacterial, parasitic, fungal and viral infections. Infections caused by viruses usually trigger a potent immune response that is necessary for the containment of the infection; however, in some cases, a failure in the regulation of this immune response may lead to harmful immune reactions directed against the host's antigens. The autoimmune attack can be carried out by different arms and components of the immune system and through different possible mechanisms including molecular mimicry, bystander activation, and epitope spreading among others. In this review, we examine the data available for the involvement of viral infections in triggering or exacerbating autoimmune diseases in addition to discussing the mechanisms by which these viral infections and the immune pathways they trigger possibly contribute to the development of autoimmunity.
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Affiliation(s)
- Hadi M Hussein
- Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut , Beirut , Lebanon.,Center for Infectious Diseases Research (CIDR), American University of Beirut , Beirut , Lebanon
| | - Elias A Rahal
- Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut , Beirut , Lebanon.,Center for Infectious Diseases Research (CIDR), American University of Beirut , Beirut , Lebanon
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24
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Evaluation of EBV- and HCMV-Specific T Cell Responses in Systemic Lupus Erythematosus (SLE) Patients Using a Normalized Enzyme-Linked Immunospot (ELISPOT) Assay. J Immunol Res 2019; 2019:4236503. [PMID: 30906789 PMCID: PMC6397965 DOI: 10.1155/2019/4236503] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/09/2018] [Indexed: 11/17/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease with a complex etiology. Opportunistic viral pathogens, such as human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV), are particularly relevant. The role of the T cell response in SLE has not been deeply studied; we investigated the role of HCMV- and EBV-specific T cell responses in SLE patients also in relation to their pharmacological immunosuppressive status. PBMCs from 70 SLE patients and 50 healthy controls were stimulated with EBV- and HCMV-specific antigens, and IFN-γ-secreting T cells were quantified. We observed that both EBV- and HCMV-specific T cell responses were significantly lower in SLE patients compared with healthy subjects. We reported decreased EBV- and HCMV-specific T cell responses among medium-high immunosuppressed patients compared to low immunosuppressed patients. Immunosuppressive level could exert a role in the control of herpesviruses reactivation, even if the immunosuppressive condition of SLE remains the driving cause of skewed virus-specific T cell response.
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A Human Gain-of-Function STING Mutation Causes Immunodeficiency and Gammaherpesvirus-Induced Pulmonary Fibrosis in Mice. J Virol 2019; 93:JVI.01806-18. [PMID: 30463976 DOI: 10.1128/jvi.01806-18] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/15/2018] [Indexed: 12/11/2022] Open
Abstract
We previously generated STING N153S knock-in mice that have a human disease-associated gain-of-function mutation in STING. Patients with this mutation (STING N154S in humans) develop STING-associated vasculopathy with onset in infancy (SAVI), a severe pediatric autoinflammatory disease characterized by pulmonary fibrosis. Since this mutation promotes the upregulation of antiviral type I interferon-stimulated genes (ISGs), we hypothesized that STING N153S knock-in mice may develop more severe autoinflammatory disease in response to a virus challenge. To test this hypothesis, we infected heterozygous STING N153S mice with murine gammaherpesvirus 68 (γHV68). STING N153S mice were highly vulnerable to infection and developed pulmonary fibrosis after infection. In addition to impairing CD8+ T cell responses and humoral immunity, STING N153S also promoted the replication of γHV68 in cultured macrophages. In further support of a combined innate and adaptive immunodeficiency, γHV68 infection was more severe in Rag1-/- STING N153S mice than in Rag1-/- littermate mice, which completely lack adaptive immunity. Thus, a gain-of-function STING mutation creates a combined innate and adaptive immunodeficiency that leads to virus-induced pulmonary fibrosis.IMPORTANCE A variety of human rheumatologic disease-causing mutations have recently been identified. Some of these mutations are found in viral nucleic acid-sensing proteins, but whether viruses can influence the onset or progression of these human diseases is less well understood. One such autoinflammatory disease, called STING-associated vasculopathy with onset in infancy (SAVI), affects children and leads to severe lung disease. We generated mice with a SAVI-associated STING mutation and infected them with γHV68, a common DNA virus that is related to human Epstein-Barr virus. Mice with the human disease-causing STING mutation were more vulnerable to infection than wild-type littermate control animals. Furthermore, the STING mutant mice developed lung fibrosis similar to that of patients with SAVI. These findings reveal that a human STING mutation creates severe immunodeficiency, leading to virus-induced lung disease in mice.
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Tu J, Wang X, Geng G, Xue X, Lin X, Zhu X, Sun L. The Possible Effect of B-Cell Epitopes of Epstein-Barr Virus Early Antigen, Membrane Antigen, Latent Membrane Protein-1, and -2A on Systemic Lupus Erythematosus. Front Immunol 2018; 9:187. [PMID: 29497417 PMCID: PMC5819577 DOI: 10.3389/fimmu.2018.00187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/22/2018] [Indexed: 12/31/2022] Open
Abstract
This study was aimed to evaluate the role of B-cell epitopes of Epstein-Barr virus (EBV) Early antigen protein D (EA), envelope glycoprotein GP340/membrane antigen (MA), latent membrane protein (LMP)-1, and LMP-2A in systemic lupus erythematosus (SLE). B-cell epitopes were predicted by analyzing secondary structure, transmembrane domains, surface properties, and homological comparison. 60 female mice were randomized equally into 12 groups: 1-10 groups were immunized by epitope peptides (EPs) 1-10, respectively, while 11 and 12 groups were PBS and Keyhole limpet hemocyanin (KLH) control groups. Immunoglobulin G (IgG) and autoantibody to nuclear antigen (ANA) concentrations in mice serum were determined at week 8. Indirect levels of EP1-10 were further detected by enzyme-linked immuno sorbent assay (ELISA) in 119 SLE patients and 64 age- and gender-matched health controls (HCs). 10 probable EBV EA, MA, LMP-1, and LMP-2A B-cell epitopes related to SLE self-antigens were predicted and corresponding EP1-10 were synthesized. IgG concentrations at week 8 were increased in EP1-10 and KLH groups compared with PBS group in mice; while ANA levels were elevated in only EP1-4, EP6-7, and EP10 groups compared to KLH group by ELISA, and ANA-positive rates were increased in only EP1, EP2, EP4, EP6, and EP10 groups by indirect immunofluorescence assay. EP1-4, EP6, and EP10 indirect levels were increased in SLE patients than HCs, while EP1, EP3, EP6, and EP9 were correlated with SLE disease activity index score. In conclusion, EBV EA, MA, LMP-1, and LMP-2A B-cell EPs increased SLE-related autoantibodies in mice, and their indirect levels might be served as potential biomarkers for SLE diagnosis and disease severity.
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Affiliation(s)
- Jianxin Tu
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaobing Wang
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guannan Geng
- Central Laboratory, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangyang Xue
- Department of Microbiology and Immunology, Basic Medical College of Wenzhou Medical University, Wenzhou, China
| | - Xiangyang Lin
- Medical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaochun Zhu
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Li Sun
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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27
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Vista ES, Weisman MH, Ishimori ML, Chen H, Bourn RL, Bruner BF, Hamijoyo L, Tanangunan RD, Gal NJ, Robertson JM, Harley JB, Guthridge JM, Navarra SV, James JA. Strong viral associations with SLE among Filipinos. Lupus Sci Med 2017; 4:e000214. [PMID: 29214036 PMCID: PMC5704743 DOI: 10.1136/lupus-2017-000214] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/25/2017] [Accepted: 05/31/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Epstein-Barr virus (EBV) is considered an important environmental factor in SLE aetiology, but the relationship between SLE and EBV in the Filipino population is unknown. We tested associations between SLE, lupus-associated autoantibodies and seropositivity for EBV and other herpes viruses in the Filipino population. METHODS Sera from Filipino patients with SLE (n=233), unaffected first-degree relatives (FDRs, n=543) and unrelated controls (n=221) were tested for antibodies against EBV, cytomegalovirus (CMV) and herpes simplex viruses (HSV-1 and HSV-2) by standardised ELISAs. Humoral specificity against EBV nuclear antigen (EBNA)-1 was compared by solid-phase epitope mapping. Autoantibodies were detected by a bead-based multiplex assay. Results were analysed by Fisher's exact test, Student's t-test, χ2 test and one-way analysis of variance, as appropriate for the question. RESULTS Filipino patients with SLE had increased seroprevalence and elevated antibody concentrations against EBV viral capsid antigen (EBV-VCA), CMV, HSV-1 and HSV-2 compared with unrelated controls (p<0.05). Seropositivity for anti-EBV early antigen (EA), a marker of EBV reactivation, was dramatically increased in patients with SLE compared with unrelated controls (92.3% vs 40.4%; OR 17.15(95% CI 10.10, 30.66), p<0.0001) or unaffected FDRs (49.4%; OR 12.04(7.42, 20.74), p<0.0001), despite similar seroprevalence of EBV-VCA in patients and FDRs. In patients with SLE, EBV-EA seropositivity correlated with lupus-associated autoantibodies (p<0.001), most notably with autoantibodies against dsDNA, chromatin, Sm, SmRNP and RNP A (p<0.01). Patient and unrelated control sera reacted to the highly repetitive glycine and alanine domain of EBNA-1. An epitope spanning EBNA-1410-420 was identified in sera of patients with SLE and showed limited binding by FDR and control sera. CONCLUSIONS Filipino patients with SLE have elevated prevalence and concentrations of antibodies against EBV, CMV, HSV-1 and HSV-2 antigens, along with altered anti-EBNA-1 specificities. EBV reactivation is more common among Filipino patients with SLE compared with healthy Filipinos and may contribute to SLE pathogenesis in this population.
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Affiliation(s)
- Evan S Vista
- Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Michael H Weisman
- Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mariko L Ishimori
- Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hua Chen
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Rebecka L Bourn
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Ben F Bruner
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- Department of Biology, Harding University, Searcy, Arkansas, USA
| | - Laniyati Hamijoyo
- Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines
| | - Robelle D Tanangunan
- Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines
| | - Noga J Gal
- Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Julie M Robertson
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - John B Harley
- Center for Autoimmune Genomics and Etiology (CAGE), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Veterans Affairs Medical Center, Cincinnati, Ohio, USA
| | - Joel M Guthridge
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Sandra V Navarra
- Section of Rheumatology, University of Santo Tomas Hospital, Manila, Philippines
| | - Judith A James
- Arthritis & Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Abstract
PURPOSE OF REVIEW This review examines evidence relating environmental factors to the development of systemic lupus erythematosus (SLE). RECENT FINDINGS The strongest epidemiologic evidence exists for the associations of silica, cigarette smoking, oral contraceptives, postmenopausal hormone therapy and endometriosis, with SLE incidence. Recent studies have also provided robust evidence of the association between alcohol consumption and decreased SLE risk. There are preliminary, conflicting or unsubstantiated data that other factors, including air pollution, ultraviolet light, infections, vaccinations, solvents, pesticides and heavy metals such as mercury, are related to SLE risk. Biologic mechanisms linking environmental exposures and SLE risk include increased oxidative stress, systemic inflammation and inflammatory cytokine upregulation, and hormonal triggers, as well as epigenetic modifications resulting from exposure that could lead to SLE. SUMMARY Identifying the environmental risk factors related to risk of SLE is essential as it will lead to increased understanding of pathogenesis of this complex disease and will also make risk factor modification possible for those at increased risk.
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Yadav P, Carr MT, Yu R, Mumbey-Wafula A, Spatz LA. Mapping an epitope in EBNA-1 that is recognized by monoclonal antibodies to EBNA-1 that cross-react with dsDNA. IMMUNITY INFLAMMATION AND DISEASE 2016; 4:362-75. [PMID: 27621818 PMCID: PMC5004290 DOI: 10.1002/iid3.119] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 01/19/2023]
Abstract
Introduction The Epstein Barr Virus (EBV) has been associated with the autoimmune disease, Systemic Lupus Erythematosus (SLE). EBV nuclear antigen‐I (EBNA‐1) is the major nuclear protein of EBV. We previously generated an IgG monoclonal antibody (MAb) to EBNA‐1, 3D4, and demonstrated that it cross‐reacts with double stranded DNA (dsDNA) and binds the 148 amino acid viral binding site (VBS) in the carboxyl region of EBNA‐1. The aim of the present study was to characterize another antibody to EBNA‐1 that cross‐reacts with dsDNA, compare its immunoglobulin genes to 3D4, and finely map the epitope in EBNA‐1 that is recognized by these cross‐reactive antibodies. Methods We generated an IgM MAb to EBNA‐1, 16D2, from EBNA‐1 injected mice and demonstrated by ELISA that it cross‐reacts with dsDNA and binds the 148 amino acid VBS. We sequenced the variable heavy and light chain genes of 3D4 and 16D2 and compared V gene usage. To more finely map the epitope in EBNA‐1 recognized by these MAbs, we examined their binding by ELISA to 15 overlapping peptides spanning the 148 amino acid domain. Results Sequence analysis revealed that 3D4 and 16D2 utilize different VH and VL genes but identical JH and Jk regions with minimal junctional diversity. This accounts for similarities in their CDR3 regions and may explain their similar dual binding specificity. Epitope mapping revealed 3D4 and 16D2 bind the same peptide in the VBS. Based on the crystal structure of EBNA‐1, we observed that this peptide resides at the base of an exposed proline rich loop in EBNA‐1. Conclusion We have demonstrated that two MAbs that bind EBNA‐1 and cross‐react with dsDNA, recognize the same peptide in the VBS. This peptide may serve as a mimetope for dsDNA and may be of diagnostic and therapeutic value in SLE.
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Affiliation(s)
- Pragya Yadav
- Department of ChemistryCity College of New York160 Convent AvenueNew YorkNew York10031; Graduate Program in BiochemistryGraduate Center of the City University of New York160 Convent AvenueNew YorkNew York10031
| | - Matthew T Carr
- Department of ChemistryCity College of New York160 Convent AvenueNew YorkNew York10031; Graduate Program in BiochemistryGraduate Center of the City University of New York160 Convent AvenueNew YorkNew York10031
| | - Ruby Yu
- Department of Biology City College of New York 160 Convent Avenue New York New York 10031
| | - Alice Mumbey-Wafula
- Department of Pathobiology, Sophie Davis School of Biomedical Education City College of New York 160 Convent Avenue New York New York 10031
| | - Linda A Spatz
- Department of Pathobiology, Sophie Davis School of Biomedical Education City College of New York 160 Convent Avenue New York New York 10031
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Harley JB, Harley ITW, Guthridge JM, James JA. The curiously suspicious: a role for Epstein-Barr virus in lupus. Lupus 2016; 15:768-77. [PMID: 17153849 DOI: 10.1177/0961203306070009] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While the events initiating the development of autoantibodies in systemic lupus erythematosus (SLE) have not yet been convincingly established, newly developed tools for molecular investigation make such an undertaking increasingly practical. Applied to the earliest events in the sequence culminating in lupus autoimmunity, we present a critical potential role for Epstein-Barr virus (EBV) in the development and perhaps perpetuation of SLE. The expected properties for an environmental risk factor for SLE are found in this virus and the human host response against it. Existing data show the molecular progression to autoimmunity observed in SLE patient sera, the discovery of the first autoimmune epitopes in the Sm and Ro autoantigen systems, and the possible emergence of these autoantibodies from the heterologous antibodies against Epstein-Barr nuclear antigen-1 (EBNA-1). Further, existing data demonstrate association of SLE with EBV infection, even preceding the development of autoimmunity. Finally, the data are consistent with a proposed model of lupus pathogenesis that begins with antibodies to EBNA-1, predisposing to immune responses that develop crossreactive autoantibodies that culminate in the development of SLE autoimmunity.
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Affiliation(s)
- J B Harley
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma 73104, USA
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31
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Lu JJY, Chen DY, Hsieh CW, Lan JL, Lin FJ, Lin SH. Association of Epstein-Barr virus infection with systemic lupus erythematosus in Taiwan. Lupus 2016; 16:168-75. [PMID: 17432101 DOI: 10.1177/0961203306075800] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
An association between Epstein-Barr virus (EBV) infection and systemic lupus erythematosus (SLE) has been suggested from previous serologic evidence. Since most adults in Taiwan are EBV-infected, seroepidemiologic studies based on standard assays for EBV are unlikely to dissociate SLE patients and control groups. We reexamine this question by using novel methodologies in which IgA anti-EBV-coded nuclear antigens-1 (EBNA-1) and IgG anti-EBV DNase antibodies were analysed by ELISA, and EBV viral loads were detected by real-time quantitative PCR for 93 adult SLE patients and 370 age-, sex- and living place-matched healthy controls in Taiwan. The specificities of antibodies for extractible nuclear antigens were determined by Western blot. Our results show that IgA anti-EBV EBNA1 antibodies were detectable in 31.2% SLE patients but only in 4.1% of controls (odds ratio [OR] = 10.72, 95% confidence interval [CI] = 5.19–22.35; P < 10-7), IgG anti-EBV DNase antibodies were detected in 53.8% SLE patients but only in 12.2% controls (OR = 8.40, 95% CI = 4.87–14.51; P < 10-7). EBV DNA was amplifiable from the sera of 41.9% SLE patients but from only 3.24% controls ( P < 0.05). A significant association of IgG anti-EBV DNase antibodies with anti-Sm/RNP antibodies was observed ( P < 0.005). The higher seroreactivity and higher copy numbers of EBV genome indicated association of EBV infection with SLE in Taiwan.
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MESH Headings
- Adrenal Cortex Hormones/administration & dosage
- Adrenal Cortex Hormones/therapeutic use
- Adult
- Antibodies, Viral/blood
- Asian People
- Autoantigens/immunology
- DNA, Viral/blood
- Deoxyribonucleases/immunology
- Dose-Response Relationship, Drug
- Epstein-Barr Virus Infections/complications
- Epstein-Barr Virus Nuclear Antigens/immunology
- Genome, Viral
- Herpesvirus 4, Human/enzymology
- Herpesvirus 4, Human/genetics
- Humans
- Immunoglobulin A/blood
- Immunoglobulin G/blood
- Lupus Erythematosus, Systemic/blood
- Lupus Erythematosus, Systemic/drug therapy
- Lupus Erythematosus, Systemic/immunology
- Lupus Erythematosus, Systemic/virology
- Middle Aged
- Ribonucleoproteins, Small Nuclear/immunology
- Taiwan
- Viral Load
- snRNP Core Proteins
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Affiliation(s)
- J J Y Lu
- National Taichung Nursing College, Taichung, Taiwan
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32
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Antigen nature and complexity influence human antibody light chain usage and specificity. Vaccine 2016; 34:2813-20. [PMID: 27113164 DOI: 10.1016/j.vaccine.2016.04.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 04/05/2016] [Accepted: 04/14/2016] [Indexed: 01/03/2023]
Abstract
Human antibodies consist of a heavy chain and one of two possible light chains, kappa (κ) or lambda (λ). Here we tested how these two possible light chains influence the overall antibody response to polysaccharide and protein antigens by measuring light chain usage in human monoclonal antibodies from antibody secreting cells obtained following vaccination with Pneumovax23. Remarkably, we found that individuals displayed restricted light chain usage to certain serotypes and that lambda antibodies have different specificities and modes of cross-reactivity than kappa antibodies. Thus, at both the monoclonal (7 kappa, no lambda) and serum levels (145μg/mL kappa, 2.82μg/mL lambda), antibodies to cell wall polysaccharide were nearly always kappa. The pneumococcal reference serum 007sp was analyzed for light chain usage to 12 pneumococcal serotypes for which it is well characterized. Similar to results at the monoclonal level, certain serotypes tended to favor one of the light chains (14 and 19A, lambda; 6A and 23F, kappa). We also explored differences in light chain usage at the serum level to a variety of antigens. We examined serum antibodies to diphtheria toxin mutant CRM197 and Epstein-Barr virus protein EBNA-1. These responses tended to be kappa dominant (average kappa-to-lambda ratios of 4.52 and 9.72 respectively). Responses to the influenza vaccine were more balanced with kappa-to-lambda ratio averages having slight strain variations: seasonal H1N1, 1.1; H3N2, 0.96; B, 0.91. We conclude that antigens with limited epitopes tend to produce antibodies with restricted light chain usage and that in most individuals, antibodies with lambda light chains have specificities different and complementary to kappa-containing antibodies.
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Stearns NA, Pisetsky DS. The role of monogamous bivalency and Fc interactions in the binding of anti-DNA antibodies to DNA antigen. Clin Immunol 2016; 166-167:38-47. [PMID: 27083935 DOI: 10.1016/j.clim.2016.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/06/2016] [Accepted: 04/08/2016] [Indexed: 11/18/2022]
Abstract
Antibodies to DNA (anti-DNA) are the serological hallmark of systemic lupus erythematosus. These antibodies can bind DNA avidly by monogamous bivalency, a mechanism which requires the interaction of both Fab combining regions with antigenic determinants on the same polynucleotide. To explore further this mechanism, we tested Fab and F(ab')2 fragments prepared from IgG from patient plasmas in an ELISA with native DNA antigen, detecting antibody with a peroxidase conjugated anti-Fab reagent. These studies showed that Fab fragments, which can only bind monovalently, had negligible activity. Although bivalent F(ab')2 fragments would be predicted to bind DNA, these fragments also showed poor anti-DNA activity. Control studies showed that the fragments retained antibody activity to tetanus toxoid and an EBV antigen preparation. Together, these findings suggest that anti-DNA avidity depends on monogamous bivalency, with the antibody Fc portion also influencing DNA binding, in a mechanism which can be termed Fc-dependent monogamous bivalency.
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Affiliation(s)
- Nancy A Stearns
- Division of Rheumatology and Immunology, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Medical Research Service, VA Medical Center, Durham, NC, USA
| | - David S Pisetsky
- Division of Rheumatology and Immunology, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Medical Research Service, VA Medical Center, Durham, NC, USA.
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Impaired Cytokine Responses to Epstein-Barr Virus Antigens in Systemic Lupus Erythematosus Patients. J Immunol Res 2016; 2016:6473204. [PMID: 27110576 PMCID: PMC4826706 DOI: 10.1155/2016/6473204] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/06/2016] [Indexed: 01/05/2023] Open
Abstract
We analyzed cytokine responses against latent and lytic Epstein-Barr virus (EBV) antigens in systemic lupus erythematosus (SLE) patients and healthy controls (HCs) to obtain an overview of the distinctive immune regulatory response in SLE patients and to expand the previously determined impaired EBV-directed T-cell response. The concentrations of 14 cytokines (IL2, IL4, IL5, IL6, IL10, IL12, IL17, IL18, IL1β, IFNγ, TNFα, TNFβ, TGFβ, and GM-CSF) were quantified upon stimulation of whole blood with latent state antigen EBNA1, lytic cycle antigen EBV-EA/D, and the superantigen SEB. To avoid results affected by lack of lymphocytes, we focused on SLE patients with normal levels. Decreased induction of IL12, IFNγ, IL17, and IL6 upon EBNA1 stimulation and that of IFNγ, IL6, TNFβ, IL1β, and GM-CSF upon EBV-EA/D stimulation were detected in SLE patients compared to HCs. IFNγ responses, especially, were shown to be reduced. Induction of several cytokines was furthermore impaired in SLE patients upon SEB stimulation, but no difference was observed in basic levels. Results substantiate the previously proposed impaired regulation of the immune response against latent and lytic cycle EBV infection in SLE patients without lymphopenia. Furthermore, results indicate general dysfunction of leukocytes and their cytokine regulations in SLE patients.
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Hecker M, Fitzner B, Wendt M, Lorenz P, Flechtner K, Steinbeck F, Schröder I, Thiesen HJ, Zettl UK. High-Density Peptide Microarray Analysis of IgG Autoantibody Reactivities in Serum and Cerebrospinal Fluid of Multiple Sclerosis Patients. Mol Cell Proteomics 2016; 15:1360-80. [PMID: 26831522 DOI: 10.1074/mcp.m115.051664] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Indexed: 11/06/2022] Open
Abstract
Intrathecal immunoglobulin G (IgG) synthesis and oligoclonal IgG bands in cerebrospinal fluid (CSF) are hallmarks of multiple sclerosis (MS), but the antigen specificities remain enigmatic. Our study is the first investigating the autoantibody repertoire in paired serum and CSF samples from patients with relapsing-remitting MS (RRMS), primary progressive MS (PPMS), and other neurological diseases by the use of high-density peptide microarrays. Protein sequences of 45 presumed MS autoantigens (e.g.MOG, MBP, and MAG) were represented on the microarrays by overlapping 15mer peptides. IgG reactivities were screened against a total of 3991 peptides, including also selected viral epitopes. The measured antibody reactivities were highly individual but correlated for matched serum and CSF samples. We found 54 peptides to be recognized significantly more often by serum or CSF antibodies from MS patients compared with controls (pvalues <0.05). The results for RRMS and PPMS clearly overlapped. However, PPMS patients presented a broader peptide-antibody signature. The highest signals were detected for a peptide mapping to a region of the Epstein-Barr virus protein EBNA1 (amino acids 392-411), which is homologous to the N-terminal part of human crystallin alpha-B. Our data confirmed several known MS-associated antigens and epitopes, and they delivered additional potential linear epitopes, which await further validation. The peripheral and intrathecal humoral immune response in MS is polyspecific and includes antibodies that are also found in serum of patients with other diseases. Further studies are required to assess the pathogenic relevance of autoreactive and anti-EBNA1 antibodies as well as their combinatorial value as biomarkers for MS.
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Affiliation(s)
- Michael Hecker
- From the ‡University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany; §Steinbeis Transfer Center for Proteome Analysis, Schillingallee 70, 18057 Rostock, Germany;
| | - Brit Fitzner
- From the ‡University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany; §Steinbeis Transfer Center for Proteome Analysis, Schillingallee 70, 18057 Rostock, Germany
| | - Matthias Wendt
- From the ‡University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Peter Lorenz
- ¶University of Rostock, Institute of Immunology, Schillingallee 70, 18057 Rostock, Germany
| | - Kristin Flechtner
- ¶University of Rostock, Institute of Immunology, Schillingallee 70, 18057 Rostock, Germany
| | - Felix Steinbeck
- ¶University of Rostock, Institute of Immunology, Schillingallee 70, 18057 Rostock, Germany; ‖Gesellschaft für Individualisierte Medizin mbH (IndyMED), Lessingstr. 17, 18055 Rostock, Germany
| | - Ina Schröder
- From the ‡University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Hans-Jürgen Thiesen
- §Steinbeis Transfer Center for Proteome Analysis, Schillingallee 70, 18057 Rostock, Germany; ¶University of Rostock, Institute of Immunology, Schillingallee 70, 18057 Rostock, Germany; ‖Gesellschaft für Individualisierte Medizin mbH (IndyMED), Lessingstr. 17, 18055 Rostock, Germany
| | - Uwe Klaus Zettl
- From the ‡University of Rostock, Department of Neurology, Division of Neuroimmunology, Gehlsheimer Str. 20, 18147 Rostock, Germany
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Magna M, Pisetsky DS. The Role of Cell Death in the Pathogenesis of SLE: Is Pyroptosis the Missing Link? Scand J Immunol 2015; 82:218-24. [PMID: 26118732 DOI: 10.1111/sji.12335] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/21/2015] [Indexed: 12/20/2022]
Abstract
Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease characterized by the production of antinuclear antibodies (ANAs) in association with systemic inflammation and organ damage. In addition to genetic factors, a contribution of infection to disease induction has been proposed. In the pathogenesis of lupus, immune complexes of ANAs with nuclear antigens can form and both deposit in the tissue and stimulate cytokine production to intensify inflammation. As such, the extracellular release of nuclear antigens to form pathogenic immune complexes is an important step in the pathway to disease. This release has been considered the consequence of cell death, with apoptotic cells the relevant source of nuclear material. While apoptosis could serve this role, other death forms may act similarly. Among these death forms, pyroptosis, which can be induced by inflammasome activation during infection, has features suggesting involvement in lupus. Thus, unlike apoptosis, pyroptosis is a pro-inflammatory process. Furthermore, pyroptosis leads to the release of intracellular contents including HMGB1 and ATP, both of which can act as DAMPs (death associated molecular patterns) to stimulate further inflammation. Importantly, pyroptosis can lead to the release of intact nuclei, suggesting a relationship to events in the formation of LE cells. While the role of pyroptosis in SLE is hypothetical at this time, further analysis of this death form should provide new insights into lupus pathogenesis and provide the missing link between infection and the initiation of lupus by products of dead and dying cells.
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Affiliation(s)
- M Magna
- Division of Rheumatology and Immunology, Duke University Medical Center, Durham, NC, USA
| | - D S Pisetsky
- Medical Research Service, Durham Veterans Administration Medical Center, Durham, NC, USA.,Division of Rheumatology and Immunology, Duke University Medical Center, Durham, NC, USA
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Draborg AH, Lydolph MC, Westergaard M, Olesen Larsen S, Nielsen CT, Duus K, Jacobsen S, Houen G. Elevated Concentrations of Serum Immunoglobulin Free Light Chains in Systemic Lupus Erythematosus Patients in Relation to Disease Activity, Inflammatory Status, B Cell Activity and Epstein-Barr Virus Antibodies. PLoS One 2015; 10:e0138753. [PMID: 26402865 PMCID: PMC4581754 DOI: 10.1371/journal.pone.0138753] [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: 03/23/2015] [Accepted: 08/09/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In this study, we examined the concentration of serum immunoglobulin free light chains (FLCs) in systemic lupus erythematosus (SLE) patients and investigated its association with various disease parameters in order to evaluate the role of FLCs as a potential biomarker in SLE. Furthermore, FLCs' association with Epstein-Barr virus (EBV) antibodies was examined. METHODS Using a nephelometric assay, κFLC and λFLC concentrations were quantified in sera from 45 SLE patients and 40 healthy controls. SLE patients with renal insufficiency were excluded in order to preclude high concentrations of serum FLCs due to decreased clearance. RESULTS Serum FLC concentrations were significantly elevated in SLE patients compared to healthy controls (p<0.0001) also after adjusting for Ig levels (p<0.0001). The concentration of serum FLCs correlated with a global disease activity (SLE disease activity index (SLEDAI)) score of the SLE patients (r = 0.399, p = 0.007). Furthermore, concentrations of FLCs correlated with titers of dsDNA antibodies (r = 0.383, p = 0.009), and FLC levels and SLEDAI scores correlated in the anti-dsDNA-positive SLE patients, but not in anti-dsDNA-negative SLE patients. Total immunoglobulin (IgG and IgA) concentrations correlated with FLC concentrations and elevated FLC levels were additionally shown to associate with the inflammatory marker C-reactive protein and also with complement consumption determined by low C4 in SLE patients. Collectively, results indicated that elevated serum FLCs reflects increased B cell activity in relation to inflammation. SLE patients had an increased seropositivity of EBV-directed antibodies that did not associate with elevated FLC concentrations. An explanation for this could be that serum FLC concentrations reflect the current EBV activity (reactivation) whereas EBV-directed antibodies reflect the extent of previous infection/reactivations. CONCLUSION SLE patients have elevated concentrations of serum FLCs that correlate with global disease activity scores and especially serologic markers for active disease. These findings are suggestive of circulating FLCs having potential as a new supplementary serologic biomarker in SLE.
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Affiliation(s)
- Anette H. Draborg
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - Magnus C. Lydolph
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - Marie Westergaard
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - Severin Olesen Larsen
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - Christoffer T. Nielsen
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
- Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Karen Duus
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - Søren Jacobsen
- Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gunnar Houen
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
- * E-mail:
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Research Progress on Systemic Lupus Erythematosus Complicated with Infection. INFECTION INTERNATIONAL 2015. [DOI: 10.1515/ii-2017-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractIn recent years, in treatment standardization of systemic lupus erythematosus (SLE), infections and serious complications became the leading cause of death related to this disease, exceeding those of renal involvement and lupus encephalopathy. SLE coinfection is mainly related to defects in humoral immunity and cellular immunity, SLE disease activity, and doses of hormone and immune inhibitors.
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Abstract
The etiology of systemic lupus erythematosus (SLE) is unknown, but multiple genetic, epigenetic, and environmental risk factors have been implicated. The inheritance of genes alone is not sufficient for developing SLE, suggesting the influence of environmental triggers on disease expression. Despite the tremendous amount of progress in elucidating potential environmental risk factors for SLE, much more needs to be done. An interdisciplinary approach to studies of the causes and, ultimately, prevention of SLE is needed. This article reviews what is understood about the epidemiology of the relationship between environmental exposures and SLE, in addition to emerging areas of study.
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40
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Rist MJ, Hibbert KM, Croft NP, Smith C, Neller MA, Burrows JM, Miles JJ, Purcell AW, Rossjohn J, Gras S, Burrows SR. T Cell Cross-Reactivity between a Highly Immunogenic EBV Epitope and a Self-Peptide Naturally Presented by HLA-B*18:01+ Cells. THE JOURNAL OF IMMUNOLOGY 2015; 194:4668-75. [PMID: 25855358 DOI: 10.4049/jimmunol.1500233] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/12/2015] [Indexed: 01/06/2023]
Abstract
T cell cross-reactivity underpins the molecular mimicry hypothesis in which microbial peptides sharing structural features with host peptides stimulate T cells that cross-react with self-peptides, thereby initiating and/or perpetuating autoimmune disease. EBV represents a potentially important factor in the pathogenesis of several T cell-mediated autoimmune disorders, with molecular mimicry a likely mechanism. In this study, we describe a human self-peptide (DELEIKAY) that is a homolog of a highly immunogenic EBV T cell epitope (SELEIKRY) presented by HLA-B*18:01. This self-peptide was shown to bind stably to HLA-B*18:01, and peptide elution/mass spectrometric studies showed it is naturally presented by this HLA molecule on the surface of human cells. A significant proportion of CD8(+) T cells raised from some healthy individuals against this EBV epitope cross-reacted with the self-peptide. A diverse array of TCRs was expressed by the cross-reactive T cells, with variable functional avidity for the self-peptide, including some T cells that appeared to avoid autoreactivity by a narrow margin, with only 10-fold more of the self-peptide required for equivalent activation as compared with the EBV peptide. Structural studies revealed that the self-peptide-HLA-B*18:01 complex is a structural mimic of the EBV peptide-HLA-B*18:01 complex, and that the strong antiviral T cell response is primarily dependent on the alanine/arginine mismatch at position 7. To our knowledge, this is the first report confirming the natural presentation of a self-peptide cross-recognized in the context of self-HLA by EBV-reactive CD8(+) T cells. These results illustrate how aberrant immune responses and immunopathological diseases could be generated by EBV infection.
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Affiliation(s)
- Melissa J Rist
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland 4029, Australia; School of Medicine, University of Queensland, Brisbane, Queensland 4072, Australia
| | - Kelly M Hibbert
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria 3800, Australia; Australian Research Council Centre of Excellence in Advanced Molecular Imaging, Monash University, Clayton, Victoria 3800, Australia; and
| | - Nathan P Croft
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria 3800, Australia
| | - Corey Smith
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland 4029, Australia
| | - Michelle A Neller
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland 4029, Australia
| | | | - John J Miles
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland 4029, Australia; School of Medicine, University of Queensland, Brisbane, Queensland 4072, Australia; Institute of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff CF14 4XN, United Kingdom
| | - Anthony W Purcell
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria 3800, Australia
| | - Jamie Rossjohn
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria 3800, Australia; Australian Research Council Centre of Excellence in Advanced Molecular Imaging, Monash University, Clayton, Victoria 3800, Australia; and Institute of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff CF14 4XN, United Kingdom
| | - Stephanie Gras
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria 3800, Australia; Australian Research Council Centre of Excellence in Advanced Molecular Imaging, Monash University, Clayton, Victoria 3800, Australia; and
| | - Scott R Burrows
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland 4029, Australia; School of Medicine, University of Queensland, Brisbane, Queensland 4072, Australia;
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Epidemiology and classification of systemic lupus erythematosus. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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Graves J, Grandhe S, Weinfurtner K, Krupp L, Belman A, Chitnis T, Ness J, Weinstock-Guttman B, Gorman M, Patterson M, Rodriguez M, Lotze T, Aaen G, Mowry EM, Rose JW, Simmons T, Casper TC, James J, Waubant E. Protective environmental factors for neuromyelitis optica. Neurology 2014; 83:1923-9. [PMID: 25339213 DOI: 10.1212/wnl.0000000000001001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether early environmental factors, such as cesarean delivery, breastfeeding, and exposure to smoking or herpes viruses, are associated with neuromyelitis optica (NMO) risk in children. METHODS This is a case-control study of pediatric NMO, multiple sclerosis (MS), and healthy subjects. Early-life exposures were obtained by standardized questionnaire. Epstein-Barr virus, cytomegalovirus, and herpes simplex virus 1 antibody responses were determined by ELISA. Multivariate logistic regression models were used to adjust for age at sampling, sex, race, and ethnicity. RESULTS Early-life exposures were obtained from 36 pediatric subjects with NMO, 491 with MS, and 224 healthy controls. Daycare (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.14, 0.78; p < 0.01) and breastfeeding (OR 0.42, 95% CI 0.18, 0.99; p = 0.05) were associated with lower odds of having NMO compared with healthy subjects. Cesarean delivery tended to be associated with 2-fold-higher odds of NMO compared with having MS/clinically isolated syndrome (OR 1.98, 95% CI 0.88, 4.59; p = 0.12) or with being healthy (OR 1.95, 95% CI 0.81, 4.71; p = 0.14). Sera and DNA were available for 31 subjects with NMO, 189 with MS, and 94 healthy controls. Epstein-Barr virus, herpes simplex virus 1, cytomegalovirus exposure, and being HLA-DRB1*15 positive were not associated with odds of having NMO compared with healthy subjects. CONCLUSIONS Exposure to other young children may be an early protective factor against the development of NMO, as previously reported for MS, consistent with the hypothesis that infections contribute to disease risk modification. Unlike MS, pediatric NMO does not appear to be associated with exposures to common herpes viruses.
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Affiliation(s)
- Jennifer Graves
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital.
| | - Siri Grandhe
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - Kelley Weinfurtner
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - Lauren Krupp
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - Anita Belman
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - Tanuja Chitnis
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - Jayne Ness
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - Bianca Weinstock-Guttman
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - Mark Gorman
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - Marc Patterson
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - Moses Rodriguez
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - Tim Lotze
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - Gregory Aaen
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - Ellen M Mowry
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - John W Rose
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - Timothy Simmons
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - T Charles Casper
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - Judith James
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
| | - Emmanuelle Waubant
- From the Department of Neurology (J.G., K.W., E.W.), University of California, San Francisco; Virginia Commonwealth Medical School (S.G.); Lourie Center for Pediatric MS (L.K., A.B.), Stony Brook Children's Hospital, NY; Partners MS Center (T.C.), Massachusetts General Hospital for Children, Harvard Medical School; UAB Center for Pediatric Onset Demyelinating Disease (J.N.), Children's Hospital of Alabama; Pediatric Multiple Sclerosis Center (B.W.-G.), Jacobs Neurological Institute, SUNY Buffalo, NY; Pediatric Multiple Sclerosis and Related Diseases Program (M.G.), Boston Children's Hospital, MA; Mayo Clinic's Pediatric MS Center (M.P., M.R.), Rochester, MN; Blue Bird Circle Multiple Sclerosis Center (T.L.), Texas Children's Hospital, Houston; Pediatric MS Center at Loma Linda University Children's Hospital (G.A.), CA; Multiple Sclerosis Center (E.M.M.), Johns Hopkins University, Baltimore, MD; Department of Pediatrics (J.W.R., T.S., T.C.C.), University of Utah, Salt Lake City; Oklahoma Medical Research Foundation (J.J.), Oklahoma City; and Department of Pediatrics (E.W.), UCSF Benioff Children's Hospital
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Cuomo L, Cirone M, Di Gregorio AO, Vitillo M, Cattivelli M, Magliocca V, Maiorano S, Meledandri M, Scagnolari C, La Rocca S, Trivedi P. Elevated antinuclear antibodies and altered anti-Epstein-Barr virus immune responses. Virus Res 2014; 195:95-9. [PMID: 25300805 DOI: 10.1016/j.virusres.2014.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/28/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
Abstract
It has been shown that Epstein-Barr virus (EBV) is able to alter the immune response towards self-antigens and may enhance risk of autoimmune diseases such as systemic lupus erythematosus (SLE) in genetically predisposed individuals. In this study, we evaluated the specific antibody immune response against EBV in patients with anti-nuclear autoantibodies (ANA) in comparison with ANA-negative healthy controls. For this purpose, 92 patients with an high anti-ANA reactivity with or without concomitant extractable nuclear antigen (ENA) or double stranded DNA (dsDNA) positivity were selected and compared with 146 healthy donors. We found that anti-EBV-VCA and EA IgG concentrations were significantly higher in ANA-positive patients in comparison to the controls (VCA P<0.0001 and EA P<0,03) as well as in those ANA-positive patients that showed a concomitant ENA positivity (P=0.0002). Interestingly, elevated anti-EBNA-1 IgG was found in a group of patients who had anti SSA/Ro antibodies. Anti-VCA IgM Abs were more frequently found in those patients with a very high titer of ANA (P=0.06); moreover detection of anti-VCA IgM/IgG in absence of anti-EBNA-1 IgG was more frequent in the patient than in the control group. Both these conditions correlate with a recent EBV infection or reactivation. The data suggest that EBV, particularly during acute infection or in its reactivation phase, could be involved in the ANA and ENA autoantibody formation.
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Affiliation(s)
- Laura Cuomo
- U.O.C. Patologia Clinica, A.C.O. San Filippo Neri, Rome, Italy
| | - Mara Cirone
- Department of Experimental Medicine, La Sapienza University, Rome, Italy
| | | | - Marina Vitillo
- U.O.C. Patologia Clinica, A.C.O. San Filippo Neri, Rome, Italy
| | - Marina Cattivelli
- U.O.C. Microbiologia e Virologia, A.C.O. San Filippo Neri, Rome, Italy
| | | | - Silvana Maiorano
- U.O.C. Microbiologia e Virologia, A.C.O. San Filippo Neri, Rome, Italy
| | | | | | | | - Pankaj Trivedi
- Department of Experimental Medicine, La Sapienza University, Rome, Italy.
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Pavlović MD, Jandrlić DR, Mitić NS. Epitope distribution in ordered and disordered protein regions. Part B — Ordered regions and disordered binding sites are targets of T- and B-cell immunity. J Immunol Methods 2014; 407:90-107. [DOI: 10.1016/j.jim.2014.03.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 03/31/2014] [Accepted: 03/31/2014] [Indexed: 01/04/2023]
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Human cytomegalovirus and autoimmune disease. BIOMED RESEARCH INTERNATIONAL 2014; 2014:472978. [PMID: 24967373 PMCID: PMC4022258 DOI: 10.1155/2014/472978] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/17/2014] [Indexed: 11/28/2022]
Abstract
Human cytomegalovirus (HCMV) represents a prototypic pathogenic member of the β-subgroup of the herpesvirus family. A range of HCMV features like its lytic replication in multiple tissues, the lifelong persistence through periods of latency and intermitting reactivation, the extraordinary large proteome, and extensive manipulation of adaptive and innate immunity make HCMV a high profile candidate for involvement in autoimmune disorders. We surveyed the available literature for reports on HCMV association with onset or exacerbation of autoimmune disease. A causative linkage between HCMV and systemic lupus erythematosus (SLE), systemic sclerosis (SSc), diabetes mellitus type 1, and rheumatoid arthritis (RA) is suggested by the literature. However, a clear association of HCMV seroprevalence and disease could not be established, leaving the question open whether HCMV could play a coresponsible role for onset of disease. For convincing conclusions population-based prospective studies must be performed in the future. Specific immunopathogenic mechanisms by which HCMV could contribute to the course of autoimmune disease have been suggested, for example, molecular mimicry by UL94 in SSc and UL83/pp65 in SLE patients, as well as aggravation of joint inflammation by induction and expansion of CD4+/CD28− T-cells in RA patients. Further studies are needed to validate these findings and to lay the grounds for targeted therapeutic intervention.
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Draborg AH, Jacobsen S, Westergaard M, Mortensen S, Larsen JL, Houen G, Duus K. Reduced response to Epstein-Barr virus antigens by T-cells in systemic lupus erythematosus patients. Lupus Sci Med 2014; 1:e000015. [PMID: 25396062 PMCID: PMC4225738 DOI: 10.1136/lupus-2014-000015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 01/07/2023]
Abstract
Objective Epstein–Barr virus (EBV) has for long been associated with systemic lupus erythematosus (SLE). In this study, we investigated the levels of latent and lytic antigen EBV-specific T-cells and antibodies in SLE patients. Methods T cells were analyzed by flow cytometry and antibodies were analyzed by enzyme-linked immunosorbent assay. Results SLE patients showed a significantly reduced number of activated (CD69) T-cells upon ex vivo stimulation with EBV nuclear antigen (EBNA) 1 or EBV early antigen diffuse (EBV-EA/D) in whole blood samples compared with healthy controls. Also, a reduced number of T-cells from SLE patients were found to produce interferon-γ upon stimulation with these antigens. Importantly, responses to a superantigen were normal in SLE patients. Compared with healthy controls, SLE patients had fewer EBV-specific T-cells but higher titres of antibodies against EBV. Furthermore, an inverse correlation was revealed between the number of lytic antigen EBV-specific T-cells and disease activity of the SLE patients, with high-activity SLE patients having fewer T-cells than low-activity SLE patients. Conclusions These results indicate a limited or a defective EBV-specific T-cell response in SLE patients, which may suggest poor control of EBV infection in SLE with an immune reaction shift towards a humoral response in an attempt to control viral reactivation. A role for decreased control of EBV as a contributing agent in the development or exacerbation of SLE is proposed.
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Affiliation(s)
- Anette Holck Draborg
- Department of Clinical Biochemistry, Immunology and Genetics , Statens Serum Institut , Copenhagen , Denmark
| | - Søren Jacobsen
- Department of Infectious Diseases and Rheumatology, Rigshospitalet , Copenhagen University Hospital , Copenhagen , Denmark
| | - Marie Westergaard
- Department of Clinical Biochemistry, Immunology and Genetics , Statens Serum Institut , Copenhagen , Denmark
| | - Shila Mortensen
- Department of Microbiological Diagnostics and Virology , Statens Serum Institut , Copenhagen , Denmark
| | - Janni Lisander Larsen
- Department of Infectious Diseases and Rheumatology, Rigshospitalet , Copenhagen University Hospital , Copenhagen , Denmark
| | - Gunnar Houen
- Department of Clinical Biochemistry, Immunology and Genetics , Statens Serum Institut , Copenhagen , Denmark
| | - Karen Duus
- Department of Clinical Biochemistry, Immunology and Genetics , Statens Serum Institut , Copenhagen , Denmark
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Caza T, Oaks Z, Perl A. Interplay of Infections, Autoimmunity, and Immunosuppression in Systemic Lupus Erythematosus. Int Rev Immunol 2014; 33:330-63. [DOI: 10.3109/08830185.2013.863305] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Auwaerter PG. Recent advances in the understanding of infectious mononucleosis: are prospects improved for treatment or control? Expert Rev Anti Infect Ther 2014; 4:1039-49. [PMID: 17181419 DOI: 10.1586/14787210.4.6.1039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Symptomatic primary Epstein-Barr virus infection is known more commonly as infectious mononucleosis, an illness known for afflicting adolescents and younger adults as a febrile illness accompanied by pharyngitis and lymphadenopathy. Historically believed to be generally benign, infectious mononucleosis has been linked more recently to increased risks of developing Hodgkin's lymphoma and multiple sclerosis. Advances in the understanding of host immune responses to Epstein-Barr virus have begun to elucidate the reasons why younger children typically experience subclinical infection whereas older individuals develop infectious mononucleosis. This review will highlight recent advances in the understanding of primary Epstein-Barr virus infection, and whether prospective treatments or vaccine strategies may affect native infection and its sequelae.
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Affiliation(s)
- Paul G Auwaerter
- The Johns Hopkins University School of Medicine, Division of Infectious Diseases, 1830 East Monument Street, #449, Baltimore, MD 21205, USA.
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Hanlon P, Avenell A, Aucott L, Vickers MA. Systematic review and meta-analysis of the sero-epidemiological association between Epstein-Barr virus and systemic lupus erythematosus. Arthritis Res Ther 2014; 16:R3. [PMID: 24387619 PMCID: PMC3978841 DOI: 10.1186/ar4429] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 12/10/2013] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Infection with Epstein-Barr virus (EBV) has been suggested to contribute to the pathogenesis of systemic lupus erythematosus (SLE). We sought to determine whether prior infection with the virus occurs more frequently in patients with SLE compared to matched controls. METHODS We performed a systematic review and meta-analyses of studies that reported the prevalence of anti-EBV antibodies in the sera from cases of SLE and controls by searching Medline and Embase databases from 1966 to 2012, with no language restriction. Mantel-Haenszel odds ratios (OR) for the detection of anti-EBV antibodies were calculated, and meta-analyses conducted. Quality assessments were performed using a modified version of the Newcastle-Ottawa scale. RESULTS Twenty-five case-control studies were included. Quality assessment found most studies reported acceptable selection criteria but poor description of how cases and controls were recruited. There was a statistically significant higher seroprevalence of anti-viral capsid antigen (VCA) IgG (OR 2.08; 95% confidence interval (CI) 1.15 - 3.76, p = 0.007) but not anti-EBV-nuclear antigen1 (EBNA1) (OR 1.45; 95% CI 0.7 to 2.98, p = 0.32) in cases compared to controls. The meta-analyses for anti-early antigen (EA) /D IgG and anti-VCA IgA also showed significantly high ORs (4.5; 95% CI 3.00 to 11.06, p < 0.00001 and 5.05 (95% CI 1.95 - 13.13), p = 0.0009 respectively). However, funnel plot examination suggested publication bias. CONCLUSIONS Overall, our findings support the hypothesis that infection with EBV predisposes to the development of SLE. However, publication bias cannot be excluded and the methodological conduct of studies could be improved, with regard to recruitment, matching and reporting of blinded laboratory analyses.
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Epstein-Barr virus in systemic autoimmune diseases. Clin Dev Immunol 2013; 2013:535738. [PMID: 24062777 PMCID: PMC3766599 DOI: 10.1155/2013/535738] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 07/17/2013] [Indexed: 02/07/2023]
Abstract
Systemic autoimmune diseases (SADs) are a group of connective tissue diseases with diverse, yet overlapping, symptoms and autoantibody development. The etiology behind SADs is not fully elucidated, but a number of genetic and environmental factors are known to influence the incidence of SADs. Recent findings link dysregulation of Epstein-Barr virus (EBV) with SAD development. EBV causes a persistent infection with a tight latency programme in memory B-cells, which enables evasion of the immune defence. A number of immune escape mechanisms and immune-modulating proteins have been described for EBV. These immune modulating functions make EBV a good candidate for initiation of autoimmune diseases and exacerbation of disease progression. This review focuses on systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and Sjögren's syndrome (SS) and sum up the existing data linking EBV with these diseases including elevated titres of EBV antibodies, reduced T-cell defence against EBV, and elevated EBV viral load. Together, these data suggest that uncontrolled EBV infection can develop diverse autoreactivities in genetic susceptible individuals with different manifestations depending on the genetic background and the site of reactivation.
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