1
|
Reales G, Amos CI, Benveniste O, Chinoy H, De Bleecker J, De Paepe B, Doria A, Gregersen PK, Lamb JA, Limaye V, Lundberg IE, Machado PM, Maurer B, Miller FW, Molberg Ø, Pachman LM, Padyukov L, Radstake TR, Reed AM, Rider LG, Rothwell S, Selva-O'Callaghan A, Vencovský J, Wedderburn LR, Wallace C. Discovery of new myositis genetic associations through leveraging other immune-mediated diseases. HGG ADVANCES 2024; 5:100336. [PMID: 39044428 PMCID: PMC11350499 DOI: 10.1016/j.xhgg.2024.100336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 07/16/2024] [Accepted: 07/16/2024] [Indexed: 07/25/2024] Open
Abstract
Genome-wide association studies (GWASs) have been successful at finding associations between genetic variants and human traits, including the immune-mediated diseases (IMDs). However, the requirement of large sample sizes for discovery poses a challenge for learning about less common diseases, where increasing volunteer numbers might not be feasible. An example of this is myositis (or idiopathic inflammatory myopathies [IIM]s), a group of rare, heterogeneous autoimmune diseases affecting skeletal muscle and other organs, severely impairing life quality. Here, we applied a feature engineering method to borrow information from larger IMD GWASs to find new genetic associations with IIM and its subgroups. Combining this approach with two clustering methods, we found 17 IMDs genetically close to IIM, including some common comorbid conditions, such as systemic sclerosis and Sjögren's syndrome, as well as hypo- and hyperthyroidism. All IIM subtypes were genetically similar within this framework. Next, we colocalized IIM signals that overlapped IMD signals, and found seven potentially novel myositis associations mapped to immune-related genes, including BLK, IRF5/TNPO3, and ITK/HAVCR2, implicating a role for both B and T cells in IIM. This work proposes a new paradigm of genetic discovery in rarer diseases by leveraging information from more common IMD, and can be expanded to other conditions and traits beyond IMD.
Collapse
Affiliation(s)
- Guillermo Reales
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), University of Cambridge, Cambridge, UK; Department of Medicine, University of Cambridge, Cambridge, UK.
| | | | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière Hospital, Paris, France
| | - Hector Chinoy
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK; Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Jan De Bleecker
- Department of Neurology, Ghent University, Ghent, Belgium; Neuromuscular Reference Center, Ghent University Hospital, Ghent, Belgium
| | - Boel De Paepe
- Department of Neurology, Ghent University, Ghent, Belgium; Neuromuscular Reference Center, Ghent University Hospital, Ghent, Belgium
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Peter K Gregersen
- The Robert S. Boas Center for Genomics and Human Genetics, The Feinstein Institute, Manhasset, NY, USA
| | - Janine A Lamb
- Epidemiology and Public Health Group, Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Vidya Limaye
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Medicine, Adelaide University, Adelaide, South Australia, Australia
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Pedro M Machado
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology. London, UK; Centre for Rheumatology, UCL Division of Medicine, University College London, London, UK
| | - Britta Maurer
- Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Frederick W Miller
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, NIH, Bethesda, MD, USA
| | - Øyvind Molberg
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Lauren M Pachman
- Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Timothy R Radstake
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, the Netherlands
| | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, NIH, Bethesda, MD, USA
| | - Simon Rothwell
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Albert Selva-O'Callaghan
- Internal Medicine Department, Vall d'Hebron General Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jiri Vencovský
- Institute of Rheumatology and Department of Rheumatology, First Medical Faculty, Charles University, Prague, Czech Republic
| | - Lucy R Wedderburn
- Centre for Adolescent Rheumatology Versus Arthritis, UCL Great Ormond Street Institute of Child Health, University College London, London, UK; NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
| | - Chris Wallace
- Cambridge Institute of Therapeutic Immunology and Infectious Disease (CITIID), University of Cambridge, Cambridge, UK; Department of Medicine, University of Cambridge, Cambridge, UK; MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| |
Collapse
|
2
|
Văcăraş V, Vulturar R, Chiş A, Damian L. Inclusion body myositis, viral infections, and TDP-43: a narrative review. Clin Exp Med 2024; 24:91. [PMID: 38693436 PMCID: PMC11062973 DOI: 10.1007/s10238-024-01353-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024]
Abstract
The ubiquitous RNA-processing molecule TDP-43 is involved in neuromuscular diseases such as inclusion body myositis, a late-onset acquired inflammatory myopathy. TDP-43 solubility and function are disrupted in certain viral infections. Certain viruses, high viremia, co-infections, reactivation of latent viruses, and post-acute expansion of cytotoxic T cells may all contribute to inclusion body myositis, mainly in an age-shaped immune landscape. The virally induced senescent, interferon gamma-producing cytotoxic CD8+ T cells with increased inflammatory, and cytotoxic features are involved in the occurrence of inclusion body myositis in most such cases, in a genetically predisposed host. We discuss the putative mechanisms linking inclusion body myositis, TDP-43, and viral infections untangling the links between viruses, interferon, and neuromuscular degeneration could shed a light on the pathogenesis of the inclusion body myositis and other TDP-43-related neuromuscular diseases, with possible therapeutic implications.
Collapse
Affiliation(s)
- Vitalie Văcăraş
- Department of Neurosciences, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, 43, Victor Babeş St, 400012, Cluj-Napoca, Romania
- Neurology Department of Cluj, County Emergency Hospital, 3-5, Clinicilor St, 400347, Cluj-Napoca, Romania
| | - Romana Vulturar
- Department of Molecular Sciences, "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca, 6, Pasteur St, 400349, Cluj-Napoca, Romania
- Cognitive Neuroscience Laboratory, University Babeş-Bolyai, 30, Fântânele St, 400294, Cluj-Napoca, Romania
- Association for Innovation in Rare Inflammatory, Metabolic, Genetic Diseases INNOROG, 30E, Făgetului St, 400497, Cluj-Napoca, Romania
| | - Adina Chiş
- Department of Molecular Sciences, "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca, 6, Pasteur St, 400349, Cluj-Napoca, Romania.
- Cognitive Neuroscience Laboratory, University Babeş-Bolyai, 30, Fântânele St, 400294, Cluj-Napoca, Romania.
- Association for Innovation in Rare Inflammatory, Metabolic, Genetic Diseases INNOROG, 30E, Făgetului St, 400497, Cluj-Napoca, Romania.
| | - Laura Damian
- Association for Innovation in Rare Inflammatory, Metabolic, Genetic Diseases INNOROG, 30E, Făgetului St, 400497, Cluj-Napoca, Romania
- Department of Rheumatology, Centre for Rare Autoimmune and Autoinflammatory Diseases, Emergency, Clinical County Hospital Cluj, 2-4, Clinicilor St, 400006, Cluj-Napoca, Romania
- CMI Reumatologie Dr. Damian, 6-8, Petru Maior St, 400002, Cluj-Napoca, Romania
| |
Collapse
|
3
|
Oyama M, Holzer MT, Ohnuki Y, Saito Y, Nishimori Y, Suzuki S, Shiina T, Leonard-Louis S, Benveniste O, Schneider U, Stenzel W, Nishino I, Suzuki S, Uruha A. Pathologic Features of Anti-Ku Myositis. Neurology 2024; 102:e209268. [PMID: 38547417 PMCID: PMC11175641 DOI: 10.1212/wnl.0000000000209268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/16/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE Characteristics of myositis with anti-Ku antibodies are poorly understood. The purpose of this study was to elucidate the pathologic features of myositis associated with anti-Ku antibodies, compared with immune-mediated necrotizing myopathy (IMNM) with anti-signal recognition particle (SRP) and anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibodies, in muscle biopsy-oriented registration cohorts in Japan and Germany. METHODS We performed a retrospective pathology review of patients with anti-Ku myositis samples diagnosed in the Japanese and German cohorts. We evaluated histologic features and performed HLA phenotyping. RESULTS Fifty biopsied muscle samples in the Japanese cohort and 10 in the German cohort were obtained. After exclusion of myositis-specific autoantibodies or other autoimmune connective tissue diseases, 26 samples (43%) of anti-Ku antibody-positive myositis were analyzed. All the samples shared some common features with IMNM, whereas they showed expression of MHC class II and clusters of perivascular inflammatory cells more frequently than the anti-SRP/HMGCR IMNM samples (71% vs 7%/16%; p < 0.005/<0.005; 64% vs 0%/0%; p < 0.005/<0.005). Anti-Ku myositis biopsies could be divided into 2 subgroups based on the extent of necrosis and regeneration. The group with more abundant necrosis and regeneration showed a higher frequency of MHC class II expression and perivascular inflammatory cell clusters. HLA phenotyping in the 44 available patients showed possible associations of HLA-DRB1*03:01, HLA-DRB1*11:01, and HLA-DQB1*03:01 (p = 0.0045, 0.019, and 0.027; odds ratio [OR] 50.2, 4.6, and 2.8; 95% CI 2.6-2942.1, 1.1-14.5, and 1.0-7.0) in the group with less conspicuous necrosis and regeneration. On the contrary, in the group of more abundant necrosis and regeneration, the allele frequencies of HLA-A*24:02, HLA-B*52:01, HLA-C*12:02, and HLA-DRB1*15:02 were lower than those of healthy controls (p = 0.0036, 0.027, 0.016, and 0.026; OR = 0.27, 0, 0, and 0; 95% CI 0.1-0.7, 0-0.8, 0-0.8, and 0-0.8). However, these HLA associations did not remain significant after statistical correction for multiple testing. DISCUSSION While anti-Ku myositis shows necrotizing myopathy features, they can be distinguished from anti-SRP/HMGCR IMNM by their MHC class II expression and clusters of perivascular inflammatory cells. The HLA analyses suggest that anti-Ku myositis may have different subsets associated with myopathologic subgroups.
Collapse
Affiliation(s)
- Munenori Oyama
- From the Department of Neurology (M.O., S. Suzuki), Keio University School of Medicine, Tokyo, Japan; Department of Medicine for Nephrology, Rheumatology and Endocrinology (M.-T.H.), Division of Rheumatology and Systemic Inflammatory Diseases, III, University Medical Center Hamburg-Eppendorf, Germany; Department of Medical Ethics (Y.O.), Tokai University School of Medicine; Department of Clinical Genetics (Y.O.), Tokai University Hospital, Kanagawa; Department of Neuromuscular Research (Y.S., Y.N., I.N.), National Institute of Neuroscience, and Department of Genome Medicine Development (Y.S., Y.N., I.N.), Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo; Department of Neurology (Y.N.), Nara Medical University; Department of Molecular Life Science (S. Suzuki, T.S.), Tokai University School of Medicine, Kanagawa, Japan; Department of Neuropathology (S.L.-L.), Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Neuromyology (S.L.-L.), National Reference Center of Neuromuscular Disorders, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Internal Medicine and Clinical Immunology (O.B.), Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Universi, France; Department of Rheumatology (U.S.), and Department of Neuropathology (W.S.), Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universtät zu Berlin, and Berlin Institute of Health; Leibniz ScienceCampus Chronic Inflammation (W.S.), Berlin, Germany; and Department of Neurology (A.U.), Tokyo Metropolitan Neurological Hospital, Japan
| | - Marie-Therese Holzer
- From the Department of Neurology (M.O., S. Suzuki), Keio University School of Medicine, Tokyo, Japan; Department of Medicine for Nephrology, Rheumatology and Endocrinology (M.-T.H.), Division of Rheumatology and Systemic Inflammatory Diseases, III, University Medical Center Hamburg-Eppendorf, Germany; Department of Medical Ethics (Y.O.), Tokai University School of Medicine; Department of Clinical Genetics (Y.O.), Tokai University Hospital, Kanagawa; Department of Neuromuscular Research (Y.S., Y.N., I.N.), National Institute of Neuroscience, and Department of Genome Medicine Development (Y.S., Y.N., I.N.), Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo; Department of Neurology (Y.N.), Nara Medical University; Department of Molecular Life Science (S. Suzuki, T.S.), Tokai University School of Medicine, Kanagawa, Japan; Department of Neuropathology (S.L.-L.), Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Neuromyology (S.L.-L.), National Reference Center of Neuromuscular Disorders, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Internal Medicine and Clinical Immunology (O.B.), Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Universi, France; Department of Rheumatology (U.S.), and Department of Neuropathology (W.S.), Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universtät zu Berlin, and Berlin Institute of Health; Leibniz ScienceCampus Chronic Inflammation (W.S.), Berlin, Germany; and Department of Neurology (A.U.), Tokyo Metropolitan Neurological Hospital, Japan
| | - Yuko Ohnuki
- From the Department of Neurology (M.O., S. Suzuki), Keio University School of Medicine, Tokyo, Japan; Department of Medicine for Nephrology, Rheumatology and Endocrinology (M.-T.H.), Division of Rheumatology and Systemic Inflammatory Diseases, III, University Medical Center Hamburg-Eppendorf, Germany; Department of Medical Ethics (Y.O.), Tokai University School of Medicine; Department of Clinical Genetics (Y.O.), Tokai University Hospital, Kanagawa; Department of Neuromuscular Research (Y.S., Y.N., I.N.), National Institute of Neuroscience, and Department of Genome Medicine Development (Y.S., Y.N., I.N.), Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo; Department of Neurology (Y.N.), Nara Medical University; Department of Molecular Life Science (S. Suzuki, T.S.), Tokai University School of Medicine, Kanagawa, Japan; Department of Neuropathology (S.L.-L.), Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Neuromyology (S.L.-L.), National Reference Center of Neuromuscular Disorders, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Internal Medicine and Clinical Immunology (O.B.), Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Universi, France; Department of Rheumatology (U.S.), and Department of Neuropathology (W.S.), Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universtät zu Berlin, and Berlin Institute of Health; Leibniz ScienceCampus Chronic Inflammation (W.S.), Berlin, Germany; and Department of Neurology (A.U.), Tokyo Metropolitan Neurological Hospital, Japan
| | - Yoshihiko Saito
- From the Department of Neurology (M.O., S. Suzuki), Keio University School of Medicine, Tokyo, Japan; Department of Medicine for Nephrology, Rheumatology and Endocrinology (M.-T.H.), Division of Rheumatology and Systemic Inflammatory Diseases, III, University Medical Center Hamburg-Eppendorf, Germany; Department of Medical Ethics (Y.O.), Tokai University School of Medicine; Department of Clinical Genetics (Y.O.), Tokai University Hospital, Kanagawa; Department of Neuromuscular Research (Y.S., Y.N., I.N.), National Institute of Neuroscience, and Department of Genome Medicine Development (Y.S., Y.N., I.N.), Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo; Department of Neurology (Y.N.), Nara Medical University; Department of Molecular Life Science (S. Suzuki, T.S.), Tokai University School of Medicine, Kanagawa, Japan; Department of Neuropathology (S.L.-L.), Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Neuromyology (S.L.-L.), National Reference Center of Neuromuscular Disorders, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Internal Medicine and Clinical Immunology (O.B.), Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Universi, France; Department of Rheumatology (U.S.), and Department of Neuropathology (W.S.), Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universtät zu Berlin, and Berlin Institute of Health; Leibniz ScienceCampus Chronic Inflammation (W.S.), Berlin, Germany; and Department of Neurology (A.U.), Tokyo Metropolitan Neurological Hospital, Japan
| | - Yukako Nishimori
- From the Department of Neurology (M.O., S. Suzuki), Keio University School of Medicine, Tokyo, Japan; Department of Medicine for Nephrology, Rheumatology and Endocrinology (M.-T.H.), Division of Rheumatology and Systemic Inflammatory Diseases, III, University Medical Center Hamburg-Eppendorf, Germany; Department of Medical Ethics (Y.O.), Tokai University School of Medicine; Department of Clinical Genetics (Y.O.), Tokai University Hospital, Kanagawa; Department of Neuromuscular Research (Y.S., Y.N., I.N.), National Institute of Neuroscience, and Department of Genome Medicine Development (Y.S., Y.N., I.N.), Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo; Department of Neurology (Y.N.), Nara Medical University; Department of Molecular Life Science (S. Suzuki, T.S.), Tokai University School of Medicine, Kanagawa, Japan; Department of Neuropathology (S.L.-L.), Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Neuromyology (S.L.-L.), National Reference Center of Neuromuscular Disorders, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Internal Medicine and Clinical Immunology (O.B.), Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Universi, France; Department of Rheumatology (U.S.), and Department of Neuropathology (W.S.), Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universtät zu Berlin, and Berlin Institute of Health; Leibniz ScienceCampus Chronic Inflammation (W.S.), Berlin, Germany; and Department of Neurology (A.U.), Tokyo Metropolitan Neurological Hospital, Japan
| | - Shingo Suzuki
- From the Department of Neurology (M.O., S. Suzuki), Keio University School of Medicine, Tokyo, Japan; Department of Medicine for Nephrology, Rheumatology and Endocrinology (M.-T.H.), Division of Rheumatology and Systemic Inflammatory Diseases, III, University Medical Center Hamburg-Eppendorf, Germany; Department of Medical Ethics (Y.O.), Tokai University School of Medicine; Department of Clinical Genetics (Y.O.), Tokai University Hospital, Kanagawa; Department of Neuromuscular Research (Y.S., Y.N., I.N.), National Institute of Neuroscience, and Department of Genome Medicine Development (Y.S., Y.N., I.N.), Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo; Department of Neurology (Y.N.), Nara Medical University; Department of Molecular Life Science (S. Suzuki, T.S.), Tokai University School of Medicine, Kanagawa, Japan; Department of Neuropathology (S.L.-L.), Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Neuromyology (S.L.-L.), National Reference Center of Neuromuscular Disorders, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Internal Medicine and Clinical Immunology (O.B.), Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Universi, France; Department of Rheumatology (U.S.), and Department of Neuropathology (W.S.), Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universtät zu Berlin, and Berlin Institute of Health; Leibniz ScienceCampus Chronic Inflammation (W.S.), Berlin, Germany; and Department of Neurology (A.U.), Tokyo Metropolitan Neurological Hospital, Japan
| | - Takashi Shiina
- From the Department of Neurology (M.O., S. Suzuki), Keio University School of Medicine, Tokyo, Japan; Department of Medicine for Nephrology, Rheumatology and Endocrinology (M.-T.H.), Division of Rheumatology and Systemic Inflammatory Diseases, III, University Medical Center Hamburg-Eppendorf, Germany; Department of Medical Ethics (Y.O.), Tokai University School of Medicine; Department of Clinical Genetics (Y.O.), Tokai University Hospital, Kanagawa; Department of Neuromuscular Research (Y.S., Y.N., I.N.), National Institute of Neuroscience, and Department of Genome Medicine Development (Y.S., Y.N., I.N.), Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo; Department of Neurology (Y.N.), Nara Medical University; Department of Molecular Life Science (S. Suzuki, T.S.), Tokai University School of Medicine, Kanagawa, Japan; Department of Neuropathology (S.L.-L.), Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Neuromyology (S.L.-L.), National Reference Center of Neuromuscular Disorders, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Internal Medicine and Clinical Immunology (O.B.), Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Universi, France; Department of Rheumatology (U.S.), and Department of Neuropathology (W.S.), Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universtät zu Berlin, and Berlin Institute of Health; Leibniz ScienceCampus Chronic Inflammation (W.S.), Berlin, Germany; and Department of Neurology (A.U.), Tokyo Metropolitan Neurological Hospital, Japan
| | - Sarah Leonard-Louis
- From the Department of Neurology (M.O., S. Suzuki), Keio University School of Medicine, Tokyo, Japan; Department of Medicine for Nephrology, Rheumatology and Endocrinology (M.-T.H.), Division of Rheumatology and Systemic Inflammatory Diseases, III, University Medical Center Hamburg-Eppendorf, Germany; Department of Medical Ethics (Y.O.), Tokai University School of Medicine; Department of Clinical Genetics (Y.O.), Tokai University Hospital, Kanagawa; Department of Neuromuscular Research (Y.S., Y.N., I.N.), National Institute of Neuroscience, and Department of Genome Medicine Development (Y.S., Y.N., I.N.), Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo; Department of Neurology (Y.N.), Nara Medical University; Department of Molecular Life Science (S. Suzuki, T.S.), Tokai University School of Medicine, Kanagawa, Japan; Department of Neuropathology (S.L.-L.), Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Neuromyology (S.L.-L.), National Reference Center of Neuromuscular Disorders, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Internal Medicine and Clinical Immunology (O.B.), Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Universi, France; Department of Rheumatology (U.S.), and Department of Neuropathology (W.S.), Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universtät zu Berlin, and Berlin Institute of Health; Leibniz ScienceCampus Chronic Inflammation (W.S.), Berlin, Germany; and Department of Neurology (A.U.), Tokyo Metropolitan Neurological Hospital, Japan
| | - Olivier Benveniste
- From the Department of Neurology (M.O., S. Suzuki), Keio University School of Medicine, Tokyo, Japan; Department of Medicine for Nephrology, Rheumatology and Endocrinology (M.-T.H.), Division of Rheumatology and Systemic Inflammatory Diseases, III, University Medical Center Hamburg-Eppendorf, Germany; Department of Medical Ethics (Y.O.), Tokai University School of Medicine; Department of Clinical Genetics (Y.O.), Tokai University Hospital, Kanagawa; Department of Neuromuscular Research (Y.S., Y.N., I.N.), National Institute of Neuroscience, and Department of Genome Medicine Development (Y.S., Y.N., I.N.), Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo; Department of Neurology (Y.N.), Nara Medical University; Department of Molecular Life Science (S. Suzuki, T.S.), Tokai University School of Medicine, Kanagawa, Japan; Department of Neuropathology (S.L.-L.), Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Neuromyology (S.L.-L.), National Reference Center of Neuromuscular Disorders, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Internal Medicine and Clinical Immunology (O.B.), Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Universi, France; Department of Rheumatology (U.S.), and Department of Neuropathology (W.S.), Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universtät zu Berlin, and Berlin Institute of Health; Leibniz ScienceCampus Chronic Inflammation (W.S.), Berlin, Germany; and Department of Neurology (A.U.), Tokyo Metropolitan Neurological Hospital, Japan
| | - Udo Schneider
- From the Department of Neurology (M.O., S. Suzuki), Keio University School of Medicine, Tokyo, Japan; Department of Medicine for Nephrology, Rheumatology and Endocrinology (M.-T.H.), Division of Rheumatology and Systemic Inflammatory Diseases, III, University Medical Center Hamburg-Eppendorf, Germany; Department of Medical Ethics (Y.O.), Tokai University School of Medicine; Department of Clinical Genetics (Y.O.), Tokai University Hospital, Kanagawa; Department of Neuromuscular Research (Y.S., Y.N., I.N.), National Institute of Neuroscience, and Department of Genome Medicine Development (Y.S., Y.N., I.N.), Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo; Department of Neurology (Y.N.), Nara Medical University; Department of Molecular Life Science (S. Suzuki, T.S.), Tokai University School of Medicine, Kanagawa, Japan; Department of Neuropathology (S.L.-L.), Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Neuromyology (S.L.-L.), National Reference Center of Neuromuscular Disorders, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Internal Medicine and Clinical Immunology (O.B.), Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Universi, France; Department of Rheumatology (U.S.), and Department of Neuropathology (W.S.), Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universtät zu Berlin, and Berlin Institute of Health; Leibniz ScienceCampus Chronic Inflammation (W.S.), Berlin, Germany; and Department of Neurology (A.U.), Tokyo Metropolitan Neurological Hospital, Japan
| | - Werner Stenzel
- From the Department of Neurology (M.O., S. Suzuki), Keio University School of Medicine, Tokyo, Japan; Department of Medicine for Nephrology, Rheumatology and Endocrinology (M.-T.H.), Division of Rheumatology and Systemic Inflammatory Diseases, III, University Medical Center Hamburg-Eppendorf, Germany; Department of Medical Ethics (Y.O.), Tokai University School of Medicine; Department of Clinical Genetics (Y.O.), Tokai University Hospital, Kanagawa; Department of Neuromuscular Research (Y.S., Y.N., I.N.), National Institute of Neuroscience, and Department of Genome Medicine Development (Y.S., Y.N., I.N.), Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo; Department of Neurology (Y.N.), Nara Medical University; Department of Molecular Life Science (S. Suzuki, T.S.), Tokai University School of Medicine, Kanagawa, Japan; Department of Neuropathology (S.L.-L.), Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Neuromyology (S.L.-L.), National Reference Center of Neuromuscular Disorders, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Internal Medicine and Clinical Immunology (O.B.), Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Universi, France; Department of Rheumatology (U.S.), and Department of Neuropathology (W.S.), Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universtät zu Berlin, and Berlin Institute of Health; Leibniz ScienceCampus Chronic Inflammation (W.S.), Berlin, Germany; and Department of Neurology (A.U.), Tokyo Metropolitan Neurological Hospital, Japan
| | - Ichizo Nishino
- From the Department of Neurology (M.O., S. Suzuki), Keio University School of Medicine, Tokyo, Japan; Department of Medicine for Nephrology, Rheumatology and Endocrinology (M.-T.H.), Division of Rheumatology and Systemic Inflammatory Diseases, III, University Medical Center Hamburg-Eppendorf, Germany; Department of Medical Ethics (Y.O.), Tokai University School of Medicine; Department of Clinical Genetics (Y.O.), Tokai University Hospital, Kanagawa; Department of Neuromuscular Research (Y.S., Y.N., I.N.), National Institute of Neuroscience, and Department of Genome Medicine Development (Y.S., Y.N., I.N.), Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo; Department of Neurology (Y.N.), Nara Medical University; Department of Molecular Life Science (S. Suzuki, T.S.), Tokai University School of Medicine, Kanagawa, Japan; Department of Neuropathology (S.L.-L.), Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Neuromyology (S.L.-L.), National Reference Center of Neuromuscular Disorders, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Internal Medicine and Clinical Immunology (O.B.), Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Universi, France; Department of Rheumatology (U.S.), and Department of Neuropathology (W.S.), Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universtät zu Berlin, and Berlin Institute of Health; Leibniz ScienceCampus Chronic Inflammation (W.S.), Berlin, Germany; and Department of Neurology (A.U.), Tokyo Metropolitan Neurological Hospital, Japan
| | - Shigeaki Suzuki
- From the Department of Neurology (M.O., S. Suzuki), Keio University School of Medicine, Tokyo, Japan; Department of Medicine for Nephrology, Rheumatology and Endocrinology (M.-T.H.), Division of Rheumatology and Systemic Inflammatory Diseases, III, University Medical Center Hamburg-Eppendorf, Germany; Department of Medical Ethics (Y.O.), Tokai University School of Medicine; Department of Clinical Genetics (Y.O.), Tokai University Hospital, Kanagawa; Department of Neuromuscular Research (Y.S., Y.N., I.N.), National Institute of Neuroscience, and Department of Genome Medicine Development (Y.S., Y.N., I.N.), Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo; Department of Neurology (Y.N.), Nara Medical University; Department of Molecular Life Science (S. Suzuki, T.S.), Tokai University School of Medicine, Kanagawa, Japan; Department of Neuropathology (S.L.-L.), Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Neuromyology (S.L.-L.), National Reference Center of Neuromuscular Disorders, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Internal Medicine and Clinical Immunology (O.B.), Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Universi, France; Department of Rheumatology (U.S.), and Department of Neuropathology (W.S.), Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universtät zu Berlin, and Berlin Institute of Health; Leibniz ScienceCampus Chronic Inflammation (W.S.), Berlin, Germany; and Department of Neurology (A.U.), Tokyo Metropolitan Neurological Hospital, Japan
| | - Akinori Uruha
- From the Department of Neurology (M.O., S. Suzuki), Keio University School of Medicine, Tokyo, Japan; Department of Medicine for Nephrology, Rheumatology and Endocrinology (M.-T.H.), Division of Rheumatology and Systemic Inflammatory Diseases, III, University Medical Center Hamburg-Eppendorf, Germany; Department of Medical Ethics (Y.O.), Tokai University School of Medicine; Department of Clinical Genetics (Y.O.), Tokai University Hospital, Kanagawa; Department of Neuromuscular Research (Y.S., Y.N., I.N.), National Institute of Neuroscience, and Department of Genome Medicine Development (Y.S., Y.N., I.N.), Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo; Department of Neurology (Y.N.), Nara Medical University; Department of Molecular Life Science (S. Suzuki, T.S.), Tokai University School of Medicine, Kanagawa, Japan; Department of Neuropathology (S.L.-L.), Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Neuromyology (S.L.-L.), National Reference Center of Neuromuscular Disorders, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital; Department of Internal Medicine and Clinical Immunology (O.B.), Inflammatory Myopathies Reference Center, Research Center in Myology UMR974, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Universi, France; Department of Rheumatology (U.S.), and Department of Neuropathology (W.S.), Charité-Universitätsmedizin, Freie Universität Berlin, Humboldt-Universtät zu Berlin, and Berlin Institute of Health; Leibniz ScienceCampus Chronic Inflammation (W.S.), Berlin, Germany; and Department of Neurology (A.U.), Tokyo Metropolitan Neurological Hospital, Japan
| |
Collapse
|
4
|
Slater N, Sooda A, McLeish E, Beer K, Brusch A, Shakya R, Bundell C, James I, Chopra A, Mastaglia FL, Needham M, Coudert JD. High-resolution HLA genotyping in inclusion body myositis refines 8.1 ancestral haplotype association to DRB1*03:01:01 and highlights pathogenic role of arginine-74 of DRβ1 chain. J Autoimmun 2024; 142:103150. [PMID: 38043487 DOI: 10.1016/j.jaut.2023.103150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/01/2023] [Accepted: 11/15/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Inclusion body myositis (IBM) is a progressive inflammatory-degenerative muscle disease of older individuals, with some patients producing anti-cytosolic 5'-nucleotidase 1A (NT5C1A, aka cN1A) antibodies. Human Leukocyte Antigens (HLA) is the highest genetic risk factor for developing IBM. In this study, we aimed to further define the contribution of HLA alleles to IBM and the production of anti-cN1A antibodies. METHODS We HLA haplotyped a Western Australian cohort of 113 Caucasian IBM patients and 112 ethnically matched controls using Illumina next-generation sequencing. Allele frequency analysis and amino acid alignments were performed using the Genentech/MiDAS bioinformatics package. Allele frequencies were compared using Fisher's exact test. Age at onset analysis was performed using the ggstatsplot package. All analysis was carried out in RStudio version 1.4.1717. RESULTS Our findings validated the independent association of HLA-DRB1*03:01:01 with IBM and attributed the risk to an arginine residue in position 74 within the DRβ1 protein. Conversely, DRB4*01:01:01 and DQA1*01:02:01 were found to have protective effects; the carriers of DRB1*03:01:01 that did not possess these alleles had a fourteenfold increased risk of developing IBM over the general Caucasian population. Furthermore, patients with the abovementioned genotype developed symptoms on average five years earlier than patients without. We did not find any HLA associations with anti-cN1A antibody production. CONCLUSIONS High-resolution HLA sequencing more precisely characterised the alleles associated with IBM and defined a haplotype linked to earlier disease onset. Identification of the critical amino acid residue by advanced biostatistical analysis of immunogenetics data offers mechanistic insights and future directions into uncovering IBM aetiopathogenesis.
Collapse
Affiliation(s)
- Nataliya Slater
- Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, WA, Australia
| | - Anuradha Sooda
- Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, WA, Australia
| | - Emily McLeish
- Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, WA, Australia
| | - Kelly Beer
- Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, WA, Australia; Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Anna Brusch
- PathWest Laboratory Medicine, Dept of Clinical Immunology, QEII Medical Centre, Nedlands, WA, Australia
| | - Rakesh Shakya
- PathWest Laboratory Medicine, Dept of Clinical Immunology, QEII Medical Centre, Nedlands, WA, Australia
| | - Christine Bundell
- PathWest Laboratory Medicine, Dept of Clinical Immunology, QEII Medical Centre, Nedlands, WA, Australia
| | - Ian James
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia; Murdoch University, Institute for Immunology and Infection Diseases, Murdoch, WA, Australia
| | - Abha Chopra
- Murdoch University, Institute for Immunology and Infection Diseases, Murdoch, WA, Australia
| | - Frank L Mastaglia
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia; University of Western Australia, Centre for Neuromuscular & Neurological Disorders, Crawley, WA, Australia
| | - Merrilee Needham
- Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, WA, Australia; Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia; University of Notre Dame Australia, School of Medicine, Fremantle, WA, Australia; Fiona Stanley Hospital, Department of Neurology, Murdoch, WA, Australia
| | - Jerome D Coudert
- Murdoch University, Centre for Molecular Medicine and Innovative Therapeutics, Murdoch, WA, Australia; Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia; University of Notre Dame Australia, School of Medicine, Fremantle, WA, Australia.
| |
Collapse
|
5
|
Khoo T, Lilleker JB, Thong BYH, Leclair V, Lamb JA, Chinoy H. Epidemiology of the idiopathic inflammatory myopathies. Nat Rev Rheumatol 2023; 19:695-712. [PMID: 37803078 DOI: 10.1038/s41584-023-01033-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/08/2023]
Abstract
The idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of systemic autoimmune diseases that affect the skeletal muscles and can also involve the skin, joints, lungs and heart. The epidemiology of IIM is obscured by changing classification criteria and the inherent shortcomings of case identification using healthcare record diagnostic coding. The incidence of IIM is estimated to range from 0.2 to 2 per 100,000 person-years, with prevalence from 2 to 25 per 100,000 people. Although the effects of age and gender on incidence are known, there is only sparse understanding of ethnic differences, particularly in indigenous populations. The incidence of IIM has reportedly increased in the twenty-first century, but whether this is a genuine increase is not yet known. Understanding of the genetic risk factors for different IIM subtypes has advanced considerably. Infections, medications, malignancy and geography are also commonly identified risk factors. Potentially, the COVID-19 pandemic has altered IIM incidence, although evidence of this occurrence is limited to case reports and small case series. Consideration of the current understanding of the epidemiology of IIM can highlight important areas of interest for future research into these rare diseases.
Collapse
Affiliation(s)
- Thomas Khoo
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - James B Lilleker
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neuroscience, Manchester Academic Health Science Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Valérie Leclair
- Department of Medicine, Division of Rheumatology, McGill University, Montreal, Canada
| | - Janine A Lamb
- Epidemiology and Public Health Group, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Hector Chinoy
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.
| |
Collapse
|
6
|
Rothwell S, Amos CI, Miller FW, Rider LG, Lundberg IE, Gregersen PK, Vencovsky J, McHugh N, Limaye V, Selva‐O'Callaghan A, Hanna MG, Machado PM, Pachman LM, Reed AM, Molberg Ø, Benveniste O, Mathiesen P, Radstake T, Doria A, De Bleecker JL, De Paepe B, Maurer B, Ollier WE, Padyukov L, O'Hanlon TP, Lee A, Wedderburn LR, Chinoy H, Lamb JA. Identification of Novel Associations and Localization of Signals in Idiopathic Inflammatory Myopathies Using Genome-Wide Imputation. Arthritis Rheumatol 2023; 75:1021-1027. [PMID: 36580032 PMCID: PMC10238560 DOI: 10.1002/art.42434] [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: 03/08/2022] [Revised: 10/07/2022] [Accepted: 12/22/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The idiopathic inflammatory myopathies (IIMs) are heterogeneous diseases thought to be initiated by immune activation in genetically predisposed individuals. We imputed variants from the ImmunoChip array using a large reference panel to fine-map associations and identify novel associations in IIM. METHODS We analyzed 2,565 Caucasian IIM patient samples collected through the Myositis Genetics Consortium (MYOGEN) and 10,260 ethnically matched control samples. We imputed 1,648,116 variants from the ImmunoChip array using the Haplotype Reference Consortium panel and conducted association analysis on IIM and clinical and serologic subgroups. RESULTS The HLA locus was consistently the most significantly associated region. Four non-HLA regions reached genome-wide significance, SDK2 and LINC00924 (both novel) and STAT4 in the whole IIM cohort, with evidence of independent variants in STAT4, and NAB1 in the polymyositis (PM) subgroup. We also found suggestive evidence of association with loci previously associated with other autoimmune rheumatic diseases (TEC and LTBR). We identified more significant associations than those previously reported in IIM for STAT4 and DGKQ in the total cohort, for NAB1 and FAM167A-BLK loci in PM, and for CCR5 in inclusion body myositis. We found enrichment of variants among DNase I hypersensitivity sites and histone marks associated with active transcription within blood cells. CONCLUSION We found novel and strong associations in IIM and PM and localized signals to single genes and immune cell types.
Collapse
Affiliation(s)
- Simon Rothwell
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | | | - Frederick W. Miller
- Environmental Autoimmunity GroupNational Institute of Environmental Health Sciences, NIHBethesdaMaryland
| | - Lisa G. Rider
- Environmental Autoimmunity GroupNational Institute of Environmental Health Sciences, NIHBethesdaMaryland
| | - Ingrid E. Lundberg
- Division of Rheumatology, Department of Medicine, Solna, Karolinska InstitutetKarolinska University HospitalStockholmSweden
| | - Peter K. Gregersen
- The Robert S. Boas Center for Genomics and Human GeneticsThe Feinstein InstituteManhassetNew York
| | - Jiri Vencovsky
- Institute of Rheumatology and Department of Rheumatology, First Medical FacultyCharles UniversityPragueCzech Republic
| | - Neil McHugh
- Department of Pharmacy and PharmacologyUniversity of BathBathUK
| | - Vidya Limaye
- Rheumatology Unit, Royal Adelaide Hospital and Discipline of MedicineAdelaide UniversityAdelaideAustralia
| | - Albert Selva‐O'Callaghan
- Internal Medicine Department, Vall d'Hebron General Hospital, Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Michael G. Hanna
- Department of Neuromuscular Diseases, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Pedro M. Machado
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, and Centre for Rheumatology, UCL Division of MedicineUniversity College LondonLondonUK
| | - Lauren M. Pachman
- Ann & Robert H. Lurie Children's Hospital of ChicagoNorthwestern University Feinberg School of MedicineChicagoIllinois
| | - Ann M. Reed
- Department of PediatricsDuke UniversityDurhamNorth Carolina
| | - Øyvind Molberg
- Department of RheumatologyOslo University HospitalOsloNorway
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Pitié‐Salpêtrière HospitalParisFrance
| | - Pernille Mathiesen
- Paediatric Department, Slagelse Hospital and Paediatric Rheumatology Unit, RigshospitaletCopenhagenDenmark
| | - Timothy Radstake
- Department of Rheumatology and Clinical ImmunologyUniversity Medical CenterUtrechtthe Netherlands
| | - Andrea Doria
- Rheumatology Unit, Department of MedicineUniversity of PadovaPadovaItaly
| | | | | | - Britta Maurer
- Department of Rheumatology and ImmunologyUniversity HospitalBernSwitzerland
| | - William E. Ollier
- Manchester Metropolitan University, School of Healthcare SciencesManchesterUK
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine, Solna, Karolinska InstitutetKarolinska University HospitalStockholmSweden
| | - Terrance P. O'Hanlon
- Environmental Autoimmunity GroupNational Institute of Environmental Health Sciences, NIHBethesdaMaryland
| | - Annette Lee
- The Robert S. Boas Center for Genomics and Human GeneticsThe Feinstein InstituteManhassetNew York
| | - Lucy R. Wedderburn
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, and Arthritis Research UK Centre for Adolescent Rheumatology, UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK, and Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK, and Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of ManchesterManchesterUK
| | - Janine A. Lamb
- Epidemiology and Public Health Group, Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | | |
Collapse
|
7
|
Nagy S, Khan A, Machado PM, Houlden H. Inclusion body myositis: from genetics to clinical trials. J Neurol 2023; 270:1787-1797. [PMID: 36399165 PMCID: PMC9971047 DOI: 10.1007/s00415-022-11459-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022]
Abstract
Inclusion body myositis (IBM) belongs to the group of idiopathic inflammatory myopathies and is characterized by a slowly progressive disease course with asymmetric muscle weakness of predominantly the finger flexors and knee extensors. The disease leads to severe disability and most patients lose ambulation due to lack of curative or disease-modifying treatment options. Despite some genes reported to be associated with hereditary IBM (a distinct group of conditions), data on the genetic susceptibility of sporadic IBM are very limited. This review gives an overview of the disease and focuses on the current genetic knowledge and potential therapeutic implications.
Collapse
Affiliation(s)
- Sara Nagy
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK.
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Alaa Khan
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
- Molecular Diagnostic Unit, Clinical Laboratory Department, King Abdullah Medical City in Makkah, Mecca, Saudi Arabia
| | - Pedro M Machado
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
- Division of Medicine, Centre for Rheumatology, University College London, London, UK
| | - Henry Houlden
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK
| |
Collapse
|
8
|
Goyal NA. Inclusion Body Myositis. Continuum (Minneap Minn) 2022; 28:1663-1677. [PMID: 36537974 DOI: 10.1212/con.0000000000001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW This article highlights the clinical and diagnostic features of inclusion body myositis (IBM) and provides recent insights into the pathomechanisms and therapeutic strategies of the disease. RECENT FINDINGS IBM is an often-misdiagnosed myopathy subtype. Due to the insidious onset and slow progression of muscle weakness, it can often be dismissed as a sign of aging as it commonly presents in older adults. While challenging to recognize upon initial clinical evaluation, the recent recognition of specialized stains highlighting features seen on muscle pathology, the use of diagnostic tools such as the anti-cytosolic 5'-nucleotidase 1A antibody biomarker, and the ability of muscle imaging to detect patterns of preferential muscle involvement seen in IBM has allowed for earlier diagnosis of the disease than was previously possible. While the pathogenesis of IBM has historically been poorly understood, several ongoing studies point toward mechanisms of autophagy and highly differentiated cytotoxic T cells that are postulated to be pathogenic in IBM. SUMMARY Overall advancements in our understanding of IBM have resulted in improvements in the management of the disease and are the foundation of several strategies for current and upcoming novel therapeutic drug trials in IBM.
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW To discuss recent developments in our understanding of epidemiology, diagnostics, biomarkers, pathology, pathogenesis, outcome measures, and therapeutics in inclusion body myositis (IBM). RECENT FINDINGS Recent epidemiology data confirms a relatively higher prevalence in the population aged above 50 years and the reduced life expectancy. Association with cancer and other systemic disorders is better defined. The role of magnetic resonance imaging (MRI) and ultrasound in diagnosis as well as in following disease progression has been elucidated. There are new blood and imaging biomarkers that show tremendous promise for diagnosis and as outcome measures in therapeutic trials. Improved understanding of the pathogenesis of the disease will lead to better therapeutic interventions, but also highlights the importance to have sensitive and responsive outcome measures that accurately quantitate change. SUMMARY There are exciting new developments in our understanding of IBM which should lead to improved management and therapeutic options.
Collapse
Affiliation(s)
- Mari Perez-Rosendahl
- Department of Pathology & Laboratory Medicine, School of Medicine, University of California, Irvine
| | - Tahseen Mozaffar
- Department of Pathology & Laboratory Medicine, School of Medicine, University of California, Irvine
- Department of Neurology, School of Medicine, University of California, Irvine
- Institute for Immunology, School of Medicine, University of California, Irvine
| |
Collapse
|
10
|
Grover KM, Sripathi N. Prevention of Adverse Outcomes and Treatment Side Effects in Patients with Neuromuscular Disorders. Semin Neurol 2022; 42:594-610. [PMID: 36400111 DOI: 10.1055/s-0042-1758779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this article, we review prevention of serious adverse clinical outcomes and treatment side effects in patients with neuromuscular disorders including myopathies and myasthenia gravis. While neither of these entities is preventable, their course can often be modified, and severe sequelae may be prevented, with the identification of risk factors and proactive attention toward treatment planning.
Collapse
Affiliation(s)
- Kavita M Grover
- Department of Neurology, Henry Ford Medical Group, Wayne State University, Detroit, Michigan
| | - Naganand Sripathi
- Department of Neurology, Henry Ford Medical Group, Wayne State University, Detroit, Michigan
| |
Collapse
|
11
|
Naddaf E. Inclusion body myositis: Update on the diagnostic and therapeutic landscape. Front Neurol 2022; 13:1020113. [PMID: 36237625 PMCID: PMC9551222 DOI: 10.3389/fneur.2022.1020113] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Inclusion body myositis (IBM) is a progressive muscle disease affecting patients over the age of 40, with distinctive clinical and histopathological features. The typical clinical phenotype is characterized by prominent involvement of deep finger flexors and quadriceps muscles. Less common presentations include isolated dysphagia, asymptomatic hyper-CKemia, and axial or limb weakness beyond the typical pattern. IBM is associated with marked morbidity as majority of patients eventually become wheelchair dependent with limited use of their hands and marked dysphagia. Furthermore, IBM mildly affects longevity with aspiration pneumonia and respiratory complications being the most common cause of death. On muscle biopsy, IBM is characterized by a peculiar combination of endomysial inflammation, rimmed vacuoles, and protein aggregation. These histopathological features are reflective of the complexity of underlying disease mechanisms. No pharmacological treatment is yet available for IBM. Monitoring for swallowing and respiratory complications, exercise, and addressing mobility issues are the mainstay of management. Further research is needed to better understand disease pathogenesis and identify novel therapeutic targets.
Collapse
|
12
|
Naddaf E. Comment on: Survival and associated comorbidities in inclusion body myositis: Reply. Rheumatology (Oxford) 2022; 61:e348-e349. [PMID: 35781321 DOI: 10.1093/rheumatology/keac379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elie Naddaf
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
13
|
Connolly CM, Plomp L, Paik JJ, Allenbach Y. Possible future avenues for myositis therapeutics: DM, IMNM and IBM. Best Pract Res Clin Rheumatol 2022; 36:101762. [PMID: 35778272 DOI: 10.1016/j.berh.2022.101762] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Idiopathic inflammatory myopathies (IIMs) represent a heterogeneous group of systemic autoimmune diseases characterized by immune-mediated muscle injury. As insights into pathogenesis of IIM evolve, novel therapeutic strategies have become available to optimize outcomes. Herein, we summarize novel and emerging strategies in the management of dermatomyositis (DM), immunemediated necrotizing myopathy (IMNM), and inclusion body myositis (IBM).
Collapse
Affiliation(s)
- Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lotta Plomp
- Department of Internal Medicine and Clinical Immunology, Pitié Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Pitié Salpêtrière Hospital, Sorbonne University, Paris, France.
| |
Collapse
|
14
|
McLeish E, Slater N, Sooda A, Wilson A, Coudert JD, Lloyd TE, Needham M. Inclusion body myositis: The interplay between ageing, muscle degeneration and autoimmunity. Best Pract Res Clin Rheumatol 2022; 36:101761. [PMID: 35760741 DOI: 10.1016/j.berh.2022.101761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Inclusion body myositis (IBM) is a slowly progressive muscle disease affecting ageing individuals. IBM presents with a distinctive pattern of weakness involving the quadriceps and finger flexor muscles, although other muscles including pharyngeal muscles become affected over time. Pathological hallmarks of IBM include autoimmune features, including endomysial infiltration by highly differentiated T cells, as well as degenerative features marked by intramyofibre protein aggregates organised into inclusion bodies. Despite some progress in understanding the cellular pathways involved in IBM, it remains untreatable, and the progression of the disease leads to progressive weakness, disability, wheelchair dependency and loss of independence. Therefore, there is an urgent need to improve our understanding of the underlying mechanisms and pathways involved in this disease to identify new treatment targets. Here, we discuss the current understanding of aetiopathogenesis, the interrelationship between autoimmunity and degeneration, and how ageing is a major influencer of both these features.
Collapse
Affiliation(s)
- E McLeish
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, WA, Australia.
| | - N Slater
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, WA, Australia
| | - A Sooda
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, WA, Australia
| | - A Wilson
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J D Coudert
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, WA, Australia; Perron Institute for Neurological and Translational Science, Perth, WA, Australia; School of Medicine, University of Notre Dame, Fremantle, WA, Australia
| | - T E Lloyd
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - M Needham
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, WA, Australia; Perron Institute for Neurological and Translational Science, Perth, WA, Australia; School of Medicine, University of Notre Dame, Fremantle, WA, Australia; Fiona Stanley Hospital, Department of Neurology, Perth, WA, Australia
| |
Collapse
|
15
|
Abstract
The idiopathic inflammatory myopathies (IIM) are rare, heterogeneous systemic autoimmune disorders, characterized by inflammation of skeletal muscle and multi-organ involvement. Studies to identify genetic risk factors and dysregulated gene expression in IIM aim to increase our understanding of disease pathogenesis. Genome-wide association studies have confirmed the HLA region as the most strongly associated region in IIM, with different associations between clinically-defined subgroups. Associated genes are involved in both the innate and adaptive immune response, while identification of variants reported in other autoimmune disorders suggests shared biological pathways. Targeted imputation analysis has identified key associated amino acid residues within HLA molecules that may influence antigen recognition. These amino acids increase risk for specific clinical phenotypes and autoantibody subgroups, and suggest that serology-defined subgroups may be more homogeneous. Recent data support the contribution of rare genetic variation to disease susceptibility in IIM, including mitochondrial DNA variation in sporadic inclusion body myositis and somatic mutations and loss of heterozygosity in cancer-associated myositis. Gene expression studies in skeletal muscle, blood and skin from individuals with IIM has confirmed the role of interferon signalling and other dysregulated pathways, and identified cell-type specific signatures. These dysregulated genes differentiate IIM subgroups and identify potential biomarkers. Here, we review recent genetic studies in IIM, and how these inform our understanding of disease pathogenesis and provide mechanistic insights into biological pathways.
Collapse
|
16
|
Affiliation(s)
- Andrew L Mammen
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD .,Departments of Neurology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
17
|
Wu Y, Zhao Z, Zhang J, Wang Y, Song X. Identification of Hub Genes and Biological Pathways in Inclusion Body Myositis Using Bioinformatics Analysis. Int J Gen Med 2022; 15:1281-1293. [PMID: 35173467 PMCID: PMC8841524 DOI: 10.2147/ijgm.s346965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/12/2022] [Indexed: 12/04/2022] Open
Abstract
Background Inclusion body myositis (IBM) is a unique idiopathic inflammatory myopathy with unclear pathogenesis and poor prognosis. Although previous publications have identified some molecular biomarkers, the value of these biomarkers is unknown. Objective To identify hub genes and signaling pathways related to IBM for understanding the IBM-related mechanisms and providing guidance for therapy development. Methods Two microarray datasets (GSE3112 and GSE128470) were downloaded from the Gene Expression Omnibus (GEO) database. GEO2R was used to detect differentially expressed genes (DEGs) between IBM and normal muscle tissues. The hub genes were determined using protein–protein interaction (PPI) network in Cytoscape. The specific signaling pathways and biological functions of IBM were identified using GO, KEGG, and GSEA enrichment analyses. Moreover, CIBERSORT was applied to estimate the expression level of 22 immune cell types in IBM and normal muscle tissue. The relationship between the immune cell types and hub genes was then explored. Results A total of 219 DEGs and 10 hub genes were identified. Enrichment analyses revealed that the chemokine signaling pathway, cellular response to interferon-gamma, and P53 pathway have crucial roles in IBM. Immune infiltration analyses showed that IBM was associated with high level of CD8 T cells, Tregs, and macrophages. Finally, five potential drugs were predicted for IBM patients through CMap (connectivity map) database. Conclusion In this study, the underlying molecular mechanisms and immunological landscape of IBM were investigated, and thus may provide new directions for future research on IBM pathogenesis.
Collapse
Affiliation(s)
- Yue Wu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, People’s Republic of China
- Neurological Laboratory of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
| | - Zijun Zhao
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Heibei, 050000, People’s Republic of China
| | - Jinru Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, People’s Republic of China
- Neurological Laboratory of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
| | - Yaye Wang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, People’s Republic of China
- Neurological Laboratory of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
| | - Xueqin Song
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, People’s Republic of China
- Neurological Laboratory of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
- Correspondence: Xueqin Song, Department of Neurology, The Second Hospital of Hebei Medical University, 215 Heping West Road, Shijiazhuang, Hebei, 050000, People’s Republic of China, Tel/Fax +86-318-2187209, Email
| |
Collapse
|
18
|
Ikenaga C, Date H, Kanagawa M, Mitsui J, Ishiura H, Yoshimura J, Pinal‐Fernandez I, Mammen AL, Lloyd TE, Tsuji S, Shimizu J, Toda T, Goto J. Muscle transcriptomics shows overexpression of
cadherin 1
in inclusion body myositis. Ann Neurol 2022; 91:317-328. [PMID: 35064929 PMCID: PMC9092834 DOI: 10.1002/ana.26304] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/18/2022]
Abstract
Objective This study aimed to elucidate the molecular features of inclusion body myositis (IBM). Methods We performed RNA sequencing analysis of muscle biopsy samples from 67 participants, consisting of 58 myositis patients with the pathological finding of CD8‐positive T cells invading non‐necrotic muscle fibers expressing major histocompatibility complex class I (43 IBM, 6 polymyositis, and 9 unclassifiable myositis), and 9 controls. Results Cluster analysis, principal component analysis, and pathway analysis showed that differentially expressed genes and pathways identified in IBM and polymyositis were mostly comparable. However, pathways related to cell adhesion molecules were upregulated in IBM as compared with polymyositis and controls (p < 0.01). Notably, CDH1, which encodes the epidermal cell junction protein cadherin 1, was overexpressed in the muscles of IBM, which was validated by another RNA sequencing dataset from previous publications. Western blotting confirmed the presence of mature cadherin 1 protein in the muscles of IBM. Immunohistochemical staining confirmed the positivity for anti‐cadherin 1 antibody in the muscles of IBM, whereas there was no muscle fiber positive for anti‐cadherin 1 antibody in immune‐mediated necrotizing myopathy, antisynthetase syndrome, and controls. The fibers stained with anti‐cadherin 1 antibody did not have rimmed vacuoles or abnormal protein accumulation. Experimental skeletal muscle regeneration and differentiation systems showed that CDH1 is expressed during skeletal muscle regeneration and differentiation. Interpretation CDH1 was detected as a differentially expressed gene, and immunohistochemistry showed that cadherin 1 exists in the muscles of IBM, whereas it was rarely seen in those of other idiopathic inflammatory myopathies. Cadherin 1 upregulation in muscle could provide a valuable clue to the pathological mechanisms of IBM. ANN NEUROL 2022;91:317–328
Collapse
Affiliation(s)
- Chiseko Ikenaga
- Department of Neurology, Graduate School of Medicine the University of Tokyo Tokyo Japan
- Department of Neurology Johns Hopkins University School of Medicine Baltimore MD US
| | - Hidetoshi Date
- Department of Neurology, National Center Hospital National Center of Neurology and Psychiatry Tokyo Japan
| | - Motoi Kanagawa
- Division of Molecular Brain Science Kobe University Graduate School of Medicine Kobe Japan
- Department of Cell Biology and Molecular Medicine Ehime University Graduate School of Medicine Ehime Japan
| | - Jun Mitsui
- Department of Molecular Neurology, Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Jun Yoshimura
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences The University of Tokyo Chiba Japan
| | - Iago Pinal‐Fernandez
- Department of Neurology Johns Hopkins University School of Medicine Baltimore MD US
- Muscle Disease Unit National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health Bethesda MD US
- Faculty of Health Sciences and Faculty of Computer Science, Multimedia and Telecommunications Universitat Oberta de Catalunya Barcelona Spain
| | - Andrew L. Mammen
- Department of Neurology Johns Hopkins University School of Medicine Baltimore MD US
- Muscle Disease Unit National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health Bethesda MD US
| | - Thomas E. Lloyd
- Department of Neurology Johns Hopkins University School of Medicine Baltimore MD US
- Solomon H. Synder Department of Neuroscience Johns Hopkins University School of Medicine Baltimore MD US
| | - Shoji Tsuji
- Department of Molecular Neurology, Graduate School of Medicine The University of Tokyo Tokyo Japan
- Institute of Medical Genomics International University of Health and Welfare Chiba Japan
| | - Jun Shimizu
- Department of Neurology, Graduate School of Medicine the University of Tokyo Tokyo Japan
- Department of Physical Therapy Tokyo University of Technology Tokyo Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine the University of Tokyo Tokyo Japan
- Division of Molecular Brain Science Kobe University Graduate School of Medicine Kobe Japan
| | - Jun Goto
- Department of Neurology International University of Health and Welfare, Mita Hospital Tokyo Japan
- Department of Neurology International University of Health and Welfare, Ichikawa Hospital Chiba Japan
| |
Collapse
|
19
|
Britson KA, Ling JP, Braunstein KE, Montagne JM, Kastenschmidt JM, Wilson A, Ikenaga C, Tsao W, Pinal-Fernandez I, Russell KA, Reed N, Mozaffar T, Wagner KR, Ostrow LW, Corse AM, Mammen AL, Villalta SA, Larman HB, Wong PC, Lloyd TE. Loss of TDP-43 function and rimmed vacuoles persist after T cell depletion in a xenograft model of sporadic inclusion body myositis. Sci Transl Med 2022; 14:eabi9196. [PMID: 35044790 PMCID: PMC9118725 DOI: 10.1126/scitranslmed.abi9196] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sporadic inclusion body myositis (IBM) is the most common acquired muscle disease in adults over age 50, yet it remains unclear whether the disease is primarily driven by T cell–mediated autoimmunity. IBM muscle biopsies display nuclear clearance and cytoplasmic aggregation of TDP-43 in muscle cells, a pathologic finding observed initially in neurodegenerative diseases, where nuclear loss of TDP-43 in neurons causes aberrant RNA splicing. Here, we show that loss of TDP-43–mediated splicing repression, as determined by inclusion of cryptic exons, occurs in skeletal muscle of subjects with IBM. Of 119 muscle biopsies tested, RT-PCR–mediated detection of cryptic exon inclusion was able to diagnose IBM with 84% sensitivity and 99% specificity. To determine the role of T cells in pathogenesis, we generated a xenograft model by transplanting human IBM muscle into the hindlimb of immunodeficient mice. Xenografts from subjects with IBM displayed robust regeneration of human myofibers and recapitulated both inflammatory and degenerative features of the disease. Myofibers in IBM xenografts showed invasion by human, oligoclonal CD8+ T cells and exhibited MHC-I up-regulation, rimmed vacuoles, mitochondrial pathology, p62-positive inclusions, and nuclear clearance and cytoplasmic aggregation of TDP-43, associated with cryptic exon inclusion. Reduction of human T cells within IBM xenografts by treating mice intraperitoneally with anti-CD3 (OKT3) suppressed MHC-I up-regulation. However, rimmed vacuoles and loss of TDP-43 function persisted. These data suggest that T cell depletion does not alter muscle degenerative pathology in IBM.
Collapse
Affiliation(s)
- Kyla A. Britson
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jonathan P. Ling
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Kerstin E. Braunstein
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Janelle M. Montagne
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jenna M. Kastenschmidt
- Department of Physiology and Biophysics, Institute for Immunology, University of California Irvine, Irvine, CA 92697, USA
| | - Andrew Wilson
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Chiseko Ikenaga
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - William Tsao
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Iago Pinal-Fernandez
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Katelyn A. Russell
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Nicole Reed
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Tahseen Mozaffar
- Institute for Immunology, Department of Neurology, University of California Irvine, Irvine, CA 92697, USA
| | - Kathryn R. Wagner
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, MD 21205, USA
| | - Lyle W. Ostrow
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Andrea M. Corse
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Andrew L. Mammen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - S. Armando Villalta
- Department of Physiology and Biophysics, Institute for Immunology, University of California Irvine, Irvine, CA 92697, USA
| | - H. Benjamin Larman
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Philip C. Wong
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Solomon H. Synder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Thomas E. Lloyd
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Solomon H. Synder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| |
Collapse
|
20
|
Lundberg IE, Fujimoto M, Vencovsky J, Aggarwal R, Holmqvist M, Christopher-Stine L, Mammen AL, Miller FW. Idiopathic inflammatory myopathies. Nat Rev Dis Primers 2021; 7:87. [PMID: 34857780 PMCID: PMC10425161 DOI: 10.1038/s41572-021-00325-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Idiopathic inflammatory myopathies (IIM), also known as myositis, are a heterogeneous group of autoimmune disorders with varying clinical manifestations, treatment responses and prognoses. Muscle weakness is usually the classical clinical manifestation but other organs can be affected, including the skin, joints, lungs, heart and gastrointestinal tract, and they can even result in the predominant manifestations, supporting that these are systemic inflammatory disorders. Different myositis-specific autoantibodies have been identified and, on the basis of clinical, histopathological and serological features, IIMs can be classified into several subgroups — dermatomyositis (including amyopathic dermatomyositis), antisynthetase syndrome, immune-mediated necrotizing myopathy, inclusion body myositis, polymyositis and overlap myositis. The prognoses, treatment responses and organ manifestations vary among these groups, implicating different pathophysiological mechanisms in each subtype. A deeper understanding of the molecular pathways underlying the pathogenesis and identifying the autoantigens of the immune reactions in these subgroups is crucial to improve outcomes. New, more homogeneous subgroups defined by autoantibodies may help define disease mechanisms, and will also be important in future clinical trials to develop targeted therapies and in identifying biomarkers to guide treatment decisions for the individual patient.
Collapse
Affiliation(s)
- Ingrid E. Lundberg
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, and Karolinska University Hospital. Stockholm, Sweden
| | - Manabu Fujimoto
- Department of Dermatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jiri Vencovsky
- Institute of Rheumatology, Prague, Czech Republic
- Deptartment of Rheumatology, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Rohit Aggarwal
- UPMC Myositis Center, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marie Holmqvist
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, and Karolinska University Hospital. Stockholm, Sweden
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Lisa Christopher-Stine
- Johns Hopkins Myositis Center, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew L. Mammen
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Departments of Neurology and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Frederick W. Miller
- Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| |
Collapse
|
21
|
Abstract
Idiopathic inflammatory myopathies (IIM), also known as myositis, are a heterogeneous group of autoimmune disorders with varying clinical manifestations, treatment responses and prognoses. Muscle weakness is usually the classical clinical manifestation but other organs can be affected, including the skin, joints, lungs, heart and gastrointestinal tract, and they can even result in the predominant manifestations, supporting that IIM are systemic inflammatory disorders. Different myositis-specific auto-antibodies have been identified and, on the basis of clinical, histopathological and serological features, IIM can be classified into several subgroups - dermatomyositis (including amyopathic dermatomyositis), antisynthetase syndrome, immune-mediated necrotizing myopathy, inclusion body myositis, polymyositis and overlap myositis. The prognoses, treatment responses and organ manifestations vary among these groups, implicating different pathophysiological mechanisms in each subtype. A deeper understanding of the molecular pathways underlying the pathogenesis and identifying the auto-antigens of the immune reactions in these subgroups is crucial to improving outcomes. New, more homogeneous subgroups defined by auto-antibodies may help define disease mechanisms and will also be important in future clinical trials for the development of targeted therapies and in identifying biomarkers to guide treatment decisions for the individual patient.
Collapse
|
22
|
Benveniste O, Hogrel JY, Belin L, Annoussamy M, Bachasson D, Rigolet A, Laforet P, Dzangué-Tchoupou G, Salem JE, Nguyen LS, Stojkovic T, Zahr N, Hervier B, Landon-Cardinal O, Behin A, Guilloux E, Reyngoudt H, Amelin D, Uruha A, Mariampillai K, Marty B, Eymard B, Hulot JS, Greenberg SA, Carlier PG, Allenbach Y. Sirolimus for treatment of patients with inclusion body myositis: a randomised, double-blind, placebo-controlled, proof-of-concept, phase 2b trial. THE LANCET. RHEUMATOLOGY 2021; 3:e40-e48. [PMID: 38273639 DOI: 10.1016/s2665-9913(20)30280-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inclusion body myositis is the most frequent myositis in patients older than 50 years. Classical immunosuppressants are ineffective in treating inclusion body myositis, and to date there are no recommendations for pharmacological approaches to treatment. When used after organ transplantation, sirolimus can block the proliferation of effector T cells, while preserving T regulatory cells, and induce autophagy, all of which are processes that are impaired in inclusion body myositis. In this pilot study, we aimed to test the efficacy of sirolimus in patients with inclusion body myositis. METHODS This randomised, double-blind, placebo-controlled, proof-of-concept, phase 2b trial was done at a single hospital in Paris, France. The study included men and women (aged 45-80 years) who had a defined diagnosis of inclusion body myositis according to established criteria. Eligible participants were randomly assigned (1:1) to receive once-daily oral sirolimus 2 mg or placebo. Centralised balanced block randomisation (blocks of four) was computer generated without stratification. The study comprised a 15-day screening period (days -15 to 0) and a 52-week treatment period (day 0 to month 12). The primary endpoint was the relative percentage change from baseline to month 12 in maximal voluntary isometric knee extension strength. Secondary endpoints included the following assessments at months 6 and 12: 6-min walking distance, isometric muscle strength for hand grip (finger flexors), knee flexion and elbow flexion and extension, forced vital capacity, muscle replacement with fat measured by quantitative nuclear MRI, Inclusion Body Myositis Weakness Composite Index (IBMWCI), Inclusion Body Myositis Functional Rating Scale (IBMFRS), Health Assessment Questionnaire without Disability Index (HAQ-DI), and analyses of T-cell subpopulations by mass cytometry. The primary analysis was done on the intention-to-treat population. The trial is registered at ClinicalTrials.gov, NCT02481453. FINDINGS Between July 15, 2015, and May 13, 2016, we screened 285 patients, 44 of whom were randomly allocated to sirolimus (22 patients) or placebo (22 patients). We observed no difference in the primary outcome of relative percentage change from baseline to month 12 of the maximal voluntary isometric knee extension strength (median difference 3·78, 95% CI -10·61 to 17·31; p=0·85). For secondary outcomes, differences between the groups were not significant for changes in strength of other muscle groups (grip, elbow flexion and extension, or knee flexion), IBMWCI, IBMFRS, and lower limb muscle fat fraction. However, we observed significant differences in favour of sirolimus between the study groups for HAQ-DI, forced vital capacity, thigh fat fraction, and 6-min walking distance. Ten (45%) of 22 patients in the sirolimus group had a serious adverse event compared with six (27%) of 22 patients in the placebo group. Four (18%) patients in the sirolimus group stopped their treatment because of adverse events (severe mouth ulcers, aseptic pneumonia, renal insufficiency, and peripheral lower limb oedema), which resolved after treatment discontinuation. Canker sores were the most frequent side-effect and were mainly mild or moderate in ten patients. INTERPRETATION We found no evidence for efficacy of sirolimus for treating inclusion body myositis based on maximal voluntary isometric knee extension strength and other muscle strength measures, and the side-effects of treatment were substantial for some patients. However, we believe there was enough evidence of benefit in certain secondary outcomes to pursue a multicentre phase 3 trial to further assess the safety and efficacy of sirolimus. FUNDING Institut national de la santé et de la recherche médicale, Direction générale de l'offre de soins, and Association Française contre les Myopathies.
Collapse
Affiliation(s)
- Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Neuromuscular Rare Diseases Reference Center of Paris, Sorbonne Université, INSERM U974, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, Paris, France.
| | - Jean-Yves Hogrel
- Neuromuscular Physiology Laboratory, Neuromuscular Investigation Center, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Lisa Belin
- Département Biostatistique Santé Publique et Information Médicale, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France
| | | | - Damien Bachasson
- Neuromuscular Physiology Laboratory, Neuromuscular Investigation Center, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Aude Rigolet
- Department of Internal Medicine and Clinical Immunology, Neuromuscular Rare Diseases Reference Center of Paris, Sorbonne Université, INSERM U974, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, Paris, France
| | - Pascal Laforet
- Neuromuscular Reference Center Nord/Est/Ile de France, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France
| | - Gaëlle Dzangué-Tchoupou
- Department of Internal Medicine and Clinical Immunology, Neuromuscular Rare Diseases Reference Center of Paris, Sorbonne Université, INSERM U974, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, Paris, France
| | - Joe-Elie Salem
- Department of Pharmacology, Sorbonne Université, INSERM, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Centre d'investigation Clinique Paris-Est, CIC 1421, Paris, France
| | - Lee S Nguyen
- Department of Pharmacology, Sorbonne Université, INSERM, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Centre d'investigation Clinique Paris-Est, CIC 1421, Paris, France
| | - Tanya Stojkovic
- Neuromuscular Reference Center Nord/Est/Ile de France, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France
| | - Noel Zahr
- Clinical Pharmacology & Center of Clinical Investigation Paris-Est, Sorbonne Université, AP-HP, INSERM, Paris, France
| | - Baptiste Hervier
- Department of Internal Medicine and Clinical Immunology, Neuromuscular Rare Diseases Reference Center of Paris, Sorbonne Université, INSERM U974, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, Paris, France
| | - Océane Landon-Cardinal
- Division of Rheumatology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada; Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Anthony Behin
- Neuromuscular Reference Center Nord/Est/Ile de France, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France
| | - Edith Guilloux
- Department of Pharmacology, Sorbonne Université, INSERM, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Centre d'investigation Clinique Paris-Est, CIC 1421, Paris, France
| | - Harmen Reyngoudt
- NMR Laboratory, CEA/DRF/IBJF/MIRCen, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Damien Amelin
- Department of Internal Medicine and Clinical Immunology, Neuromuscular Rare Diseases Reference Center of Paris, Sorbonne Université, INSERM U974, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, Paris, France
| | - Akinori Uruha
- Department of Internal Medicine and Clinical Immunology, Neuromuscular Rare Diseases Reference Center of Paris, Sorbonne Université, INSERM U974, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, Paris, France
| | - Kuberaka Mariampillai
- Department of Internal Medicine and Clinical Immunology, Neuromuscular Rare Diseases Reference Center of Paris, Sorbonne Université, INSERM U974, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, Paris, France
| | - Benjamin Marty
- NMR Laboratory, CEA/DRF/IBJF/MIRCen, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Bruno Eymard
- Neuromuscular Reference Center Nord/Est/Ile de France, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, France
| | - Jean-Sébastien Hulot
- Department of Pharmacology, Sorbonne Université, INSERM, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Centre d'investigation Clinique Paris-Est, CIC 1421, Paris, France
| | - Steven A Greenberg
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pierre G Carlier
- NMR Laboratory, CEA/DRF/IBJF/MIRCen, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Neuromuscular Rare Diseases Reference Center of Paris, Sorbonne Université, INSERM U974, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière University Hospital, Paris, France
| |
Collapse
|
23
|
HLA-DRB1 allele and autoantibody profiles in Japanese patients with inclusion body myositis. PLoS One 2020; 15:e0237890. [PMID: 32810190 PMCID: PMC7437458 DOI: 10.1371/journal.pone.0237890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/04/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Inclusion body myositis (IBM) is an idiopathic inflammatory myopathy, characterized by unique clinical features including finger flexor and quadriceps muscle weakness and a lack of any reliable treatment. The human leukocyte antigen (HLA)-DRB1 allele and autoantibody profiles in Japanese IBM patients have not been fully elucidated. Methods We studied 83 Japanese IBM patients with a mean age of 69 years (49 males and 34 females) who participated in the ‘Integrated Diagnosis Project for Inflammatory Myopathies’ from January 2011 to September 2016. IBM was diagnosed by histological diagnosis. Various autoantibodies were screened by RNA immunoprecipitation and enzyme-linked immunosorbent assays. HLA-DRB1 genotyping was performed using polymerase chain reaction-sequence based typing. A total of 460 unrelated healthy Japanese controls were also studied. Results The allele frequencies of DRB1*01:01, DRB1*04:10, and DRB1*15:02 were significantly higher in the IBM group than in the healthy control group (Corrected P = 0.00078, 0.00038 and 0.0046). There was a weak association between the DRB1*01:01 allele and severe leg muscle weakness and muscle atrophy. While hepatitis type C virus infection and autoantibodies to cytosolic 5’-nucleotidase 1A were found in 18 and 28 patients, respectively, no significant association with HLA-DRB1 alleles was observed. Conclusion Japanese IBM patients had the specific HLA-DRB1 allele and autoantibody profiles.
Collapse
|
24
|
Rothwell S, Chinoy H, Lamb JA. Genetics of idiopathic inflammatory myopathies: insights into disease pathogenesis. Curr Opin Rheumatol 2020; 31:611-616. [PMID: 31415030 PMCID: PMC6791565 DOI: 10.1097/bor.0000000000000652] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To review the advances that have been made in our understanding of the genetics of idiopathic inflammatory myopathies (IIM) in the past 2 years, with a particular focus on dermatomyositis and polymyositis.
Collapse
Affiliation(s)
- Simon Rothwell
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester.,Rheumatology Department, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford
| | - Janine A Lamb
- Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| |
Collapse
|
25
|
Zhang J, Khasanova E, Zhang L. Bioinformatics analysis of gene expression profiles of Inclusion body myositis. Scand J Immunol 2020; 91:e12887. [PMID: 32259312 DOI: 10.1111/sji.12887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/15/2020] [Accepted: 03/30/2020] [Indexed: 11/27/2022]
Abstract
Inclusion body myositis (IBM) is a disease with a poor prognosis and limited treatment options. This study aimed at exploring gene expression profile alterations, investigating the underlying mechanisms and identifying novel targets for IBM. We analysed two microarray datasets (GSE39454 and GSE128470) derived from the Gene Expression Omnibus (GEO) database. The GEO2R tool was used to screen out differentially expressed genes (DEGs) between IBM and normal samples. Gene Ontology(GO)function and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis were performed using the Database for Annotation, Visualization and Integrated Discovery to identify the pathways and functional annotation of DEGs. Finally, protein-protein interaction (PPI) networks were constructed using STRING and Cytoscape, in order to identify hub genes. A total of 144 upregulated DEGs and one downregulated DEG were identified. The GO enrichment analysis revealed that the immune response was the most significantly enriched term within the DEGs. The KEGG pathway analysis identified 22 significant pathways, the majority of which could be divided into the immune and infectious diseases. Following the construction of PPI networks, ten hub genes with high degrees of connectivity were picked out, namely PTPRC, IRF8, CCR5, VCAM1, HLA-DRA, TYROBP, C1QB, HLA-DRB1, CD74 and CXCL9. Our research hypothesizes that autoimmunity plays an irreplaceable role in the pathogenesis of IBM. The novel DEGs and pathways identified in this study may provide new insight into the underlying mechanisms of IBM at the molecular level.
Collapse
Affiliation(s)
- Jiuchang Zhang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Elona Khasanova
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Liming Zhang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| |
Collapse
|
26
|
Greenberg SA. Inclusion body myositis: clinical features and pathogenesis. Nat Rev Rheumatol 2020; 15:257-272. [PMID: 30837708 DOI: 10.1038/s41584-019-0186-x] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Inclusion body myositis (IBM) is often viewed as an enigmatic disease with uncertain pathogenic mechanisms and confusion around diagnosis, classification and prospects for treatment. Its clinical features (finger flexor and quadriceps weakness) and pathological features (invasion of myofibres by cytotoxic T cells) are unique among muscle diseases. Although IBM T cell autoimmunity has long been recognized, enormous attention has been focused for decades on several biomarkers of myofibre protein aggregates, which are present in <1% of myofibres in patients with IBM. This focus has given rise, together with the relative treatment refractoriness of IBM, to a competing view that IBM is not an autoimmune disease. Findings from the past decade that implicate autoimmunity in IBM include the identification of a circulating autoantibody (anti-cN1A); the absence of any statistically significant genetic risk factor other than the common autoimmune disease 8.1 MHC haplotype in whole-genome sequencing studies; the presence of a marked cytotoxic T cell signature in gene expression studies; and the identification in muscle and blood of large populations of clonal highly differentiated cytotoxic CD8+ T cells that are resistant to many immunotherapies. Mounting evidence that IBM is an autoimmune T cell-mediated disease provides hope that future therapies directed towards depleting these cells could be effective.
Collapse
Affiliation(s)
- Steven A Greenberg
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA. .,Children's Hospital Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
27
|
Miller FW, Lamb JA, Schmidt J, Nagaraju K. Risk factors and disease mechanisms in myositis. Nat Rev Rheumatol 2019; 14:255-268. [PMID: 29674613 DOI: 10.1038/nrrheum.2018.48] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Autoimmune diseases develop as a result of chronic inflammation owing to interactions between genes and the environment. However, the mechanisms by which autoimmune diseases evolve remain poorly understood. Newly discovered risk factors and pathogenic processes in the various idiopathic inflammatory myopathy (IIM) phenotypes (known collectively as myositis) have illuminated innovative approaches for understanding these diseases. The HLA 8.1 ancestral haplotype is a key risk factor for major IIM phenotypes in some populations, and several genetic variants associated with other autoimmune diseases have been identified as IIM risk factors. Environmental risk factors are less well studied than genetic factors but might include viruses, bacteria, ultraviolet radiation, smoking, occupational and perinatal exposures and a growing list of drugs (including biologic agents) and dietary supplements. Disease mechanisms vary by phenotype, with evidence of shared innate and adaptive immune and metabolic pathways in some phenotypes but unique pathways in others. The heterogeneity and rarity of the IIMs make advancements in diagnosis and treatment cumbersome. Novel approaches, better-defined phenotypes, and international, multidisciplinary consensus have contributed to progress, and it is hoped that these methods will eventually enable therapeutic intervention before the onset or major progression of disease. In the future, preemptive strategies for IIM management might be possible.
Collapse
Affiliation(s)
- Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Janine A Lamb
- Centre for Epidemiology, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Jens Schmidt
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Kanneboyina Nagaraju
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Binghamton, NY, USA
| |
Collapse
|
28
|
Greenberg SA, Pinkus JL, Kong SW, Baecher-Allan C, Amato AA, Dorfman DM. Highly differentiated cytotoxic T cells in inclusion body myositis. Brain 2019; 142:2590-2604. [DOI: 10.1093/brain/awz207] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/21/2019] [Accepted: 05/16/2019] [Indexed: 01/12/2023] Open
Abstract
Abstract
Inclusion body myositis is a late onset treatment-refractory autoimmune disease of skeletal muscle associated with a blood autoantibody (anti-cN1A), an HLA autoimmune haplotype, and muscle pathology characterized by cytotoxic CD8+ T cell destruction of myofibres. Here, we report on translational studies of inclusion body myositis patient muscle compared with a diverse set of other muscle disease samples. Using available microarray data on 411 muscle samples from patients with inclusion body myositis (n = 40), other muscle diseases (n = 265), and without neuromuscular disease (normal, n = 106), we identified a signature of T-cell cytotoxicity in inclusion body myositis muscle coupled with a signature of highly differentiated CD8 T-cell effector memory and terminally differentiated effector cells. Further, we examined killer cell lectin-like receptor G1 (KLRG1) as a marker of this population of cells, demonstrated the correlation of KLRG1 gene expression with lymphocyte cytotoxicity across 28 870 human tissue samples, and identified the presence of KLRG1 on pathogenic inclusion body myositis muscle invading T cells and an increase in KLRG1 expressing T cells in inclusion body myositis blood. We examined inclusion body myositis muscle T-cell proliferation by Ki67 immunohistochemistry demonstrating that diseased muscle-invading T cells are minimally or non-proliferative, in accordance with known properties of highly differentiated or terminally differentiated T cells. We found low expression of KLRG1 on infection-protective human lymphoid tissue central memory T cells and autoimmune-protective human blood regulatory T cells. Targeting highly differentiated cytotoxic T cells could be a favourable approach to treatment of inclusion body myositis.
Collapse
Affiliation(s)
- Steven A Greenberg
- Brigham and Women’s Hospital Department of Neurology, Division of Neuromuscular Disease, and Harvard Medical School, Boston, MA, USA
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA and Harvard Medical School, Boston, MA, USA
| | - Jack L Pinkus
- Brigham and Women’s Hospital Department of Neurology, Division of Neuromuscular Disease, and Harvard Medical School, Boston, MA, USA
| | - Sek Won Kong
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA and Harvard Medical School, Boston, MA, USA
| | - Clare Baecher-Allan
- Brigham and Women’s Hospital Department of Neurology, Division of Neuromuscular Disease, and Harvard Medical School, Boston, MA, USA
- Ann Romney Center for Neurologic Disease, Brigham and Women's Hospital, Boston, MA, USA
| | - Anthony A Amato
- Brigham and Women’s Hospital Department of Neurology, Division of Neuromuscular Disease, and Harvard Medical School, Boston, MA, USA
| | - David M Dorfman
- Brigham and Women’s Hospital Department of Neurology, Division of Neuromuscular Disease, and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
29
|
Rothwell S, Chinoy H, Lamb JA, Miller FW, Rider LG, Wedderburn LR, McHugh NJ, Mammen AL, Betteridge ZE, Tansley SL, Bowes J, Vencovský J, Deakin CT, Dankó K, Vidya L, Selva-O'Callaghan A, Pachman LM, Reed AM, Molberg Ø, Benveniste O, Mathiesen PR, Radstake TRDJ, Doria A, de Bleecker J, Lee AT, Hanna MG, Machado PM, Ollier WE, Gregersen PK, Padyukov L, O'Hanlon TP, Cooper RG, Lundberg IE. Focused HLA analysis in Caucasians with myositis identifies significant associations with autoantibody subgroups. Ann Rheum Dis 2019; 78:996-1002. [PMID: 31138531 PMCID: PMC6585280 DOI: 10.1136/annrheumdis-2019-215046] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/14/2019] [Accepted: 03/30/2019] [Indexed: 12/23/2022]
Abstract
Objectives Idiopathic inflammatory myopathies (IIM) are a spectrum of rare autoimmune diseases characterised clinically by muscle weakness and heterogeneous systemic organ involvement. The strongest genetic risk is within the major histocompatibility complex (MHC). Since autoantibody presence defines specific clinical subgroups of IIM, we aimed to correlate serotype and genotype, to identify novel risk variants in the MHC region that co-occur with IIM autoantibodies. Methods We collected available autoantibody data in our cohort of 2582 Caucasian patients with IIM. High resolution human leucocyte antigen (HLA) alleles and corresponding amino acid sequences were imputed using SNP2HLA from existing genotyping data and tested for association with 12 autoantibody subgroups. Results We report associations with eight autoantibodies reaching our study-wide significance level of p<2.9×10–5. Associations with the 8.1 ancestral haplotype were found with anti-Jo-1 (HLA-B*08:01, p=2.28×10–53 and HLA-DRB1*03:01, p=3.25×10–9), anti-PM/Scl (HLA-DQB1*02:01, p=1.47×10–26) and anti-cN1A autoantibodies (HLA-DRB1*03:01, p=1.40×10–11). Associations independent of this haplotype were found with anti-Mi-2 (HLA-DRB1*07:01, p=4.92×10–13) and anti-HMGCR autoantibodies (HLA-DRB1*11, p=5.09×10–6). Amino acid positions may be more strongly associated than classical HLA associations; for example with anti-Jo-1 autoantibodies and position 74 of HLA-DRB1 (p=3.47×10–64) and position 9 of HLA-B (p=7.03×10–11). We report novel genetic associations with HLA-DQB1 anti-TIF1 autoantibodies and identify haplotypes that may differ between adult-onset and juvenile-onset patients with these autoantibodies. Conclusions These findings provide new insights regarding the functional consequences of genetic polymorphisms within the MHC. As autoantibodies in IIM correlate with specific clinical features of disease, understanding genetic risk underlying development of autoantibody profiles has implications for future research.
Collapse
Affiliation(s)
- Simon Rothwell
- Centre for Genetics and Genomics, Arthritis Research UK, University of Manchester, Manchester, UK
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Janine A Lamb
- Centre for Epidemiology, The University of Manchester, Manchester, UK
| | - Frederick W Miller
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, Bethesda, Maryland, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, Bethesda, Maryland, USA
| | - Lucy R Wedderburn
- NIHR Great Ormond Street Biomedical Research Centre, University College London, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Neil J McHugh
- Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Andrew L Mammen
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA.,Departments of Neurology and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Sarah L Tansley
- Pharmacy and Pharmacology, University of Bath, Bath, UK.,Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - John Bowes
- Arthritis Research UK Centre for Genetics and Genomics, The University of Manchester, Manchester, UK
| | - Jiří Vencovský
- Institute of Rheumatology and Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Claire T Deakin
- NIHR Great Ormond Street Biomedical Research Centre, University College London, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Katalin Dankó
- Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - Limaye Vidya
- Rheumatology Unit, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Albert Selva-O'Callaghan
- Internal Medicine Department, Vall d'Hebron General Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Lauren M Pachman
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ann M Reed
- Pediatrics, Duke University, Durham, North Carolina, USA
| | - Øyvind Molberg
- Department of Rheumatology, University of Oslo, Oslo, Norway
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, France, France
| | - Pernille R Mathiesen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Timothy R D J Radstake
- Department of Rheumatology and Clinical Immunology, Utrecht Medical Center, Utrecht, The Netherlands
| | - Andrea Doria
- Division of Rheumatology, University of Padova, Padova, Italy
| | | | - Annette T Lee
- Robert S. Boas Center for Genomics and Human Genetics, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Michael G Hanna
- MRC Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, University College London Institute of Neurology, London, UK
| | - Pedro M Machado
- Department of Rheumatology, University College London Hospital NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - William E Ollier
- Centre for Epidemiology, The University of Manchester, Manchester, UK.,School of Healthcare Sciences, Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | - Peter K Gregersen
- Center for Genomics and Human Genetics, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Terrance P O'Hanlon
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, Bethesda, Maryland, USA
| | - Robert G Cooper
- MRC/ARUK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool, Merseyside, UK
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | |
Collapse
|
30
|
Naddaf E, Barohn RJ, Dimachkie MM. Inclusion Body Myositis: Update on Pathogenesis and Treatment. Neurotherapeutics 2018; 15:995-1005. [PMID: 30136253 PMCID: PMC6277289 DOI: 10.1007/s13311-018-0658-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Inclusion body myositis is the most common acquired myopathy after the age of 50. It is characterized by progressive asymmetric weakness predominantly affecting the quadriceps and/or finger flexors. Loss of ambulation and dysphagia are major complications of the disease. Inclusion body myositis can be associated with cytosolic 5'-nucleotidase 1A antibodies. Muscle biopsy usually shows inflammatory cells surrounding and invading non-necrotic muscle fibers, rimmed vacuoles, congophilic inclusions, and protein aggregates. Disease pathogenesis remains poorly understood and consists of an interplay between inflammatory and degenerative pathways. Antigen-driven, clonally restricted, cytotoxic T cells represent a main feature of the inflammatory component, whereas abnormal protein homeostasis with protein misfolding, aggregation, and dysfunctional protein disposal is the hallmark of the degenerative component. Inclusion body myositis remains refractory to treatment. Better understanding of the disease pathogenesis led to the identification of novel therapeutic targets, addressing both the inflammatory and degenerative pathways.
Collapse
Affiliation(s)
- Elie Naddaf
- Neuromuscular Medicine Division, Department of Neurology, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - Richard J Barohn
- Neuromuscular Medicine Division, Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, 66103, USA
| | - Mazen M Dimachkie
- Neuromuscular Medicine Division, Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, 66103, USA.
| |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW To describe recent advancements in diagnostic and therapeutic approaches to inclusion body myositis (IBM). RECENT FINDINGS Our understanding of the implications of anti-cytosolic 5'-nucleotidase 1A autoantibody status in IBM and other diseases is increasing. Muscle imaging using magnetic resonance techniques and ultrasound is increasingly being performed and characteristic patterns of muscle involvement may help with diagnosis. Longitudinal imaging studies are likely to help with monitoring and as an outcome measure in clinical trials. Recent small-scale studies of Arimoclomol and Rapamycin have shown promising results and further investigation of these medications is ongoing. Exercise is likely to form an increasingly important facet of management of patients with IBM, but the optimal type of exercise programme to enrol patients in is not yet determined. SUMMARY Antibody testing and muscle imaging results may improve our ability to diagnose IBM and the availability of effective disease modifying treatments targeting novel non-inflammatory pathways could soon become a reality. It remains the duty of those involved in the management of patients with IBM to facilitate involvement in clinical trials and other research studies.
Collapse
|
32
|
Jabari D, Vedanarayanan VV, Barohn RJ, Dimachkie MM. Update on Inclusion Body Myositis. Curr Rheumatol Rep 2018; 20:52. [DOI: 10.1007/s11926-018-0755-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
33
|
Rietveld A, van den Hoogen LL, Bizzaro N, Blokland SLM, Dähnrich C, Gottenberg JE, Houen G, Johannsen N, Mandl T, Meyer A, Nielsen CT, Olsson P, van Roon J, Schlumberger W, van Engelen BGM, Saris CGJ, Pruijn GJM. Autoantibodies to Cytosolic 5'-Nucleotidase 1A in Primary Sjögren's Syndrome and Systemic Lupus Erythematosus. Front Immunol 2018; 9:1200. [PMID: 29922285 PMCID: PMC5996144 DOI: 10.3389/fimmu.2018.01200] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 05/14/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction Autoantibodies to cytosolic 5′-nucleotidase 1A (cN-1A; NT5C1A) have a high specificity when differentiating sporadic inclusion body myositis from polymyositis and dermatomyositis. In primary Sjögren’s syndrome (pSS) and systemic lupus erythematosus (SLE) anti-cN-1A autoantibodies can be detected as well. However, various frequencies of anti-cN-1A reactivity have been reported in SLE and pSS, which may at least in part be explained by the different assays used. Here, we determined the occurrence of anti-cN-1A reactivity in a large number of patients with pSS and SLE using one standardized ELISA. Methods Sera from pSS (n = 193) and SLE patients (n = 252) were collected in five European centers. Anti-cN-1A, anti-Ro52, anti-nucleosome, and anti-dsDNA reactivities were tested by ELISA (Euroimmun AG) in a single laboratory. Correlations of anti-cN-1A reactivity with demographic data and clinical data (duration of disease at the moment of serum sampling, autoimmune comorbidity and presence of muscular symptoms) were analyzed using SPSS software. Results Anti-cN-1A autoantibodies were found on average in 12% of pSS patients, with varying frequencies among the different cohorts (range: 7–19%). In SLE patients, the anti-cN-1A positivity on average was 10% (range: 6–21%). No relationship was found between anti-cN-1A reactivity and the presence or absence of anti-Ro52, anti-nucleosome, and anti-dsDNA reactivity in both pSS and SLE. No relationship between anti-cN-1A reactivity and duration of disease at the moment of serum sampling and the duration of serum storage was observed. The frequency of muscular symptoms or viral infections did not differ between anti-cN-1A-positive and -negative patients. In both disease groups anti-cN-1A-positive patients suffered more often from other autoimmune diseases than the anti-cN-1A-negative patients (15 versus 5% (p = 0.05) in pSS and 50 versus 30% (p = 0.02) in SLE). Conclusion Our results confirm the relatively frequent occurrence of anti-cN-1A in pSS and SLE patients and the variation in anti-cN-1A reactivity between independent groups of these patients. The explanation for this variation remains elusive. The correlation between anti-cN-1A reactivity and polyautoimmunity should be evaluated in future studies. We conclude that anti-cN-1A should be classified as a myositis-associated-, not as a myositis-specific-autoantibody based on its frequent presence in SLE and pSS.
Collapse
Affiliation(s)
- Anke Rietveld
- Department of Neurology, Center for Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Luuk L van den Hoogen
- Laboratory of Translational Immunology, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Nicola Bizzaro
- Laboratorio di Patologia Clinica, Ospedale San Antonio, Azienda Sanitaria Universitaria Integrata di Udine, Tolmezzo, Italy
| | - Sofie L M Blokland
- Laboratory of Translational Immunology, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Cornelia Dähnrich
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Jacques-Eric Gottenberg
- Service de physiologie et d'explorations fonctionnelles, Service de rhumatologie, Centre de référence des maladies auto-immunes rares and Fédération de médecine translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Gunnar Houen
- Department of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen, Denmark
| | - Nora Johannsen
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Thomas Mandl
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden and Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Alain Meyer
- Service de physiologie et d'explorations fonctionnelles, Service de rhumatologie, Centre de référence des maladies auto-immunes rares and Fédération de médecine translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Christoffer T Nielsen
- Copenhagen Lupus and Vasculitis Clinic, Centre for Rheumatology and Spine Disease, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Olsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden and Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Joel van Roon
- Laboratory of Translational Immunology, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Baziel G M van Engelen
- Department of Neurology, Center for Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Christiaan G J Saris
- Department of Neurology, Center for Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ger J M Pruijn
- Department of Biomolecular Chemistry, Radboud Institute for Molecular Life Sciences and Institute for Molecules and Materials, Radboud University, Nijmegen, Netherlands
| |
Collapse
|
34
|
Abstract
Inflammatory disorders of the skeletal muscle include polymyositis (PM), dermatomyositis (DM), (immune mediated) necrotizing myopathy (NM), overlap syndrome with myositis (overlap myositis, OM) including anti-synthetase syndrome (ASS), and inclusion body myositis (IBM). Whereas DM occurs in children and adults, all other forms of myositis mostly develop in middle aged individuals. Apart from a slowly progressive, chronic disease course in IBM, patients with myositis typically present with a subacute onset of weakness of arms and legs, often associated with pain and clearly elevated creatine kinase in the serum. PM, DM and most patients with NM and OM usually respond to immunosuppressive therapy, whereas IBM is largely refractory to treatment. The diagnosis of myositis requires careful and combinatorial assessment of (1) clinical symptoms including pattern of weakness and paraclinical tests such as MRI of the muscle and electromyography (EMG), (2) broad analysis of auto-antibodies associated with myositis, and (3) detailed histopathological work-up of a skeletal muscle biopsy. This review provides a comprehensive overview of the current classification, diagnostic pathway, treatment regimen and pathomechanistic understanding of myositis.
Collapse
Affiliation(s)
- Jens Schmidt
- Department of Neurology, Muscle Immunobiology Group, Neuromuscular Center, University Medical Center Göttingen, Göttingen, Germany,Correspondence to: Prof. Dr. Jens Schmidt, MD, FEAN, FAAN, Muscle Immunobiology Group, Neuromuscular Center, Department of Neurology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany. Tel.: +49 551 39 22355; Fax: +49 551 39 8405; E-mail:
| |
Collapse
|
35
|
Abstract
PURPOSE OF REVIEW Our goal is to review the recent literature pertaining to the genetics of sporadic inclusion body myositis (IBM). RECENT FINDINGS In a study of 252 IBM patients, the class II MHC allele HLA-DRB1*03:01 showed the most significant association with IBM, and that risk could be largely attributed to amino acids within the peptide-binding pocket. Candidate gene sequencing identified rare missense variants in proteins regulating protein homeostasis including VCP and SQSTM1. An unbiased approach employing exome sequencing of genes encoding rimmed vacuole proteins identified FYCO1 variants in IBM. Ongoing GWAS approaches may shed new light on genetic risk factors for IBM. Many variants have been reported at an increased frequency in IBM in small studies; however, only HLA association has shown genome-wide significance. Future studies are needed to validate variants in larger cohorts and to understand the molecular roles these risk factors play in IBM.
Collapse
Affiliation(s)
- Kyla A Britson
- Departments of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Graduate program in Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephanie Y Yang
- Departments of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Graduate program in Human Genetics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas E Lloyd
- Departments of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
36
|
Miosite da corpi inclusi. Neurologia 2018. [DOI: 10.1016/s1634-7072(18)89405-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
37
|
Abstract
PURPOSE OF REVIEW To review the advances in our understanding of the genetics of inclusion body myositis (IBM) in the past year. RECENT FINDINGS One large genetic association study focusing on immune-related genes in IBM has refined the association within the human leukocyte antigen (HLA) region to HLA-DRB1 alleles, and identified certain amino acid positions in HLA-DRB1 that may explain this risk. A suggestive association with CCR5 may indicate genetic overlap with other autoimmune diseases. Sequencing studies of candidate genes involved in related neuromuscular or neurodegenerative diseases have identified rare variants in VCP and SQSTM1. Proteomic studies of rimmed vacuoles in IBM and subsequent genetic analyses of candidate genes identified rare missense variants in FYCO1. Complex, large-scale mitochondrial deletions in cytochrome c oxidase-deficient muscle fibres expand our understanding of mitochondrial abnormalities in IBM. SUMMARY The pathogenesis of IBM is likely multifactorial, including inflammatory and degenerative changes, and mitochondrial abnormalities. There has been considerable progress in our understanding of the genetic architecture of IBM, using complementary genetic approaches to investigate these different pathways.
Collapse
Affiliation(s)
- Simon Rothwell
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester
| | - James B. Lilleker
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester
- Greater Manchester Neurosciences Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford
| | - Janine A. Lamb
- Centre for Epidemiology, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| |
Collapse
|
38
|
Affiliation(s)
- Steven A. Greenberg
- Department of Neurology, Brigham and Women's Hospital; Children's Hospital Informatics Program, and Harvard Medical School; Boston MA
| |
Collapse
|
39
|
|