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Lescoat A, Roofeh D, Kuwana M, Lafyatis R, Allanore Y, Khanna D. Therapeutic Approaches to Systemic Sclerosis: Recent Approvals and Future Candidate Therapies. Clin Rev Allergy Immunol 2023; 64:239-261. [PMID: 34468946 PMCID: PMC9034469 DOI: 10.1007/s12016-021-08891-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 02/06/2023]
Abstract
Systemic sclerosis is the rheumatic disease with the highest individual mortality. The severity of the disease is determined by the extent of fibrotic changes to cutaneous and internal organ tissues, the most life-threatening visceral manifestations being interstitial lung disease, SSc-associated-pulmonary arterial hypertension and myocardial involvement. The heterogeneity of the disease has initially hindered the design of successful clinical trials, but considerations on classification criteria have improved patient selection in trials, allowing the identification of more homogeneous groups of patients based on progressive visceral manifestations or the extent of skin involvement with a focus of patients with early disease. Two major subsets of systemic sclerosis are classically described: limited cutaneous systemic sclerosis characterized by distal skin fibrosis and the diffuse subset with distal and proximal skin thickening. Beyond this dichotomic subgrouping of systemic sclerosis, new phenotypic considerations based on antibody subtypes have provided a better understanding of the heterogeneity of the disease, anti-Scl70 antibodies being associated with progressive interstitial lung disease regardless of cutaneous involvement. Two targeted therapies, tocilizumab (a monoclonal antibody targeting interleukin-6 receptors (IL-6R)) and nintedanib (a tyrosine kinase inhibitor), have recently been approved by the American Food & Drug Administration to limit the decline of lung function in patients with SSc-associated interstitial lung disease, demonstrating that such better understanding of the disease pathogenesis with the identification of key targets can lead to therapeutic advances in the management of some visceral manifestations of the disease. This review will provide a brief overview of the pathogenesis of SSc and will present a selection of therapies recently approved or evaluated in this context. Therapies evaluated and approved in SSc-ILD will be emphasized and a review of recent phase II trials in diffuse cutaneous systemic sclerosis will be proposed. We will also discuss selected therapeutic pathways currently under investigation in systemic sclerosis that still lack clinical data in this context but that may show promising results in the future based on preclinical data.
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Affiliation(s)
- Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - David Roofeh
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Robert Lafyatis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yannick Allanore
- INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
- Université de Paris, Université Paris Descartes, Paris, France
- Service de Rhumatologie, Hôpital Cochin, AP-HP.CUP, Paris, France
| | - Dinesh Khanna
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI, USA.
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Bagnato G, Versace AG, La Rosa D, De Gaetano A, Imbalzano E, Chiappalone M, Ioppolo C, Roberts WN, Bitto A, Irrera N, Allegra A, Pioggia G, Gangemi S. Autologous Haematopoietic Stem Cell Transplantation and Systemic Sclerosis: Focus on Interstitial Lung Disease. Cells 2022; 11:843. [PMID: 35269465 PMCID: PMC8909673 DOI: 10.3390/cells11050843] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
Autologous hematopoietic stem cells transplantation (AHSCT) has been employed as treatment for severe systemic sclerosis (SSc) with high risk of organ failure. In the last 25 years overall survival and treatment-related mortality have improved, in accordance with a better patient selection and mobilization and conditioning protocols. This review analyzes the evidence from the last 5 years for AHSCT-treated SSc patients, considering in particular the outcomes related to interstitial lung disease. There are increasing data supporting the use of AHSCT in selected patients with rapidly progressive SSc. However, some unmet needs remain, such as an accurate patient selection, pre-transplantation analysis to identify subclinical conditions precluding the transplantation, and the alternatives for post-transplant ILD recurrence.
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Affiliation(s)
- Gianluca Bagnato
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (A.G.V.); (A.D.G.); (E.I.); (M.C.); (C.I.); (A.B.); (N.I.); (A.A.); (S.G.)
| | - Antonio Giovanni Versace
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (A.G.V.); (A.D.G.); (E.I.); (M.C.); (C.I.); (A.B.); (N.I.); (A.A.); (S.G.)
| | - Daniela La Rosa
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (A.G.V.); (A.D.G.); (E.I.); (M.C.); (C.I.); (A.B.); (N.I.); (A.A.); (S.G.)
| | - Alberta De Gaetano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (A.G.V.); (A.D.G.); (E.I.); (M.C.); (C.I.); (A.B.); (N.I.); (A.A.); (S.G.)
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (A.G.V.); (A.D.G.); (E.I.); (M.C.); (C.I.); (A.B.); (N.I.); (A.A.); (S.G.)
| | - Marianna Chiappalone
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (A.G.V.); (A.D.G.); (E.I.); (M.C.); (C.I.); (A.B.); (N.I.); (A.A.); (S.G.)
| | - Carmelo Ioppolo
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (A.G.V.); (A.D.G.); (E.I.); (M.C.); (C.I.); (A.B.); (N.I.); (A.A.); (S.G.)
| | | | - Alessandra Bitto
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (A.G.V.); (A.D.G.); (E.I.); (M.C.); (C.I.); (A.B.); (N.I.); (A.A.); (S.G.)
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (A.G.V.); (A.D.G.); (E.I.); (M.C.); (C.I.); (A.B.); (N.I.); (A.A.); (S.G.)
| | - Alessandro Allegra
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (A.G.V.); (A.D.G.); (E.I.); (M.C.); (C.I.); (A.B.); (N.I.); (A.A.); (S.G.)
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation, National Research Council of Italy, 98125 Messina, Italy;
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.B.); (A.G.V.); (A.D.G.); (E.I.); (M.C.); (C.I.); (A.B.); (N.I.); (A.A.); (S.G.)
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Di Benedetto P, Ruscitti P, Berardicurti O, Vomero M, Navarini L, Dolo V, Cipriani P, Giacomelli R. Endothelial-to-mesenchymal transition in systemic sclerosis. Clin Exp Immunol 2021; 205:12-27. [PMID: 33772754 DOI: 10.1111/cei.13599] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/19/2021] [Indexed: 12/14/2022] Open
Abstract
Systemic sclerosis (SSc) is an autoimmune disease characterized by significant vascular alterations and multi-organ fibrosis. Microvascular alterations are the first event of SSc and injured endothelial cells (ECs) may transdifferentiate towards myofibroblasts, the cells responsible for fibrosis and collagen deposition. This process is identified as endothelial-to-mesenchymal transition (EndMT), and understanding of its development is pivotal to identify early pathogenetic events and new therapeutic targets for SSc. In this review, we have highlighted the molecular mechanisms of EndMT and summarize the evidence of the role played by EndMT during the development of progressive fibrosis in SSc, also exploring the possible therapeutic role of its inhibition.
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Affiliation(s)
- P Di Benedetto
- Clinical Pathology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - P Ruscitti
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - O Berardicurti
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - M Vomero
- Unit of Rheumatology and Clinical Immunology, University of Rome 'Campus Biomedico', Rome, Italy
| | - L Navarini
- Unit of Rheumatology and Clinical Immunology, University of Rome 'Campus Biomedico', Rome, Italy
| | - V Dolo
- Clinical Pathology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - P Cipriani
- Division of Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - R Giacomelli
- Unit of Rheumatology and Clinical Immunology, University of Rome 'Campus Biomedico', Rome, Italy
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Escobar-Soto CH, Mejia-Romero R, Aguilera N, Alzate-Granados JP, Mendoza-Pinto C, Munguía-Realpozo P, Méndez-Martínez S, García-Carrasco M, Rojas-Villarraga A. Human mesenchymal stem cells for the management of systemic sclerosis. Systematic review. Autoimmun Rev 2021; 20:102831. [PMID: 33878487 DOI: 10.1016/j.autrev.2021.102831] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/11/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Sistemic Sclerosis (SSc) is a heterogeneous autoimmune disease with a high rate of progression and therapeutic failure, and treatment is a challenge, new therapeutic proposals being needed, being mesenchymal stem cells (MSCs) considered as alternative therapy for SSc for its immunomodulatory capacity. We evaluated the efficacy and safety of human MSC (hMSC) in patients with SSc through a systematic literature review (SLR). METHODS SLR (PRISMA guideline) on MEDLINE/OVID, LILACS, EMBASE, and Cochrane/OVID bases (until July 2020, without limits). All types of clinical studies were considered: patients ≥18 years old with SSc and treatment with hMSC. EXCLUSION CRITERIA animal models, autologous/allogenic hematopoietic stem cell transplants, narrative reviews, letters to the editor. MeSH and "Key word" terms were used. The level of evidence and the quality rating were rated [Joanna Briggs Institute (JBI) lists]. Registration in PROSPERO repository (ID CRD42020185245) The Synthesis Without Meta-analysis (SWiM) guideline was followed. RESULTS We initially identified 508 articles, of which 11 were finally included (8 case series and 3 case reports). The 11 articles included 101 patients (85 female, age range 18-75 years). The level of evidence was mostly 4 (JBI); the quality of evidence was met (≥50% of JBI items). SWiM showed that vascular skin involvement (digital ulcers, necrosis, and gangrene) and associated pain were the predominant outcomes, while improvements were found in almost all cases. One patient died in the first month, and the frequency of complications was low. Expanded hMSCs were used in 24 patients and other cell sources in the remaining patients. CONCLUSION There is too little reported data to reach definite conclusions about the use of hMSC in SSc. Further studies with better epidemiological designs are needed to evaluate the benefit of hMSCs in SSc patients.
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Affiliation(s)
| | | | - Natalia Aguilera
- Research Division, Fundación Universitaria de Ciencias de la Salud, University of Health Sciences, Bogotá, Colombia
| | - Juan Pablo Alzate-Granados
- Research Division, Fundación Universitaria de Ciencias de la Salud, University of Health Sciences, Bogotá, Colombia
| | - Claudia Mendoza-Pinto
- Systemic Autoimmune Disease Research Unit, UMAE-CIBIOR, Instituto Mexicano del Seguro Social, Puebla, Mexico; Rheumatology Department, Medicine School, Benemerita Universidad Autonoma de Puebla, Puebla, Mexico
| | - Pamela Munguía-Realpozo
- Rheumatology Department, Medicine School, Benemerita Universidad Autonoma de Puebla, Puebla, Mexico
| | - Socorro Méndez-Martínez
- Coordinator of Planning and Institutional Liaison, Instituto Mexicano del Seguro Social Puebla, Mexico
| | - Mario García-Carrasco
- Systemic Autoimmune Disease Research Unit, UMAE-CIBIOR, Instituto Mexicano del Seguro Social, Puebla, Mexico; Rheumatology Department, Medicine School, Benemerita Universidad Autonoma de Puebla, Puebla, Mexico.
| | - Adriana Rojas-Villarraga
- Research Institute, Fundación Universitaria De Ciencias De La Salud, University of Health Sciences, Bogota, Colombia
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Greco R, Alexander T, Burman J, Del Papa N, de Vries-Bouwstra J, Farge D, Henes J, Kazmi M, Kirgizov K, Muraro PA, Ricart E, Rovira M, Saccardi R, Sharrack B, Snarski E, Withers B, Jessop H, Boglione C, Kramer E, Badoglio M, Labopin M, Orchard K, Corbacioglu S, Ljungman P, Mikulska M, De la Camara R, Snowden JA. Hematopoietic stem cell transplantation for autoimmune diseases in the time of COVID-19: EBMT guidelines and recommendations. Bone Marrow Transplant 2021; 56:1493-1508. [PMID: 34031556 PMCID: PMC8143059 DOI: 10.1038/s41409-021-01326-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/17/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023]
Abstract
Coronavirus disease-19 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), represents one of the biggest challenges of 21st century, threatening public health around the globe. Increasing age and presence of co-morbidities are reported risk factors for severe disease and mortality, along with autoimmune diseases (ADs) and immunosuppressive treatments such as haematopoietic stem cell transplantation (HSCT), which are also associated with adverse outcomes. We review the impact of the pandemic on specific groups of patients with neurological, rheumatological, and gastroenterological indications, along with the challenges delivering HSCT in adult and pediatric populations. Moving forward, we developed consensus-based guidelines and recommendations for best practice and quality of patient care in order to support clinicians, scientists, and their multidisciplinary teams, as well as patients and their carers. These guidelines aim to support national and international organizations related to autoimmune diseases and local clinical teams delivering HSCT. Areas of unmet need and future research questions are also highlighted. The waves of the COVID-19 pandemic are predicted to be followed by an "endemic" phase and therefore an ongoing risk within a "new normality". These recommendations reflect currently available evidence, coupled with expert opinion, and will be revised according to necessary modifications in practice.
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Affiliation(s)
- Raffaella Greco
- grid.15496.3fUnit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Tobias Alexander
- grid.7468.d0000 0001 2248 7639Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joachim Burman
- grid.8993.b0000 0004 1936 9457Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | | | - Jeska de Vries-Bouwstra
- grid.10419.3d0000000089452978Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dominique Farge
- Centre de Référence des Maladies Auto-Immunes Systémiques Rares d’Ile-de-France, Filière, Paris, France ,grid.508487.60000 0004 7885 7602EA 3518, Université Denis Diderot, Paris, France ,grid.14709.3b0000 0004 1936 8649Department of Internal Medicine, McGill University, Montreal, QC Canada
| | - Jörg Henes
- grid.411544.10000 0001 0196 8249Department for Internal Medicine II (Oncology, Hematology, Rheumatology and Immunology), University Hospital Tuebingen, Tübingen, Germany
| | - Majid Kazmi
- grid.239826.40000 0004 0391 895XKings Health Partners, Department of Haematology, Guys Hospital, London, UK
| | - Kirill Kirgizov
- N.N. Blokhin National Medical Center of Oncology, Institute of Pediatric Oncology and Hematology, Moscow, Russia
| | - Paolo A. Muraro
- grid.7445.20000 0001 2113 8111Department of Brain Sciences, Imperial College London, London, UK
| | - Elena Ricart
- grid.410458.c0000 0000 9635 9413Inflammatory Bowel Disease Unit, Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain ,grid.10403.36Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Montserrat Rovira
- grid.10403.36BMT Unit, Department of Haematology, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Institute Josep Carreras, Barcelona, Spain
| | - Riccardo Saccardi
- grid.24704.350000 0004 1759 9494Department of Haematology, Careggi University Hospital, Florence, Italy
| | - Basil Sharrack
- grid.31410.370000 0000 9422 8284Department of Neuroscience, Sheffield Teaching Hospitals NHS, Foundation Trust, Sheffield, UK ,grid.11835.3e0000 0004 1936 9262NIHR Neurosciences Biomedical Research Centre, University of Sheffield, Sheffield, UK
| | - Emilian Snarski
- grid.13339.3b0000000113287408Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland ,LUX MED Oncology, Warsaw, Poland ,grid.499028.ePolish Stem Cells Bank (PBKM), Warsaw, Poland
| | - Barbara Withers
- Department of Haematology and Bone Marrow Transplant, Sydney, Australia
| | - Helen Jessop
- grid.31410.370000 0000 9422 8284Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Claudia Boglione
- grid.24704.350000 0004 1759 9494Department of Haematology, Careggi University Hospital, Florence, Italy
| | - Ellen Kramer
- Patient Advocacy Committee, EBMT Executive Office, Eddific Dr. Frederic, Duran i Jorda, Barcelona, Spain
| | - Manuela Badoglio
- grid.492743.fEBMT Paris study office/CEREST-TC—Department of Haematology, Saint Antoine Hospital—INSERM UMR 938—Université Pierre et Marie Curie, Paris, France
| | - Myriam Labopin
- grid.492743.fEBMT Paris study office/CEREST-TC—Department of Haematology, Saint Antoine Hospital—INSERM UMR 938—Université Pierre et Marie Curie, Paris, France
| | - Kim Orchard
- grid.123047.30000000103590315Department of Haematology, University Hospital Southampton and University of Southampton, Southampton, UK
| | - Selim Corbacioglu
- grid.7727.50000 0001 2190 5763Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany
| | - Per Ljungman
- grid.24381.3c0000 0000 9241 5705Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge; Division of Hematology, Department of Medicine Huddinge Karolinska Institutet, Stockholm, Sweden
| | - Malgorzata Mikulska
- grid.410345.70000 0004 1756 7871Division of Infectious Diseases, University of Genoa (DISSAL) and Ospedale Policlinico San Martino, Genoa, Italy
| | - Rafael De la Camara
- grid.411251.20000 0004 1767 647XDepartment of Hematology, Hospital de la Princesa, Madrid, Spain
| | - John A. Snowden
- grid.31410.370000 0000 9422 8284Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK ,grid.11835.3e0000 0004 1936 9262Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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