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Liu L, Zhang Y, Sun L. Medimatrix: innovative pre-training of grayscale images for rheumatoid arthritis diagnosis revolutionises medical image classification. Health Inf Sci Syst 2023; 11:44. [PMID: 37771395 PMCID: PMC10522544 DOI: 10.1007/s13755-023-00246-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
Efficient and accurate medical image classification (MIC) methods face two major challenges: (1) high similarity between images of different disease classes; and (2) generating large medical image datasets for training deep neural networks is challenging due to privacy restrictions and the need for expert ground truth annotations. In this paper, we introduce a novel deep learning method called pre-training grayscale images with supervised learning for MIC (MediMatrix). Instead of pre-training on color ImageNet, our approach uses MediMatrix on grayscale ImageNet. To improve the performance of the network, we introduce ShuffleAttention (SA), a self-attention mechanism. By combining SA with the multiple residual structure (ResSA block) and replacing short-cut connections with dense residual connections between corresponding layers (densepath), our network can dynamically adjust channel attention weights and receive image inputs of different sizes, resulting in improved feature representation and better discrimination of similarities between different categories. MediMatrix effectively classifies X-ray images of rheumatoid arthritis (RA), enabling efficient screening without the need for expert analysis or invasive testing. Through extensive experiments, we demonstrate the superiority of MediMatrix over state-of-the-art methods and that color is not critical for rich natural image classification. Our results highlight the potential of computer-aided diagnosis combined with MediMatrix as a valuable screening tool for early detection and intervention in RA.
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Affiliation(s)
- Linchen Liu
- Department of Rheumatology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009 China
| | - Yiyang Zhang
- Department of Jiangsu Collaborative Innovation Center of Atmospheric Environment and Equipment Technology (CICAEET), Nanjing University of Information Science and Technology, Nanjing, 210044 China
| | - Le Sun
- Department of Jiangsu Collaborative Innovation Center of Atmospheric Environment and Equipment Technology (CICAEET), Nanjing University of Information Science and Technology, Nanjing, 210044 China
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2
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Momtazmanesh S, Nowroozi A, Rezaei N. Artificial Intelligence in Rheumatoid Arthritis: Current Status and Future Perspectives: A State-of-the-Art Review. Rheumatol Ther 2022; 9:1249-1304. [PMID: 35849321 PMCID: PMC9510088 DOI: 10.1007/s40744-022-00475-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/24/2022] [Indexed: 11/23/2022] Open
Abstract
Investigation of the potential applications of artificial intelligence (AI), including machine learning (ML) and deep learning (DL) techniques, is an exponentially growing field in medicine and healthcare. These methods can be critical in providing high-quality care to patients with chronic rheumatological diseases lacking an optimal treatment, like rheumatoid arthritis (RA), which is the second most prevalent autoimmune disease. Herein, following reviewing the basic concepts of AI, we summarize the advances in its applications in RA clinical practice and research. We provide directions for future investigations in this field after reviewing the current knowledge gaps and technical and ethical challenges in applying AI. Automated models have been largely used to improve RA diagnosis since the early 2000s, and they have used a wide variety of techniques, e.g., support vector machine, random forest, and artificial neural networks. AI algorithms can facilitate screening and identification of susceptible groups, diagnosis using omics, imaging, clinical, and sensor data, patient detection within electronic health record (EHR), i.e., phenotyping, treatment response assessment, monitoring disease course, determining prognosis, novel drug discovery, and enhancing basic science research. They can also aid in risk assessment for incidence of comorbidities, e.g., cardiovascular diseases, in patients with RA. However, the proposed models may vary significantly in their performance and reliability. Despite the promising results achieved by AI models in enhancing early diagnosis and management of patients with RA, they are not fully ready to be incorporated into clinical practice. Future investigations are required to ensure development of reliable and generalizable algorithms while they carefully look for any potential source of bias or misconduct. We showed that a growing body of evidence supports the potential role of AI in revolutionizing screening, diagnosis, and management of patients with RA. However, multiple obstacles hinder clinical applications of AI models. Incorporating the machine and/or deep learning algorithms into real-world settings would be a key step in the progress of AI in medicine.
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Affiliation(s)
- Sara Momtazmanesh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Dr. Gharib St, Keshavarz Blvd, Tehran, Iran
| | - Ali Nowroozi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran. .,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Dr. Gharib St, Keshavarz Blvd, Tehran, Iran. .,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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3
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Qiu S, Li B, Xia Y, Xuan Z, Li Z, Xie L, Gu C, Lv J, Lu C, Jiang T, Fang L, Xu P, Yang J, Li Y, Chen Z, Zhang L, Wang L, Zhang D, Xu H, Wang W, Xu Z. CircTHBS1 drives gastric cancer progression by increasing INHBA mRNA expression and stability in a ceRNA- and RBP-dependent manner. Cell Death Dis 2022; 13:266. [PMID: 35338119 PMCID: PMC8949653 DOI: 10.1038/s41419-022-04720-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/16/2022] [Accepted: 03/09/2022] [Indexed: 12/15/2022]
Abstract
Circular RNAs (circRNAs) play vital regulatory roles in the progression of multiple cancers. In our study, transcriptome analysis and self-organizing maps (SOM) were applied to screen backbone circRNAs in gastric cancer (GC). Upon validation of the expression patterns of screened circRNAs, gain- and loss-of-function assays were performed in vitro and in vivo. Underlying mechanisms were investigated using RNA pull-down, luciferase reporter assay and RNA immunoprecipitation. The expression of circTHBS1 was significantly increased in GC and associated with poor prognosis. CircTHBS1 facilitated the malignant behavior and epithelial-to-mesenchymal transition of GC cells. Mechanistically, circTHBS1 sponged miR-204-5p to promote the expression of Inhibin Subunit Beta A (INHBA). Moreover, circTHBS1 could enhance the HuR-mediated mRNA stability of INHBA, which subsequently activated the TGF-β pathway. Our research identified circTHBS1 as an oncogenic circRNA that enhances GC malignancy by elevating INHBA expression, providing new insight and a feasible target for the diagnosis and treatment of GC.
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Affiliation(s)
- Shengkui Qiu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China.,Department of General Surgery, The Second Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu Province, China
| | - Bowen Li
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Yiwen Xia
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Zhe Xuan
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Zheng Li
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Li Xie
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Chao Gu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Jialun Lv
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Chen Lu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Tianlu Jiang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Lang Fang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Penghui Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Jing Yang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Ying Li
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Zetian Chen
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Lu Zhang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Linjun Wang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Diancai Zhang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Hao Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Weizhi Wang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China.
| | - Zekuan Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China. .,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, 211166, Jiangsu Province, China.
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4
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Pauk J, Trinkunas J, Puronaite R, Ihnatouski M, Wasilewska A. A computational method to differentiate rheumatoid arthritis patients using thermography data. Technol Health Care 2021; 30:209-216. [PMID: 34806634 DOI: 10.3233/thc-219004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The traditional rheumatoid arthritis (RA) diagnosis is very complicated because it uses many clinical and image data. Therefore, there is a need to develop a new method for diagnosing RA using a consolidated set of blood analysis and thermography data. OBJECTIVE The following issues related to RA are discussed: 1) Which clinical data are significant in the primary diagnosis of RA? 2) What parameters from thermograms should be used to differentiate patients with RA from the healthy? 3) Can artificial neural networks (ANN) differentiate patients with RA from the healthy? METHODS The dataset was composed of clinical and thermal data from 65 randomly selected patients with RA and 104 healthy subjects. Firstly, the univariate logistic regression model was proposed in order to find significant predictors. Next, the feedforward neural network model was used. The dataset was divided into the training set (75% of data) and the test set (25% of data). The Broyden-Fletcher-Goldfarb-Shanno (BFGS) and non-linear logistic function to transformation nodes in the output layer were used for training. Finally, the 10 fold Cross-Validation was used to assess the predictive performance of the ANN model and to judge how it performs. RESULT The training set consisted of the temperature of all fingers, patient age, BMI, erythrocyte sedimentation rate, C-reactive protein and White Blood Cells (10 parameters in total). High level of sensitivity and specificity was obtained at 81.25% and 100%, respectively. The accuracy was 92.86%. CONCLUSIONS This methodology suggests that the thermography data can be considered in addition to the currently available tools for screening, diagnosis, monitoring of disease progression.
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Affiliation(s)
- Jolanta Pauk
- Faculty of Mechanical Engineering, Bialystok University of Technology, Bialystok, Poland
| | | | - Roma Puronaite
- Institute of Data Science and Digital Technologies, Vilnius University, Vilnius, Lithuania
| | - Mikhail Ihnatouski
- Scientific and Research Department, Yanka Kupala State University of Grodno, Grodno, Belarus
| | - Agnieszka Wasilewska
- Faculty of Mechanical Engineering, Bialystok University of Technology, Bialystok, Poland
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Lo Vercio L, Amador K, Bannister JJ, Crites S, Gutierrez A, MacDonald ME, Moore J, Mouches P, Rajasheka D, Schimert S, Subbanna N, Tuladhar A, Wang N, Wilms M, Winder A, Forkert ND. Supervised machine learning tools: a tutorial for clinicians. J Neural Eng 2020; 17. [PMID: 33036008 DOI: 10.1088/1741-2552/abbff2] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Abstract
In an increasingly data-driven world, artificial intelligence is expected to be a key tool for converting big data into tangible benefits and the healthcare domain is no exception to this. Machine learning aims to identify complex patterns in multi-dimensional data and use these uncovered patterns to classify new unseen cases or make data-driven predictions. In recent years, deep neural networks have shown to be capable of producing results that considerably exceed those of conventional machine learning methods for various classification and regression tasks. In this paper, we provide an accessible tutorial of the most important supervised machine learning concepts and methods, including deep learning, which are potentially the most relevant for the medical domain. We aim to take some of the mystery out of machine learning and depict how machine learning models can be useful for medical applications. Finally, this tutorial provides a few practical suggestions for how to properly design a machine learning model for a generic medical problem.
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Affiliation(s)
| | | | | | | | | | | | - Jasmine Moore
- Radiology, University of Calgary, Calgary, Alberta, CANADA
| | | | | | | | | | - Anup Tuladhar
- Radiology, University of Calgary, Calgary, Alberta, CANADA
| | - Nanjia Wang
- Radiology, University of Calgary, Calgary, Alberta, CANADA
| | - Matthias Wilms
- Radiology, University of Calgary, Calgary, Alberta, CANADA
| | - Anthony Winder
- Radiology, University of Calgary, Calgary, Alberta, CANADA
| | - Nils Daniel Forkert
- Radiology, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 1N4, CANADA
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6
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ARTIE and MUSCLE models: building ensemble classifiers from fuzzy ART and SOM networks. Neural Comput Appl 2011. [DOI: 10.1007/s00521-011-0747-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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7
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Instance-based classifiers applied to medical databases: Diagnosis and knowledge extraction. Artif Intell Med 2011; 52:123-39. [DOI: 10.1016/j.artmed.2011.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 03/20/2011] [Accepted: 04/18/2011] [Indexed: 02/04/2023]
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8
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Gustafsson MG, Wallman M, Wickenberg Bolin U, Göransson H, Fryknäs M, Andersson CR, Isaksson A. Improving Bayesian credibility intervals for classifier error rates using maximum entropy empirical priors. Artif Intell Med 2010; 49:93-104. [DOI: 10.1016/j.artmed.2010.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 12/07/2009] [Accepted: 02/16/2010] [Indexed: 10/19/2022]
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9
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Shi SQ, Maner WL, Mackay LB, Garfield RE. Identification of term and preterm labor in rats using artificial neural networks on uterine electromyography signals. Am J Obstet Gynecol 2008; 198:235.e1-4. [PMID: 18226633 DOI: 10.1016/j.ajog.2007.08.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 06/06/2007] [Accepted: 08/20/2007] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study was undertaken to use artificial neural networks on uterine electromyography data to identify term and preterm labor in rats. STUDY DESIGN Controls (group 1: n = 4) and preterm labor models (group 2: n = 4, treated with onapristone) were used. Uterine electromyography and intrauterine pressure (IUP) variables were measured by implanted telemetric devices. For each timepoint assessed, either a "labor event" or "nonlabor event" was first assigned by using visual and other means. 112 total labor and nonlabor events were observed. Artificial neural networks were then used with electromyography and intrauterine pressure parameters to attempt algorithmic, objective identification for time of labor in each group. RESULTS For group 1, all 8 (100%) labor events and all 44 (100%) nonlabor events were correctly identified by the artificial neural networks. For group 2, 22 of 24 (92%) labor events and 31 of 36 (86%) nonlabor events were correctly determined by the artificial neural networks. CONCLUSION Artificial neural networks can effectively predict term and preterm labor during pregnancy with the use of uterine electromyography and intrauterine pressure variables.
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Affiliation(s)
- Shao-Qing Shi
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX 77555, USA
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10
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Maner WL, Garfield RE. Identification of human term and preterm labor using artificial neural networks on uterine electromyography data. Ann Biomed Eng 2007; 35:465-73. [PMID: 17226089 DOI: 10.1007/s10439-006-9248-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Accepted: 12/07/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To use artificial neural networks (ANNs) on uterine electromyography (EMG) data to classify term/preterm labor/non-labor pregnant patients. MATERIALS AND METHODS A total of 134 term and 51 preterm women (all ultimately delivered spontaneously) were included. Uterine EMG was measured trans-abdominally using surface electrodes. "Bursts" of elevated uterine EMG, corresponding to uterine contractions, were quantified by finding the means and/or standard deviations of the power spectrum (PS) peak frequency, burst duration, number of bursts per unit time, and total burst activity. Measurement-to-delivery (MTD) time was noted for each patient. Term and preterm patient groups were sub-divided, resulting in the following categories: [term-laboring (TL): n = 75; preterm-laboring (PTL): n = 13] and [term-non-laboring (TN): n = 59; preterm-non-laboring (PTN): n = 38], with labor assessed using clinical determinations. ANN was then used on the calculated uterine EMG data to algorithmically and objectively classify patients into labor and non-labor. The percent of correctly categorized patients was found. Comparison between ANN-sorted groups was then performed using Student's t test (with p < 0.05 significant). RESULTS In total, 59/75 (79%) of TL patients, 12/13 (92%) of PTL patients, 51/59 (86%) of TN patients, and 27/38 (71%) of PTN patients were correctly classified. CONCLUSION ANNs, used with uterine EMG data, can effectively classify term/preterm labor/non-labor patients.
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Affiliation(s)
- William L Maner
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University, Route 1062, Galveston, TX 77555, USA
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Binder SR, Genovese MC, Merrill JT, Morris RI, Metzger AL. Computer-assisted pattern recognition of autoantibody results. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2006; 12:1353-7. [PMID: 16339056 PMCID: PMC1317078 DOI: 10.1128/cdli.12.12.1353-1357.2005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Immunoassay-based anti-nuclear antibody (ANA) screens are increasingly used in the initial evaluation of autoimmune disorders, but these tests offer no "pattern information" comparable to the information from indirect fluorescence assay-based screens. Thus, there is no indication of "next steps" when a positive result is obtained. To improve the utility of immunoassay-based ANA screening, we evaluated a new method that combines a multiplex immunoassay with a k nearest neighbor (kNN) algorithm for computer-assisted pattern recognition. We assembled a training set, consisting of 1,152 sera from patients with various rheumatic diseases and non-diseased patients. The clinical sensitivity and specificity of the multiplex method and algorithm were evaluated with a test set that consisted of 173 sera collected at a rheumatology clinic from patients diagnosed by using standard criteria, as well as 152 age- and sex-matched sera from presumably healthy individuals (sera collected at a blood bank). The test set was also evaluated with a HEp-2 cell-based enzyme-linked immunosorbent assay (ELISA). Both the ELISA and multiplex immunoassay results were positive for 94% of the systemic lupus erythematosus (SLE) patients. The kNN algorithm correctly proposed an SLE pattern for 84% of the antibody-positive SLE patients. For patients with no connective tissue disease, the multiplex method found fewer positive results than the ELISA screen, and no disease was proposed by the kNN algorithm for most of these patients. In conclusion, the automated algorithm could identify SLE patterns and may be useful in the identification of patients who would benefit from early referral to a specialist, as well as patients who do not require further evaluation.
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Affiliation(s)
- Steven R Binder
- Bio-Rad Laboratories, 4000 Alfred Nobel Drive, Hercules, CA 94547, USA.
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12
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Binder SR, Hixson C, Glossenger J. Protein arrays and pattern recognition: new tools to assist in the identification and management of autoimmune disease. Autoimmun Rev 2005; 5:234-41. [PMID: 16697963 DOI: 10.1016/j.autrev.2005.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The occurrence of antibody patterns in connective tissue diseases has been recognized for thirty years, but the generation of multiple antibody results relied on time-consuming immunodiffusion or electrophoretic techniques. Today it is possible to study the antibody repertoire using rapid multi-analyte technologies, generally referred to as protein arrays. These arrays may use planar surfaces similar to DNA arrays, or use microspheres in suspension ("liquid arrays"). Also, many high quality autoantigens are now commercially available, including recombinant antigens. The vast amount of information that can be generated by measuring multiple antibodies for multiple patients has created demand for data processing. Software programs to aid physicians in reviewing multiple inputs as an aid to disease diagnosis and classification have been available for twenty years. Initial work used the "expert systems" approach; more recently pattern recognition has been widely evaluated because of the improvements in software programs and computational speed. The use of antibody data, generated in protein arrays, may assist in establishing diagnosis, in identifying potentially significant antibody patterns in advance of clinical symptoms, and in classifying patients based on expected disease progression.
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Affiliation(s)
- Steven R Binder
- Clinical Diagnostics Group, Bio-Rad Laboratories, Hercules CA, USA.
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13
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Baeten D, Kruithof E, De Rycke L, Boots AM, Mielants H, Veys EM, De Keyser F. Infiltration of the synovial membrane with macrophage subsets and polymorphonuclear cells reflects global disease activity in spondyloarthropathy. Arthritis Res Ther 2005; 7:R359-69. [PMID: 15743484 PMCID: PMC1065336 DOI: 10.1186/ar1501] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2004] [Revised: 11/22/2004] [Accepted: 12/21/2004] [Indexed: 11/30/2022] Open
Abstract
Considering the relation between synovial inflammation and global disease activity in rheumatoid arthritis (RA) and the distinct but heterogeneous histology of spondyloarthropathy (SpA) synovitis, the present study analyzed whether histopathological features of synovium reflect specific phenotypes and/or global disease activity in SpA. Synovial biopsies obtained from 99 SpA and 86 RA patients with active knee synovitis were analyzed for 15 histological and immunohistochemical markers. Correlations with swollen joint count, serum C-reactive protein concentrations, and erythrocyte sedimentation rate were analyzed using classical and multiparameter statistics. SpA synovitis was characterized by higher vascularity and infiltration with CD163+ macrophages and polymorphonuclear leukocytes (PMNs) and by lower values for lining-layer hyperplasia, lymphoid aggregates, CD1a+ cells, intracellular citrullinated proteins, and MHC–HC gp39 complexes than RA synovitis. Unsupervised clustering of the SpA samples based on synovial features identified two separate clusters that both contained different SpA subtypes but were significantly differentiated by concentration of C-reactive protein and erythrocyte sedimentation rate. Global disease activity in SpA correlated significantly with lining-layer hyperplasia as well as with inflammatory infiltration with macrophages, especially the CD163+ subset, and with PMNs. Accordingly, supervised clustering using these synovial parameters identified a cluster of 20 SpA patients with significantly higher disease activity, and this finding was confirmed in an independent SpA cohort. However, multiparameter models based on synovial histopathology were relatively poor predictors of disease activity in individual patients. In conclusion, these data indicate that inflammatory infiltration of the synovium with CD163+ macrophages and PMNs as well as lining-layer hyperplasia reflect global disease activity in SpA, independently of the SpA subtype. These data support a prominent role for innate immune cells in SpA synovitis and warrant further evaluation of synovial histopathology as a surrogate marker in early-phase therapeutic trials in SpA.
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MESH Headings
- Adult
- Aged
- Antigens, CD/analysis
- Antigens, Differentiation/analysis
- Antigens, Differentiation, Myelomonocytic/analysis
- Arthritis, Psoriatic/blood
- Arthritis, Psoriatic/pathology
- Arthritis, Rheumatoid/blood
- Arthritis, Rheumatoid/pathology
- Autoimmune Diseases/blood
- Autoimmune Diseases/pathology
- Biopsy, Needle
- Blood Sedimentation
- C-Reactive Protein/analysis
- Citrulline/immunology
- Cluster Analysis
- Cohort Studies
- Female
- Humans
- Hyperplasia
- Inflammatory Bowel Diseases/blood
- Inflammatory Bowel Diseases/complications
- Knee Joint/pathology
- Macrophages/classification
- Macrophages/pathology
- Male
- Middle Aged
- Neutrophils/pathology
- Phenotype
- Receptors, Cell Surface/analysis
- Severity of Illness Index
- Spondylarthropathies/blood
- Spondylarthropathies/complications
- Spondylarthropathies/pathology
- Spondylitis, Ankylosing/blood
- Spondylitis, Ankylosing/pathology
- Synovial Membrane/pathology
- Synovitis/blood
- Synovitis/pathology
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Affiliation(s)
- Dominique Baeten
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
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