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Ponchel F, Burska AN, Hunt L, Gul H, Rabin T, Parmar R, Buch MH, Conaghan PG, Emery P. T-cell subset abnormalities predict progression along the Inflammatory Arthritis disease continuum: implications for management. Sci Rep 2020; 10:3669. [PMID: 32111870 PMCID: PMC7048829 DOI: 10.1038/s41598-020-60314-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/15/2020] [Indexed: 11/18/2022] Open
Abstract
The presence of a disease continuum in inflammatory arthritis (IA) is a recognised concept, with distinct stages from at-risk stage (presence of anti citrullinated-peptide autoantibody) to diagnosis of rheumatoid arthritis (RA), including therapy-induced remission. Despite T-cell dysregulation being a key feature of RA, there are few reports of T-cell phenotyping along the IA-continuum. We investigated the disturbances of naïve, regulatory and inflammation related cell (IRC) CD4+ T-cell subsets in 705 individuals across the IA-continuum, developing a simple risk-score (summing presence/absence of a risk-associated with a subset) to predict progression from one stage to the next. In 158 at-risk individuals, the 3 subsets had individual association with progression to IA and the risk-score was highly predictive (p < 0.0001). In evolving IA patients, 219/294 developed RA; the risk-score included naïve and/or Treg and predicted progression (p < 0.0001). In 120 untreated RA patients, the risk-score for predicting treatment-induced remission using naïve T-cells had an odds ratio of 15.4 (p < 0.0001). In RA patients in treatment-induced remission, a score using naïve T-cells predicted disease flare (p < 0.0001). Evaluating the risk of progression using naïve CD4+ T-cells was predictive of progression along the whole IA-continuum. This should allow identification of individuals at high-risk of progression, permitting targeted therapy for improved outcomes.
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Affiliation(s)
- Frederique Ponchel
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, The University of Leeds, Leeds, UK. .,NIHR Leeds Musculoskeletal Biomedical Research Centre, The Leeds Trust Teaching Hospital, Leeds, UK.
| | - Agata N Burska
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, The University of Leeds, Leeds, UK
| | - Laura Hunt
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, The University of Leeds, Leeds, UK
| | - Hanna Gul
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, The University of Leeds, Leeds, UK
| | - Thibault Rabin
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, The University of Leeds, Leeds, UK
| | - Rekha Parmar
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, The University of Leeds, Leeds, UK
| | - Maya H Buch
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, The University of Leeds, Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Centre, The Leeds Trust Teaching Hospital, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, The University of Leeds, Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Centre, The Leeds Trust Teaching Hospital, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, The University of Leeds, Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Centre, The Leeds Trust Teaching Hospital, Leeds, UK
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Ponchel F, Vital E, Kingsbury SR, El-Sherbiny YM. CD4+T-cell subsets in rheumatoid arthritis. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/ijr.11.69] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dowdell K, Whitacre C. Regulation of Inflammatory Autoimmune Diseases. Compr Physiol 2001. [DOI: 10.1002/cphy.cp070420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
A dense infiltrate of activated T cells, macrophages, and B cells in the synovial membrane is the cardinal pathological feature of rheumatoid arthritis (RA). Frequently, tissue infiltrating cells acquire a morphological organization reminiscent of secondary lymphoid tissue. The composition of the inflammatory lesions, the production of autoantibodies, and the association of disease risk with genes related to the HLA-D region have all been cited as evidence for a critical role of T cells in disease pathogenesis. Investigations on the precise role of HLA genes in RA have confirmed the importance of this genetic risk factor and have identified a consensus sequence within the HLA-DRBI genes. The observation that HLA polymorphisms are mostly associated with disease progression and severity and that a gene dose effect for HLA-DR genes is operational has challenged the simple model that HLA molecules select and present an arthritogenic antigen. Studies analyzing the repertoire of tissue infiltrating T cells have not been able to identify a dominant and common disease relevant T cell. The infiltrate is diverse in terms of T cell receptor gene usage but consistently includes clonally expanded populations. Recent evidence indicates that RA patients carry expanded CD4 clonotypes which are characterized by deficient CD28 expression and autoreactivity. These autoreactive CD4 T cells are not restricted to the joint, raising the possibility that rheumatoid synovitis is a manifestation of a systemic autoimmune disease. Support for this model has come from studies in T cell receptor (TCR) transgenic animals which develop inflammation of the synovial membrane stimulated by a T cell response to ubiquitously expressed self-MHC molecules. Antigens driving the chronic persistent immune response in RA may not be restricted to the joint but rather may be widely distributed, providing an explanation for the difficulties in identifying arthritogenic antigens directly or indirectly through the selection of joint infiltrating T cells.
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Affiliation(s)
- C M Weyand
- Department of Medicine, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
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Navaneetham D, Penn AS, Howard JF, Conti-Fine BM. TCR-Vbeta usage in the thymus and blood of myasthenia gravis patients. J Autoimmun 1998; 11:621-33. [PMID: 9878084 DOI: 10.1006/jaut.1998.0246] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In myasthenia gravis (MG) the muscle acetylcholine receptor (AChR) is the target of an autoimmune response. The anti-AChR response may originate in the thymus, which is abnormal in most MG patients and contains anti-AChR T and B cells. Microbial superantigens (sAg) may trigger autoimmune responses and in this study we sought clues as to whether sAg play a role in the pathogenesis of MG. We investigated the frequency of use of the different TCR Vbeta families by the thymus and blood T cells in MG patients and in control subjects, using a multi-primer PCR assay. Identical TCR-Vbeta usage was found in the thymi of MG patients and controls, except Vbeta2, which showed a small increase in MG patients' thymi. Blood T cells of MG patients used Vbeta4, Vbeta6, Vbeta15, Vbeta16 and Vbeta24 significantly more than those of the controls. Vbeta4 and Vbeta6 are the gene families most frequently used by anti-AChR CD4(+) cells in MG patients. Blood T cells from MG patients used Vbeta12, Vbeta14, Vbeta17 and Vbeta18 significantly less than controls. MG patients used Vbeta4 and Vbeta6 significantly more in the blood than in the thymus, while the opposite occurred for Vbeta7, Vbeta12 and Vbeta14. Controls used Vbeta17 more and Vbeta24 less in the blood than in the thymus. The preferential expansion of Vbeta4 and Vbeta6 in MG patients might reflect the immunodominance of certain AChR epitopes, or the action of a sAg outside the thymus. The minimal differences in the TCR-Vbeta usage in the blood and thymus of control subjects might be due to expansion of T cell clones specific for common antigens. Identical Vbeta usage in the thymi of MG patients and controls does not support an important role of the thymus as the location of anti-AChR sensitization when MG is clinically evident. The differences observed in the Vbeta usage in blood and thymi of MG patients are likely to be due to preferential Vbeta usage by the anti-AChR T cells in the blood.
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Affiliation(s)
- D Navaneetham
- College of Biological Sciences, University of Minnesota, St. Paul, MN, 55108, USA
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