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Li XX, Maitiyaer M, Tan Q, Huang WH, Liu Y, Liu ZP, Wen YQ, Zheng Y, Chen X, Chen RL, Tao Y, Yu SL. Emerging biologic frontiers for Sjogren's syndrome: Unveiling novel approaches with emphasis on extra glandular pathology. Front Pharmacol 2024; 15:1377055. [PMID: 38828450 PMCID: PMC11140030 DOI: 10.3389/fphar.2024.1377055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/29/2024] [Indexed: 06/05/2024] Open
Abstract
Primary Sjögren's Syndrome (pSS) is a complex autoimmune disorder characterized by exocrine gland dysfunction, leading to dry eyes and mouth. Despite growing interest in biologic therapies for pSS, FDA approval has proven challenging due to trial complications. This review addresses the absence of a molecular-target-based approach to biologic therapy development and highlights novel research on drug targets and clinical trials. A literature search identified potential pSS treatment targets and recent advances in molecular understanding. Overlooking extraglandular symptoms like fatigue and depression is a notable gap in trials. Emerging biologic agents targeting cytokines, signal pathways, and immune responses have proven efficacy. These novel therapies could complement existing methods for symptom alleviation. Improved grading systems accounting for extraglandular symptoms are needed. The future of pSS treatment may involve gene, stem-cell, and tissue-engineering therapies. This narrative review offers insights into advancing pSS management through innovative biologic interventions.
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Affiliation(s)
- Xiao Xiao Li
- Department of Rheumatology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Maierhaba Maitiyaer
- Department of Rheumatology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Qing Tan
- Department of Rheumatology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Wen Hui Huang
- Department of Rheumatology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Yu Liu
- Department of Clinical Medicine, The First Clinical Medical School of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Zhi Ping Liu
- Ophthalmic Center, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yue Qiang Wen
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Yu Zheng
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Xing Chen
- Department of Geriatrics, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Rui Lin Chen
- Department of Rheumatology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Yi Tao
- Department of Rheumatology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Shui Lian Yu
- Department of Rheumatology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
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Nguyen Y, Nocturne G, Henry J, Ng WF, Belkhir R, Desmoulins F, Bergé E, Morel J, Perdriger A, Dernis E, Devauchelle-Pensec V, Sène D, Dieudé P, Couderc M, Fauchais AL, Larroche C, Vittecoq O, Salliot C, Hachulla E, Le Guern V, Gottenberg JE, Mariette X, Seror R. Identification of distinct subgroups of Sjögren's disease by cluster analysis based on clinical and biological manifestations: data from the cross-sectional Paris-Saclay and the prospective ASSESS cohorts. THE LANCET. RHEUMATOLOGY 2024; 6:e216-e225. [PMID: 38437852 PMCID: PMC10949202 DOI: 10.1016/s2665-9913(23)00340-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 03/06/2024]
Abstract
BACKGROUND Sjögren's disease is a heterogenous autoimmune disease with a wide range of symptoms-including dryness, fatigue, and pain-in addition to systemic manifestations and an increased risk of lymphoma. We aimed to identify distinct subgroups of the disease, using cluster analysis based on subjective symptoms and clinical and biological manifestations, and to compare the prognoses of patients in these subgroups. METHODS This study included patients with Sjögren's disease from two independent cohorts in France: the cross-sectional Paris-Saclay cohort and the prospective Assessment of Systemic Signs and Evolution of Sjögren's Syndrome (ASSESS) cohort. We first used an unsupervised multiple correspondence analysis to identify clusters within the Paris-Saclay cohort using 26 variables comprising patient-reported symptoms and clinical and biological manifestations. Next, we validated these clusters using patients from the ASSESS cohort. Changes in disease activity (measured by the European Alliance of Associations for Rheumatology [EULAR] Sjögren's Syndrome Disease Activity Index [ESSDAI]), patient-acceptable symptom state (measured by the EULAR Sjögren's Syndrome Patient Reported Index [ESSPRI]), and lymphoma incidence during follow-up were compared between clusters. Finally, we compared our clusters with the symptom-based subgroups previously described by Tarn and colleagues. FINDINGS 534 patients from the Paris-Saclay cohort (502 [94%] women, 32 [6%] men, median age 54 years [IQR 43-64]), recruited between 1999 and 2022, and 395 patients from the ASSESS cohort (370 [94%] women, 25 [6%] men, median age 53 years [43-63]), recruited between 2006 and 2009, were included in this study. In both cohorts, hierarchical cluster analysis revealed three distinct subgroups of patients: those with B-cell active disease and low symptom burden (BALS), those with high systemic disease activity (HSA), and those with low systemic disease activity and high symptom burden (LSAHS). During follow-up in the ASSESS cohort, disease activity and symptom states worsened for patients in the BALS cluster (67 [36%] of 186 patients with ESSPRI score <5 at month 60 vs 92 [49%] of 186 at inclusion; p<0·0001). Lymphomas occurred in patients in the BALS cluster (five [3%] of 186 patients; diagnosed a median of 70 months [IQR 42-104] after inclusion) and the HSA cluster (six [4%] of 158 patients; diagnosed 23 months [13-83] after inclusion). All patients from the Paris-Saclay cohort with a history of lymphoma were in the BALS and HSA clusters. This unsupervised clustering classification based on symptoms and clinical and biological manifestations did not correlate with a previous classification based on symptoms only. INTERPRETATION On the basis of symptoms and clinical and biological manifestations, we identified three distinct subgroups of patients with Sjögren's disease with different prognoses. Our results suggest that these subgroups represent different heterogeneous pathophysiological disease mechanisms, stages of disease, or both. These findings could be of interest when stratifying patients in future therapeutic trials. FUNDING Fondation pour la Recherche Médicale, French Ministry of Health, French Society of Rheumatology, Innovative Medicines Initiative 2 Joint Undertaking, Medical Research Council UK, and Foundation for Research in Rheumatology.
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Affiliation(s)
- Yann Nguyen
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Paris, France; Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Université Paris-Saclay, Paris, France
| | - Gaëtane Nocturne
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Paris, France; Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Université Paris-Saclay, Paris, France
| | - Julien Henry
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Paris, France
| | - Wan-Fai Ng
- Faculty of Medical Sciences, Clinical and Translational Research Institute, Newcastle University, NIHR Newcastle Biomedical Research Centre and NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Rakiba Belkhir
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Paris, France
| | - Frédéric Desmoulins
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Paris, France
| | - Elisabeth Bergé
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Paris, France
| | - Jacques Morel
- Rheumatology Department, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Aleth Perdriger
- Rheumatology Department, CHU Rennes, Université Rennes, Rennes, France
| | - Emmanuelle Dernis
- Department of Rheumatology and Clinical Immunology, General Hospital, Le Mans, France
| | - Valérie Devauchelle-Pensec
- Department of Rheumatology, CHU de Brest, INSERM 1227, LBAI, Université de Bretagne Occidentale, Centre de Référence des Maladies Auto-Immunes Rares de l'Adulte, Brest, France
| | - Damien Sène
- Department of Internal Medicine, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Philippe Dieudé
- Department of Rheumatology, Hôpital Bichat-Claude Bernard, Assistance Publique - Hôpitaux de Paris, INSERM UMR1152, Paris-Cité University, Paris, France
| | - Marion Couderc
- Department of Rheumatology, CHU de Clermont-Ferrand, INSERM UMR 1240, Clermont Auvergne University, Clermont-Ferrand, France
| | - Anne-Laure Fauchais
- Department of Internal Medicine, University Hospital of Limoges, Limoges, France
| | - Claire Larroche
- Department of Internal Medicine, Assistance Publique - Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France
| | - Olivier Vittecoq
- Department of Rheumatology, Rouen University Hospital, Rouen, France
| | - Carine Salliot
- Department of Rheumatology, Centre Hospitalier Universitaire d'Orléans, Orléans, France
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Hôpital Claude Huriez, University of Lille, Lille, France
| | - Véronique Le Guern
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris Centre, Université Paris Cité, Paris, France
| | - Jacques-Eric Gottenberg
- Rheumatology Department, EA 3432, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | - Xavier Mariette
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Paris, France; Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Université Paris-Saclay, Paris, France
| | - Raphaèle Seror
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Paris, France; Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Université Paris-Saclay, Paris, France.
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Kazakov AS, Deryusheva EI, Rastrygina VA, Sokolov AS, Permyakova ME, Litus EA, Uversky VN, Permyakov EA, Permyakov SE. Interaction of S100A6 Protein with the Four-Helical Cytokines. Biomolecules 2023; 13:1345. [PMID: 37759746 PMCID: PMC10526228 DOI: 10.3390/biom13091345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/19/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
S100 is a family of over 20 structurally homologous, but functionally diverse regulatory (calcium/zinc)-binding proteins of vertebrates. The involvement of S100 proteins in numerous vital (patho)physiological processes is mediated by their interaction with various (intra/extra)cellular protein partners, including cell surface receptors. Furthermore, recent studies have revealed the ability of specific S100 proteins to modulate cell signaling via direct interaction with cytokines. Previously, we revealed the binding of ca. 71% of the four-helical cytokines via the S100P protein, due to the presence in its molecule of a cytokine-binding site overlapping with the binding site for the S100P receptor. Here, we show that another S100 protein, S100A6 (that has a pairwise sequence identity with S100P of 35%), specifically binds numerous four-helical cytokines. We have studied the affinity of the recombinant forms of 35 human four-helical cytokines from all structural families of this fold to Ca2+-loaded recombinant human S100A6, using surface plasmon resonance spectroscopy. S100A6 recognizes 26 of the cytokines from all families of this fold, with equilibrium dissociation constants from 0.3 nM to 12 µM. Overall, S100A6 interacts with ca. 73% of the four-helical cytokines studied to date, with a selectivity equivalent to that for the S100P protein, with the differences limited to the binding of interleukin-2 and oncostatin M. The molecular docking study evidences the presence in the S100A6 molecule of a cytokine-binding site, analogous to that found in S100P. The findings argue the presence in some of the promiscuous members of the S100 family of a site specific to a wide range of four-helical cytokines. This unique feature of the S100 proteins potentially allows them to modulate the activity of the numerous four-helical cytokines in the disorders accompanied by an excessive release of the cytokines.
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Affiliation(s)
- Alexey S. Kazakov
- Pushchino Scientific Center for Biological Research of the Russian Academy of Sciences, Institute for Biological Instrumentation, Institutskaya str., 7, Pushchino, Moscow Region 142290, Russia; (A.S.K.); (E.I.D.); (V.A.R.); (A.S.S.); (M.E.P.); (E.A.L.); (E.A.P.)
| | - Evgenia I. Deryusheva
- Pushchino Scientific Center for Biological Research of the Russian Academy of Sciences, Institute for Biological Instrumentation, Institutskaya str., 7, Pushchino, Moscow Region 142290, Russia; (A.S.K.); (E.I.D.); (V.A.R.); (A.S.S.); (M.E.P.); (E.A.L.); (E.A.P.)
| | - Victoria A. Rastrygina
- Pushchino Scientific Center for Biological Research of the Russian Academy of Sciences, Institute for Biological Instrumentation, Institutskaya str., 7, Pushchino, Moscow Region 142290, Russia; (A.S.K.); (E.I.D.); (V.A.R.); (A.S.S.); (M.E.P.); (E.A.L.); (E.A.P.)
| | - Andrey S. Sokolov
- Pushchino Scientific Center for Biological Research of the Russian Academy of Sciences, Institute for Biological Instrumentation, Institutskaya str., 7, Pushchino, Moscow Region 142290, Russia; (A.S.K.); (E.I.D.); (V.A.R.); (A.S.S.); (M.E.P.); (E.A.L.); (E.A.P.)
| | - Maria E. Permyakova
- Pushchino Scientific Center for Biological Research of the Russian Academy of Sciences, Institute for Biological Instrumentation, Institutskaya str., 7, Pushchino, Moscow Region 142290, Russia; (A.S.K.); (E.I.D.); (V.A.R.); (A.S.S.); (M.E.P.); (E.A.L.); (E.A.P.)
| | - Ekaterina A. Litus
- Pushchino Scientific Center for Biological Research of the Russian Academy of Sciences, Institute for Biological Instrumentation, Institutskaya str., 7, Pushchino, Moscow Region 142290, Russia; (A.S.K.); (E.I.D.); (V.A.R.); (A.S.S.); (M.E.P.); (E.A.L.); (E.A.P.)
| | - Vladimir N. Uversky
- Pushchino Scientific Center for Biological Research of the Russian Academy of Sciences, Institute for Biological Instrumentation, Institutskaya str., 7, Pushchino, Moscow Region 142290, Russia; (A.S.K.); (E.I.D.); (V.A.R.); (A.S.S.); (M.E.P.); (E.A.L.); (E.A.P.)
- Department of Molecular, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
- USF Health Byrd Alzheimer’s Research Institute, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
| | - Eugene A. Permyakov
- Pushchino Scientific Center for Biological Research of the Russian Academy of Sciences, Institute for Biological Instrumentation, Institutskaya str., 7, Pushchino, Moscow Region 142290, Russia; (A.S.K.); (E.I.D.); (V.A.R.); (A.S.S.); (M.E.P.); (E.A.L.); (E.A.P.)
| | - Sergei E. Permyakov
- Pushchino Scientific Center for Biological Research of the Russian Academy of Sciences, Institute for Biological Instrumentation, Institutskaya str., 7, Pushchino, Moscow Region 142290, Russia; (A.S.K.); (E.I.D.); (V.A.R.); (A.S.S.); (M.E.P.); (E.A.L.); (E.A.P.)
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Lee JJ, Piras E, Tamburini S, Bu K, Wallach DS, Remsen B, Cantor A, Kong J, Goetz D, Hoffman KW, Bonner M, Joe P, Mueller BR, Robinson-Papp J, Lotan E, Gonen O, Malaspina D, Clemente JC. Gut and oral microbiome modulate molecular and clinical markers of schizophrenia-related symptoms: A transdiagnostic, multilevel pilot study. Psychiatry Res 2023; 326:115279. [PMID: 37331068 PMCID: PMC10595250 DOI: 10.1016/j.psychres.2023.115279] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/09/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023]
Abstract
Although increasing evidence links microbial dysbiosis with the risk for psychiatric symptoms through the microbiome-gut-brain axis (MGBA), the specific mechanisms remain poorly characterized. In a diagnostically heterogeneous group of treated psychiatric cases and nonpsychiatric controls, we characterized the gut and oral microbiome, plasma cytokines, and hippocampal inflammatory processes via proton magnetic resonance spectroscopic imaging (1H-MRSI). Using a transdiagnostic approach, these data were examined in association with schizophrenia-related symptoms measured by the Positive and Negative Syndrome Scale (PANSS). Psychiatric cases had significantly greater heterogeneity of gut alpha diversity and an enrichment of pathogenic taxa, like Veillonella and Prevotella, in the oral microbiome, which was an accurate classifier of phenotype. Cases exhibited significantly greater positive, negative, and general PANSS scores that uniquely correlated with bacterial taxa. Strong, positive correlations of bacterial taxa were also found with cytokines and hippocampal gliosis, dysmyelination, and excitatory neurotransmission. This pilot study supports the hypothesis that the MGBA influences psychiatric symptomatology in a transdiagnostic manner. The relative importance of the oral microbiome in peripheral and hippocampal inflammatory pathways was highlighted, suggesting opportunities for probiotics and oral health to diagnose and treat psychiatric conditions.
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Affiliation(s)
- Jakleen J Lee
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Enrica Piras
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sabrina Tamburini
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kevin Bu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - David S Wallach
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Brooke Remsen
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Adam Cantor
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jennifer Kong
- Academy for the Advancement of Science and Technology, Bergen County Academies, Hackensack, NJ, United States
| | - Deborah Goetz
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Kevin W Hoffman
- Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Mharisi Bonner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Peter Joe
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Bridget R Mueller
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jessica Robinson-Papp
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Eyal Lotan
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Oded Gonen
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Dolores Malaspina
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Jose C Clemente
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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Predisposing Factors, Clinical Picture, and Outcome of B-Cell Non-Hodgkin’s Lymphoma in Sjögren’s Syndrome. IMMUNO 2022. [DOI: 10.3390/immuno2040037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Among other systemic autoimmune diseases, primary Sjögren syndrome (pSS) bears the highest risk for lymphoma development. In pSS, chronic antigenic stimulation gradually drives the evolution from polyclonal B-cell expansion to oligoclonal/monoclonal B-cell predominance to malignant B-cell transformation. Thus, most pSS-related lymphomas are B-cell non-Hodgkin lymphomas (NHLs), with mucosa-associated lymphoid tissue (MALT) lymphomas predominating, followed by diffuse large B-cell lymphomas (DLBCLs) and nodal marginal zone lymphomas (NMZLs). Since lymphomagenesis is one of the most serious complications of pSS, affecting patients’ survival, a plethora of possible predisposing factors has been studied over the years, ranging from classical clinical, serological, hematological, and histological, to the more recently proposed genetic and molecular, allowing clinicians to timely detect and to closely follow-up the subgroup of pSS patients with increased risk for lymphoma development. Overall predisposing factors for pSS-related lymphomagenesis reflect the status of B-cell hyperactivity. Different clinical features have been described for each of the distinct pSS-related B-cell NHL subtypes. While generally pSS patients developing B-cell NHLs display a fairly good prognosis, outcomes in terms of treatment response and survival rates seem to differ depending on the lymphoma subtype, with MALT lymphomas being characterized by a rather indolent course and DLBCLs gravely affecting patients’ survival.
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Stergiou IE, Bakasis AD, Giannouli S, Voulgarelis M. Biomarkers of lymphoma in Sjögren's syndrome: what's the latest? Expert Rev Clin Immunol 2022; 18:1155-1171. [PMID: 36097855 DOI: 10.1080/1744666x.2022.2123794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Primary Sjögren's syndrome (pSS) is a chronic autoimmune disease standing in the crossroads of autoimmunity and lymphomagenesis, characterized by chronic B-cell hyperactivity and ectopic lymphoid tissue neoformation, potentially driving lymphoid malignant transformation. Lymphoma development is considered the most serious complication of pSS. AREAS COVERED: “ Old-classical" biomarkers (clinical, serological, hematological, and histological) validated in the past are analyzed under the perspective of recently published research. Biomarkers that have emerged during the last decade are subdivided to "old-new" and "newly proposed-novel" ones, including biomarkers pathophysiologically related to B-cell differentiation, lymphoid organization, and immune responses, identified in serum and tissue, both at genetic and protein level. Upcoming new imaging biomarkers, promising for further patient stratification, are also analyzed. EXPERT OPINION Salivary gland enlargement and cryoglobulinemia still remain the best validated "classical-old" biomarkers for lymphoma development. Though new biomarkers still need to be validated, some can be used for the identification of high-risk patients long before lymphoma diagnosis, some might be more relevant in distinct age subgroups, while others have an added value in the assessment of lymphoma remission or relapse. Future development of composite indices integrating old and recently proposed biomarkers could contribute to a more precise lymphoma prediction model.
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Affiliation(s)
- Ioanna E Stergiou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios-Dimitrios Bakasis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Giannouli
- Hematology Unit, Second Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Voulgarelis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Seror R, Nocturne G, Mariette X. Current and future therapies for primary Sjögren syndrome. Nat Rev Rheumatol 2021; 17:475-486. [PMID: 34188206 DOI: 10.1038/s41584-021-00634-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 02/06/2023]
Abstract
Primary Sjögren syndrome (pSS) is a systemic autoimmune disease that is characterized by a triad of symptoms that affect all patients (dryness, pain and fatigue). In addition, systemic involvement can affect between one-third and one-half of patients. The management of patients with pSS has been negatively affected by a lack of effective treatments; however, knowledge of the epidemiology of pSS has increased, and advances in developing classification criteria, systemic disease activity scoring and patient-reported outcomes have been made during the past decade. Progress has also been made in understanding the mechanisms that underlie the pathogenesis of pSS, which has enabled a more targeted therapeutic approach to be taken. At present, therapeutic decisions rely on the evaluation of symptoms and systemic manifestations and are mostly formed on the basis of experience rather than evidence, and on similarities with other autoimmune diseases, although the 2019 management recommendations from EULAR are now being used to inform clinical management of pSS. This Review summarizes the available evidence for systemic treatments for pSS and includes discussions of advances in outcome assessment, the current evidence for DMARD use and an overview of promising future therapeutics.
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Affiliation(s)
- Raphaèle Seror
- Department of Rheumatology, Université Paris-Saclay, INSERM U1184: Centre for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, Paris, France
| | - Gaetane Nocturne
- Department of Rheumatology, Université Paris-Saclay, INSERM U1184: Centre for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, Paris, France
| | - Xavier Mariette
- Department of Rheumatology, Université Paris-Saclay, INSERM U1184: Centre for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, Paris, France.
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Ruiz-Ordoñez I, Piedrahita JM, Arévalo JA, Agualimpia A, Tobón GJ. Lymphomagenesis predictors and related pathogenesis. J Transl Autoimmun 2021; 4:100098. [PMID: 33889831 PMCID: PMC8050773 DOI: 10.1016/j.jtauto.2021.100098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Abstract
Sjögren's syndrome (SS) is a systemic autoimmune disease characterised by a wide range of clinical manifestations and complications, including B-cell lymphoma. This study aims to describe the predictors associated with lymphomagenesis in patients with Sjögren's syndrome, emphasising the pathophysiological bases that support this association. We performed a review of the literature published through a comprehensive search strategy in PubMed/MEDLINE, Scopus, and Web of science. Forty publications describing a total of 45,208 patients with SS were retrieved. The predictors were grouped according to their pathophysiological role in the lymphoproliferation process. Also, some new biomarkers such as MicroRNAs, P2X7 receptor-NLRP3 inflammasome, Thymic stromal lymphopoietin, and Three-prime repair exonuclease 1 (TREX1) were identified. The knowledge of the pathophysiology allows the discrimination of markers that participate in the initial stages. Considering that the lymphoproliferation process includes the progression of lymphoma towards more aggressive subtypes, it is essential to recognise biomarkers associated with a worse prognosis.
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Affiliation(s)
- Ingrid Ruiz-Ordoñez
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra 98 No. 18-49, Cali, 760032, Colombia
- Universidad Icesi, Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
| | - Juan-Manuel Piedrahita
- Universidad Icesi, Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
- Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | - Javier-Andrés Arévalo
- Universidad Icesi, Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
- Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | - Andrés Agualimpia
- Universidad Icesi, Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
- Fundación Valle del Lili, Unidad de Reumatología, Cra 98 No. 18-49, Cali. 760032, Colombia
| | - Gabriel J Tobón
- Universidad Icesi, Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
- Fundación Valle del Lili, Unidad de Reumatología, Cra 98 No. 18-49, Cali. 760032, Colombia
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Roszkowska AM, Oliverio GW, Aragona E, Inferrera L, Severo AA, Alessandrello F, Spinella R, Postorino EI, Aragona P. Ophthalmologic Manifestations of Primary Sjögren's Syndrome. Genes (Basel) 2021; 12:genes12030365. [PMID: 33806489 PMCID: PMC7998625 DOI: 10.3390/genes12030365] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023] Open
Abstract
Sjögren’s syndrome (SS) is a chronic, progressive, inflammatory, autoimmune disease, characterized by the lymphocyte infiltration of exocrine glands, especially the lacrimal and salivary, with their consequent destruction. The onset of primary SS (pSS) may remain misunderstood for several years. It usually presents with different types of severity, e.g., dry eye and dry mouth symptoms, due to early involvement of the lacrimal and salivary glands, which may be associated with parotid enlargement and dry eye; keratoconjunctivitis sicca (KCS) is its most common ocular manifestation. It is still doubtful if the extent ocular surface manifestations are secondary to lacrimal or meibomian gland involvement or to the targeting of corneal and conjunctival autoantigens. SS is the most representative cause of aqueous deficient dry eye, and the primary role of the inflammatory process was evidenced. Recent scientific progress in understanding the numerous factors involved in the pathogenesis of pSS was registered, but the exact mechanisms involved still need to be clarified. The unquestionable role of both the innate and adaptive immune system, participating actively in the induction and evolution of the disease, was recognized. The ocular surface inflammation is a central mechanism in pSS leading to the decrease of lacrimal secretion and keratoconjunctival alterations. However, there are controversies about whether the ocular surface involvement is a direct autoimmune target or secondary to the inflammatory process in the lacrimal gland. In this review, we aimed to present actual knowledge relative to the pathogenesis of the pSS, considering the role of innate immunity, adaptive immunity, and genetics.
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Affiliation(s)
- Anna Maria Roszkowska
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
- Correspondence:
| | - Giovanni William Oliverio
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Emanuela Aragona
- IRCCS San Raffaele Scientific Institute, Ophthalmology Clinic, Vita Salute San Raffaele University, 20132 Milan, Italy;
| | - Leandro Inferrera
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Alice Antonella Severo
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Federica Alessandrello
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Rosaria Spinella
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Elisa Imelde Postorino
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
| | - Pasquale Aragona
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98124 Messina, Italy; (G.W.O.); (L.I.); (A.A.S.); (F.A.); (R.S.); (E.I.P.); (P.A.)
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Abstract
Introduction: Primary Sjögren's syndrome (pSS) is an autoimmune systemic disease characterized by a complex and not yet completely elucidated etiopathogenesis, where autoimmune manifestations coexist with different degree of lymphoproliferation, resulting in multiple possible scenarios extremely heterogeneous from patient to patient. Although considerable progress has been made in the identifications of potential novel therapeutic targets in recent years, the biological complexity of pSS, combined to such heterogeneous clinical manifestations, makes the treatment of pSS, even today, a great challenge. Areas covered: A therapy specifically approved for pSS is still lacking. In recent years, several novel promising agents are being tested in pSS. Based on a deep revision of drugs evaluated for pSS therapy, it is striking that several clinical trials, some of them testing very promising agents, failed. Expert opinion: a renewal of clinical trial design, including the definition of novel inclusion criteria and outcome measures, together with the development of a stratification model of pSS patients and the advance in the definition of pathogenetic mechanisms underlying peculiar pSS subsets, represent preliminary and crucial steps to overcome the current therapeutic impasse in pSS.
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Affiliation(s)
- Saviana Gandolfo
- a Rheumatology Clinic, Udine University Hospital, Department of Medical Area , University of Udine , Udine , Italy
| | - Salvatore De Vita
- a Rheumatology Clinic, Udine University Hospital, Department of Medical Area , University of Udine , Udine , Italy
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Skarlis C, Argyriou E, Mavragani CP. Lymphoma in Sjögren’s Syndrome: Predictors and Therapeutic Options. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00138-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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12
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Noureldine HA, Nour-Eldine W, Hodroj MH, Noureldine MHA, Taher A, Uthman I. Hematological malignancies in connective tissue diseases. Lupus 2020; 29:225-235. [PMID: 31933408 DOI: 10.1177/0961203319899986] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Chronic inflammation has profound tumor-promoting effects. Inflammatory cells are the key players in immunosurveillance against tumors, and immunosuppression is known to increase the risk of tumors. Autoimmune diseases, which manifest as loss of self-tolerance and chronic immune dysregulation, provide a perfect environment for tumor development. Aside from managing the direct inflammatory consequences of autoimmune pathogenesis, cancer risk profiles should be considered as a part of a patient's treatment. In this review, we describe the various associations of malignancies with autoimmune diseases, specifically systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, and Sjögren's syndrome, as well as discuss the mechanisms contributing to the pathogenesis of both disorders.
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Affiliation(s)
- H A Noureldine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - W Nour-Eldine
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - M H Hodroj
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - M H A Noureldine
- Johns Hopkins University School of Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, USA
| | - A Taher
- Division of Hematology and Medical Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - I Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Invariant NKT Cells and Rheumatic Disease: Focus on Primary Sjogren Syndrome. Int J Mol Sci 2019; 20:ijms20215435. [PMID: 31683641 PMCID: PMC6862604 DOI: 10.3390/ijms20215435] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 02/07/2023] Open
Abstract
Primary Sjogren syndrome (pSS) is a complex autoimmune disease mainly affecting salivary and lacrimal glands. Several factors contribute to pSS pathogenesis; in particular, innate immunity seems to play a key role in disease etiology. Invariant natural killer (NK) T cells (iNKT) are a T-cell subset able to recognize glycolipid antigens. Their function remains unclear, but studies have pointed out their ability to modulate the immune system through the promotion of specific cytokine milieu. In this review, we discussed the possible role of iNKT in pSS development, as well as their implications as future markers of disease activity.
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Nezos A, Evangelopoulos ME, Mavragani CP. Genetic contributors and soluble mediators in prediction of autoimmune comorbidity. J Autoimmun 2019; 104:102317. [PMID: 31444033 DOI: 10.1016/j.jaut.2019.102317] [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: 07/31/2019] [Accepted: 08/03/2019] [Indexed: 12/20/2022]
Abstract
Comorbidities including subclinical atherosclerosis, neuropsychological aberrations and lymphoproliferation represent a major burden among patients with systemic autoimmune diseases; they occur either as a result of intrinsic disease related characteristics including therapeutic interventions or traditional risk factors similar to those observed in general population. Soluble molecules recently shown to contribute to subclinical atherosclerosis in the context of systemic lupus erythematosus (SLE) include among others B-cell activating factor (BAFF), hyperhomocysteinemia, parathormone (PTH) levels and autoantibodies against oxidized lipids. Variations of the 5, 10- methylenetetrahydrofolate reductase (MTHFR) gene -the main genetic determinant of hyperhomocystenemia in humans-as well the interferon regulatory factor-8 (IRF8), FcγRIIA and BAFF genes have been all linked to subclinical atherosclerosis in SLE. BAFF variants have been also found to confer increased risk for subclinical atherosclerosis and lymphoma development in Sjogren's syndrome (SS) patients. Other genes shown to be implicated in SS lymphoproliferation include genes involved a. in inflammatory responses such as the NFκB regulator Tumor necrosis factor alpha-induced protein 3 (TNFAIP3) and the Leukocyte immunoglobulin-like receptor A3 (LILRA3) immunoreceptor, b. B cell activation and signaling (BAFF/BAFF-receptor), c. type I IFN pathway such as three-prime repair exonuclease 1 (TREX1), d. epigenetic processes including DNA methylation (MTHFR rs1801133, 677T allele) and e. genomic instability (MTHFR rs1801131, 1298C allele). Emerging soluble biomarkers for SS related lymphoma include mediators of B cell growth and germinal center formation such as BAFF, FMS-like tyrosine kinase 3 ligand (Flt-3L) and CXCL13 as well as inflammatory contributors such as inteleukin (IL)-17, IL-18, ASC, LILRA3 and the extracellular lipoprotein-associated phospholipase A2 (Lp-PLA2). In regard to fatigue and neuropsychologic features in the setting of SS, contributing factors such as BAFF variants, antibodies against neuropeptides, proteins involved in nervous system function as well as inflammatory cytokines have been reported.
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Affiliation(s)
- Adrianos Nezos
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria-Eleutheria Evangelopoulos
- First Department of Neurology, Demyelinating Diseases Unit, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Clio P Mavragani
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece; Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
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15
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Kapsogeorgou EK, Voulgarelis M, Tzioufas AG. Predictive markers of lymphomagenesis in Sjögren's syndrome: From clinical data to molecular stratification. J Autoimmun 2019; 104:102316. [PMID: 31431317 DOI: 10.1016/j.jaut.2019.102316] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 12/26/2022]
Abstract
Sjögren's syndrome (SS) is a chronic systemic autoimmune disease, affecting predominantly the exocrine glands, a large array of systemic manifestations and high risk of lymphoma development. The latter constitutes the major adverse outcome of SS contributing in the increased morbidity and mortality of the disease. The vast majority of lymphomas in SS are B-cell non-Hodgkin's lymphomas (NHL), primarily indolent mucosa-associated lymphoid tissue (MALT) lymphomas, followed by nodal marginal zone lymphomas (NMZL) and diffuse large B cell lymphomas (DLBCL). In the last 3 decades and due to the adverse impact of NHL in disease outcome, an effort has been undertaken to identify markers and models predicting patients with SS at high risk for lymphoma development. Several epidemiological, clinical, laboratory and histological parameters, some of which are evident at the time of SS diagnosis, were proved to independently predict the development of NHL. These include salivary gland enlargement, skin vasculitis/purpura, glomerulonephritis, peripheral neuropathy, Raynaud's phenomenon, lymphadenopathy, splenomegaly, cytopenias, hypocomplementemia, cryoglobulinemia, rheumatoid factor, anti-Ro/La autoantibodies, hypergammaglobulinemia, serum monoclonal gammopathy, biopsy focus score and organization of lymphocytic infiltrates in the salivary glands into ectopic germinal centers. Prediction models combining some of the afore-mentioned predictors have also been described. However, the identification of specific and sensitive molecular biomarkers, related to the process of lymphomagenesis is still pending. Recently, we described a novel biomarker the miR200b-5p micro-RNA. Low levels of this miRNA in the minor salivary glands, appears to discriminate with high specificity and sensitivity the SS patients who have from those who do not have NHL. miR200b-5p, being expressed years before the clinical onset of NHL, independently predicts NHL development with a predictive value higher than the previously published multifactorial models and has a possible role in the monitoring of therapeutic response. Thus, it is a strong candidate for the identification and follow-up of patients at risk.
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Affiliation(s)
- Efstathia K Kapsogeorgou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece; Academic Joint Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Greece.
| | - Michael Voulgarelis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece; Academic Joint Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Greece.
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece; Academic Joint Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Greece.
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16
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Mielle J, Tison A, Cornec D, Le Pottier L, Daien C, Pers JO. B cells in Sjögren's syndrome: from pathophysiology to therapeutic target. Rheumatology (Oxford) 2019; 60:2545-2560. [PMID: 30770916 DOI: 10.1093/rheumatology/key332] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/04/2018] [Indexed: 12/12/2022] Open
Abstract
Biological abnormalities associated with B lymphocytes are a hallmark of patients with primary Sjögren's syndrome. Those patients present abnormal distribution of B lymphocytes in peripheral blood and B cells in exocrine glands. B cells produce auto-antibodies, cytokines and present antigens but can also suppressive functions. In this review, we will summarize current knowledge on B cells in primary Sjögren's syndrome patients, demonstrate their critical role in the immunopathology of the disease and describe the past and current trials targeting B cells.
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Affiliation(s)
- Julie Mielle
- Departement of Rheumatology, UMR5535, Inflammation and Cancer, University of Montpellier and Teaching hospital of Montpellier, Montpellier, France
| | - Alice Tison
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, France.,Service de Rhumatologie, CHU de Brest, Brest, France
| | - Divi Cornec
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, France.,Service de Rhumatologie, CHU de Brest, Brest, France
| | | | - Claire Daien
- Departement of Rheumatology, UMR5535, Inflammation and Cancer, University of Montpellier and Teaching hospital of Montpellier, Montpellier, France
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Cha S, Mona M, Lee KE, Kim DH, Han K. MicroRNAs in Autoimmune Sjögren's Syndrome. Genomics Inform 2018; 16:e19. [PMID: 30602080 PMCID: PMC6440664 DOI: 10.5808/gi.2018.16.4.e19] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/17/2018] [Indexed: 12/19/2022] Open
Abstract
MicroRNAs (miRNAs), small non-coding RNAs, have been implicated in various diseases and cellular functions as microregulators of gene expression. Although the history of miRNA investigation in autoimmune Sjögren’s syndrome (SjS) is fairly short, a substantial amount of data has already been accumulated. These findings clearly indicate potential clinical implications of miRNAs, such as autoantigen expression and autoantibody production, viral miRNAs regulating the calcium signaling pathway, and aberrant immune cell regulation and cytokine production. Research endeavors in the field are currently underway to select disease-specific diagnostic and prognostic biomarkers by utilizing different types of tissues or biological specimens of SjS patients. Various techniques for miRNA analysis with different stringencies have been applied, with the most recent one being next-generation sequencing. This review compiles and highlights differentially-expressed miRNAs in various samples collected from SjS patients and their potential implications in the pathogenesis of SjS. To facilitate the development of miRNA-targeted personalized therapy in the future, we urge more follow-up studies that confirm these findings and elucidate the immunopathological roles of differentially-expressed miRNAs. Furthermore, improved diagnostic criteria for the disease itself will minimize sampling errors in patient recruitment, preventing the generation of inconsistent data.
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Affiliation(s)
- Seunghee Cha
- Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL 32610, USA
| | - Mahmoud Mona
- Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL 32610, USA
| | - Kyung Eun Lee
- Department of Oral Medicine, School of Dentistry, Chonbuk National University, Jeonju 54896, Korea
| | - Dong Hee Kim
- Department of Anesthesiology and Pain Management, College of Medicine, Dankook University, Cheonan 31116, Korea
| | - Kyudong Han
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, Korea
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Goules AV, Tzioufas AG. Lymphomagenesis in Sjögren's syndrome: Predictive biomarkers towards precision medicine. Autoimmun Rev 2018; 18:137-143. [PMID: 30572133 DOI: 10.1016/j.autrev.2018.08.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/08/2018] [Indexed: 12/22/2022]
Abstract
Sjögren's syndrome (SS) is characterized by B cell hyperactivity documented by the production of plethora of autoantibodies and a strong tendency for NHL of B cell origin. Classical predictors of lymphoma have been already proposed and proved their validity, including clinical, serological and histopathologic biomarkers. The process of lymphomagenesis is multistep and encompasses mechanisms of antigen driven selection of the BCR with RF activity and various genetic contributors implicated in B cell proliferation, cell growth and cell cycle control, enhanced by a complex milieu of cytokines and trophic agents that are abundant within the inflammatory lesion of minor salivary glands of SS patients. Extensive efforts in the basic research field have revealed several novel biomarkers for lymphoma prediction while the major cellular and molecular mechanisms of evolutionary transition of B cells towards malignancy are under investigation. In this review, we present the current data regarding the newly proposed biomarkers for SS associated lymphoma prediction and a hypothetical model of lymphomagenesis based on the emerging data.
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Affiliation(s)
- Andreas V Goules
- Department of Pathophysiology, School of Medicine, University of Athens, Mikras Asias Str 75, 115 27 Athens, Greece
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, University of Athens, Mikras Asias Str 75, 115 27 Athens, Greece.
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19
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Cytokine markers of B lymphocytes in minor salivary gland infiltrates in Sjögren's syndrome. Autoimmun Rev 2018; 17:709-714. [DOI: 10.1016/j.autrev.2018.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/04/2018] [Indexed: 12/18/2022]
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Sandhya P, Kurien BT, Danda D, Scofield RH. Update on Pathogenesis of Sjogren's Syndrome. Curr Rheumatol Rev 2018; 13:5-22. [PMID: 27412602 DOI: 10.2174/1573397112666160714164149] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 11/15/2015] [Accepted: 01/01/2016] [Indexed: 01/06/2023]
Abstract
Sjogren's syndrome is a common autoimmune disease that presents with sicca symptoms and extraglandular features. Sjogren's syndrome is presumably as common as RA; yet it is poorly understood, underdiagnosed and undertreated. From the usual identity as an autoimmune exocrinopathy to its most recent designate as an autoimmune epithelitis - the journey of SS is complex. We herein review some of the most important milestones that have shed light on different aspects of pathogenesis of this enigmatic disease. This includes role of salivary gland epithelial cells, and their interaction with cells of the innate and adaptive immune system. Non-immune factors acting in concert or in parallel with immune factors may also be important. The risk genes identified so far have only weak association, nevertheless advances in genetics have enhanced understanding of disease mechanisms. Role of epigenetic and environmental role factors is also being explored. SS has also some unique features such as congenital heart block and high incidence of lymphoma; disease mechanisms accounting for these manifestations are also reviewed.
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Foulquier N, Redou P, Le Gal C, Rouvière B, Pers JO, Saraux A. Pathogenesis-based treatments in primary Sjogren's syndrome using artificial intelligence and advanced machine learning techniques: a systematic literature review. Hum Vaccin Immunother 2018; 14:2553-2558. [PMID: 29771635 DOI: 10.1080/21645515.2018.1475872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Big data analysis has become a common way to extract information from complex and large datasets among most scientific domains. This approach is now used to study large cohorts of patients in medicine. This work is a review of publications that have used artificial intelligence and advanced machine learning techniques to study physio pathogenesis-based treatments in pSS. A systematic literature review retrieved all articles reporting on the use of advanced statistical analysis applied to the study of systemic autoimmune diseases (SADs) over the last decade. An automatic bibliography screening method has been developed to perform this task. The program called BIBOT was designed to fetch and analyze articles from the pubmed database using a list of keywords and Natural Language Processing approaches. The evolution of trends in statistical approaches, sizes of cohorts and number of publications over this period were also computed in the process. In all, 44077 abstracts were screened and 1017 publications were analyzed. The mean number of selected articles was 101.0 (S.D. 19.16) by year, but increased significantly over the time (from 74 articles in 2008 to 138 in 2017). Among them only 12 focused on pSS but none of them emphasized on the aspect of pathogenesis-based treatments. To conclude, medicine progressively enters the era of big data analysis and artificial intelligence, but these approaches are not yet used to describe pSS-specific pathogenesis-based treatment. Nevertheless, large multicentre studies are investigating this aspect with advanced algorithmic tools on large cohorts of SADs patients.
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Affiliation(s)
- Nathan Foulquier
- a LATIM, Laboratoire de Traitement de l'Information Médicale, Université de Brest, Inserm, CHU Brest , Brest , France.,b Lymphocytes B et Autoimmunité Université de Brest, Inserm, CHU Brest, LabEx IGO , Brest , France
| | - Pascal Redou
- a LATIM, Laboratoire de Traitement de l'Information Médicale, Université de Brest, Inserm, CHU Brest , Brest , France
| | - Christophe Le Gal
- a LATIM, Laboratoire de Traitement de l'Information Médicale, Université de Brest, Inserm, CHU Brest , Brest , France
| | - Bénédicte Rouvière
- b Lymphocytes B et Autoimmunité Université de Brest, Inserm, CHU Brest, LabEx IGO , Brest , France.,c Internal Medicine Unit, CHU , Brest , France
| | | | - Alain Saraux
- c Internal Medicine Unit, CHU , Brest , France.,d Rheumatology Unit, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU , Brest , France
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Alunno A, Leone MC, Giacomelli R, Gerli R, Carubbi F. Lymphoma and Lymphomagenesis in Primary Sjögren's Syndrome. Front Med (Lausanne) 2018; 5:102. [PMID: 29707540 PMCID: PMC5909032 DOI: 10.3389/fmed.2018.00102] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/28/2018] [Indexed: 12/12/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease mainly affecting exocrine glands and leading to impaired secretory function. The clinical picture is dominated by signs and symptoms of mucosal dryness and the course of the disease is mild and indolent in the majority of cases. However, a subgroup of patients can also experience extraglandular manifestations that worsen the disease prognosis. pSS patients are consistently found to have a higher risk of developing non-Hodgkin lymphoma (NHL) compared with patients with other autimmune disorders and to the general population. NHL is the most severe comorbidity that can occur in pSS, therefore recent research has aimed to identify reliable clinical, serological, and histological biomarkers able to predict NHL development in these subjects. This review article encompasses the body of evidence published so far in this field highlighting the challenges and pitfalls of different biomarkers within clinical practice. We also provide an overview of epidemiological data, diagnostic procedures, and evidence-based treatment strategies for NHL in pSS.
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Affiliation(s)
- Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Maria Comasia Leone
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Francesco Carubbi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,ASL1 Avezzano-Sulmona-L'Aquila, Department of Medicine, L'Aquila, Italy
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23
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Shih YH, Yang Y, Chang KH, Chen YH, Teng CLJ. Clinical features and outcome of lymphoma patients with pre-existing autoimmune diseases. Int J Rheum Dis 2017; 21:93-101. [DOI: 10.1111/1756-185x.13231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Yu-Hsuan Shih
- Division of Hematology/Medical Oncology; Department of Medicine; Taichung Veterans General Hospital; Taichung Taiwan
| | - Youngsen Yang
- Division of Hematology/Medical Oncology; Department of Medicine; Taichung Veterans General Hospital; Taichung Taiwan
- Internal Medicine; China Medical University; Taichung Taiwan
| | - Kuang-Hsi Chang
- Graduate Institute of Biomedical Sciences; China Medical University; Taichung Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology; Department of Medicine; Taichung Veterans General Hospital; Taichung Taiwan
- Department of Life Science; Tunghai University; Taichung Taiwan
- Faculty of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Chieh-Lin Jerry Teng
- Division of Hematology/Medical Oncology; Department of Medicine; Taichung Veterans General Hospital; Taichung Taiwan
- Department of Life Science; Tunghai University; Taichung Taiwan
- Faculty of Medicine; Chung Shan Medical University; Taichung Taiwan
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24
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Primary Sjögren’s syndrome: clinical phenotypes, outcome and the development of biomarkers. Immunol Res 2016; 65:331-344. [DOI: 10.1007/s12026-016-8844-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Primary Sjögren syndrome (pSS) is a progressive autoimmune disease characterized by sicca and systemic manifestations. In this Review, we summarize the available data on topical and systemic medications, according to clinical signs and disease activity, and we describe the ongoing studies using biologic drugs in the treatment of pSS. Expanding knowledge about the epidemiology, classification criteria, systemic activity scoring (ESSDAI) and patient-reported outcomes (ESSPRI) is driving active research. Treatment decisions are based on the evaluation of symptoms and extraglandular manifestations. Symptomatic treatment is usually appropriate, whereas systemic treatment is reserved for systemic manifestations. Sicca is managed by education, environment modification, elimination of contingent offending drugs, artificial tears, secretagogues and treatments for complications. Mild systemic signs such as fatigue are treated by exercise. Pain can require short-term moderate-dose glucocorticoid therapy and, in some cases, disease-modifying drugs. Severe and acute systemic manifestations indicate treatment with glucocorticoids and/or immunosuppressant drugs. The role for biologic agents is promising, but no double-blind randomized controlled trials (RCTs) proving the efficacy of these drugs are available. Targets for new treatments directed against the immunopathological mechanisms of pSS include epithelial cells, T cells, B-cell overactivity, the interferon signature, proinflammatory cytokines, ectopic germinal centre formation, chemokines involved in lymphoid cell homing, and epigenetic modifications.
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Affiliation(s)
- Alain Saraux
- EA2216, INSERM ESPRI ERI29, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Université de Brest, Labex 'Immunotherapy, Graft, Oncology', 29609 Brest Cedex, France.,Department of Rheumatology, Centre Hospitalier Universitaire de la Cavale Blanche, 29609 Brest, France
| | - Jacques-Olivier Pers
- Department of Rheumatology, Centre Hospitalier Universitaire de la Cavale Blanche, 29609 Brest, France
| | - Valérie Devauchelle-Pensec
- EA2216, INSERM ESPRI ERI29, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Université de Brest, Labex 'Immunotherapy, Graft, Oncology', 29609 Brest Cedex, France.,Department of Rheumatology, Centre Hospitalier Universitaire de la Cavale Blanche, 29609 Brest, France
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26
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Goules AV, Tzioufas AG. Primary Sjӧgren's syndrome: Clinical phenotypes, outcome and the development of biomarkers. Autoimmun Rev 2016; 15:695-703. [DOI: 10.1016/j.autrev.2016.03.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 11/25/2022]
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27
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Seror R, Meiners P, Baron G, Bootsma H, Bowman SJ, Vitali C, Gottenberg JE, Theander E, Tzioufas A, De Vita S, Ramos-Casals M, Dörner T, Quartuccio L, Ravaud P, Mariette X. Development of the ClinESSDAI: a clinical score without biological domain. A tool for biological studies. Ann Rheum Dis 2016; 75:1945-1950. [DOI: 10.1136/annrheumdis-2015-208504] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/20/2015] [Indexed: 11/04/2022]
Abstract
ObjectiveTo develop and validate ClinESSDAI (Clinical European League Against Rheumatism Sjögren's Syndrome Disease Activity Index), ie, ESSDAI without the biological domain.Patients and methodsThe 702 fictive vignettes derived from 96 real cases of primary Sjögren's syndrome of the ESSDAI development study were used. As for ESSDAI development, the physician assessment of disease activity (0–10 scale) was used as the ‘gold standard’ in a multivariate model for weighting domains, after removing the biological domain. The reliability, assessed by intraclass correlation coefficient (ICC) between ClinESSDAI and ESSDAI, explored if ClinESSDAI was equivalent to ESSDAI. Its psychometric (ie, measurement) properties were compared with that of ESSDAI in an independent cohort. Also, its use was evaluated on data of two clinical trials.ResultsIn multivariate modelling, all 11 domains remained significantly associated with disease activity, with slight modifications of some domain weights. Reliability between clinESSDAI and ESSDAI was excellent (ICC=0.98 and 0.99). Psychometric properties of clinESSDAI, disease activity levels and minimal clinically important improvement thresholds and its ability to detect change over time in clinical trials were very close to that of ESSDAI.ConclusionsClinESSDAI appears valid and very close to the original ESSDAI. This score provides an accurate evaluation of disease activity independent of B-cell biomarkers. It could be used in various circumstances: (i) in biological/clinical studies to avoid data collinearity, (ii) in clinical trials, as secondary endpoint, to detect change independent of biological effect of the drug, (iii) in clinical practice to assess disease activity for visits where immunological tests have not been done.
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28
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Papageorgiou A, Mavragani CP, Nezos A, Zintzaras E, Quartuccio L, De Vita S, Koutsilieris M, Tzioufas AG, Moutsopoulos HM, Voulgarelis M. A BAFF Receptor His159Tyr Mutation in Sjögren's Syndrome-Related Lymphoproliferation. Arthritis Rheumatol 2015; 67:2732-41. [DOI: 10.1002/art.39231] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 06/04/2015] [Indexed: 01/05/2023]
Affiliation(s)
| | | | | | - Elias Zintzaras
- University of Thessaly School of Medicine, Larissa, Greece, and The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts University School of Medicine; Boston Massachusetts
| | - Luca Quartuccio
- University Hospital Santa Maria della Misericordia; Udine Italy
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29
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Chen W, Cao H, Lin J, Olsen N, Zheng SG. Biomarkers for Primary Sjögren's Syndrome. GENOMICS PROTEOMICS & BIOINFORMATICS 2015; 13:219-23. [PMID: 26362815 PMCID: PMC4610966 DOI: 10.1016/j.gpb.2015.06.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/24/2015] [Accepted: 06/08/2015] [Indexed: 02/06/2023]
Abstract
Primary Sjögren’s syndrome (pSS) is a systemic autoimmune disease with exocrine gland dysfunction and multi-organ involvement. Recent progress in understanding the pathogenesis of pSS offers an opportunity to find new biomarkers for the diagnosis and assessment of disease activity. Screening noninvasive biomarkers from the saliva and tears has significant potential. The need for specific and sensitive biomarker candidates in pSS is significant. This review aims to summarize recent advances in the identification of biomarkers of Sjögren syndrome, trying to identify reliable, sensitive, and specific biomarkers that can be used to guide treatment decisions.
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Affiliation(s)
- Weiqian Chen
- Division of Rheumatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China; Division of Rheumatology, Penn State University Hershey College of Medicine, Hershey, PA 17033, USA
| | - Heng Cao
- Division of Rheumatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Jin Lin
- Division of Rheumatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
| | - Nancy Olsen
- Division of Rheumatology, Penn State University Hershey College of Medicine, Hershey, PA 17033, USA
| | - Song Guo Zheng
- Division of Rheumatology, Penn State University Hershey College of Medicine, Hershey, PA 17033, USA.
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30
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Clinical picture, outcome and predictive factors of lymphoma in Sjӧgren syndrome. Autoimmun Rev 2015; 14:641-9. [DOI: 10.1016/j.autrev.2015.03.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/16/2015] [Indexed: 12/12/2022]
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31
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Papageorgiou A, Ziogas DC, Mavragani CP, Zintzaras E, Tzioufas AG, Moutsopoulos HM, Voulgarelis M. Predicting the outcome of Sjogren's syndrome-associated non-hodgkin's lymphoma patients. PLoS One 2015; 10:e0116189. [PMID: 25723713 PMCID: PMC4344229 DOI: 10.1371/journal.pone.0116189] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/08/2014] [Indexed: 01/14/2023] Open
Abstract
Background Non-Hodgkin's lymphoma (NHL) development in Sjögren’s syndrome (SS) remains a potentially lethal complication and efforts should focus on the identification of predictors that could aid in appropriate therapeutic decisions. Methods In order to identify potential prognostic factors for outcome in SS-associated NHL, we retrospectively analyzed a cohort of 77 patients, diagnosed with NHL according to WHO classification criteria and meeting the American-European Consensus Classification (AECC) criteria for SS and examined the effect of SS-activity (defined as the EULAR SS disease activity index-ESSDAI) in the prognosis of SS-related NHLs, as defined in terms of overall and event-free survivals (OS and EFS). An event was defined as lymphoma relapse, treatment failure, disease progression, histological transformation or death. The effect of NHL clinical and laboratory characteristics was also investigated. Results MALT lymphomas constituted the majority (66.2%) of lymphomas. During the follow-up (median = 57.93 months), the 5-year OS was 90.91% (95% CI: 82.14–95.80%) and the EFS was 77.92% (95% CI: 67.37–85.82%). Patients with high ESSDAI score at lymphoma diagnosis had a greater risk for death (OR = 5.241, 95% CI: 1.034–26.568) or for event (OR = 4.317, 95% CI: 1.146–9.699, p = 0.008). These patients had also significantly worse EFS (HR = 4.541, 95% CI: 1.772–11.637) and OS (HR = 5.946, 95% CI: 1.259–28.077). In addition, post-chemotherapy ESSDAI improvement was significantly lower in patients who had experienced an event (p = 0.005). An unfavorable International prognostic index (IPI) score (high-intermediate/high) was associated with high risk of death and event (OR = 13.867, 95% CI: 2.656–72.387 and OR = 12.589, 95% CI: 3.911–40.526, respectively), worse EFS (log-rank p<0.001, HR = 8.718, 95% CI: 3.477–21.858), as well as with worse OS (log-rank p<0.001, HR = 11.414, 95% CI: 2.414–53.974). After adjustment for identified risk factors, IPI score retained a significant prognostic role following by a strong effect of ESSDAI in survival outcomes. Conclusions At the point of NHL diagnosis, IPI and ESSDAI might be proved useful predictive tools in SS-associated lymphoma prognosis, directing to a more patient-tailored approach.
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Affiliation(s)
- Aristea Papageorgiou
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
| | - Dimitrios C. Ziogas
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
| | - Clio P. Mavragani
- Department of Physiology, School of Medicine, University of Athens, Athens, Greece
| | - Elias Zintzaras
- Department of Biomathematics, School of Medicine, University of Thessaly, Larissa, Greece
| | | | | | - Michael Voulgarelis
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
- * E-mail:
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32
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Seror R, Bowman SJ, Brito-Zeron P, Theander E, Bootsma H, Tzioufas A, Gottenberg JE, Ramos-Casals M, Dörner T, Ravaud P, Vitali C, Mariette X, Asmussen K, Jacobsen S, Bartoloni E, Gerli R, Bijlsma JW, Kruize AA, Bombardieri S, Bookman A, Kallenberg C, Meiners P, Brun JG, Jonsson R, Caporali R, Carsons S, De Vita S, Del Papa N, Devauchelle V, Saraux A, Fauchais AL, Sibilia J, Hachulla E, Illei G, Isenberg D, Jones A, Manoussakis M, Mandl T, Jacobsson L, Demoulins F, Montecucco C, Ng WF, Nishiyama S, Omdal R, Parke A, Praprotnik S, Tomsic M, Price E, Scofield H, L Sivils K, Smolen J, Laqué RS, Steinfeld S, Sutcliffe N, Sumida T, Valesini G, Valim V, Vivino FB, Vollenweider C. EULAR Sjögren's syndrome disease activity index (ESSDAI): a user guide. RMD Open 2015; 1:e000022. [PMID: 26509054 PMCID: PMC4613159 DOI: 10.1136/rmdopen-2014-000022] [Citation(s) in RCA: 196] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/10/2015] [Accepted: 01/18/2015] [Indexed: 12/22/2022] Open
Abstract
The EULAR Sjögren's syndrome (SS) disease activity index (ESSDAI) is a systemic disease activity index that was designed to measure disease activity in patients with primary SS. With the growing use of the ESSDAI, some domains appear to be more challenging to rate than others. The ESSDAI is now in use as a gold standard to measure disease activity in clinical studies, and as an outcome measure, even a primary outcome measure, in current randomised clinical trials. Therefore, ensuring an accurate and reproducible rating of each domain, by providing a more detailed definition of each domain, has emerged as an urgent need. The purpose of the present article is to provide a user guide for the ESSDAI. This guide provides definitions and precisions on the rating of each domain. It also includes some minor improvement of the score to integrate advance in knowledge of disease manifestations. This user guide may help clinicians to use the ESSDAI, and increase the reliability of rating and consequently of the ability to detect true changes over time. This better appraisal of ESSDAI items, along with the recent definition of disease activity levels and minimal clinically important change, will improve the assessment of patients with primary SS and facilitate the demonstration of effectiveness of treatment for patients with primary SS.
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Affiliation(s)
- Raphaèle Seror
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Simon J Bowman
- Rheumatology Department , University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - Pilar Brito-Zeron
- Laboratory of Autoimmune Diseases "Josep Font", CELLEX-IDIBAPS, Department of Autoimmune Diseases , ICMiD, Hospital Clinic , Barcelona , Spain
| | - Elke Theander
- Department of Rheumatology , Skane University Hospital Malmö, Lund University , Malmo , Sweden
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Athanasios Tzioufas
- Department of Pathophysiology , School of Medicine, University of Athens , Athens , Greece
| | - Jacques-Eric Gottenberg
- Rheumatology , Centre National de Référence des Maladies Auto-Immunes Rares, INSERM UMRS_1109, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg University Hospital, Université de Strasbourg , Strasbourg , France
| | - Manel Ramos-Casals
- Laboratory of Autoimmune Diseases "Josep Font", CELLEX-IDIBAPS, Department of Autoimmune Diseases , ICMiD, Hospital Clinic , Barcelona , Spain
| | - Thomas Dörner
- Rheumatology Department , Charité, University Hospital , Berlin , Germany
| | - Philippe Ravaud
- Center of Clinical Epidemiology , Hôpital Hôtel Dieu , Paris , France ; INSERM U738, Université Paris-René Descartes , Paris , France
| | - Claudio Vitali
- Sections of Rheumatology , Instituto San Giuseppe, Como and Casa di Cura di Lecco , Lecco , Italy
| | - Xavier Mariette
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Karsten Asmussen
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Soren Jacobsen
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Elena Bartoloni
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Roberto Gerli
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Johannes Wj Bijlsma
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Aike A Kruize
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Stefano Bombardieri
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Arthur Bookman
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Cees Kallenberg
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Petra Meiners
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Johan G Brun
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Roland Jonsson
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Roberto Caporali
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Steven Carsons
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Salvatore De Vita
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Nicoletta Del Papa
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Valerie Devauchelle
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Alain Saraux
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Anne-Laure Fauchais
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Jean Sibilia
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Eric Hachulla
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Gabor Illei
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - David Isenberg
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Adrian Jones
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Menelaos Manoussakis
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Thomas Mandl
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Lennart Jacobsson
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Frederic Demoulins
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Carlomaurizio Montecucco
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Wan-Fai Ng
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Sumusu Nishiyama
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Roald Omdal
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Ann Parke
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Sonja Praprotnik
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Matjia Tomsic
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Elizabeth Price
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Hal Scofield
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Kathy L Sivils
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Josef Smolen
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Roser Solans Laqué
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Serge Steinfeld
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Nurhan Sutcliffe
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Takayuki Sumida
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Guido Valesini
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Valeria Valim
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Frederick B Vivino
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Cristina Vollenweider
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
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Sada PR, Isenberg D, Ciurtin C. Biologic treatment in Sjogren's syndrome. Rheumatology (Oxford) 2014; 54:219-30. [DOI: 10.1093/rheumatology/keu417] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Hamm-Alvarez SF, Janga SR, Edman MC, Madrigal S, Shah M, Frousiakis SE, Renduchintala K, Zhu J, Bricel S, Silka K, Bach D, Heur M, Christianakis S, Arkfeld DG, Irvine J, Mack WJ, Stohl W. Tear cathepsin S as a candidate biomarker for Sjögren's syndrome. Arthritis Rheumatol 2014; 66:1872-81. [PMID: 24644101 DOI: 10.1002/art.38633] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/13/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The diagnosis of Sjögren's syndrome (SS) in routine practice is largely a clinical one and requires a high index of suspicion by the treating physician. This great dependence on clinical judgment frequently leads to delayed diagnosis or misdiagnosis. Tear protein profiles have been proposed as simple and reliable biomarkers for the diagnosis of SS. Given that cathepsin S activity is increased in the lacrimal glands and tears of NOD mice (a murine model of SS), the aim of this study was to explore the clinical utility of using tear cathepsin S (CTSS) activity as a biomarker for SS. METHODS A method to measure CTSS activity in tears eluted from Schirmer's test strips was developed and validated. Schirmer's tests were performed and CTSS activity measurements were obtained in 278 female subjects, including 73 with SS, 79 with rheumatoid arthritis, 40 with systemic lupus erythematosus, 10 with blepharitis, 31 with nonspecific dry eye disease, and 12 with other autoimmune diseases, as well as 33 healthy control subjects. RESULTS The median tear CTSS activity in patients with SS was 4.1-fold higher than that in patients with other autoimmune diseases, 2.1-fold higher than that in patients with nonspecific dry eye disease, and 41.1-fold higher than that in healthy control subjects. Tear CTSS levels were equally elevated in patients with primary SS and those with secondary SS, independent of the Schirmer's test strip values or the levels of circulating anti-SSA or anti-SSB antibodies. CONCLUSION Markedly high levels of tear CTSS activity are suggestive of SS. CTSS activity in tears can be measured in a simple, quick, economical, and noninvasive manner and may serve as a novel biomarker for autoimmune dacryoadenitis during the diagnostic evaluation for SS.
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Identification of lymphoma predictors in patients with primary Sjögren’s syndrome: a systematic literature review and meta-analysis. Rheumatol Int 2014; 35:17-26. [DOI: 10.1007/s00296-014-3051-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 05/16/2014] [Indexed: 12/23/2022]
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36
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Seror R, Theander E, Bootsma H, Bowman SJ, Tzioufas A, Gottenberg JE, Ramos-Casals M, Dörner T, Ravaud P, Mariette X, Vitali C. Outcome measures for primary Sjögren's syndrome: A comprehensive review. J Autoimmun 2014; 51:51-6. [DOI: 10.1016/j.jaut.2013.12.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/12/2013] [Indexed: 02/03/2023]
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Sjögren's syndrome: A forty-year scientific journey. J Autoimmun 2014; 51:1-9. [DOI: 10.1016/j.jaut.2014.01.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 01/01/2014] [Indexed: 12/16/2022]
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Konsta OD, Thabet Y, Le Dantec C, Brooks WH, Tzioufas AG, Pers JO, Renaudineau Y. The contribution of epigenetics in Sjögren's Syndrome. Front Genet 2014; 5:71. [PMID: 24765104 PMCID: PMC3982050 DOI: 10.3389/fgene.2014.00071] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 03/17/2014] [Indexed: 12/17/2022] Open
Abstract
Sjögren’s syndrome (SS) is a chronic autoimmune epithelitis that combines exocrine gland dysfunctions and lymphocytic infiltrations. While the pathogenesis of SS remains unclear, its etiology is multifunctional and includes a combination of genetic predispositions, environmental factors, and epigenetic factors. Recently, interest has grown in the involvement of epigenetics in autoimmune diseases. Epigenetics is defined as changes in gene expression, that are inheritable and that do not entail changes in the DNA sequence. In SS, several epigenetic mechanisms are defective including DNA demethylation that predominates in epithelial cells, an abnormal expression of microRNAs, and abnormal chromatin positioning-associated with autoantibody production. Last but not least, epigenetic modifications are reversible as observed in minor salivary glands from SS patients after B cell depletion using rituximab. Thus epigenetic findings in SS open new perspectives for therapeutic approaches as well as the possible identification of new biomarkers.
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Affiliation(s)
- Orsia D Konsta
- Research Unit EA2216 Immunology, Pathology and Immunotherapy, SFR ScinBios and Labex Igo "Immunotherapy Graft, Oncology", Réseau Épigénétique du Cancéropole Grand Ouest, European University of Brittany Brest France ; Department of Pathophysiology, School of Medicine, National University of Athens Athens, Greece
| | - Yosra Thabet
- Research Unit EA2216 Immunology, Pathology and Immunotherapy, SFR ScinBios and Labex Igo "Immunotherapy Graft, Oncology", Réseau Épigénétique du Cancéropole Grand Ouest, European University of Brittany Brest France
| | - Christelle Le Dantec
- Research Unit EA2216 Immunology, Pathology and Immunotherapy, SFR ScinBios and Labex Igo "Immunotherapy Graft, Oncology", Réseau Épigénétique du Cancéropole Grand Ouest, European University of Brittany Brest France
| | - Wesley H Brooks
- Department of Chemistry, University of South Florida Tampa, FL, USA
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National University of Athens Athens, Greece
| | - Jacques-Olivier Pers
- Research Unit EA2216 Immunology, Pathology and Immunotherapy, SFR ScinBios and Labex Igo "Immunotherapy Graft, Oncology", Réseau Épigénétique du Cancéropole Grand Ouest, European University of Brittany Brest France
| | - Yves Renaudineau
- Research Unit EA2216 Immunology, Pathology and Immunotherapy, SFR ScinBios and Labex Igo "Immunotherapy Graft, Oncology", Réseau Épigénétique du Cancéropole Grand Ouest, European University of Brittany Brest France ; Laboratory of Immunology and Immunotherapy, Hôpital Morvan - Brest University Medical School Brest France
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Cornec D, Jamin C, Pers JO. Sjögren's syndrome: where do we stand, and where shall we go? J Autoimmun 2014; 51:109-14. [PMID: 24612946 DOI: 10.1016/j.jaut.2014.02.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 02/11/2014] [Indexed: 01/04/2023]
Abstract
Primary Sjögren's syndrome (pSS) is one of the most frequent autoimmune systemic diseases, mainly characterized by ocular and oral dryness due to the progressive destruction of lachrymal and salivary glands by an inflammatory process. A noteworthy proportion of patients also features extraglandular manifestations, sometimes severe and life-threatening. Until now, its management relies mostly on symptomatic interventions, long-term monitoring, and, in patients with severe systemic complications, immunosuppressive drugs can be provided. However, recent years have seen great progresses in the understanding of the pathological processes of the disease. The central role of regulatory lymphocytes, the implication of the type 1 interferon pathway in some patients or the importance of epigenetics have been highlighted. New classification criteria have been recently published and have shed in light an international attempt for a better recognition of the patients, probably thanks to the development of new diagnostic procedures such as salivary gland ultrasonography. To facilitate the detection of treatment efficacy in clinical trials and to help in determining which subgroups of patients would have benefits from intensive therapies, a better definition of activity scores and the availability of new prognostic markers are urgent. Thereby, the development of future therapies should be based on specific molecular signatures that will enable a personalized management of each patient. This review focuses on the most striking advances in the fields of pathophysiology, diagnosis and treatment of pSS, which generate a great hope for pSS patients.
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Affiliation(s)
- Divi Cornec
- Department of Rheumatology, Brest Teaching Hospital, Brest, France; EA 2216 Immunology and Pathology, Brest University, SFR ScinBios, Labex 'Immunotherapy, Graft, Oncology', Brest, France
| | - Christophe Jamin
- EA 2216 Immunology and Pathology, Brest University, SFR ScinBios, Labex 'Immunotherapy, Graft, Oncology', Brest, France
| | - Jacques-Olivier Pers
- EA 2216 Immunology and Pathology, Brest University, SFR ScinBios, Labex 'Immunotherapy, Graft, Oncology', Brest, France.
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Kroese FGM, Abdulahad WH, Haacke E, Bos NA, Vissink A, Bootsma H. B-cell hyperactivity in primary Sjögren's syndrome. Expert Rev Clin Immunol 2014; 10:483-99. [PMID: 24564507 DOI: 10.1586/1744666x.2014.891439] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary Sjögren's syndrome (pSS) is characterized by mononuclear inflammatory infiltrates and IgG plasma cells in salivary and lacrimal glands which lead to irreversible destruction of the glandular tissue and is accompanied by sensation of dryness of mouth and eyes. B cells play a central role in the immunopathogenesis and exhibit signs of hyperactivity. Hyperactivity of B cells is the consequence of the coordinated and integrated action of stimulation of the B-cell receptor, CD40 and toll-like receptors in the presence of appropriate cytokines. As discussed, overexpression of type I IFN and BAFF on one hand and IL-6 and IL-21 on the other hand are critically involved in the enhanced plasma cell formation in pSS patients. Hyperactivity of B cells results in secretion of autoantibodies and production of various cytokines. These insights in the role of B cells in the pathogenetic process of pSS offer ample targets for successful therapeutical intervention in pSS.
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Affiliation(s)
- Frans G M Kroese
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Giannouli S, Voulgarelis M. Predicting progression to lymphoma in Sjögren's syndrome patients. Expert Rev Clin Immunol 2014; 10:501-12. [DOI: 10.1586/1744666x.2014.872986] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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