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Saisirivechakun P, Mahakkanukrauh A, Pongchaiyakul C, Boonya-Ussadorn T, Narongroeknawin P, Pakchotanon R, Assavatanabodee P, Chaiamnuay S. Prevalence of low trabecular bone score and its association with disease severity and activity in patients with axial spondyloarthritis. Sci Rep 2023; 13:16258. [PMID: 37758825 PMCID: PMC10533482 DOI: 10.1038/s41598-023-43321-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 09/22/2023] [Indexed: 09/29/2023] Open
Abstract
Axial spondyloarthritis (axSpA) increases the risk of osteoporosis and vertebral fractures. Bone mineral density (BMD) measured by dual X-ray absorptiometry (DXA) has limitations in axSpA patients. Trabecular bone score (TBS) indirectly assesses bone microarchitecture and can be used to predict fracture risk. However, few studies have investigated the role of TBS in axSpA patients. The objective of this study were to compare TBS between axSpA patients and 1:1 sex- and age-matched healthy volunteers and determine factors associated with low TBS in axSpA patients. A cross-sectional study was conducted in two tertiary-care hospitals. A total of 137 axSpA patients and healthy volunteers were enrolled. Demographics, disease characteristics, and risk factors for osteoporosis were recorded. TBS, BMD at the lumbar spine, hip, and vertebral fractures were assessed by DXA. Low TBS was defined as a TBS value < 1.230. Factors associated with low TBS were examined by logistic regression. Most patients were male (75.9%) and tested positive for HLA-B27 (88.3%). The mean (SD) age was 42.8 (12.0) years. The mean (SD) of TBS in the axSpA patients was lower than those in the healthy volunteers [1.402 (0.107) vs 1.440 (0.086), respectively; p = 0.002]. The mean (SD) of lumbar BMD in the axSpA patients was higher than in healthy volunteers [1.186 (0.212) vs 1.087 (0.124), p < 0.001], whereas the mean (SD) of femoral neck BMD in the axSpA group was lower than that in the healthy volunteers [0.867 (0.136) vs 0.904 (0.155), p = 0.038]. Disease severity as indicated by sacroiliac joint fusion and a high ASDAS score were associated with low TBS with the odds ratios (95% confidence interval) of 11.8 (1.2-115.4) and 5.2 (1.6-16.9), respectively. In conclusion, axSpA patients had a higher prevalence of low TBS than healthy volunteers. Sacroiliac joint fusion and a high ASDAS score were associated with low TBS.
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Affiliation(s)
- Pannarat Saisirivechakun
- Rheumatic Diseases Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Ajanee Mahakkanukrauh
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Trirat Boonya-Ussadorn
- Division of Nuclear Medicine, Department of Radiology, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Pongthorn Narongroeknawin
- Rheumatic Diseases Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Rattapol Pakchotanon
- Rheumatic Diseases Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Paijit Assavatanabodee
- Rheumatic Diseases Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Sumapa Chaiamnuay
- Rheumatic Diseases Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand.
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Coletto LA, Rizzo C, Guggino G, Caporali R, Alivernini S, D’Agostino MA. The Role of Neutrophils in Spondyloarthritis: A Journey across the Spectrum of Disease Manifestations. Int J Mol Sci 2023; 24:ijms24044108. [PMID: 36835520 PMCID: PMC9959122 DOI: 10.3390/ijms24044108] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Spondyloarthritis (SpA) contemplates the inflammatory involvement of the musculoskeletal system, gut, skin, and eyes, delineating heterogeneous diseases with a common pathogenetic background. In the framework of innate and adaptive immune disruption in SpA, neutrophils are arising, across different clinical domains, as pivotal cells crucial in orchestrating the pro-inflammatory response, both at systemic and tissue levels. It has been suggested they act as key players along multiple stages of disease trajectory fueling type 3 immunity, with a significant impact in the initiation and amplification of inflammation as well as in structural damage occurrence, typical of long-standing disease. The aim of our review is to focus on neutrophils' role within the spectrum of SpA, dissecting their functions and abnormalities in each of the relevant disease domains to understand their rising appeal as potential biomarkers and therapeutic targets.
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Affiliation(s)
- Lavinia Agra Coletto
- Division of Rheumatology, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
- Correspondence:
| | - Chiara Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, 90127 Palermo, Italy
| | - Giuliana Guggino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Rheumatology Section, University of Palermo, 90127 Palermo, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Stefano Alivernini
- Division of Rheumatology, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
| | - Maria Antonietta D’Agostino
- Division of Rheumatology, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, 00168 Rome, Italy
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Guo C, Zheng K, Xie Z, Lu X, Wu S, Ye Q, He Y, Zhou Q, Sun E. Intravoxel incoherent motion diffusion-weighted imaging as a quantitative tool for evaluating disease activity in patients with axial spondyloarthritis. Clin Radiol 2022; 77:e434-e441. [PMID: 35232574 DOI: 10.1016/j.crad.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/02/2022] [Indexed: 12/31/2022]
Abstract
AIM To determine the correlations between four quantitative magnetic resonance imaging (MRI) parameters derived from intravoxel incoherent motion diffusion-weighted images (IVIM DWI) and the semi-quantitative Spondyloarthritis Research Consortium of Canada (SPARCC) score of the sacroiliac joint (SIJ) and five clinical activity indices in patients with axial spondyloarthritis (axSpA). AND METHODS A total of 75 patients with axSpA and complete clinical activity indices and SIJ MRI were enrolled to this prospective study. Univariable and multivariable linear regression analyses were performed to evaluate correlations between MRI parameters and clinical activity indices after controlling for confounders. All data were further analysed using Pearson's correlation coefficients (r). RESULTS Only pure diffusion coefficient (D) and incoherent perfusion related microcirculation (D∗) were found to be independently positively correlated with several clinical activity indices (all p<0.05). Positive correlations were observed between D and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), Patient Global Assessment (PGA), extent of influence of pain, with r of 0.605, 0.402, 0.319, and 0.485 (all p<0.0125). D∗ correlated positively with BASDAI, BASFI, and PGA (r=0.436, 0.356, 0.301, respectively; all p<0.0125). CONCLUSION D and D∗ derived from IVIM DWI could be associated with some disease activity indices in patients with axSpA; apparent diffusion coefficient (ADC) and SPARCC scores were not correlated with these indices. IVIM DWI may be a useful tool for the quantitative assessment of disease activity in patients with axSpA.
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Affiliation(s)
- C Guo
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, Guangdong, 510630, China
| | - K Zheng
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, Guangdong, 510630, China
| | - Z Xie
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, Guangdong, 510630, China
| | - X Lu
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, Guangdong, 510630, China
| | - S Wu
- Department of Rheumatology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, Guangdong, 510630, China
| | - Q Ye
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, Guangdong, 510630, China
| | - Y He
- Department of Rheumatology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, Guangdong, 510630, China
| | - Q Zhou
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, Guangdong, 510630, China
| | - E Sun
- Department of Rheumatology, The Third Affiliated Hospital of Southern Medical University (Academy of Orthopedics, Guangdong Province), Guangzhou, Guangdong, 510630, China
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Abstract
Spondyloarthritis (SpA) is a blanket term encompassing entities such as enthesitis-related arthritis, nonradiographic axial SpA, and ankylosing spondylitis. These diseases share many clinical features, including a predilection for inflammation of the entheses and the sacroiliac joints. The nomenclature is based on the evolution of the classification of the disease and the age of the patient. SpA has a prevalence of approximately 1% of the population of the United States, with 10% to 20% of patients experiencing the onset during childhood. Children with onset of arthritis before age 16 years are classified as having juvenile idiopathic arthritis. Children with enthesitis and/or sacroiliitis are further classified as belonging to the enthesitis-related arthritis subtype of juvenile idiopathic arthritis. The initial manifestations can be subtle and will usually include a peripheral pattern of arthritis and enthesitis. It may take several years for axial disease to develop in children. Except for an association with the human leukocyte antigen (HLA-B27) serotype, there are no laboratory markers for the disease, and the radiographic findings are often negative. A careful clinical evaluation for evidence of inflammation in the entheses and the joints and a search for comorbidities are required. Magnetic resonance imaging facilitates the early detection of sacroiliitis, an important feature that may be clinically silent. Because recent studies indicate that earlier introduction of therapy can help achieve better outcomes, rapid identification and treatment of children with SpA is essential.
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Affiliation(s)
- Lita Aeder
- Department of Pediatrics, Brookdale University Hospital and Medical Center, New York, NY; and State University of New York Health Science Center at Brooklyn, Brooklyn, NY
| | - Karen B Onel
- Department of Pediatric Rheumatology, Hospital for Special Surgery, New York, NY; and Department of Clinical Pediatrics, Weill Cornell Medicine, New York, NY
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Garrido-Castro JL, Aranda-Valera IC, Peña-Amaro J, Martínez-Galisteo A, González-Navas C, Rodrigues-de-Souza DP, Alcaraz-Clariana S, García-Luque L, Sánchez IRM, López-Medina C, Collantes-Estévez E, Alburquerque-Sendín F. Mechanical Properties of Lumbar and Cervical Paravertebral Muscles in Patients with Axial Spondyloarthritis: A Case-Control Study. Diagnostics (Basel) 2021; 11:diagnostics11091662. [PMID: 34574003 PMCID: PMC8472659 DOI: 10.3390/diagnostics11091662] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Axial spondyloarthritis (axSpA) affects spinal muscles, due to inflammation and structural damage. The mechanical properties of the muscles, such as tone or stiffness, could be altered in axSpA. The aim of this work is to analyze the mechanical properties of cervical and lumbar spine muscles in axSpA patients and their relationship with metrology measures, function, disease activity, structural damage and quality of life. Methods: axSpA patients and age/gender/BMI matched healthy controls were recruited. The muscle mechanical properties (MMPs), such as tone or frequency, stiffness, decrement (linear elastic properties), relaxation and creep (viscoelastic properties), of cervical (semispinalis capitis) and lumbar (erector spinae) muscles were bilaterally measured at rest using myotonometry. Additionally, conventional metrology, BASMI (metrology index), BASDAI (disease activity index), mSASSS (radiological structural damage index) and SF-12 (health-related quality of life questionnaire) were used in the axSpA group. Between-groups comparison, intra-group correlations and multivariable regression analyses were performed to achieve the study aims. Results: Thirty-four axSpA patients (mean age: 46.21 ± 8.53 y) and 34 healthy volunteers (mean age: 43.97 ± 8.49 y) were recruited. Both in cervical and lumbar spine, linear elastic parameters were significantly higher in axSpA patients in comparison with controls, while viscoelastic parameters were significantly lower. Lumbar muscle frequency, stiffness, relaxation, creep and cervical muscle elasticity were fair to strongly correlated (|0.346| < r < |0.774|) with age, functional status, activity of disease, structural damage and quality of life in axSpA patients. Furthermore, moderate to good fitted multivariate models (0.328 < R2 < 0.697) were obtained combining age, conventional metrology, activity of the disease and function for the estimation of cervical and lumbar MMPs. Conclusion: Mechanical properties of spinal muscles of axSpA patients differ from controls. Lumbar and cervical muscles exhibit greater linear elastic properties and lower viscoelastic properties, which are related with age, clinical and psychophysiological features of axSpA.
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Affiliation(s)
- Juan L. Garrido-Castro
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; (J.L.G.-C.); (I.C.A.-V.); (J.P.-A.); (C.G.-N.); (C.L.-M.); (E.C.-E.); (F.A.-S.)
| | - I. Concepción Aranda-Valera
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; (J.L.G.-C.); (I.C.A.-V.); (J.P.-A.); (C.G.-N.); (C.L.-M.); (E.C.-E.); (F.A.-S.)
- Department of Rheumatology, University Hospital Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, 14004 Cordoba, Spain
| | - José Peña-Amaro
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; (J.L.G.-C.); (I.C.A.-V.); (J.P.-A.); (C.G.-N.); (C.L.-M.); (E.C.-E.); (F.A.-S.)
- Department of Morphological and Social Health Sciences, University of Cordoba, 14004 Cordoba, Spain
| | | | - Cristina González-Navas
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; (J.L.G.-C.); (I.C.A.-V.); (J.P.-A.); (C.G.-N.); (C.L.-M.); (E.C.-E.); (F.A.-S.)
| | - Daiana P. Rodrigues-de-Souza
- Department of Nursing, Pharmacology and Physical Therapy, University of Cordoba, 14004 Cordoba, Spain; (S.A.-C.); (L.G.-L.)
- Correspondence: ; Tel.: +34-957-218-241
| | - Sandra Alcaraz-Clariana
- Department of Nursing, Pharmacology and Physical Therapy, University of Cordoba, 14004 Cordoba, Spain; (S.A.-C.); (L.G.-L.)
| | - Lourdes García-Luque
- Department of Nursing, Pharmacology and Physical Therapy, University of Cordoba, 14004 Cordoba, Spain; (S.A.-C.); (L.G.-L.)
| | - Iago R. Martínez Sánchez
- Advanced Informatics Research Group (GIIA) TIC-252, University of Cordoba, 14014 Cordoba, Spain;
| | - Clementina López-Medina
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; (J.L.G.-C.); (I.C.A.-V.); (J.P.-A.); (C.G.-N.); (C.L.-M.); (E.C.-E.); (F.A.-S.)
- Department of Rheumatology, University Hospital Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, 14004 Cordoba, Spain
| | - Eduardo Collantes-Estévez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; (J.L.G.-C.); (I.C.A.-V.); (J.P.-A.); (C.G.-N.); (C.L.-M.); (E.C.-E.); (F.A.-S.)
- Department of Rheumatology, University Hospital Reina Sofía, 14004 Cordoba, Spain
- Department of Medical and Surgical Sciences, University of Cordoba, 14004 Cordoba, Spain
| | - Francisco Alburquerque-Sendín
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain; (J.L.G.-C.); (I.C.A.-V.); (J.P.-A.); (C.G.-N.); (C.L.-M.); (E.C.-E.); (F.A.-S.)
- Department of Nursing, Pharmacology and Physical Therapy, University of Cordoba, 14004 Cordoba, Spain; (S.A.-C.); (L.G.-L.)
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The Association of Fecal Microbiota in Ankylosing Spondylitis Cases with C-Reactive Protein and Erythrocyte Sedimentation Rate. Mediators Inflamm 2020; 2020:8884324. [PMID: 33204218 PMCID: PMC7666627 DOI: 10.1155/2020/8884324] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 01/21/2023] Open
Abstract
The purpose of this work was to identify the features of the gut microbiome in cases of ankylosing spondylitis (AS) testing positive for human leukocyte antigen- (HLA-) B27 and healthy controls (HCs) as well as to determine how bacterial populations were correlated with C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Fecal DNA extracted from fecal samples from 10 AS cases and 12 HCs was subjected to 16S rRNA gene sequencing. The two research groups did not differ significantly regarding alpha diversity. By comparison to HCs, AS cases displayed a lower relative level of Bacteroidetes (P < 0.05), but a higher level of Firmicutes and Verrucomicrobia (P < 0.05). Furthermore, the correlation between the specific gut bacteria and ESR or CRP was investigated. At the phylum level, Firmicutes and Verrucomicrobia had a positive association with ESR and CRP, while Bacteroidetes exhibited an inverse correlation with ESR and CRP. Meanwhile, in terms of genus, Bacteroides had a positive association with ESR and CRP, whereas Ruminococcus and Parasutterella had an inverse correlation with ESR and CRP, and Helicobacter also displayed an inverse correlation with CRP. Such findings indicated dissimilarities between AS cases and HCs regarding the gut microbiome, as well as the existence of correlations between bacterial populations and both ESR and CRP.
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Briolay A, El Jamal A, Arnolfo P, Le Goff B, Blanchard F, Magne D, Bougault C. Enhanced BMP-2/BMP-4 ratio in patients with peripheral spondyloarthritis and in cytokine- and stretch-stimulated mouse chondrocytes. Arthritis Res Ther 2020; 22:234. [PMID: 33046134 PMCID: PMC7552569 DOI: 10.1186/s13075-020-02330-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 09/28/2020] [Indexed: 12/03/2022] Open
Abstract
Background Excessive bone formation in the entheses is one of the features of peripheral spondyloarthritis (SpA). Complex pathological mechanisms connecting inflammation, mechanical stress, and ossification are probably involved. We focused on bone morphogenetic protein (BMP)-2, -4, and -7 as possible mediators of this process. Methods BMP-2, -4, and -7 concentration was measured by ELISA in synovial fluids (SFs) of SpA (n = 56) and osteoarthritic (n = 21) patients. Mouse organotypic ankle cultures were challenged by a pro-inflammatory cocktail. Mouse primary chondrocytes, osteoblasts, or tenocytes were treated with TNF-α, interleukin (IL)-17, or IL-22 and/or subjected to cyclic stretch, or with recombinant BMP-2 or -4. Results In SpA SFs, if BMP-7 was barely detectable, BMP-2 concentration was higher and BMP-4 was lower than in osteoarthritic samples, so that BMP-2/BMP-4 ratio augmented 6.5 folds (p < 0.001). In SpA patients, TNF-α, IL-6, and IL-17 levels correlated this ratio (n = 21). Bmp-2/Bmp-4 ratio was similarly enhanced by cytokine treatment in explant and cell cultures, at mRNA level. In particular, simultaneous application of TNF-α and cyclical stretch induced a 30-fold increase of the Bmp-2/Bmp-4 ratio in chondrocytes (p = 0.027). Blockade of prostaglandin E2 and IL-6 production had almost no effect on the stretch-induced regulation of Bmp-2 or -4. Osteoinductive effects of BMP-4, and to a lesser extend BMP-2, were identified on cultured chondrocytes and tenocytes. Conclusions Our results first settle that BMP factors are locally deregulated in the SpA joint. An unexpected decrease in BMP-4 could be associated to an increase in BMP-2, possibly in response to mechanical and/or cytokine stimulations.
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Affiliation(s)
- Anne Briolay
- Univ Lyon, Univ Claude Bernard Lyon 1, CNRS UMR 5246, ICBMS, F-69622, Lyon, France
| | - Alaeddine El Jamal
- Univ Lyon, Univ Claude Bernard Lyon 1, CNRS UMR 5246, ICBMS, F-69622, Lyon, France
| | - Paul Arnolfo
- INSERM UMR1238, Nantes University, Nantes, France.,Rheumatology Department, CHU Nantes, Nantes, France
| | - Benoît Le Goff
- INSERM UMR1238, Nantes University, Nantes, France.,Rheumatology Department, CHU Nantes, Nantes, France
| | | | - David Magne
- Univ Lyon, Univ Claude Bernard Lyon 1, CNRS UMR 5246, ICBMS, F-69622, Lyon, France
| | - Carole Bougault
- Univ Lyon, Univ Claude Bernard Lyon 1, CNRS UMR 5246, ICBMS, F-69622, Lyon, France.
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Voruganti A, Bowness P. New developments in our understanding of ankylosing spondylitis pathogenesis. Immunology 2020; 161:94-102. [PMID: 32696457 PMCID: PMC7496782 DOI: 10.1111/imm.13242] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/17/2022] Open
Abstract
Ankylosing spondylitis (AS) is a common immune‐mediated inflammatory arthritis with a strong genetic predisposition. We review recent data from genetic and animal studies highlighting the importance of Type 17 immune responses. Furthermore, the efficacy (or lack thereof) of different anti‐cytokine monoclonal antibodies has highlighted the diversity of Type 17 immune cells and cytokines critical to AS and related spondyloarthritis pathogenesis. Recent studies have strongly implicated the gut microbiome in AS. Finally, we propose that the local metabolic environment of the joint may have a key role in driving AS, and present a novel model of AS pathogenesis.
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Affiliation(s)
| | - Paul Bowness
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Science (NDORMS), Botnar Research Centre, University of Oxford, Headington, Oxford, UK
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Chimenti MS, Perricone C, Conigliaro P, Triggianese P, D'Antonio A, de Martino E, Fonti GL, Caso F, Costa L, Perricone R. Tackling the autoimmune side in Spondyloarthritis: A systematic review. Autoimmun Rev 2020; 19:102648. [PMID: 32801035 DOI: 10.1016/j.autrev.2020.102648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 02/07/2023]
Abstract
Spondyloarthritis (SpA) are a heterogeneous group of inflammatory chronic diseases characterized by sharing common pathogenic, clinical and radiologic features. The aim of this review is to support clinicians in understanding and managing this complex disease, from pathogenesis to therapeutic targets, through a systematic review of the current literature in accordance with PRISMA guidelines and checklist. HLA-B27 has been found to be associated with axial involvement either in SA and in PsA patients: it might be involved through presentation of an "arthritogenic peptide" to autoreactive CD8+ T cells or might accumulate in misfolded form and induce production pro-inflammatory cytokines by binding to several innate immune receptors. This genetic background in combination with mechanical stress leads to the activation of both innate and acquired immune responses as well as a possible role of autoimmunity in SpA pathogenesis. The release of IL-23 and IL-17 is relevant for their systemic and local effect on bone, inducing the activation of osteoclasts. Thus, the regulatory role of IL-17 on fibroblasts, osteoblasts and chondrocytes has an impact in both synovial inflammation and joint destruction. Innovative therapies targeting IL-12/23 and IL-17 and the use of small targeted synthetic molecules, as JAK-inhibitors, proved to be effective in SpA patients representing an alternative strategy to TNF-inhibitors.
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Affiliation(s)
- Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Perricone
- Rheumatology, Department of Medicine, University of Perugia, Piazzale Giorgio Menghini, 1, 06129 Perugia, Italy.
| | - Paola Conigliaro
- Rheumatology, Allergology and Clinical Immunology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Arianna D'Antonio
- Rheumatology, Allergology and Clinical Immunology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Erica de Martino
- Rheumatology, Allergology and Clinical Immunology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giulia Lavinia Fonti
- Rheumatology, Allergology and Clinical Immunology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131 Naples, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, via S. Pansini 5, 80131 Naples, Italy
| | - Roberto Perricone
- Rheumatology, Allergology and Clinical Immunology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
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Yao D, Huang L, Ke J, Zhang M, Xiao Q, Zhu X. Bone metabolism regulation: Implications for the treatment of bone diseases. Biomed Pharmacother 2020; 129:110494. [PMID: 32887023 DOI: 10.1016/j.biopha.2020.110494] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022] Open
Abstract
Bone cells in the human body are continuously engaged in cellular metabolism, including the interaction between bone cells, the interaction between the erythropoietic cells of the bone marrow and stromal cells, for the remodeling and reconstruction of bone. Osteoclasts and osteoblasts play an important role in bone metabolism. Diseases occur when bone metabolism is abnormal, but little is known about the signaling pathways that affect bone metabolism. The study of these signaling pathways will help us to use the relevant techniques to intervene, so as to improve the condition. The study of these signaling pathways will help us to use the relevant techniques to intervene, so as to improve the condition. I believe they will shine in the diagnosis and treatment of future clinical bone diseases.
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Affiliation(s)
- Danqi Yao
- Guangdong Key Laboratory for Research and Development of Natural Drugs, The Marine Biomedical Research Institute, Guangdong Medical University, Zhanjiang, Guangdong 524023, China; The Marine Biomedical Research Institute of Guangdong Zhanjiang, Zhanjiang, Guangdong 524023, China
| | - Lianfang Huang
- Guangdong Key Laboratory for Research and Development of Natural Drugs, The Marine Biomedical Research Institute, Guangdong Medical University, Zhanjiang, Guangdong 524023, China; The Marine Biomedical Research Institute of Guangdong Zhanjiang, Zhanjiang, Guangdong 524023, China
| | - Jianhao Ke
- College of Agriculture, South China Agricultural University, Guangzhou 510046, China
| | - Ming Zhang
- Department of Physical Medicine and Rehabilitation, Zibo Central Hospital, Shandong University, Zibo 255000, China.
| | - Qin Xiao
- Department of Blood Transfusion, Peking University Shenzhen Hospital, Shenzhen 518036, China.
| | - Xiao Zhu
- Guangdong Key Laboratory for Research and Development of Natural Drugs, The Marine Biomedical Research Institute, Guangdong Medical University, Zhanjiang, Guangdong 524023, China; The Marine Biomedical Research Institute of Guangdong Zhanjiang, Zhanjiang, Guangdong 524023, China; Southern Marine Science and Engineering Guangdong Laboratory (Zhanjiang), Zhanjiang, Guangdong, 524023, China.
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11
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Ruiz-Limon P, Ladehesa-Pineda ML, Castro-Villegas MDC, Abalos-Aguilera MDC, Lopez-Medina C, Lopez-Pedrera C, Barbarroja N, Espejo-Peralbo D, Gonzalez-Reyes JA, Villalba JM, Perez-Sanchez C, Escudero-Contreras A, Collantes-Estevez E, Font-Ugalde P, Jimenez-Gomez Y. Enhanced NETosis generation in radiographic axial spondyloarthritis: utility as biomarker for disease activity and anti-TNF-α therapy effectiveness. J Biomed Sci 2020; 27:54. [PMID: 32303225 PMCID: PMC7164280 DOI: 10.1186/s12929-020-00634-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/26/2020] [Indexed: 12/21/2022] Open
Abstract
Background Radiographic axial spondyloarthritis (r-axSpA) is a chronic inflammatory form of arthritis in which tumor necrosis factor (TNF)-α, a potent inducer of inflammatory response and a key regulator of innate immunity and of Th1 immune responses, plays a central role. NETosis is a mechanism of innate immune defense that is involved in diverse rheumatology diseases. Nevertheless, spontaneous NETosis generation in r-axSpA, its association to disease pathogenesis, and the NETosis involvement on anti-TNF-α therapy’s effects has never been explored. Methods Thirty r-axSpA patients and 32 healthy donors (HDs) were evaluated. Neutrophil extracellular trap (NET) formation, mediators of signal-transduction cascade required for NETosis induction and cell-free NETosis-derived products were quantified. An additional cohort of 15 r-axSpA patients treated with infliximab (IFX) for six months were further analyzed. In vitro studies were designed to assess the effects of IFX in NETosis generation and the inflammatory profile triggered. Results Compared to HDs, neutrophils from r-axSpA patients displayed augmented spontaneous NET formation, elevated expression of NET-associated signaling components, nuclear peptidylarginine deiminase 4 translocation and increased citrullinated histone H3. Furthermore, patients exhibited altered circulating levels of cell-free NETosis-derived products (DNA, nucleosomes and elastase). Additional studies revealed that cell-free NETosis-derived products could be suitable biomarkers for distinguish r-axSpA patients from HDs. Correlation studies showed association between cell-free NETosis-derived products and clinical inflammatory parameters. Besides, nucleosomes displayed potential as a biomarker for discriminate patients according to disease activity. IFX therapy promoted a reduction in both NETosis generation and disease activity in r-axSpA patients. Mechanistic in vitro studies further unveiled the relevance of IFX in reducing NET release and normalizing the augmented inflammatory activities promoted by NETs in mononuclear cells. Conclusions This study reveals that NETosis is enhanced in r-axSpA patients and identifies the NETosis-derived products as potential disease activity biomarkers. In addition, the data suggests the potential role of NET generation analysis for assessment of therapeutic effectiveness in r-axSpA.
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Affiliation(s)
- Patricia Ruiz-Limon
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain. .,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain. .,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain. .,Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, Campus Teatinos s/n, 29010, Málaga, Spain.
| | - Maria Lourdes Ladehesa-Pineda
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Maria Del Carmen Castro-Villegas
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Maria Del Carmen Abalos-Aguilera
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Clementina Lopez-Medina
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Chary Lopez-Pedrera
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Nuria Barbarroja
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Daniel Espejo-Peralbo
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Jose Antonio Gonzalez-Reyes
- Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Campus de Excelencia Internacional Agroalimentario ceiA3, Campus de Rabanales, Edificio Severo Ochoa, 3ª planta, 14014, Córdoba, Spain
| | - Jose Manuel Villalba
- Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Campus de Excelencia Internacional Agroalimentario ceiA3, Campus de Rabanales, Edificio Severo Ochoa, 3ª planta, 14014, Córdoba, Spain
| | - Carlos Perez-Sanchez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Alejandro Escudero-Contreras
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Eduardo Collantes-Estevez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Pilar Font-Ugalde
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Yolanda Jimenez-Gomez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain. .,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain. .,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Avda. Menéndez Pidal s/n, 14004, Córdoba, Spain.
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12
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Liu G, Ma Y, Yang Q, Deng S. Modulation of inflammatory response and gut microbiota in ankylosing spondylitis mouse model by bioactive peptide IQW. J Appl Microbiol 2020; 128:1669-1677. [PMID: 31977125 DOI: 10.1111/jam.14588] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/03/2019] [Accepted: 01/17/2020] [Indexed: 12/12/2022]
Abstract
AIMS Ankylosing spondylitis (AS) is a widespread and chronic inflammatory autoimmune disease of unknown provenance. Naturally occurring peptides and proteins have shown significant promise as modulators of immune responses. Thus, the aims of this study were to assess the protective effects of the bioactive peptide IQW (Ile-Gln-Trp) with respect to inflammatory indicators, gut microbiota and oxidative stress, and to examine the potential mechanisms of these effects. METHODS AND RESULTS A mouse model was prepared by four injections of human proteoglycan extract (2 mg) in dimethyldioctadecylammonium solution (2 mg) over an interval of 2 weeks. Enzyme-linked immunosorbent assay results for the markers of oxidative stress and inflammation in the AS mice revealed increased concentrations of malondialdehyde, IL-6, IL-1β and TNF-α, along with decreased concentrations of catalase (CAT), glutathione peroxidase (GSH-PX) and superoxide dismutase (SOD). Treatment with IQW was found to decrease the concentrations of IL-6, IL-1β and TNF-α, and increase the concentrations of CAT, GSH-PX and SOD. Moreover the quantification of the microbiota via 16s rRNA sequencing revealed a reduced microbial diversity in the AS mice, while a significantly increased microbial diversity was displayed by those treated with IQW. Whereas, there was a significant reduction in the relative abundance of Bacteroidetes and an increased relative abundance of Verrucomicrobia in AS mice, this was reversed following the IQW treatment. CONCLUSIONS The results demonstrated that IQW exerts a beneficial influence in AS by delaying progression of the disease, reducing the arthritic grade of intervertebral joints, altering the concentrations of cytokines and modulating the microbial diversity and composition. SIGNIFICANCE AND IMPACT OF THE STUDY Oral IQW treatment might represent a new approach to mitigate the onset and development of AS.
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Affiliation(s)
- G Liu
- Tianjin Hospital, Tianjin, China
| | - Y Ma
- Tianjin Hospital, Tianjin, China
| | - Q Yang
- Tianjin Hospital, Tianjin, China
| | - S Deng
- Tianjin Hospital, Tianjin, China
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13
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Lim DH, Lee EJ, Kwon OC, Hong S, Lee CK, Yoo B, Youn J, Kim TH, Kim YG. Effect of tumor necrosis factor inhibition on spinal inflammation and spinal ankylosis in SKG mice. Sci Rep 2019; 9:18000. [PMID: 31784598 PMCID: PMC6884438 DOI: 10.1038/s41598-019-54549-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022] Open
Abstract
To prevent spinal progression in ankylosing spondylitis, initiating TNF-inhibitor treatment as early as possible is suggested. However, the outcomes are inconsistent in previous clinical studies. Here, we investigated the effect of TNF inhibition alone on spinal progression when used during arthritis development in a murine model. We injected 8-week-old SKG mice with curdlan (curdlan group). We injected adalimumab at 3 and 9 weeks after the first curdlan injection (ADA group). The clinical scores of peripheral arthritis decreased in the ADA group at 3 weeks after first adalimumab injection. Using positron emission tomography–magnetic resonance imaging and histologic examination, spinal inflammation was observed in the curdlan group, and was significantly deceased in the ADA group. However, spinal osteoblast activities by imaging using OsteoSense 680 EX and bone metabolism-related cytokines such as receptor activator of nuclear factor-kappa B ligand, osteoprotegerin, Dickkopf-1, and sclerostin levels except IL-17A level were not different between the two groups. We conclude that treating TNF inhibitor alone reduced peripheral arthritis score and spinal inflammation in curdlan-injected SKG mice but did not decrease the spinal osteoblast activity, suggesting little effect on spinal ankylosis.
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Affiliation(s)
- Doo-Ho Lim
- Division of Rheumatology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Eun-Ju Lee
- Asan Institute for Life Science, Asan Medical Center, Seoul, Republic of Korea
| | - Oh Chan Kwon
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seokchan Hong
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang-Keun Lee
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bin Yoo
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeehee Youn
- Department of Anatomy and Cell Biology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Yong-Gil Kim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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14
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Mechili EA, Nikitara K, Girvalaki C, Kyriakos C, Vardavas C. Patient journey pain points in spondyloarthritis and
psoriasis: The case of Greece. POPULATION MEDICINE 2019. [DOI: 10.18332/popmed/113401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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15
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Izumiyama T, Mori Y, Mori S, Mori N, Kodama T, Itoi E. The effect of anti-IL-6 receptor antibody for the treatment of McH-lpr/lpr-RA1 mice that spontaneously developed destructive arthritis and enthesitis. BMC Musculoskelet Disord 2019; 20:286. [PMID: 31200688 PMCID: PMC6570918 DOI: 10.1186/s12891-019-2664-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 06/04/2019] [Indexed: 11/28/2022] Open
Abstract
Background McH-lpr/lpr-RA1 mice are a new strain of mice which spontaneously develop destructive arthritis and enthesitis in the ankle. There is no published data that drug treatment has been trialed on these mice. This study examined the effect of the mouse anti-IL-6 receptor antibody, MR16–1, for the treatment of arthritis and enthesitis in McH-lpr/lpr-RA1 mice. Methods Male McH-lpr/lpr-RA1 mice were randomly divided into control and treatment groups. MR16–1 was administered from 10 weeks of age for the treatment group. Saline was applied for the control group. The drug was administered once a week, at an initial dose of 2 mg, then maintained at 0.5 mg once per week thereafter. The effects were evaluated by the histopathological synovitis score, in vivo imaging using indocyanine green liposomes, and analysis of the gene expression of inflammatory cytokines. Results Tissue analyses were carried out at 14, 17 and 20 weeks of age. The synovitis scores of treated groups were significantly lower compared with those of the control group at 14 and 17 weeks of age. The kappa coefficient was 0.77. However, progression of entheseal ossification persisted in the MR16–1 treated group. In vivo imaging using indocyanine green liposomes showed significant decreases in signal intensities of treated groups at week 14, but no significant differences were observed at week 18. Blood serum amyloid A levels in treated groups were significantly lower at 17 weeks of age. The gene expression levels of Tnf and Il17 were also significantly lower in MR16–1 treated groups. Conclusions Administration of the anti-IL-6 receptor antibody is effective for the treatment of synovitis and bone destruction of McH-lpr/lpr-RA1 mice. McH-lpr/lpr-RA1 mice may be a suitable experimental model for the development of new treatments for destructive arthritis and enthesitis. IL-6 signal blockade could contribute to the treatment of destructive arthritis, and further studies should be carried out to confirm its potential in the prevention of enthesopathy developed to ossification.
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Affiliation(s)
- Takuya Izumiyama
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Shiro Mori
- Laboratory of Biomedical Engineering for Cancer, Department of Biomedical Engineering, Graduate School of Biomedical Engineering, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Naoko Mori
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Tetsuya Kodama
- Laboratory of Biomedical Engineering for Cancer, Department of Biomedical Engineering, Graduate School of Biomedical Engineering, Tohoku University, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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16
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Keeling SO, Bowker SL, Savu A, Kaul P. A Population-level Analysis of the Differing Effects of Rheumatoid Arthritis and Spondyloarthritis on Peripartum Outcomes. J Rheumatol 2019; 47:197-203. [PMID: 31043549 DOI: 10.3899/jrheum.181320] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The effects of rheumatoid arthritis (RA) and spondyloarthritis (SpA) on maternal and neonatal outcomes at a population level have not previously been well compared. METHODS A contemporary pregnancy cohort of 312,081 women and corresponding birth events was assembled for the province of Alberta from the random selection of 1 live birth event per woman. We identified 3 groups: (1) no inflammatory arthritis (no IA, n = 308,989), (2) RA (n = 631), and (3) SpA (n = 2461). We compared maternal and neonatal outcomes, comorbid conditions, and medication use among the 3 groups. Multivariable logistic regression models evaluated the independent association between RA and SpA, relative to no IA, and the outcomes of small for gestation age (SGA) and hypertensive disorders during pregnancy. RESULTS Pregnant women with RA were significantly more likely to have preterm delivery (13.5%), cesarean delivery (33.9%), hypertensive disorders in pregnancy (10.5%), and SGA babies (15.6%), compared to pregnant women with either SpA or no IA. Nonsteroidal antiinflammatory drugs and corticosteroid use were significantly higher in pregnant women with RA compared to the other groups. Women with RA were significantly more likely to have an SGA baby (OR 1.51, 95% CI 1.21-1.88; p < 0.01), and hypertensive disorder in pregnancy (OR 1.51, 95% CI 1.16-1.97; p < 0.01), compared to women with no IA, while no difference was found between women with SpA and those with no IA. CONCLUSION Women with RA have a higher risk of worse maternal and neonatal outcomes, whereas the risk of these events is similar between women with and without SpA.
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Affiliation(s)
- Stephanie O Keeling
- From the Division of Rheumatology, Department of Medicine, University of Alberta; Faculty of Medicine and Dentistry, University of Alberta; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada. .,S.O. Keeling, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; S.L. Bowker, PhD, Research Associate, Faculty of Medicine and Dentistry, University of Alberta; A. Savu, PhD, Biostatistician, Faculty of Medicine and Dentistry, University of Alberta; P. Kaul, PhD, Professor of Medicine, Faculty of Medicine and Dentistry, University of Alberta.
| | - Samantha L Bowker
- From the Division of Rheumatology, Department of Medicine, University of Alberta; Faculty of Medicine and Dentistry, University of Alberta; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,S.O. Keeling, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; S.L. Bowker, PhD, Research Associate, Faculty of Medicine and Dentistry, University of Alberta; A. Savu, PhD, Biostatistician, Faculty of Medicine and Dentistry, University of Alberta; P. Kaul, PhD, Professor of Medicine, Faculty of Medicine and Dentistry, University of Alberta
| | - Anamaria Savu
- From the Division of Rheumatology, Department of Medicine, University of Alberta; Faculty of Medicine and Dentistry, University of Alberta; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,S.O. Keeling, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; S.L. Bowker, PhD, Research Associate, Faculty of Medicine and Dentistry, University of Alberta; A. Savu, PhD, Biostatistician, Faculty of Medicine and Dentistry, University of Alberta; P. Kaul, PhD, Professor of Medicine, Faculty of Medicine and Dentistry, University of Alberta
| | - Padma Kaul
- From the Division of Rheumatology, Department of Medicine, University of Alberta; Faculty of Medicine and Dentistry, University of Alberta; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.,S.O. Keeling, MD, MSc, Associate Professor of Medicine, Division of Rheumatology, Department of Medicine, University of Alberta; S.L. Bowker, PhD, Research Associate, Faculty of Medicine and Dentistry, University of Alberta; A. Savu, PhD, Biostatistician, Faculty of Medicine and Dentistry, University of Alberta; P. Kaul, PhD, Professor of Medicine, Faculty of Medicine and Dentistry, University of Alberta
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17
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Pan Z, Zhang X, Ma Y, Xu S, Shuai Z, Pan F, Sun G. Genetic variation of rs7958311 in P2X7R gene is associated with the susceptibility and disease activity of ankylosing spondylitis. Postgrad Med J 2019; 95:251-257. [PMID: 30992418 DOI: 10.1136/postgradmedj-2018-136036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/05/2019] [Accepted: 03/12/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To describe association between the genetic variation of inflammation-associated gene, P2X7R, and ankylosing spondylitis (AS) susceptibility. METHODS Four single nucleotide polymorphisms (SNPs) of P2 X 7 R gene were genotyped in 673 patients with AS and 687 healthy controls. Allele and genotype frequencies and different genetic models were performed to calculate ORs and 95% CIs, the demographic and clinical characteristics of patients were recorded. The data analyses were also conducted by sex. RESULTS Compared with controls, genetic variation in rs7958311 but not the other three SNPs was statistically significant in female patients (χ2=6.907, p=0.032). Specifically, the P2 X 7 R gene rs7958311 polymorphism A allele showed a protective effect in AS susceptibility (OR=0.704, p=0.049, pFDR=0.061). In addition, female individuals with GA and/or AA genotypes had a lower risk of having AS compared with those with GG genotype (GA vs GG: OR=0.446, p=0.012, pFDR=0.030; AA vs GG: OR=0.440, p=0.039, pFDR=0.061; GA/AA vs GG: OR=0.445, p=0.009, pFDR=0.030). Furthermore, individuals with A allele (ie, GA/AA vs GG) had a higher disease activity, including Bath Ankylosing Spondylitis Disease Activity Index (overall: Z=- 2.630, p=0.014; male: Z=- 2.243, p=0.025), Schober test (overall: Z=- 3.041, p<0.001; male: Z=- 2.243, p=0.025) and chest expansion (overall: Z=- 3.895, p=0.004; male: Z=- 2.403, p=0.016). CONCLUSION The allelic variation of rs7958311 SNP in P2X7R gene may have a protective effect on AS susceptibility in females and is associated with disease activity in male patients.
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Affiliation(s)
- Zhipeng Pan
- Department of Medical Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,School of Public Health, The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, China
| | - Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,School of Public Health, The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, China
| | - Shengqian Xu
- Department of Rheumatism and Immunity, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zongwen Shuai
- Department of Rheumatism and Immunity, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China .,School of Public Health, The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, China
| | - Guoping Sun
- Department of Medical Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, China
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18
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Perez-Sanchez C, Font-Ugalde P, Ruiz-Limon P, Lopez-Pedrera C, Castro-Villegas MC, Abalos-Aguilera MC, Barbarroja N, Arias-de la Rosa I, Lopez-Montilla MD, Escudero-Contreras A, Lopez-Medina C, Collantes-Estevez E, Jimenez-Gomez Y. Circulating microRNAs as potential biomarkers of disease activity and structural damage in ankylosing spondylitis patients. Hum Mol Genet 2019; 27:875-890. [PMID: 29329380 DOI: 10.1093/hmg/ddy008] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/30/2017] [Indexed: 12/15/2022] Open
Abstract
Ankylosing spondylitis (AS) remains difficult to diagnose before irreversible damage to sacroiliac joint is noticeable. Circulating microRNAs have demonstrated to serve as diagnostic tools for several human diseases. Here, we analysed plasma microRNAs to identify potential AS biomarkers. Higher expression levels of microRNA (miR)-146a-5p, miR-125a-5p, miR-151a-3p and miR-22-3p, and lower expression of miR-150-5p, and miR-451a were found in AS versus healthy donors. Interestingly, higher miR-146a-5p, miR-125a-5p, miR-151a-3p, miR-22-3p and miR-451a expression was also observed in AS than psoriatic arthritis patients. The areas under the curve, generated to assess the accuracy of microRNAs as diagnostic biomarkers for AS, ranged from 0.614 to 0.781; the six-microRNA signature reached 0.957. Bioinformatics analysis revealed that microRNAs targeted inflammatory and bone remodeling genes, underlying their potential role in this pathology. Indeed, additional studies revealed an association between these six microRNAs and potential target proteins related to AS pathophysiology. Furthermore, miR-146a-5p, miR-125a-5p and miR-22-3p expression was increased in active versus non-active patients. Moreover, miR-125a-5p, miR-151a-3p, miR-150-5p and miR-451a expression was related to the presence of syndesmophytes in AS patients. Overall, this study identified a six-plasma microRNA signature that could be attractive candidates as non-invasive biomarkers for the AS diagnosis, and may help to elucidate the disease pathogenesis.
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Affiliation(s)
- Carlos Perez-Sanchez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba 14004, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba 14004, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Córdoba 14004, Spain
| | - Pilar Font-Ugalde
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba 14004, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba 14004, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Córdoba 14004, Spain
| | - Patricia Ruiz-Limon
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba 14004, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba 14004, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Córdoba 14004, Spain
| | - Chary Lopez-Pedrera
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba 14004, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba 14004, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Córdoba 14004, Spain
| | - Maria C Castro-Villegas
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba 14004, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba 14004, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Córdoba 14004, Spain
| | - Maria C Abalos-Aguilera
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba 14004, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba 14004, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Córdoba 14004, Spain
| | - Nuria Barbarroja
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba 14004, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba 14004, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Córdoba 14004, Spain
| | - Ivan Arias-de la Rosa
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba 14004, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba 14004, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Córdoba 14004, Spain
| | - Maria D Lopez-Montilla
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba 14004, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba 14004, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Córdoba 14004, Spain
| | - Alejandro Escudero-Contreras
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba 14004, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba 14004, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Córdoba 14004, Spain
| | - Clementina Lopez-Medina
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba 14004, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba 14004, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Córdoba 14004, Spain
| | - Eduardo Collantes-Estevez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba 14004, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba 14004, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Córdoba 14004, Spain
| | - Yolanda Jimenez-Gomez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba 14004, Spain.,Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba 14004, Spain.,Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Córdoba 14004, Spain
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19
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Mödinger Y, Löffler B, Huber-Lang M, Ignatius A. Complement involvement in bone homeostasis and bone disorders. Semin Immunol 2018; 37:53-65. [DOI: 10.1016/j.smim.2018.01.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/17/2018] [Accepted: 01/22/2018] [Indexed: 12/12/2022]
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20
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Xu Z, Wang X, Zheng Y. Screening for key genes and transcription factors in ankylosing spondylitis by RNA-Seq. Exp Ther Med 2017; 15:1394-1402. [PMID: 29434723 PMCID: PMC5774495 DOI: 10.3892/etm.2017.5556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 07/07/2017] [Indexed: 12/14/2022] Open
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory arthritis and autoimmune disease, the etiology and pathogenesis of which remain largely unknown. In the present study, blood samples were harvested from patients with AS and from healthy volunteers as a normal control (NC) for RNA-sequencing. Differentially expressed genes (DEGs) in the AS group compared with the NC group were identified, and gene ontology (GO) term and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were subsequently performed. Protein-protein interaction (PPI) network and AS-specific transcriptional regulatory network construction was performed for the DEGs. A total of 503 DEGs, including 338 upregulated and 165 downregulated DEGs, were identified in patients with AS compared with the NC group. Three upregulated DEGs identified, interferon-induced protein with tetratricopeptide repeats (IFIT)1, IFIT3 and radical S-adenosyl methionine domain containing (RSAD)2, are interferon (IFN)-stimulated genes that serve a role in the IFN signaling pathway. The most significantly enriched GO term was response to other organisms. Osteoclast differentiation was a significantly enriched pathway for eight DEGs [High affinity immunoglobulin gamma Fc receptor (FCGR)1A, FCGR2B, four and a half LIM domains 2, integrin β3, signal transducer and activator of transcription 2 (STAT2), suppressor of cytokine signaling 3 (SOCS3), leukocyte immunoglobulin like receptor (LILR)A4 and LILRA6]. The six hub genes in the PPI network constructed were interferon-stimulated gene 15, heat shock protein β1, microtubule-associated proteins 1A/1B light chain 3A, IFIT1, IFIT3 and SOCS3. POU domain class 2 transcription factor 1 (1-Oct) and ecotropic virus integration site-1 (Evi-1) were identified as two important transcription factors (TFs) in AS according to the AS-specific transcriptional regulatory network constructed. In addition, IFIT1 and IFIT3 were identified as targets of 1-Oct. The results of the present study indicate that osteoclast differentiation, the IFN signaling pathway and genes associated with these two signaling pathways, particularly FCGR2B, STAT2, SOCS3, IFIT1 and IFIT3, may serve a role in AS. In addition, Evi-1 and 1-Oct may be two important TFs associated with AS. These results may provide a basis for elucidating the underlying mechanisms of and developing novel treatments for AS.
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Affiliation(s)
- Zhongyang Xu
- Department of Orthopedics, Shandong University Qilu Hospital, Jinan, Shandong 250012, P.R. China.,Department of Orthopedics, Jining No. 1 People's Hospital, Jining, Shandong 272011, P.R. China
| | - Xiuyu Wang
- Department of Anesthesia, Shandong University Qilu Hospital, Jinan, Shandong 250012, P.R. China
| | - Yanping Zheng
- Department of Orthopedics, Shandong University Qilu Hospital, Jinan, Shandong 250012, P.R. China
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21
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Yang C, Ding P, Wang Q, Zhang L, Zhang X, Zhao J, Xu E, Wang N, Chen J, Yang G, Hu W, Zhou X. Inhibition of Complement Retards Ankylosing Spondylitis Progression. Sci Rep 2016; 6:34643. [PMID: 27698377 PMCID: PMC5048143 DOI: 10.1038/srep34643] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/14/2016] [Indexed: 01/20/2023] Open
Abstract
Ankylosing spondylitis (AS) is a chronic axial spondyloarthritis (SpA) resulting in back pain and progressive spinal ankyloses. Currently, there are no effective therapeutics targeting AS largely due to elusive pathogenesis mechanisms, even as potential candidates such as HLA-B27 autoantigen have been identified. Herein, we employed a proteoglycan (PG)-induced AS mouse model together with clinical specimens, and found that the complement system was substantially activated in the spinal bone marrow, accompanied by a remarkable proportion alteration of neutrophils and macrophage in bone marrow and spleen, and by the significant increase of TGF-β1 in serum. The combined treatment with a bacteria-derived complement inhibitor Efb-C (C-terminal of extracellular fibrinogen-binding protein of Staphylococcus aureus) remarkably retarded the progression of mouse AS by reducing osteoblast differentiation. Furthermore, we demonstrated that two important modulators involved in AS disease, TGF-β1 and RANKL, were elevated upon in vitro complement attack in osteoblast and/or osteoclast cells. These findings further unravel that complement activation is closely related with the pathogenesis of AS, and suggest that complement inhibition may hold great potential for AS therapy.
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Affiliation(s)
- Chaoqun Yang
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.,Department of Hand Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Peipei Ding
- Fudan University Shanghai Cancer Center and Institutes of Biomedical Sciences, Collaborative Innovation Center of Cancer Medicine, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Qingkai Wang
- Fudan University Shanghai Cancer Center and Institutes of Biomedical Sciences, Collaborative Innovation Center of Cancer Medicine, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Long Zhang
- Fudan University Shanghai Cancer Center and Institutes of Biomedical Sciences, Collaborative Innovation Center of Cancer Medicine, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xin Zhang
- Fudan University Shanghai Cancer Center and Institutes of Biomedical Sciences, Collaborative Innovation Center of Cancer Medicine, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jianquan Zhao
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Enjie Xu
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Na Wang
- Fudan University Shanghai Cancer Center and Institutes of Biomedical Sciences, Collaborative Innovation Center of Cancer Medicine, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jianfeng Chen
- Fudan University Shanghai Cancer Center and Institutes of Biomedical Sciences, Collaborative Innovation Center of Cancer Medicine, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Guang Yang
- Beijing Institute of Basic Medical Sciences, 27 Taiping Road, Beijing 100850, China
| | - Weiguo Hu
- Fudan University Shanghai Cancer Center and Institutes of Biomedical Sciences, Collaborative Innovation Center of Cancer Medicine, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Department of Immunology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xuhui Zhou
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
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22
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Gudmann NS, Munk HL, Christensen AF, Ejstrup L, Sørensen GL, Loft AG, Karsdal MA, Bay-Jensen AC, He Y, Siebuhr AS, Junker P. Chondrocyte activity is increased in psoriatic arthritis and axial spondyloarthritis. Arthritis Res Ther 2016; 18:141. [PMID: 27306080 PMCID: PMC4910260 DOI: 10.1186/s13075-016-1040-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/31/2016] [Indexed: 01/22/2023] Open
Abstract
Background Psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) are chronic inflammatory rheumatic diseases with complex origins. Both are characterized by altered extracellular matrix remodeling in joints and entheses that results in destructive and osteochondral proliferative lesions. There is a need for biomarkers reflecting core disease pathways for diagnosis and disease mapping. Pro-C2 reflects mature cartilage collagen type IIB formation, while C-Col10 represents turnover of type X collagen, which is exclusively expressed by hypertrophic chondrocytes. The objectives of this study were to study cartilage metabolism in axSpA and PsA by assessing Pro-C2 and C-Col10 and to evaluate their diagnostic utility against a healthy reference population. Methods Patients with PsA (n = 101) or axSpA (n = 110) were recruited consecutively from three rheumatology outpatient clinics. Demographic and clinical disease measures were recorded. Pro-C2 and C-Col10 were quantified in serum by using newly developed and specific competitive enzyme-linked immunosorbent assays based on monoclonal antibodies. One-way analysis of variance and Tukey’s multiple comparison tests were performed on log-transformed data. ROC curve analysis was carried out to evaluate their discriminative power. Results Pro-C2 levels in serum were significantly increased in both axSpA (median concentration 1.11 ng/ml, 0.67–1.64) and PsA (median concentration 1.03 ng/ml, 0.53–1.47) compared with healthy controls (median concentration 0.30 ng/ml, 0.16–0.41) (p < 0.0001). Pro-C2 did not differ according to treatment. C-Col10 was slightly but equally elevated in the PsA and axSpA groups vs. the control group, but it was significantly lower in patients with axSpA undergoing tumor necrosis factor-α inhibitor (TNFi) treatment. ROC curve analysis revealed AUCs of 0.85 (95 % CI 0.79–0.89) for axSpA and 0.81 (95 % CI 0.75–0.86) for PsA. Conclusions These findings indicate that cartilage collagen metabolism was enhanced in the axSpA and PsA groups compared with the healthy control group. The lower C-Col10 level in patients with axSpA undergoing TNFi treatment may reflect that hypertrophic chondrocytes in axSpA are targeted by TNFi. ROC curve analysis showed a diagnostic potential for Pro-C2 in axSpA and PsA.
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Affiliation(s)
- Natasja Stæhr Gudmann
- Nordic Bioscience Biomarkers and Research, Herlev Hovedgade 207, Herlev, 2730, Denmark.
| | | | | | - Leif Ejstrup
- Department of Rheumatology, Esbjerg Hospital, Esbjerg, Denmark
| | - Grith Lykke Sørensen
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Anne Gitte Loft
- Department of Rheumatology, Vejle Hospital, Vejle, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Asser Karsdal
- Nordic Bioscience Biomarkers and Research, Herlev Hovedgade 207, Herlev, 2730, Denmark
| | | | - Yi He
- Nordic Bioscience Biomarkers and Research, Herlev Hovedgade 207, Herlev, 2730, Denmark
| | - Anne Sofie Siebuhr
- Nordic Bioscience Biomarkers and Research, Herlev Hovedgade 207, Herlev, 2730, Denmark
| | - Peter Junker
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
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23
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Lin C, MacKenzie JD, Courtier JL, Gu JT, Milojevic D. Magnetic resonance imaging findings in juvenile spondyloarthropathy and effects of treatment observed on subsequent imaging. Pediatr Rheumatol Online J 2014; 12:25. [PMID: 25067925 PMCID: PMC4110533 DOI: 10.1186/1546-0096-12-25] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 06/29/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is often used to diagnose and monitor treatment effects of juvenile spondyloarthropathy (SpA). Our objective was to describe MRI findings in juvenile SpA and determine predictors of active sacroiliitis and response to treatment. METHODS Children who had MRI of the sacroiliac (SI) joints and were referred to the pediatric rheumatology clinic from 2009 to 2012 were retrospectively studied. The clinical parameters, laboratory studies and findings on MRI were collected and a composite score ratio (CR) was calculated for both SI joints on each MRI study based on a semi-quantitative scale that included evaluation of bone marrow edema (BME), synovial enhancement (SE), and erosions (ER). The findings on MRI were correlated with clinical and laboratory values. RESULTS 50 subjects who underwent 76 MRI for suspected or known SpA were included in the study. Sacroiliitis was seen in 48 MRIs in 32 subjects. Of the subjects with sacroiliitis, mean age ± standard deviation was 13.7 ± 2.6 years, 71% were male and 41% were HLA B27 positive. SE without BME was seen in 31% cases of sacroiliitis. In subjects with sacroiliitis, 79% also had hip arthritis and 41% had enthesitis of the pelvic region on MRI. In 38% of subjects with sacroiliitis, physical exam was not indicative of sacroiliitis or hip arthritis. Longitudinal data were available for 13 subjects. Sacroiliitis on MRI improved in 9 subjects with the greatest improvement in MRI composite score ratio after initiation of etanercept therapy. CR improvement was due to improvement of BME and SE components, while the ER score remained the same or worsened in all but 1 subject. CONCLUSION History, physical exam or laboratory data may not predict sacroiliitis in children. Magnetic resonance imaging plays a valuable role in the initial evaluation and later treatment monitoring of children with spondyloarthropathy. Synovial enhancement is significantly reduced after treatment, and unlike adults, synovial enhancement may be detected without accompanying bone marrow edema, which suggests gadolinium contrast may be an important component in the assessment of children with spondyloarthropathy.
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Affiliation(s)
- Clara Lin
- Children’s Hospital Colorado Pediatric Rheumatology, 13123 East 16th Street, Box B311, 80045 Aurora, CO, USA
| | - John D MacKenzie
- UCSF Pediatric Radiology, 505 Parnassus Ave, Moffitt Room: M396, Box 0628, 94143 San Francisco, CA, USA
| | - Jesse L Courtier
- UCSF Pediatric Radiology, 505 Parnassus Ave, Moffitt Room: M396, Box 0628, 94143 San Francisco, CA, USA
| | - Jeffrey T Gu
- UCSF Pediatric Radiology, 505 Parnassus Ave, Moffitt Room: M396, Box 0628, 94143 San Francisco, CA, USA
| | - Diana Milojevic
- Floating Hospital for Children @ Tufts Medical Center, 800 Washington Street #190, 02111 Boston, MA, USA
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24
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Masi AT. Might axial myofascial properties and biomechanical mechanisms be relevant to ankylosing spondylitis and axial spondyloarthritis? Arthritis Res Ther 2014; 16:107. [PMID: 25166000 PMCID: PMC4060468 DOI: 10.1186/ar4532] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Ankylosing spondylitis and axial spondyloarthropathy have characteristic age- and sex-specific onset patterns, typical entheseal lesions, and marked heritability, but the integrative mechanisms causing the pathophysiological and structural alterations remain largely undefined. Myofascial tissues are integrated in the body into webs and networks which permit transmission of passive and active tensional forces that provide stabilizing support and help to control movements. Axial myofascial hypertonicity was hypothesized as a potential excessive polymorphic trait which could contribute to chronic biomechanical overloading and exaggerated stresses at entheseal sites. Such a mechanism may help to integrate many of the characteristic host, pathological, and structural features of ankylosing spondylitis and axial spondyloarthritis. Biomechanical stress and strain were recently documented to correlate with peripheral entheseal inflammation and new bone formation in a murine model of spondyloarthritis. Ankylosing spondylitis has traditionally been classified by the modified New York criteria, which require the presence of definite radiographic sacroiliac joint lesions. New classification criteria for axial spondyloarthritis now include patients who do not fulfill the modified New York criteria. The male-to-female sex ratios clearly differed between the two patient categories - 2:1 or 3:1 in ankylosing spondylitis and 1:1 in non-radiographic axial spondyloarthritis - and this suggests a spectral concept of disease and, among females, milder structural alterations. Magnetic resonance imaging of active and chronic lesions in ankylosing spondylitis and axial spondyloarthritis reveals complex patterns, usually interpreted as inflammatory reactions, but shows similarities to acute degenerative disc disease, which attributed to edema formation following mechanical stresses and micro-damage. A basic question is whether mechanically induced microinjury and immunologically mediated inflammatory mechanisms operate in both ankylosing spondylitis and degenerative disc disease but differ in relative degrees. The hypothesized biomechanical properties raised in this commentary require documentation of their association with the onset risk and course of ankylosing spondylitis and axial spondyloarthritis. If particular subsets of ankylosing spondylitis and axial spondyloarthritis patients are confirmed to have altered axial myofascial properties, their biological basis and underlying biomechanical mechanisms promise to become clarified. Understanding how biomechanical and physical properties can affect symptomatic and structural manifestations of these disorders could also improve their management.
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25
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Miller TL, Cass N, Siegel C. Ankylosing spondylitis in an athlete with chronic sacroiliac joint pain. Orthopedics 2014; 37:e207-10. [PMID: 24679210 DOI: 10.3928/01477447-20140124-27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/09/2013] [Indexed: 02/03/2023]
Abstract
Ankylosing spondylitis is a disease in which inflammation of joints, most often in the axial skeleton, can lead to reactive fibrosis and eventual joint fusion with associated immobility and kyphosis. The disease often involves extra-articular features, such as uveitis and aortic regurgitation, as well as associated inflammatory conditions of the intestines. Its etiology is unknown. Ankylosing spondylitis most commonly presents in young males (15-30 years old) as persistent low back pain and stiffness that is worse in the morning and at night and improves with activity. The authors report the case of a young male athlete whose symptoms were initially incorrectly diagnosed as sacroiliac joint instability and dysfunction and later as a sacroiliac stress fracture before further workup revealed a seronegative spondyloarthropathy and the diagnosis of ankylosing spondylitis. The patient was prescribed oral indomethacin daily by the attending rheumatologist and started on a slow progression of return to running, jumping, and weight lifting. Within 4 weeks of beginning this treatment, the patient had complete cessation of pain with the medication. At follow-up 1 year after graduation from his university, the patient was nearly symptom free and working in a non-heavy labor job. The purpose of this case report is to remind sports medicine physicians of the prevalence of rheumatologic diseases in general and ankylosing spondylitis in particular and of the various ways in which spondyloarthropathies may present in athletes. Increased suspicion may lead to earlier diagnosis and treatment, potentially reducing illness severity and duration and improving the performance of athletes with this condition.
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Mease PJ. Is there a role for rituximab in the treatment of spondyloarthritis and psoriatic arthritis? J Rheumatol 2013. [PMID: 23204311 DOI: 10.3899/jrheum.121149] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Haynes KR, Pettit AR, Duan R, Tseng HW, Glant TT, Brown MA, Thomas GP. Excessive bone formation in a mouse model of ankylosing spondylitis is associated with decreases in Wnt pathway inhibitors. Arthritis Res Ther 2012; 14:R253. [PMID: 23171658 PMCID: PMC3674607 DOI: 10.1186/ar4096] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 11/20/2012] [Indexed: 12/17/2022] Open
Abstract
Introduction Ankylosing spondylitis (AS) is unique in its pathology where inflammation commences at the entheses before progressing to an osteoproliferative phenotype generating excessive bone formation that can result in joint fusion. The underlying mechanisms of this progression are poorly understood. Recent work has suggested that changes in Wnt signalling, a key bone regulatory pathway, may contribute to joint ankylosis in AS. Using the proteoglycan-induced spondylitis (PGISp) mouse model which displays spondylitis and eventual joint fusion following an initial inflammatory stimulus, we have characterised the structural and molecular changes that underlie disease progression. Methods PGISp mice were characterised 12 weeks after initiation of inflammation using histology, immunohistochemistry (IHC) and expression profiling. Results Inflammation initiated at the periphery of the intervertebral discs progressing to disc destruction followed by massively excessive cartilage and bone matrix formation, as demonstrated by toluidine blue staining and IHC for collagen type I and osteocalcin, leading to syndesmophyte formation. Expression levels of DKK1 and SOST, Wnt signalling inhibitors highly expressed in joints, were reduced by 49% and 63% respectively in the spine PGISp compared with control mice (P < 0.05) with SOST inhibition confirmed by IHC. Microarray profiling showed genes involved in inflammation and immune-regulation were altered. Further, a number of genes specifically involved in bone regulation including other members of the Wnt pathway were also dysregulated. Conclusions This study implicates the Wnt pathway as a likely mediator of the mechanism by which inflammation induces bony ankylosis in spondyloarthritis, raising the potential that therapies targeting this pathway may be effective in preventing this process.
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