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Wu J, Song L, Lu M, Gao Q, Xu S, Zhou P, Ma T. The multifaceted functions of DNA-PKcs: implications for the therapy of human diseases. MedComm (Beijing) 2024; 5:e613. [PMID: 38898995 PMCID: PMC11185949 DOI: 10.1002/mco2.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 06/21/2024] Open
Abstract
The DNA-dependent protein kinase (DNA-PK), catalytic subunit, also known as DNA-PKcs, is complexed with the heterodimer Ku70/Ku80 to form DNA-PK holoenzyme, which is well recognized as initiator in the nonhomologous end joining (NHEJ) repair after double strand break (DSB). During NHEJ, DNA-PKcs is essential for both DNA end processing and end joining. Besides its classical function in DSB repair, DNA-PKcs also shows multifaceted functions in various biological activities such as class switch recombination (CSR) and variable (V) diversity (D) joining (J) recombination in B/T lymphocytes development, innate immunity through cGAS-STING pathway, transcription, alternative splicing, and so on, which are dependent on its function in NHEJ or not. Moreover, DNA-PKcs deficiency has been proven to be related with human diseases such as neurological pathogenesis, cancer, immunological disorder, and so on through different mechanisms. Therefore, it is imperative to summarize the latest findings about DNA-PKcs and diseases for better targeting DNA-PKcs, which have shown efficacy in cancer treatment in preclinical models. Here, we discuss the multifaceted roles of DNA-PKcs in human diseases, meanwhile, we discuss the progresses of DNA-PKcs inhibitors and their potential in clinical trials. The most updated review about DNA-PKcs will hopefully provide insights and ideas to understand DNA-PKcs associated diseases.
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Affiliation(s)
- Jinghong Wu
- Cancer Research CenterBeijing Chest HospitalCapital Medical University/Beijing Tuberculosis and Thoracic Tumor Research InstituteBeijingChina
| | - Liwei Song
- Department of Thoracic SurgeryBeijing Chest HospitalCapital Medical University, Beijing Tuberculosis and Thoracic Tumor Research InstituteBeijingChina
| | - Mingjun Lu
- Cancer Research CenterBeijing Chest HospitalCapital Medical University/Beijing Tuberculosis and Thoracic Tumor Research InstituteBeijingChina
| | - Qing Gao
- Cancer Research CenterBeijing Chest HospitalCapital Medical University/Beijing Tuberculosis and Thoracic Tumor Research InstituteBeijingChina
| | - Shaofa Xu
- Department of Thoracic SurgeryBeijing Chest HospitalCapital Medical University, Beijing Tuberculosis and Thoracic Tumor Research InstituteBeijingChina
| | - Ping‐Kun Zhou
- Beijing Key Laboratory for RadiobiologyBeijing Institute of Radiation MedicineBeijingChina
| | - Teng Ma
- Cancer Research CenterBeijing Chest HospitalCapital Medical University/Beijing Tuberculosis and Thoracic Tumor Research InstituteBeijingChina
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Zaizen Y, Okamoto M, Azuma K, Fukuoka J, Hozumi H, Sakamoto N, Suda T, Mukae H, Hoshino T. Enhanced immune complex formation in the lungs of patients with dermatomyositis. Respir Res 2023; 24:86. [PMID: 36934274 PMCID: PMC10024827 DOI: 10.1186/s12931-023-02362-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/08/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Interstitial lung disease is frequently comorbid with dermatomyositis and has a poor prognosis, especially in patients with the anti-melanoma differentiation-associated gene 5 (MDA5) autoantibody. However, the pathogenesis of dermatomyositis-related interstitial lung disease remains unclear. METHODS We examined 18 and 19 patients with dermatomyositis-related interstitial lung disease and idiopathic pulmonary fibrosis (control), respectively. Lung tissues obtained from these patients were semi-quantitatively evaluated by immunohistochemical staining with in-house anti-human MDA5 monoclonal antibodies, as well as anti-human immunoglobulin (Ig) G, IgM, IgA, and complement component 3(C3) antibodies. We established human MDA5 transgenic mice and treated them with rabbit anti-human MDA5 polyclonal antibodies, and evaluated lung injury and Ig and C3 expression. RESULTS MDA5 was moderately or strongly expressed in the lungs of patients in both groups, with no significant differences between the groups. However, patients with dermatomyositis-related interstitial lung disease showed significantly stronger expression of C3 (p < 0.001), IgG (p < 0.001), and IgM (p = 0.001) in the lungs than control. Moreover, lung C3, but IgG, IgA, nor IgM expression was significantly stronger in MDA5 autoantibody-positive dermatomyositis-related interstitial lung disease (n = 9) than in MDA5 autoantibody-negative dermatomyositis-related interstitial lung disease (n = 9; p = 0.022). Treatment with anti-MDA5 antibodies induced lung injury in MDA5 transgenic mice, and strong immunoglobulin and C3 expression was observed in the lungs of the mice. CONCLUSION Strong immunoglobulin and C3 expression in the lungs involve lung injury related to dermatomyositis-related interstitial lung disease. Enhanced immune complex formation in the lungs may contribute to the poor prognosis of MDA5 autoantibody-positive dermatomyositis-related interstitial lung disease.
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Affiliation(s)
- Yoshiaki Zaizen
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Masaki Okamoto
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyouhama, Chuo-Ku, Fukuoka, 810-8563, Japan
| | - Koichi Azuma
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Sizuoka, 431-3192, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 82-8501, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-Ku, Hamamatsu, Sizuoka, 431-3192, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 82-8501, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan.
- Cancer Innovation Laboratory (CIL), Center for Cancer Research (CCR), National Cancer Institute (NCI)-Frederick, 1050 Boyles St, MD, 21702-1201, Frederick, USA.
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Qiu R, Wang Z, Wei X, Sui H, Jiang Z, Yu XF. The pathogenesis of anti-signal recognition particle necrotizing myopathy: A Review. Biomed Pharmacother 2022; 156:113936. [DOI: 10.1016/j.biopha.2022.113936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
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Thomas R, Yeoh SA, Berkeley R, Woods A, Stevens M, Marino S, Radunovic A. Initial seronegative immune-mediated necrotising myopathy with subsequent anti-HMGCR antibody development and response to rituximab: case report. BMC Rheumatol 2020; 4:29. [PMID: 32613157 PMCID: PMC7325302 DOI: 10.1186/s41927-020-00128-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/31/2020] [Indexed: 11/23/2022] Open
Abstract
Background Immune-mediated necrotising myopathy (IMNM) is characterised by severe muscle weakness and necrosis with a paucity of inflammation on muscle biopsy. Around 60% of cases are associated with antibodies to the signal recognition particle (SRP) or 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR); the remainder are seronegative. IMNM is more treatment resistant than inflammatory myopathies. Case presentation A 69-year-old woman with previous statin exposure presented aged 63 with muscle weakness and raised creatinine kinase (CK). Anti-SRP and anti-HMGCR antibodies were not detected, but muscle biopsy revealed changes consistent with necrotising myopathy. Statins were discontinued, and she was treated with prednisolone and methotrexate achieving disease remission. Clinical and biochemical parameters were largely stable until 6 years after diagnosis she experienced a rapid deterioration. This was found to be associated with new development of anti-HMGCR antibody. Rituximab was commenced, resulting rapidly in remission. She has remained in remission since, following 2 cycles of rituximab. Conclusions To our knowledge, this is the first reported case of serologically negative IMNM whose subsequent rapid deterioration was associated with development of anti-HMGCR antibody. The response to rituximab and subsequent sustained remission suggests a role for early use of rituximab in aggressive cases of anti-HMGCR myopathy.
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Affiliation(s)
- Rhys Thomas
- Department of Rheumatology, Whipps Cross Hospital, Whipps Cross University Hospital, Barts Health NHS Trust, London, E11 1NR UK
| | - Su-Ann Yeoh
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rupert Berkeley
- Department of Radiology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Andrew Woods
- Department of Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire UK
| | - Mike Stevens
- Department of Pathology, Barts Health NHS Trust, London, UK
| | - Silvia Marino
- Department of Pathology, Barts Health NHS Trust, London, UK.,Department of Neuropathology, Barts Health NHS Trust, London, UK
| | - Aleksandar Radunovic
- Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK
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Immune Myopathy With Perimysial Pathology Associated With Interstitial Lung Disease and Anti-EJ Antibodies. J Clin Neuromuscul Dis 2018; 18:223-227. [PMID: 28538253 DOI: 10.1097/cnd.0000000000000148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES We report a case of immune myopathy with perimysial pathology associated with anti-glycyl-transfer RNA synthetase (anti-EJ) antibody and an excellent treatment response. METHODS Chart review. RESULTS A 36-year-old woman presented with 3 months of fatigue, weight loss, progressive weakness in a scapuloperoneal distribution, and dysphagia. Nerve conduction studies, electromyography, and ultrasound suggested an irritable myopathy. She had marked elevations of creatine kinase and positive anti-glycyl-transfer RNA synthetase (anti-EJ) antibodies. A left biceps muscle biopsy revealed inflammation of the perimysium and surrounding perimysial blood vessels with focal fragmentation of the perimysium. Further evaluation revealed interstitial lung disease. Treatment with prednisone and mycophenolate mofetil led to marked clinical improvement of her symptoms. CONCLUSIONS Our case adds to the growing spectrum of inflammatory myopathies and highlights the importance of performing a comprehensive, multisystem workup.
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Zhang YM, Yang HB, Shi JL, Chen H, Shu XM, Lu X, Wang GC, Peng QL. The prevalence and clinical significance of anti-PUF60 antibodies in patients with idiopathic inflammatory myopathy. Clin Rheumatol 2018. [PMID: 29541951 DOI: 10.1007/s10067-018-4031-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Autoantibodies against poly-U-binding factor 60 kDa protein (PUF60) have been reported in Caucasian dermatomyositis (DM) patients. However, their clinical significance in idiopathic inflammatory myopathy (IIM) remains to be fully clarified. Our objective was to analyze the prevalence and clinical significance of anti-PUF60 antibodies in a large cohort of Chinese IIM patients. In our study, 388 IIM patients, 301 disease controls, and 167 healthy controls (HCs) were involved. An enzyme-linked immunosorbent assay (ELISA) was developed to detect serum anti-PUF60 levels and was validated using immunoblotting methods. Unpaired Mann-Whitney U test and Spearman correlation analysis were used when appropriate. Anti-PUF60 antibodies were observed in IIM patients at a frequency of 10.6% (41/388). Subgrouping analysis revealed that the prevalence of anti-PUF60 antibodies was 10% in DM, 5.5% in polymyositis (PM), 10% in immune-mediated necrotizing myositis (IMNM), and 26.5% in myositis-overlap syndrome. Anti-PUF60 antibodies were also observed in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and Sjögren's syndrome (SS) patients at a positive rate of 17.3, 14.5, and 10.1% respectively. Intriguingly, anti-PUF60 antibodies were frequently observed in clinically amyopathic dermatomyositis (CADM) patients and DM patients without currently known myositis autoantibodies. Furthermore, DM patients with anti-PUF60 antibodies had higher prevalence of skin ulcerations. Moreover, longitudinal investigation in eight DM patients with anti-PUF60 antibodies revealed that the antibodies levels decreased with disease remission. Anti-PUF60 antibodies were nonspecific for myositis, since they could be detected in other rheumatic diseases. Further investigation of anti-PUF60 antibodies may reveal shared pathogenic pathways in systemic autoimmune disorders.
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Affiliation(s)
- Ya-Mei Zhang
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China.,Graduate School of Peking Union Medical College, Beijing, 100730, China
| | - Han-Bo Yang
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China
| | - Jing-Li Shi
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China
| | - He Chen
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China
| | - Xiao-Ming Shu
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China
| | - Xin Lu
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China
| | - Guo-Chun Wang
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China.,Graduate School of Peking Union Medical College, Beijing, 100730, China
| | - Qing-Lin Peng
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China.
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Bizzaro N, Bagnasco M, Tozzoli R, Brusca I, Cinquanta L, Tampoia M, Deleonardi G, Antico A, Pesce G, Alessio MG, Liguori M, Bassetti D, Villalta D. Choosing Wisely in autoimmunologia: le 5 Proposte del Gruppo di Studio in Autoimmunologia della SIPMeL. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s13631-018-0181-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Shi J, Li S, Yang H, Zhang Y, Peng Q, Lu X, Wang G. Clinical Profiles and Prognosis of Patients with Distinct Antisynthetase Autoantibodies. J Rheumatol 2017; 44:1051-1057. [PMID: 28461650 DOI: 10.3899/jrheum.161480] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To compare the clinical characteristics and identify the longterm outcomes of Chinese patients with different antisynthetase antibodies. METHODS We investigated retrospectively 124 consecutive patients with antisynthetase syndrome. Medical records, laboratory results, and computed tomography images were obtained. RESULTS The antisynthetase antibodies we investigated were anti-Jo1 (n = 62), anti-PL7 (n = 31), anti-PL12 (n = 12), and anti-EJ (n = 19). The overall prevalence of interstitial lung disease (ILD) reached 94.4% among study patients. Eleven patients (8.9%) developed rapidly progressive ILD (RP-ILD). Eight patients (6.5%) experienced malignancy. RP-ILD was statistically more prevalent in patients with antisynthetase syndrome with anti-PL7 than those without anti-PL7 (p = 0.028). Anti-Ro52-positive patients with antisynthetase syndrome experienced higher frequency of RP-ILD than those without anti-Ro52 (p = 0.001). Further, anti-PL7-positive patients coexisting with anti-Ro52 exhibited more RP-ILD than those without anti-Ro52 (p = 0.001). Patients with antisynthetase syndrome with RP-ILD had a higher proportion of neutrophils in bronchoalveolar lavage fluid and serum ferritin than those without RP-ILD (p = 0.006 and p = 0.013, respectively). Although no differences were observed between the Kaplan-Meier curves of the 4 antisynthetase antibodies subgroups (p = 0.349), the survival rate of patients with anti-PL7 decreased more rapidly in the early stage of longterm followup compared with those with other antisynthetase antibodies. The presence of RP-ILD, malignancy, and elevated serum ferritin was identified to be associated with poor prognosis in patients with antisynthetase syndrome. CONCLUSION Our study investigates the clinical phenotypes and outcomes of patients with antisynthetase syndrome with distinct antisynthetase antibodies and highlights the link between the anti-PL7 antibody and RP-ILD.
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Affiliation(s)
- Jingli Shi
- From the Peking University China-Japan Friendship School of Clinical Medicine; Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China.,J. Shi, PhD, Peking University China-Japan Friendship School of Clinical Medicine; S. Li, PhD, Department of Rheumatology, China-Japan Friendship Hospital; H. Yang, PhD, Department of Rheumatology, China-Japan Friendship Hospital; Y. Zhang, MD, Peking University China-Japan Friendship School of Clinical Medicine; Q. Peng, PhD, Department of Rheumatology, China-Japan Friendship Hospital; X. Lu, PhD, Department of Rheumatology, China-Japan Friendship Hospital; G. Wang, PhD, Peking University China-Japan Friendship School of Clinical Medicine, and Department of Rheumatology, China-Japan Friendship Hospital
| | - Shanshan Li
- From the Peking University China-Japan Friendship School of Clinical Medicine; Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China.,J. Shi, PhD, Peking University China-Japan Friendship School of Clinical Medicine; S. Li, PhD, Department of Rheumatology, China-Japan Friendship Hospital; H. Yang, PhD, Department of Rheumatology, China-Japan Friendship Hospital; Y. Zhang, MD, Peking University China-Japan Friendship School of Clinical Medicine; Q. Peng, PhD, Department of Rheumatology, China-Japan Friendship Hospital; X. Lu, PhD, Department of Rheumatology, China-Japan Friendship Hospital; G. Wang, PhD, Peking University China-Japan Friendship School of Clinical Medicine, and Department of Rheumatology, China-Japan Friendship Hospital
| | - Hanbo Yang
- From the Peking University China-Japan Friendship School of Clinical Medicine; Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China.,J. Shi, PhD, Peking University China-Japan Friendship School of Clinical Medicine; S. Li, PhD, Department of Rheumatology, China-Japan Friendship Hospital; H. Yang, PhD, Department of Rheumatology, China-Japan Friendship Hospital; Y. Zhang, MD, Peking University China-Japan Friendship School of Clinical Medicine; Q. Peng, PhD, Department of Rheumatology, China-Japan Friendship Hospital; X. Lu, PhD, Department of Rheumatology, China-Japan Friendship Hospital; G. Wang, PhD, Peking University China-Japan Friendship School of Clinical Medicine, and Department of Rheumatology, China-Japan Friendship Hospital
| | - Yamei Zhang
- From the Peking University China-Japan Friendship School of Clinical Medicine; Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China.,J. Shi, PhD, Peking University China-Japan Friendship School of Clinical Medicine; S. Li, PhD, Department of Rheumatology, China-Japan Friendship Hospital; H. Yang, PhD, Department of Rheumatology, China-Japan Friendship Hospital; Y. Zhang, MD, Peking University China-Japan Friendship School of Clinical Medicine; Q. Peng, PhD, Department of Rheumatology, China-Japan Friendship Hospital; X. Lu, PhD, Department of Rheumatology, China-Japan Friendship Hospital; G. Wang, PhD, Peking University China-Japan Friendship School of Clinical Medicine, and Department of Rheumatology, China-Japan Friendship Hospital
| | - Qinglin Peng
- From the Peking University China-Japan Friendship School of Clinical Medicine; Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China.,J. Shi, PhD, Peking University China-Japan Friendship School of Clinical Medicine; S. Li, PhD, Department of Rheumatology, China-Japan Friendship Hospital; H. Yang, PhD, Department of Rheumatology, China-Japan Friendship Hospital; Y. Zhang, MD, Peking University China-Japan Friendship School of Clinical Medicine; Q. Peng, PhD, Department of Rheumatology, China-Japan Friendship Hospital; X. Lu, PhD, Department of Rheumatology, China-Japan Friendship Hospital; G. Wang, PhD, Peking University China-Japan Friendship School of Clinical Medicine, and Department of Rheumatology, China-Japan Friendship Hospital
| | - Xin Lu
- From the Peking University China-Japan Friendship School of Clinical Medicine; Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China.,J. Shi, PhD, Peking University China-Japan Friendship School of Clinical Medicine; S. Li, PhD, Department of Rheumatology, China-Japan Friendship Hospital; H. Yang, PhD, Department of Rheumatology, China-Japan Friendship Hospital; Y. Zhang, MD, Peking University China-Japan Friendship School of Clinical Medicine; Q. Peng, PhD, Department of Rheumatology, China-Japan Friendship Hospital; X. Lu, PhD, Department of Rheumatology, China-Japan Friendship Hospital; G. Wang, PhD, Peking University China-Japan Friendship School of Clinical Medicine, and Department of Rheumatology, China-Japan Friendship Hospital
| | - Guochun Wang
- From the Peking University China-Japan Friendship School of Clinical Medicine; Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China. .,J. Shi, PhD, Peking University China-Japan Friendship School of Clinical Medicine; S. Li, PhD, Department of Rheumatology, China-Japan Friendship Hospital; H. Yang, PhD, Department of Rheumatology, China-Japan Friendship Hospital; Y. Zhang, MD, Peking University China-Japan Friendship School of Clinical Medicine; Q. Peng, PhD, Department of Rheumatology, China-Japan Friendship Hospital; X. Lu, PhD, Department of Rheumatology, China-Japan Friendship Hospital; G. Wang, PhD, Peking University China-Japan Friendship School of Clinical Medicine, and Department of Rheumatology, China-Japan Friendship Hospital.
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Betteridge Z, McHugh N. Myositis-specific autoantibodies: an important tool to support diagnosis of myositis. J Intern Med 2016; 280:8-23. [PMID: 26602539 DOI: 10.1111/joim.12451] [Citation(s) in RCA: 233] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The idiopathic inflammatory myopathies are characterized by muscle weakness, skin disease and internal organ involvement. Autoimmunity is known to have a role in myositis pathogenesis, and myositis-specific autoantibodies, targeting important intracellular proteins, are regarded as key biomarkers aiding in the diagnosis of patients. In recent years, a number of novel myositis autoantibodies including anti-TIF1, anti-NXP2, anti-MDA5, anti-SAE, anti-HMGCR and anti-cN1A have been identified in both adult and juvenile patients. These autoantibodies correlate with distinct clinical manifestations and importantly are found in inclusion body, statin-induced, clinically amyopathic and juvenile groups of myositis patients, previously believed to be mainly autoantibody negative. In this review, we will describe the main myositis-specific and myositis-associated autoantibodies and their frequencies and clinical associations across different ages and ethnic groups. We will also discuss preliminary studies investigating correlations between specific myositis autoantibody titres and clinical markers of disease course, collectively demonstrating the utility of myositis autoantibodies as both diagnostic and prognostic markers of disease.
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Affiliation(s)
- Z Betteridge
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - N McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.,Royal National Hospital for Rheumatic Disease, Bath, UK
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Srivastava P, Dwivedi S, Misra R. Myositis-specific and myositis-associated autoantibodies in Indian patients with inflammatory myositis. Rheumatol Int 2016; 36:935-43. [DOI: 10.1007/s00296-016-3494-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/05/2016] [Indexed: 12/21/2022]
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Bundell C, Rojana-Udomsart A, Mastaglia F, Hollingsworth P, McLean-Tooke A. Diagnostic performance of a commercial immunoblot assay for myositis antibody testing. Pathology 2016; 48:363-6. [PMID: 27114370 DOI: 10.1016/j.pathol.2016.03.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/26/2015] [Accepted: 01/24/2016] [Indexed: 10/21/2022]
Abstract
The objective of this study was to establish a population based reference range for a commercial immunoblot assay detecting myositis specific autoantibodies (MSAs) and myositis associated autoantibodies (MAAs), and to assess the diagnostic performance of this reference range against the manufacturer's recommended ranges in a myositis patient cohort. A total of 124 patients from a myositis cohort and 197 healthy controls were serologically assessed using a commercial immunoblot containing eleven autoantigens (Jo-1, EJ, OJ, PL7, PL12, Mi-2, SRP, Ku, PMScl75, PMScl100 and Ro52) according to the manufacturer's instructions. Use of the manufacturer's reference ranges resulted in detection of MSAs in 19.4% of myositis patients and 9.1% of controls; MAAs were detected in 41.1% of myositis patients and 14.2% of controls. Reference values derived from the healthy control population resulted in significant differences in cut-off values for some autoantibodies, particularly Ro52 and PMScl75. Use of local reference ranges reduced detection of MSAs to 16.9% of myositis patients and 3% of healthy controls, with MAAs 23.4% of patients and 2% of healthy controls. Application of population based reference ranges resulted in significant differences in detection of MSAs and MAAs compared to the manufacturer's recommended ranges. Cut-off levels should be assessed to ensure suitability for the population tested.
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Affiliation(s)
- Chris Bundell
- Department of Clinical Immunology, PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre, Perth, Australia; School of Pathology and Laboratory Medicine, and University of Western Australia, Perth, Australia
| | - Arada Rojana-Udomsart
- Western Australian Neuroscience Research Institute, University of Western Australia, Perth, WA, Australia; Department of Medicine, Yala Hospital, Yala, Thailand
| | - Frank Mastaglia
- Institute for Immunology and Infectious Diseases, Murdoch University, Perth, WA, Australia
| | - Peter Hollingsworth
- Department of Clinical Immunology, PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre, Perth, Australia; School of Pathology and Laboratory Medicine, and University of Western Australia, Perth, Australia
| | - Andrew McLean-Tooke
- Department of Clinical Immunology, PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre, Perth, Australia.
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Lega JC, Reynaud Q, Belot A, Fabien N, Durieu I, Cottin V. Idiopathic inflammatory myopathies and the lung. Eur Respir Rev 2016; 24:216-38. [PMID: 26028634 DOI: 10.1183/16000617.00002015] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Idiopathic inflammatory myositis (IIM) is a group of rare connective tissue diseases (CTDs) characterised by muscular and extramuscular signs, in which lung involvement is a challenging issue. Interstitial lung disease (ILD) is the hallmark of pulmonary involvement in IIM, and causes morbidity and mortality, resulting in an estimated excess mortality of 50% in some series. Except for inclusion body myositis, these extrapulmonary disorders are associated with the general and visceral involvement frequently found in other CTDs including fever, Raynaud's phenomenon, arthralgia, nonspecific cutaneous modifications and ILD, for which the prevalence is estimated to be up to 65%. Substantial heterogeneity exists within the spectrum of IIMs, and each condition is associated with various frequencies and subtypes of pulmonary involvement. This heterogeneity is partly related to the presence of various autoantibodies encompassing anti-synthetase, anti-MDA5 and anti-PM/Scl. ILD is present in all subsets of IIM including juvenile myositis, but is more frequent in dermatomyositis and overlap myositis. IIM can also be associated with other presentations of respiratory involvement, namely pulmonary arterial hypertension, pleural disease, infections, drug-induced toxicity, malignancy and respiratory muscle weakness. Here, we critically review the current knowledge about adult and juvenile myositis-associated lung disease with a detailed description of therapeutics for chronic and rapidly progressive ILD.
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Affiliation(s)
- Jean-Christophe Lega
- Dept of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Claude Bernard University Lyon 1, University of Lyon, Lyon, France UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, CNRS, Claude Bernard University Lyon 1, University of Lyon, Lyon, France
| | - Quitterie Reynaud
- Dept of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Claude Bernard University Lyon 1, University of Lyon, Lyon, France
| | - Alexandre Belot
- Dept of Pediatric Rheumatology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Claude Bernard University Lyon 1, University of Lyon, Lyon, France
| | - Nicole Fabien
- Dept of Immunology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Isabelle Durieu
- Dept of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Claude Bernard University Lyon 1, University of Lyon, Lyon, France
| | - Vincent Cottin
- National Reference Centre for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, Claude Bernard University Lyon 1, University of Lyon, Lyon, France
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Fernandes das Neves M, Caetano J, Oliveira S, Delgado Alves J. Immune-mediated necrotising myopathy associated with antibodies to the signal recognition particle treated with a combination of rituximab and cyclophosphamide. BMJ Case Rep 2015; 2015:bcr-2014-206250. [PMID: 26240092 DOI: 10.1136/bcr-2014-206250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 50-year-old man presented with dysphagia and proximal muscle weakness. He was diagnosed with immune-mediated necrotising myopathy associated with antibodies to the signal recognition particle. After an initial response following treatment with high-dose steroids, intravenous immunoglobulin and methotrexate, there was a relapse of the immune condition. The clinical deterioration occurred less than 2 months after disease onset. The refractoriness of this disease was characterised by an increase of the already severe muscle wasting that led to respiratory failure and progressive dysphagia, regardless of the immunosuppressant treatment. At this time the patient was referred to our department. He was restarted on intravenous pulses of methylprednisolone associated with intravenous cyclophosphamide, but with no effect. After 3 weeks, rituximab was started with a dramatic and progressive improvement. There were no complications associated with rituximab/cyclophosphamide treatment and the disease has been kept in remission, for the last 3 years.
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Affiliation(s)
- Marisa Fernandes das Neves
- Department of Medicine IV, Fernando Fonseca Hospital, Amadora, Portugal CEDOC - Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal
| | - Joana Caetano
- Department of Medicine IV, Fernando Fonseca Hospital, Amadora, Portugal
| | - Susana Oliveira
- Department of Medicine IV, Fernando Fonseca Hospital, Amadora, Portugal
| | - José Delgado Alves
- Department of Medicine IV, Fernando Fonseca Hospital, Amadora, Portugal CEDOC - Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal
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Anti-PL7 antisynthetase syndrome: A rare cause of autoimmune-mediated interstitial lung disease. Allergol Immunopathol (Madr) 2015; 43:326-8. [PMID: 25092352 DOI: 10.1016/j.aller.2014.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 04/15/2014] [Accepted: 04/24/2014] [Indexed: 11/21/2022]
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16
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Krause C, Ens K, Fechner K, Voigt J, Fraune J, Rohwäder E, Hahn M, Danckwardt M, Feirer C, Barth E, Martinetz T, Stöcker W. EUROPattern Suite technology for computer-aided immunofluorescence microscopy in autoantibody diagnostics. Lupus 2015; 24:516-29. [DOI: 10.1177/0961203314559635] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Antinuclear autoantibodies (ANA) are highly informative biomarkers in autoimmune diagnostics. The increasing demand for effective test systems, however, has led to the development of a confusingly large variety of different platforms. One of them, the indirect immunofluorescence (IIF), is regarded as the common gold standard for ANA screening, as described in a position statement by the American College of Rheumatology in 2009. Technological solutions have been developed aimed at standardization and automation of IIF to overcome methodological limitations and subjective bias in IIF interpretation. In this review, we present the EUROPattern Suite, a system for computer-aided immunofluorescence microscopy (CAIFM) including automated acquisition of digital images and evaluation of IIF results. The system was originally designed for ANA diagnostics on human epithelial cells, but its applications have been extended with the latest system update version 1.5 to the analysis of antineutrophil cytoplasmic antibodies (ANCA) and anti-dsDNA antibodies.
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Affiliation(s)
- C Krause
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - K Ens
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - K Fechner
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - J Voigt
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - J Fraune
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - E Rohwäder
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - M Hahn
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - M Danckwardt
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - C Feirer
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - E Barth
- Institute for Neuro- and Bioinformatics, University of Lübeck, Lübeck, Germany
| | - T Martinetz
- Institute for Neuro- and Bioinformatics, University of Lübeck, Lübeck, Germany
| | - W Stöcker
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
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Intérêt de la recherche d’anticorps anti-SRP dans les maladies musculaires inflammatoires. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rhum.2014.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rohwäder E, Locke M, Fraune J, Fechner K. Diagnostic profile on the IFA 40: HEp-20-10 - an immunofluorescence test for reliable antinuclear antibody screening. Expert Rev Mol Diagn 2014; 15:451-62. [PMID: 25530004 DOI: 10.1586/14737159.2015.993612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Indirect immunofluorescence assay is the recommended gold standard to test for antinuclear antibodies (ANA), which are important biomarkers for systemic rheumatic autoimmune diseases. It is internationally accepted that indirect immunofluorescence assay ANA screening is most sensitive on human epithelial (HEp-2) cells. The cells present a multitude of antigens that display distinguishable localization patterns in interphase and mitotic cells in indirect immunofluorescence analysis. Here, we present the IFA 40: HEp-20-10 test kit (Euroimmun AG, Lübeck, Germany), which is cleared for sale on the US market by the FDA. The test has been designed for qualitative and semiquantitative screening of ANA in human sera. It uses the commonly applied 1:40 cutoff dilution and the enhanced HEp-20-10 cell line for more efficient pattern recognition and has been validated in various studies and by method comparison. The IFA 40: HEp-20-10 test fulfills the essential criteria for reliable application in autoimmune diagnostics.
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Affiliation(s)
- Edda Rohwäder
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
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Curtin D, Costigan D, McCarthy C, Jansen M, Farrell M, Reid V, O'Rourke K. Novel antibody associations in immune-mediated necrotising myopathy without inflammation. Ir J Med Sci 2014; 185:941-943. [PMID: 25359222 DOI: 10.1007/s11845-014-1207-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 09/27/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The patient presenting with proximal muscle weakness, elevated serum creatinine kinase and myopathic electromyography and biopsy findings has a wide differential diagnosis that includes toxic, autoimmune, paraneoplastic and congenital myopathies. Autoimmune myopathies are important to identify because they may respond to immunosuppressive therapies. METHODS We describe two cases of immune-mediated necrotizing myopathy each associated with a novel antibody. RESULTS Case 1 describes a progressive myopathy in a statin user. Antibodies to 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase were identified and the patient responded to steroid therapy. Case 2 describes an aggressive myopathy associated with antibodies to signal recognition particle. There was no response to steroids. Clinical improvement followed treatment with rituximab and cyclophosphamide. CONCLUSION The identification of myositis-specific antibodies is important because they are associated with distinct clinical phenotypes and may guide the physician in terms of treatment strategies.
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Affiliation(s)
- D Curtin
- Dublin Neurological Institute at the Mater Misericordiae University Hospital, 57 Eccles St., Dublin 7, Ireland.
| | - D Costigan
- Department of Neurology, Mater Private Hospital, Dublin, Ireland
| | - C McCarthy
- Department of Rheumatology, Mater Private Hospital, Dublin, Ireland
| | - M Jansen
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - M Farrell
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - V Reid
- Department of Clinical Neurophysiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - K O'Rourke
- Dublin Neurological Institute at the Mater Misericordiae University Hospital, 57 Eccles St., Dublin 7, Ireland
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Wendling D, Guillot X, Godfrin-Valnet M, Prati C. Usefulness of anti-SRP antibody testing in inflammatory myopathies. Joint Bone Spine 2014; 81:548-9. [PMID: 24956983 DOI: 10.1016/j.jbspin.2014.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel Wendling
- Service de rhumatologie, CHRU de Besançon, université de Franche-Comté, Besançon, France.
| | - Xavier Guillot
- Service de rhumatologie, CHRU de Besançon, université de Franche-Comté, Besançon, France
| | - Marie Godfrin-Valnet
- Service de rhumatologie, CHRU de Besançon, université de Franche-Comté, Besançon, France
| | - Clément Prati
- Service de rhumatologie, CHRU de Besançon, université de Franche-Comté, Besançon, France
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Marie I, Josse S, Decaux O, Dominique S, Landron C, Roblot P, Jouneau S, Vittecoq O, Jouen F. Outcome of anti-PL12 positive patients with antisynthetase syndrome. Presse Med 2013; 42:e153-8. [DOI: 10.1016/j.lpm.2012.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 12/15/2012] [Accepted: 12/20/2012] [Indexed: 10/27/2022] Open
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Tournadre A, Miossec P. A critical role for immature muscle precursors in myositis. Nat Rev Rheumatol 2013; 9:438-42. [PMID: 23478496 DOI: 10.1038/nrrheum.2013.26] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The innate and adaptive immune responses contribute to the development of inflammatory myopathies; the innate immune system does so through activation of the type I interferon and Toll-like receptor pathways. Dendritic cells have a pivotal role in the development of both adaptive and innate immune responses. Equipped with a range of pattern-recognition receptors, dendritic cells link innate and adaptive immunity. This Perspectives article discusses novel concepts in myositis, focusing on immature muscle precursors. Of interest, the immature muscle precursors involved in regeneration are associated with upregulation of HLA class I antigens and myositis-associated autoantigens, as well as activation of the Toll-like receptor pathway and production of type I interferon, and could have a critical contribution to the pathogenesis of myositis. These regenerating immature muscle cells might also be a target of the immune response in myositis, thereby explaining why muscle regeneration is not effective in the context of such inflammation.
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Affiliation(s)
- Anne Tournadre
- Department of Rheumatology, Centre Hospitalier Universitaire Clermont-Ferrand, G Montpied Hospital, Place H Dunant, BP 69, 63003 Clermont-Ferrand, France
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23
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Mehra S, Walker J, Patterson K, Fritzler MJ. Autoantibodies in systemic sclerosis. Autoimmun Rev 2013; 12:340-54. [DOI: 10.1016/j.autrev.2012.05.011] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 05/15/2012] [Indexed: 01/06/2023]
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Fernandez C, Bardin N, De Paula AM, Salort-Campana E, Benyamine A, Franques J, Schleinitz N, Weiller PJ, Pouget J, Pellissier JF, Figarella-Branger D. Correlation of clinicoserologic and pathologic classifications of inflammatory myopathies: study of 178 cases and guidelines for diagnosis. Medicine (Baltimore) 2013; 92:15-24. [PMID: 23269233 PMCID: PMC5370748 DOI: 10.1097/md.0b013e31827ebba1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The idiopathic inflammatory myopathies (IIM) are acquired muscle diseases characterized by muscle weakness and inflammation on muscle biopsy. Clinicoserologic classifications do not take muscle histology into account to distinguish the subsets of IIM. Our objective was to determine the pathologic features of each serologic subset of IIM and to correlate muscle biopsy results with the clinicoserologic classification defined by Troyanov et al, and with the final diagnoses. We retrospectively studied a cohort of 178 patients with clinicopathologic features suggestive of IIM with the exclusion of inclusion body myositis. At the end of follow-up, 156 of 178 cases were still categorized as IIM: pure dermatomyositis, n = 44; pure polymyositis, n = 14; overlap myositis, n = 68; necrotizing autoimmune myopathy, n = 8; cancer-associated myositis, n = 18; and unclassified IIM, n = 4. The diagnosis of IIM was ruled out in the 22 remaining cases. Pathologic dermatomyositis was the most frequent histologic picture in all serologic subsets of IIM, with the exception of patients with anti-Ku or anti-SRP autoantibodies, suggesting that it supports the histologic diagnosis of pure dermatomyositis, but also myositis of connective tissue diseases and cancer-associated myositis. Unspecified myositis was the second most frequent histologic pattern. It frequently correlated with overlap myositis, especially with anti-Ku or anti-PM-Scl autoantibodies. Pathologic polymyositis was rare and more frequently correlated with myositis mimickers than true polymyositis. The current study shows that clinicoserologic and pathologic data are complementary and must be taken into account when classifying patients with IIM patients. We propose guidelines for diagnosis according to both clinicoserologic and pathologic classifications, to be used in clinical practice.
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Affiliation(s)
- Carla Fernandez
- From the Department of Pathology and Neuropathology (CF, AMdP, JFP, DFB); Department of Neurology and Neuromuscular Diseases (ESC, JF, JP), Centre de référence des maladies neuromusculaires; and Department of Internal Medicine (AB, PJW); Hôpital Timone, AP-HM, Marseille; Department of Immunology (NB) and Department of Internal Medicine (NS), Hôpital de la Conception, AP-HM, Marseille; France
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Stenzel W, Goebel HH, Aronica E. Review: Immune-mediated necrotizing myopathies - a heterogeneous group of diseases with specific myopathological features. Neuropathol Appl Neurobiol 2012; 38:632-46. [DOI: 10.1111/j.1365-2990.2012.01302.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- W. Stenzel
- Department of Neuropathology; Charité - Universitätsmedizin Berlin; Berlin; Germany
| | | | - E. Aronica
- Department of Neuropathology; University Medicine; Johannes Gutenberg University; Mainz; Germany
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Automated indirect immunofluorescence evaluation of antinuclear autoantibodies on HEp-2 cells. Clin Dev Immunol 2012; 2012:651058. [PMID: 23251220 PMCID: PMC3502836 DOI: 10.1155/2012/651058] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 10/18/2012] [Indexed: 01/16/2023]
Abstract
Indirect immunofluorescence (IIF) on human epithelial (HEp-2) cells is considered as the gold standard screening method for the detection of antinuclear autoantibodies (ANA). However, in terms of automation and standardization, it has not been able to keep pace with most other analytical techniques used in diagnostic laboratories. Although there are already some automation solutions for IIF incubation in the market, the automation of result evaluation is still in its infancy. Therefore, the EUROPattern Suite has been developed as a comprehensive automated processing and interpretation system for standardized and efficient ANA detection by HEp-2 cell-based IIF. In this study, the automated pattern recognition was compared to conventional visual interpretation in a total of 351 sera. In the discrimination of positive from negative samples, concordant results between visual and automated evaluation were obtained for 349 sera (99.4%, kappa = 0.984). The system missed out none of the 272 antibody-positive samples and identified 77 out of 79 visually negative samples (analytical sensitivity/specificity: 100%/97.5%). Moreover, 94.0% of all main antibody patterns were recognized correctly by the software. Owing to its performance characteristics, EUROPattern enables fast, objective, and economic IIF ANA analysis and has the potential to reduce intra- and interlaboratory variability.
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Mehndiratta P, Mehta S, Manjila SV, Kammer GM, Cohen ML, Preston DC. Isolated necrotizing myopathy associated with ANTI-PL12 antibody. Muscle Nerve 2012; 46:282-6. [PMID: 22806380 DOI: 10.1002/mus.23383] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Immune-mediated myopathies are a heterogeneous group of chronic autoimmune disorders. Autoantibodies associated with this disease complex are classified into myositis-associated and myositis-specific. Anti-tRNA synthetase antibodies are the most well known of the myositis-specific antibodies. Previous reports have revealed an association of tRNA synthetase autoantibodies with systemic connective tissue disorders. METHODS Our case report involved a 49-year-old man who developed difficulty walking and climbing stairs 5 months prior to his initial visit. No rash or skin changes were observed. RESULTS Laboratory testing was positive for anti-PL12 autoantibody with a negative evaluation for connective tissue disorder (CTD). The patient was found to have necrotizing myopathy associated with anti-PL12 antibodies in the absence of inflammatory changes on biopsy, significant derangement of muscle enzymes, or findings characteristic of a typical CTD. CONCLUSION A high index of suspicion must be maintained for immune-mediated necrotizing myopathy despite the absence of an identifiable CTD and milder symptoms.
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Affiliation(s)
- Prachi Mehndiratta
- Department of Neurology, University Hospitals Case Medical Center, Bolwell Fifth Floor, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA.
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Ghirardello A, Zampieri S, Tarricone E, Iaccarino L, Gorza L, Doria A. Cutting edge issues in polymyositis. Clin Rev Allergy Immunol 2012; 41:179-89. [PMID: 21191666 DOI: 10.1007/s12016-010-8238-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Skeletal muscle is the target tissue of immunoflogistic processes in patients affected with idiopathic inflammatory myopathies (IIM). IIM are classified into three major forms: polymyositis (PM), dermatomyositis (DM), and inclusion body myositis. Recent data suggest that, in the major subsets of myositis, antigens in muscles drive a B-cell antigen-specific immune response. Moreover, some non-immunological mechanisms have been advocated. In this regard, an increased expression of Jo-1 and Mi-2 in muscle biopsies from PM and DM patients compared to normal muscle has been demonstrated; these candidate autoantigens in myositis are expressed at high levels in regenerating muscle cells rather than in mature myotubes. Myositis autoantigen upregulation has also been observed in neoplastic tissues, thus representing a potential link between cancer and autoimmunity in myositis. Myositis-specific autoantibodies (MSA) are disease markers and target intracellular proteins involved in key processes such as translocation and nuclear transcription. Myositis target antigens encompass aminoacyl-tRNA synthetases, the Mi-2 helicase/histone deacetylase protein complex, the signal recognition particle ribonucleoprotein, together with novel target antigens including p155/140, CADM-140, and SAE. Despite their high specificity for autoimmune myositis, MSA target non-muscle restricted proteins ubiquitary to all cell types, making the specific muscle involvement difficult to explain. Non-immunological mechanisms also seem to contribute to the pathogenesis of IIM; activation of endoplasmic reticulum stress response due to muscle regeneration and inflammation but independent to MHC-1 up-regulation has been recently reported in patients with myositis.
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Affiliation(s)
- Anna Ghirardello
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Padova, Italy
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29
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A novel automated indirect immunofluorescence autoantibody evaluation. Clin Rheumatol 2011; 31:503-9. [DOI: 10.1007/s10067-011-1884-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 09/24/2011] [Accepted: 10/15/2011] [Indexed: 12/20/2022]
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Salajegheh M, Lam T, Greenberg SA. Autoantibodies against a 43 KDa muscle protein in inclusion body myositis. PLoS One 2011; 6:e20266. [PMID: 21629782 PMCID: PMC3100335 DOI: 10.1371/journal.pone.0020266] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 04/28/2011] [Indexed: 01/18/2023] Open
Abstract
Background Inclusion body myositis (IBM) is a poorly understood and refractory autoimmune muscle disease. Though widely believed to have no significant humoral autoimmunity, we sought to identify novel autoantibodies with high specificity for this disease. Methodology/Principal Findings Plasma autoantibodies from 65 people, including 25 with IBM, were analyzed by immunoblots against normal human muscle. Thirteen of 25 (52%) IBM patient samples recognized an approximately 43 kDa muscle protein. No other disease (N = 25) or healthy volunteer (N = 15) samples recognized this protein. Conclusions Circulating antibodies against a 43-kDa muscle autoantigen may lead to the discovery of a novel biomarker for IBM. Its high specificity for IBM among patients with autoimmune myopathies furthermore suggests a relationship to disease pathogenesis.
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Affiliation(s)
- Mohammad Salajegheh
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
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Valiyil R, Casciola-Rosen L, Hong G, Mammen A, Christopher-Stine L. Rituximab therapy for myopathy associated with anti-signal recognition particle antibodies: a case series. Arthritis Care Res (Hoboken) 2010; 62:1328-34. [PMID: 20506493 DOI: 10.1002/acr.20219] [Citation(s) in RCA: 158] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The myopathy associated with anti-signal recognition particle (anti-SRP) is a severe necrotizing immune-mediated disease characterized by rapidly progressive proximal muscle weakness, markedly elevated serum creatine kinase (CK) levels, and poor responsiveness to traditional immunosuppressive therapies. Reports on the efficacy of B cell depletion therapy for anti-SRP-associated myopathy are mixed. We describe 8 patients with anti-SRP-associated myopathy and their response to treatment with the anti-CD20 monoclonal antibody rituximab. METHODS We identified 8 patients with myopathy who tested positive for anti-SRP antibodies by immunoprecipitation and were treated with rituximab as part of clinical care. We reviewed their medical records to assess clinical, serologic, and histologic characteristics and response to therapy. In 5 patients, serum was collected before and after rituximab therapy. Autoantibodies were detected by immunoprecipitation and quantitated by densitometry, and the percent decreases in anti-SRP autoantibody levels were calculated. RESULTS Six of 8 patients who had been refractory to standard immunosuppressive therapy demonstrated improved manual muscle strength and/or decline in CK levels as early as 2 months after rituximab treatment. Three patients sustained the response for 12-18 months after initial dosing. All of the patients were continued on adjunctive corticosteroids, but doses were substantially reduced after rituximab. Quantitative levels of serum anti-SRP antibodies also decreased after rituximab treatment. CONCLUSION B cell depletion therapy with rituximab is effective for patients with myopathy associated with anti-SRP. The substantial decrease in anti-SRP antibody levels after rituximab treatment also suggests that B cells and anti-SRP antibodies may play a role in the pathogenesis of this myopathy.
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Affiliation(s)
- Ritu Valiyil
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Tournadre A, Dubost JJ, Soubrier M. Treatment of inflammatory muscle disease in adults. Joint Bone Spine 2010; 77:390-4. [DOI: 10.1016/j.jbspin.2010.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2010] [Indexed: 11/16/2022]
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Ghirardello A, Rampudda M, Ekholm L, Bassi N, Tarricone E, Zampieri S, Zen M, Vattemi GA, Lundberg IE, Doria A. Diagnostic performance and validation of autoantibody testing in myositis by a commercial line blot assay. Rheumatology (Oxford) 2010; 49:2370-4. [PMID: 20724434 DOI: 10.1093/rheumatology/keq281] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Serological testing for myositis-specific or associated autoantibodies [myositis-specific antibody (MSA) and myositis-associated antibody (MAA)] is useful for the diagnosis of idiopathic inflammatory myopathies (IIMs). However, available assays are neither standardized nor validated. The objective is to evaluate the accuracy of a commercial line blot assay for myositis diagnosis. METHODS IgG antibodies against Jo-1, PL-7, PL-12, PM/Scl, Ku, Mi-2 and Ro52 antigens were detected by a line blot and in-house RNA immunoprecipitation or immunoblot. We tested sera from 208 IIM patients, 50 healthy subjects and 180 control patients (11 non-autoimmune myopathy, 23 muscular dystrophy, 11 UCTD, 68 SLE, 36 SSc, 22 SS and 9 arthropathy). RESULTS MSAs or MAAs were detected in 98 (47%) out of the 208 IIM patients by line blot: anti-Jo-1 in 43 (21%), anti-PL-7 or anti-PL-12 in 8 (4%), anti-Mi-2 in 9 (4%), anti-PM/Scl in 9 (4%), anti-Ku in 10 (5%) and anti-Ro52 in 49 (24%). Overall specificity was: 100% for anti-Jo-1, anti-PL-7 or PL-12 and anti-PM/Scl; 96% for anti-Ku; 98% for anti-Mi-2; and 76% for anti-Ro52. In-house testing confirmed line blot results regarding anti-Jo-1, anti-PM/Scl and anti-Ku, while it was more accurate than line blot in detecting anti-Mi-2 (7 vs 4% sensitivity, 100 vs 98% specificity), and anti-aminoacyl-tRNA synthetase (anti-ARS) non-Jo-1 antibodies (11 vs 4% sensitivity, 97 vs 99% specificity). CONCLUSIONS Line blot could be a suitable serological test in the diagnostic workup for myositis, and it represents a reliable alternative to more time-consuming procedures. Continuous effort is recommended in order to improve its accuracy.
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Affiliation(s)
- Anna Ghirardello
- Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
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Do-Pham G, Pagès C, Picard C, Galicier L, Lémann M, Dubertret L, Viguier M. A first case report of a patient with paraneoplastic dermatomyositis developing diffuse alveolar haemorrhage. Br J Dermatol 2010; 163:227-8. [PMID: 20394626 DOI: 10.1111/j.1365-2133.2010.09800.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Egerer K, Roggenbuck D, Hiemann R, Weyer MG, Büttner T, Radau B, Krause R, Lehmann B, Feist E, Burmester GR. Automated evaluation of autoantibodies on human epithelial-2 cells as an approach to standardize cell-based immunofluorescence tests. Arthritis Res Ther 2010; 12:R40. [PMID: 20214808 PMCID: PMC2888187 DOI: 10.1186/ar2949] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 02/19/2010] [Accepted: 03/09/2010] [Indexed: 11/10/2022] Open
Abstract
Introduction Analysis of autoantibodies (AAB) by indirect immunofluorescence (IIF) is a basic tool for the serological diagnosis of systemic rheumatic disorders. Automation of autoantibody IIF reading including pattern recognition may improve intra- and inter-laboratory variability and meet the demand for cost-effective assessment of large numbers of samples. Comparing automated and visual interpretation, the usefulness for routine laboratory diagnostics was investigated. Methods Autoantibody detection by IIF on human epithelial-2 (HEp-2) cells was conducted in a total of 1222 consecutive sera of patients with suspected systemic rheumatic diseases from a university routine laboratory (n = 924) and a private referral laboratory (n = 298). IIF results from routine diagnostics were compared with a novel automated interpretation system. Results Both diagnostic procedures showed a very good agreement in detecting AAB (kappa = 0.828) and differentiating respective immunofluorescence patterns. Only 98 (8.0%) of 1222 sera demonstrated discrepant results in the differentiation of positive from negative samples. The contingency coefficients of chi-square statistics were 0.646 for the university laboratory cohort with an agreement of 93.0% and 0.695 for the private laboratory cohort with an agreement of 90.6%, P < 0.0001, respectively. Comparing immunofluorescence patterns, 111 (15.3%) sera yielded differing results. Conclusions Automated assessment of AAB by IIF on HEp-2 cells using an automated interpretation system is a reliable and robust method for positive/negative differentiation. Employing novel mathematical algorithms, automated interpretation provides reproducible detection of specific immunofluorescence patterns on HEp-2 cells. Automated interpretation can reduce drawbacks of IIF for AAB detection in routine diagnostics providing more reliable data for clinicians.
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Affiliation(s)
- Karl Egerer
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
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Abstract
Cardiac involvement is a complication of end stage polymyositis with left heart insufficiency reported to be the most frequent manifestation. We here describe an unusual clinical presentation of antisynthetases syndrome, beginning with right-sided cardiomyopathy associated with right heart failure. A 26 year-old Caucasian male experienced a 6-month clinical course of polyarthritis, fever, sweats, and myalgia. Laboratory studies showed elevated C reactive protein, elevated sedimentation rate, and myolysis associated with anti SSA and anti JO1 antibodies. Electromyography showed a myopathic pattern. Muscle biopsy confirmed the diagnosis of polymyositis. Chest X ray, chest scan, and cardiac echography were normal. One week after hospital admission, the patient developed acute right heart insufficiency, and magnetic resonance imaging showed a right ventricular myocarditis with myocardial inflammatory thickening. Treatment with corticosteroids rapidly improved both symptoms and biological abnormalities.
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Tarabishy AB, Khan M, Bunyard M, Lowder CY. Retinal Vasculitis Associated with the Anti-Synthetase Syndrome. Ocul Immunol Inflamm 2010; 18:16-8. [DOI: 10.3109/09273940903312005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Giroux M, Dequatre N, Zéphir H, Lacour A, Vermersch P. Polymyosite révélant un syndrome de Gougerot-Sjögren. Rev Neurol (Paris) 2010; 166:96-9. [DOI: 10.1016/j.neurol.2009.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 02/24/2009] [Accepted: 02/28/2009] [Indexed: 11/16/2022]
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Cauwe B, Martens E, Proost P, Opdenakker G. Multidimensional degradomics identifies systemic autoantigens and intracellular matrix proteins as novel gelatinase B/MMP-9 substrates. Integr Biol (Camb) 2009; 1:404-26. [PMID: 20023747 DOI: 10.1039/b904701h] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The action radius of matrix metalloproteinases or MMPs is not restricted to massive extracellular matrix (ECM) degradation, it extends to the proteolysis of numerous secreted and membrane-bound proteins. Although many instances exist in which cells disintegrate, often in conjunction with induction of MMPs, the intracellular MMP substrate repertoire or degradome remains relatively unexplored. We started an unbiased exploration of the proteolytic modification of intracellular proteins by MMPs, using gelatinase B/MMP-9 as a model enzyme. To this end, multidimensional degradomics technology was developed by the integration of broadly available biotechniques. In this way, 100-200 MMP-9 candidate substrates were isolated, of which 69 were identified. Integration of these results with the known biological functions of the substrates revealed many novel MMP-9 substrates from the intracellular matrix (ICM), such as actin, tubulin, gelsolin, moesin, ezrin, Arp2/3 complex subunits, filamin B and stathmin. About 2/3 of the identified candidates were autoantigens described in multiple autoimmune conditions and in cancer (e.g. annexin I, nucleolin, citrate synthase, HMGB1, alpha-enolase, histidyl-tRNA synthetase, HSP27, HSC70, HSP90, snRNP D3). These findings led to the insight that MMPs and other proteases may have novel (immuno)regulatory properties by the clearance of toxic and immunogenic burdens of abundant ICM proteins released after extensive necrosis. In line with the extracellular processing of organ-specific autoantigens, proteolysis might also assist in the generation of immunodominant 'neo-epitopes' from systemic autoantigens. The study of proteolysis of ICM molecules, autoantigens, alarmins and other crucial intracellular molecules may result in the discovery of novel roles for proteolytic modification.
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Affiliation(s)
- Bénédicte Cauwe
- Department of Microbiology and Immunology, Laboratory of Immunobiology, Rega Institute for Medical Research, University of Leuven, Minderbroedersstraat 10, Leuven, Belgium
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Parker JC, Burlingame RW, Bunn CC. Prevalence of antibodies to Ro-52 in a serologically defined population of patients with systemic sclerosis. JOURNAL OF AUTOIMMUNE DISEASES 2009; 6:2. [PMID: 19267890 PMCID: PMC2654555 DOI: 10.1186/1740-2557-6-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 03/06/2009] [Indexed: 12/03/2022]
Abstract
Background Antibodies against Ro-52 have been described in patients with a broad spectrum of autoimmune disease, most commonly in association with anti-Ro-60 in systemic lupus erythematosus and Sjogrens syndrome. However, in inflammatory myositis anti-Ro-52 is frequently present without anti-Ro-60 and is closely linked to the presence of aminoacyl-tRNA synthetase (aats) antibodies. To date there have been no comprehensive reports on the frequency of anti-Ro-52 in systemic sclerosis (SSc), a disease characterised by hallmark autoantibodies that occur in non-overlapping subsets. Clinically, each antibody-defined group has a distinct pattern of organ involvement, some featuring myositis. Objectives To determine the frequency of anti-Ro-52 in serologically defined groups of SSc patients and to investigate a possible link with myositis-associated autoantibodies. Methods Serum samples from 1010 patients with SSc and 55 and 32 patients with anti-aats and anti-Ku respectively were tested for the presence of anti-Ro-52 using a commercial ELISA. Results The prevalence of anti-Ro-52 was 15–38% in nine of the eleven sub-groups. There were no significant differences in mean anti-Ro-52 levels in these groups with the exception of that defined by the presence of anti-U1-RNP. In the remaining groups defined by anti-Ro-60 and anti-aats, anti-Ro-52 was present in 92% and 100% respectively. In sera from non-SSc patients with anti-aats, anti-Ro-52 was detected in 64%. Conclusion Anti-Ro-52 is present throughout the SSc population. It is neither more prevalent in the myositis-associated antibody groups nor does it segregate with any other major SSc-specific autoantibodies. The co-existence of anti-Ro-52 with both anti-Ro-60 and anti-aats is confirmed.
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Affiliation(s)
- Jennifer C Parker
- Department of Clinical Immunology, Royal Free Hospital, London NW32QG, UK
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Hiemann R, Büttner T, Krieger T, Roggenbuck D, Sack U, Conrad K. Challenges of automated screening and differentiation of non-organ specific autoantibodies on HEp-2 cells. Autoimmun Rev 2009; 9:17-22. [PMID: 19245860 DOI: 10.1016/j.autrev.2009.02.033] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Accepted: 02/17/2009] [Indexed: 11/18/2022]
Abstract
Analysis of autoantibodies (AAB) by indirect immunofluorescence (IIF) remains the hallmark of diagnosing autoimmune diseases despite the introduction of multiplex techniques. Non-organ specific AAB are screened in routine diagnostics by IIF on HEp-2 cells. However, IIF results vary due to objective (e.g., cell fixation) and subjective factors (e.g., expert knowledge). Therefore, inter- and intralaboratory variance is relatively high. Standardisation of AAB testing by IIF remains a critical issue in and between routine laboratories and may be improved by automated interpretation systems. An overview of existing interpretation techniques will be given taking into account own data of the first fully automated reading system AKLIDES. The novel system provides fully automated reading of IIF images and software algorithms for the mathematical description of IIF AAB patterns. It can be used for screening and preclassification of non-organ specific AAB in routine diagnostics regarding systemic autoimmune and autoimmune liver diseases. Furthermore, this system paves the way for economic data processing of cell-based IIF assays and can contribute to the reduction of interlaboratory variance of AAB testing. More sophisticated pattern recognition algorithms and novel calibration systems will improve standardised quantifications of IIF image interpretation.
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Affiliation(s)
- Rico Hiemann
- Department of Biology, Chemistry and Process Technology, Lausitz University of Applied Sciences, Senftenberg, Germany
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Abstract
Malignancy and interstitial lung disease (ILD) are 2 conditions associated with dermatomyositis (DM) that are responsible for a significant portion of the morbidity and mortality related to this disease; however, they rarely occur in the same patient. The antisynthetase syndrome consists of several characteristics, including ILD, arthritis, Raynaud phenomenon, "mechanic's hands," and positive antibodies to tRNA synthetases, which have each been negatively associated with cancer. When patients with DM present with such characteristics, clinicians may be falsely reassured that a thorough malignancy screen is unnecessary. We describe a patient who presented with the antisynthetase syndrome and was subsequently found to have colon cancer. Removal of the cancer led to resolution of the myositis and lung disease, but the patient's rash and arthritis persisted and ultimately required immunosuppressive therapy. We provide a review of the literature describing the concurrence of both this syndrome and ILD alone, with malignancy. We conclude that a thorough and expedited age-appropriate malignancy work up is indicated in all patients with a new diagnosis of DM, despite the presence of disease characteristics that are usually not associated with cancer.
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Burd CJ, Kinyamu HK, Miller FW, Archer TK. UV radiation regulates Mi-2 through protein translation and stability. J Biol Chem 2008; 283:34976-82. [PMID: 18922793 DOI: 10.1074/jbc.m805383200] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Dermatomyositis (DM) is an autoimmune disease, which is often accompanied by the development of disease-specific autoantibodies directed against the SNF2-superfamily helicase, Mi-2. Recent evidence suggests that ultraviolet radiation exposure may be an important risk factor for the development of not only the disease but also specific autoimmunity against Mi-2. Consequently, we investigated the effects of ultraviolet radiation on Mi-2 protein expression. We observed an increase in protein levels upon ultraviolet radiation exposure in cell culture systems. These changes in expression occur quite rapidly, are maximized just 1 h following exposure, and are unique to Mi-2 when compared with other members of the NuRD complex. Changes in protein levels are not mediated through transcriptional mechanisms. Treatment results in a more efficiently translated message through regulatory elements in the 5'-UTR region of the transcript. Investigation into protein half-life further demonstrated increased stability of Mi-2 following UV exposure. Taken together, we describe a system by which Mi-2 protein expression can be quickly increased following UV exposure and then maintained up to 16 h later. These data provide a novel regulation of an important transcriptional regulator and provide insight into the possible mechanisms of the development of DM and associated autoantibodies.
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Affiliation(s)
- Craig J Burd
- Laboratory of Molecular Carcinogenesis, NIEHS, National Intitutes of Health, Research Triangle Park, NC 27709, USA
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Abstract
Juvenile dermatomyositis, the most common inflammatory myopathy of childhood, is a rare systemic autoimmune vasculopathy that is characterised by weakness in proximal muscles and pathognomonic skin rashes. The length of time before the initiation of treatment affects presenting symptoms, laboratory measures, and pathophysiology. It also affects disease outcomes, including the development of pathological calcifications, which are associated with increased morbidity. Both genetic and environmental risk factors seem to have a role in the cause of juvenile dermatomyositis; HLA B8-DRB1*0301 ancestral haplotype is a strong immunogenetic risk factor, and antecedent infections and birth seasonality suggest that environmental stimuli might increase risk. Activation of dendritic cells with upregulation of genes induced by type-1 interferon (alpha) in muscle and peripheral blood seems to be central to disease pathogenesis. Treatment often includes combinations of corticosteroids, methotrexate, and other immunosuppressive agents. Disease outcome, if treatment is initiated early, is generally good. Randomised controlled trials are needed to define the most effective treatments.
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Affiliation(s)
- Brian M Feldman
- Departments of Pediatrics, Health Policy Management and Evaluation, and Public Health Sciences, University of Toronto, Division of Rheumatology, Hospital for Sick Children, Toronto, ON, Canada.
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[Dense cytoplasmic fluorescence on Hep-2 cells: do not overlook anti-PL]. ACTA ACUST UNITED AC 2008; 56:15-20. [PMID: 18178329 DOI: 10.1016/j.patbio.2007.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Accepted: 08/27/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Any dense cytoplasmic fluorescence on Hep-2000 cells seen in the immunology laboratory of the Clermont-Ferrand teaching hospital was closely studied to determine the presence or not of anti-PL antibodies. PATIENTS AND METHODS From January 2006 to January 2007, twelve patients presented a dense cytoplasmic fluorescence on Hep-2000 cells. So we activated a Hep-2 cells'slide, a triple substrate's slide and a dot in order to exclude antiribosomes and anti-JO1 antibodies. After having excluded these antibodies, we sent the sera to the immunology laboratory of the South Lyon hospital to confirm the dense cytoplasmic fluorescence and to detect anti-PL antibodies. RESULTS Four patients presented anti-PL7 and three anti-PL12. For four other patients, the dense cytoplasmic fluorescence was only due to anti-SSA antibodies. Last for one patient, no antibody was found despite an evocative clinic of myositis. CONCLUSION The systematically extensive exploration during the discovery of a dense cytoplasmic fluorescence proved very efficient, permitting to diagnose five new cases of antisynthetases syndrome including three not evoked by the clinician and to confirm two cases clinically known. This study permitted us to better recognize anti-PL from others dense cytoplasmic fluorescences and not to mix them up with particular anti-SSA.
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