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Arvidsson G, Czarnewski P, Johansson A, Raine A, Imgenberg-Kreuz J, Nordlund J, Nordmark G, Syvänen AC. Multimodal Single-Cell Sequencing of B Cells in Primary Sjögren's Syndrome. Arthritis Rheumatol 2024; 76:255-267. [PMID: 37610265 DOI: 10.1002/art.42683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/08/2023] [Accepted: 08/18/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE B cells are important in the pathogenesis of primary Sjögren's syndrome (pSS). Patients positive for Sjögren's syndrome antigen A/Sjögren syndrome antigen B (SSA/SSB) autoantibodies are more prone to systemic disease manifestations and adverse outcomes. We aimed to determine the role of B cell composition, gene expression, and B cell receptor usage in pSS subgroups stratified for SSA/SSB antibodies. METHODS Over 230,000 B cells were isolated from peripheral blood of patients with pSS (n = 6 SSA-, n = 8 SSA+ single positive and n = 10 SSA/SSB+ double positive) and four healthy controls and processed for single-cell RNA sequencing (scRNA-seq) and single-cell variable, diversity, and joining (VDJ) gene sequencing (scVDJ-seq). RESULTS We show that SSA/SSB+ patients present the highest and lowest proportion of naïve and memory B cells, respectively, and the highest up-regulation of interferon-induced genes across all B cell subtypes. Differential usage of IGHV showed that IGHV1-69 and IGHV4-30-4 were more often used in all pSS subgroups compared with controls. Memory B cells from SSA/SSB+ patients displayed a higher proportion of cells with unmutated VDJ transcripts compared with other pSS patient groups and controls, indicating altered somatic hypermutation processes. Comparison with previous studies revealed heterogeneous clonotype pools, with little overlap in CDR3 sequences. Joint analysis using scRNA-seq and scVDJ-seq data allowed unsupervised stratification of patients with pSS and identified novel parameters that correlated to disease manifestations and antibody status. CONCLUSION We describe heterogeneity and molecular characteristics in B cells from patients with pSS, providing clues to intrinsic differences in B cells that affect the phenotype and outcome and allowing stratification of patients with pSS at improved resolution.
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Barcelos F, Brás-Geraldes C, Martins C, Papoila AL, Monteiro R, Cardigos J, Madeira N, Alves N, Vaz-Patto J, Cunha-Branco J, Borrego LM. Added value of lymphocyte subpopulations in the classification of Sjögren's syndrome. Sci Rep 2023; 13:6872. [PMID: 37106029 PMCID: PMC10140065 DOI: 10.1038/s41598-023-31782-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/17/2023] [Indexed: 04/29/2023] Open
Abstract
Sjögren's Syndrome (SjS) is a chronic systemic immune-mediated inflammatory disease characterized by lymphocytic infiltration and consequent lesion of exocrine glands. SjS diagnosis and classification remains a challenge, especially at SjS onset, when patients may have milder phenotypes of the disease or uncommon presentations. New biomarkers are needed for the classification of SjS, thus, we aimed to evaluate the added-value of lymphocyte subpopulations in discriminating SjS and non-Sjögren Sicca patients. Lymphocyte subsets from 62 SjS and 63 Sicca patients were characterized by flow cytometry. The 2002 AECG and the 2016 ACR/EULAR SjS classification criteria were compared with clinical diagnosis. The added discriminative ability of joining lymphocytic populations to classification criteria was assessed by the area under the Receiver-Operating-Characteristic Curve (AUC). Considering clinical diagnosis as the gold-standard, we obtained an AUC = 0.952 (95% CI: 0.916-0.989) for AECG and an AUC = 0.921 (95% CI: 0.875-0.966) for ACR/EULAR criteria. Adding Tfh and Bm1 subsets to AECG criteria, performance increased, attaining an AUC = 0.985 (95% CI: 0.968-1.000) (p = 0.021). Th1/Breg-like CD24hiCD27+ and switched-memory B-cells maximized the AUC of ACR/EULAR criteria to 0.953 (95% CI: 0.916-0.990) (p = 0.043). Our exploratory study supports the potential use of lymphocyte subpopulations, such as unswitched memory B cells, to improve the performance of classification criteria, since their discriminative ability increases when specific subsets are added to the criteria.
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Affiliation(s)
- Filipe Barcelos
- Comprehensive Health Research Centre, CEDOC, Chronic Diseases Research Center, Immunology, NOVA Medical School, Universidade Nova de Lisboa, Campo Dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, FCM, Universidade Nova de Lisboa, Lisbon, Portugal.
- Rheumatology Department, Instituto Português de Reumatologia, Lisbon, Portugal.
- Rheumatology Department, Hospital CUF Descobertas, Lisbon, Portugal.
| | - Carlos Brás-Geraldes
- ISEL-Instituto Superior de Engenharia de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
- Centro de Estatística E Aplicações, CEAUL, Universidade de Lisboa, Lisbon, Portugal
| | - Catarina Martins
- Comprehensive Health Research Centre, CEDOC, Chronic Diseases Research Center, Immunology, NOVA Medical School, Universidade Nova de Lisboa, Campo Dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana-Luísa Papoila
- Centro de Estatística E Aplicações, CEAUL, Universidade de Lisboa, Lisbon, Portugal
- NOVA Medical School, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ricardo Monteiro
- Comprehensive Health Research Centre, CEDOC, Chronic Diseases Research Center, Immunology, NOVA Medical School, Universidade Nova de Lisboa, Campo Dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Joana Cardigos
- Ophthalmology Department, Centro Hospitalar de Lisboa Central, Hospital de Santo António Dos Capuchos, Lisbon, Portugal
| | - Nathalie Madeira
- Rheumatology Department, Instituto Português de Reumatologia, Lisbon, Portugal
| | - Nuno Alves
- Ophthalmology Department, Centro Hospitalar de Lisboa Central, Hospital de Santo António Dos Capuchos, Lisbon, Portugal
- Ophthalmology Department, Hospital CUF Descobertas, Lisbon, Portugal
| | - José Vaz-Patto
- Rheumatology Department, Instituto Português de Reumatologia, Lisbon, Portugal
| | - Jaime Cunha-Branco
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- Rheumatology Department, Hospital CUF Descobertas, Lisbon, Portugal
- Chronic Diseases Research Center, NOVA Medical School, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- Rheumatology Department, Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisbon, Portugal
| | - Luís-Miguel Borrego
- Comprehensive Health Research Centre, CEDOC, Chronic Diseases Research Center, Immunology, NOVA Medical School, Universidade Nova de Lisboa, Campo Dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- Immunoalergy Department, Hospital da Luz Lisboa, Lisbon, Portugal
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Wiriyakijja P, Niklander S, Santos-Silva AR, Shorrer MK, Simms ML, Villa A, Sankar V, Kerr AR, Riordain RN, Jensen SB, Delli K. World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00068-8. [PMID: 37198047 DOI: 10.1016/j.oooo.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth. STUDY DESIGN A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized. RESULTS From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains. CONCLUSION There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.
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Lin L, Hang H, Zhang J, Lu J, Chen D, Shi J. Clinical significance of anti-SSA/Ro antibody in Neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2022; 58:103494. [PMID: 35051897 DOI: 10.1016/j.msard.2022.103494] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/19/2021] [Accepted: 01/01/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disease of the central nervous system (CNS), also described as CNS autoimmune astrocytopathy, due to the production of pathogenic antibodies against aquaporin-4 (AQP4) expressed on the foot of astrocytes. NMOSD coexists with autoimmune diseases and related autoantibodies [anti-Sjogren's syndrome A (anti-SSA)/Ro antibody, anti-Sjogren's syndrome B (anti-SSB)/La antibody, anti-nuclear (anti-ANA) antibodies, anti-double-stranded DNA (anti-dsDNA) antibody, anti-thyroglobulin antibody, and anti-thyroid peroxidase antibody]. OBJECTIVES No precise conclusion has been drawn on the role of the anti-SSA/Ro antibody in NMOSD. Therefore, the aim of this work was to evaluate whether the anti-SSA/Ro antibody has an impact on the clinical manifestation or prognosis of NMOSD. METHODS Data were retrospectively collected from 102 patients with NMOSD diagnosed by experienced neurologists. The study population was divided into two groups based on the serum anti-SSA/Ro antibody status: NMOSD with or without anti-SSA/Ro antibody. The clinical, neuroimaging and laboratory parameters were compared between the two groups, including the neurological symptoms, MRI results, frequency of systemic autoantibodies, Expanded Disability Status Scale (EDSS), and NMOSD relapse rate. The EDSS and relapse were applied as measures of the NMOSD patient prognostic value. Cox regression analysis was used to evaluate the prognostic impact of anti-SSA/Ro antibody on NMOSD. RESULTS Among the 102 NMOSD patients, striking differences were observed in the positive rate of AQP4-IgG (89.2% vs. 72.3%, p = 0.046) between those patients with and without the anti-SSA/Ro antibody. In addition, NMOSD patients with anti-SSA/Ro antibody showed the presence of more frequent anti-ANA antibodies (p = 0.002), anti-SSB/La antibody (p < 0.001), anti-dsDNA antibody (p < 0.002), Sjogren's syndrome (SS, p < 0.001) and systemic lupus erythematosus (SLE, p = 0.045). Univariate and multivariate Cox regression analysis were performed to confirm that the anti-SSA/Ro antibody affected the EDSS score and the relapse of NMOSD patients. The analysis of the survival curve revealed that the EDSS score in the NMOSD patients positive for the anti-SSA/Ro antibody reached 4.0 (p = 0.035) and relapsed (p = 0.039) earlier than in the negative group. CONCLUSION The anti-SSA/Ro antibody could be associated with disease activity and severe disability in NMOSD.
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Affiliation(s)
- Liuyu Lin
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Hailun Hang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jihong Zhang
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jie Lu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China.
| | - Daowen Chen
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jingping Shi
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
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Urbanski G, Gury A, Jeannin P, Chevailler A, Lozac’h P, Reynier P, Lavigne C, Lacout C, Vinatier E. Discordant Predictions of Extraglandular Involvement in Primary Sjögren's Syndrome According to the Anti-SSA/Ro60 Antibodies Detection Assay in a Cohort Study. J Clin Med 2022; 11:jcm11010242. [PMID: 35011983 PMCID: PMC8745780 DOI: 10.3390/jcm11010242] [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: 11/28/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Electrophoresis-derived techniques for anti-SSA/Ro60 KDa (anti-SSA) antibodies detection have been progressively replaced by methods using non-native antigens. We aimed to compare the patients’ phenotypes and the occurrence of extraglandular manifestations in primary Sjögren’s syndrome according to the method used to detect anti-SSA antibodies. Sera from patients with a diagnosis of pSS according to ACR/EULAR 2016 criteria between 2008 and 2017 were tested for anti-SSA antibodies using methods with non-native antigens (magnetic bead multiplex assay; line immunoassays) and one with native antigens (counterimmunoelectrophoresis (CIE)). The population was split into three groups according to anti-SSA antibodies status: absence (SSA−), presence in any method except for CIE (SSA+CIE−), and presence in CIE (SSA+CIE+). The patients in the SSA+CIE+ group (n = 70, 42.7%) were ten years younger and presented more immunological activity compared with both the SSA− (n = 80, 48.8%) and SSA+CIE− groups (n = 14, 8.5%). The SSA− and SSA+CIE− groups were poorly distinct. The presence of anti-SSA antibodies solely in CIE was significantly associated with the occurrence of extraglandular manifestations of pSS (HR = 4.45 (2.35–8.42)). Contrary to CIE, methods using non-native antigens to detect anti-SSA antibodies were unable to predict the occurrence of systemic expression of pSS.
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Affiliation(s)
- Geoffrey Urbanski
- Department of Internal Medicine and Clinical Immunology, University Hospital, 49000 Angers, France; (A.G.); (P.L.); (C.L.); (C.L.)
- Mitolab, MitoVasc Institute, CNRS 6015, INSERM U1083, University of Angers, 49000 Angers, France;
- Correspondence: ; Tel.: +33-(0)2-4135-4003
| | - Aline Gury
- Department of Internal Medicine and Clinical Immunology, University Hospital, 49000 Angers, France; (A.G.); (P.L.); (C.L.); (C.L.)
| | - Pascale Jeannin
- Laboratory of Immunology, University Hospital, 49000 Angers, France; (P.J.); (A.C.); (E.V.)
- INSERM, CRCINA, Angers University, 49000 Angers, France
| | - Alain Chevailler
- Laboratory of Immunology, University Hospital, 49000 Angers, France; (P.J.); (A.C.); (E.V.)
| | - Pierre Lozac’h
- Department of Internal Medicine and Clinical Immunology, University Hospital, 49000 Angers, France; (A.G.); (P.L.); (C.L.); (C.L.)
- Department of Internal Medicine, General Hospital, 72000 Le Mans, France
| | - Pascal Reynier
- Mitolab, MitoVasc Institute, CNRS 6015, INSERM U1083, University of Angers, 49000 Angers, France;
| | - Christian Lavigne
- Department of Internal Medicine and Clinical Immunology, University Hospital, 49000 Angers, France; (A.G.); (P.L.); (C.L.); (C.L.)
| | - Carole Lacout
- Department of Internal Medicine and Clinical Immunology, University Hospital, 49000 Angers, France; (A.G.); (P.L.); (C.L.); (C.L.)
| | - Emeline Vinatier
- Laboratory of Immunology, University Hospital, 49000 Angers, France; (P.J.); (A.C.); (E.V.)
- INSERM, CRCINA, Angers University, 49000 Angers, France
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