1
|
Arvidsson G, Czarnewski P, Johansson A, Raine A, Imgenberg-Kreuz J, Nordlund J, Nordmark G, Syvänen AC. Multimodal Single-Cell Sequencing of B Cells in Primary Sjögren's Syndrome. Arthritis Rheumatol 2024; 76:255-267. [PMID: 37610265 DOI: 10.1002/art.42683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/08/2023] [Accepted: 08/18/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE B cells are important in the pathogenesis of primary Sjögren's syndrome (pSS). Patients positive for Sjögren's syndrome antigen A/Sjögren syndrome antigen B (SSA/SSB) autoantibodies are more prone to systemic disease manifestations and adverse outcomes. We aimed to determine the role of B cell composition, gene expression, and B cell receptor usage in pSS subgroups stratified for SSA/SSB antibodies. METHODS Over 230,000 B cells were isolated from peripheral blood of patients with pSS (n = 6 SSA-, n = 8 SSA+ single positive and n = 10 SSA/SSB+ double positive) and four healthy controls and processed for single-cell RNA sequencing (scRNA-seq) and single-cell variable, diversity, and joining (VDJ) gene sequencing (scVDJ-seq). RESULTS We show that SSA/SSB+ patients present the highest and lowest proportion of naïve and memory B cells, respectively, and the highest up-regulation of interferon-induced genes across all B cell subtypes. Differential usage of IGHV showed that IGHV1-69 and IGHV4-30-4 were more often used in all pSS subgroups compared with controls. Memory B cells from SSA/SSB+ patients displayed a higher proportion of cells with unmutated VDJ transcripts compared with other pSS patient groups and controls, indicating altered somatic hypermutation processes. Comparison with previous studies revealed heterogeneous clonotype pools, with little overlap in CDR3 sequences. Joint analysis using scRNA-seq and scVDJ-seq data allowed unsupervised stratification of patients with pSS and identified novel parameters that correlated to disease manifestations and antibody status. CONCLUSION We describe heterogeneity and molecular characteristics in B cells from patients with pSS, providing clues to intrinsic differences in B cells that affect the phenotype and outcome and allowing stratification of patients with pSS at improved resolution.
Collapse
|
2
|
Longobardi S, Lopez-Davis C, Khatri B, Georgescu C, Pritchett-Frazee C, Lawrence C, Rasmussen A, Radfar L, Scofield RH, Baer AN, Robinson SA, Darrah E, Axtell RC, Pardo G, Wren JD, Koelsch KA, Guthridge JM, James JA, Lessard CJ, Farris AD. Autoantibodies identify primary Sjögren's syndrome in patients lacking serum IgG specific for Ro/SS-A and La/SS-B. Ann Rheum Dis 2023; 82:1181-1190. [PMID: 37147113 PMCID: PMC10546962 DOI: 10.1136/ard-2022-223105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Identify autoantibodies in anti-Ro/SS-A negative primary Sjögren's syndrome (SS). METHODS This is a proof-of-concept, case-control study of SS, healthy (HC) and other disease (OD) controls. A discovery dataset of plasma samples (n=30 SS, n=15 HC) was tested on human proteome arrays containing 19 500 proteins. A validation dataset of plasma and stimulated parotid saliva from additional SS cases (n=46 anti-Ro+, n=50 anti-Ro-), HC (n=42) and OD (n=54) was tested on custom arrays containing 74 proteins. For each protein, the mean+3 SD of the HC value defined the positivity threshold. Differences from HC were determined by Fisher's exact test and random forest machine learning using 2/3 of the validation dataset for training and 1/3 for testing. Applicability of the results was explored in an independent rheumatology practice cohort (n=38 Ro+, n=36 Ro-, n=10 HC). Relationships among antigens were explored using Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) interactome analysis. RESULTS Ro+ SS parotid saliva contained autoantibodies binding to Ro60, Ro52, La/SS-B and muscarinic receptor 5. SS plasma contained 12 novel autoantibody specificities, 11 of which were detected in both the discovery and validation datasets. Binding to ≥1 of the novel antigens identified 54% of Ro- SS and 37% of Ro+ SS cases, with 100% specificity in both groups. Machine learning identified 30 novel specificities showing receiver operating characteristic area under the curve of 0.79 (95% CI 0.64 to 0.93) for identifying Ro- SS. Sera from Ro- cases of an independent cohort bound 17 of the non-canonical antigens. Antigenic targets in both Ro+ and Ro- SS were part of leukaemia cell, ubiquitin conjugation and antiviral defence pathways. CONCLUSION We identified antigenic targets of the autoantibody response in SS that may be useful for identifying up to half of Ro seronegative SS cases.
Collapse
Affiliation(s)
- Sherri Longobardi
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- Department of Microbiology and Immunology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Charmaine Lopez-Davis
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Bhuwan Khatri
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Constantin Georgescu
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Cherilyn Pritchett-Frazee
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Christina Lawrence
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Astrid Rasmussen
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Lida Radfar
- College of Dentistry, Department of Oral Diagnosis and Radiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Robert Hal Scofield
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- Department of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Alan N Baer
- Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan A Robinson
- Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erika Darrah
- Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert C Axtell
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Gabriel Pardo
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Jonathan D Wren
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Kristi A Koelsch
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- Department of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Joel M Guthridge
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Judith A James
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- Department of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Christopher J Lessard
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Amy Darise Farris
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- Department of Microbiology and Immunology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| |
Collapse
|
3
|
Lee AYS, Wang JJ, Gordon TP, Reed JH. Phases and Natural History of Sjögren's Disease: A New Model for an Old Disease? Arthritis Care Res (Hoboken) 2023; 75:1580-1587. [PMID: 36063396 PMCID: PMC10953327 DOI: 10.1002/acr.25011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023]
Abstract
Sjögren's disease (SjD) is an archetypal and heterogenous autoimmune disorder that is characterized by exocrine glandular dysfunction. A proportion of patients develop severe extraglandular manifestations, such as cryoglobulinemia, and have an increased risk of lymphoma, both of which can adversely affect quality of life and occasionally mortality. As with most autoimmune disorders, the pathogenesis is poorly understood and difficult to predict, and, frustratingly, there is a lack of targeted therapies to cure this disease. We review the disease manifestations of SjD and propose a staged model for understanding the evolution of pathology. In longitudinal studies, most patients remain relatively stable in terms of their laboratory and clinical parameters. However, in the setting of various risk factors, a proportion of patients develop severe symptoms and/or lymphoma. We discuss potential underlying mechanisms for disease progression and the strengths and limitations of using a staged model to correlate the pathogenesis and spectrum of manifestations in SjD. Ultimately, understanding how and why some patients remain relatively stable, whereas others progress and develop florid systemic disease and a fraction develop lymphoma, is key to developing preventative and therapeutic treatments.
Collapse
Affiliation(s)
- Adrian Y. S. Lee
- The Westmead Institute for Medical ResearchUniversity of Sydney, Westmead Hospital, NSW Health PathologyWestmeadNew South WalesAustralia
| | - Jing Jing Wang
- SA Pathology and Flinders UniversityBedford ParkSouth AustraliaAustralia
| | - Tom P. Gordon
- SA Pathology and Flinders UniversityBedford ParkSouth AustraliaAustralia
| | - Joanne H. Reed
- The Westmead Institute for Medical ResearchUniversity of SydneyWestmeadNew South WalesAustralia
| |
Collapse
|
4
|
Fenton KA, Pedersen HL. Advanced methods and novel biomarkers in autoimmune diseases ‑ a review of the recent years progress in systemic lupus erythematosus. Front Med (Lausanne) 2023; 10:1183535. [PMID: 37425332 PMCID: PMC10326284 DOI: 10.3389/fmed.2023.1183535] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/01/2023] [Indexed: 07/11/2023] Open
Abstract
There are several autoimmune and rheumatic diseases affecting different organs of the human body. Multiple sclerosis (MS) mainly affects brain, rheumatoid arthritis (RA) mainly affects joints, Type 1 diabetes (T1D) mainly affects pancreas, Sjogren's syndrome (SS) mainly affects salivary glands, while systemic lupus erythematosus (SLE) affects almost every organ of the body. Autoimmune diseases are characterized by production of autoantibodies, activation of immune cells, increased expression of pro-inflammatory cytokines, and activation of type I interferons. Despite improvements in treatments and diagnostic tools, the time it takes for the patients to be diagnosed is too long, and the main treatment for these diseases is still non-specific anti-inflammatory drugs. Thus, there is an urgent need for better biomarkers, as well as tailored, personalized treatment. This review focus on SLE and the organs affected in this disease. We have used the results from various rheumatic and autoimmune diseases and the organs involved with an aim to identify advanced methods and possible biomarkers to be utilized in the diagnosis of SLE, disease monitoring, and response to treatment.
Collapse
Affiliation(s)
- Kristin Andreassen Fenton
- UiT The Arctic University of Norway, Tromsø, Norway
- Centre of Clinical Research and Education, University Hospital of North Norway, Tromsø, Norway
| | - Hege Lynum Pedersen
- UiT The Arctic University of Norway, Tromsø, Norway
- Centre of Clinical Research and Education, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
5
|
Peck AB, Ambrus JL. A Temporal Comparative RNA Transcriptome Profile of the Annexin Gene Family in the Salivary versus Lacrimal Glands of the Sjögren's Syndrome-Susceptible C57BL/6.NOD- Aec1Aec2 Mouse. Int J Mol Sci 2022; 23:11709. [PMID: 36233010 PMCID: PMC9570365 DOI: 10.3390/ijms231911709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022] Open
Abstract
A generally accepted hypothesis for the initial activation of an immune or autoimmune response argues that alarmins are released from injured, dying and/or activated immune cells, and these products complex with receptors that activate signal transduction pathways and recruit immune cells to the site of injury where the recruited cells are stimulated to initiate immune and/or cellular repair responses. While there are multiple diverse families of alarmins such as interleukins (IL), heat-shock proteins (HSP), Toll-like receptors (TLR), plus individual molecular entities such as Galectin-3, Calreticulin, Thymosin, alpha-Defensin-1, RAGE, and Interferon-1, one phylogenetically conserved family are the Annexin proteins known to promote an extensive range of biomolecular and cellular products that can directly and indirectly regulate inflammation and immune activities. For the present report, we examined the temporal expression profiles of the 12 mammalian annexin genes (Anxa1-11 and Anxa13), applying our temporal genome-wide transcriptome analyses of ex vivo salivary and lacrimal glands from our C57BL/6.NOD-Aec1Aec2 mouse model of Sjögren's Syndrome (SS), a human autoimmune disease characterized primarily by severe dry mouth and dry eye symptoms. Results indicate that annexin genes Anax1-7 and -11 exhibited upregulated expressions and the initial timing for these upregulations occurred as early as 8 weeks of age and prior to any covert signs of a SS-like disease. While the profiles of the two glands were similar, they were not identical, suggesting the possibility that the SS-like disease may not be uniform in the two glands. Nevertheless, this early pre-clinical and concomitant upregulated expression of this specific set of alarmins within the immune-targeted organs represents a potential target for identifying the pre-clinical stage in human SS as well, a fact that would clearly impact future interventions and therapeutic strategies.
Collapse
Affiliation(s)
- Ammon B Peck
- Department of Infectious Diseases and Immunology, College of Veterinary Medicine, University of Florida, P.O. Box 100125, Gainesville, FL 32610, USA
| | - Julian L Ambrus
- Division of Allergy, Immunology and Rheumatology, SUNY Buffalo School of Medicine, 875 Ellicott Street, Buffalo, NY 14203, USA
| |
Collapse
|
6
|
Hill DG, Ward A, Nicholson LB, Jones GW. Emerging roles for IL-6 family cytokines as positive and negative regulators of ectopic lymphoid structures. Cytokine 2021; 146:155650. [PMID: 34343865 DOI: 10.1016/j.cyto.2021.155650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023]
Abstract
IL-6 family cytokines display broad effects in haematopoietic and non-haematopoietic cells that regulate immune homeostasis, host defence, haematopoiesis, development, reproduction and wound healing. Dysregulation of these activities places this cytokine family as important mediators of autoimmunity, chronic inflammation and cancer. In this regard, ectopic lymphoid structures (ELS) are a pathological hallmark of many tissues affected by chronic disease. These inducible lymphoid aggregates form compartmentalised T cell and B cell zones, germinal centres, follicular dendritic cell networks and high endothelial venules, which are defining qualities of peripheral lymphoid organs. Accordingly, ELS can support local antigen-specific responses to self-antigens, alloantigens, pathogens and tumours. ELS often correlate with severe disease progression in autoimmune conditions, while tumour-associated ELS are associated with enhanced anti-tumour immunity and a favourable prognosis in cancer. Here, we discuss emerging roles for IL-6 family cytokines as regulators of ELS development, maintenance and activity and consider how modulation of these activities has the potential to aid the successful treatment of autoimmune conditions and cancers where ELS feature.
Collapse
Affiliation(s)
- David G Hill
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Amy Ward
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Lindsay B Nicholson
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Gareth W Jones
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK.
| |
Collapse
|
7
|
Barcelos F, Martins C, Madeira N, Ângelo-Dias M, Cardigos J, Alves N, Vaz-Patto J, Cunha-Branco J, Borrego LM. Lymphocyte subpopulations in Sjögren's syndrome are distinct in anti-SSA-positive patients and related to disease activity. Clin Rheumatol 2021; 40:2791-2804. [PMID: 33443605 DOI: 10.1007/s10067-020-05537-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Sjögren's syndrome (SjS) patients exhibit great phenotypical heterogeneity, reinforced by the positiveness of anti-SSA antibody. We aimed to evaluate lymphocyte subpopulations in SSA-positive (SSA+SjS) and SSA-negative (SSA-SjS) SjS patients, Sicca patients, and healthy controls (HC), and to investigate associations between lymphocyte subpopulations and disease activity in SjS. METHODS According to the fulfilment of the ACR/EULAR 2016 classification criteria, patients were included as SjS or as Sicca. HC were selected from the Ophthalmology outpatient clinic. Lymphocyte subpopulations were characterized by flow cytometry. Statistical analysis was performed with GraphPad PrismTM, with statistical significance concluded if p < 0.05. RESULTS We included 53 SjS patients (38 SSA+ and 15 SSA-), 72 Sicca, and 24 HC. SSA+SjS patients presented increased IL-21+CD4+ and CD8+ T cells compared to Sicca and HC, whereas compared to SSA-SjS patients, only IL-21+CD4+ T cell percentages were increased and Tfh17 percentages and numbers were decreased. Compared to Sicca and HC, SSA+SjS patients had higher levels of CD24HiCD38Hi B cells, naïve B cells, and IgM-/+CD38++ plasmablasts, and lower levels of memory B cells, including CD24HiCD27+ B cells. SSA+SjS patients with clinically active disease had positive correlations between ESSDAI and IL-21+CD4+ (p = 0.038, r = 0.456) and IL-21+CD8+ T cells (p = 0.046, r = 0.451). CONCLUSIONS In SjS, a distinct lymphocyte subset distribution profile seems to be associated with positive anti-SSA. Moreover, the association between ESSDAI and IL-21+CD4+ and IL-21+CD8+ (follicular) T cells in SSA+SjS patients suggests the involvement of these cells in disease pathogenesis and activity, and possibly their utility for the prognosis and assessment of response to therapy. Key Points • SSA+SjS patients have a pronounced naïve/memory B cell imbalance. • SSA+SjS patients have more active disease associated with IL-21+CD4+ and IL-21+CD8+ follicular T cell expansion. • IL-21+CD4+ and IL-21+CD8+ T cell quantification may be useful for the prognosis and assessment of response to therapy.
Collapse
Affiliation(s)
- Filipe Barcelos
- CEDOC, Chronic Diseases Research Center, Immunology, NOVA Medical School
- FCM, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal. .,Comprehensive Health Research Centre (CHRC), NOVA Medical School / FCM, Universidade Nova de Lisboa, Lisbon, Portugal. .,Rheumatology Department, Instituto Português de Reumatologia, Lisbon, Portugal. .,Rheumatology Department, Hospital CUF Descobertas, Lisbon, Portugal.
| | - Catarina Martins
- CEDOC, Chronic Diseases Research Center, Immunology, NOVA Medical School
- FCM, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), NOVA Medical School / FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Nathalie Madeira
- Rheumatology Department, Instituto Português de Reumatologia, Lisbon, Portugal
| | - Miguel Ângelo-Dias
- CEDOC, Chronic Diseases Research Center, Immunology, NOVA Medical School
- FCM, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Joana Cardigos
- Ophthalmology Department, Centro Hospitalar de Lisboa Central, Hospital de Santo António dos Capuchos, Lisbon, Portugal
| | - Nuno Alves
- Ophthalmology Department, Centro Hospitalar de Lisboa Central, Hospital de Santo António dos Capuchos, Lisbon, Portugal.,Ophthalmology Department, Hospital CUF Descobertas, Lisbon, Portugal
| | - José Vaz-Patto
- Rheumatology Department, Instituto Português de Reumatologia, Lisbon, Portugal
| | - Jaime Cunha-Branco
- CEDOC, Chronic Diseases Research Center, Immunology, NOVA Medical School
- FCM, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), NOVA Medical School / FCM, Universidade Nova de Lisboa, Lisbon, Portugal.,Rheumatology Department, Hospital CUF Descobertas, Lisbon, Portugal.,Rheumatology Department, Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisbon, Portugal
| | - Luís-Miguel Borrego
- CEDOC, Chronic Diseases Research Center, Immunology, NOVA Medical School
- FCM, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), NOVA Medical School / FCM, Universidade Nova de Lisboa, Lisbon, Portugal.,Immunoalergy Department, Hospital da Luz Lisboa, Lisbon, Portugal
| |
Collapse
|
8
|
Pathogenetic Mechanisms Implicated in Sjögren's Syndrome Lymphomagenesis: A Review of the Literature. J Clin Med 2020; 9:jcm9123794. [PMID: 33255258 PMCID: PMC7759999 DOI: 10.3390/jcm9123794] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/16/2020] [Accepted: 11/21/2020] [Indexed: 02/08/2023] Open
Abstract
Sjögren's Syndrome (SS) is a chronic autoimmune disorder characterized by focal mononuclear cell infiltrates that surround the ducts of the exocrine glands, impairing the function of their secretory units. Compared to other autoimmune disorders, SS is associated with a notably high incidence of non-Hodgkin lymphoma (NHL) and more frequently mucosa associated lymphoid tissue (MALT) lymphoma, leading to increased morbidity and mortality rates. High risk features of lymphoma development include systemic extraepithelial manifestations, low serum levels of complement component C4 and mixed type II cryoglobulinemia. The discrimination between reactive and neoplastic lymphoepithelial lesion (LEL) is challenging, probably reflecting a continuum in the evolution from purely inflammatory lymphoid infiltration to the clonal neoplastic evolution. Early lesions display a predominance of activated T cells, while B cells prevail in severe histologic lesions. This strong B cell infiltration is not only a morphologic phenomenon, but it is also progressively associated with the presence of ectopic germinal centers (GCs). Ectopic formation of GCs in SS represents a complex process regulated by an array of cytokines, adhesion molecules and chemokines. Chronic antigenic stimulation is the major driver of specific B cell proliferation and increases the frequency of their transformation in the ectopic GCs and marginal zone (MZ) equivalents. B cells expressing cell surface rheumatoid factor (RF) are frequently detected in the salivary glands, suggesting that clonal expansion might arise from antigen selection of RF-expressing B cells. Abnormal stimulation and incomplete control mechanisms within ectopic lymphoid structures predispose RF MZ like cells to lymphoma development. Immunoglobulin recombination, somatic mutation and isotype switching during B cell development are events that may increase the translocation of oncogenes to immunoglobulin loci or tumor suppressor gene inactivation, leading to monoclonal B cell proliferation and lymphoma development. Concerning chronic antigenic stimulation, conclusive data is so far lacking. However immune complexes containing DNA or RNA are the most likely candidates. Whether additional molecular oncogenic events contribute to the malignant overgrowth remains to be proved.
Collapse
|
9
|
Kajio N, Takeshita M, Suzuki K, Kaneda Y, Yamane H, Ikeura K, Sato H, Kato S, Shimizu H, Tsunoda K, Takeuchi T. Anti-centromere antibodies target centromere-kinetochore macrocomplex: a comprehensive autoantigen profiling. Ann Rheum Dis 2020; 80:651-659. [PMID: 33208344 PMCID: PMC8053351 DOI: 10.1136/annrheumdis-2020-218881] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 12/01/2022]
Abstract
Objectives Anti-centromere antibodies (ACAs) are detected in patients with various autoimmune diseases such as Sjögren’s syndrome (SS), systemic sclerosis (SSc) and primary biliary cholangitis (PBC). However, the targeted antigens of ACAs are not fully elucidated despite the accumulating understanding of the molecular structure of the centromere. The aim of this study was to comprehensively reveal the autoantigenicity of centromere proteins. Methods A centromere antigen library including 16 principal subcomplexes composed of 41 centromere proteins was constructed. Centromere protein/complex binding beads were used to detect serum ACAs in patients with SS, SSc and PBC. ACA-secreting cells in salivary glands obtained from patients with SS were detected with green fluorescent protein-fusion centromere antigens and semiquantified with confocal microscopy. Results A total of 241 individuals with SS, SSc or PBC and healthy controls were recruited for serum ACA profiling. A broad spectrum of serum autoantibodies was observed, and some of them had comparative frequency as anti-CENP-B antibody, which is the known major ACA. The prevalence of each antibody was shared across the three diseases. Immunostaining of SS salivary glands showed the accumulation of antibody-secreting cells (ASCs) specific for kinetochore, which is a part of the centromere, whereas little reactivity against CENP-B was seen. Conclusions We demonstrated that serum autoantibodies target the centromere–kinetochore macrocomplex in patients with SS, SSc and PBC. The specificity of ASCs in SS salivary glands suggests kinetochore complex-driven autoantibody selection, providing insight into the underlying mechanism of ACA acquisition.
Collapse
Affiliation(s)
- Nobuhiko Kajio
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masaru Takeshita
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Katsuya Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yukari Kaneda
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Humitsugu Yamane
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiro Ikeura
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hidekazu Sato
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shin Kato
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hiroyuki Shimizu
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kazuyuki Tsunoda
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
10
|
Joachims ML, Leehan KM, Dozmorov MG, Georgescu C, Pan Z, Lawrence C, Marlin MC, Macwana S, Rasmussen A, Radfar L, Lewis DM, Stone DU, Grundahl K, Scofield RH, Lessard CJ, Wren JD, Thompson LF, Guthridge JM, Sivils KL, Moore JS, Farris AD. Sjögren's Syndrome Minor Salivary Gland CD4 + Memory T Cells Associate with Glandular Disease Features and have a Germinal Center T Follicular Helper Transcriptional Profile. J Clin Med 2020; 9:jcm9072164. [PMID: 32650575 PMCID: PMC7408878 DOI: 10.3390/jcm9072164] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
To assess the types of salivary gland (SG) T cells contributing to Sjögren's syndrome (SS), we evaluated SG T cell subtypes for association with disease features and compared the SG CD4+ memory T cell transcriptomes of subjects with either primary SS (pSS) or non-SS sicca (nSS). SG biopsies were evaluated for proportions and absolute numbers of CD4+ and CD8+ T cells. SG memory CD4+ T cells were evaluated for gene expression by microarray. Differentially-expressed genes were identified, and gene set enrichment and pathways analyses were performed. CD4+CD45RA- T cells were increased in pSS compared to nSS subjects (33.2% vs. 22.2%, p < 0.0001), while CD8+CD45RA- T cells were decreased (38.5% vs. 46.0%, p = 0.0014). SG fibrosis positively correlated with numbers of memory T cells. Proportions of SG CD4+CD45RA- T cells correlated with focus score (r = 0.43, p < 0.0001), corneal damage (r = 0.43, p < 0.0001), and serum Ro antibodies (r = 0.40, p < 0.0001). Differentially-expressed genes in CD4+CD45RA- cells indicated a T follicular helper (Tfh) profile, increased homing and increased cellular interactions. Predicted upstream drivers of the Tfh signature included TCR, TNF, TGF-β1, IL-4, and IL-21. In conclusion, the proportions and numbers of SG memory CD4+ T cells associate with key SS features, consistent with a central role in disease pathogenesis.
Collapse
Affiliation(s)
- Michelle L. Joachims
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Kerry M. Leehan
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Mikhail G. Dozmorov
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Constantin Georgescu
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Zijian Pan
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Christina Lawrence
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - M. Caleb Marlin
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Susan Macwana
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Astrid Rasmussen
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Lida Radfar
- College of Dentistry, University of Oklahoma Health Sciences Center, 1201 N Stonewall Avenue, Oklahoma City, OK 73117, USA; (L.R.); (D.M.L.)
| | - David M. Lewis
- College of Dentistry, University of Oklahoma Health Sciences Center, 1201 N Stonewall Avenue, Oklahoma City, OK 73117, USA; (L.R.); (D.M.L.)
| | - Donald U. Stone
- Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Boulevard, Oklahoma City, OK 73104, USA;
| | - Kiely Grundahl
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - R. Hal Scofield
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
- Department of Medicine, University of Oklahoma Health Sciences Center, 1100 N Lindsay Avenue, Oklahoma City, OK 73104, USA
- Department of Veteran’s Affairs Medical Center, 931 NE 13th Street, Oklahoma City, OK 73104, USA
| | - Christopher J. Lessard
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Jonathan D. Wren
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Linda F. Thompson
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Joel M. Guthridge
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Kathy L. Sivils
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - Jacen S. Moore
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
| | - A. Darise Farris
- Oklahoma Medical Research Foundation, Arthritis & Clinical Immunology Program, 825 NE 13th Street, Oklahoma City, OK 73104, USA; (M.L.J.); (K.M.L.); (M.G.D.); (C.G.); (Z.P.); (C.L.); (M.C.M.); (S.M.); (A.R.); (K.G.); (R.H.S.); (C.J.L.); (J.D.W.); (L.F.T.); (J.M.G.); (K.L.S.); (J.S.M.)
- Correspondence: ; Tel.: +1-405-271-7389
| |
Collapse
|
11
|
Sharma R, Chaudhari KS, Kurien BT, Grundahl K, Radfar L, Lewis DM, Lessard CJ, Li H, Rasmussen A, Sivils KL, Scofield RH. Sjögren Syndrome without Focal Lymphocytic Infiltration of the Salivary Glands. J Rheumatol 2020; 47:394-399. [PMID: 31092717 PMCID: PMC7304293 DOI: 10.3899/jrheum.181443] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Primary Sjögren syndrome (SS) is characterized by a focal lymphocytic infiltrate in exocrine glands. We describe patients who lacked this key feature. METHODS We evaluated patients with sicca in a comprehensive clinic at which medical, dental, and ophthalmological examinations were performed. All subjects underwent a minor salivary gland biopsy with focus score calculation. Extraglandular manifestations were also determined. We categorized subjects as high, intermediate, or low in terms of expression of interferon (IFN)-regulated genes. RESULTS About 20% (51 of 229, 22%) of those classified as having primary SS had a focus score of zero. Compared to those with anti-Ro positivity and a focus score > 1.0, the patients with focus score of zero (who by classification criteria must be anti-Ro-positive) were statistically less likely to have anti-La (or SSB) and elevated immunoglobulin, as well as less severe corneal staining. The focus score zero patients were less likely to have elevated expression of IFN-regulated genes in peripheral blood mononuclear cells than anti-Ro-positive SS patients with a focal salivary infiltrate. CONCLUSION There are only a few clinical differences between patients with primary SS with focus score zero and those with both anti-Ro and a focus score > 1.0. The small subset of focus score zero patients tested did not have elevated expression of IFN-regulated genes, but did have systemic disease. Thus, extraglandular manifestations are perhaps more related to the presence of anti-Ro than increased IFN. This may have relevance to pathogenesis of SS.
Collapse
Affiliation(s)
- Rohan Sharma
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - Kaustubh S Chaudhari
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - Biji T Kurien
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - Kiely Grundahl
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - Lida Radfar
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - David M Lewis
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - Christopher J Lessard
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - He Li
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - Astrid Rasmussen
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - Kathy L Sivils
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center
| | - R Hal Scofield
- From the Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma; Department of Neurology, University of Arkansas Medical Sciences Center, Little Rock, Arkansas; Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; College of Dentistry, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
- R. Sharma, MBBS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Neurology, University of Arkansas Medical Sciences Center; K.S. Chaudhari, MBBS, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center; B.T. Kurien, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center; K. Grundahl, BS, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; L. Radfar, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; D.M. Lewis, DDS, College of Dentistry, University of Oklahoma Health Sciences Center; C.J. Lessard, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; H. Li, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (currently Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas); A. Rasmussen, MD, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; K.L. Sivils, PhD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation; R.H. Scofield, MD, Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Medical and Research Services, Oklahoma City Department of Veterans Affairs Medical Center, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center.
| |
Collapse
|
12
|
Takeshita M, Suzuki K, Kaneda Y, Yamane H, Ikeura K, Sato H, Kato S, Tsunoda K, Arase H, Takeuchi T. Antigen-driven selection of antibodies against SSA, SSB and the centromere 'complex', including a novel antigen, MIS12 complex, in human salivary glands. Ann Rheum Dis 2019; 79:150-158. [PMID: 31611218 PMCID: PMC6937410 DOI: 10.1136/annrheumdis-2019-215862] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/24/2019] [Accepted: 09/14/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Recent evidences have revealed that anti-SSA/SSB antibodies, the major autoantibodies in Sjögren's syndrome (SS), are produced in salivary glands. This study aims to clarify overall of autoantibody production at lesion site, including anti-centromere antibody (ACA)-positive SS. METHODS Antibodies of antibody-secreting cells in human salivary glands were produced as recombinant antibodies. The reactivity of these antibodies and their revertants were investigated by ELISA and newly developed antigen-binding beads assay, which can detect conformational epitopes. The target of uncharacterised antibodies was identified by immunoprecipitation and mass spectrometry. Autoantibody-secreting cells in salivary gland tissue were identified by immunohistochemistry using green fluorescent protein-autoantigen fusion proteins. RESULTS A total of 256 lesion antibodies were generated, and 69 autoantibodies including 24 ACAs were identified among them. Beads assay could detect more autoantibodies than ELISA, suggesting autoantibodies target to antigens with native conformation. After somatic hypermutations were reverted, autoantibodies drastically decreased antigen reactivity. We showed that MIS12 complex, a novel target of ACA, and CENP-C are major targets of ACA produced in salivary glands by examining cloned antibodies and immunohistochemistry, whereas few anti-CENP-B antibodies were detected. The target profiling of serum ACA from 269 patients with SS, systemic sclerosis (SSc), primary biliary cirrhosis (PBC) and healthy controls revealed that ACA-positive patients have antibodies against various sites of centromere complex regardless of disease. CONCLUSION We showed direct evidences of antigen-driven maturation of anti-SSA/SSB antibody and ACA in SS lesion. ACA recognises centromere 'complex' rather than individual protein, and this feature is common among patients with SS, SSc and PBC.
Collapse
Affiliation(s)
- Masaru Takeshita
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Katsuya Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yukari Kaneda
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Humitsugu Yamane
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kazuhiro Ikeura
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hidekazu Sato
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shin Kato
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kazuyuki Tsunoda
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hisashi Arase
- Department of Immunochemistry, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan.,Laboratory of Immunochemistry, WPI Immunology Frontier Research Center, Osaka University, Suita, Osaka, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| |
Collapse
|
13
|
Scofield RH, Fayyaz A, Kurien BT, Koelsch KA. Prognostic value of Sjögren's syndrome autoantibodies. ACTA ACUST UNITED AC 2018; 3. [PMID: 32090197 DOI: 10.21037/jlpm.2018.08.05] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Sjögren's syndrome is in part considered an autoimmune disease because patient sera contain antibodies binding self-structures. In fact, in addition to anti-Ro (or SSA) and anti-La (or SSB), which are included in the classification criteria, there are a wide variety of autoantibodies found among these patients. We reviewed English-language MEDLINE sources. Anti-Ro and anti-La found among healthy individuals, including mothers giving birth to infants with neonatal lupus, predicts future connective tissue disease. Those with Sjögren's syndrome can be divided into two groups; patients with only exocrine gland involvement and those with systemic disease. The presence of anti-Ro/La is associated with systemic, extraglandular disease. Rheumatoid factor is also associated with extraglandular disease while anti-cyclic citrullinated peptide (CCP) is likely associated with inflammatory arthritis and progression to rheumatoid arthritis. Anti-mitochondrial antibodies are uncommon but predict progression to primary biliary cirrhosis. Cryoglobulinemia is found in excess among those with non-Hodgkin's lymphoma. Determination of autoantibodies on the sera of Sjögren's syndrome patients has prognostic implications for Sjögren's syndrome itself as well as associated diseases.
Collapse
Affiliation(s)
- R Hal Scofield
- Arthritis & Clinical Immunol Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.,Department of Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Medical and Research Services, US Department of Veterans Affairs Hospital, Oklahoma City, OK, USA
| | - Anum Fayyaz
- Arthritis & Clinical Immunol Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.,Department of Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Medical and Research Services, US Department of Veterans Affairs Hospital, Oklahoma City, OK, USA
| | - Biji T Kurien
- Arthritis & Clinical Immunol Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.,Department of Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Medical and Research Services, US Department of Veterans Affairs Hospital, Oklahoma City, OK, USA
| | - Kristi A Koelsch
- Arthritis & Clinical Immunol Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.,Department of Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Medical and Research Services, US Department of Veterans Affairs Hospital, Oklahoma City, OK, USA
| |
Collapse
|
14
|
Pipi E, Nayar S, Gardner DH, Colafrancesco S, Smith C, Barone F. Tertiary Lymphoid Structures: Autoimmunity Goes Local. Front Immunol 2018; 9:1952. [PMID: 30258435 PMCID: PMC6143705 DOI: 10.3389/fimmu.2018.01952] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 08/07/2018] [Indexed: 12/18/2022] Open
Abstract
Tertiary lymphoid structures (TLS) are frequently observed in target organs of autoimmune diseases. TLS present features of secondary lymphoid organs such as segregated T and B cell zones, presence of follicular dendritic cell networks, high endothelial venules and specialized lymphoid fibroblasts and display the mechanisms to support local adaptive immune responses toward locally displayed antigens. TLS detection in the tissue is often associated with poor prognosis of disease, auto-antibody production and malignancy development. This review focuses on the contribution of TLS toward the persistence of the inflammatory drive, the survival of autoreactive lymphocyte clones and post-translational modifications, responsible for the pathogenicity of locally formed autoantibodies, during autoimmune disease development.
Collapse
Affiliation(s)
- Elena Pipi
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Experimental Medicine Unit, Immuno-Inflammation Therapeutic Area, GSK Medicines Research Centre, Stevenage, United Kingdom
| | - Saba Nayar
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - David H Gardner
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | | | - Charlotte Smith
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Francesca Barone
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
15
|
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.
Collapse
|
16
|
Koelsch KA, Cavett J, Smith K, Moore JS, Lehoux SD, Jia N, Mather T, Quadri SMS, Rasmussen A, Kaufman CE, Lewis DM, Radfar L, Scordino TA, Lessard CJ, Kurien BT, Cummings RD, James JA, Sivils KL, Farris AD, Scofield RH. Evidence of Alternative Modes of B Cell Activation Involving Acquired Fab Regions of N-Glycosylation in Antibody-Secreting Cells Infiltrating the Labial Salivary Glands of Patients With Sjögren's Syndrome. Arthritis Rheumatol 2018; 70:1102-1113. [PMID: 29457375 DOI: 10.1002/art.40458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 02/13/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To better understand the role of B cells, the potential mechanisms responsible for their aberrant activation, and the production of autoantibodies in the pathogenesis of Sjögren's syndrome (SS), this study explored patterns of selection pressure and sites of N-glycosylation acquired by somatic mutation (acN-glyc) in the IgG variable (V) regions of antibody-secreting cells (ASCs) isolated from the minor salivary glands of patients with SS and non-SS control patients with sicca symptoms. METHODS A novel method to produce and characterize recombinant monoclonal antibodies (mAb) from single cell-sorted ASC infiltrates was applied to concurrently probe expressed genes (all heavy- and light-chain isotypes as well as any other gene of interest not related to immunoglobulin) in the labial salivary glands of patients with SS and non-SS controls. V regions were amplified by reverse transcription-polymerase chain reaction, sequenced, and analyzed for the incidence of N-glycosylation and selection pressure. For specificity testing, the amplified regions were expressed as either the native mAb or mutant mAb lacking the acN-glyc motif. Protein modeling was used to demonstrate how even an acN-glyc site outside of the complementarity-determining region could participate in, or inhibit, antigen binding. RESULTS V-region sequence analyses revealed clonal expansions and evidence of secondary light-chain editing and allelic inclusion, of which neither of the latter two have previously been reported in patients with SS. Increased frequencies of acN-glyc were found in the sequences from patients with SS, and these acN-glyc regions were associated with an increased number of replacement mutations and lowered selection pressure. A clonal set of polyreactive mAb with differential framework region 1 acN-glyc motifs was also identified, and removal of the acN-glyc could nearly abolish binding to autoantigens. CONCLUSION These findings support the notion of an alternative mechanism for the selection and proliferation of some autoreactive B cells, involving V-region N-glycosylation, in patients with SS.
Collapse
Affiliation(s)
- Kristi A Koelsch
- University of Oklahoma Health Sciences Center, Oklahoma Medical Research Foundation, and Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma
| | - Joshua Cavett
- University of Oklahoma Health Sciences Center, Oklahoma Medical Research Foundation, and Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma
| | | | - Jacen S Moore
- University of Oklahoma Health Sciences Center, Oklahoma Medical Research Foundation, and Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma
| | - Sylvain D Lehoux
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Nan Jia
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Tim Mather
- Oklahoma Medical Research Foundation, Oklahoma City
| | - Syed M S Quadri
- University of Oklahoma Health Sciences Center and Oklahoma Medical Research Foundation, Oklahoma City
| | | | - C Erick Kaufman
- University of Oklahoma Health Sciences Center, Oklahoma City
| | - David M Lewis
- University of Oklahoma College of Dentistry, Oklahoma City
| | - Lida Radfar
- University of Oklahoma College of Dentistry, Oklahoma City
| | | | - Christopher J Lessard
- University of Oklahoma Health Sciences Center and Oklahoma Medical Research Foundation, Oklahoma City
| | - Biji T Kurien
- University of Oklahoma Health Sciences Center, Oklahoma Medical Research Foundation, and Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma
| | - Richard D Cummings
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Judith A James
- University of Oklahoma Health Sciences Center and Oklahoma Medical Research Foundation, Oklahoma City
| | - Kathy L Sivils
- University of Oklahoma Health Sciences Center and Oklahoma Medical Research Foundation, Oklahoma City
| | - A Darise Farris
- University of Oklahoma Health Sciences Center and Oklahoma Medical Research Foundation, Oklahoma City
| | - R Hal Scofield
- University of Oklahoma Health Sciences Center, Oklahoma Medical Research Foundation, and Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma
| |
Collapse
|
17
|
Piras C, Guo Y, Soggiu A, Chanrot M, Greco V, Urbani A, Charpigny G, Bonizzi L, Roncada P, Humblot P. Changes in protein expression profiles in bovine endometrial epithelial cells exposed to E. coli LPS challenge. MOLECULAR BIOSYSTEMS 2017; 13:392-405. [PMID: 28070584 DOI: 10.1039/c6mb00723f] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
E. coli is one of the most frequently involved bacteria in uterine diseases. Lipopolysaccharide (LPS) is a component of the outer membrane of Gram-negative bacteria involved in pathogenic processes leading to post-partum metritis and endometritis in cattle. It also causes inflammation of the endometrium. The increase of cell proliferation by LPS is part of the inflammatory process. The aim of this study was to investigate possible changes in protein expression in relation to the proliferative response of bEECs after challenge with E. coli-LPS. In vitro culture of bEECs was performed from cow genital tracts collected at a slaughterhouse. In passage 5, bEECs from each of 9 cows (3 series of 3 cows) were exposed to 0, 8, and 16 μg ml-1 LPS for 72 h. At time 0 and 72 h later, attached cells/living cells were counted and for each time and LPS dosage, cells were frozen for proteomic analyses. All samples from the 3 series were analyzed by 2-D gel electrophoresis coupled to MALDI-TOF/TOF mass spectrometry. The samples from the first series were subjected to shotgun nLC-MS/MS analysis. From the whole differential proteomics analysis, 38 proteins were differentially expressed (p < 0.05 to p < 0.001) following exposure to LPS. Among them, twenty-eight were found to be up-regulated in the LPS groups in comparison to control groups and ten were down-regulated. Differentially expressed proteins were associated with cell proliferation and apoptosis, transcription, destabilization of cell structure, oxidative stress, regulation of histones, allergy and general cell metabolism pathways. The de-regulations induced by LPS were consistent with the proliferative phenotype and indicated strong alterations of several cell functions. In addition, some of the differentially expressed proteins relates to pathways activated at the time of implantation. The specific changes induced through those signals may have negative consequences for the establishment of pregnancy.
Collapse
Affiliation(s)
- Cristian Piras
- Dipartimento di Medicina Veterinaria, Università degli studi di Milano, Milano, Italy
| | - Yongzhi Guo
- Division of Reproduction, Department of Clinical Sciences, Swedish University of Agricultural Sciences, SLU, Sweden
| | - Alessio Soggiu
- Dipartimento di Medicina Veterinaria, Università degli studi di Milano, Milano, Italy
| | - Metasu Chanrot
- Division of Reproduction, Department of Clinical Sciences, Swedish University of Agricultural Sciences, SLU, Sweden and Rajamangala University of Srivijaya (RMUTSV), Thungyai, Thailand
| | - Viviana Greco
- Proteomics and Metabonomics Unit Fondazione Santa Lucia - IRCCS, Rome, Italy
| | - Andrea Urbani
- Istituto di Biochimica e Biochimica Clinica, Università Cattolica, Roma, Italy
| | - Gilles Charpigny
- INRA, Biologie du Développement et Reproduction, 78350, Jouy en Josas, France
| | - Luigi Bonizzi
- Dipartimento di Medicina Veterinaria, Università degli studi di Milano, Milano, Italy
| | - Paola Roncada
- Dipartimento di Medicina Veterinaria, Università degli studi di Milano, Milano, Italy and Istituto Sperimentale Italiano L. Spallanzani, Milano and TechnologieS srl, via Celoria 10, 20133 Milano, Italy.
| | - Patrice Humblot
- Division of Reproduction, Department of Clinical Sciences, Swedish University of Agricultural Sciences, SLU, Sweden
| |
Collapse
|
18
|
Slight-Webb S, Lu R, Ritterhouse LL, Munroe ME, Maecker HT, Fathman CG, Utz PJ, Merrill JT, Guthridge JM, James JA. Autoantibody-Positive Healthy Individuals Display Unique Immune Profiles That May Regulate Autoimmunity. Arthritis Rheumatol 2017; 68:2492-502. [PMID: 27059145 PMCID: PMC5042816 DOI: 10.1002/art.39706] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 03/29/2016] [Indexed: 01/07/2023]
Abstract
Objective Antinuclear antibodies (ANAs) are detected in ∼18% of females, yet autoimmune disease develops in only 5–8%. Immunologic differences between ANA‐positive healthy individuals and patients with systemic lupus erythematosus (SLE) may elucidate the regulatory mechanisms by which ANA‐positive individuals avoid transition to clinical autoimmune disease. Methods Healthy individuals (n = 790) were screened for autoantibodies specific for 11 antigens associated with lupus, systemic sclerosis, and Sjögren's syndrome. From this screening, 31 European American ANA‐positive healthy individuals were selected and demographically matched to ANA‐negative controls and SLE patients. Serum cytokine profiles, leukocyte subset frequency, and reactivity were analyzed by multiplex assays, immunophenotyping, and phosphospecific flow cytometry. Results Of 790 individuals screened, 57 (7%) were ANA‐positive. The majority of proinflammatory cytokines, including interferon‐γ (IFNγ), tumor necrosis factor, interleukin‐17 (IL‐17), and granulocyte colony‐stimulating factor, exhibited a stepwise increase in serum levels from ANA‐negative controls to ANA‐positive healthy individuals to SLE patients (P < 0.0001). IFNα, IFNβ, IL‐12p40, and stem cell factor/c‐Kit ligand were increased in SLE patients only (P < 0.05). B lymphocyte stimulator (BlyS) was elevated in SLE patients but decreased in ANA‐positive individuals (P < 0.001). Further, IL‐1 receptor antagonist (IL‐1Ra) was down‐regulated in SLE patients only (P < 0.0001). ANA‐positive individuals had increased frequencies of monocytes, memory B cells, and plasmablasts and increased levels of pSTAT‐1 and pSTAT‐3 following IFNα stimulation compared with ANA‐negative controls (P < 0.05). Conclusion ANA‐positive healthy individuals exhibit dysregulation in multiple immune pathways yet differ from SLE patients by the absence of elevated IFNs, BLyS, IL‐12p40, and stem cell factor/c‐Kit ligand. Further, severely decreased levels of IL‐1Ra in SLE patients compared with ANA‐positive individuals may contribute to disease development. These results highlight the importance of IFN‐related pathways and regulatory elements in SLE pathogenesis.
Collapse
Affiliation(s)
| | - Rufei Lu
- Oklahoma Medical Research Foundation, and University of Oklahoma Health Sciences Center, Oklahoma City
| | - Lauren L Ritterhouse
- Oklahoma Medical Research Foundation, and University of Oklahoma Health Sciences Center, Oklahoma City
| | | | | | | | - Paul J Utz
- Stanford University School of Medicine, Stanford, California
| | | | - Joel M Guthridge
- Oklahoma Medical Research Foundation, and University of Oklahoma Health Sciences Center, Oklahoma City
| | - Judith A James
- Oklahoma Medical Research Foundation, and University of Oklahoma Health Sciences Center, Oklahoma City.
| |
Collapse
|
19
|
Peck AB, Nguyen CQ. What can Sjögren's syndrome-like disease in mice contribute to human Sjögren's syndrome? Clin Immunol 2017; 182:14-23. [PMID: 28478104 DOI: 10.1016/j.clim.2017.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 05/01/2017] [Accepted: 05/01/2017] [Indexed: 12/12/2022]
Abstract
For decades, Sjögren's syndrome (SS) and Sjögren's syndrome-like (SS-like) disease in patients and mouse models, respectively, have been intensely investigated in attempts to identify the underlying etiologies, the pathophysiological changes defining disease phenotypes, the nature of the autoimmune responses, and the propensity for developing B cell lymphomas. An emerging question is whether the generation of a multitude of mouse models and the data obtained from their studies is actually important to the understanding of the human disease and potential interventional therapies. In this brief report, we comment on how and why mouse models can stimulate interest in specific lines of research that apparently parallel aspects of human SS. Focusing on two mouse models, NOD and B6·Il14α, we present the possible relevance of mouse models to human SS, highlighting a few selected disease-associated biological processes that have baffled both SS and SS-like investigations for decades.
Collapse
Affiliation(s)
- Ammon B Peck
- Department of Pathology and Infectious Diseases, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA; Center for Orphan Autoimmune Disorders, College of Dentistry, University of Florida, Gainesville, FL 32608, USA.
| | - Cuong Q Nguyen
- Department of Pathology and Infectious Diseases, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA; Center for Orphan Autoimmune Disorders, College of Dentistry, University of Florida, Gainesville, FL 32608, USA; Department of Oral Biology, College of Dentistry, University of Florida, FL 32608, USA
| |
Collapse
|
20
|
Abstract
Primary Sjögren's syndrome (SS) is a common chronic autoimmune disease characterized by lymphocytic infiltration of exocrine glands, mainly salivary and lacrimal, resulting in oral and ocular dryness, although virtually any organ system can be affected. SS-related systemic manifestations are classified as either related to the presence of periepithelial infiltrates in exocrine and parenchymal organs or resulting from immunocomplex deposition due to B cell hyperactivity with increased risk for B cell lymphoma development. Activation of both innate and adaptive immune pathways contributes to disease pathogenesis, with prominent interferon (IFN) signatures identified in both peripheral blood and affected salivary gland tissues. Recently, LINE-1 genomic repeat elements have been proposed as potential triggers of type I IFN pathway activation in SS through activation of Toll-like receptor-dependent and -independent pathways. In view of the increasingly appreciated variability of SS, elucidation of distinct operating pathways in relation to diverse clinical phenotypes and selection of the optimal therapeutic intervention remain major challenges. Inhibition of cathepsin S molecules, blockade of costimulation through administration of abatacept and inhibitors of B7-related molecules and CD40, blockade of B cell function and B cell survival factors, and disruption of the formation of ectopic germinal centers are considered the main therapeutic targets. Well-controlled multicenter clinical trials are ongoing and data are awaited.
Collapse
Affiliation(s)
- Clio P Mavragani
- Department of Physiology, School of Medicine and Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Athens, Greece;
| |
Collapse
|
21
|
Haskett S, Ding J, Zhang W, Thai A, Cullen P, Xu S, Petersen B, Kuznetsov G, Jandreski L, Hamann S, Reynolds TL, Allaire N, Zheng TS, Mingueneau M. Identification of Novel CD4+ T Cell Subsets in the Target Tissue of Sjögren's Syndrome and Their Differential Regulation by the Lymphotoxin/LIGHT Signaling Axis. THE JOURNAL OF IMMUNOLOGY 2016; 197:3806-3819. [PMID: 27815440 DOI: 10.4049/jimmunol.1600407] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/11/2016] [Indexed: 12/14/2022]
Abstract
Despite being one of the most common rheumatologic diseases, there is still no disease-modifying drug for primary Sjögren's syndrome (pSS). Advancing our knowledge of the target tissue has been limited by the low dimensionality of histology techniques and the small size of human salivary gland biopsies. In this study, we took advantage of a molecularly validated mouse model of pSS to characterize tissue-infiltrating CD4+ T cells and their regulation by the lymphotoxin/LIGHT signaling axis. Novel cell subsets were identified by combining highly dimensional flow and mass cytometry with transcriptomic analyses. Pharmacologic modulation of the LTβR signaling pathway was achieved by treating mice with LTβR-Ig, a therapeutic intervention currently being tested in pSS patients (Baminercept trial NCT01552681). Using these approaches, we identified two novel CD4+ T cell subsets characterized by high levels of PD1: Prdm1+ effector regulatory T cells expressing immunoregulatory factors, such as Il10, Areg, Fgl2, and Itgb8, and Il21+ effector conventional T cells expressing a pathogenic transcriptional signature. Mirroring these observations in mice, large numbers of CD4+PD1+ T cells were detected in salivary glands from Sjögren's patients but not in normal salivary glands or kidney biopsies from lupus nephritis patients. Unexpectedly, LTβR-Ig selectively halted the recruitment of PD1- naive, but not PD1+, effector T cells to the target tissue, leaving the cells with pathogenic potential unaffected. Altogether, this study revealed new cellular players in pSS pathogenesis, their transcriptional signatures, and differential dependency on the lymphotoxin/LIGHT signaling axis that help to interpret the negative results of the Baminercept trial and will guide future therapeutic interventions.
Collapse
Affiliation(s)
| | - Jian Ding
- Immunology Research, Biogen, Cambridge, MA 02142
| | - Wei Zhang
- Immunology Research, Biogen, Cambridge, MA 02142
| | - Alice Thai
- Immunology Research, Biogen, Cambridge, MA 02142
| | | | - Shanqin Xu
- Immunology Research, Biogen, Cambridge, MA 02142
| | | | | | | | | | | | - Norm Allaire
- Immunology Research, Biogen, Cambridge, MA 02142
| | | | | |
Collapse
|
22
|
Wang JJ, Al Kindi MA, Colella AD, Dykes L, Jackson MW, Chataway TK, Reed JH, Gordon TP. IgV peptide mapping of native Ro60 autoantibody proteomes in primary Sjögren's syndrome reveals molecular markers of Ro/La diversification. Clin Immunol 2016; 173:57-63. [PMID: 27609500 DOI: 10.1016/j.clim.2016.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/18/2016] [Accepted: 09/01/2016] [Indexed: 01/25/2023]
Abstract
We have used high-resolution mass spectrometry to sequence precipitating anti-Ro60 proteomes from sera of patients with primary Sjögren's syndrome and compare immunoglobulin variable-region (IgV) peptide signatures in Ro/La autoantibody subsets. Anti-Ro60 were purified by elution from native Ro60-coated ELISA plates and subjected to combined de novo amino acid sequencing and database matching. Monospecific anti-Ro60 Igs comprised dominant public and minor private sets of IgG1 kappa and lambda restricted heavy and light chains. Specific IgV amino acid substitutions stratified anti-Ro60 from anti-Ro60/La responses, providing a molecular fingerprint of Ro60/La determinant spreading and suggesting that different forms of Ro60 antigen drive these responses. Sequencing of linked anti-Ro52 proteomes from individual patients and comparison with their anti-Ro60 partners revealed sharing of a dominant IGHV3-23/IGKV3-20 paired clonotype but with divergent IgV mutational signatures. In summary, anti-Ro60 IgV peptide mapping provides insights into Ro/La autoantibody diversification and reveals serum-based molecular markers of humoral Ro60 autoimmunity.
Collapse
Affiliation(s)
- Jing J Wang
- Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park 5042, South Australia, Australia
| | - Mahmood A Al Kindi
- Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park 5042, South Australia, Australia; Department of Microbiology and Immunology, Sultan Qaboos University Hospital, Muscat 123, Oman
| | - Alex D Colella
- Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park 5042, South Australia, Australia; Flinders Proteomics Facility, Flinders University, Bedford Park 5042, South Australia, Australia
| | - Lukah Dykes
- Flinders Proteomics Facility, Flinders University, Bedford Park 5042, South Australia, Australia
| | - Michael W Jackson
- Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park 5042, South Australia, Australia
| | - Tim K Chataway
- Flinders Proteomics Facility, Flinders University, Bedford Park 5042, South Australia, Australia
| | - Joanne H Reed
- Garvan Institute of Medical Research, Immunology Division, Immunogenomics Laboratory, 384 Victoria Street, Darlinghurst, NSW 2010, Australia
| | - Tom P Gordon
- Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park 5042, South Australia, Australia.
| |
Collapse
|
23
|
Abstract
We compiled information on antibodies in Sjögren syndrome, focusing more on clinical manifestations associated with anti-Ro/SSA and anti-La/SSB antibodies and studies regarding novel antibodies. We reviewed previous as well as most recent studies with the subject heading Sjogren in combination with antibodies and congenital heart block (CHB). Almost half of asymptomatic mothers giving birth to children with CHB ultimately develop Sjögren. We discussed studies concerning the presence of antibodies predating clinical manifestations of disease. Studies in the future are required to ascertain the pathogenic mechanisms associated with these antibodies and the specific clinical manifestation related to new autoantibodies.
Collapse
Affiliation(s)
- Anum Fayyaz
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, 825 Northeast, 13th Street, Oklahoma City, OK 73104, USA; Department of Medicine, College of Medicine, 1000 N Lincoln Boulevard, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; Medical and Research Services, US Department of Veterans Affairs Hospital, 921 NE 13th Street, Oklahoma City, OK 73104, USA
| | - Biji T Kurien
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, 825 Northeast, 13th Street, Oklahoma City, OK 73104, USA; Department of Medicine, College of Medicine, 1000 N Lincoln Boulevard, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; Medical and Research Services, US Department of Veterans Affairs Hospital, 921 NE 13th Street, Oklahoma City, OK 73104, USA
| | - R Hal Scofield
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, 825 Northeast, 13th Street, Oklahoma City, OK 73104, USA; Department of Medicine, College of Medicine, 1000 N Lincoln Boulevard, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; Medical and Research Services, US Department of Veterans Affairs Hospital, 921 NE 13th Street, Oklahoma City, OK 73104, USA.
| |
Collapse
|
24
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to give an update on the understanding of the immune responses involved in the pathogenesis of primary Sjögren's syndrome (pSS), and to highlight recent findings on the underlying molecular and cellular mechanisms at play. RECENT FINDINGS In recent years, genetic studies have confirmed the importance of aberrant type I interferon (IFN) and B cell responses in pSS and highlighted critical pathways involved in disease pathogenesis. In particular, the formation of ectopic lymphoid structures has emerged as an important factor in the establishment of chronic autoimmune responses in target organs. Interestingly, recent studies on viral infection in the context of pSS, as well as findings on the contribution of salivary gland epithelial cells in local immune responses, offer further clues to understand pSS etiology and its target organ specificity. Finally, new evidence brings T cells and natural killer cells under renewed attention as possible important contributors to pSS pathogenesis. SUMMARY Progress made during the last few years on the pathogenesis of pSS has been mirrored by clinical trials directed at inhibiting cytokines, B, or T cell responses. Future efforts should focus on identifying additional pSS specific targets and developing methods to help choose optimal therapeutic strategies for the individual patient.
Collapse
|
25
|
Joachims ML, Leehan KM, Lawrence C, Pelikan RC, Moore JS, Pan Z, Rasmussen A, Radfar L, Lewis DM, Grundahl KM, Kelly JA, Wiley GB, Shugay M, Chudakov DM, Lessard CJ, Stone DU, Scofield RH, Montgomery CG, Sivils KL, Thompson LF, Farris AD. Single-cell analysis of glandular T cell receptors in Sjögren's syndrome. JCI Insight 2016; 1. [PMID: 27358913 DOI: 10.1172/jci.insight.85609] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
CD4+ T cells predominate in salivary gland (SG) inflammatory lesions in Sjögren's syndrome (SS). However, their antigen specificity, degree of clonal expansion, and relationship to clinical disease features remain unknown. We used multiplex reverse-transcriptase PCR to amplify paired T cell receptor α (TCRα) and β transcripts of single CD4+CD45RA- T cells from SG and peripheral blood (PB) of 10 individuals with primary SS, 9 of whom shared the HLA DR3/DQ2 risk haplotype. TCRα and β sequences were obtained from a median of 91 SG and 107 PB cells per subject. The degree of clonal expansion and frequency of cells expressing two productively rearranged α genes were increased in SG versus PB. Expanded clones from SG exhibited complementary-determining region 3 (CDR3) sequence similarity both within and among subjects, suggesting antigenic selection and shared antigen recognition. CDR3 similarities were shared among expanded clones from individuals discordant for canonical Ro and La autoantibodies, suggesting recognition of alternative SG antigen(s). The extent of SG clonal expansion correlated with reduced saliva production and increased SG fibrosis, linking expanded SG T cells with glandular dysfunction. Knowledge of paired TCRα and β sequences enables further work toward identification of target antigens and development of novel therapies.
Collapse
Affiliation(s)
- Michelle L Joachims
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, Oklahoma, USA
| | - Kerry M Leehan
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, Oklahoma, USA; Department of Pathology, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Oklahoma, USA
| | - Christina Lawrence
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, Oklahoma, USA
| | - Richard C Pelikan
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, Oklahoma, USA
| | - Jacen S Moore
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, Oklahoma, USA
| | - Zijian Pan
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, Oklahoma, USA
| | - Astrid Rasmussen
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, Oklahoma, USA
| | - Lida Radfar
- Department of Oral Diagnosis and Radiology, College of Dentistry, OUHSC, Oklahoma City, Oklahoma, USA
| | - David M Lewis
- Department of Oral and Maxillofacial Pathology, College of Dentistry, OUHSC, Oklahoma City, Oklahoma, USA
| | - Kiely M Grundahl
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, Oklahoma, USA
| | - Jennifer A Kelly
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, Oklahoma, USA
| | - Graham B Wiley
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, Oklahoma, USA
| | - Mikhail Shugay
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry of the Russian Academy of Sciences, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia; Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Dmitriy M Chudakov
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry of the Russian Academy of Sciences, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia; Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Christopher J Lessard
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, Oklahoma, USA; Department of Pathology, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Oklahoma, USA
| | - Donald U Stone
- Department of Ophthalmology, College of Medicine, OUHSC, Oklahoma City, Oklahoma, USA
| | - R Hal Scofield
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, Oklahoma, USA; Department of Pathology, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Oklahoma, USA; Section of Endocrinology and Diabetes, College of Medicine, OUHSC, Oklahoma City, Oklahoma, USA
| | - Courtney G Montgomery
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, Oklahoma, USA
| | - Kathy L Sivils
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, Oklahoma, USA; Department of Pathology, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Oklahoma, USA
| | - Linda F Thompson
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, Oklahoma, USA
| | - A Darise Farris
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation (OMRF), Oklahoma City, Oklahoma, USA; Department of Pathology, University of Oklahoma Health Sciences Center (OUHSC), Oklahoma City, Oklahoma, USA
| |
Collapse
|
26
|
Esfandiary L, Gupta N, Voigt A, Wanchoo A, Chan EKL, Sukumaran S, Nguyen CQ. Single-cell antibody nanowells: a novel technology in detecting anti-SSA/Ro60- and anti-SSB/La autoantibody-producing cells in peripheral blood of rheumatic disease patients. Arthritis Res Ther 2016; 18:107. [PMID: 27184054 PMCID: PMC4869329 DOI: 10.1186/s13075-016-1010-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 05/03/2016] [Indexed: 12/31/2022] Open
Abstract
Background Anti-SSA/Ro60 and anti-SSB/La are essential serological biomarkers for rheumatic diseases, specifically Sjögren’s syndrome (SS) and systemic lupus erythematosus (SLE). Currently, laboratory detection technology and platforms are designed with an emphasis on high-throughput methodology; therefore, the relationship of sensitivity with specificity remains a significant area for improvement. In this study, we used single-cell antibody nanowells (SCAN) technology to directly profile individual B cells producing antibodies against specific autoantigens such as SSA/Ro60 and SSB/La. Methods Peripheral blood mononuclear cells were isolated using Ficoll gradient. Fluorescently labeled cells were added to fabricated nanowells and imaged using a high-speed epifluorescence microscope. The microengraving process was conducted using printed slides coated with immunoglobulins. Printed slides were hybridized with fluorescence-conjugated immunoglobulin G (IgG), SSA/Ro60, and SSB/La antigens. Microarray spots were analyzed for nanowells with single live B cells that produced antigen-specific autoantibodies. Results Our results indicate that SCAN can simultaneously detect high frequencies of anti-SSA/Ro60 and anti-SSB/La with a specific IgG isotype in peripheral blood mononuclear cells of patients, as well as measure their individual secretion levels. The data showed that patients with SS and SLE exhibited higher frequency and greater concentration of anti-SSA/Ro60- and anti-SSB/La-producing B cells in the IgG isotype. Furthermore, individual B cells of patients produced higher levels of IgG-specific anti-SSA/Ro60 autoantibody, but not IgG-specific anti-SSB/La autoantibody, compared with healthy control subjects. Conclusions These results support the application of SCAN as a robust multiparametric analytical bioassay that can directly measure secretion of autoantibody and accurately report antigen-specific, autoantibody-producing cells.
Collapse
Affiliation(s)
- Lida Esfandiary
- Department of Infectious Diseases and Pathology, College of Veterinary Medicine, University of Florida, PO Box 110880, Gainesville, FL 32611-0880, USA
| | - Nirupama Gupta
- Department of Pediatric Nephrology, University of Florida, Gainesville, FL, USA
| | - Alexandria Voigt
- Department of Infectious Diseases and Pathology, College of Veterinary Medicine, University of Florida, PO Box 110880, Gainesville, FL 32611-0880, USA
| | - Arun Wanchoo
- Department of Infectious Diseases and Pathology, College of Veterinary Medicine, University of Florida, PO Box 110880, Gainesville, FL 32611-0880, USA
| | - Edward K L Chan
- Department of Oral Biology, University of Florida, Gainesville, FL, USA
| | - Sukesh Sukumaran
- Rheumatology Section, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Cuong Q Nguyen
- Department of Infectious Diseases and Pathology, College of Veterinary Medicine, University of Florida, PO Box 110880, Gainesville, FL 32611-0880, USA. .,Center of Orphaned Autoimmune Diseases, University of Florida, Gainesville, FL, USA.
| |
Collapse
|
27
|
Al Kindi MA, Colella AD, Chataway TK, Jackson MW, Wang JJ, Gordon TP. Secreted autoantibody repertoires in Sjögren's syndrome and systemic lupus erythematosus: A proteomic approach. Autoimmun Rev 2016; 15:405-10. [PMID: 26804757 DOI: 10.1016/j.autrev.2016.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/13/2016] [Indexed: 12/18/2022]
Abstract
The structures of epitopes bound by autoantibodies against RNA-protein complexes have been well-defined over several decades, but little is known of the clonality, immunoglobulin (Ig) variable (V) gene usage and mutational status of the autoantibodies themselves at the level of the secreted (serum) proteome. A novel proteomic workflow is presented based on affinity purification of specific Igs from serum, high-resolution two-dimensional gel electrophoresis, and de novo and database-driven sequencing of V-region proteins by mass spectrometry. Analysis of anti-Ro52/Ro60/La proteomes in primary Sjögren's syndrome (SS) and anti-Sm and anti-ribosomal P proteomes in systemic lupus erythematosus (SLE) has revealed that these antibody responses are dominated by restricted sets of public (shared) clonotypes, consistent with common pathways of production across unrelated individuals. The discovery of shared sets of specific V-region peptides can be exploited for diagnostic biomarkers in targeted mass spectrometry platforms and for tracking and removal of pathogenic clones.
Collapse
Affiliation(s)
- Mahmood A Al Kindi
- Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park, 5042, South Australia, Australia
| | - Alex D Colella
- Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park, 5042, South Australia, Australia; Flinders Proteomic Facility, Flinders University, Australia
| | - Tim K Chataway
- Flinders Proteomic Facility, Flinders University, Australia
| | - Michael W Jackson
- Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park, 5042, South Australia, Australia
| | - Jing J Wang
- Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park, 5042, South Australia, Australia.
| | - Tom P Gordon
- Department of Immunology, Flinders Medical Centre and Flinders University, SA Pathology, Bedford Park, 5042, South Australia, Australia.
| |
Collapse
|
28
|
Bende RJ, Slot LM, Hoogeboom R, Wormhoudt TAM, Adeoye AO, Guikema JEJ, van Noesel CJM. Stereotypic Rheumatoid Factors That Are Frequently Expressed in Mucosa-Associated Lymphoid Tissue-Type Lymphomas Are Rare in the Labial Salivary Glands of Patients With Sjögren's Syndrome. Arthritis Rheumatol 2015; 67:1074-83. [DOI: 10.1002/art.39002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 12/16/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Richard J. Bende
- Academic Medical Center and University of Amsterdam; Amsterdam The Netherlands
| | - Linda M. Slot
- Academic Medical Center and University of Amsterdam; Amsterdam The Netherlands
| | - Robbert Hoogeboom
- Academic Medical Center and University of Amsterdam; Amsterdam The Netherlands
| | | | - Akanbi O. Adeoye
- Academic Medical Center and University of Amsterdam; Amsterdam The Netherlands
| | | | | |
Collapse
|
29
|
Fayyaz A, Igoe A, Kurien BT, Danda D, James JA, Stafford HA, Scofield RH. Haematological manifestations of lupus. Lupus Sci Med 2015; 2:e000078. [PMID: 25861458 PMCID: PMC4378375 DOI: 10.1136/lupus-2014-000078] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 01/12/2015] [Accepted: 01/18/2015] [Indexed: 12/14/2022]
Abstract
Our purpose was to compile information on the haematological manifestations of systemic lupus erythematosus (SLE), namely leucopenia, lymphopenia, thrombocytopenia, autoimmune haemolytic anaemia (AIHA), thrombotic thrombocytopenic purpura (TTP) and myelofibrosis. During our search of the English-language MEDLINE sources, we did not place a date-of-publication constraint. Hence, we have reviewed previous as well as most recent studies with the subject heading SLE in combination with each manifestation. Neutropenia can lead to morbidity and mortality from increased susceptibility to infection. Severe neutropenia can be successfully treated with granulocyte colony-stimulating factor. While related to disease activity, there is no specific therapy for lymphopenia. Severe lymphopenia may require the use of prophylactic therapy to prevent select opportunistic infections. Isolated idiopathic thrombocytopenic purpura maybe the first manifestation of SLE by months or even years. Some manifestations of lupus occur more frequently in association with low platelet count in these patients, for example, neuropsychiatric manifestation, haemolytic anaemia, the antiphospholipid syndrome and renal disease. Thrombocytopenia can be regarded as an important prognostic indicator of survival in patients with SLE. Medical, surgical and biological treatment modalities are reviewed for this manifestation. First-line therapy remains glucocorticoids. Through our review, we conclude glucocorticoids do produce a response in majority of patients initially, but sustained response to therapy is unlikely. Glucocorticoids are used as first-line therapy in patients with SLE with AIHA, but there is no conclusive evidence to guide second-line therapy. Rituximab is promising in refractory and non-responding AIHA. TTP is not recognised as a criteria for classification of SLE, but there is a considerable overlap between the presenting features of TTP and SLE, and a few patients with SLE have concurrent TTP. Myelofibrosis is an uncommon yet well-documented manifestation of SLE. We have compiled the cases that were reported in MEDLINE sources.
Collapse
Affiliation(s)
- Anum Fayyaz
- Arthritis & Clinical Immunology Program , Oklahoma Medical Research Foundation , Oklahoma City, Oklahoma , USA ; Department of Medicine , University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma , USA ; Medical Service, Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma , USA
| | - Ann Igoe
- Arthritis & Clinical Immunology Program , Oklahoma Medical Research Foundation , Oklahoma City, Oklahoma , USA ; Department of Medicine , University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma , USA ; Departments of Medicine and Pediatrics , Metro Health System , Cleveland, Ohio , USA
| | - Biji T Kurien
- Arthritis & Clinical Immunology Program , Oklahoma Medical Research Foundation , Oklahoma City, Oklahoma , USA ; Department of Medicine , University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma , USA ; Medical Service, Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma , USA
| | - Debashish Danda
- Arthritis & Clinical Immunology Program , Oklahoma Medical Research Foundation , Oklahoma City, Oklahoma , USA ; Department of Rheumatology , Christian Medical Center , Vellore , India
| | - Judith A James
- Arthritis & Clinical Immunology Program , Oklahoma Medical Research Foundation , Oklahoma City, Oklahoma , USA ; Department of Medicine , University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma , USA ; Medical Service, Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma , USA
| | - Haraldine A Stafford
- Depertment of Medicine , Roy J. and Lucille A. Carver College of Medicine, University of Iowa , Iowa City, Iowa , USA
| | - R Hal Scofield
- Arthritis & Clinical Immunology Program , Oklahoma Medical Research Foundation , Oklahoma City, Oklahoma , USA ; Department of Medicine , University of Oklahoma Health Sciences Center , Oklahoma City, Oklahoma , USA ; Medical Service, Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma , USA
| |
Collapse
|