1
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Makled S, Abbas H, Ali ME, Zewail M. Melatonin hyalurosomes in collagen thermosensitive gel as a potential repurposing approach for rheumatoid arthritis management via the intra-articular route. Int J Pharm 2024; 661:124449. [PMID: 38992734 DOI: 10.1016/j.ijpharm.2024.124449] [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: 02/23/2024] [Revised: 06/30/2024] [Accepted: 07/07/2024] [Indexed: 07/13/2024]
Abstract
Despite the fact that several rheumatoid arthritis treatments have been utilized, none of them achieved complete joint healing and has been accompanied by several side effects that compromise patient compliance. This study aims to provide an effective safe RA treatment with minimum side effects through the encapsulation of melatonin (MEL) in hyalurosomes and loading these hyalurosomes in collagen thermos-sensitive poloxamer 407 (PCO) hydrogels, followed by their intra-articular administration in AIA model rats. In vitro characterization of MEL-hyalurosomes and PCO hydrogel along with in vivo evaluation of the selected formulation were conducted. Particle size, PDI and EE % of the selected formulation were 71.5 nm, 0.09 and 90 %. TEM micrographs demonstrated that the particles had spherical shape with no aggregation signs. Loading PCO hydrogels with MEL-hyalurosomes did not cause significant changes in pH although it increased its viscosity and injection time. FTIR analysis showed that no interactions were noted among the delivery system components. In vivo results revealed the superior effect of MEL-hyalurosomes PCO hydrogel over MEL-PCO hydrogel and blank PCO hydrogels in improving joint healing, cartilage repair, pannus formation and cell infiltrations. Also, MEL-hyalurosomes PCO hydrogel group showed comparable levels of TNF-α, IL1, MDA, NRF2 and HO-1 with the negative control group. These findings highlight the MEL encapsulation role in augmenting its pharmacological effects along with the synergistic effect of hyaluronic acid in hyalurosomes and collagen in PCO hydrogel in promoting joint healing.
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Affiliation(s)
- Shaimaa Makled
- Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, 21521, Egypt
| | - Haidy Abbas
- Department of Pharmaceutics, Faculty of Pharmacy, Damanhour University, Egypt P.O. Box 22511, Damanhour, Egypt.
| | - Merhan E Ali
- Department of Pathology, Faculty of Veterinary Medicine, Cairo University, Giza 12211, Egypt
| | - Mariam Zewail
- Department of Pharmaceutics, Faculty of Pharmacy, Damanhour University, Egypt P.O. Box 22511, Damanhour, Egypt
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2
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Cutellè C, De Lorenzo A, Doneddu PE, Creta MF, Selmi C, Liberatore G, Giordano A, Gentile F, Erre GL, Nobile-Orazio E. Cytokines and chemokines in patients with chronic inflammatory demyelinating polyradiculoneuropathy and multifocal motor neuropathy: A systematic review. J Peripher Nerv Syst 2024; 29:124-134. [PMID: 38600685 DOI: 10.1111/jns.12622] [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: 12/02/2023] [Revised: 02/18/2024] [Accepted: 03/12/2024] [Indexed: 04/12/2024]
Abstract
Advances in the understanding of cytokines have revolutionized mechanistic treatments for chronic inflammatory and autoimmune diseases, as exemplified by rheumatoid arthritis. We conducted a systematic literature review on the role of cytokines and chemokines in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy (MMN). Ovid Medline, EMBASE and Web of Science were searched until August 31, 2022 for human studies investigating cytokines levels in CIDP or MMN. Fifty-five articles on 1061 CIDP patients and 86 MMN patients were included, with a median of 18 patients per study (range 3-71). Studies differed in the inclusion criteria, type of assay, manufacturer, control subjects, and tested biological material. Only a minority of studies reported data on disease activity. Interleukin (IL)-6, IL-17, CXCL10, and tumor necrosis factor alpha (TNF-α), were elevated in CIDP compared to controls in most of the studies. IL-6 and TNF-α levels are also correlated with disability. In MMN patients, IL-1Ra was elevated in the majority of the reports. While acknowledging the challenges in comparing studies and the various limitations of the studies, including small patient numbers, particularly in MMN, our review suggests that IL-6, IL-17, CXCL10, and TNF-α might play a role in CIDP pathogenesis. Larger studies are needed in MMN.
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Affiliation(s)
- Claudia Cutellè
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Pietro Emiliano Doneddu
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giuseppe Liberatore
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | | | - Gian Luca Erre
- Department of Medicine, Surgery and Pharmacy, Sassari University, Sassari, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Milan University, Milano, Italy
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3
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Zhang M, Li J, Su Y, Guo G, Chen N. Effects of a home-based exercise combined yoga and resistance training in enthesitis-related arthritis in China: study protocol for a randomised controlled trial. BMJ Open 2024; 14:e078549. [PMID: 38382959 PMCID: PMC10882405 DOI: 10.1136/bmjopen-2023-078549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Enthesitis-related arthritis (ERA) is a category of juvenile idiopathic arthritis (JIA). The complications of JIA include pain, muscle weakness, limited movement and worsening quality of life. Yoga is an effective exercise therapy for rheumatoid arthritis and may have similar benefits for JIA. Considering the limitation of yoga for strengthening muscles, combined yoga and resistance training (CYRT) may compensate for the shortcomings and provide more benefits for JIA patients. Despite this, there is currently a lack of studies investigating the effectiveness of CYRT for JIA patients. Due to the inaccessibility of traditional exercise therapy, home-based exercise is needed. The study aims to assess the effectiveness of home-based CYRT on JIA. METHODS AND ANALYSIS This is a 12-week randomised single-blind controlled trial study. 60 patients with ERA will be randomised into two groups: the home-based exercise group (HBE) and the health education (HE) group. The HBE group (n=30) will perform the CYRT programme 3 times a week at home for 12 weeks and receive HE. The HE group (n=30) will only receive HE. The outcomes include primary outcome (pain levels) and secondary outcomes (lower limb muscle strength, motion range of joint, aerobic fitness, function ability, fatigue levels, mental health, quality of life and blood biomarkers). The assessments will be conducted at baseline, postintervention (12 weeks) and follow-up (24 weeks). Data will be analysed by intention to treat. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine in December 2023 (approval no. XHEC-C-2023-059-3). This study will require informed consent from all subjects and guardians of children under 18 years of age. The findings will be published in a peer-reviewed journal and international conferences. TRIAL REGISTRATION NUMBER ChiCTR2300073446.
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Affiliation(s)
- Mei Zhang
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Jiaoyu Li
- Department of Pediatric Nephrology and Rheumatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yue Su
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guimei Guo
- Department of Pediatric Nephrology and Rheumatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Nan Chen
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
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4
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Abd-El-Azim H, Abbas H, El Sayed NS, Fayez AM, Zewail M. Non-invasive management of rheumatoid arthritis using hollow microneedles as a tool for transdermal delivery of teriflunomide loaded solid lipid nanoparticles. Int J Pharm 2023; 644:123334. [PMID: 37604364 DOI: 10.1016/j.ijpharm.2023.123334] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/10/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023]
Abstract
Conventional RA treatments required prolonged therapy courses that have been accompanied with numerous side effects impairing the patient's quality of life. Therefore, microneedles combined with nanotechnology emerged as a promising alternative non-invasive, effective and self-administrating treatment option. Hence, the main aim of this study is to reduce the side effects associated with systemic teriflunomide administration through its encapsulation in solid lipid nanoparticles (TER-SLNs) and their administration through transdermal route using AdminPen™ hollow microneedles array in the affected joint area directly. In vitro characterization studies were conducted including particle size, zeta potential, encapsulation efficiency and in vitro drug release. Also, ex vivo insertion properties of AdminPen™ hollow microneedles array was carried out. Besides, in vivo evaluation in rats with antigen induced arthritis model were also conducted by assessment of joint diameter, histopathological examination of the dissected joints and testing the levels of TNF-α, IL1B, IL7, MDA, MMP 3, and NRF2 at the end of the experiment. The selected TER-SLNs formulation was about 155.3 nm with negative surface charge and 96.45 % entrapment efficiency. TER-SLNs had a spherical shape and provided sustained release for nearly 96 h. In vivo results demonstrated that nanoencapsulation along with the use of hollow microneedles had a significant influence in improving TER anti-arthritic effects compared with TER suspension with no significant difference from the negative control group.
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Affiliation(s)
- Heba Abd-El-Azim
- Department of Pharmaceutics, Faculty of Pharmacy ,Damanhour University, Damanhour, Egypt
| | - Haidy Abbas
- Department of Pharmaceutics, Faculty of Pharmacy ,Damanhour University, Damanhour, Egypt.
| | - Nesrine S El Sayed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Ahmed M Fayez
- Department of Pharmacology, School of Life and Medical Sciences, University of Hertfordshire Hosted by Global Academic Foundation, New Administrative Capital, Cairo, Egypt
| | - Mariam Zewail
- Department of Pharmaceutics, Faculty of Pharmacy ,Damanhour University, Damanhour, Egypt
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5
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Allaeys I, Ribeiro de Vargas F, Bourgoin SG, Poubelle PE. Human Inflammatory Neutrophils Express Genes Encoding Peptidase Inhibitors: Production of Elafin Mediated by NF-κB and CCAAT/Enhancer-Binding Protein β. THE JOURNAL OF IMMUNOLOGY 2021; 206:1943-1956. [PMID: 33762327 DOI: 10.4049/jimmunol.2000852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/11/2021] [Indexed: 11/19/2022]
Abstract
The concept of plasticity of neutrophils is highlighted by studies showing their ability to transdifferentiate into APCs. In this regard, transdifferentiated neutrophils were found at inflammatory sites of autoimmune arthritis (AIA). Exposure of neutrophils to inflammatory stimuli prolongs their survival, thereby favoring the acquisition of pathophysiologically relevant phenotypes and functions. By using microarrays, quantitative RT-PCR, and ELISAs, we showed that long-lived (LL) neutrophils obtained after 48 h of culture in the presence of GM-CSF, TNF, and IL-4 differentially expressed genes related to apoptosis, MHC class II, immune response, and inflammation. The expression of anti-inflammatory genes mainly of peptidase inhibitor families is upregulated in LL neutrophils. Among these, the PI3 gene encoding elafin was the most highly expressed. The de novo production of elafin by LL neutrophils depended on a synergism between GM-CSF and TNF via the activation and cooperativity of C/EBPβ and NF-κB pathways, respectively. Elafin concentrations were higher in synovial fluids (SF) of patients with AIA than in SF of osteoarthritis. SF neutrophils produced more elafin than blood counterparts. These results are discussed with respect to implications of neutrophils in chronic inflammation and the potential influence of elafin in AIA.
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Affiliation(s)
- Isabelle Allaeys
- Infectious Diseases and Immunity Research Division, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec G1V 4G2, Canada
| | - Flavia Ribeiro de Vargas
- Infectious Diseases and Immunity Research Division, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec G1V 4G2, Canada
| | - Sylvain G Bourgoin
- Infectious Diseases and Immunity Research Division, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec G1V 4G2, Canada
| | - Patrice E Poubelle
- Infectious Diseases and Immunity Research Division, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec City, Quebec G1V 4G2, Canada
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6
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Juhl CB, Cagnotto G, Ahlström F, Bruschettini M, Petersson I, Dreyer L, Compagno M. TNF-alpha inhibitors for juvenile idiopathic arthritis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Carsten B Juhl
- SEARCH (Research group for synthesis of evidence and research), Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense M Denmark
| | - Giovanni Cagnotto
- Department of Clinical Sciences Malmö, Rheumatology; Lund University, Malmö, Skåne University Hospital; Lund Sweden
| | | | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics; Lund University, Skåne University Hospital; Lund Sweden
| | - Ingemar Petersson
- Institution for Clinical Sciences Lund; Lund University; Lund Sweden
| | - Lene Dreyer
- Department of Clinical Medicine; Aalborg University Hospital Reberbansgade; Aalborg Denmark
| | - Michele Compagno
- Department of Clinical Sciences Lund, Rheumatology; Lund University, Skane University Hospital; Lund Sweden
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7
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Low Serum IGF-1 in Boys with Recent Onset of Juvenile Idiopathic Arthritis. J Immunol Res 2018; 2018:3856897. [PMID: 30622975 PMCID: PMC6304197 DOI: 10.1155/2018/3856897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/17/2018] [Indexed: 01/26/2023] Open
Abstract
Background Liver-derived insulin-like growth factor-1 (IGF-1) contributes bone formation. Decreased IGF-1 levels are common in juvenile idiopathic arthritis (JIA), but whether IGF-1 is related to sex and differ during the pathogenic progress of JIA is unknown. Objective The aim of this study was to examine IGF-1 levels in boys and girls with newly diagnosed JIA, with established JIA and in controls. Methods The study group included 131 patients from the Estonian population-based prevalence JIA study. Blood samples were obtained from 27 boys and 38 girls with early JIA (≤1 month from the diagnosis), 29 boys and 36 girls with established JIA (mean disease duration 18 months), and from 47 age- and sex-matched controls. Results IGF-1 levels in boys were significantly decreased in early JIA compared to male controls, while IGF-1 levels in girls were comparable between JIA and controls. In early JIA, IGF-1 levels were 12-fold lower in boys relative to girls. In controls, IGF-1 levels correlated with both age and height, while these correlations were lost in boys with early JIA. Conclusion We report a sex-dependent deficiency in serum IGF-1 in boys with early JIA, which argues for sex-related differences in biological mechanisms involved in the disease pathogenesis.
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8
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Li XY, Liang CH, Parkman V, Lv ZT. The association between TNF-α 238A/G and 308A/G polymorphisms and juvenile idiopathic arthritis: An updated PRISMA-compliant meta-analysis. Medicine (Baltimore) 2018; 97:e12883. [PMID: 30412082 PMCID: PMC6221581 DOI: 10.1097/md.0000000000012883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE A previous meta-analysis concluded that TNF-α 238A/G and TNF-α 308A/G polymorphisms were not associated with the risk of juvenile idiopathic arthritis (JIA) in the overall population or Caucasian subjects. With the publication of a fair number of studies on the association between TNF-α polymorphisms and JIA in recent years, we conducted this updated meta-analysis to make a more accurate evaluation of such relationship. METHODS We adopted PubMed, EMBASE, ISI Web of Science and CNKI to identify observational studies that addressed the association between TNF-α polymorphisms and risk for JIA. The allelic effect of variant A for the risk of JIA was expressed as odds ratio (OR) along with the associated 95% confidence interval (95% CI). Meta-analyses were performed by pooling ORs and 95%CI from included studies using RevMan 5.3 software. The stratified-analysis based on ethnicity was performed to confirm the ethnicity-dependent effect on the relationship. RESULTS A total of 15 case-control studies including 2845 patients in JIA groups and 4771 patients in control groups were included in our study. The findings indicated a statistically significant association between the A allele of the TNF-alpha 238A/G polymorphism and the decreased JIA risk in Caucasians (P = .0002). The study in Iranian showed similar results (P = .0002) whereas the studies in other ethnicities failed to replicate this finding: Han (P = .29), Mexican (P = .64) and Turkish population (P = .32). TNF-α 308A/G was not statistically associated with JIA in overall subjects or Caucasians. CONCLUSION Our study confirmed the protective role of the A allele in TNF-α 238A/G but not TNF-α 308A/G against the occurrence of JIA in the Caucasian population. To exactly validate the correlation between TNF-α polymorphisms and JIA in other ethnic backgrounds, additional studies are required.
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Affiliation(s)
- Xing-yan Li
- Department of Orthopedics, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Chun-hua Liang
- Department of Orthopedics, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Virginia Parkman
- Harvard School of Dental Medicine, Division of Bone and Mineral Research, Department of Oral Medicine, Infection and Immunity, Boston, MA
| | - Zheng-tao Lv
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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9
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Rodríguez-Nuevo A, Díaz-Ramos A, Noguera E, Díaz-Sáez F, Duran X, Muñoz JP, Romero M, Plana N, Sebastián D, Tezze C, Romanello V, Ribas F, Seco J, Planet E, Doctrow SR, González J, Borràs M, Liesa M, Palacín M, Vendrell J, Villarroya F, Sandri M, Shirihai O, Zorzano A. Mitochondrial DNA and TLR9 drive muscle inflammation upon Opa1 deficiency. EMBO J 2018; 37:embj.201796553. [PMID: 29632021 DOI: 10.15252/embj.201796553] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 01/04/2023] Open
Abstract
Opa1 participates in inner mitochondrial membrane fusion and cristae morphogenesis. Here, we show that muscle-specific Opa1 ablation causes reduced muscle fiber size, dysfunctional mitochondria, enhanced Fgf21, and muscle inflammation characterized by NF-κB activation, and enhanced expression of pro-inflammatory genes. Chronic sodium salicylate treatment ameliorated muscle alterations and reduced the muscle expression of Fgf21. Muscle inflammation was an early event during the progression of the disease and occurred before macrophage infiltration, indicating that it is a primary response to Opa1 deficiency. Moreover, Opa1 repression in muscle cells also resulted in NF-κB activation and inflammation in the absence of necrosis and/or apoptosis, thereby revealing that the activation is a cell-autonomous process and independent of cell death. The effects of Opa1 deficiency on the expression NF-κB target genes and inflammation were absent upon mitochondrial DNA depletion. Under Opa1 deficiency, blockage or repression of TLR9 prevented NF-κB activation and inflammation. Taken together, our results reveal that Opa1 deficiency in muscle causes initial mitochondrial alterations that lead to TLR9 activation, and inflammation, which contributes to enhanced Fgf21 expression and to growth impairment.
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Affiliation(s)
- Aida Rodríguez-Nuevo
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona, Spain.,Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Angels Díaz-Ramos
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona, Spain.,Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Eduard Noguera
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona, Spain.,Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Díaz-Sáez
- Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Xavier Duran
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitari de Tarragona Joan XXIII-IISPV, Facultat de Medicina, Universitat Rovira i Virgili, Tarragona, Spain
| | - Juan Pablo Muñoz
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona, Spain.,Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Romero
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona, Spain.,Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Natàlia Plana
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona, Spain.,Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - David Sebastián
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona, Spain.,Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Francesc Ribas
- Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.,CIBER Fisiopatologia de la Obesidad y Nutricion, Instituto de Salud Carlos III, Barcelona, Spain
| | - Jordi Seco
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona, Spain.,Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Evarist Planet
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona, Spain
| | - Susan R Doctrow
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Javier González
- Experimental Toxicology and Ecotoxicology Unit (CERETOX), Barcelona Science Park, Barcelona, Spain
| | - Miquel Borràs
- Experimental Toxicology and Ecotoxicology Unit (CERETOX), Barcelona Science Park, Barcelona, Spain
| | - Marc Liesa
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Manuel Palacín
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona, Spain.,Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Joan Vendrell
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitari de Tarragona Joan XXIII-IISPV, Facultat de Medicina, Universitat Rovira i Virgili, Tarragona, Spain
| | - Francesc Villarroya
- Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.,CIBER Fisiopatologia de la Obesidad y Nutricion, Instituto de Salud Carlos III, Barcelona, Spain
| | - Marco Sandri
- Venetian Institute of Molecular Medicine, Padova, Italy
| | - Orian Shirihai
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Antonio Zorzano
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona, Spain .,Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
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10
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Funk RS, Chan MA, Becker ML. Cytokine Biomarkers of Disease Activity and Therapeutic Response after Initiating Methotrexate Therapy in Patients with Juvenile Idiopathic Arthritis. Pharmacotherapy 2018; 37:700-711. [PMID: 28475276 DOI: 10.1002/phar.1938] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE To evaluate the relationship between plasma cytokine levels with disease activity and therapeutic response in patients with juvenile idiopathic arthritis (JIA) after initiating methotrexate (MTX) therapy. DESIGN Single-center observational prospective cohort study. SETTING Outpatient pediatric rheumatology clinic at a tertiary care academic pediatric hospital. PATIENTS The study included 61 patients diagnosed with JIA who started therapy with standard-dose MTX 15 mg/m2 /week. At 3 months, treating physicians were given the option of maintaining the MTX dose, increasing the MTX dose, or adding etanercept (ETN), based on their clinical judgment. MEASUREMENTS AND MAIN RESULTS Patients were evaluated at baseline, 3 months (51 patients), and 6 months (35 patients). Plasma samples from each visit were analyzed for interleukin (IL)-1α, IL-1β, IL-1Ra, IL-6, and tumor necrosis factor-α (TNF-α). Cytokine concentrations were evaluated for relationships with disease activity using the 71-joint count Juvenile Arthritis Disease Activity Score (JADAS). Therapeutic response was assessed by changes in JADAS. Failure to respond to standard-dose MTX was defined as the need for the addition of ETN or a MTX dose increase at or before the 3-month visit. Increased disease severity at baseline was associated with increased IL-6 (p=0.01) and TNF-α (p=0.008) levels. Initiation of MTX was associated with reductions in IL-1α (p=0.009), IL-1β (p=0.01), IL-1Ra (p=0.007), and IL-6 (p=0.03) levels; however, reductions in JADAS were only associated with reductions in IL-6 (p=0.009) and TNF-α levels (p=0.02). Compared with responders, patients failing to respond to standard-dose MTX had increased TNF-α levels at baseline (p=0.02) and at 3 months (p=0.005). Reductions in JADAS by 6 months were observed following either the addition of ETN (p=0.009) or an increase in MTX dose (p=0.007), but the addition of ETN was associated with a median 7-fold increase in TNF-α levels (p=0.003) that corresponded with clinical response. CONCLUSION Plasma cytokine levels were responsive to MTX therapy in patients with JIA, but only TNF-α and IL-6 levels were consistently associated with disease activity and therapeutic response. Increased TNF-α levels at baseline were associated with failure to respond to standard-dose MTX and the need for more aggressive drug therapy. Initiation of ETN resulted in increased TNF-α levels that corresponded with therapeutic response, suggesting a potential clinical benefit of monitoring TNF-α levels as a pharmacodynamic marker of etanercept activity.
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Affiliation(s)
- Ryan S Funk
- Department of Pharmacy Practice, University of Kansas Medical Center, Kansas City, Kansas.,Division of Clinical Pharmacology and Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, Missouri
| | - Marcia A Chan
- Division of Allergy, Asthma and Immunology, Children's Mercy Kansas City, Kansas City, Missouri
| | - Mara L Becker
- Division of Clinical Pharmacology and Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, Missouri.,Division of Rheumatology, Children's Mercy Kansas City, Kansas City, Missouri
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11
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Abd El Razek Hafez E, Mosaad H. CD226 and CD40 gene polymorphism in Egyptian juvenile idiopathic arthritis children: Relation to disease susceptibility and activity. THE EGYPTIAN RHEUMATOLOGIST 2018; 40:59-62. [DOI: 10.1016/j.ejr.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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12
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El Gazzar II, Fathy HM, Gheita TA, Nour El-Din AM, Rasheed EA, Bassyouni RH, Kenawy SA. Tumor necrosis factor-α -308 A/G gene polymorphism in children with juvenile idiopathic arthritis: relation to disease activity, damage, and functional status. Clin Rheumatol 2017; 36:1757-1763. [PMID: 28593608 DOI: 10.1007/s10067-017-3719-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/24/2017] [Accepted: 05/31/2017] [Indexed: 12/12/2022]
Abstract
The study aims to evaluate the clinical significance of serum levels of tumor necrosis factor alpha (TNF-α) and -308 A/G promoter polymorphism in juvenile idiopathic arthritis (JIA) patients and find any association to the subsets, clinical and laboratory features, disease activity, and damage as well as functional disability. Forty-eight JIA children and 30 controls were included in the present study. Juvenile arthritis disease activity score in 27 joints (JADAS-27) was calculated, juvenile arthritis damage index (JADI) was assessed, and Childhood Health Assessment Questionnaire (CHAQ) measured the functional status. Serum TNF-α was assayed by ELISA and gene (-308) promoter polymorphism was determined by polymerase chain reaction. The 48 JIA children (mean age 11.5 ± 2.8 years) were 13 systemic, 17 oligoarticular, and 18 polyarticular onset. The serum TNF-α was significantly higher in patients (90.4 ± 6.3 ng/ml) compared to control (3.5 ± 2.6 ng/ml) (p < 0.0001) with a tendency to be higher in the polyarticular subtype. All controls had TNF-α -308 GG alleles. The frequency of GG genotype tended to be higher in systemic onset compared to oligoarticular and polyarticular subtypes. The serum TNF-α significantly correlated with JADAS-27 (r = 0.32, p = 0.03) and CHAQ (r = 0.37, p = 0.01) and negatively with the presence of GG alleles (r = -0.48, p = 0.001). The GG alleles were significantly negatively associated with C-reactive protein (r = -0.32, p = 0.03) with a tendency to negatively correlate with JADAS-27, CHAQ, and JADI-extrarticular (r = -0.28, p = 0.06; r = -0.25, p = 0.09 and r = -0.25, p = 0.09, respectively). There is evidence of a possible influence of the -308 SNP promoter position on the production of TNF-α, the severity of JIA which may consequently influence the response to anti-TNF-α treatment.
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Affiliation(s)
- Iman I El Gazzar
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanan M Fathy
- Rheumatology Department, Faculty of Medicine, Fayoum University, Faiyum, Egypt
| | - Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | | | - Enas Abdel Rasheed
- Clinical Pathology Department, National Research Centre (NRC), Giza, Egypt
| | - Rasha H Bassyouni
- Medical Microbiology and Immunology Department, Faculty of Medicine, Fayoum University, Faiyum, Egypt
| | - Sanaa A Kenawy
- Clinical Pharmacology, Faculty of Pharmacy, Cairo University; PhD Royal College of Surgeons, London University, London, UK
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13
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Abstract
Bone health in children with rheumatic conditions may be compromised due to several factors related to the inflammatory disease state, delayed puberty, altered life style, including decreased physical activities, sun avoidance, suboptimal calcium and vitamin D intake, and medical treatments, mainly glucocorticoids and possibly some disease-modifying anti-rheumatic drugs. Low bone density or even fragility fractures could be asymptomatic; therefore, children with diseases of high inflammatory load, such as systemic onset juvenile idiopathic arthritis, juvenile dermatomyositis, systemic lupus erythematosus, and those requiring chronic glucocorticoids may benefit from routine screening of bone health. Most commonly used assessment tools are laboratory testing including serum 25-OH-vitamin D measurement and bone mineral density measurement by a variety of methods, dual-energy X-ray absorptiometry as the most widely used. Early disease control, use of steroid-sparing medications such as disease-modifying anti-rheumatic drugs and biologics, supplemental vitamin D and calcium, and promotion of weight-bearing physical activities can help optimize bone health. Additional treatment options for osteoporosis such as bisphosphonates are still controversial in children with chronic rheumatic diseases, especially those with decreased bone density without fragility fractures. This article reviews common risk factors leading to compromised bone health in children with chronic rheumatic diseases and discusses the general approach to prevention and treatment of bone fragility.
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14
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Brescia AC, Simonds MM, Sullivan KE, Rose CD. Secretion of pro-inflammatory cytokines and chemokines and loss of regulatory signals by fibroblast-like synoviocytes in juvenile idiopathic arthritis. Proteomics Clin Appl 2017; 11:1600088. [PMID: 28012239 PMCID: PMC6084365 DOI: 10.1002/prca.201600088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 06/28/2016] [Accepted: 12/19/2016] [Indexed: 11/08/2022]
Abstract
PURPOSE The goal is to investigate the specific contribution of fibroblast-like synoviocytes (FLS) to the inflammatory milieu of the synovium in juvenile idiopathic arthritis (JIA) through detection of secreted proteins. EXPERIMENTAL DESIGN Expression of 89 cytokines and chemokines is determined on unprocessed synovial fluid from controls and JIA patients using antibody arrays. Supernatants from pure cell cultures of FLS grown from synovial fluids or tissues from JIA and controls are also examined for protein expression. Ingenuity Pathway Analysis (IPA) is revealed top pathways and upstream regulators of significant proteins. RESULTS Protein studies is revealed that JIA FLS release pro-inflammatory cytokines and chemokines, including IL-4, IL-6, IL-17, CXCL1, and CXCL6, and lose expression of important regulator signals, such as IL-10 and TIMP2. Of the 84 proteins differentially expressed between controls and JIA in the synovial fluid, 1/3 (29 proteins) are differentially expressed in the cell culture supernatants of JIA and control FLS. ELISA of cell culture supernatants and synovial fluid confirmed seven key proteins. CONCLUSION AND CLINICAL RELEVANCE JIA FLS are central to perpetuation of inflammation in JIA, including trafficking of inflammatory cells and effects on the extracellular matrix. These cells express key disease-specific chemokines that, with further refinement, may allow us to tailor therapy appropriately.
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15
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Tabeian H, Bakker AD, Betti BF, Lobbezoo F, Everts V, de Vries TJ. Cyclic Tensile Strain Reduces TNF-α Induced Expression of MMP-13 by Condylar Temporomandibular Joint Cells. J Cell Physiol 2017; 232:1287-1294. [PMID: 27618228 DOI: 10.1002/jcp.25593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 09/09/2016] [Indexed: 01/27/2023]
Abstract
To investigate whether the disproportionate degradation of mandibular condyle cartilage in arthritic juvenile temporomandibular joint (TMJ) is related to distinctive responses of TMJ-derived cells to tumor necrosis factor-α (TNF-α), and whether mechanical loading affects this response. The effect of TNF-α (0.1-10 ng/ml) was tested on juvenile porcine TMJ cells isolated from the condyle, fossa, and disc, grown in 3D agarose gels. Expression of anabolic and catabolic factors was quantified by RT-qPCR and/or immunohistochemistry. Condylar cells were stimulated for 12 h with TNF-α (10 ng/ml), followed by 8 h of 6% cyclic tensile strain, and gene expression of MMPs was quantified. TNF-α (10 ng/ml) reduced the expression of the matrix proteins collagen types I and II after 6 h of incubation. Aggrecan gene expression was increased in the presence of 0.1 ng/ml TNF-α. The fossa and disc cells responded to TNF-α with an increased expression of the aggrecanase ADAMTS4. TNF-α enhanced MMP-13 gene and protein expression only by condylar cells. Mechanical loading reduced this effect. Cells isolated from the different cartilaginous structures reacted differently to TNF-α. Since the disc and fossa contain a very low level of proteoglycans in comparison to the condyle, the role played by ADAMTS4 in degradation of the fossa and disc might be limited. TNF-α induced MMP-13 expression by condylar cells might be involved in the degradation of the juvenile condyle. Since this expression was reduced by mechanical loading, functional loading with oral physiotherapy or orthodontic activators may help to reduce the catabolic effect of TNF-α. J. Cell. Physiol. 232: 1287-1294, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hessam Tabeian
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Astrid D Bakker
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Beatriz F Betti
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.,Department of Oral Kinesiology, ACTA, University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.,Department of Orthodontics, ACTA, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, ACTA, University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Vincent Everts
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Teun J de Vries
- Department of Periodontology, ACTA, University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
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16
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Maddah M, Harsini S, Ziaee V, Moradinejad MH, Rezaei A, Zoghi S, Sadr M, Aghighi Y, Rezaei N. Association of tumour necrosis factor-alpha G/A -238 and G/A -308 single nucleotide polymorphisms with juvenile idiopathic arthritis. Int J Immunogenet 2016; 43:391-396. [DOI: 10.1111/iji.12291] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/28/2016] [Accepted: 09/25/2016] [Indexed: 12/20/2022]
Affiliation(s)
- M. Maddah
- Pediatrics Center of Excellence; Children's Medical Center; Tehran University of Medical Sciences; Tehran Iran
| | - S. Harsini
- Research Center for Immunodeficiencies; Children's Medical Center; Tehran University of Medical Sciences; Tehran Iran
- Network of Immunity in Infection; Malignancy and Autoimmunity (NIIMA); Universal Scientific Education and Research Network (USERN); Tehran Iran
| | - V. Ziaee
- Pediatrics Center of Excellence; Children's Medical Center; Tehran University of Medical Sciences; Tehran Iran
- Pediatric Rheumatology Research Group; Rheumatology Research Center; Tehran University of Medical Sciences; Tehran Iran
| | - M. H. Moradinejad
- Pediatrics Center of Excellence; Children's Medical Center; Tehran University of Medical Sciences; Tehran Iran
| | - A. Rezaei
- Research Center for Immunodeficiencies; Children's Medical Center; Tehran University of Medical Sciences; Tehran Iran
| | - S. Zoghi
- Network of Immunity in Infection; Malignancy and Autoimmunity (NIIMA); Universal Scientific Education and Research Network (USERN); Tehran Iran
- Department of Immunology; School of Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - M. Sadr
- Molecular Immunology Research Center; School of Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Y. Aghighi
- Department of Pediatrics; Imam Khomeini Hospital; Tehran University of Medical Sciences; Tehran Iran
| | - N. Rezaei
- Research Center for Immunodeficiencies; Children's Medical Center; Tehran University of Medical Sciences; Tehran Iran
- Network of Immunity in Infection; Malignancy and Autoimmunity (NIIMA); Universal Scientific Education and Research Network (USERN); Tehran Iran
- Department of Immunology; School of Medicine; Tehran University of Medical Sciences; Tehran Iran
- Molecular Immunology Research Center; School of Medicine; Tehran University of Medical Sciences; Tehran Iran
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17
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Liu C, Yang Y, Sun D, Wang C, Wang H, Jia S, Liu L, Lin N. Total Saponin from Anemone flaccida Fr. Schmidt Prevents Bone Destruction in Experimental Rheumatoid Arthritis via Inhibiting Osteoclastogenesis. Rejuvenation Res 2015; 18:528-42. [PMID: 26418168 DOI: 10.1089/rej.2015.1688] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Anemone flaccida Fr. Schmidt is used in the clinical compound prescription for the treatment of rheumatoid arthritis (RA) in China and has the traditional use of draining dampness, diminishing swelling, and relieving pain. Total saponins (TS) are the characteristic components and also the main active ingredients of A. flaccida. Previous reports indicated that TS possess anti-inflammatory and immunoregulatory properties; however, the effects of TS on bone destruction of RA have not been evaluated. In this study, our data first showed the therapeutic effects of TS on severity of arthritis and arthritis progression in collagen-induced arthritis (CIA) rats. Then, by microfocal computed tomography (CT) quantification, TS significantly increased bone mineral density, bone volume fraction, and trabecular thickness and decreased trabecular separation of inflamed joints both at peri-articular and extra-articular locations. TS also diminished the level of the bone resorption marker CTX-I and simultaneously increased the bone formation marker osteocalcin in sera of CIA rats. Interestingly, TS prevented bone destruction by reducing the number of osteoclasts in inflamed joints, reducing the expression of receptor activator of nuclear factor-κF (RANK) ligand (RANKL) and RANK, increasing the expression of osteoprotegerin (OPG), at both mRNA and protein levels, and decreasing the ratio of RANKL to OPG in inflamed joints and sera of CIA rats. This was further confirmed in the co-culture system of human fibroblast-like synovial and peripheral blood mononuclear cells. In addition, TS inhibited the levels of pro-inflammatory cytokines implicated in bone resorption, such as interleukin-1β (IL-1β), tumor necrosis factor-α (TNFα), IL-6, IL-17, and IL-23 in sera and joints. These findings offer convincing evidence that TS attenuate RA partially by preventing both focal bone destruction and systemic bone loss. This anti-erosive effect results in part from inhibiting osteoclastogenesis by regulating the RANKL/RANK/OPG signaling pathway. The suppression of systemic and local pro-osteoclastogenic cytokines by TS was also highly effective.
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Affiliation(s)
- Chunfang Liu
- 1 Institute of Chinese Materia Medica , China Academy of Chinese Medical Sciences, Beijing, China
| | - Yue Yang
- 1 Institute of Chinese Materia Medica , China Academy of Chinese Medical Sciences, Beijing, China
| | - Danni Sun
- 1 Institute of Chinese Materia Medica , China Academy of Chinese Medical Sciences, Beijing, China
| | - Chao Wang
- 1 Institute of Chinese Materia Medica , China Academy of Chinese Medical Sciences, Beijing, China
| | - Hui Wang
- 1 Institute of Chinese Materia Medica , China Academy of Chinese Medical Sciences, Beijing, China
| | - Shiwei Jia
- 2 Guangzhou Kanghe Pharmaceutical Limited Company , Guangzhou, China
| | - Liang Liu
- 1 Institute of Chinese Materia Medica , China Academy of Chinese Medical Sciences, Beijing, China .,3 State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology , Macau, China
| | - Na Lin
- 1 Institute of Chinese Materia Medica , China Academy of Chinese Medical Sciences, Beijing, China
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18
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TNF-α gene polymorphisms and juvenile idiopathic arthritis: Influence on disease outcome and therapeutic response. Semin Arthritis Rheum 2015; 45:35-41. [DOI: 10.1016/j.semarthrit.2015.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 01/26/2015] [Accepted: 02/16/2015] [Indexed: 11/16/2022]
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19
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Smith EMD, Foster HE, Beresford MW. The development and assessment of biological treatments for children. Br J Clin Pharmacol 2015; 79:379-94. [PMID: 24750505 PMCID: PMC4345949 DOI: 10.1111/bcp.12406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 04/11/2014] [Indexed: 12/14/2022] Open
Abstract
The development of biological agents with specific immunological targets has revolutionized the treatment of a wide variety of paediatric diseases where traditional immunosuppressive agents have been partly ineffective or intolerable. The increasing requirement for pharmaceutical companies to undertake paediatric studies has provided impetus for studies of biologics in children. The assessment of biological agents in children to date has largely relied upon randomized controlled trials using a withdrawal design, rather than a parallel study design. This approach has been largely used due to ethical concerns, including use of placebo treatments in children with active chronic disease, and justified on the basis that treatments have usually already undergone robust assessment in related adult conditions. However, this study design limits the reliability of the data and can confuse the interpretation of safety results. Careful ongoing monitoring of safety and efficacy in real-world practice through national and international biologics registries and robust reporting systems is crucial. The most commonly used biological agents in children target tumour necrosis factor-α, interleukin-1, interleukin-6 and cytotoxic lymphocyte-associated antigen-4. These agents are most frequently used in paediatric rheumatic diseases. This review discusses the development and assessment of biologics within paediatric rheumatology with reference to the lessons learned from use in other subspecialties.
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Affiliation(s)
- Eve M D Smith
- Institute of Translational Medicine, University of LiverpoolLiverpool, UK
| | - Helen E Foster
- Paediatric Rheumatology, Institute of Cellular Medicine, Newcastle UniversityNewcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle Hospitals NHS Foundation TrustNewcastle upon Tyne, UK
| | - Michael W Beresford
- Institute of Translational Medicine, University of LiverpoolLiverpool, UK
- Alder Hey Children's NHS Foundation TrustLiverpool, UK
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20
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Berg EL, O'Mahony A. Complex Primary Human Cell Systems for Drug Discovery. HUMAN-BASED SYSTEMS FOR TRANSLATIONAL RESEARCH 2014. [DOI: 10.1039/9781782620136-00088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Phenotypic or biofunctional assays play an important role in drug discovery by helping to bridge the gap between high-throughput, target-based screening assays used for compound identification and more physiologically relevant in vivo disease models used for preclinical development. We have developed a standardised panel of phenotypic assays using primary human cells and co-cultures that model tissue and disease biology for characterization of drug leads. Here we show application of these assays for characterisation of clinical stage kinase inhibitors for rheumatoid arthritis, the recently approved JAK kinase inhibitor, tofacitinib, and the SYK kinase inhibitor, fostamatinib. We demonstrate how profiling in this assay panel can relate to clinical effects, both efficacy and safety related.
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Affiliation(s)
- Ellen L. Berg
- BioSeek, A Division of DiscoveRx 310 Utah Avenue Suite 100 South San Francisco CA 94080 USA
| | - Alison O'Mahony
- BioSeek, A Division of DiscoveRx 310 Utah Avenue Suite 100 South San Francisco CA 94080 USA
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21
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Choukair D, Hügel U, Sander A, Uhlmann L, Tönshoff B. Inhibition of IGF-I-related intracellular signaling pathways by proinflammatory cytokines in growth plate chondrocytes. Pediatr Res 2014; 76:245-51. [PMID: 24941214 DOI: 10.1038/pr.2014.84] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 02/27/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Children with chronic inflammatory diseases suffer from severe growth failure associated with resistance toward the anabolic action of insulin-like growth factor I (IGF-I). We hypothesized that proinflammatory cytokines interfere with IGF-I signaling. METHODS We used the mesenchymal chondrogenic cell line RCJ3.1C5.18 as a model of the growth plate. Cell proliferation was assessed by [(3)H]-thymidine-uptake and differentiation by gene expression (quantitative reverse-transcriptase PCR) of specific differentiation markers. Key signaling molecules of the respective IGF-I-related intracellular pathways were determined by western immunoblotting. RESULTS Coincubation of the proinflammatory cytokines interleukin (IL)-1β (10 ng/ml), IL-6 (100 ng/ml), or tumor necrosis factor-α (50 ng/ml) with IGF-I inhibited IGF-I-driven cell proliferation by 50%, while baseline cell proliferation was not altered. These cytokines attenuated the IGF-I-induced phosphorylation of AKT as a key signaling molecule of the phosphatidylinositol-3 kinase pathway by 30-50% and the phosphorylation of ERK as a key signaling molecule of the mitogen-activated protein kinase/extracellular signal-regulated kinase pathway by 50-75%. Also, IGF-I-enhanced chondrocyte differentiation was inhibited by these proinflammatory cytokines. CONCLUSION The insensitivity toward the anabolic action of IGF-I in the growth plate in conditions of chronic inflammation is partially due to inhibition of IGF-I-specific signaling pathways by proinflammatory cytokines, which affect both IGF-I-driven chondrocyte proliferation and differentiation.
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Affiliation(s)
- Daniela Choukair
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Ulrike Hügel
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Anja Sander
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
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22
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Dore RK. Clinical utility of etanercept in the treatment of arthritides in children and adolescents. Adolesc Health Med Ther 2014; 5:35-48. [PMID: 24729739 PMCID: PMC3970916 DOI: 10.2147/ahmt.s38909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is a group of chronic inflammatory diseases affecting approximately 300,000 children and adolescents in the United States of unknown cause. It can affect children from the age of 0 years up to the age of 16 years. The International League of Associations of Rheumatology has defined seven subsets of JIA based on several factors including the number of affected joints and the involvement of other tissues; the prognosis for each affected child also depends on multiple factors including age of onset, number of joints involved, and systemic features. As with rheumatoid arthritis in adults, the goal of therapy is remission and resolution of disease activity; however, as a cure does not seem attainable in the near future, a reasonable goal of therapy is prevention of joint damage, inhibition of inflammation, and a high level of quality of life. Even with available therapies, many children with JIA enter adulthood with persistently active disease, suboptimal function, and impaired quality of life. Methotrexate remains the standard of care for children with JIA; etanercept was approved in 2000 in the United States for the treatment of JIA resistant to methotrexate. The efficacy and safety of etanercept therapy in children with JIA is reviewed and its place in the therapeutic regimen is discussed; the available long term data is also presented. The data presented was obtained from a PubMed search as well as a review of the references presented in the 2011 American College of Rheumatology Recommendations for the Treatment of Juvenile Idiopathic Arthritis and the 2013 Update. It is hoped that treatment with etanercept and other biologic therapies will lead to improved outcomes for children with JIA in the future.
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Affiliation(s)
- Robin K Dore
- David Geffen School of Medicine, Division of Rheumatology, UCLA, Los Angeles, CA, USA
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23
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Serum amyloid A induces mitogenic signals in regulatory T cells via monocyte activation. Mol Immunol 2014; 59:172-9. [PMID: 24632292 DOI: 10.1016/j.molimm.2014.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 02/12/2014] [Accepted: 02/14/2014] [Indexed: 12/23/2022]
Abstract
Serum amyloid A (SAA) has recently been identified by our group as a mitogen for regulatory T cells (Treg). However, the molecular mechanism by which SAA induces Treg proliferation is unknown. Here we provide evidence that IL-1β and IL-6 are directly involved in the SAA-mediated proliferation of Treg. By engaging its several cognate receptors, SAA induces IL-1β and IL-6 secretion by monocytes and drives them toward an HLA-DR(hi) HVEM(lo) phenotype resembling immature dendritic cells, which have been implicated in tolerance generation. This monocyte-derived cytokine milieu is required for Treg expansion, as inhibition of IL-1β and IL-6 abrogate the ability of SAA to induce Treg proliferation. Furthermore, both IL-1β and IL-6 are required for ERK1/2 and AKT signaling in proliferating Treg. Collectively, these results point to a novel mechanism, by which SAA initiates a monocyte-dependent process that drives mitogenic signals in Treg.
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24
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Honke N, Ohl K, Wiener A, Bierwagen J, Peitz J, Di Fiore S, Fischer R, Wagner N, Wüller S, Tenbrock K. The p38-Mediated Rapid Down-Regulation of Cell Surface gp130 Expression Impairs Interleukin-6 Signaling in the Synovial Fluid of Juvenile Idiopathic Arthritis Patients. Arthritis Rheumatol 2014; 66:470-8. [DOI: 10.1002/art.38245] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 10/17/2013] [Indexed: 11/10/2022]
Affiliation(s)
| | - Kim Ohl
- RWTH Aachen University; Aachen Germany
| | | | | | | | - Stefano Di Fiore
- Fraunhofer Institute for Molecular Biology and Applied Ecology; Aachen Germany
| | - Rainer Fischer
- Fraunhofer Institute for Molecular Biology and Applied Ecology; Aachen Germany
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Marzan KAB, Reiff AO. Adalimumab in juvenile rheumatoid arthritis/juvenile idiopathic arthritis. Expert Rev Clin Immunol 2014; 4:549-58. [DOI: 10.1586/1744666x.4.5.549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Giannini C, Mohn A, Chiarelli F. Growth abnormalities in children with type 1 diabetes, juvenile chronic arthritis, and asthma. Int J Endocrinol 2014; 2014:265954. [PMID: 24648838 PMCID: PMC3932221 DOI: 10.1155/2014/265954] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 12/12/2013] [Indexed: 11/17/2022] Open
Abstract
Children and adolescents with chronic diseases are commonly affected by a variable degree of growth failure, leading to an impaired final height. Of note, the peculiar onset during childhood and adolescence of some chronic diseases, such as type 1 diabetes, juvenile idiopathic arthritis, and asthma, underlines the relevant role of healthcare planners and providers in detecting and preventing growth abnormalities in these high risk populations. In this review article, the most relevant common and disease-specific mechanisms by which these major chronic diseases affect growth in youth are analyzed. In addition, the available and potential targeting strategies to restore the physiological, hormonal, and inflammatory pattern are described.
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Affiliation(s)
- Cosimo Giannini
- Department of Pediatrics, University of Chieti, Ospedale Policlinico, Via dei Vestini 5, 66100-Chieti, Italy
- Center of Excellence on Aging, “G. D'Annunzio” University Foundation, University of Chieti, Via dei Vestini 5, 66100-Chieti, Italy
| | - Angelika Mohn
- Department of Pediatrics, University of Chieti, Ospedale Policlinico, Via dei Vestini 5, 66100-Chieti, Italy
- Center of Excellence on Aging, “G. D'Annunzio” University Foundation, University of Chieti, Via dei Vestini 5, 66100-Chieti, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, University of Chieti, Ospedale Policlinico, Via dei Vestini 5, 66100-Chieti, Italy
- Center of Excellence on Aging, “G. D'Annunzio” University Foundation, University of Chieti, Via dei Vestini 5, 66100-Chieti, Italy
- *Francesco Chiarelli:
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Kadavath S, Efthimiou P. Canakinumab in autoimmune and autoinflammatory rheumatic diseases. Expert Opin Orphan Drugs 2013. [DOI: 10.1517/21678707.2014.868802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Simsa-Maziel S, Zaretsky J, Reich A, Koren Y, Shahar R, Monsonego-Ornan E. IL-1RI participates in normal growth plate development and bone modeling. Am J Physiol Endocrinol Metab 2013; 305:E15-21. [PMID: 23592480 DOI: 10.1152/ajpendo.00335.2012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The proinflammatory cytokine interleukin-1 (IL-1) signals through IL-1 receptor type I (IL-1RI) and induces osteoclastogenesis and bone resorption mainly during pathological conditions. Little is known about the effect of excess or absence of IL-1 signaling on the physiological development of the growth plate and bone. In this study, we examine growth plate morphology, bone structure, and mechanical properties as well as osteoclast number in IL-1RI knockout mice to evaluate the role of IL-1RI in the normal development of the growth plate and bone. We show for the first time that IL-1RI knockout mice have narrower growth plates due to a smaller hypertrophic zone, suggesting a role for this cytokine in hypertrophic differentiation, together with higher proteoglycan content. The bones of theses mice exhibit higher trabecular and cortical mass, increased mineral density, and superior mechanical properties. In addition, IL-1RI knockout mice have significantly reduced osteoclast numbers in the chondro-osseous junction, trabecular bone, and cortical bone. These results suggest that IL-1RI is involved in normal growth plate development and ECM homeostasis and that it is significant in the physiological process of bone modeling.
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Affiliation(s)
- Stav Simsa-Maziel
- Institute of Biochemistry and Nutrition, The Robert H. Smith Faculty of Agriculture, Food, and Environment, The Hebrew University, Rehovot, Israel
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Almanzar G, Zlamy M, Koppelstaetter C, Brunner A, Jeller V, Duftner C, Dejaco C, Brunner J, Prelog M. Increased replication of CD4+ naive T cells and changes in T cell homeostasis in a case of acute exacerbation of juvenile idiopathic arthritis: a case comparison study. J Med Case Rep 2013; 7:135. [PMID: 23692985 PMCID: PMC3686624 DOI: 10.1186/1752-1947-7-135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 04/05/2013] [Indexed: 11/15/2022] Open
Abstract
Introduction Juvenile idiopathic arthritis is a heterogeneous T cell-mediated autoimmune disease with symptoms of premature aging of the immune system (immunosenescence). The present work is an investigation of immunosenescence parameters, such as quantity of naive and CD28- T cells, T cell receptor excision circles, relative telomere length and alterations of peripheral T cell replication, and was performed via comparison of a case of acute exacerbation of juvenile idiopathic arthritis against six patients with juvenile idiopathic arthritis with disease remission and six age-matched healthy donors over a follow-up course of 12 months. Case presentation Phenotypical T cell characterization and intracellular interferon γ, tumor necrosis factor α, and interleukin 2 production were studied in peripheral blood mononuclear cells from seven patients with juvenile idiopathic arthritis and six healthy control donors, with findings determined by flow cytometry. T cell receptor excision circles and relative telomere length quantification were performed on deoxyribonucleic acid isolated from naive (CD4+CD28+CD45RA+) T cells and investigated via reverse transcription polymerase chain reaction. Ki67 expression was studied by immunohistochemistry on naive T cells. The non-parametric Mann-Whitney U test and Wilcoxon test for two independent groups of variables were used to compare healthy donors with patients with juvenile idiopathic arthritis. During follow-up, patients with juvenile idiopathic arthritis showed lower total counts of naive and CD28-expressing T cells compared to healthy donors. Acute exacerbation led to low naive and CD28+ T cell populations and elevated proportions of Ki67-expressing CD4+ naive T cells. In conditions of exacerbation, T cell receptor excision circle numbers were in the lower range in patients with juvenile idiopathic arthritis and increased after follow-up. Healthy donors showed significantly higher relative telomere lengths compared to patients with juvenile idiopathic arthritis. Conclusions This investigation illustrates that the changes in T cell homeostasis in patients with juvenile idiopathic arthritis may be the result of several mechanisms, such as diminished thymus function and peripheral exertions to maintain the peripheral T cell pool. The results also demonstrate that hallmarks of immunosenescence such as decreased naive T cell levels and lower T cell receptor excision circle numbers can only be interpreted together with replication markers such as relative telomere length or Ki67 expression.
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Affiliation(s)
- Giovanni Almanzar
- Department of Pediatrics, University of Würzburg, Würzburg, Germany.
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Yim DS, Zhou H, Buckwalter M, Nestorov I, Peck CC, Lee H. Population Pharmacokinetic Analysis and Simulation of the Time-Concentration Profile of Etanercept in Pediatric Patients With Juvenile Rheumatoid Arthritis. J Clin Pharmacol 2013; 45:246-56. [PMID: 15703360 DOI: 10.1177/0091270004271945] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was performed to estimate the population pharmacokinetic (PK) parameters of etanercept in pediatric juvenile rheumatoid arthritis (JRA) patients and to compare the steady-state time-concentration profiles between etanercept 0.8-mg/kg once-weekly and 0.4-mg/kg twice-weekly subcutaneous (SC) regimens by clinical trial simulation. To this end, mixed-effect analysis (NONMEM, Version 5.1) was performed using the etanercept PK database consisting of 69 JRA patients (4-17 years). Based on the population PK parameters obtained herein, a Monte Carlo clinical trial simulation experiment was conducted to compare the PK profiles in 200 virtual JRA patients who randomly received either etanercept 0.4 mg/kg SC twice weekly or 0.8 mg/kg once weekly for 12 weeks. The following population PK model could adequately describe etanercept PK profiles for twice-weekly SC dosing of 0.4 mg/kg: CL/F (L/h)=0.0576 (female) or 0.0772 (male) x (body surface area in m2/1.071)1.41, V/F(L)=7.88 x (body weight in kg/30.8). The means +/- standard deviations of simulated trough concentrations for 0.8-mg/kg once-weekly and 0.4-mg/kg twice-weekly dosing regimens were 1.58 +/- 1.07 mg/L and 1.92 +/- 1.09 mg/L, respectively. Peaks during 0.8-mg/kg once-weekly dosing (2.92 +/- 1.41 mg/L) were only 11% higher than during 0.4 mg/kg twice-weekly dosing (2.62 +/- 1.23 mg/L). In conclusion, the clinical trial simulation confirmed that 0.8-mg/kg once-weekly and 0.4-mg/kg twice-weekly SC regimens of etanercept are expected to yield overlapping steady-state time-concentration profiles, leading to equivalent clinical outcomes. This has been the basis of the recent Food and Drug Administration approval of the 0.8-mg/kg once-weekly regimen in pediatric patients with JRA.
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Affiliation(s)
- Dong-Seok Yim
- Center for Drug Development Science, Department of Pharmacology, Box 571441, Georgetown University School of Medicine, Washington, DC 20057-1441, USA
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Abstract
Sepsis is among the most common causes of death in hospitals. It arises from the host response to infection. Currently, diagnosis relies on nonspecific physiological criteria and culture-based pathogen detection. This results in diagnostic uncertainty, therapeutic delays, the mis- and overuse of antibiotics, and the failure to identify patients who might benefit from immunomodulatory therapies. There is a need for new sepsis biomarkers that can aid in therapeutic decision making and add information about screening, diagnosis, risk stratification, and monitoring of the response to therapy. The host response involves hundreds of mediators and single molecules, many of which have been proposed as biomarkers. It is, however, unlikely that one single biomarker is able to satisfy all the needs and expectations for sepsis research and management. Among biomarkers that are measurable by assays approved for clinical use, procalcitonin (PCT) has shown some usefulness as an infection marker and for antibiotic stewardship. Other possible new approaches consist of molecular strategies to improve pathogen detection and molecular diagnostics and prognostics based on transcriptomic, proteomic, or metabolic profiling. Novel approaches to sepsis promise to transform sepsis from a physiologic syndrome into a group of distinct biochemical disorders and help in the development of better diagnostic tools and effective adjunctive sepsis therapies.
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TNF-α Polymorphisms in Juvenile Idiopathic Arthritis: Which Potential Clinical Implications? Int J Rheumatol 2012; 2012:756291. [PMID: 23133455 PMCID: PMC3485518 DOI: 10.1155/2012/756291] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 07/13/2012] [Accepted: 08/03/2012] [Indexed: 02/06/2023] Open
Abstract
Whether tumor necrosis factor alpha (TNF-α) gene polymorphisms (SNPs) influence disease susceptibility and treatment of patients with juvenile idiopathic arthritis (JIA) is presently uncertain. TNF-α is one of the most important cytokine involved in JIA pathogenesis. Several single nucleotide polymorphisms (SNPs) have been identified within the region of the TNF-α gene but only a very small minority have proven functional consequences and have been associated with susceptibility to JIA. An association between some TNF-α SNPs and adult rheumatoid arthritis (RA) susceptibility, severity and clinical response to anti-TNF-α treatment has been reported. The most frenquetly studied TNF-α SNP is located at -308 position, where a substitution of the G allele with the rare A allele has been found. The presence of the allele -308A is associated to JIA and to a poor prognosis. Besides, the -308G genotype has been associated with a better response to anti-TNF-α therapy in JIA patients, confirming adult data. Psoriatic and oligoarticular arthritis are significantly associated to the -238 SNP only in some works. Studies considering other SNPs are conflicting and inconclusive. Large scale studies are required to define the contribution of TNF-α gene products to disease pathogenesis and anti-TNF-α therapeutic efficacy in JIA.
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Marzan KAB. Role of adalimumab in the management of children and adolescents with juvenile idiopathic arthritis and other rheumatic conditions. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2012; 3:85-93. [PMID: 24600289 PMCID: PMC3916012 DOI: 10.2147/ahmt.s22607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Treatment of children and adolescents with juvenile idiopathic arthritis and other pediatric rheumatic diseases has evolved. Where once there was only a limited arsenal of medications, with significant side effects and inadequate efficacy, today, with an increased understanding of the pathogenesis of these diseases, there is a wider variety of more targeted and effective treatments. TNF-α is a cytokine involved in a number of inflammatory pathways in pediatric rheumatic diseases. The emergence of biologic modifiers that target TNF-α has been pivotal in providing the ability to deliver early and aggressive treatment. Adalimumab, a recombinant monoclonal antibody to TNF-α, is an important therapeutic option, which affords children and adolescents with chronic illnesses an improved quality of life.
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Simsa-Maziel S, Monsonego-Ornan E. Interleukin-1β promotes proliferation and inhibits differentiation of chondrocytes through a mechanism involving down-regulation of FGFR-3 and p21. Endocrinology 2012; 153:2296-310. [PMID: 22492305 DOI: 10.1210/en.2011-1756] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The proinflammatory cytokine IL-1β is elevated in many childhood chronic inflammatory diseases as well as obesity and can be associated with growth retardation. Here we show that IL-1β affects bone growth by directly disturbing the normal sequence of events in the growth plate, resulting in increased proliferation and widening of the proliferative zone, whereas the hypertrophic zone becomes disorganized, with impaired matrix structure and increased apoptosis and osteoclast activity. This was also evident in vitro: IL-1β increased proliferation and caused a G1-to-S phase shift in the cell cycle in ATDC5 chondrocytes, accompanied by a reduction in fibroblast growth factor receptor-3 (FGFR-3) and its downstream gene, the cell-cycle inhibitor p21 and its family member p57, whereas the cell-cycle promoter E2F-2 was increased. The reduction in FGFR-3, p21, and p57 was followed by delayed cell differentiation, manifested by decreases in proteoglycan synthesis, mineralization, alkaline phosphatase activity, and the expression of Sox9, RunX2, collagen type II, collagen type X, and other matrix proteins. Taken together, we suggest that IL-1β alters normal chondrogenesis and bone growth through a mechanism involving down-regulation of FGFR-3 and p21.
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Affiliation(s)
- Stav Simsa-Maziel
- Institute of Biochemistry and Nutrition, The Robert H. Smith Faculty of Agriculture, Food, and Environment, The Hebrew University, P.O. Box 12, Rehovot 76100, Israel
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Hwang SJ, Choi B, Kang SS, Chang JH, Kim YG, Chung YH, Sohn DH, So MW, Lee CK, Robinson WH, Chang EJ. Interleukin-34 produced by human fibroblast-like synovial cells in rheumatoid arthritis supports osteoclastogenesis. Arthritis Res Ther 2012; 14:R14. [PMID: 22264405 PMCID: PMC3392804 DOI: 10.1186/ar3693] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 11/21/2011] [Accepted: 01/20/2012] [Indexed: 01/03/2023] Open
Abstract
Introduction Interleukin-34 (IL-34) is a recently defined cytokine, showing a functional overlap with macrophage colony stimulating factor (M-CSF). This study was undertaken to address the expression of IL-34 in rheumatoid arthritis (RA) patients and to investigate its regulation and pathogenic role in RA. Methods IL-34 levels were determined in the RA synovium, synovial fluid (SF) and fibroblast-like synovial cells (FLS) by immunohistochemistry, real-time PCR, enzyme-linked immunosorbent assay and immunoblotting. RA activity was assessed using Disease Activity Score 28 (DAS28) activity in the plasma collected at baseline and one year after treatment. Conditioned media (CM) were prepared from RA FLS culture with tumor necrosis factor alpha (TNFα) for 24 hours and used for functional assay. Results IL-34 was expressed in the synovium, SF, and FLS from RA patients. The production of IL-34 in FLS was up-regulated by TNFα in RA samples compared with osteoarthritis (OA) patients. Importantly, the preferential induction of IL-34 rather than M-CSF by TNFα in RAFLS was mediated by the transcription factor nuclear factor kappa B (NF-κB) and activation of c-Jun N-terminal kinase (JNK). IL-34 elevation in plasma from RA patients was decreased after the administration of disease-modifying anti-rheumatic drugs (DMARDs) in accordance with a decrease in DAS28. CM from RAFLS cultured with TNFα promoted chemotactic migration of human peripheral blood mononuclear cells (PBMCs) and subsequent osteoclast (OC) formation, effects that were attenuated by an anti-IL-34 antibody. Conclusions These data provide novel information about the production of IL-34 in RA FLS and indicate that IL-34 is an additional osteoclastogenic factor regulated by TNFα in RA, suggesting a discrete role of IL-34 in inflammatory RA diseases.
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Affiliation(s)
- Seung-Jun Hwang
- Department of Anatomy and Cell Biology, University of Ulsan College of Medicine, Seoul 138-736, Korea
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Shim YS, Kim JS, Lee KK, Lee KM, Kim KN. Juvenile Rheumatoid Arthritis in Children with Ebstein-barr Virus Infection. JOURNAL OF RHEUMATIC DISEASES 2012. [DOI: 10.4078/jrd.2012.19.1.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Young-Seok Shim
- Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea
| | - Joon-Sik Kim
- Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea
| | - Kyung-Kyu Lee
- Department of Radiology, College of Medicine, Hallym University, Seoul, Korea
| | - Kyu-Man Lee
- Department of Laboratory Medicine, College of Medicine, Hallym University, Seoul, Korea
| | - Kwang-Nam Kim
- Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea
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Haufe S, Haug M, Schepp C, Kuemmerle-Deschner J, Hansmann S, Rieber N, Tzaribachev N, Hospach T, Maier J, Dannecker GE, Holzer U. Impaired suppression of synovial fluid CD4+CD25− T cells from patients with juvenile idiopathic arthritis by CD4+CD25+ Treg cells. ACTA ACUST UNITED AC 2011; 63:3153-62. [DOI: 10.1002/art.30503] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Breda L, Del Torto M, De Sanctis S, Chiarelli F. Biologics in children's autoimmune disorders: efficacy and safety. Eur J Pediatr 2011; 170:157-67. [PMID: 20556424 DOI: 10.1007/s00431-010-1238-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 06/02/2010] [Indexed: 01/19/2023]
Abstract
Advances in understanding the pathogenesis of rheumatic diseases have led to the discovery of mechanisms of inflammation and autoimmunity and have made possible the invention of new target-specific drugs. Biologic drugs, designed to inhibit specific components of the immune system, such as cytokines, cytokine gene expression, and their complex interactions, have revolutionized the treatment options in pediatric rheumatology. Only three agents are currently available for treating juvenile idiopathic arthritis (JIA): etanercept, at the dose of 0.8 mg/kg once weekly, adalimumab at the dose of 24 mg/m(2) every 2 weeks, and abatacept at the dose of 10 mg/kg at weeks 0, 2, 4, and then every 4 weeks. They are well tolerated and relatively safe in children: Side effects are generally mild and include injection site reactions and infections. Infliximab, rilonacept, and canakinumab are also approved by the Food and Drug Administration for treatment of pediatric autoimmune disorders and are currently investigated in JIA. This review summarizes the current state of biologic drugs, their clinical application, and their efficacy and safety in the pediatric age.
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Affiliation(s)
- Luciana Breda
- Department of Pediatrics, University of Chieti, Via Vestini 5, 66100 Chieti, Italy
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Eda H, Shimada H, Beidler DR, Monahan JB. Proinflammatory cytokines, IL-1β and TNF-α, induce expression of interleukin-34 mRNA via JNK- and p44/42 MAPK-NF-κB pathway but not p38 pathway in osteoblasts. Rheumatol Int 2010; 31:1525-30. [DOI: 10.1007/s00296-010-1688-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 11/14/2010] [Indexed: 01/10/2023]
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Hahn YS, Kim JG. Pathogenesis and clinical manifestations of juvenile rheumatoid arthritis. KOREAN JOURNAL OF PEDIATRICS 2010; 53:921-30. [PMID: 21218013 PMCID: PMC3012271 DOI: 10.3345/kjp.2010.53.11.921] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 10/19/2010] [Indexed: 12/24/2022]
Abstract
Juvenile rheumatoid arthritis (JRA) is the most common rheumatic childhood disease; its onset is before 16 years of age and it persists for at least 6 weeks. JRA encompasses a heterogeneous group of diseases that is classified according to 3 major presentations: oligoarthritis, polyarthritis, and systemic onset diseases. These presentations may originate from the same or different causes that involve interaction with specific immunogenetic predispositions, and result in heterogeneous clinical manifestations. An arthritic joint exhibits cardinal signs of joint inflammation, such as swelling, pain, heat, and loss of function; any joint can be arthritic, but large joints are more frequently affected. Extra-articular manifestations include high fever, skin rash, serositis, and uveitis. The first 2 types of JRA are regarded as T helper 1 (Th1) cell-mediated inflammatory disorders, mainly based on the abundance of activated Th1 cells in the inflamed synovium and the pathogenetic role of proinflammatory cytokines that are mainly produced by Th1 cell-stimulated monocytes. In contrast, the pathogenesis of systemic onset disease differs from that of other types of JRA in several respects, including the lack of association with human leukocyte antigen type and the absence of autoantibodies or autoreactive T cells. Although the precise mechanism that leads to JRA remains unclear, proinflammatory cytokines are thought to be responsible for at least part of the clinical symptoms in all JRA types. The effectiveness of biologic therapy in blocking the action of these cytokines in JRA patients provides strong evidence that they play a fundamental role in JRA inflammation.
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Affiliation(s)
- Youn-Soo Hahn
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Joong-Gon Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Martinez AE, Allgrove J, Brain C. Growth and pubertal delay in patients with epidermolysis bullosa. Dermatol Clin 2010; 28:357-9, xii. [PMID: 20447503 DOI: 10.1016/j.det.2010.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Puberty is the acquisition of secondary sexual characteristics, associated with a growth spurt, resulting in the attainment of reproductive function and final adult height. Delayed puberty is defined as the absence of any pubertal development at an age 2 standard deviations (SD) more than the mean, which corresponds to an age of approximately 14 years for boys and 13 years for girls. The degree to which growth and pubertal development are affected in chronic illness depends on the disease itself, as well as factors such as age of onset, duration and severity; the earlier the onset and the more severe the disease, the greater the effect on growth and pubertal development. Most children with severe types of epidermolysis bullosa have abnormal growth and pubertal delay. The possible pathophysiology is discussed.
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Affiliation(s)
- Anna E Martinez
- Department of Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Stolina M, Schett G, Dwyer D, Vonderfecht S, Middleton S, Duryea D, Pacheco E, Van G, Bolon B, Feige U, Zack D, Kostenuik P. RANKL inhibition by osteoprotegerin prevents bone loss without affecting local or systemic inflammation parameters in two rat arthritis models: comparison with anti-TNFalpha or anti-IL-1 therapies. Arthritis Res Ther 2009; 11:R187. [PMID: 20003323 PMCID: PMC3003514 DOI: 10.1186/ar2879] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 11/17/2009] [Accepted: 12/11/2009] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Rat adjuvant-induced arthritis (AIA) and collagen-induced arthritis (CIA) feature bone loss and systemic increases in TNFalpha, IL-1beta, and receptor activator of NF-kappaB ligand (RANKL). Anti-IL-1 or anti-TNFalpha therapies consistently reduce inflammation in these models, but systemic bone loss often persists. RANKL inhibition consistently prevents bone loss in both models without reducing joint inflammation. Effects of these therapies on systemic markers of bone turnover and inflammation have not been directly compared. METHODS Lewis rats with established AIA or CIA were treated for 10 days (from day 4 post onset) with either PBS (Veh), TNFalpha inhibitor (pegsunercept), IL-1 inhibitor (anakinra), or RANKL inhibitor (osteoprotegerin (OPG)-Fc). Local inflammation was evaluated by monitoring hind paw swelling. Bone mineral density (BMD) of paws and lumbar vertebrae was assessed by dual X-ray absorptiometry. Markers and mediators of bone resorption (RANKL, tartrate-resistant acid phosphatase 5b (TRACP 5B)) and inflammation (prostaglandin E2 (PGE2), acute-phase protein alpha-1-acid glycoprotein (alpha1AGP), multiple cytokines) were measured in serum (day 14 post onset). RESULTS Arthritis progression significantly increased paw swelling and ankle and vertebral BMD loss. Anti-TNFalpha reduced paw swelling in both models, and reduced ankle BMD loss in AIA rats. Anti-IL-1 decreased paw swelling in CIA rats, and reduced ankle BMD loss in both models. Anti-TNFalpha and anti-IL-1 failed to prevent vertebral BMD loss in either model. OPG-Fc reduced BMD loss in ankles and vertebrae in both models, but had no effect on paw swelling. Serum RANKL was elevated in AIA-Veh and CIA-Veh rats. While antiTNFalpha and anti-IL-1 partially normalized serum RANKL without any changes in serum TRACP 5B, OPG-Fc treatment reduced serum TRACP 5B by over 90% in both CIA and AIA rats. CIA-Veh and AIA-Veh rats had increased serum alpha1AGP, IL-1beta, IL-8 and chemokine (C-C motif) ligand 2 (CCL2), and AIA-Veh rats also had significantly greater serum PGE2, TNFalpha and IL-17. Anti-TNFalpha reduced systemic alpha1AGP, CCL2 and PGE2 in AIA rats, while anti-IL-1 decreased systemic alpha1AGP, IL-8 and PGE2. In contrast, RANKL inhibition by OPG-Fc did not lessen systemic cytokine levels in either model. CONCLUSIONS Anti-TNFalpha or anti-IL-1 therapy inhibited parameters of local and systemic inflammation, and partially reduced local but not systemic bone loss in AIA and CIA rats. RANKL inhibition prevented local and systemic bone loss without significantly inhibiting local or systemic inflammatory parameters.
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Affiliation(s)
- Marina Stolina
- Department of Metabolic Disorders, Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA 91320, USA.
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Zeng HS, Chen XY, Luo XP. The association with the -159C/T polymorphism in the promoter region of the CD14 gene and juvenile idiopathic arthritis in a Chinese Han population. J Rheumatol 2009; 36:2025-8. [PMID: 19605672 DOI: 10.3899/jrheum.081093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Juvenile idiopathic arthritis (JIA) is generally considered to be caused by interaction of genetic and environmental factors. We investigated the association of a C-to-T transition in the promoter region of the CD14 gene on chromosome 5q31.1 and JIA in a Chinese Han population. METHODS One hundred sixty-three children with JIA and 281 healthy children (age- and sex-matched to JIA group) were studied. Polymerase chain reaction-restriction fragment-length polymorphism (PCR-RFLP) was used for analysis of the genotypes. (Trial registration number ChiCTR-CCC-00000312.) RESULTS CD14 promoter-159 genotype frequencies of CC, CT, and TT were 11.48%, 49.18%, and 39.34%, respectively, in the systemic onset JIA group; 21.62%, 43.24%, and 35.14%, in the polyarticular JIA group; 16.67%, 50%, and 33.33%, in the oligoarticular JIA group; 6.9%, 75.86%, and 17.24%, in the group with other types of JIA; and 37.01%, 46.98%, and 16.01%, in the control group. Genotype frequency and allele frequency distribution were in accord with Hardy-Weinberg equilibrium. There were statistically significant differences in frequencies of genotype and allele in CD14 C-159T polymorphism between JIA group and control group (genotype: chi-squared = 33.168, p < 0.05, CT vs CC, OR 2.946, 95% CI 1.739-4.990; TT vs CC, OR 5.426, 95% CI 2.977-9.891. Allele: chi-squared = 33.168, p < 0.05, T vs C, OR 2.251, 95% CI 1.704-2.973). The T allele frequencies of boys and girls were significantly higher than those in the control group (p < 0.001 of both). CONCLUSION CD14 gene promoter C-159T polymorphism is significantly correlated with JIA in the Chinese Han population. The T allele of the C-159T polymorphism of CD14 gene may be a genetic risk factor for JIA.
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Affiliation(s)
- Hua Song Zeng
- Pediatric Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Rutgers M, Saris DBF, Auw Yang KG, Dhert WJA, Creemers LB. Joint injury and osteoarthritis: soluble mediators in the course and treatment of cartilage pathology. Immunotherapy 2009; 1:435-45. [DOI: 10.2217/imt.09.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Osteoarthritis is a disabling disease of the aging generation, which results in loss of quality of life and increased healthcare costs. Cytokines appear to play an important role in the cartilaginous degeneration characterizing the pathological process. Increasing experience is being gained with cytokine-modulating therapies aimed at interfering with effects of chondrodegradative cytokines in the synovial fluid. Although in vitro and in vivo effectiveness of several of these therapies has been demonstrated, clinical effectiveness remains disputable, which may be related to the low levels of inflammatory cytokines found in osteoarthritic joints. By contrast, directly after joint trauma, which has been shown to predipose to early osteoarthritis, synovial fluid cytokine levels are strongly increased. Cytokine-modulating therapies, however, have hardly been considered for this indication. Increased knowledge of intra-articular soluble mediators correlating with cartilage pathology will lead to further development of cytokine-modulating products and, eventually, to effective inhibition of cartilage degeneration, in both the osteoarthritic as well as injured joints.
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Affiliation(s)
- Marijn Rutgers
- University Medical Center Utrecht, Department of Orthopaedics, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Daniël BF Saris
- University Medical Center Utrecht, Department of Orthopaedics, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Kiem Gie Auw Yang
- University Medical Center Utrecht, Department of Orthopaedics, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Wouter JA Dhert
- University Medical Center Utrecht, Department of Orthopaedics, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Faculty of Veterinary Medicine, Utrecht University, The Netherlands
| | - Laura B Creemers
- University Medical Center Utrecht, Department of Orthopaedics, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Knowlton N, Jiang K, Frank MB, Aggarwal A, Wallace C, McKee R, Chaser B, Tung C, Smith L, Chen Y, Osban J, O’Neil K, Centola M, McGhee JL, Jarvis JN. The meaning of clinical remission in polyarticular juvenile idiopathic arthritis: gene expression profiling in peripheral blood mononuclear cells identifies distinct disease states. ARTHRITIS AND RHEUMATISM 2009; 60:892-900. [PMID: 19248118 PMCID: PMC2758237 DOI: 10.1002/art.24298] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The development of biomarkers to predict response to therapy in polyarticular juvenile idiopathic arthritis (JIA) is an important issue in pediatric rheumatology. A critical step in this process is determining whether there is biologic meaning to clinically derived terms such as "active disease" and "remission." The aim of this study was to use a systems biology approach to address this question. METHODS We performed gene transcriptional profiling on children who fulfilled the criteria for specific disease states as defined by the consensus criteria developed by Wallace and colleagues. The study group comprised children with active disease (n = 14), children with clinical remission on medication (CRM; n = 9), children with clinical remission off medication (CR; n = 6), and healthy control children (n = 13). Transcriptional profiles in peripheral blood mononuclear cells (PBMCs) were obtained using Affymetrix U133 Plus 2.0 arrays. RESULTS Hierarchical cluster analysis and predictive modeling demonstrated that the clinically derived criteria represent biologically distinct states. Minimal differences were seen between children with active disease and those with disease in CRM. Thus, underlying immune/inflammatory abnormalities persist despite a response to therapy. The PBMC transcriptional profiles of children whose disease was in remission did not return to normal but revealed networks of proinflammatory and antiinflammatory genes, suggesting that remission is a state of homeostasis, not a return to a normal state. CONCLUSION Gene transcriptional profiling of PBMCs revealed that clinically derived criteria for JIA disease states reflect underlying biology. We also demonstrated that neither CRM nor CR status results in resolution of the underlying inflammatory process, but that these conditions are more likely to be states of balanced homeostasis between proinflammatory and antiinflammatory mechanisms.
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Affiliation(s)
| | | | | | - Amita Aggarwal
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Carol Wallace
- Children's Hospital and Regional Medical Center, Seattle, Washington
| | | | | | | | | | | | | | | | | | | | - James N. Jarvis
- Children's Hospital of Oklahoma, University of Oklahoma, and Oklahoma University Health Services Center, Oklahoma City
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Hayward K, Wallace CA. Recent developments in anti-rheumatic drugs in pediatrics: treatment of juvenile idiopathic arthritis. Arthritis Res Ther 2009; 11:216. [PMID: 19291269 PMCID: PMC2688259 DOI: 10.1186/ar2619] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common autoimmune-autoinflammatory disease in childhood and affects approximately 1 in 1,000 children. Despite advances in diagnosis and treatment options, JIA remains a chronic condition for most affected children. Recent evidence suggests that disease control at onset may determine the tempo of subsequent disease course and long-term outcomes, and raises the concept of a therapeutic window of opportunity in patients with JIA. This underscores the importance of early aggressive treatment in patients with JIA. With the advent of novel biologic therapeutics, the repertoire of agents available for treatment of children with JIA has greatly increased. The present article will summarize recent developments in the medical treatment of children with JIA and will offer insights into emerging therapies.
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Affiliation(s)
- Kristen Hayward
- Division of Rheumatology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way, NE MS R-5420, Seattle, WA 98105, USA.
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Stoustrup P, Kristensen KD, Küseler A, Pedersen TK, Gelineck J, Herlin T. Intra-articular vs. systemic administration of etanercept in antigen-induced arthritis in the temporomandibular joint. Part II: mandibular growth. Pediatr Rheumatol Online J 2009; 7:6. [PMID: 19200378 PMCID: PMC2657784 DOI: 10.1186/1546-0096-7-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 02/06/2009] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Temporomandibular joint (TMJ) arthritis in children causes alterations in the craniomandibular growth. Resultant abnormalities include; condylar erosions, a posterior mandibular rotation pattern, micrognathia, malocclusion with an anterior open bite, altered joint and muscular function occasionally associated with pain. These alterations may be prevented by early aggressive anti-inflammatory intervention. Previously, we have shown that intra-articular (IA) corticosteroid reduces TMJ inflammation but causes additional mandibular growth inhibition in young rabbits. Local blockage of TNF-alpha may be an alternative treatment approach against TMJ involvement in juvenile idiopathic arthritis (JIA). We evaluated the anti-inflammatory effect of IA etanercept compared to subcutaneous etanercept in antigen-induced TMJ-arthritis in young rabbits in terms of mandibular growth. This article (Part II) presents the data and discussion on the effects on facial growth. In Part I the anti-inflammatory effects of systemic and IA etanercept administration are discussed. METHODS Arthritis was induced and maintained in the TMJs of 10-week old pre-sensitized rabbits (n = 42) by four repeated IA TMJ injections with ovalbumin, over a 12-week period. One group was treated weekly with systemic etanercept (0.8 mg/kg) (n = 14), another group (n = 14) received IA etanercept (0.1 mg/kg) bilaterally one week after induction of arthritis and one group (n = 14) served as an untreated arthritis group receiving IA TMJ saline injections. Head computerized tomographic scans were done before arthritis was induced and at the end of the study. Three small tantalum implants were inserted into the mandible, serving as stable landmarks for the super-impositions. Nineteen variables were evaluated in a mandibular growth analysis for inter-group differences. All data was evaluated blindedly. ANOVA and T-tests were applied for statistical evaluation using p < 0.05 as significance level. RESULTS Significant larger mandibular growth disturbances were observed in the group receiving IA saline injections compared with the systemic etanercept group. The most pronounced unfavourable posterior mandibular rotation pattern was observed in the group receiving IA saline injections. CONCLUSION Intervention with systemic etanercept monotherapy equivalent to the recommended human dose allows a mandibular growth towards an original morphology in experimental TMJ arthritis. Systemic administrations of etanercept are superior to IA TMJ administration of etanercept in maintaining mandibular vertical growth.
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Affiliation(s)
- Peter Stoustrup
- Department of Orthodontics, Faculty of Health Sciences, University of Aarhus, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark.
| | - Kasper D Kristensen
- Department of Orthodontics, Faculty of Health Sciences, University of Aarhus, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark
| | - Annelise Küseler
- Department of Orthodontics, Faculty of Health Sciences, University of Aarhus, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark
| | - Thomas K Pedersen
- Department of Orthodontics, Faculty of Health Sciences, University of Aarhus, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark
| | - John Gelineck
- Department of Radiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital Skejby, Brendstrupgaardvej 100, 8200 Aarhus N, Denmark
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MOURÃO ANAFILIPA, CAETANO-LOPES JOANA, COSTA PAULA, CANHÃO HELENA, SANTOS MARIAJOSÉ, PINTO PATRÍCIA, BRITO IVA, NICOLA PAULO, CAVALEIRO JOÃO, TELES JOSÉ, SOUSA ARTUR, GOMES JOSÉMELO, BRANCO JAIME, da COSTA JOSÉTEIXEIRA, PEDRO JOÃOGOMES, de QUEIROZ MÁRIOVIANA, FONSECA JOÃOEURICO. Tumor Necrosis Factor-α −308 Genotypes Influence Inflammatory Activity and TNF-α Serum Concentrations in Children with Juvenile Idiopathic Arthritis. J Rheumatol 2009; 36:837-42. [DOI: 10.3899/jrheum.080615] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective.Considering the relevance of tumor necrosis factor-α (TNF-α) in the pathophysiology of juvenile idiopathic arthritis (JIA), it is likely that polymorphisms in its promoter area may be relevant in disease susceptibility and activity. We investigated if clinical measures of JIA activity and TNF-α serum concentrations were associated with TNF-α −308 genotypes.Methods.Portuguese patients with JIA in 5 pediatric rheumatology centers were recruited consecutively, along with a control group of healthy subjects. Demographic and clinical data and blood samples were collected from each patient. DNA was extracted for analysis of TNF-α gene promoter polymorphisms at position −308 by restriction fragment-length polymorphism.Results.One hundred fourteen patients and 117 controls were evaluated; 57% of patients presented the oligoarticular subtype, 25% the polyarticular subtype, 8% the systemic subtype, and 9% had enthesitis-related arthritis and 5% psoriatic arthritis. Twenty-four percent of the patients presented the −308 GA/AA genotypes and 76% the −308 GG genotype, similar to findings in controls. Patients with the −308 GA/AA genotype had higher degree of functional impairment, erythrocyte sedimentation rate, 100-mm visual analog scale score for disease activity, and TNF-α levels compared to those with the −308 GG genotype.Conclusion.TNF-α −308 GA/AA genotypes were found to be related to higher inflammatory activity and worse measures of disease activity in Portuguese patients with JIA. They were not associated with susceptibility to JIA.
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Spelling P, Bonfá E, Caparbo VF, Pereira RMR. Osteoprotegerin/RANKL system imbalance in active polyarticular-onset juvenile idiopathic arthritis: a bone damage biomarker? Scand J Rheumatol 2008; 37:439-44. [PMID: 18802807 DOI: 10.1080/03009740802116224] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the importance of receptor activator of nuclear factor kappaB (RANK)/receptor activator of nuclear factor kappaB ligand (RANKL)/osteoprotegerin (OPG) modulation in active polyarticular juvenile idiopathic arthritis (pJIA) patients with and without bone erosions. METHODS Thirty female patients (mean age 11.07+/-3.77 years, range 4-17 years) with active pJIA and 30 healthy gender- and age-matched controls were consecutively selected for this study. All involved articulations were assessed by X-ray and examined for the presence of bone erosions. The serum levels of RANKL and OPG were measured using an enzyme-linked immunosorbent assay (ELISA). RESULTS Patients with active pJIA had higher levels of serum RANKL than controls [2.90 (0.1-37.4) vs. 0.25 (0.1-5.7) pg/mL, p = 0.007] and a lower OPG/RANKL ratio [21.25 (1.8-897.6) vs. 347.5 (9-947.8), p = 0.005]. However, levels of OPG were comparable in both groups [55.24 (28.34-89.76) vs. 64.42 (30.68-111.28) pg/mL, p = 0.255]. Higher levels of serum RANKL and a lower OPG/RANKL ratio were also observed in active pJIA patients with bone erosions compared to controls [3.49 (0.1-37.4) vs. 0.25 (0.1-5.7) pg/mL, p = 0.0115 and 14.3 (1.8-897.6) vs. 347.5 (9-947.8), p = 0.016]. However, RANKL levels and OPG/RANKL ratio were similar in pJIA patients without bone erosion and controls [1.75 (0.1-10.9) vs. 0.25 (0.1-5.7) pg/mL, p = 0.055 and 29.2 (3.3-756.8) vs. 347.5 (9-947.8), p = 0.281]. CONCLUSION These data suggest that active pJIA with bone erosions is associated with high serum levels of RANKL and a low OPG/RANKL ratio, indicating that these alterations may reflect bone damage in this disease.
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Affiliation(s)
- P Spelling
- Paediatric Rheumatology Division, Hospital Evangelico de Curitiba, Paraná, Brazil
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Anakinra in the treatment of polyarticular-course juvenile rheumatoid arthritis: safety and preliminary efficacy results of a randomized multicenter study. Clin Rheumatol 2008; 28:129-37. [PMID: 18766426 DOI: 10.1007/s10067-008-0995-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 07/25/2008] [Accepted: 08/04/2008] [Indexed: 10/21/2022]
Abstract
This study assessed the safety and preliminary efficacy of the interleukin-1 receptor antagonist anakinra in patients with polyarticular-course juvenile rheumatoid arthritis (JRA). Eighty-six patients entered a 12-week open-label run-in phase (1 mg/kg anakinra daily, < or =100 mg/day). Fifty responders were randomized to anakinra or placebo in a 16-week blinded phase, followed by a 12-month open-label extension (N = 44). Due to low enrollment, the primary endpoint was changed from efficacy to safety. The incidence and nature of adverse events were similar across all study phases, with the exception of injection site reactions, which were mild to moderate and decreased with time. Anakinra produced a nonsignificant (P = 0.11) reduction in disease flares compared with placebo. When normalized to 1 mg/kg dose, anakinra plasma concentrations were similar to values in adult patients with rheumatoid arthritis. These results indicate that anakinra 1 mg/kg once daily (< or =100 mg/day) is safe and well tolerated in patients with JRA.
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