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Kuchinad KE, Kim JS, Woods A, Leatherman G, Gutierrez-Alamillo L, Mayes MD, Domsic R, Ramos PS, Silver RM, Varga J, Saketkoo LA, Kafaja S, Shanmugan VK, Gordon J, Chung L, Bernstein EJ, Gourh P, Boin F, Kastner DL, Zeger SL, Casciola-Rosen L, Wigley FM, Shah AA. Racial variability in immune responses only partially explains differential systemic sclerosis disease severity. Ann Rheum Dis 2024:ard-2023-225458. [PMID: 39019570 DOI: 10.1136/ard-2023-225458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/19/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE To understand if autoantibodies account for racial variation in disease severity, we compared autoantibody distribution and associated phenotype between self-identified black and white systemic sclerosis (SSc) patients. METHODS 803 black and 2178 white SSc patients had systematic testing for autoantibodies using Euroimmun (centromere (ACA), RNA-polymerase III (POLR3), Scl70, PM/Scl, NOR90, Th/To, Ku, U3RNP and Ro52) and commercial ELISA (U1RNP). In this observational study, logistic regression was performed to assess the association between self-identified race and outcomes, adjusting for autoantibodies. To estimate whether the effect of race was mediated by autoantibody status, race coefficients from multivariate models including and excluding autoantibodies were compared. RESULTS Anti-Scl70, anti-U1RNP, anti-U3RNP, anti-Th/To, anti-Ku and anti-NOR90 were more common in the black cohort than in the white cohort, which was enriched for ACA, anti-POLR3 and anti-PM/Scl. Black individuals had a higher prevalence of severe Raynaud's, skin, lung, gastrointestinal and renal disease whereas white individuals had a higher prevalence of severe heart and muscle disease. Adjusting for autoantibodies decreased the effect of race on outcome for telangiectasias, forced vital capacity <70%, pulmonary hypertension and severe lung, heart, muscle and gastrointestinal disease by 11%-44% and increased the association between race and renal crisis and severe kidney disease by 37%-52%. CONCLUSIONS This study is the largest systematic analysis of autoantibody responses in a geographically diverse population of black SSc patients. Black and white individuals with SSc have distinct autoantibody profiles. Autoantibodies explain only a fraction of the effect of race on clinical outcomes, suggesting other factors contribute to disparate outcomes between these groups.
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Affiliation(s)
- Kamini E Kuchinad
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ji Soo Kim
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adrianne Woods
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gwen Leatherman
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura Gutierrez-Alamillo
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maureen D Mayes
- Division of Rheumatology and Clinical Immunogenetics, The University of Texas Health Science Center John P and Katherine G McGovern Medical School, Houston, Texas, USA
| | - Robyn Domsic
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Paula S Ramos
- Department of Medicine, Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Richard M Silver
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John Varga
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Section of Pulmonary Medicine, University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Suzanne Kafaja
- Internal Medicine/Division of Rheumatology, University of California Los Angeles, Los Angeles, California, USA
| | - Victoria K Shanmugan
- Office of Autoimmune Disease Research, National Institute of Health, Bethesda, Maryland, USA
| | - Jessica Gordon
- Department of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA
| | - Elana J Bernstein
- Division of Rheumatology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Pravitt Gourh
- NIAMS, National Institutes of Health, Bethesda, Maryland, USA
| | - Francesco Boin
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Daniel L Kastner
- National Human Genome Research Institute Division of Intramural Research, Bethesda, Maryland, USA
| | - Scott L Zeger
- Biostatistics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Livia Casciola-Rosen
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fredrick M Wigley
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ami A Shah
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Chatanaka MK, Sohaei D, Diamandis EP, Prassas I. Beyond the amyloid hypothesis: how current research implicates autoimmunity in Alzheimer's disease pathogenesis. Crit Rev Clin Lab Sci 2023; 60:398-426. [PMID: 36941789 DOI: 10.1080/10408363.2023.2187342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023]
Abstract
The amyloid hypothesis has so far been at the forefront of explaining the pathogenesis of Alzheimer's Disease (AD), a progressive neurodegenerative disorder that leads to cognitive decline and eventual death. Recent evidence, however, points to additional factors that contribute to the pathogenesis of this disease. These include the neurovascular hypothesis, the mitochondrial cascade hypothesis, the inflammatory hypothesis, the prion hypothesis, the mutational accumulation hypothesis, and the autoimmunity hypothesis. The purpose of this review was to briefly discuss the factors that are associated with autoimmunity in humans, including sex, the gut and lung microbiomes, age, genetics, and environmental factors. Subsequently, it was to examine the rise of autoimmune phenomena in AD, which can be instigated by a blood-brain barrier breakdown, pathogen infections, and dysfunction of the glymphatic system. Lastly, it was to discuss the various ways by which immune system dysregulation leads to AD, immunomodulating therapies, and future directions in the field of autoimmunity and neurodegeneration. A comprehensive account of the recent research done in the field was extracted from PubMed on 31 January 2022, with the keywords "Alzheimer's disease" and "autoantibodies" for the first search input, and "Alzheimer's disease" with "IgG" for the second. From the first search, 19 papers were selected, because they contained recent research on the autoantibodies found in the biofluids of patients with AD. From the second search, four papers were selected. The analysis of the literature has led to support the autoimmune hypothesis in AD. Autoantibodies were found in biofluids (serum/plasma, cerebrospinal fluid) of patients with AD with multiple methods, including ELISA, Mass Spectrometry, and microarray analysis. Through continuous research, the understanding of the synergistic effects of the various components that lead to AD will pave the way for better therapeutic methods and a deeper understanding of the disease.
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Affiliation(s)
- Miyo K Chatanaka
- Department of Laboratory and Medicine Pathobiology, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Dorsa Sohaei
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Eleftherios P Diamandis
- Department of Laboratory and Medicine Pathobiology, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
- Department of Clinical Biochemistry, University Health Network, Toronto, Canada
| | - Ioannis Prassas
- Laboratory Medicine Program, University Health Network, Toronto, Canada
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Ghosh S, Tanna D, Telang K, Dhuria S, Gupta R. Clinical and autoantibody profiles of systemic sclerosis patients: A cross-sectional study from North India. Indian J Dermatol Venereol Leprol 2023; 0:1-7. [PMID: 37436007 DOI: 10.25259/ijdvl_901_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/12/2023] [Indexed: 07/13/2023]
Abstract
Objectives This cross-sectional study was designed to assess the clinical profile and frequency of associated autoantibodies in all consecutive patients classified as systemic sclerosis (SSc) at Medanta-the Medicity Hospital, Gurgaon, India. Methods Between August 2017 and July 2019, we identified a total of 119 consecutive patients meeting the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2013 criteria for SSc and 106 patients consented to this study. Their clinical and serological data at the time of enrolment were analysed. Results Our cohort had a mean age at symptom onset of 40 ± 13 years with a median symptom duration of 6 years. We had 76 patients (71.7%) with interstitial lung disease (ILD), which was a higher proportion compared to European cohorts. 62 patients (58.5%) had diffuse cutaneous involvement which was significantly associated with anti-Scl70 antibodies (p < 0.001), digital ulcers (p = 0.039) and the presence of ILD (p = 0.004). 65 patients (61.3%) had anti-Scl70 and 15 patients (14.2%) had anti-centromere (anti-CENP) antibodies. Scl70 positivity was associated with the presence of ILD (p < 0.001) and digital ulcers (p = 0.01). Centromere antibodies had a negative association with ILD (p < 0.001), but was a risk factor for calcinosis (p < 0.001) and pulmonary arterial hypertension (PAH) (p = 0.01). The combination of diffuse cutaneous disease and Scl70 antibodies was the strongest predictor of ILD and digital ulcers (p = 0.015). sm/RMP, RNP68 and Ku antibodies correlated with musculoskeletal involvement (p < 0.01), while all seven of the patients with Pm/Scl antibodies had ILD. Renal involvement was noted in only two patients. Limitations A single-centre study may not capture the true prevalence of disease characteristics in the population. Referral bias for patients with diffuse cutaneous disease has been noted. Data on RNA-Polymerase antibodies have not been provided. Conclusion North Indian patients have some characteristic differences in disease phenotype as compared to their Caucasian counterparts with a larger proportion of patients presenting with ILD and Scl70 antibodies. Antibodies against Ku, RNP and Pm/Scl occur in a minority of patients, but may be associated with musculoskeletal features.
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Affiliation(s)
- Shounak Ghosh
- Department of Rheumatology and Clinical Immunology, Medanta-the Medicity, Gurgaon, Haryana, India
| | - Dhaval Tanna
- Department of Rheumatology and Clinical Immunology, Medanta-the Medicity, Gurgaon, Haryana, India
| | - Kaustubh Telang
- Department of Rheumatology and Clinical Immunology, Medanta-the Medicity, Gurgaon, Haryana, India
| | - Shahzeene Dhuria
- Department of Rheumatology and Clinical Immunology, Medanta-the Medicity, Gurgaon, Haryana, India
| | - Rajiva Gupta
- Department of Rheumatology and Clinical Immunology, Medanta-the Medicity, Gurgaon, Haryana, India
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Li H, Zhang X, Yu L, Shang J, Fan J, Feng X, Zhang R, Ren J, Guo Q, Duan X. Comparing clinical characteristics of systemic sclerosis with or without interstitial lung disease: A cross-sectional study from a single center of the Chinese Rheumatism Data Center. Front Med (Lausanne) 2022; 9:1061738. [PMID: 36561716 PMCID: PMC9763297 DOI: 10.3389/fmed.2022.1061738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Background We aimed to compare the clinical characteristics of patients with systemic sclerosis (SSc) with or without interstitial lung disease (ILD) to identify relationships with the presence of ILD in SSc at a single center in China. Methods A cross-sectional study was conducted using retrospective data from the Chinese Rheumatology Data Center. Patients diagnosed with SSc at the Second Affiliated Hospital of Nanchang University between 2013 and 2022 were included. Demographic and clinical characteristics were compared between patients with SSc with and without ILD. Logistic regression analyses were performed to explore these associations. Results A total of 227 patients with SSc were included (male:female ratio = 1:4.82), of which 121 (53.3%) were accompanied with ILD. SSc patients with ILD had a higher percentage of diffuse cutaneous systemic sclerosis (dcSSc), sclerodactyly, loss of finger pad, muscle involvement, left ventricular diastolic dysfunction (LVDD), and pulmonary hypertension (PAH), elevated Krebs von den Lungen-6 (KL-6), and elevated ferritin than those without ILD, and a higher modified Rodnan skin score (mRSS), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) (all P < 0.05). Antinuclear antibody (ANA) and anti-scleroderma-70 (anti-Scl-70) positivity was presented frequently in SSc patients with ILD, while SSc patients without ILD were more often anti-centromere antibody (ACA) positive (all P < 0.05). On the multivariable analysis, muscle involvement [OR 2.551 (95% CI 1.054-6.175), P = 0.038], LVDD [OR 2.360 (95% CI 1.277-4.361), P = 0.006], PAH [OR 9.134 (95% CI 2.335-35.730), P = 0.001], dcSSc [OR 2.859 (95% CI 1.489-5.487), P = 0.002], PLR [OR 1.005 (95% CI 1.001-1.008), P = 0.020], elevated KL-6 [OR 2.033 (95% CI 1.099-3.763), P = 0.024], and anti-Scl-70 [OR 3.101 (95% CI 1.647-5.840), P < 0.001] were statistically significant associations with SSc patients with ILD. Conclusion Systemic sclerosis was found mainly in females. Several important differences in clinical and laboratory characteristics have been demonstrated between SSc patients with or without ILD. Muscle involvement, LVDD, PAH, dcSSc, PLR, elevated KL-6, and Anti-Scl-70 antibody may be associated with SSc in patients with ILD.
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Satoh M, Ceribelli A, Hasegawa T, Tanaka S. Clinical Significance of Antinucleolar Antibodies: Biomarkers for Autoimmune Diseases, Malignancies, and others. Clin Rev Allergy Immunol 2022; 63:210-239. [PMID: 35258843 DOI: 10.1007/s12016-022-08931-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2022] [Indexed: 01/13/2023]
Abstract
Nucleolar staining is one of the standard patterns in immunofluorescence antinuclear antibodies (ANA), seen in 5-9% of ANA in various conditions. Antinucleolar antibodies (ANoA) are classified into 3 patterns in the International Consensus on ANA Patterns (ICAP) classification; AC-8 homogeneous pattern, AC-9 clumpy pattern, and AC-10 punctate pattern. Specificities known to show AC-8 include anti-Th/To, -PM-Scl, -nucleophosmin/B23, -nucleolin/C23, -No55, and others. AC-9 is seen by anti-fibrillarin/U3RNP and AC-10 by anti-RNA polymerase I and hUBF/NOR-90. ANoA has been classically known to be associated with scleroderma (SSc) and the characterization of nucleolar antigens identified several autoantigens recognized by SSc autoantibodies. The clinical association of anti-Th/To, PM-Scl, fibrillarin/U3RNP, and RNA polymerase I with SSc or SSc-overlap syndrome is well established, and commercial assays are developed. Anti-hUBF/NOR90, nucleophosmin/B23, and nucleolin/C23 are known for decades and reported in systemic autoimmune rheumatic diseases (SARDs), malignancies, graft versus host disease (GVHD), and others; however, their clinical significance remains to be established.
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Affiliation(s)
- Minoru Satoh
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, 1-1 Isei-gaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan.
| | - Angela Ceribelli
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano (Milan), 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Via A. Manzoni 56, Pieve Emnuele (Milan), 20089, Italy
| | - Tomoko Hasegawa
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, 1-1 Isei-gaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan
| | - Shin Tanaka
- Department of Human, Information and Sciences, School of Health Sciences, University of Occupational and Environmental Health, 1-1 Isei-gaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan
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Hossain S, Choudhury MR, Haque MM, Yeasmin S, Hossain F, Zaman MM. Functional disability and health-related quality of life among systemic sclerosis patients in Bangladesh. BMC Rheumatol 2022; 6:60. [PMID: 36175976 PMCID: PMC9524111 DOI: 10.1186/s41927-022-00291-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
Objective To assess the relationship between functional disability and health-related quality of life (HRQoL) among systemic sclerosis (SSc) patients. Methodology This cross-sectional study was carried out on 78 adults who met the classification criteria for SSc defined by the American College of Rheumatology/European League of Rheumatology (ACR/EULAR)-2013. The Bangla version of Short Form 36 (SF-36) and Health Assessment Questionnaire-Disability Index (HAQ-DI) were used to measure HRQoL and functional disability in SSc patients. Results The patients' median [IQR] HAQ-DI was 1.4 [0.6–2.1], with 37.2% having a mild functional disability, 33.3 percent having a moderate functional disability, and 29.5 percent having a severe functional disability. The hygiene and activity domains of the HAQ-DI obtained the highest scores, 2.0 [0.0–3.0] and 2.0 [1.0–3.0], respectively. The Physical Component Summary (PCS) and Mental Component Summary (MCS) of the SF-36 had median [IQR] values of 26.2 [15.0–58.1] and 42.0 [19.6–60.6]. The highest score was 50.0 [25.0–75.0] in social functioning. The PCS of the SF-36 was moderately correlated with the HAQ-DI (rs = − 0.629, P < 0.001) and the MCS of the SF-36 was weakly correlated with the HAQ-DI ((rs = − 0.344, P < 0.001). Age, female sex, and incomplete fist closure substantially influenced functional status. Calcinosis, Raynaud's Phenomenon, and flexion contracture significantly diminished the quality of life. Conclusions Functional disability negatively affects health-related quality of life. Age, Musculoskeletal, and skin involvement are significantly associated with poor quality of life and functional disability. Therefore, treatment strategies should be aimed at reducing functional disability, which will enhance the HRQoL of SSc patients.
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Affiliation(s)
- Sigma Hossain
- Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag Avenue, Dhaka, Bangladesh.
| | - Minhaj Rahim Choudhury
- Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag Avenue, Dhaka, Bangladesh
| | - Md Mahmudul Haque
- Department of Community Medicine, National Institute of Preventive and Social Medicine (NIPSOM), Dhaka, Bangladesh
| | - Surayea Yeasmin
- Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag Avenue, Dhaka, Bangladesh
| | - Farzana Hossain
- National Institute of Preventive and Social Medicine (NIPSOM), Dhaka, Bangladesh
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Cavazzana I, Vojinovic T, Airo' P, Fredi M, Ceribelli A, Pedretti E, Lazzaroni MG, Garrafa E, Franceschini F. Systemic Sclerosis-Specific Antibodies: Novel and Classical Biomarkers. Clin Rev Allergy Immunol 2022; 64:412-430. [PMID: 35716254 PMCID: PMC10167150 DOI: 10.1007/s12016-022-08946-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
Disease-specific autoantibodies are considered the most important biomarkers for systemic sclerosis (SSc), due to their ability to stratify patients with different severity and prognosis. Anti-nuclear antibodies (ANA), occurring in subjects with isolated Raynuad's phenomenon, are considered the strongest independent predictors of definite SSc and digital microvascular damage, as observed by nailfold videocapillaroscopy. ANA are present in more than 90% of SSc, but ANA negativity does not exclude SSc diagnosis: a little rate of SSc ANA negative exists and shows a distinct subtype of disease, with less vasculopathy, but more frequent lower gastrointestinal involvement and severe disease course. Anti-centromere, anti-Th/To, and anti-Topoisomerase I antibodies could be considered as classical biomarkers, covering about 60% of SSc and defining patients with well-described cardio-pulmonary complications. In particular, anti-Topoisomerase I represent a risk factor for development of diffuse cutaneous involvement and digital ulcers in the first 3 years of disease, as well as severe interstitial lung disease (ILD). Anti-RNA polymerase III is a biomarker with new clinical implications: very rapid skin thickness progression, gastric antral vascular ectasia, the occurrence of synchronous cancers, and possible association with silicone breast implants rupture. Moreover, novel SSc specific autoantibodies have been globally described in about 10% of "seronegative" SSc patients: anti-elF2B, anti-RuvBL1/2 complex, anti-U11/U12 RNP, and anti-BICD2 depict specific SSc subtypes with severe organ complications. Many autoantibodies could be considered markers of overlap syndromes, including SSc. Anti-Ku are found in 2-7% of SSc, strictly defining the PM/SSc overlap. They are associated with synovitis, joint contractures, myositis, and negatively associated with vascular manifestation of disease. Anti-U3RNP are associated with a well-defined clinical phenotype: Afro-Caribbean male patients, younger at diagnosis, and higher risk of pulmonary hypertension and gastrointestinal involvement. Anti-PM/Scl define SSc patients with high frequency of ILD, calcinosis, dermatomyositis skin changes, and severe myositis. The accurate detection of autoantibodies SSc specific and associated with overlap syndromes is crucial for patients' stratification. ANA should be correctly identified using indirect immunofluorescent assay and a standardized way of patterns' interpretation. The gold-standard technique for autoantibodies' identification in SSc is still considered immunoprecipitation, for its high sensitivity and specificity, but other assays have been widely used in routine practice. The identification of SSc autoantibodies with high diagnostic specificity and high predictive value is mandatory for early diagnosis, a specific follow-up and the possible definition of the best therapy for every SSc subsets. In addition, the validation of novel autoantibodies is mandatory in wider cohorts in order to restrict the gap of so-called seronegative SSc patients.
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Affiliation(s)
- Ilaria Cavazzana
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy.
| | - Tamara Vojinovic
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy
| | - Paolo Airo'
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Angela Ceribelli
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Eleonora Pedretti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Grazia Lazzaroni
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Emirena Garrafa
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Department of Laboratory Diagnostics, ASST Spedali Civili, Brescia, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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8
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Thoreau B, Eustache M, Fievet A, Lasfargues G, Plantier L, Diot E. Independent association between occupational exposure and decline of forced vital capacity in systemic sclerosis (SSc): a multicenter recruitment retrospective cohort study. Chest 2021; 161:1011-1021. [PMID: 34793760 DOI: 10.1016/j.chest.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/22/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although male sex is associated with poor prognosis in Systemic Sclerosis (SSc), it is unclear whether this association is independent of confounding factors such as occupational exposure to toxicants. RESEARCH QUESTION What is the respective impact of sex and occupational exposure on SSc patients' characteristics with a focus on lung function decline? STUDY DESIGN AND METHODS Patients with SSc (n=210, 55 males) underwent standardized quantitative assessment of occupational exposure through a cumulative exposure score (CES) in a multicenter recruitment retrospective cohort. Association of the CES with patients' characteristics was assessed. Mixed linear, logistic and Cox regression models were used to identify predictors of time variation of forced vital capacity (FVC) and the hemoglobin-corrected transfer coefficient for carbon monoxide in the lung (DLCOc). RESULTS Male sex was strongly associated with occupational exposure (OR=10.3, p<.0001). The CES was inversely correlated (r= -.20) and independently associated with decline in FVC over time and with occurrence of FVC decline ≥10% from baseline (p<.05). By contrast, the CES was not associated with decline in DLCOc or DLCOc decline ≥15%. There was no independent association between sex and decline in FVC or DLCOc. The prevalence of interstitial lung disease was similar across sex or occupational exposure. INTERPRETATION Occupational exposure to toxicants appears to independently predict decline of FVC in SSc patients, regardless of sex. Assessment of occupational exposure may be useful for SSc prognostication.
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Affiliation(s)
- Benjamin Thoreau
- Department of Internal Medicine and Clinical Immunology, Regional Competence Center for Systemic and Autoimmune Rare Diseases, Bretonneau Hospital, CHRU Tours, 2 Boulevard Tonnellé, Tours, France.
| | - Marine Eustache
- Department of Internal Medicine and Clinical Immunology, Regional Competence Center for Systemic and Autoimmune Rare Diseases, Bretonneau Hospital, CHRU Tours, 2 Boulevard Tonnellé, Tours, France
| | - Adèle Fievet
- Department of Pediatric Radiology, Clocheville Hospital, CHRU Tours, 49 boulevard Béranger, Tours, France
| | - Gérard Lasfargues
- Institut santé travail Paris-Est, Université Paris-Est Créteil, 61 avenue du Général de Gaulle, Créteil, France
| | - Laurent Plantier
- CEPR/INSERM UMR1100, Department of Pulmonology and Pulmonary Function Testing, CHRU Tours, Tours University, Tours, France
| | - Elisabeth Diot
- Department of Internal Medicine and Clinical Immunology, Regional Competence Center for Systemic and Autoimmune Rare Diseases, Bretonneau Hospital, CHRU Tours, 2 Boulevard Tonnellé, Tours, France
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Wang BZ, Zailan FZ, Wong BYX, Ng KP, Kandiah N. Identification of novel candidate autoantibodies in Alzheimer's disease. Eur J Neurol 2020; 27:2292-2296. [PMID: 32356904 DOI: 10.1111/ene.14290] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/23/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Accumulated failures in Alzheimer's disease (AD) clinical trials have highlighted an urgent need to identify additional biomarkers involved in AD. Recently, mounting evidence reported that autoantibodies are ubiquitous in human sera. However, it is unknown whether autoantibodies are upregulated in amyloid-tau biomarker-confirmed AD. METHODS A total of 40 subjects with mild dementia (Clinical Dementia Rating = 1) were stratified into AD (n = 16) and non-AD (n = 24) groups according to their cerebrospinal fluid levels of tau and Aβ42 . Their sera were collected and analyzed using a microarray containing > 1600 potential human autoantigens. Autoantibodies that were present exclusively in the AD group were identified and selected using the penetrance-based fold change method with the following criteria: penetrance fold change(AD) ≥ 2, frequency(AD) ≥ 15% and frequency(non-AD) = 0%. RESULTS All controls and samples passed the quality control criteria and were further used for biomarker analysis. Six autoantibodies with elevated responses to the following autoantigens were found exclusively in the AD group: nucleosome assembly protein 1-like 3 (31.3%, 5/16 subjects) and microtubule-associated protein 4, pantothenic acid kinase 3, phosphoinositide-3-kinase regulatory subunit 1, protein tyrosine phosphatase type IVA member 1 and SRY (sex-determining region Y)-box 15 (all 18.8%, 3/16 subjects). CONCLUSIONS Although some identified autoantigens are linked to AD and cognitive dysfunction, the increased autoantibody levels have not been reported in AD. Autoantibodies may provide deeper insights into the pathogenesis of AD and serve as diagnostic biomarkers; their corresponding antigens can be further studied to assess their potential as therapeutic targets.
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Affiliation(s)
- B Z Wang
- Department of Neurology, National Neuroscience Institute, Singapore
| | - F Z Zailan
- Department of Neurology, National Neuroscience Institute, Singapore
| | - B Y X Wong
- Department of Neurology, National Neuroscience Institute, Singapore
| | - K P Ng
- Department of Neurology, National Neuroscience Institute, Singapore
| | - N Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore.,Duke-NUS Graduate Medical School, Singapore.,NTU-Imperial Lee Kong Chian School of Medicine, Singapore, Singapore
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10
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Autoantibodies as biomarkers for interstitial lung disease in idiopathic inflammatory myositis and systemic sclerosis: The case of anti-eIF2B antibodies. J Transl Autoimmun 2020; 3:100049. [PMID: 32743530 PMCID: PMC7388402 DOI: 10.1016/j.jtauto.2020.100049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives Serum autoantibodies are pivotal for the early detection of systemic autoimmune rheumatic diseases such as Systemic Sclerosis (SSc) and Poly/Dermatomyositis (PM/DM), and in some cases are associated with organ complications such as interstitial lung disease (ILD). A paradigmatic example is provided by the autoantibody against the Eukaryotic Initiation Factor 2B (eIF2B) that has been recently detected in SSc. Methods Sera from 118 patients with SSc, 8 Poly/Dermatomyositis, 2 overlap SSc/Polymyositis, 4 undifferentiated connective tissue disease-UCTD and 3 healthy controls were tested first by indirect immunofluorescence for anti-nuclear antibodies-ANA pattern. Further, we employed protein-radioimmunoprecipitation (IP) and IP- Western Blot for the detection and confirmation of anti-eIF2B antibodies. Serum findings were further correlated with the clinical features of patients. Results We identified 3 SSc cases (2.5%) positive for anti-eIF2B antibodies while this autoantibody was not detected in control sera. Using protein-IP all three patients manifested the 38kD protein which is the antigenic target of anti-eIF2B antibodies, and this was associated with a cytoplasmic pattern at indirect immunofluorescence. The presence of anti-eIF2B was associated with ILD and a diffuse SSc variant, in one case in association with anti-Scl70/topoI. Conclusions Our data confirm that a small subgroup (2.5%) of patients with SSc have detectable anti-eIF2B with cytoplasmic-positive staining at immunofluorescence and this reactivity is associated with ILD.
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11
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Hughes M, Pauling JD, Armstrong-James L, Denton CP, Galdas P, Flurey C. Gender-related differences in systemic sclerosis. Autoimmun Rev 2020; 19:102494. [PMID: 32062031 DOI: 10.1016/j.autrev.2020.102494] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/19/2019] [Indexed: 12/12/2022]
Abstract
Systemic sclerosis (SSc) is a complex autoimmune connective tissue disease which is characterised by autoimmunity, widespread tissue fibrosis of the skin and internal organs, and vasculopathic alterations. SSc is more common in women but has a more severe expression of disease including internal organ-based complications and higher mortality in men. The extant literature shows that although important pathophysiological sex differences are present in SSc, behavioural differences (e.g. higher smoking rates in men) and occupational exposures may contribute to poorer outcomes in men with SSc. The higher death male death rate in the general population and greater prevalence of lung fibrosis are likely the key factors responsible for excess mortality found in men. Other important factors include (but are not limited to) a greater prevalence of the disease subset, delayed time to diagnosis, and higher disease activity in early disease in men. SSc carries a significant burden of disease-related morbidity; however, no qualitative studies to date have focussed on gender differences in SSc. The purpose of this review is to provide a comprehensive overview of gender differences in SSc including (but not limited to) epidemiology, pathophysiology, clinical expression of disease, mortality, SSc in transgender individuals, and psychosocial aspects of disease.
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Affiliation(s)
- Michael Hughes
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, UK.
| | - John D Pauling
- Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), Bath, UK; Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | | | - Christopher P Denton
- Centre for Rheumatology, Royal Free Hospital, University College London, London, UK
| | - Paul Galdas
- Department of Health Sciences, University of York, York, UK
| | - Caroline Flurey
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
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12
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Mendes C, Viana VST, Pasoto SG, Leon EP, Bonfa E, Sampaio-Barros PD. Clinical and laboratory features of African-Brazilian patients with systemic sclerosis. Clin Rheumatol 2019; 39:9-17. [PMID: 31065858 DOI: 10.1007/s10067-019-04575-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/15/2019] [Accepted: 04/22/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE African-Brazilians comprise a group of blacks and "pardos." As racial differences can be associated with distinct presentations, we evaluated the clinical and serological associations of African-Brazilians with systemic sclerosis (SSc). METHODS Sera from 260 adult SSc patients (203 whites and 57 African-Brazilians) were evaluated. Patients with overlap syndromes were excluded. Clinical and demographic data were obtained from an electronic register database. Laboratory analysis included the following: anti-CENP-A/CENP-B, Scl70, RNA polymerase III, Ku, fibrillarin, Th/To, PM-Scl75, and PM-Scl100 by line immunoassay and anti-nuclear antibodies (ANA) by indirect immunofluorescence (IIF) on HEp-2 cells. RESULTS African-Brazilian SSc patients presented shorter disease duration (12.8 ± 6.5 vs. 15.9 ± 8.1 years, p = 0.009), higher frequency of nucleolar ANA pattern (28% vs. 13%, p = 0.008), and lower frequencies of centromeric ANA pattern (14% vs. 29%, p = 0.026) and CENP-B (18% vs. 34%, p = 0.017), as well as an association with severe interstitial lung disease (58% vs. 43%; p = 0.044). Further comparison of ethnic groups according to subsets revealed that diffuse SSc African-Brazilian patients presented higher frequency of pulmonary hypertension (p = 0.017), heart involvement (p = 0.037), nucleolar ANA pattern (p = 0.036), anti-fibrillarin antibodies (p = 0.037), and higher mortality (48% vs. 19%; p = 0.009). A different pattern was observed for the limited subset with solely a lower frequency of esophageal involvement (p = 0.050) and centromeric ANA pattern (p = 0.049). Survival analysis showed that African-Brazilians had a higher mortality, when adjusted for age, gender, and clinical subset (RR 2.06, CI 95% 1.10-3.83, p = 0.023). CONCLUSION African-Brazilians have distinct characteristics according to clinical subset and an overall more severe SSc than whites, similar to the blacks from other countries.Key Points • African-Brazilian SSc patients were associated with severe interstitial lung disease and nucleolar ANA pattern when compared to white SSc patients. • When disease subsets were considered, African-Brazilian patients with diffuse SSc presented association with pulmonary hypertension, heart involvement, nucleolar ANA pattern, and anti-fibrillarin antibodies. • White SSc patients were associated with centromeric ANA pattern. • Survival analysis at 5, 10, 15, and 20 years, adjusted for age, gender, and disease subset, was significantly worse in African-Brazilian SSc patients.
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Affiliation(s)
- Cristiane Mendes
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.,Universidade Federal de Alfenas, Alfenas, Brazil
| | - Vilma S T Viana
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Sandra G Pasoto
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Elaine P Leon
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eloisa Bonfa
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Percival D Sampaio-Barros
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil. .,Disciplina de Reumatologia, Universidade de São Paulo, Avenida Dr. Arnaldo 455, sala 3142, Cerqueira César, Sao Paulo, SP, 01246-903, Brazil.
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13
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Koenig M, Bentow C, Satoh M, Fritzler MJ, Senécal JL, Mahler M. Autoantibodies to a novel Rpp38 (Th/To) derived B-cell epitope are specific for systemic sclerosis and associate with a distinct clinical phenotype. Rheumatology (Oxford) 2019; 58:1784-1793. [DOI: 10.1093/rheumatology/kez123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 03/08/2019] [Indexed: 01/06/2023] Open
Abstract
Abstract
Objective
Detection of antinuclear antibodies and specific autoantibodies is important in the diagnosis and classification of SSc. Several proteins of the Th/To complex, including Rpp25, Rpp38 and hPop1 are the target of autoantibodies in SSc patients. However, very little is known about the epitope distribution of this autoantigen. Consequently, we screened Rpp25, Rpp38 and hPop1 for B cell epitopes and evaluated their clinical relevance.
Methods
Serum pools with (n = 2) and without (n = 1) anti-Th/To autoantibodies were generated and used for epitope discovery. Identified biomarker candidate sequences were then utilized to synthesize synthetic, biotinylated, soluble peptides. The peptides were tested to determine reactivity with sera from SSc cohorts (n = 202) and controls (n = 159) using a chemiluminescence immunoassay. Additionally, samples were also tested for antibodies to full-length recombinant Rpp25 antibodies by chemiluminescence immunoassay.
Results
Several immunodominant regions were found on the three proteins. The strongest reactivity was observed with an Rpp38 peptide (aa 229–243). Autoantibodies to the Rpp38 peptide were detected in 8/149 (5.4%) limited cutaneous SSc patients, but not in any of 159 controls (P = 0.003 by two-sided Fisher's exact probability test). Although reactivity to the novel antigenic peptide was correlated with the binding to Rpp25 (rho = 0.44; P < 0.0001), subsets of patient sera either reacted strongly with Rpp25 or with the novel Rpp38-derived peptide.
Conclusion
A novel Rpp38 epitope holds promise to increase the sensitivity in the detection of anti-Th/To autoantibodies, thus enhancing the serological diagnosis of SSc.
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Affiliation(s)
- Martial Koenig
- Department of Medicine, University of Montreal, Division of Rheumatology and Research Center, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Chelsea Bentow
- Inova Diagnostics, Inc., Research & Development, San Diego, CA, USA
| | - Minoru Satoh
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan
- Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Marvin J Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Luc Senécal
- Department of Medicine, University of Montreal, Division of Rheumatology and Research Center, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Michael Mahler
- Inova Diagnostics, Inc., Research & Development, San Diego, CA, USA
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14
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Baker Frost D, Wolf B, Peoples C, Fike J, Silver K, Laffoon M, Medsger TA, Feghali-Bostwick C. Estradiol levels are elevated in older men with diffuse cutaneous SSc and are associated with decreased survival. Arthritis Res Ther 2019; 21:85. [PMID: 30940202 PMCID: PMC6444502 DOI: 10.1186/s13075-019-1870-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 03/18/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) is a female-predominant disease, characterized by excessive extracellular matrix deposition (ECM) with dermal and internal organ fibrosis. Considering the sex-based disparity in disease incidence, estradiol (E2), an estrogen form with pro-fibrotic effects, may play a role in SSc. We reported that post-menopausal women with diffuse cutaneous (dc)SSc have higher serum E2 levels compared to similar aged, healthy controls. Since males with SSc tend to have more severe disease, we examined serum E2 in dcSSc males in relation to disease characteristics and survival. METHODS We measured serum E2 in 83 dcSSc men > 50 years old from the University of Pittsburgh Scleroderma Center and similar aged healthy controls. Using statistical modeling, we examined the associations between serum E2, internal organ involvement, autoantibody profiles, and survival. RESULTS Male dcSSc patients had significantly higher serum E2 levels compared to healthy males and similar aged dcSSc post-menopausal women. Male dcSSc patients with high serum E2 had significantly more heart involvement, a trend for higher skin thickness progression rate, and worse survival. Using Cox regression modeling, increased serum E2 levels in anti-Scl-70 antibody-positive dcSSc males were associated with an increased risk of death. CONCLUSIONS dcSSc males > 50 years old have higher levels of serum E2 compared to healthy controls and dcSSc post-menopausal women. Elevated serum E2 levels in dcSSc males are associated with heart involvement, trend to progression of dermal fibrosis, and, if anti-Scl-70 antibody positive, worse survival. Our study expands on previous work implicating E2 in dermal fibrosis in SSc and associates E2 levels with internal organ involvement and survival. These data suggest a role for estrogen imbalance in dcSSc.
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Affiliation(s)
- DeAnna Baker Frost
- Department of Medicine, Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Bethany Wolf
- Department of Medicine, Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC, 29425, USA.,College of Medicine, Department of Public Health Sciences, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Christine Peoples
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, 3500 Terrace Street, Pittsburgh, PA, 15261, USA
| | - Jessica Fike
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, 3500 Terrace Street, Pittsburgh, PA, 15261, USA
| | - Katherine Silver
- Department of Medicine, Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Maureen Laffoon
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, 3500 Terrace Street, Pittsburgh, PA, 15261, USA
| | - Thomas A Medsger
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, 3500 Terrace Street, Pittsburgh, PA, 15261, USA
| | - Carol Feghali-Bostwick
- Department of Medicine, Division of Rheumatology and Immunology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC, 29425, USA.
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15
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Liaskos C, Marou E, Simopoulou T, Gkoutzourelas A, Barmakoudi M, Efthymiou G, Scheper T, Meyer W, Katsiari CG, Bogdanos DP, Sakkas LI. Multiparametric autoantibody profiling of patients with systemic sclerosis in Greece. Mediterr J Rheumatol 2018; 29:120-126. [PMID: 32185313 PMCID: PMC7046048 DOI: 10.31138/mjr.29.3.120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/13/2018] [Accepted: 09/23/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Systemic sclerosis (SSc) is an autoimmune rheumatic disease characterized by a wide range of disease-specific and disease-related autoantibodies (autoAbs). Profile assays have been developed and are currently in use to meet the demand for better characterization of all autoAbs found in SSc patients. Aim: To assess the clinical relevance of SSc-related autoantibodies in 158 patients with SSc, all from Central Greece, taking advantage of a multiparametric SSc autoantibody line immunoassay. Material and methods: 158 consecutive patients with SSc (137 females, mean age 53.2 ± 10 years; 63 patients with dcSSc and 95 with lcSSc) from central Greece were included in the study. Eighteen patients with morphea were also included. Serum samples were analyzed by a profile SSc nucleoli line assay (Euroimmun) to detect Abs against 13 autoantigens: Scl-70, Centromere (A, B), RNA polymerase III (subunits 11 & 155), fibrillarin, NOR90, Th/To, PM/Scl 100, PM/Scl75, Ku, PDGFR and Ro52. Antinuclear autoAbs (ANAs) were detected by indirect immunofluorescence. Results: ANAs were detected in 97.5% of SSc patients. Reactivities to specific autoantigens were as follows: Topo I, 40.5%; CENP, 32.9%; Ro52, 21.5%; RP11, 8.9%; RP155, 13.3%; NOR 90, 4.4%; Ku 3.8%; PM-Scl75, 3.2%; PM-Scl100, 1.3%; Th/To, 1.3%; Fibrillarin, 1.3%; PDGFR 0%; Ro52 21.5%. Twenty-one of SSc did not have any of the main autoAbs, namely anti-Topo I, anti-CENP, anti-RNA pol III Abs. Conclusions: Multiparametric autoAb test provides positive SSc-associated autoAb reactivities in SSc patients negative for the three main autoAbs and this may prove of significance in early disease diagnosis.
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Affiliation(s)
- Christos Liaskos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Emmanouela Marou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Theodora Simopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios Gkoutzourelas
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Maria Barmakoudi
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - George Efthymiou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Thomas Scheper
- Institute of Immunology affiliated to Euroimmun AG, Lübeck, Germany
| | - Wolfgang Meyer
- Institute of Immunology affiliated to Euroimmun AG, Lübeck, Germany
| | - Christina G Katsiari
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Lazaros I Sakkas
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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16
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Li X, Qian YQ, Liu N, Mu R, Zuo Y, Wang GC, Jia Y, Li ZG. Survival rate, causes of death, and risk factors in systemic sclerosis: a large cohort study. Clin Rheumatol 2018; 37:3051-3056. [PMID: 30225558 DOI: 10.1007/s10067-018-4291-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/02/2018] [Accepted: 09/09/2018] [Indexed: 01/28/2023]
Abstract
To investigate the clinical pattern, survival rate, causes of death and risk factors in a large cohort of Chinese Han patients with systemic sclerosis (SSc). Inpatients treated from 2002 to 2014 were included in this study. Patients were classified into diffuse cutaneous SSc (dcSSc), limited cutaneous SSc (lcSSc), and SSc-overlap syndrome groups. Data were analyzed using Chi-squared tests, Kaplan-Meier curves, log-rank tests, and Cox proportional hazards modeling. Among a total of 201 patients, dcSSc (50.2%) was the major subtype, followed by lcSSc (30.3%) and SSc-overlap (19.4%). Interstitial lung disease (ILD, 148/201, 74%) was the most frequent organ involvement. The overall survival rates were 98% and 95% at 5 and 10 years, respectively. The overall standard mortality ratio (SMR) was 2.22. The most common cause of death was ILD combined with infection (8/16, 50%), followed by kidney failure (2/16, 12.5%). On crude analysis, pulmonary hypertension, ILD, cardiac involvements, renal involvements, and digital ischemia were associated with poor prognosis. On multivariate analysis, pericardial effusion (p = 0.000) and digital ischemia (p = 0.016) were independent prognostic factors of death. The mortality rate of patients with SSc is mildly increased in comparison with the general population. ILD is the most common systemic involvement and the principal cause of death in SSc. Pericardial effusion and digital ischemia are independent factors associated with death.
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Affiliation(s)
- Xue Li
- Department of Rheumatology and Immunology, Peking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), 11 Xizhimen South Street, Beijing, China
| | - Yu-Quan Qian
- Department of Rheumatology and Immunology, Peking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), 11 Xizhimen South Street, Beijing, China
| | - Na Liu
- Department of Rheumatology and Immunology, Peking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), 11 Xizhimen South Street, Beijing, China
| | - Rong Mu
- Department of Rheumatology and Immunology, Peking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), 11 Xizhimen South Street, Beijing, China
| | - Yu Zuo
- Department of Rheumatology and Immunology, Peking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), 11 Xizhimen South Street, Beijing, China.,Department of Rheumatology and Immunology, China-Japan Friendship Hospital, Beijing, China
| | - Guo-Chun Wang
- Department of Rheumatology and Immunology, China-Japan Friendship Hospital, Beijing, China
| | - Yuan Jia
- Department of Rheumatology and Immunology, Peking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), 11 Xizhimen South Street, Beijing, China.
| | - Zhan-Guo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital & Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), 11 Xizhimen South Street, Beijing, China.
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17
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Moon KW, Lee SS, Lee YJ, Jun JB, Yoo SJ, Ju JH, Chang SH, Choi IA, Kang TY, Lee EB, Lee SG. Clinical and Laboratory Characteristics and Mortality in Korean Patients with Systemic Sclerosis: A Nationwide Multicenter Retrospective Cohort Study. J Rheumatol 2018; 45:1281-1288. [DOI: 10.3899/jrheum.171443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2018] [Indexed: 01/22/2023]
Abstract
Objective.We aimed to investigate demographic and clinical features and predictors of mortality in Korean patients with systemic sclerosis (SSc).Methods.We performed a retrospective multicenter medical chart review in Korean patients diagnosed with SSc from 1986 to 2016 at 11 university hospitals representing each geographic area of Korea. SSc patients were defined according to the American College of Rheumatology preliminary classification criteria and subtyped as limited cutaneous (lcSSc) or diffuse cutaneous (dcSSc) SSc.Results.We enrolled 751 patients (female, 86.7%; mean age at diagnosis, 48.9 yrs). The most common organ involvement was interstitial lung disease (52.7%), followed by gastroesophageal reflux disease (32.9%) and pulmonary arterial hypertension (13.6%). Patients with lcSSc were more common than those with dcSSc (64.8 vs 35.2%), whereas anti-Scl-70 and anticentromere antibody positivity were identified in 302 (42.5%) and 175 (25.5%) patients, respectively. In the 46 (6.1%) patients who developed a malignancy, lung cancer (23.9%) was the most common diagnosis, followed by gastric (13%) and breast cancer (13%). During the study period, 57 (7.6%) patients died, and the 5- and 10-year survival rates were 94% and 87%, respectively. Increased age at diagnosis, cardiovascular involvement, and anti-Scl-70 antibody positivity were significant predictors of death.Conclusion.Clinical manifestations and survival rates in Korean SSc patients are similar to those of other populations. However, the prevalence of anti-Scl-70 antibody is higher in Korean SSc patients compared with whites, while the prevalence of anticentromere antibody is lower.
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18
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Johnson ZI, Jones JD, Mukherjee A, Ren D, Feghali-Bostwick C, Conley YP, Yates CC. Novel classification for global gene signature model for predicting severity of systemic sclerosis. PLoS One 2018; 13:e0199314. [PMID: 29924864 PMCID: PMC6010260 DOI: 10.1371/journal.pone.0199314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/05/2018] [Indexed: 11/25/2022] Open
Abstract
Progression of systemic scleroderma (SSc), a chronic connective tissue disease that causes a fibrotic phenotype, is highly heterogeneous amongst patients and difficult to accurately diagnose. To meet this clinical need, we developed a novel three-layer classification model, which analyses gene expression profiles from SSc skin biopsies to diagnose SSc severity. Two SSc skin biopsy microarray datasets were obtained from Gene Expression Omnibus. The skin scores obtained from the original papers were used to further categorize the data into subgroups of low (<18) and high (≥18) severity. Data was pre-processed for normalization, background correction, centering and scaling. A two-layered cross-validation scheme was employed to objectively evaluate the performance of classification models of unobserved data. Three classification models were used: support vector machine, random forest, and naive Bayes in combination with feature selection methods to improve performance accuracy. For both input datasets, random forest classifier combined with correlation-based feature selection (CFS) method and naive Bayes combined with CFS or support vector machine based recursive feature elimination method yielded the best results. Additionally, we performed a principal component analysis to show that low and high severity groups are readily separable by gene expression signatures. Ultimately, we found that our novel classification prediction model produced global gene signatures that significantly correlated with skin scores. This study represents the first report comparing the performance of various classification prediction models for gene signatures from SSc patients, using current clinical diagnostic factors. In summary, our three-classification model system is a powerful tool for elucidating gene signatures from SSc skin biopsies and can also be used to develop a prognostic gene signature for SSc and other fibrotic disorders.
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Affiliation(s)
- Zariel I. Johnson
- Department of Health Promotions and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States of America
| | - Jacqueline D. Jones
- Department of Biological & Environmental Sciences, Troy University, Troy, AL, United States of America
| | - Angana Mukherjee
- Department of Biological & Environmental Sciences, Troy University, Troy, AL, United States of America
| | - Dianxu Ren
- Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States of America
| | - Carol Feghali-Bostwick
- Department of Rheumatology & Immunology, University of South Carolina, Charleston, SC, United States of America
| | - Yvette P. Conley
- Department of Health Promotions and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States of America
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Cecelia C. Yates
- Department of Health Promotions and Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, United States of America
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
- * E-mail:
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Pearson DR, Werth VP, Pappas-Taffer L. Systemic sclerosis: Current concepts of skin and systemic manifestations. Clin Dermatol 2018; 36:459-474. [PMID: 30047430 DOI: 10.1016/j.clindermatol.2018.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Systemic sclerosis is an uncommon autoimmune connective tissue disease with multiorgan system involvement and significant associated morbidity and mortality. Cutaneous signs and clinical manifestations are of particular importance, as they may be recognized before systemic manifestations, allowing earlier risk stratification into the limited and diffuse cutaneous subtypes, as well as earlier initiation of treatment. Important cutaneous manifestations include Raynaud's phenomenon, digital ulcers, cutaneous sclerosis, calcinosis cutis, telangiectasias, pruritus, and dyspigmentation. Despite investigation of a wide variety of treatments, no FDA-approved pharmacologic therapies exist for systemic sclerosis, and data from high-quality studies are limited. In the following review, we will discuss skin-directed therapies. Although there is evidence to support specific treatments for Raynaud's phenomenon, digital ulcers, and cutaneous sclerosis, there are limited rigorous studies evaluating the treatment of other cutaneous signs and clinical manifestations. Additional randomized-controlled trials and large observational studies are necessary to develop future evidence-based treatment options.
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Affiliation(s)
- David R Pearson
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Victoria P Werth
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Pappas-Taffer
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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20
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The high frequency of autoantibodies in HIV patients declines on antiretroviral therapy. Pathology 2018; 50:313-316. [PMID: 29463387 DOI: 10.1016/j.pathol.2017.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/29/2017] [Accepted: 10/15/2017] [Indexed: 01/05/2023]
Abstract
Autoantibodies have been described in samples from HIV positive patients, but the effects of antiretroviral therapy (ART) remain unclear. In a retrospective longitudinal study, we applied clinical assays for autoantibodies to sera collected from 13 HIV positive patients as they began ART with <210 CD4 T-cells/μL and over 2 years on treatment. Twelve of the 13 patients had at least one autoantibody. The frequency peaked before ART (21 from 156 assays) and declined to 8/143 positive reactions after 2 years. As anti-smooth muscle (ASM) antibodies remained common, these assays were applied to HIV patients (n = 67) who had <50 copies HIV RNA/mL plasma after 13 (2-17) years on ART, and healthy controls (n = 55). The frequency of ASM was high in these patients and correlated with levels of total IgG. Hence the high frequency of autoantibodies before ART declined, but did not disappear, with successful therapy. Autoantibody levels may reflect B-cell hyperactivity in patients stable on ART.
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21
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Morgan ND, Shah AA, Mayes MD, Domsic RT, Medsger TA, Steen VD, Varga J, Carns M, Ramos PS, Silver RM, Schiopu E, Khanna D, Hsu V, Gordon JK, Gladue H, Saketkoo LA, Criswell LA, Derk CT, Trojanowski MA, Shanmugam VK, Chung L, Valenzuela A, Jan R, Goldberg A, Remmers EF, Kastner DL, Wigley FM, Gourh P, Boin F. Clinical and serological features of systemic sclerosis in a multicenter African American cohort: Analysis of the genome research in African American scleroderma patients clinical database. Medicine (Baltimore) 2017; 96:e8980. [PMID: 29390428 PMCID: PMC5758130 DOI: 10.1097/md.0000000000008980] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Racial differences exist in the severity of systemic sclerosis (SSc). To enhance our knowledge about SSc in African Americans, we established a comprehensive clinical database from the largest multicenter cohort of African American SSc patients assembled to date (the Genome Research in African American Scleroderma Patients (GRASP) cohort).African American SSc patients were enrolled retrospectively and prospectively over a 30-year period (1987-2016), from 18 academic centers throughout the United States. The cross-sectional prevalence of sociodemographic, clinical, and serological features was evaluated. Factors associated with clinically significant manifestations of SSc were assessed using multivariate logistic regression analyses.The study population included a total of 1009 African American SSc patients, comprised of 84% women. In total, 945 (94%) patients met the 2013 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for SSc, with the remaining 64 (6%) meeting the 1980 ACR or CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia) criteria. While 43% were actively employed, 33% required disability support. The majority (57%) had the more severe diffuse subtype and a young age at symptom onset (39.1 ± 13.7 years), in marked contrast to that reported in cohorts of predominantly European ancestry. Also, 1 in 10 patients had a severe Medsger cardiac score of 4. Pulmonary fibrosis evident on computed tomography (CT) chest was present in 43% of patients and was significantly associated with anti-topoisomerase I positivity. 38% of patients with CT evidence of pulmonary fibrosis had a severe restrictive ventilator defect, forced vital capacity (FVC) ≤50% predicted. A significant association was noted between longer disease duration and higher odds of pulmonary hypertension, telangiectasia, and calcinosis. The prevalence of potentially fatal scleroderma renal crisis was 7%, 3.5 times higher than the 2% prevalence reported in the European League Against Rheumatism Scleroderma Trials and Research (EUSTAR) cohort.Our study emphasizes the unique and severe disease burden of SSc in African Americans compared to those of European ancestry.
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Affiliation(s)
- Nadia D. Morgan
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ami A. Shah
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Maureen D. Mayes
- Division of Rheumatology, University of Texas-McGovern Medical School, Houston, TX
| | | | | | - Virginia D. Steen
- Division of Rheumatology, Georgetown University School of Medicine, Washington, DC
| | - John Varga
- Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Mary Carns
- Division of Rheumatology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Paula S. Ramos
- Division of Rheumatology, Medical University of South Carolina, Charleston, SC
| | - Richard M. Silver
- Division of Rheumatology, Medical University of South Carolina, Charleston, SC
| | - Elena Schiopu
- Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Dinesh Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Vivien Hsu
- Division of Rheumatology, Robert Wood Johnson University, New Brunswick, NJ
| | - Jessica K. Gordon
- Division of Rheumatology, Hospital for Special Surgery, New York, NY
| | - Heather Gladue
- Department of Rheumatology, Arthritis and Osteoporosis Consultants of the Carolinas, Charlotte, NC
| | - Lesley A. Saketkoo
- Division of Rheumatology, Tulane University School of Medicine, New Orleans, LA
| | | | - Chris T. Derk
- Division of Rheumatology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Lorinda Chung
- Division of Rheumatology, Stanford University School of Medicine, Stanford, CA
| | - Antonia Valenzuela
- Division of Rheumatology, Stanford University School of Medicine, Stanford, CA
| | - Reem Jan
- Division of Rheumatology, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Avram Goldberg
- Division of Rheumatology, New York University Langone Medical Center, New York, NY
| | | | | | - Fredrick M. Wigley
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pravitt Gourh
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Francesco Boin
- Division of Rheumatology, University of California San Francisco, CA
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22
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Nandiwada SL, Peterson LK, Mayes MD, Jaskowski TD, Malmberg E, Assassi S, Satoh M, Tebo AE. Ethnic Differences in Autoantibody Diversity and Hierarchy: More Clues from a US Cohort of Patients with Systemic Sclerosis. J Rheumatol 2016; 43:1816-1824. [PMID: 27481902 DOI: 10.3899/jrheum.160106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the autoantibody repertoire and clinical associations in a multiethnic cohort of American patients with systemic sclerosis (SSc). METHODS There were 1000 patients with SSc (196 Hispanic, 228 African American, 555 white, and 21 other) who were screened for antinuclear antibodies (ANA), including anticentromere antibodies (ACA) by indirect immunofluorescence assay, antitopoisomerase-1 (topo-1/Scl-70) by immunodiffusion, and anti-RNA polymerase III (RNAP III) by ELISA. Sera from 160 patients with mainly nucleolar and/or speckled ANA pattern, but negative for ACA, Scl-70, and RNAP III, were further characterized by immunoprecipitation for SSc-specific antibodies. RESULTS The prevalence of antibodies against RNAP III, Th/To, and PM/Scl did not differ significantly among the ethnic groups. The frequency of anti-Scl-70 was lowest in whites (18.0%) compared with 24.0% and 26.8% in Hispanics and African Americans (p = 0.01), respectively. Compared with African American patients, Hispanic and white subjects had a higher frequency of ACA (p < 0.0001) and lower frequency of U3-RNP (p < 0.0001). U3-RNP antibodies were uniquely higher in African American patients, independent of clinical subset, while Th/To autoantibodies were associated with limited cutaneous SSc in white subjects. Overall, Hispanic and African American patients had an earlier age of onset and a predominance of diffuse cutaneous SSc compared with their white counterparts. CONCLUSION SSc-specific antibodies may predict disease subset; however, the hierarchy of their prevalence differs across ethnic groups. This study provides the most extensive analysis to date on the relevance of autoantibodies in the diagnosis and clinical manifestations of SSc in Hispanic American patients.
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Affiliation(s)
- Sarada L Nandiwada
- From the Department of Pathology, University of Utah; ARUP Laboratories, Salt Lake City, Utah; Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center, Houston, Texas; Department of Medicine, University of Florida, Gainesville, Florida, USA; Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.S.L. Nandiwada, PhD, Assistant Professor of Pediatrics, Department of Pathology, University of Utah, and Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; L.K. Peterson, PhD, Clinical Immunology Fellow, Department of Pathology, University of Utah; M.D. Mayes, MD, Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; T.D. Jaskowski, BS, R&D Scientist, ARUP Laboratories; E. Malmberg, MS, Outcomes Analyst, ARUP Laboratories; S. Assassi, MD, Associate Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; M. Satoh, MD, PhD, Professor, Department of Clinical Nursing, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Department of Medicine, University of Florida; A.E. Tebo, PhD, Associate Professor of Pathology, Department of Pathology, University of Utah, and ARUP Laboratories. Dr. Nandiwada and Dr. Peterson contributed equally to this manuscript.
| | - Lisa K Peterson
- From the Department of Pathology, University of Utah; ARUP Laboratories, Salt Lake City, Utah; Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center, Houston, Texas; Department of Medicine, University of Florida, Gainesville, Florida, USA; Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.S.L. Nandiwada, PhD, Assistant Professor of Pediatrics, Department of Pathology, University of Utah, and Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; L.K. Peterson, PhD, Clinical Immunology Fellow, Department of Pathology, University of Utah; M.D. Mayes, MD, Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; T.D. Jaskowski, BS, R&D Scientist, ARUP Laboratories; E. Malmberg, MS, Outcomes Analyst, ARUP Laboratories; S. Assassi, MD, Associate Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; M. Satoh, MD, PhD, Professor, Department of Clinical Nursing, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Department of Medicine, University of Florida; A.E. Tebo, PhD, Associate Professor of Pathology, Department of Pathology, University of Utah, and ARUP Laboratories. Dr. Nandiwada and Dr. Peterson contributed equally to this manuscript
| | - Maureen D Mayes
- From the Department of Pathology, University of Utah; ARUP Laboratories, Salt Lake City, Utah; Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center, Houston, Texas; Department of Medicine, University of Florida, Gainesville, Florida, USA; Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.S.L. Nandiwada, PhD, Assistant Professor of Pediatrics, Department of Pathology, University of Utah, and Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; L.K. Peterson, PhD, Clinical Immunology Fellow, Department of Pathology, University of Utah; M.D. Mayes, MD, Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; T.D. Jaskowski, BS, R&D Scientist, ARUP Laboratories; E. Malmberg, MS, Outcomes Analyst, ARUP Laboratories; S. Assassi, MD, Associate Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; M. Satoh, MD, PhD, Professor, Department of Clinical Nursing, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Department of Medicine, University of Florida; A.E. Tebo, PhD, Associate Professor of Pathology, Department of Pathology, University of Utah, and ARUP Laboratories. Dr. Nandiwada and Dr. Peterson contributed equally to this manuscript
| | - Troy D Jaskowski
- From the Department of Pathology, University of Utah; ARUP Laboratories, Salt Lake City, Utah; Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center, Houston, Texas; Department of Medicine, University of Florida, Gainesville, Florida, USA; Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.S.L. Nandiwada, PhD, Assistant Professor of Pediatrics, Department of Pathology, University of Utah, and Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; L.K. Peterson, PhD, Clinical Immunology Fellow, Department of Pathology, University of Utah; M.D. Mayes, MD, Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; T.D. Jaskowski, BS, R&D Scientist, ARUP Laboratories; E. Malmberg, MS, Outcomes Analyst, ARUP Laboratories; S. Assassi, MD, Associate Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; M. Satoh, MD, PhD, Professor, Department of Clinical Nursing, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Department of Medicine, University of Florida; A.E. Tebo, PhD, Associate Professor of Pathology, Department of Pathology, University of Utah, and ARUP Laboratories. Dr. Nandiwada and Dr. Peterson contributed equally to this manuscript
| | - Elisabeth Malmberg
- From the Department of Pathology, University of Utah; ARUP Laboratories, Salt Lake City, Utah; Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center, Houston, Texas; Department of Medicine, University of Florida, Gainesville, Florida, USA; Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.S.L. Nandiwada, PhD, Assistant Professor of Pediatrics, Department of Pathology, University of Utah, and Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; L.K. Peterson, PhD, Clinical Immunology Fellow, Department of Pathology, University of Utah; M.D. Mayes, MD, Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; T.D. Jaskowski, BS, R&D Scientist, ARUP Laboratories; E. Malmberg, MS, Outcomes Analyst, ARUP Laboratories; S. Assassi, MD, Associate Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; M. Satoh, MD, PhD, Professor, Department of Clinical Nursing, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Department of Medicine, University of Florida; A.E. Tebo, PhD, Associate Professor of Pathology, Department of Pathology, University of Utah, and ARUP Laboratories. Dr. Nandiwada and Dr. Peterson contributed equally to this manuscript
| | - Shervin Assassi
- From the Department of Pathology, University of Utah; ARUP Laboratories, Salt Lake City, Utah; Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center, Houston, Texas; Department of Medicine, University of Florida, Gainesville, Florida, USA; Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.S.L. Nandiwada, PhD, Assistant Professor of Pediatrics, Department of Pathology, University of Utah, and Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; L.K. Peterson, PhD, Clinical Immunology Fellow, Department of Pathology, University of Utah; M.D. Mayes, MD, Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; T.D. Jaskowski, BS, R&D Scientist, ARUP Laboratories; E. Malmberg, MS, Outcomes Analyst, ARUP Laboratories; S. Assassi, MD, Associate Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; M. Satoh, MD, PhD, Professor, Department of Clinical Nursing, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Department of Medicine, University of Florida; A.E. Tebo, PhD, Associate Professor of Pathology, Department of Pathology, University of Utah, and ARUP Laboratories. Dr. Nandiwada and Dr. Peterson contributed equally to this manuscript
| | - Minoru Satoh
- From the Department of Pathology, University of Utah; ARUP Laboratories, Salt Lake City, Utah; Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center, Houston, Texas; Department of Medicine, University of Florida, Gainesville, Florida, USA; Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.S.L. Nandiwada, PhD, Assistant Professor of Pediatrics, Department of Pathology, University of Utah, and Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; L.K. Peterson, PhD, Clinical Immunology Fellow, Department of Pathology, University of Utah; M.D. Mayes, MD, Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; T.D. Jaskowski, BS, R&D Scientist, ARUP Laboratories; E. Malmberg, MS, Outcomes Analyst, ARUP Laboratories; S. Assassi, MD, Associate Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; M. Satoh, MD, PhD, Professor, Department of Clinical Nursing, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Department of Medicine, University of Florida; A.E. Tebo, PhD, Associate Professor of Pathology, Department of Pathology, University of Utah, and ARUP Laboratories. Dr. Nandiwada and Dr. Peterson contributed equally to this manuscript
| | - Anne E Tebo
- From the Department of Pathology, University of Utah; ARUP Laboratories, Salt Lake City, Utah; Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center, Houston, Texas; Department of Medicine, University of Florida, Gainesville, Florida, USA; Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.S.L. Nandiwada, PhD, Assistant Professor of Pediatrics, Department of Pathology, University of Utah, and Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; L.K. Peterson, PhD, Clinical Immunology Fellow, Department of Pathology, University of Utah; M.D. Mayes, MD, Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; T.D. Jaskowski, BS, R&D Scientist, ARUP Laboratories; E. Malmberg, MS, Outcomes Analyst, ARUP Laboratories; S. Assassi, MD, Associate Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; M. Satoh, MD, PhD, Professor, Department of Clinical Nursing, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Department of Medicine, University of Florida; A.E. Tebo, PhD, Associate Professor of Pathology, Department of Pathology, University of Utah, and ARUP Laboratories. Dr. Nandiwada and Dr. Peterson contributed equally to this manuscript
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23
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A Unique Presentation of Anti-RNA Polymerase III Positive Systemic Sclerosis Sine Scleroderma. Case Rep Rheumatol 2016; 2016:8536341. [PMID: 27559487 PMCID: PMC4983352 DOI: 10.1155/2016/8536341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/12/2016] [Accepted: 07/10/2016] [Indexed: 11/21/2022] Open
Abstract
Systemic sclerosis is a rare autoimmune disorder with a wide spectrum of clinical manifestations and a multitude of autoantibodies that are associated with it. In the past several years, advances in serologic testing have led to research indicating important prognostic and phenotypic associations with certain subsets of autoantibodies. In particular, anti-RNA polymerase III (anti-RNAP III) has been associated with diffuse cutaneous disease, scleroderma renal crisis, a temporal relationship with malignancy, myositis, synovitis, joint contractures, and gastric antral vascular ectasia. However, anti-RNAP III has not been associated with systemic sclerosis sine scleroderma. We describe a patient with an atypical presentation of anti-RNAP III positive systemic sclerosis sine scleroderma who presented without the typical features of anti-RNAP III disease. Instead, she presented with critical digital ischemia, pulmonary arterial hypertension, gastroesophageal reflux disease, interstitial lung disease, and no clinically detectable sclerodactyly.
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Patterson KA, Roberts-Thomson PJ, Lester S, Tan JA, Hakendorf P, Rischmueller M, Zochling J, Sahhar J, Nash P, Roddy J, Hill C, Nikpour M, Stevens W, Proudman SM, Walker JG. Interpretation of an Extended Autoantibody Profile in a Well-Characterized Australian Systemic Sclerosis (Scleroderma) Cohort Using Principal Components Analysis. Arthritis Rheumatol 2016; 67:3234-44. [PMID: 26246178 DOI: 10.1002/art.39316] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/30/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine the relationships between systemic sclerosis (SSc)-related autoantibodies, as well as their clinical associations, in a well-characterized Australian patient cohort. METHODS Serum from 505 Australian SSc patients were analyzed with a commercial line immunoassay (EuroLine; Euroimmun) for autoantibodies to centromere proteins CENP-A and CENP-B, RNA polymerase III (RNAP III; epitopes 11 and 155), the 90-kd nucleolar protein NOR-90, fibrillarin, Th/To, PM/Scl-75, PM/Scl-100, Ku, topoisomerase I (topo I), tripartite motif-containing protein 21/Ro 52, and platelet-derived growth factor receptor. Patient subgroups were identified by hierarchical clustering of the first 2 dimensions of a principal components analysis of quantitative autoantibody scores. Results were compared with detailed clinical data. RESULTS A total of 449 of the 505 patients were positive for at least 1 autoantibody by immunoblotting. Heatmap visualization of autoantibody scores, along with principal components analysis clustering, demonstrated strong, mutually exclusive relationships between CENP, RNAP III, and topo I. Five patient clusters were identified: CENP, RNAP III strong, RNAP III weak, topo I, and other. Clinical features associated with CENP, RNAP III, and topo I were consistent with previously published reports concerning limited cutaneous and diffuse cutaneous SSc. A novel finding was the statistical separation of RNAP III into 2 clusters. Patients in the RNAP III strong cluster had an increased risk of gastric antral vascular ectasia, but a lower risk of esophageal dysmotility. Patients in the other cluster were more likely to be male and to have a history of smoking and a history of malignancy, but were less likely to have telangiectasia, Raynaud's phenomenon, and joint contractures. CONCLUSION Five major autoantibody clusters with specific clinical and serologic associations were identified in Australian SSc patients. Subclassification and disease stratification using autoantibodies may have clinical utility, particularly in early disease.
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Affiliation(s)
- K A Patterson
- Flinders University, Bedford Park, South Australia, and Commonwealth Scientific and Industrial Research Organization (CSIRO), Adelaide, South Australia, Australia
| | - P J Roberts-Thomson
- Flinders University and Flinders Medical Centre, Bedford Park, South Australia, and SA Pathology, Adelaide, South Australia, Australia
| | - S Lester
- Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - J A Tan
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - P Hakendorf
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - M Rischmueller
- University of Adelaide, Adelaide, South Australia, and Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - J Zochling
- Menzies Institute for Medical Research, Hobart, Tasmania, Australia
| | - J Sahhar
- Monash Health and Monash University, Melbourne, Victoria, Australia
| | - P Nash
- University of Queensland, Brisbane, Queensland, Australia
| | - J Roddy
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - C Hill
- University of Adelaide, Adelaide, South Australia, and Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - M Nikpour
- University of Melbourne and St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - W Stevens
- St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - S M Proudman
- University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - J G Walker
- Flinders University and Flinders Medical Centre, Bedford Park, South Australia, and Repatriation General Hospital, Daw Park, South Australia, Australia
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25
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Cabrera CM, Fernández-Grande E, Urra JM. Serological profile and clinical features of nucleolar antinuclear pattern in patients with systemic lupus erythematosus from southwestern Spain. Lupus 2016; 25:980-7. [DOI: 10.1177/0961203316629557] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/07/2016] [Indexed: 12/29/2022]
Abstract
Nucleolar staining of antinuclear antibodies (ANAs) is not exclusive to patients suffering systemic sclerosis (SSc) since it can occur in other autoimmune diseases, such as systemic lupus erythematosus (SLE). The nucleolar ANA pattern presents a low incidence in patients with SLE, with less than 9% reported in some studies. The significance of nucleolar staining and antinucleolar antibodies (ANoA) in SLE is still unknown, as is its association with clinical manifestations. To address these issues, a case-control study was carried out. Twenty-eight cases of SLE with nucleolar staining were enrolled, as well as 73 controls with no nucleolar staining and different ANA patterns (homogeneous, speckled, and combined homogeneous and speckled). The homogeneous nucleolar pattern was the most frequent (27 out of 28), and in 75% was combined with other ANA patterns. The anti-double stranded DNA antibodies showed no differences between the two groups of patients, nor the auto-antibodies detected by line immunoassay (LIA). However, we have found an increased frequency of anti-PM-Scl antibodies with respect to the controls ( p = 0.02), in addition to the association between Raynaud's phenomenon (RP) and anti-PM-Scl antibodies (OR = 20.72, 95% CI 1.33–323.19, p = 0.03). Moreover, the cases of SLE showed a 7.78-fold increase in the risk of developing cancer (95%, CI 1.85–32.75, p = 0.005) with respect to the control group. Taken together these findings suggest that nucleolar staining represents a comorbidity factor in patients with SLE, although its significance must still be determined.
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Affiliation(s)
- C M Cabrera
- Immunology Section, Servicio de Hematología, Hospital de Jerez de la Frontera, Cádiz, Spain
| | - E Fernández-Grande
- Immunology Section, Servicio de Análisis Clínicos, Hospital General Universitario de Ciudad Real, Spain
| | - J M Urra
- Immunology Section, Servicio de Análisis Clínicos, Hospital General Universitario de Ciudad Real, Spain
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Selmi C, Ceribelli A, Generali E, Scirè CA, Alborghetti F, Colloredo G, Porrati L, Achenza MIS, De Santis M, Cavaciocchi F, Massarotti M, Isailovic N, Paleari V, Invernizzi P, Matthias T, Zucchi A, Meroni PL. Serum antinuclear and extractable nuclear antigen antibody prevalence and associated morbidity and mortality in the general population over 15 years. Autoimmun Rev 2015; 15:162-6. [PMID: 26524640 DOI: 10.1016/j.autrev.2015.10.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 10/25/2015] [Indexed: 11/28/2022]
Abstract
The prevalence of ANA and anti-ENA in the general population is not well established, especially their clinical significance in healthy subjects. We herein determined the prevalence and predictive value of serum ANA and anti-ENA for connective tissue diseases (CTD), cancer, and mortality. We took advantage of a randomly selected sample of the 1998 general population (Isola I) consisting of 2828 subjects (53% women, age 43±13 years) from a well-defined Northern Italian area. Serum ANA and anti-ENA were tested on the 2690 samples available in 2012 (Isola II, 50% women, age 58±13 years). Administrative databases were searched for CTD, cancer diagnosis, and death cases occurring between enrollment and December 31, 2013. The hazard ratio (HR) was calculated for incident cases. Serum ANA is positive in 18.1% for any titer and 6.1% for titers ≥1:160, 23% in subjects over 50 years and 13.1% and 6.1% for any titer and titers ≥1:160, respectively, in women. The HR for CTD development was significantly high for all ANA titers, with the highest for ANA ≥1:160 (HR 14.19, 95% CI 3.07-65.68). ANA positivity was not associated with cancer (HR 1.03; 95% CI 0.75-1.43), or with mortality (HR adjusted for age and sex 1.40; 95% CI 0.94-2.09). Serum anti-ENA is positive in a minority of subjects with highest figures for anti-nucleosome (1.9%), -histone (1.6%) and -PM/Scl (1.5%). In conclusion, serum ANA prevalence in the general population is highest in senior subjects and in women, while the female predominance is significantly lower compared to overt CTD. Serum ANA is associated with an increased probability of CTD development over time, but does not influence survival or cancer risk.
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Affiliation(s)
- Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; University of Milan, Milan, Italy.
| | - Angela Ceribelli
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; University of Milan, Milan, Italy
| | - Elena Generali
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Carlo A Scirè
- Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
| | | | - Guido Colloredo
- Division of Internal Medicine, San Pietro Hospital, Ponte San Pietro, Italy
| | - Luisa Porrati
- Bergamo local health authority (ASL), Bergamo, Italy
| | - Maria I S Achenza
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Francesca Cavaciocchi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Marco Massarotti
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Natasa Isailovic
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Valentina Paleari
- Clinical Research Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Pietro Invernizzi
- Center of Autoimmune Liver Disease, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | | | | | - Pier Luigi Meroni
- University of Milan, Milan, Italy; Istituto Auxologico Italiano, Milan, Italy
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Detection of anti-U3-RNP/fibrillarin IgG antibodies by line immunoblot assay has comparable clinical significance to immunoprecipitation testing in systemic sclerosis. Immunol Res 2015; 64:483-8. [DOI: 10.1007/s12026-015-8710-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Chang WSJ, Schollum J, White DHN, Solanki KK. A cross-sectional study of autoantibody profiles in the Waikato systemic sclerosis cohort, New Zealand. Clin Rheumatol 2015; 34:1921-7. [PMID: 26022620 DOI: 10.1007/s10067-015-2981-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 05/17/2015] [Accepted: 05/20/2015] [Indexed: 11/29/2022]
Abstract
The autoantibody profiles in New Zealand systemic sclerosis patients have not previously been reported. The aim of this study was to evaluate the autoantibody profiles of patients in the Waikato Hospital Systemic Sclerosis Clinic cohort. The EUROLINE (IgG) Systemic Sclerosis panel test kit (which tests for Scl-70, CENP-A, CENP-B, RP11, RP155, Fib, NOR90, Th/To, PM100, PM75, Ku, PDGFR and Ro-52) was selected for the purpose of this study. All patients attending the Waikato Hospital Systemic Sclerosis clinic were invited to participate. These patients were categorised by systemic sclerosis subtypes [1]. Results were compared with previously published data, including the EUSTAR database. Sixty patients (56 female) were recruited, with a median age of 61 years (range 29-81 years). Forty-one had limited cutaneous systemic sclerosis (lcSSc). Of these lcSSc patients, 31 (75.6%) were positive for CENP-A and CENP-B (anti-centromere) antibodies, 12 (29.3%) for Ro-52 antibodies, 5 (12.2%) for RP11 and RP155, 4 (9.8%) for Scl-70 and 1 (2.4%) each for anti-Fib and Th/To antibodies. Fifteen patients had diffuse cutaneous systemic sclerosis (dcSSc), of which 7 patients (47.6%) were positive for RP11 and RP155, 4 (26.7%) for Scl-70. Three dcSSc patients did not have either of these two major antibodies, but of these 15 dcSSc patients, 4 patients (26.7%) were positive also for Ro-52, 2 (13.3%) for anti-Ku, and 1 (6.7%) each for anti-Fib and NOR90. Four patients had overlap syndrome (OLS), 1 had CENP-A and CENP-B antibodies, 1 had Ro-52 autoantibodies 1 had anti-Ku antibodies. Three patients had no autoantibodies. This is the first study to look at the autoantibody profile of SSc patients in New Zealand. A higher prevalence of antibodies against centromere and RNA polymerase III was demonstrated in our group compared with the EUSTAR database suggesting that antibody prevalence may vary geographically.
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Affiliation(s)
- Winston S J Chang
- Rheumatology Department, Waikato Hospital, Pembroke Street, Hamilton, New Zealand
| | - Joanna Schollum
- Rheumatology Department, Waikato Hospital, Pembroke Street, Hamilton, New Zealand
| | - Douglas H N White
- Rheumatology Department, Waikato Hospital, Pembroke Street, Hamilton, New Zealand.,Waikato Clinical School, University of Auckland, Auckland, New Zealand
| | - Kamal K Solanki
- Rheumatology Department, Waikato Hospital, Pembroke Street, Hamilton, New Zealand. .,Waikato Clinical School, University of Auckland, Auckland, New Zealand.
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Muro Y, Hosono Y, Sugiura K, Ogawa Y, Mimori T, Akiyama M. Anti-PM/Scl antibodies are found in Japanese patients with various systemic autoimmune conditions besides myositis and scleroderma. Arthritis Res Ther 2015; 17:57. [PMID: 25885224 PMCID: PMC4407870 DOI: 10.1186/s13075-015-0573-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 02/20/2015] [Indexed: 01/09/2023] Open
Abstract
Introduction Anti-PM/Scl antibodies are associated with polymyositis (PM)/systemic scleroderma (SSc) overlap syndromes and are also found in other systemic autoimmune diseases. Although anti-PM/Scl reactivity is found in 3-11% of PM or SSc patients and in approximately 25% of PM/SSc overlap patients, previous large studies of Japanese patients with scleroderma reported that anti-PM/Scl are not found in Japanese patients at all. The PM/Scl autoantigen complex comprises 11–16 different polypeptides; ELISA with PM1-α peptide, which is a major epitope of the PM/Scl complex, has frequently been used for the detection of these antibodies in recent studies. However, no ELISA kit is commercially available in Japan. Methods In this study, we developed an immunoassay for measuring antibodies against recombinant PM/Scl-100 and PM/Scl-75 polypeptides, which are the two major targets of the complex, and we investigated their presence in 600 Japanese patients with various systemic autoimmune conditions. Immunoprecipitation analysis using the recombinants in addition to traditional radiolabeled cell extracts were also applied to ELISA-positive sera. Results In ELISA, 11 patients were positive for anti-PM/Scl-100 antibodies and 7 of these 11 patients were also positive for anti-PM/Scl-75 antibodies. Immunoprecipitation analysis using the recombinants in addition to traditional radiolabeled cell extracts confirmed that 9 out of these 11 patients immunoprecipitated the typical sets of PM/Scl proteins. In total, 4/16 (25%) undifferentiated connective tissue disease (UCTD) patients, 3/126 (2.4%) dermatomyositis patients, 1/223 (0.4%) SSc patients, 1/88 (1.1%) Sjögren’s syndrome patients, 0/123 patients with systemic lupus erythematosus, 0/17 patients with overlap syndrome and 0/7 patients with PM were judged to be positive for anti-PM/Scl antibodies. Conclusions This is the first report of Japanese autoimmune patients with anti-PM/Scl antibodies. In Japanese patients, anti-PM/Scl antibodies are only very rarely found, and they are not always specific for dermatomyositis (DM) or SSc; they are also present in various autoimmune conditions with the highest prevalence being in UCTD. All anti-PM/Scl-positive DM cases are complicated with interstitial lung disease and/or cancer, while no life-threatening involvement was found in other anti-PM/Scl-positive cases. Further studies on larger cohorts are necessary to define the clinical significance of anti-PM/Scl antibodies in autoimmune diseases.
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Affiliation(s)
- Yoshinao Muro
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. .,Division of Connective Tissue Disease and Autoimmunity, Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yuji Hosono
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Kazumitsu Sugiura
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yasushi Ogawa
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Masashi Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
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30
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Mahler M, Fritzler MJ, Satoh M. Autoantibodies to the mitochondrial RNA processing (MRP) complex also known as Th/To autoantigen. Autoimmun Rev 2015; 14:254-7. [DOI: 10.1016/j.autrev.2014.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 11/11/2014] [Indexed: 02/06/2023]
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Esclerodermia en el Caribe: características en una serie de casos dominicana. ACTA ACUST UNITED AC 2014; 10:373-9. [DOI: 10.1016/j.reuma.2014.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 12/17/2013] [Accepted: 01/31/2014] [Indexed: 11/23/2022]
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Clinical and autoimmune profile of scleroderma patients from Western India. Int J Rheumatol 2014; 2014:983781. [PMID: 25386193 PMCID: PMC4216682 DOI: 10.1155/2014/983781] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/30/2014] [Accepted: 09/30/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Systemic sclerosis (SSc, scleroderma) is a disorder characterized by fibrosis of skin and visceral organs. Pathogenesis of scleroderma is complex and is incompletely understood as yet. Autoantibodies in SSc represent a serologic hallmark which have clinical relevance, with diagnostic and prognostic potential. Objectives. To study distribution of clinical manifestations and to identify frequency of autoantibodies among subtypes of scleroderma patients from Western India. Methodology. One hundred and ten scleroderma patients were clinically classified according to the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria. All these patients were in active stage of disease. Clinical manifestations were recorded at the time of presentation. Autoantibodies were tested in them by indirect immunofluorescence test and ELISA. Immunoglobulin levels were estimated by nephelometer. These parameters were further correlated with clinical presentation of the disease. Results. Scleroderma patients had M : F ratio of 1 : 10 where mean age at evaluation was 34.7 ± 10.7 years and a mean disease duration was 43.7 ± 35 months. Clinical subtypes showed that 45 patients (40.9%) had diffused cutaneous (dcSSc) lesions, 32 patients (29.1%) had limited cutaneous (lcSSc) lesions, and 33 patients (30%) had other autoimmune overlaps. The overall frequency of ANA in SSc patients studied was 85.5%. The frequency of anti-Scl70, anti-centromere, anti-endothelial cell antibodies (AECA), and anti-keratinocyte antibodies (AKA) was 62.7%, 22.7%, 30%, and 40.9%, respectively. Anti-Scl70 antibodies were significantly high (75.6% versus 46.9%) among dcSSc patients (P < 0.0115) whereas anti-centromere antibodies were significantly high (9% versus 38%) among lcSSc patients when these two subtypes were compared (P < 0.0044). Conclusion. This study supports that there are geoepidemiological variations among scleroderma patients for their clinical presentation, autoantibody profile, and immune parameters across the country.
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Hussein H, Lee P, Chau C, Johnson SR. The Effect of Male Sex on Survival in Systemic Sclerosis. J Rheumatol 2014; 41:2193-200. [DOI: 10.3899/jrheum.140006] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective.Systemic sclerosis (SSc) has a female predominance, however, little is understood about the effect of sex on SSc manifestations and survival. The objectives of our study were to evaluate differences in disease manifestations, and survival rates between males and females with SSc.Methods.A retrospective cohort study of the Toronto Scleroderma Program was conducted to evaluate sex-based differences in disease manifestations and survival. A relative survival analysis compared SSc survival to the general population.Results.There were 959 patients (791 females, 168 males) identified, with a female:male ratio of 4.7:1. Males more frequently had diffuse SSc [45% vs 30%, relative risk (RR) 1.44, 95% CI 1.18–1.75] and interstitial lung disease (ILD; 41% vs 33%, RR 1.24, 95% CI 1.01–1.52). There were 324 deaths (65 males, 259 females). Males had increased unadjusted mortality compared to females (HR 1.57, 95% CI 1.19–2.06). In an adjusted model including immunosuppressive use, male sex (HR 1.40, 95% CI 1.06–1.85), ILD (HR 1.58, 95% CI 1.26–1.98), and older age at diagnosis (HR 1.05, 95% CI 1.04–1.06) were independently associated with increased mortality, whereas the limited subtype (HR 0.70, 95% CI 0.49–0.77) and anticentromere antibodies (HR 0.70, 95% CI 0.49–0.98) were independently associated with decreased mortality. Male sex was associated with increased risk of mortality (HR 1.16, p = 0.003) in patients with SSc above that observed for males in the general population.Conclusion.The differential effect of disease between sexes is small, yet males have decreased survival compared to females with SSc.
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Mahler M, Satoh M, Hudson M, Baron M, Chan JYF, Chan EKL, Wick J, Fritzler MJ. Autoantibodies to the Rpp25 component of the Th/To complex are the most common antibodies in patients with systemic sclerosis without antibodies detectable by widely available commercial tests. J Rheumatol 2014; 41:1334-43. [PMID: 24931955 DOI: 10.3899/jrheum.131450] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Antinuclear antibodies (ANA) occur in up to 95% of patients with systemic sclerosis (SSc). In most, SSc-associated antibodies are detected (i.e., centromere, topoisomerase I, RNA polymerase III, PM/Scl, Ro52/TRIM21, and U1RNP). Ribonuclease P protein subunit p25, (Rpp25) is an autoantigenic component of the Th/To complex. The contribution of anti-Th/To and anti-Rpp25 antibodies to ANA positivity in patients with SSc remains unknown. METHODS Sera from 873 patients with SSc were tested for ANA, and SSc-associated antibodies were measured. Samples without antibodies to extractable nuclear antigens (ENA; n = 53, ANA+/ENA-), were analyzed by immunoprecipitation (IP) and metabolically labeled proteins and for anti-Rpp25 antibodies (n = 50) by a chemiluminescent immunoassay (CLIA) and Rpp25 ELISA. RESULTS Anti-Th/To antibodies occurred in 19/53 (36%), as determined by IP, and were the most common autoantibody in ANA+/ENA- SSc. Of those samples, 50/53 were available for additional testing by CLIA and ELISA. Anti-Rpp25 antibodies were detected in 12 (24% CLIA) or 10 (20% ELISA) of 50 patients. Receiver-operating characteristic curve analysis showed similar discrimination between Th/To IP-positive (n = 19) and -negative samples (n = 31) by CLIA and ELISA (area under the curve 0.90 vs 0.87; p = 0.6691). The positive percent agreement between IP and CLIA or ELISA was 12/19 (63.2%, 95% CI 38.4-83.7%) or 10/19 (52.6%, 95% CI 73.3-94.2%), respectively. Negative percent agreement was 100% for both assays. CONCLUSION Autoantibodies to the Th/To autoantigen are important in patients with SSc who have been considered negative for SSc-specific or SSc-associated antibodies by widely available commercial assays. Rpp25 can be considered a major target of anti-Th/To antibodies. Assays detecting anti-Th/To and anti-Rpp25 antibodies may be important in SSc.
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Affiliation(s)
- Michael Mahler
- From INOVA Diagnostics Inc., San Diego, California, USA; the Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan; Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, and the Department of Oral Biology, University of Florida, Gainesville, Florida, USA; Department of Medicine, McGill University; the Division of Rheumatology and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec; the Department of Medicine, University of Calgary, Calgary, Alberta, Canada.M. Mahler, PhD, INOVA Diagnostics Inc.; M. Satoh, MD, PhD, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida; M. Hudson, MD, Department of Medicine, McGill University, Division of Rheumatology and Lady Davis Institute, Jewish General Hospital; M. Baron, MD, Department of Medicine, McGill University, and Division of Rheumatology, Jewish General Hospital; J.Y.F. Chan; E.K.L. Chan, PhD, Department of Oral Biology, University of Florida; J. Wick, BSc; M.J. Fritzler, MD, PhD, Department of Medicine, University of Calgary.
| | - Minoru Satoh
- From INOVA Diagnostics Inc., San Diego, California, USA; the Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan; Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, and the Department of Oral Biology, University of Florida, Gainesville, Florida, USA; Department of Medicine, McGill University; the Division of Rheumatology and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec; the Department of Medicine, University of Calgary, Calgary, Alberta, Canada.M. Mahler, PhD, INOVA Diagnostics Inc.; M. Satoh, MD, PhD, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida; M. Hudson, MD, Department of Medicine, McGill University, Division of Rheumatology and Lady Davis Institute, Jewish General Hospital; M. Baron, MD, Department of Medicine, McGill University, and Division of Rheumatology, Jewish General Hospital; J.Y.F. Chan; E.K.L. Chan, PhD, Department of Oral Biology, University of Florida; J. Wick, BSc; M.J. Fritzler, MD, PhD, Department of Medicine, University of Calgary
| | - Marie Hudson
- From INOVA Diagnostics Inc., San Diego, California, USA; the Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan; Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, and the Department of Oral Biology, University of Florida, Gainesville, Florida, USA; Department of Medicine, McGill University; the Division of Rheumatology and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec; the Department of Medicine, University of Calgary, Calgary, Alberta, Canada.M. Mahler, PhD, INOVA Diagnostics Inc.; M. Satoh, MD, PhD, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida; M. Hudson, MD, Department of Medicine, McGill University, Division of Rheumatology and Lady Davis Institute, Jewish General Hospital; M. Baron, MD, Department of Medicine, McGill University, and Division of Rheumatology, Jewish General Hospital; J.Y.F. Chan; E.K.L. Chan, PhD, Department of Oral Biology, University of Florida; J. Wick, BSc; M.J. Fritzler, MD, PhD, Department of Medicine, University of Calgary
| | - Murray Baron
- From INOVA Diagnostics Inc., San Diego, California, USA; the Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan; Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, and the Department of Oral Biology, University of Florida, Gainesville, Florida, USA; Department of Medicine, McGill University; the Division of Rheumatology and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec; the Department of Medicine, University of Calgary, Calgary, Alberta, Canada.M. Mahler, PhD, INOVA Diagnostics Inc.; M. Satoh, MD, PhD, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida; M. Hudson, MD, Department of Medicine, McGill University, Division of Rheumatology and Lady Davis Institute, Jewish General Hospital; M. Baron, MD, Department of Medicine, McGill University, and Division of Rheumatology, Jewish General Hospital; J.Y.F. Chan; E.K.L. Chan, PhD, Department of Oral Biology, University of Florida; J. Wick, BSc; M.J. Fritzler, MD, PhD, Department of Medicine, University of Calgary
| | - Jason Y F Chan
- From INOVA Diagnostics Inc., San Diego, California, USA; the Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan; Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, and the Department of Oral Biology, University of Florida, Gainesville, Florida, USA; Department of Medicine, McGill University; the Division of Rheumatology and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec; the Department of Medicine, University of Calgary, Calgary, Alberta, Canada.M. Mahler, PhD, INOVA Diagnostics Inc.; M. Satoh, MD, PhD, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida; M. Hudson, MD, Department of Medicine, McGill University, Division of Rheumatology and Lady Davis Institute, Jewish General Hospital; M. Baron, MD, Department of Medicine, McGill University, and Division of Rheumatology, Jewish General Hospital; J.Y.F. Chan; E.K.L. Chan, PhD, Department of Oral Biology, University of Florida; J. Wick, BSc; M.J. Fritzler, MD, PhD, Department of Medicine, University of Calgary
| | - Edward K L Chan
- From INOVA Diagnostics Inc., San Diego, California, USA; the Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan; Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, and the Department of Oral Biology, University of Florida, Gainesville, Florida, USA; Department of Medicine, McGill University; the Division of Rheumatology and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec; the Department of Medicine, University of Calgary, Calgary, Alberta, Canada.M. Mahler, PhD, INOVA Diagnostics Inc.; M. Satoh, MD, PhD, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida; M. Hudson, MD, Department of Medicine, McGill University, Division of Rheumatology and Lady Davis Institute, Jewish General Hospital; M. Baron, MD, Department of Medicine, McGill University, and Division of Rheumatology, Jewish General Hospital; J.Y.F. Chan; E.K.L. Chan, PhD, Department of Oral Biology, University of Florida; J. Wick, BSc; M.J. Fritzler, MD, PhD, Department of Medicine, University of Calgary
| | - James Wick
- From INOVA Diagnostics Inc., San Diego, California, USA; the Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan; Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, and the Department of Oral Biology, University of Florida, Gainesville, Florida, USA; Department of Medicine, McGill University; the Division of Rheumatology and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec; the Department of Medicine, University of Calgary, Calgary, Alberta, Canada.M. Mahler, PhD, INOVA Diagnostics Inc.; M. Satoh, MD, PhD, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida; M. Hudson, MD, Department of Medicine, McGill University, Division of Rheumatology and Lady Davis Institute, Jewish General Hospital; M. Baron, MD, Department of Medicine, McGill University, and Division of Rheumatology, Jewish General Hospital; J.Y.F. Chan; E.K.L. Chan, PhD, Department of Oral Biology, University of Florida; J. Wick, BSc; M.J. Fritzler, MD, PhD, Department of Medicine, University of Calgary
| | - Marvin J Fritzler
- From INOVA Diagnostics Inc., San Diego, California, USA; the Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kita-kyushu, Japan; Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, and the Department of Oral Biology, University of Florida, Gainesville, Florida, USA; Department of Medicine, McGill University; the Division of Rheumatology and Lady Davis Institute, Jewish General Hospital, Montréal, Quebec; the Department of Medicine, University of Calgary, Calgary, Alberta, Canada.M. Mahler, PhD, INOVA Diagnostics Inc.; M. Satoh, MD, PhD, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Division of Rheumatology and Clinical Immunology, Department of Medicine, and Pathology, Immunology and Laboratory Medicine, University of Florida; M. Hudson, MD, Department of Medicine, McGill University, Division of Rheumatology and Lady Davis Institute, Jewish General Hospital; M. Baron, MD, Department of Medicine, McGill University, and Division of Rheumatology, Jewish General Hospital; J.Y.F. Chan; E.K.L. Chan, PhD, Department of Oral Biology, University of Florida; J. Wick, BSc; M.J. Fritzler, MD, PhD, Department of Medicine, University of Calgary
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Petit A, Dadzie O. Multisystemic diseases and ethnicity: a focus on lupus erythematosus, systemic sclerosis, sarcoidosis and Behçet disease. Br J Dermatol 2013; 169 Suppl 3:1-10. [PMID: 24098896 DOI: 10.1111/bjd.12533] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 01/15/2023]
Affiliation(s)
- A. Petit
- Service de Dermatologie; APHP Hôpital Saint-Louis; 1 avenue Claude Vellefaux 75010 Paris France
| | - O.E. Dadzie
- Department of Dermatology and Histopathology; The North West London Hospitals NHS Trust; Northwick Park Hospital; Watford Road Harrow HA1 3UJ U.K
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Muro Y, Sugiura K, Akiyama M. What autoantibody tests should become widely available to help scleroderma diagnosis and management? Arthritis Res Ther 2013; 15:116. [PMID: 23856077 PMCID: PMC3978467 DOI: 10.1186/ar4241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Anti-Th/To autoantibodies have been recognized as serological markers of systemic sclerosis (SSc) for more than 20 years. However, validated immunoassay kits to test this specificity have not been commercially available. SSc autoantibodies are basically mutually exclusive and are associated with a certain subset of the disease and/or with organ involvement. Anti-Th/To are generally considered to be markers of the limited cutaneous type of SSc with the involvement of certain internal organs. The excellent correlation between anti-Rpp25 as detected by their novel chemiluminescent method and anti-Th/To as detected by immunoprecipitation suggest that the new assays may become widely available tests for clinicians in future and could help to clarify the clinical significance of anti-Th/To in SSc as well as other conditions over different races or countries.
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Mahler M, Gascon C, Patel S, Ceribelli A, Fritzler MJ, Swart A, Chan EKL, Satoh M. Rpp25 is a major target of autoantibodies to the Th/To complex as measured by a novel chemiluminescent assay. Arthritis Res Ther 2013; 15:R50. [PMID: 23587095 PMCID: PMC3672760 DOI: 10.1186/ar4210] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/09/2013] [Indexed: 12/11/2022] Open
Abstract
Introduction Autoantibodies to the Th/To antigen have been described in systemic sclerosis (SSc) and several proteins of the macromolecular Th/To complex have been reported to react with anti-Th/To antibodies. However, anti-Th/To has not been clinically utilized due to unavailability of commercial tests. The objective of the present study is to evaluate the newly developed ELISA and chemiluminescent immunoassay (CLIA) to measure autoantibodies to Rpp25 (a component of the Th/To complex) using immunoprecipitation (IP) as the reference method. Methods The first cohort consisted of 123 SSc patients including 7 anti-Th/To positive samples confirmed by IP. Additional seven anti-Th/To positive samples from non-SSc patients were also tested. For evaluation of the QUANTA Flash Rpp25 CLIA (research use only), 8 anti-Th/To IP positives, a cohort of 70 unselected SSc patients and sera from various disease controls (n = 357) and random healthy individuals (n = 10) were studied. Results Anti-Rpp25 antibodies determined by ELISA were found in 11/14 anti-Th/To IP positive but only in 1/156 (0.6%) negative samples resulting in a positive percent agreement of 78.6% (95% confidence interval [CI] 49.2, 95.3%) and a negative percent agreement of 99.4% (95% CI 96.4, 100.0%). To verify the results using a second method, 53 samples were tested by ELISA and CLIA for anti-Rpp25 reactivity and the results were highly correlated (rho = 0.71, 95% CI 0.56, 0.81; P < 0.0001). To define the cutoff of the CLIA, anti-Th/To IP positive and negative sera were tested using the anti-Rpp25 CLIA. At the cutoff selected by receiver operating characteristic (ROC) analysis 8/8 (100.0%) of the anti-Th/To positive sera but only 2/367 (0.5%) of the controls were positive for anti-Rpp25 antibodies. The positive and negative percent agreements were 100.0% (95% CI 63.1, 100.0%) and 99.5% (95% CI 98.0, 99.9%), respectively. In the disease cohorts 2/70 (2.9%) of the SSc patients were positive for anti-Rpp25 antibodies compared to 2/367 (0.5%) of the controls (P = 0.032). ROC analysis showed discrimination between SSc patients and controls with an area under the curve value of 0.732 (95% CI 0.655, 0.809). Conclusion Rpp25 is a major target of autoantibodies to the Th/To autoantigen complex. Further studies are needed to evaluate the clinical utility of the new assays.
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Wang J, Assassi S, Guo G, Tu W, Wu W, Yang L, Xiao R, Zhao Y, Chu H, Liu J, Ma Y, Kim SJ, Jin L, Mayes MD, Zou H, Zhou X. Clinical and serological features of systemic sclerosis in a Chinese cohort. Clin Rheumatol 2012; 32:617-21. [PMID: 23271609 DOI: 10.1007/s10067-012-2145-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 10/05/2012] [Accepted: 12/08/2012] [Indexed: 11/25/2022]
Abstract
Our goal was to study the prevalence of systemic sclerosis (SSc) subtypes, autoantibody profile, and pulmonary fibrosis in a large group of Han Chinese. Chinese SSc patients (n = 419) were recruited from a multicenter study including hospitals and outpatient clinics in China. All patients met the American College of Rheumatology classification criteria for SSc. Anti-topoisomerase (ATA), anti-centromere (ACA), anti-RNA polymerase III (anti-RNAP3), and anti-U1-ribonucleoprotein (anti-U1RNP) were detected utilizing commercially available kits. The clinical and autoantibody information in Chinese patients was compared to that in the US Caucasian patients (n = 834), recruited from the Genetics versus Environment in Scleroderma Outcome Study and Scleroderma Family Registry. Chi-square test was utilized for the abovementioned comparisons. Chinese patients showed 40.3 % limited (lcSSc) and 59.7 % diffuse (dcSSc) forms of SSc. ATA was found in 59.9 %, ACA in 13.4 %, anti-RNAP3 in 1.3 %, and anti-U1RNP in 18 % of Chinese SSc patients. Compared to US patients (65.1 % lcSSc, 34.9 % dcSSc, ATA in 18.7 %, ACA in 32.4 %, anti-RNAP3 in 17.4 %, and anti-U1RNP in 2.8 %), Chinese SSc patients are significantly higher in dcSSc and the frequencies of ATA and anti-U1RNP, but lower in ACA and anti-RNAP3. In addition, pulmonary fibrosis was observed in 78 % Chinese SSc patients and was strongly associated with the presence of ATA. The present study represents the first report of SSc features in a large group of Chinese patients. Clinical subtypes and the frequencies of SSc-related autoantibodies in Chinese SSc patients are significantly different from those in SSc patients of the US Caucasian descent.
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Affiliation(s)
- Jiucun Wang
- Ministry of Education Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China
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Current world literature. Curr Opin Rheumatol 2012; 24:694-702. [PMID: 23018859 DOI: 10.1097/bor.0b013e328359ee5b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A new immunoprecipitation-real time quantitative PCR assay for anti-Th/To and anti-U3RNP antibody detection in systemic sclerosis. Arthritis Res Ther 2012; 14:R128. [PMID: 22643159 PMCID: PMC3446509 DOI: 10.1186/ar3858] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 05/05/2012] [Accepted: 05/29/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Classic anti-nucleolar antibodies anti-Th/To and U3 ribonucleoprotein (-U3RNP) can help in the diagnosis, prediction of organ involvement and prognosis in systemic sclerosis (SSc); however, no validated commercial assay is available. We aimed at establishing a novel quantitative real time PCR (qPCR) method to detect these antibodies. METHODS Standard immunoprecipitation (IP) was performed using K562 cell extract and RNA components were extracted. cDNA was reverse transcribed from RNA components and Th RNA and U3 RNA were detected by qPCR using custom primers. Cycle threshold (Ct) values were compared in a titration experiment to determine the assay efficacy. The new assay was evaluated by testing 22 anti-Th/To and 12 anti-U3RNP positive samples in addition to 88 controls, and the results were compared with IP as a gold standard. RESULTS By testing serial 1:8 dilutions of cell lysate as the substrate in the IP step, RNA extracted after IP, and its derived cDNA, linear dose response curves were noted for both anti-Th/To and -U3RNP. With every dilution, Ct values changed approximately three as expected, reflecting the eight-fold difference of cDNA. The Ct difference between positive and negative samples was 8 to 13, which was similar throughout the dilutions. In the specificity analysis, the Ct values of positive samples were clearly different from the negative groups and the results by qPCR had a near perfect correlation with IP. CONCLUSIONS Our new method readily detects these two clinically important antibodies in SSc. Making tests for anti-Th/To and -U3RNP antibodies widely available to clinicians should be helpful in the diagnosis and follow-up of SSc patients.
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