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Kong X, Wang J, Chen R, Sun Y, Chen H, Ma L, Jiang L. Exploration of molecular signatures associated with different clinical features of Takayasu arteritis based on a prospective cohort study. Clin Immunol 2023; 256:109794. [PMID: 37774906 DOI: 10.1016/j.clim.2023.109794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023]
Abstract
Takayasu arteritis (TAK) is complicated disorder without reliable biomarkers. Here, we aimed to explore TAK-associated factor panels and their changes after biologic treatment. Five factor panels were identified: 1. systemic inflammation: C3, ESR, CRP, PLT, IL-6, C4, and IgG; 2. vascular inflammation: YKL40, IL-16, PTX3, and CCL2; 3. immune regulation panel: IL-10, IFN-γ, CCL5, and MMP1; 4. angiogenesis and fibrosis: FGF, PDGFAB, and VEGF; and 5. vascular remodeling: CD19+ B cell ratio, MMP3, and leptin. Panel 1 parameters were closely related to disease activity, while Panel 5 parameters, particularly CD19+ B cell ratio and leptin, were significantly higher in ischemic patients. After treatment, tocilizumab had a stronger inhibitory effect on Panel 1 parameters, PTX3, and YKL-40, while adalimumab led to an increase in IL-16, CCL2, and leptin levels. Altogether, these data expanded our knowledge regarding molecular background in TAK development and shed light on precise treatment in future studies.
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Affiliation(s)
- Xiufang Kong
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinghua Wang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rongyi Chen
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ying Sun
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huiyong Chen
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lili Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China; Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, China.
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Monocyte subsets and monocyte-related chemokines in Takayasu arteritis. Sci Rep 2023; 13:2092. [PMID: 36746990 PMCID: PMC9902560 DOI: 10.1038/s41598-023-29369-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
The pathogenesis of Takayasu arteritis (TAK) is poorly understood and no previous studies have analyzed monocytes in TAK. This study evaluated monocyte subsets and monocyte-related chemokines in the peripheral blood of TAK patients and healthy controls (HC). Monocyte subsets were identified as classical (CD14+CD16-), intermediate (CD14+CD16dim), and non-classical (CD14dimCD16high) in the peripheral blood. The chemokines CCL (C-C chemokine ligand)2, CCL3, CCL4, CCL5, CCL7, CXCL (C-X-C motif ligand)10, and CX3CL (C-X3-C motif ligand)1 were measured in the sera. Thirty-two TAK patients and 30 HC were evaluated. Intermediate monocytes were higher in TAK than HC [25.0 cells ×106/L (16.7-52.0) vs. 17.2 cells ×106/L (9.2-25.3); p = 0.014]. Active disease was associated with monocytosis (p = 0.004), increased classical (p = 0.003), and intermediate (p < 0.001) subsets than HC. Prednisone reduced the percentage of non-classical monocytes (p = 0.011). TAK patients had lower CCL3 (p = 0.033) and CCL4 (p = 0.023) levels than HC, whereas CCL22 levels were higher in active TAK compared to the remission state (p = 0.008). Glucocorticoids were associated with lower CXCL10 levels (p = 0.012). In TAK, CCL4 correlated with total (Rho = 0.489; p = 0.005), classical and intermediate monocytes (Rho = 0.448; p = 0.010 and Rho = 0.412; p = 0.019). In conclusion, TAK is associated with altered counts of monocyte subsets in the peripheral blood compared to HC and CCL22 is the chemokine with the strongest association with active disease in TAK.
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Wen D, Feng L, Du X, Dong JZ, Ma CS. Biomarkers in Takayasu arteritis. Int J Cardiol 2023; 371:413-417. [PMID: 36067923 DOI: 10.1016/j.ijcard.2022.08.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/08/2022] [Accepted: 08/30/2022] [Indexed: 12/14/2022]
Abstract
Takayasu arteritis (TA) is a rare large vasculitis with unknown etiology, which affects the aorta and its primary branches, as well as the pulmonary and coronary arteries. Cellular and humoral immunity, chronic inflammation, and genetic factors are involved into TA pathogenesis. Several biomarkers, such as MMPs, TIMPs, cytokines, cell adhesion molecules, autoantibodies, complements, PTX3, sRAGE, NT-proBNP, 8-isoPGF2α, NO2-, acute-phase and immunology-related proteins, thrombogenicity markers, ghrelin leptin and adipokines, endothelial damage and repair factors, genetic markers etc., related to the pathogenesis could be observed in patients with TA. These biomarkers have revealed great values in early diagnosis, evaluating disease activity, guiding clinical treatment options, and thus demonstrated significant clinical application values in TA. The combination of biomarkers assay and imaging examination may detect TA more accurately. The aim of this review is to systemically observe the clinical significance of these biomarkers in TA.
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Affiliation(s)
- Dan Wen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Li Feng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
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Cincotta AH, Cersosimo E, Alatrach M, Ezrokhi M, Agyin C, Adams J, Chilton R, Triplitt C, Chamarthi B, Cominos N, DeFronzo RA. Bromocriptine-QR Therapy Reduces Sympathetic Tone and Ameliorates a Pro-Oxidative/Pro-Inflammatory Phenotype in Peripheral Blood Mononuclear Cells and Plasma of Type 2 Diabetes Subjects. Int J Mol Sci 2022; 23:ijms23168851. [PMID: 36012132 PMCID: PMC9407769 DOI: 10.3390/ijms23168851] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
Bromocriptine-QR is a sympatholytic dopamine D2 agonist for the treatment of type 2 diabetes that has demonstrated rapid (within 1 year) substantial reductions in adverse cardiovascular events in this population by as yet incompletely delineated mechanisms. However, a chronic state of elevated sympathetic nervous system activity and central hypodopaminergic function has been demonstrated to potentiate an immune system pro-oxidative/pro-inflammatory condition and this immune phenotype is known to contribute significantly to the advancement of cardiovascular disease (CVD). Therefore, the possibility exists that bromocriptine-QR therapy may reduce adverse cardiovascular events in type 2 diabetes subjects via attenuation of this underlying chronic pro-oxidative/pro-inflammatory state. The present study was undertaken to assess the impact of bromocriptine-QR on a wide range of immune pro-oxidative/pro-inflammatory biochemical pathways and genes known to be operative in the genesis and progression of CVD. Inflammatory peripheral blood mononuclear cell biology is both a significant contributor to cardiovascular disease and also a marker of the body’s systemic pro-inflammatory status. Therefore, this study investigated the effects of 4-month circadian-timed (within 2 h of waking in the morning) bromocriptine-QR therapy (3.2 mg/day) in type 2 diabetes subjects whose glycemia was not optimally controlled on the glucagon-like peptide 1 receptor agonist on (i) gene expression status (via qPCR) of a wide array of mononuclear cell pro-oxidative/pro-inflammatory genes known to participate in the genesis and progression of CVD (OXR1, NRF2, NQO1, SOD1, SOD2, CAT, GSR, GPX1, GPX4, GCH1, HMOX1, BiP, EIF2α, ATF4, PERK, XBP1, ATF6, CHOP, GSK3β, NFkB, TXNIP, PIN1, BECN1, TLR2, TLR4, TLR10, MAPK8, NLRP3, CCR2, GCR, L-selectin, VCAM1, ICAM1) and (ii) humoral measures of sympathetic tone (norepinephrine and normetanephrine), whole-body oxidative stress (nitrotyrosine, TBARS), and pro-inflammatory factors (IL-1β, IL-6, IL-18, MCP-1, prolactin, C-reactive protein [CRP]). Relative to pre-treatment status, 4 months of bromocriptine-QR therapy resulted in significant reductions of mRNA levels in PBMC endoplasmic reticulum stress-unfolded protein response effectors [GRP78/BiP (34%), EIF2α (32%), ATF4 (29%), XBP1 (25%), PIN1 (14%), BECN1 (23%)], oxidative stress response proteins [OXR1 (31%), NRF2 (32%), NQO1 (39%), SOD1 (52%), CAT (26%), GPX1 (33%), GPX4 (31%), GCH1 (30%), HMOX1 (40%)], mRNA levels of TLR pro-inflammatory pathway proteins [TLR2 (46%), TLR4 (20%), GSK3β (19%), NFkB (33%), TXNIP (18%), NLRP3 (32%), CCR2 (24%), GCR (28%)], mRNA levels of pro-inflammatory cellular receptor proteins CCR2 and GCR by 24% and 28%, and adhesion molecule proteins L-selectin (35%) and VCAM1 (24%). Relative to baseline, bromocriptine-QR therapy also significantly reduced plasma levels of norepinephrine and normetanephrine by 33% and 22%, respectively, plasma pro-oxidative markers nitrotyrosine and TBARS by 13% and 10%, respectively, and pro-inflammatory factors IL-18, MCP1, IL-1β, prolactin, and CRP by 21%,13%, 12%, 42%, and 45%, respectively. These findings suggest a unique role for circadian-timed bromocriptine-QR sympatholytic dopamine agonist therapy in reducing systemic low-grade sterile inflammation to thereby reduce cardiovascular disease risk.
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Affiliation(s)
- Anthony H. Cincotta
- VeroScience LLC, Tiverton, RI 02878, USA
- Correspondence: ; Tel.: +1-401-816-0525
| | - Eugenio Cersosimo
- Texas Diabetes Institute, University Health System, San Antonio, TX 78207, USA
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Mariam Alatrach
- Texas Diabetes Institute, University Health System, San Antonio, TX 78207, USA
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | | | - Christina Agyin
- Texas Diabetes Institute, University Health System, San Antonio, TX 78207, USA
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - John Adams
- Texas Diabetes Institute, University Health System, San Antonio, TX 78207, USA
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Robert Chilton
- Texas Diabetes Institute, University Health System, San Antonio, TX 78207, USA
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Curtis Triplitt
- Texas Diabetes Institute, University Health System, San Antonio, TX 78207, USA
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | | | | | - Ralph A. DeFronzo
- Texas Diabetes Institute, University Health System, San Antonio, TX 78207, USA
- Division of Diabetes, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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Dai X, Wang J, Zhang X, Wang L, Wu S, Chen H, Sun Y, Ma L, Ma L, Kong X, Jiang L. Biomarker Changes and Molecular Signatures Associated with Takayasu Arteritis Following Treatment with Glucocorticoids and Tofacitinib. J Inflamm Res 2022; 15:4395-4407. [PMID: 35945989 PMCID: PMC9357419 DOI: 10.2147/jir.s369963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/12/2022] [Indexed: 12/14/2022] Open
Abstract
Objective This study aimed to analyze biomarker changes in patients with TAK following treatment with glucocorticoids (GCs) and tofacitinib (TOF). Methods Seventeen patients from a prospective TAK cohort treated with GCs and TOF and 12 healthy individuals were recruited. TAK associated cytokines, chemokines, growth factors, and MMPs were analyzed in these patients before and after GCs and TOF treatment, and healthy controls. Molecular signatures associated with clinical features were evaluated. Results Patients’ cytokines (PTX3, IL-6, IFN-γ), chemokines (IL-16, CCL22, CCL2), growth factors (VEGF), and MMP9 levels were significantly higher at baseline (all p < 0.05), while patients’ FGF-2 levels were significantly lower (p = 0.02). After treatment, IL-10 was significantly increased at 6 months (p=0.007), and inflammatory cytokines such as PTX3, IL-6 demonstrated a downward trend. Patients without vascular occlusion had higher baseline CCL22 levels than patients with it (p = 0.05), which remained persistently higher after treatment. Radar plot analysis demonstrated that PTX3 was closely correlated with disease activity. In addition, patients without imaging improvement had relatively higher baseline levels of CCL22, FGF-2, and PDGF-AB (p = 0.056, p = 0.06 and p = 0.08 respectively) and lower baseline levels of TNFα, ESR, and CRP (p=0.04, p=0.056, p=0.07, respectively) compared with patients without it. Conclusion GCs and TOF are effective in decreasing inflammatory molecules but have limited efficacy in regulating multiple other markers involved in TAK. PTX3 is a prominent marker for disease activity, and CCL22 may have a predictive value for vascular progression.
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Affiliation(s)
- Xiaojuan Dai
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jinghua Wang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Xiao Zhang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Li Wang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Sifan Wu
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Huiyong Chen
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Ying Sun
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Lili Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Lingying Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Xiufang Kong
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
- Center of Clinical Epidemiology and Evidence-Based Medicine, Fudan University, Shanghai, People’s Republic of China
- Correspondence: Lindi Jiang; Xiufang Kong, Email ;
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Kong X, Wu S, Dai X, Yu W, Wang J, Sun Y, Ji Z, Ma L, Dai X, Chen H, Ma L, Jiang L. A comprehensive profile of chemokines in the peripheral blood and vascular tissue of patients with Takayasu arteritis. Arthritis Res Ther 2022; 24:49. [PMID: 35172901 PMCID: PMC8848964 DOI: 10.1186/s13075-022-02740-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/07/2022] [Indexed: 12/21/2022] Open
Abstract
Background Takayasu arteritis (TAK) is a chronic granulomatous large vessel vasculitis with multiple immune cells involved. Chemokines play critical roles in recruitment and activation of immune cells. This study aimed to investigate chemokine profile in the peripheral blood and vascular tissue of patients with TAK. Methods A total of 58 patients with TAK and 53 healthy controls were enrolled. Chemokine array assay was performed in five patients with TAK and three controls. Chemokines with higher levels were preliminarily validated in 20 patients and controls. The validated chemokines were further confirmed in another group of samples with 25 patients and 25 controls. Their expression and distribution were also examined in vascular tissue from 8 patients and 5 controls. Correlations between these chemokines and peripheral immune cells, cytokines, and disease activity parameters were analyzed. Their serum changes were also investigated in these 45 patients after glucocorticoids and immunosuppressive treatment. Results Patients and controls were age and sex-matched. Twelve higher chemokines and 4 lower chemokines were found based on the chemokine array. After validation, increase of 5 chemokines were confirmed in patients with TAK, including CCL22, RANTES, CXCL16, CXCL11, and IL-16. Their expressions were also increased in vascular tissue of patients with TAK. In addition, levels of RANTES and IL-16 were positively correlated with peripheral CD3+CD4+ T cell numbers. Close localization of CCL22, CXCL11, or IL-16 with inflammatory cells was also observed in TAK vascular tissue. No correlations were found between these chemokines and cytokines (IL-6, IL-17, IFN-γ) or inflammatory parameters (ESR, CRP). No differences were observed regarding with these chemokines between active and inactive patients. After treatment, increase of CCL22 and decrease of RANTES and CXCL16 were found, while no changes were showed in levels of CXCL11 and IL-16. Conclusions CCL22, RANTES, CXCL16, CXCL11, and IL-16 were identified as the major chemokines involved in the recruitment of immune cells in the vascular tissue of patients with TAK. Additionally, the persistently high levels of CCL22, CXCL11, and IL-16 observed after treatment indicate their role in vascular chronic inflammation or fibrosis and demonstrate the need for developing more efficacious treatment options. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02740-x.
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Affiliation(s)
- Xiufang Kong
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Sifan Wu
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Xiaojuan Dai
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Wensu Yu
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jinghua Wang
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Ying Sun
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Zongfei Ji
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Lingying Ma
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Xiaomin Dai
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Huiyong Chen
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Lili Ma
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China. .,Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, China.
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Kong X, Xu M, Cui X, Ma L, Cheng H, Hou J, Sun X, Ma L, Jiang L. Potential Role of Macrophage Phenotypes and CCL2 in the Pathogenesis of Takayasu Arteritis. Front Immunol 2021; 12:646516. [PMID: 34079541 PMCID: PMC8165246 DOI: 10.3389/fimmu.2021.646516] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/30/2021] [Indexed: 12/28/2022] Open
Abstract
Objectives To investigate vascular macrophage phenotype as well as vascular and peripheral chemokine (C-C motif) ligand 2 (CCL2) expression during different stages of disease progression in patients with Takayasu Arteritis (TA). Methods In this study, 74 patients with TA and 50 controls were recruited. TA disease activity was evaluated with Kerr scores. Macrophage phenotype and CCL2 expression were examined by immunohistochemistry in vascular specimens from 8 untreated and 7 treated TA patients, along with 4 healthy controls. Serum CCL2 were quantified by enzyme-linked immune-absorbent assay from TA patients at baseline (n=59), at 6-months (n=38), and from 46 healthy volunteers. Vascular macrophage phenotype, vascular CCL2 expression and serum CCL2 levels during different stages, as well as the relationship between serum CCL2 and disease activity or other inflammatory parameters (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin 6 (IL-6)) were investigated. Results In untreated patients, vascular M1 macrophages and CCL2 showed increased expression, mainly in the adventitia. In contrast, in treated patients, vascular adventitial M1 and CCL2 expression were decreased, while vascular medial M2 macrophages and CCL2 levels were increased. Distribution of macrophages and CCL2 was consistent within the TA vascular lesions regardless of the disease stage. Furthermore, peripheral CCL2 was elevated in patients with TA (TA: 160.30 ± 120.05 vs. Control: 65.58 ± 54.56 pg/ml, P < 0.001). CCL2 levels were found to correlate with ESR, CRP, and IL-6 (all R values between 0.55 and 0.6, all P < 0.001). Receiver operating curve analysis demonstrated that CCL2 (at the cut-off value of 100.36 pg/ml) was able to predict disease activity (area under the curve = 0.74, P = 0.03). Decrease in CCL2 level was observed in patients with clinical remission (CR), but not in patients without CR, after 6 months of treatment (CR patients: baseline 220.18 ± 222.69 vs. post-treatment 88.71 ± 55.89 pg/ml, P = 0.04; non-CR patients: baseline 142.45 ± 104.76 vs. post-treatment 279.49 ± 229.46 pg/ml, P = 0.02). Conclusions Macrophages contribute to vascular pathological changes in TA by undergoing phenotype transformation. CCL2 is an important factor for recruiting macrophages and a potential biomarker for disease activity.
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Affiliation(s)
- Xiufang Kong
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ming Xu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaomeng Cui
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lingying Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huiyong Cheng
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun Hou
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoning Sun
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lili Ma
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China.,Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, China
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Elevated chemokines concentration is associated with disease activity in Takayasu arteritis. Cytokine 2021; 143:155515. [PMID: 33849766 DOI: 10.1016/j.cyto.2021.155515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 03/05/2021] [Accepted: 03/22/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chemokines were seldom investigated in Takayasu arteritis (TA) patients. This study aimed to evaluate the plasma levels of chemokines and their association with disease activity, including C-C chemokine ligand (CCL) 2, CCL3, CCL11, CCL20, C-X-C chemokine ligand (CXCL) 8 and CXCL10. METHODS Chemokines were measured in 85 TA patients, and 28 age- and gender-matched healthy controls. The disease activity of these TA patients was assessed according to the National Institute of Health (NIH) criteria. The relationship between the plasma levels of chemokines and disease activity was analyzed. RESULTS Among the 85 TA patients, 24 (28.2%) patients had active disease according to the NIH criteria. Significantly increased levels of CCL2, CCL3, CCL20, CXCL8 and CXCL10 were observed in TA patients when compared to healthy controls, while increased levels of CCL2, CCL20, CXCL8 and CXCL10 in TA patients with active disease when compared to those with inactive disease (all p < 0.05). The plasma cut-off values of CCL2, CCL20, CXCL8 and CXCL10 were 309.6 pg/ml, 131.4 pg/ml, 4.7 pg/ml, and 282.1 pg/ml, which maximized the ability of disease activity assessment and had a sensitivity/specificity of 66.7%/67.2%, 54.2%/77.1%,70.8%/72.1%,83.3%/54.1%, respectively (p < 0.05). Among patients with negative erythrocyte sedimentation rate, C-reactive protein or high-sensitivity C-reactive protein, CCL2, CCL20, CXCL8, and CXCL10 still had a high-sensitivity to recognize patients in the active phase. CONCLUSIONS This study showed that the expression level of CCL2, CCL20, CXCL8 and CXCL10 was elevated in active TA patients, indicating that these chemokines might act as potential biomarkers in evaluating the disease activity.
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Kabeerdoss J, Goel R, Mohan H, Danda D. High expression of pro-inflammatory cytokine genes IL-1β and IL-1R2 upon TLR4 activation in Takayasu arteritis. Rheumatol Int 2021; 42:535-543. [PMID: 33528653 DOI: 10.1007/s00296-020-04785-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
Toll-like receptors (TLR) 4 and its endogenous ligands are highly expressed in aorta. In the present study, we have explored the effect of TLR-4 activation by pro-inflammatory and angiogenic factors in PBMCs of patients with Takayasu Arteritis (TA). In the screening cohort, PBMCs of TA (n = 6) and healthy controls (n = 6) were stimulated with LPS and cultured. mRNA expression of 84 genes were quantitated by RT2 Profiler™ PCR Array kit in PBMCs. Validation set of additional PBMCs from TA (n = 7) and healthy controls [HC) (n = 7) were then stimulated with LPS to study expression of selected genes with delta Ct > 0.1 in the screening cohort. Significant gene expressions were correlated with Indian Takayasu arteritis activity scores (ITAS 2010). Increased expression of CCL2 was observed only in unstimulated PBMCs of patients with TA [median relative difference (RD) of 2.37] as compared to HC (RD 1.37, p < 0.03) in validation cohort, while stimulation with TLR4 ligand led to increased mRNA expression of IL-1β (RD 7.9, p < 0.028) and IL-1R2 (RD 0.08 p < 0.013) genes as compared to that of HC [RD of 5.32 for IL-1β and 0.01 for IL-1R2, respectively] in validation cohort. TLR4 activation also led to significantly higher expression of HPSE, TIMP1 and low expression of VEGFB, S1PR1, SERPINF1, ANGPLT4, ANGPT2, TIE1 and NOS3 genes in the screening cohort. But expression of VEGFB was not significant in validation cohort. The significant gene expressions, however, did not correlate with ITAS [ITAS2010 and ITAS-A (CRP)]. TLR4 activation leads to increased expression of IL-1β and IL-1R2 genes in PBMCs of patients with TA.
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Affiliation(s)
- Jayakanthan Kabeerdoss
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Tamil Nadu, Vellore, 632004, India
| | - Ruchika Goel
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Tamil Nadu, Vellore, 632004, India
| | - Hindumathi Mohan
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Tamil Nadu, Vellore, 632004, India
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Tamil Nadu, Vellore, 632004, India.
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Miyabe Y, Miyabe C, Iwai Y, Luster AD. Targeting the Chemokine System in Rheumatoid Arthritis and Vasculitis. JMA J 2020; 3:182-192. [PMID: 33150252 PMCID: PMC7590389 DOI: 10.31662/jmaj.2020-0019] [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: 03/30/2020] [Accepted: 04/27/2020] [Indexed: 01/01/2023] Open
Abstract
Arrest of circulating leukocytes and subsequent diapedesis is a fundamental component of inflammation. In general, the leukocyte migration cascade is tightly regulated by chemoattractants, such as chemokines. Chemokines, small secreted chemotactic cytokines, as well as their G-protein-coupled seven transmembrane spanning receptors, control the migratory patterns, positioning and cellular interactions of immune cells. Increased levels of chemokines and their receptors are found in the blood and within inflamed tissue in patients with rheumatoid arthritis (RA) and vasculitis. Chemokine ligand-receptor interactions regulate the recruitment of leukocytes into tissue, thus contributing in important ways to the pathogenesis of RA and vasculitis. Despite the fact that blockade of chemokines and chemokine receptors in animal models have yielded promising results, human clinical trials in RA using inhibitors of chemokines and their receptors have generally failed to show clinical benefits. However, recent early phase clinical trials suggest that strategies blocking specific chemokines may have clinical benefits in RA, demonstrating that the chemokine system remains a promising therapeutic target for rheumatic diseases, such as RA and vasuculitis and requires further study.
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Affiliation(s)
- Yoshishige Miyabe
- Department of Cell Biology, Institute for Advanced Medical Sciences, Nippon Medical School, Tokyo, Japan
| | - Chie Miyabe
- Department of Dermatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yoshiko Iwai
- Department of Cell Biology, Institute for Advanced Medical Sciences, Nippon Medical School, Tokyo, Japan
| | - Andrew D Luster
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Bhattacharya S, Kawamura A. Using evasins to target the chemokine network in inflammation. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2019; 119:1-38. [PMID: 31997766 DOI: 10.1016/bs.apcsb.2019.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Inflammation, is driven by a network comprising cytokines, chemokines, their target receptors and leukocytes, and is a major pathologic mechanism that adversely affects organ function in diverse human diseases. Despite being supported by substantial target validation, no successful anti-chemokine therapeutic to treat inflammatory disease has yet been developed. This is in part because of the robustness of the chemokine network, which emerges from a large total chemokine load in disease, promiscuous expression of receptors on leukocytes, promiscuous and synergistic interactions between chemokines and receptors, and feedforward loops created by secretion of chemokines by leukocytes themselves. Many parasites, including viruses, helminths and ticks, evade the chemokine network by producing proteins that bind promiscuously to chemokines or their receptors. Evasins - three small glycoproteins identified in the saliva of the brown dog tick - bind multiple chemokines, and are active in several animal models of inflammatory disease. Over 50 evasin homologs have recently been identified from diverse tick species. Characterization of the chemokine binding patterns of evasins show that several have anti-chemokine activities that extend substantially beyond those previously described. These studies indicate that evasins function at the site of the tick bite by reducing total chemokine load. This not only reduces chemokine signaling to receptors, but also interrupts feedforward loops, thus disabling the chemokine network. Taking the lead from nature, a goal for the development of new anti-chemokine therapeutics would be to reduce the total chemokine load in disease. This could be achieved by administering appropriate evasin combinations or by smaller peptides that mimic evasin action.
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Affiliation(s)
- Shoumo Bhattacharya
- RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Akane Kawamura
- RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
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Chemokines in rheumatic diseases: pathogenic role and therapeutic implications. Nat Rev Rheumatol 2019; 15:731-746. [PMID: 31705045 DOI: 10.1038/s41584-019-0323-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2019] [Indexed: 12/20/2022]
Abstract
Chemokines, a family of small secreted chemotactic cytokines, and their G protein-coupled seven transmembrane spanning receptors control the migratory patterns, positioning and cellular interactions of immune cells. The levels of chemokines and their receptors are increased in the blood and within inflamed tissue of patients with rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, vasculitis or idiopathic inflammatory myopathies. Chemokine ligand-receptor interactions control the recruitment of leukocytes into tissue, which are central to the pathogenesis of these rheumatic diseases. Although the blockade of various chemokines and chemokine receptors has yielded promising results in preclinical animal models of rheumatic diseases, human clinical trials have, in general, been disappointing. However, there have been glimmers of hope from several early-phase clinical trials that suggest that sufficiently blocking the relevant chemokine pathway might in fact have clinical benefits in rheumatic diseases. Hence, the chemokine system remains a promising therapeutic target for rheumatic diseases and requires further study.
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Liu S, Li N, Zhu Q, Zhu B, Wu T, Wang G, Liu S, Luo Q. Increased Serum MCP-1 Levels in Systemic Vasculitis Patients with Renal Involvement. J Interferon Cytokine Res 2018; 38:406-412. [PMID: 30230985 DOI: 10.1089/jir.2017.0140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Shasha Liu
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, Hypertension Institute of Xinjiang China, Xinjiang, China
| | - Nanfang Li
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, Hypertension Institute of Xinjiang China, Xinjiang, China
| | - Qing Zhu
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, Hypertension Institute of Xinjiang China, Xinjiang, China
| | - Bin Zhu
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, Hypertension Institute of Xinjiang China, Xinjiang, China
| | - Ting Wu
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, Hypertension Institute of Xinjiang China, Xinjiang, China
| | - Guoliang Wang
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, Hypertension Institute of Xinjiang China, Xinjiang, China
| | - Shanshan Liu
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, Hypertension Institute of Xinjiang China, Xinjiang, China
| | - Qin Luo
- The Center for Hypertension of the People's Hospital of Xinjiang Uygur Autonomous Region, Hypertension Institute of Xinjiang China, Xinjiang, China
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Dawood A, Alkafrawy N, Saleh S, Noreldin R, Zewain S. The relationship between IL-18 and atherosclerotic cardiovascular risk in Egyptian lean women with polycystic ovary syndrome. Gynecol Endocrinol 2018; 34:294-297. [PMID: 29105530 DOI: 10.1080/09513590.2017.1395835] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. The evidence in support of low-grade inflammation in PCOS as an etiology is emerging. Inflammation is likely to be associated with other prominent aspects of PCOS including insulin resistance (IR) and cardiovascular disease (CVD) risk. Interleukin-18 (IL-18) is considered as a strong marker of inflammation. OBJECTIVES Evaluation of the relation between serum IL-18 and atherosclerotic CVD (ASCVD) risk in Egyptian lean females with PCO. METHODS This study included control group of healthy lean normally menstruating females, lean PCOS group (BMI < 25 kg/m2), and obese PCOS group (BMI > 25 kg/m2) presented with infertility and diagnosed according to Rotterdam criteria. Measurements of serum lipid profile, IR, and IL-18 were done. RESULTS Lipid accumulation product (LAP), IR and ASCVD risk were significantly higher in PCOS patients (lean and obese) compared to controls and in obese compared to lean. Serum IL-18 was significantly higher in the PCOV groups compared to the controls and correlated directly with LAP, IR and ASCVD risk. CONCLUSION IL-18 is elevated in PCOS patients even in lean ones and is correlated with IR and ASCVD risk.
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Affiliation(s)
- Alaaeldin Dawood
- a Internal Medicine , Menoufia University , Shebin El-Kom , Egypt
| | - Nabil Alkafrawy
- a Internal Medicine , Menoufia University , Shebin El-Kom , Egypt
| | - Said Saleh
- b Obstetrics and Gynecology , Faculty of Medicine-Menoufia University , Shebin El-Kom , Egypt
| | - Rasha Noreldin
- c Clinical Pathology , Menoufia University , Shebin El-Kom , Egypt
| | - Shimaa Zewain
- a Internal Medicine , Menoufia University , Shebin El-Kom , Egypt
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Savioli B, Abdulahad WH, Brouwer E, Kallenberg CG, de Souza AWS. Are cytokines and chemokines suitable biomarkers for Takayasu arteritis? Autoimmun Rev 2017; 16:1071-1078. [DOI: 10.1016/j.autrev.2017.07.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/19/2017] [Indexed: 12/26/2022]
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Relationship of HLA-B*51 and HLA-B*52 alleles and TNF-α-308A/G polymorphism with susceptibility to Takayasu arteritis: a meta-analysis. Clin Rheumatol 2016; 36:173-181. [DOI: 10.1007/s10067-016-3445-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 08/21/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022]
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Fukui S, Ichinose K, Tsuji S, Umeda M, Nishino A, Nakashima Y, Suzuki T, Horai Y, Koga T, Kawashiri SY, Iwamoto N, Hirai Y, Tamai M, Nakamura H, Sato S, Aramaki T, Iwanaga N, Izumi Y, Origuchi T, Migita K, Ueki Y, Kawakami A. Hypocholesterolemia predicts relapses in patients with Takayasu arteritis. Mod Rheumatol 2015; 26:415-420. [DOI: 10.3109/14397595.2015.1083148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shoichi Fukui
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Sosuke Tsuji
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Masataka Umeda
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Ayako Nishino
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Yoshikazu Nakashima
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Takahisa Suzuki
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Yoshiro Horai
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Shin-ya Kawashiri
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
- Department of Public Health, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Naoki Iwamoto
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Yasuko Hirai
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Mami Tamai
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
| | - Shuntaro Sato
- Nagasaki University Hospital Clinical Research Center, Nagasaki, Japan,
| | - Toshiyuki Aramaki
- Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Sasebo, Nagasaki, Japan,
| | - Nozomi Iwanaga
- Department of General Internal Medicine and Rheumatology, Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan, and
| | - Yasumori Izumi
- Department of General Internal Medicine and Rheumatology, Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan, and
| | - Tomoki Origuchi
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
- Department of Rehabilitation Sciences, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kiyoshi Migita
- Department of General Internal Medicine and Rheumatology, Clinical Research Center, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan, and
| | - Yukitaka Ueki
- Rheumatic and Collagen Disease Center, Sasebo Chuo Hospital, Sasebo, Nagasaki, Japan,
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan,
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de Souza AWS, van der Geest KSM, Brouwer E, Pinheiro FAG, Oliveira ACD, Sato EI, Andrade LEC, Bijl M, Westra J, Kallenberg CGM. High mobility group box 1 levels in large vessel vasculitis are not associated with disease activity but are influenced by age and statins. Arthritis Res Ther 2015; 17:158. [PMID: 26062541 PMCID: PMC4480896 DOI: 10.1186/s13075-015-0672-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 06/02/2015] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Takayasu arteritis (TA) and giant cell arteritis (GCA) are large vessel vasculitides (LVV) that usually present as granulomatous inflammation in arterial walls. High mobility group box 1 (HMGB1) is a nuclear protein that acts as an alarmin when released by dying or activated cells. This study aims to evaluate whether serum HMGB1 can be used as a biomarker in LVV. METHODS Twenty-nine consecutive TA patients with 29 healthy controls (HC) were evaluated in a cross-sectional study. Eighteen consecutive GCA patients with 16 HC were evaluated at the onset of disease and some of them during follow-up. Serum HMGB1 levels were measured by enzyme-linked immunosorbent assay. RESULTS In GCA patients at disease onset mean serum HMGB1 levels did not differ from HC (5.74 ± 4.19 ng/ml vs. 4.17 ± 3.14 ng/ml; p = 0.230). No differences in HMGB1 levels were found between GCA patients with and without polymyalgia rheumatica (p = 0.167), ischemic manifestations (p = 0.873), systemic manifestations (p = 0.474) or relapsing disease (p = 0.608). During follow-up, no significant fluctuations on serum HMGB1 levels were observed from baseline to 3 months (n = 13) (p = 0.075), 12 months (n = 6) (p = 0.093) and at the first relapse (n = 4) (p = 0.202). Serum HMGB1 levels did not differ between TA patients and HC [1.19 (0.45-2.10) ng/ml vs. 1.46 (0.89-3.34) ng/ml; p = 0.181] and no difference was found between TA patients with active disease and in remission [1.31 (0.63-2.16) ng/ml vs. 0.75 (0.39-2.05) ng/ml; p = 0.281]. HMGB1 levels were significantly lower in 16 TA patients on statins compared with 13 patients without statins [0.59 (0.29-1.46) ng/ml vs. 1.93 (0.88-3.34) ng/ml; p = 0.019]. Age was independently associated with higher HMGB1 levels regardless of LVV or control status. CONCLUSIONS Patients with TA and GCA present similar serum HMGB1 levels compared with HC. Serum HMGB1 is not useful to discriminate between active disease and remission. In TA, use of statins was associated with lower HMGB1 levels. HMGB1 is not a biomarker for LVV.
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Affiliation(s)
- Alexandre W S de Souza
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700, RB, Groningen, The Netherlands. .,Rheumatology Division, Universidade Federal de São Paulo - Escola Paulista de Medicina, R. Botucatu, 720, 04023 900, São Paulo, SP, Brazil.
| | - Kornelis S M van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700, RB, Groningen, The Netherlands.
| | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700, RB, Groningen, The Netherlands.
| | - Frederico A G Pinheiro
- Rheumatology Division, Universidade Federal de São Paulo - Escola Paulista de Medicina, R. Botucatu, 720, 04023 900, São Paulo, SP, Brazil.
| | - Ana Cecília Diniz Oliveira
- Rheumatology Division, Universidade Federal de São Paulo - Escola Paulista de Medicina, R. Botucatu, 720, 04023 900, São Paulo, SP, Brazil.
| | - Emília Inoue Sato
- Rheumatology Division, Universidade Federal de São Paulo - Escola Paulista de Medicina, R. Botucatu, 720, 04023 900, São Paulo, SP, Brazil.
| | - Luis Eduardo C Andrade
- Rheumatology Division, Universidade Federal de São Paulo - Escola Paulista de Medicina, R. Botucatu, 720, 04023 900, São Paulo, SP, Brazil.
| | - Marc Bijl
- Department of Internal Medicine and Rheumatology, Martini Hospital, Van Swietenplein 1, 9728, NT, Groningen, The Netherlands.
| | - Johanna Westra
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700, RB, Groningen, The Netherlands.
| | - Cees G M Kallenberg
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700, RB, Groningen, The Netherlands.
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Santhosh S, Mittal BR, Gayana S, Bhattacharya A, Sharma A, Jain S. F-18 FDG PET/CT in the evaluation of Takayasu arteritis: an experience from the tropics. J Nucl Cardiol 2014; 21:993-1000. [PMID: 24875577 DOI: 10.1007/s12350-014-9910-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the performance parameters of FDG PET/CT in patients with Takayasu arteritis at diagnosis and during immunosuppression. METHODS Retrospective analysis of 60 FDG PET/CT studies in 51 patients was performed (17 scans at diagnosis out of which 4 had follow-up scans also and 43 scans on immunosuppression). The degree of FDG uptake in the vessels was assessed visually using a 4-point scale and maximum standardized uptake value (SUVmax), SUVratio, extent of vasculitis and association with ESR were calculated. RESULTS PET/CT was positive for active vasculitis in all 17 patients at diagnosis. The mean SUVmax and mean SUV ratio of the active areas were 5.1 ± 3.0 and 3.2 ± 1.9, respectively. On immunosuppression, PET scan was positive for active vasculitis in 14/43 (32.5%) scans. The mean SUVmax and mean SUVratio of the active areas were 1.7 ± 2.1 and 0.95 ± 1.2, respectively. There was significant difference between the mean SUVmax and mean SUVratio at diagnosis and on immunosuppression, respectively (P < .01). The median number of vascular segments in each uptake grade group was also statistically different (P < .01) between scans at diagnosis and on immunosuppression. The median ESR level in PET positive scans was 29 mm/hour (2-53), whereas in PET negative scans was 35.5 mm/hour (6-50) and the difference was not statistically significant. CONCLUSION FDG PET/CT showed good sensitivity to detect active vasculitis at diagnosis and during immunosuppression. The change in SUVmax between the successive FDG PET/CT scans may give an objective assessment of response to immunosuppression.
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Affiliation(s)
- Sampath Santhosh
- Department of Nuclear Medicine & PET, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
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Acknowledged signatures of matrix metalloproteinases in Takayasu's arteritis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:827105. [PMID: 25276821 PMCID: PMC4167960 DOI: 10.1155/2014/827105] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/12/2014] [Accepted: 08/12/2014] [Indexed: 01/28/2023]
Abstract
Takayasu's arteritis (TA) was reported as an eye disease in the year 1905 and later was confirmed as a vasculitis. Since then, the etiology of the disease remains unknown; however, characteristic clinical features suggest multiple causative factors. Recent progress in vascular biology and other disciplines enlightens the pathophysiology of TA and demonstrated induction of various nonspecific inflammatory symptoms and destruction of the arterial wall, which leads to aneurysms and rupture of the affected arteries. Matrix metalloproteinases (MMPs) as an enzyme family have well-established roles in several vascular pathologies including intima formation, atherosclerosiss and aneurysms. MMPs have been proposed to be one of the molecules with a potential of having dual role in the course of TA, first as an active participant in pathophysiology and secondly as a diagnostic biomarker for TA disease. The desire to improve our understanding of the importance of MMPs and their endogenous inhibitors (TIMPs) in TA disease and for the development of therapeutic agents has inspired basic and clinical scientists for over a decade. In the present paper, we summarized the scientific rationale which highlights the signatures of matrix metalloproteinases and their endogenous inhibitors in pathophysiology as well as their being a potential candidate as biomarker for Takayasu's arteritis.
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Soto ME, Soria-Castro E, Lans VG, Ontiveros EM, Mejía BIH, Hernandez HJM, García RB, Herrera V, Pérez-Torres I. Analysis of oxidative stress enzymes and structural and functional proteins on human aortic tissue from different aortopathies. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2014; 2014:760694. [PMID: 25101153 PMCID: PMC4102031 DOI: 10.1155/2014/760694] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/28/2014] [Accepted: 05/28/2014] [Indexed: 01/15/2023]
Abstract
The role of oxidative stress in different aortopathies is evaluated. Thirty-two tissue samples from 18 men and 14 women were divided into: 4 control (C) subjects, 11 patients with systemic arterial hypertension (SAH), 4 with variants of Marfan's syndrome (MV), 9 with Marfan's syndrome (M), 2 with Turner's syndrome, and 2 with Takayasu's arteritis (TA). Aorta fragments were homogenized. Lipoperoxidation (LPO), copper-zinc and manganese superoxide dismutase (Mn and Cu-Zn-SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione S-transferase (GST), endothelial nitric oxide synthase (eNOS), nitrates and nitrites (NO3(-)/NO2(-)), and type IV collagen, and laminin were evaluated. There was an increase in Mn- and Cu-Zn-SOD activity in SAH, MV, M, and Turner's syndrome. There was also an increase in CAT activity in M and Turner' syndrome. GPx and GST activity decreased and LPO increased in all groups. eNOS was decreased in SAH, MV, and M and NO3 (-)/NO2 (-) were increased in SAH and TA. Type IV collagen was decreased in Turner's syndrome and TA. Laminin γ-1 was decreased in MV and increased in M. In conclusion, similarities and differences in oxidative stress in the different aortopathies studied including pathologies with aneurysms were found with alterations in SOD, CAT, GPx, GST, and eNOS activity that modify subendothelial basement membrane proteins.
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Affiliation(s)
- María Elena Soto
- Immunology Department, National Institute of Cardiology "Ignacio Chavez", Juan Badiano 1, Sección XVI, Tlalpan, 14080 Mexico City, DF, Mexico
| | - Elizabeth Soria-Castro
- Pathology Department, National Institute of Cardiology "Ignacio Chavez", Juan Badiano 1, Sección XVI, Tlalpan, 14080 Mexico City, DF, Mexico
| | - Verónica Guarner Lans
- Physiology Department, National Institute of Cardiology "Ignacio Chavez", Juan Badiano 1, Sección XVI, Tlalpan, 14080 Mexico City, DF, Mexico
| | - Eleazar Muruato Ontiveros
- Cardiovascular Surgery Department, National Institute of Cardiology "Ignacio Chavez", Juan Badiano 1, Sección XVI, Tlalpan, 14080 Mexico City, DF, Mexico
| | - Benjamín Iván Hernández Mejía
- Cardiovascular Surgery Department, National Institute of Cardiology "Ignacio Chavez", Juan Badiano 1, Sección XVI, Tlalpan, 14080 Mexico City, DF, Mexico
| | - Humberto Jorge Martínez Hernandez
- Cardiovascular Surgery Department, National Institute of Cardiology "Ignacio Chavez", Juan Badiano 1, Sección XVI, Tlalpan, 14080 Mexico City, DF, Mexico
| | - Rodolfo Barragán García
- Cardiovascular Surgery Department, National Institute of Cardiology "Ignacio Chavez", Juan Badiano 1, Sección XVI, Tlalpan, 14080 Mexico City, DF, Mexico
| | - Valentín Herrera
- Cardiovascular Surgery Department, National Institute of Cardiology "Ignacio Chavez", Juan Badiano 1, Sección XVI, Tlalpan, 14080 Mexico City, DF, Mexico
| | - Israel Pérez-Torres
- Pathology Department, National Institute of Cardiology "Ignacio Chavez", Juan Badiano 1, Sección XVI, Tlalpan, 14080 Mexico City, DF, Mexico
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Maksimowicz-McKinnon K. New insights into the pathogenesis and treatment of Takayasu arteritis. Expert Rev Clin Immunol 2014; 5:445-9. [DOI: 10.1586/eci.09.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Receptor for advanced glycation end products (RAGE) in vascular and inflammatory diseases. Int J Cardiol 2013; 168:1788-94. [DOI: 10.1016/j.ijcard.2013.05.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 05/04/2013] [Indexed: 02/06/2023]
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Mahajan N, Mahmood S, Jain S, Dhawan V. Receptor for advanced glycation end products (RAGE), inflammatory ligand EN-RAGE and soluble RAGE (sRAGE) in subjects with Takayasu's arteritis. Int J Cardiol 2013; 168:532-4. [DOI: 10.1016/j.ijcard.2013.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 01/12/2013] [Indexed: 11/27/2022]
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Abstract
Takayasu arteritis (TA) is a chronic nonspecific granulomatous vasculitis affecting aorta and its main branches, coronary and pulmonary arteries. TA often occurs in young women and has a characteristic heterogeneity depending on ethnicity and geographical location. Although the pathogenesis of TA remains unclear, the interaction of many factors, such as autoimmunity, inflammation, genetic and environmental factors and so on, is involved in the occurrence and development of TA. Angiography, which is recognized as the gold standard in evaluating vascular lesions in TA, combined with computer tomography angiography (CTA), magnetic resonance angiography (MRA), ultrasonography, (18)Fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) could not only provide important information for early diagnosis but also detect disease activity, and thus further guide the treatment in TA. In addition, beside the commonly used corticosteroids, immunosuppressive agents, percutaneous transluminal angioplasty (PTA) and surgical revascularization, anti-tumor necrosis factor (TNF) agent has been more widely used in refractory cases of TA. The objective of this review is to systemically describe the pathogenesis, clinical characteristics, diagnosis, treatment and prognosis of TA.
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Affiliation(s)
- Dan Wen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, China
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Extracellular Matrix Remodeling in Takayasu's Arteritis: Role of Matrix Metalloproteinases and Adventitial Inflammation. Arch Med Res 2012; 43:406-10. [DOI: 10.1016/j.arcmed.2012.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 07/16/2012] [Indexed: 11/23/2022]
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LV NAQIANG, DANG AIMIN, ZHU XILIN, LIU YING, LIU YIWEN, ZHENG DEYU, HUI RUTAI, LIU GUOZHANG. The Role of Tumor Necrosis Factor-α Promoter Genetic Variation in Takayasu Arteritis Susceptibility and Medical Treatment. J Rheumatol 2011; 38:2602-7. [DOI: 10.3899/jrheum.110231] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.Tumor necrosis factor-α (TNF-α) is a multifunctional proinflammatory cytokine that influences the pathogenesis of Takayasu arteritis (TA). There is still no evidence of the relationship between TNF-α gene promoter polymorphisms and TA. We examined whether variations in the TNF-α promoter region may lead to TA susceptibility and disease progression.Methods.Five TNF-α gene promoter polymorphisms (−238G/A, −308G/A, −857C/T, −863C/A, and −1031C/T) were analyzed in 110 Chinese Han patients with TA, with a control group of 362 unrelated healthy individuals. Genotypes of TNF-α gene promoter polymorphisms were identified by direct sequencing. TNF-α plasma concentrations were determined by ELISA.Results.Our results indicated that the frequency of the −863A allele was significantly lower in the patients with TA than in the controls (18.2% vs 25.7%; p = 0.011), but the significance was lost after Bonferroni correction (pc= 0.055). The frequency of −863CA/AA genotypes was significantly lower in the patients with refractory TA than in those with the 863CC genotype (22.4% vs 44.2%; pc< 0.01). The frequency of the GGCCT haplotype was significantly higher in patients than in the controls, while the frequencies of GGCAT and GGCCC haplotypes were significantly lower in patients than in controls. The plasma TNF-α concentrations were significantly lower in the subjects carrying the −863A allele than in those without. Patients with active TA had a significant increase in plasma levels of TNF-α compared with remission patients and the control group.Conclusion.Polymorphisms of the TNF-α promoter are not associated with TA in the Chinese Han population. The A allele of the −863C/A polymorphism is associated with decreased TNF-α expression, which might affect medical treatment.
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Direskeneli H, Aydin SZ, Kermani TA, Matteson EL, Boers M, Herlyn K, Luqmani RA, Neogi T, Seo P, Suppiah R, Tomasson G, Merkel PA. Development of outcome measures for large-vessel vasculitis for use in clinical trials: opportunities, challenges, and research agenda. J Rheumatol 2011; 38:1471-9. [PMID: 21724719 PMCID: PMC3653638 DOI: 10.3899/jrheum.110275] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Giant cell (GCA) and Takayasu's arteritis (TAK) are 2 forms of large-vessel vasculitis (LVV) that involve the aorta and its major branches. GCA has a predilection for the cranial branches, while TAK tends to affect the extracranial branches. Both disorders may also cause nonspecific constitutional symptoms. Although some clinical features are more common in one or the other disorder and the ages of initial presentation differ substantially, there is enough clinical and histopathologic overlap between these disorders that some investigators suggest GCA and TAK may be 2 processes within the spectrum of a single disease. There have been few randomized therapeutic trials completed in GCA, and none in TAK. The lack of therapeutic trials in LVV is only partially explained by the rarity of these diseases. It is likely that the lack of well validated outcome measures for LVV and uncertainties regarding trial design contribute to the paucity of trials for these diseases. An initiative to develop a core set of outcome measures for use in clinical trials of LVV was launched by the international OMERACT Vasculitis Working Group in 2009 and subsequently endorsed by the OMERACT community at the OMERACT 10 meeting. Aims of this initiative include: (1) to review the literature and existing data related to outcome assessments in LVV; (2) to obtain the opinion of experts and patients on disease content; and (3) to formulate a research agenda to facilitate a more data-based approach to outcomes development.
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Implication of oxidative stress and its correlation with activity of matrix metalloproteinases in patients with Takayasu's arteritis disease. Int J Cardiol 2010; 145:286-288. [DOI: 10.1016/j.ijcard.2009.09.557] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 09/09/2009] [Indexed: 11/21/2022]
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Tervaert JWC. Translational mini-review series on immunology of vascular disease: accelerated atherosclerosis in vasculitis. Clin Exp Immunol 2009; 156:377-85. [PMID: 19309350 DOI: 10.1111/j.1365-2249.2009.03885.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Premature atherosclerosis has been observed during the course of different systemic inflammatory diseases such as rheumatoid arthritis and sytemic lupus erythematosus. Remarkably, relatively few studies have been published on the occurrence of accelerated atherosclerosis in patients with vasculitis. In giant cell arteritis (GCA), mortality because of ischaemic heart disease is not increased. In addition, intima media thickness (IMT) is lower in patients with GCA than in age-matched controls. In contrast, IMT is increased significantly in Takayasu arteritis, another form of large vessel vasculitis occurring in younger patients. In Takayasu arteritis and in Kawasaki disease, a form of medium-sized vessel vasculitis, accelerated atherosclerosis has been well documented. In small vessel vasculitis because of anti-neutrophil cytoplasmic autoantibodies-associated vasculitis, cardiovascular diseases are a major cause of mortality. IMT measurements reveal conflicting results. During active disease these patients experience acceleration of the atherosclerotic process. However, when inflammation is controlled, these patients have atherosclerotic development as in healthy subjects. Several risk factors, such as diabetes and hypertension, are present more often in patients with vasculitis compared with healthy controls. In addition, steroids may be pro-atherogenic. Most importantly, many patients have impaired renal function, persistent proteinuria and increased levels of C-reactive protein, well-known risk factors for acceleration of atherosclerosis. Enhanced oxidation processes, persistently activated T cells and reduced numbers of regulatory T cells are among the many pathophysiological factors that play a role during acceleration of atherogenesis. Finally, autoantibodies that may be relevant for acceleration of atherosclerosis are found frequently in elevated titres in patients with vasculitis. Because patients have an increased risk for cardiovascular events, vasculitis should be treated with as much care as possible. In addition, treatment should be considered with angiotensin-converting-enzyme inhibitors and/or angiotensin receptor-1 blockers, statins and acetylsalicyl acid. Finally, classical risk factors for cardiovascular disease should be monitored and treated as much as possible.
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Affiliation(s)
- J W Cohen Tervaert
- Department of Internal Medicine, Division of Clinical and Experimental Immunology, Maastricht University Medical Center, Maastricht, The Netherlands.
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Risk factors for cardiovascular disease and endothelin-1 levels in Takayasu arteritis patients. Clin Rheumatol 2008; 28:379-83. [DOI: 10.1007/s10067-008-1056-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 11/03/2008] [Accepted: 11/13/2008] [Indexed: 10/21/2022]
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Hamdan A, Porter A, Georghiou GP, Mulad Y, Raanani E, Hasdai D, Battler A, Assali AR. Unusual presentation of Takayasu arteritis. Int J Cardiol 2007; 119:249-50. [PMID: 17064787 DOI: 10.1016/j.ijcard.2006.07.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2006] [Revised: 07/21/2006] [Accepted: 07/29/2006] [Indexed: 11/21/2022]
Abstract
Takayasu arteritis (TA) is an inflammatory arteritis involving large vessels, predominantly the aorta and its main branches. Angina pectoris or myocardial infarction may occur in 3-5% of patients. Symptomatic coronary artery disease may be in rare case the first sign of TA. We describe a case of a young woman in whom acute myocardial infarction and cardiogenic shock and stroke were the initial presentations of TA.
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Abstract
PURPOSE OF REVIEW Giant cell arteritis and Takayasu arteritis are well known large vessel vasculitides with an unknown etiology. As they have similar clinical features, this short article reviews recent advances in clinical and pathophysiological findings, focusing in particular on papers published in the past year. RECENT FINDINGS Delayed gadolinium-enhanced magnetic resonance imaging showed delayed hyperenhancement in the aortic wall in Takayasu arteritis. This technique may be useful in monitoring disease activity or inflammation in the arterial wall and can be used for small vessels such as temporal arteries in giant cell arteritis with high-resolution imaging. Evidence is accumulating that antitumor necrosis factor-alpha monoclonal antibody therapy can be useful for patients refractory to corticosteroid and/or immunosuppressant treatment. Functional promoter polymorphisms of genes encoding inducible nitric oxide synthase and I-kappaB-like protein were suggested to be associated with susceptibility to giant cell arteritis and Takayasu arteritis, respectively. SUMMARY Advances in imaging technique will make it possible to evaluate inflammatory activity of the vascular lesions and provide a useful guide for treatment of giant cell arteritis and Takayasu arteritis. Further understanding of the pathophysiological mechanism may contribute to the development of new medicine targeting critical factors in the pathogenesis, such as antitumor necrosis factor-alpha agents.
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Affiliation(s)
- Yoshinori Seko
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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