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Dermatologic Manifestations of Noninflammasome-Mediated Autoinflammatory Diseases. JID INNOVATIONS 2023; 3:100176. [PMID: 36876221 PMCID: PMC9982332 DOI: 10.1016/j.xjidi.2022.100176] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Autoinflammatory diseases (AIDs) arise from disturbances that alter interactions of immune cells and tissues. They give rise to prominent (auto)inflammation in the absence of aberrant autoantibodies and/or autoreactive T cells. AIDs that are predominantly caused by changes in the inflammasome pathways, such as the NLRP3- or pyrin-associated inflammasome, have gained substantial attention over the last years. However, AIDs resulting primarily from other changes in the defense system of the innate immune system are less well-studied. These noninflammasome-mediated AIDs relate to, for example, disturbance in the TNF or IFN signaling pathways or aberrations in genes affecting the IL-1RA. The spectrum of clinical signs and symptoms of these conditions is vast. Thus, recognizing early cutaneous signs constitutes an important step in differential diagnoses for dermatologists and other physicians. This review provides an overview of the pathogenesis, clinical presentation, and available treatment options highlighting dermatologic aspects of noninflammasome-mediated AIDs.
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Key Words
- AID, autoinflammatory disease
- ANCA, antineutrophil cytoplasmic antibody
- AOSD, adult-onset Still disease
- BASDAI, Bath Ankylosing Spondylitis Activity Index
- CANDLE, chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature
- CAPS, cryopyrin-associated periodic syndrome
- CRD, cysteine-rich domain
- DIRA, deficiency of IL-1RA
- DITRA, deficiency of IL-36RA
- ER, endoplasmic reticulum
- ESR, erythrocyte sedimentation rate
- FMF, familial Mediterranean fever
- M-CSF, macrophage colony-stimulating factor
- MAS, macrophage activation syndrome
- NET, neutrophil extracellular trap
- NOS, nitrous oxide
- NSAID, nonsteroidal anti-inflammatory drug
- NUD, neutrophilic urticarial dermatosis
- PFAPA, periodic fever, aphthous stomatitis, pharyngitis, and adenitis
- PKR, protein kinase R
- PRAAS, proteosome-associated autoinflammatory disease
- SAPHO, synovitis, acne, pustulosis, hyperostosis, osteitis syndrome
- SAVI, STING-associated vasculopathy with onset in infancy
- STAT, signal transducer and activator of transcription
- SchS, Schnitzler syndrome
- TNFR, TNF receptor
- TRAPS, TNF receptor‒associated autoinflammatory disease
- Th17, T helper 17
- VAS, Visual Analog Scale
- sTNFR, soluble TNF receptor
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Masson Regnault M, Frouin E, Jéru I, Delwail A, Charreau S, Barbarot S, Néel A, Masseau A, Puéchal X, Kyndt X, Gayet S, Lifermann F, Asli B, Balguerie X, Blanchard-Delaunay C, Aubin F, Rizzi R, Rongioletti F, Boyé T, Gusdorf L, Bessis D, Morel F, Hainaut E, Lipsker D, Lecron JC. Cytokine Signature in Schnitzler Syndrome: Proinflammatory Cytokine Production Associated to Th Suppression. Front Immunol 2020; 11:588322. [PMID: 33324407 PMCID: PMC7726442 DOI: 10.3389/fimmu.2020.588322] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/06/2020] [Indexed: 12/23/2022] Open
Abstract
Background Schnitzler syndrome (SchS) is a rare autoinflammatory disease characterized by urticarial exanthema, bone and joint alterations, fever and monoclonal IgM gammopathy. Overactivation of the interleukin(IL)-1 system is reported, even though the exact pathophysiological pathways remain unknown. Objective To determine ex vivo cytokine profiles of Peripheral Blood Mononuclear Cells (PBMCs) from SchS patients prior to treatment and after initiation of anti-IL-1 therapy (anakinra). The sera cytokine profile was studied in parallel. Methods We collected blood samples from thirty-six untreated or treated SchS. PBMCs were cultured with and without LPS or anti-CD3/CD28. Cytokine levels were evaluated in serum and cell culture supernatants using Luminex technology. Results Spontaneous TNFα, IL-6, IL-1β, IL-1α, and IL-1RA release by PBMCs of SchS patients were higher than in controls. LPS-stimulation further induced the secretion of these cytokines. In contrast, after T-cell stimulation, TNFα, IL-10, IFNγ, IL-17A, and IL-4 production decreased in SchS patients compared to healthy controls, but less in treated patients. Whereas IL-1β serum level was not detected in most sera, IL-6, IL-10, and TNFα serum levels were higher in patients with SchS and IFNγ and IL-4 levels were lower. Of note, IL-6 decreased after treatment in SchS (p = 0.04). Conclusion Our data strengthen the hypothesis of myeloid inflammation in SchS, mediated in particular by IL-1β, TNFα, and IL-6, associated with overproduction of the inhibitors IL-1RA and IL-10. In contrast, we observed a loss of Th1, Th2, and Th17 cell functionalities that tends to be reversed by anakinra.
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Affiliation(s)
- Marie Masson Regnault
- Centre Hospitalo-Universitaire de Poitiers, Service de Dermatologie, Poitiers, France.,Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), EA4331, Université de Poitiers, Poitiers, France
| | - Eric Frouin
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), EA4331, Université de Poitiers, Poitiers, France.,Centre Hospitalo-universitaire, Service de Anatomopathologie, Poitiers, France
| | - Isabelle Jéru
- Sorbonne Université, Inserm UMR 933, Childhood Genetic Disorders, Hôpital Trousseau, Paris, France
| | - Adriana Delwail
- ImageUP, Plate-forme d'Imagerie et Laboratoire Signalisation et Transport Ioniques Membranaires ERL CNRS 7003/EA 7349, Université de Poitiers, Poitiers, France
| | - Sandrine Charreau
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), EA4331, Université de Poitiers, Poitiers, France
| | - Sébastien Barbarot
- Centre Hospitalo-universitaire de Nantes, Service de Dermatologie, Nantes, France
| | - Antoine Néel
- CHU Nantes, Service de Médecine Interne, Nantes, France.,CHU Nantes, Université de Nantes, Inserm, Centre de Recherche en Transplantation et Immunologie, UMR 1064, ITUN, Nantes, France
| | | | - Xavier Puéchal
- Centre de Référence Maladies Systémiques et Auto-Immunes Rares, Université Paris Descartes, APHP, Hôpital Cochin, Paris, France
| | - Xavier Kyndt
- Centre Hospitalier de Valenciennes, Service de Médecine Interne, Valenciennes, France
| | - Stephane Gayet
- Service de Medecine Interne, Centre hospitalo-Universitaire La Timone, Marseille, France
| | - François Lifermann
- Centre Hospitalier de Dax, Service de Médecine Interne Hématologie, Dax, France
| | - Bouchra Asli
- Centre Hospitalier Edouard Herriot-Lyon, Service de Médecine Interne, Lyon, France
| | - Xavier Balguerie
- Centre Hospitalier de Rouen, Service de Dermatologie, Rouen, France
| | | | - François Aubin
- Centre Hospitalier de Besançon, Service de Dermatologie, Besançon, France
| | - Rita Rizzi
- Department of Hematology, University of Bari Medical School, Bari, Italy
| | - Franco Rongioletti
- Department of Medical Sciences and Public Health, Unit of Dermatology, University of Cagliari, Cagliari, Italy
| | - Thierry Boyé
- Service de Dermatologie, Hôpital d'instruction des Armées Sainte-Anne, Toulon, France
| | - Laurence Gusdorf
- Centre Hospitalier Universitaire de Reims, Service de Dermatologie et Vénéréologie, Reims, France
| | - Didier Bessis
- Centre Hospitalier Universitaire de Montpellier, Hôpital Saint-Eloi, Service de Dermatologie et Vénéréologie, Montpellier, France
| | - Franck Morel
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), EA4331, Université de Poitiers, Poitiers, France
| | - Ewa Hainaut
- Centre Hospitalo-Universitaire de Poitiers, Service de Dermatologie, Poitiers, France.,Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), EA4331, Université de Poitiers, Poitiers, France
| | - Dan Lipsker
- Faculté de Médecine, Université de Strasbourg et Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean-Claude Lecron
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), EA4331, Université de Poitiers, Poitiers, France.,CHU de Poitiers, Laboratoire Immunologie-Inflammation, Poitiers, France
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Rubbert-Roth A, Furst DE, Nebesky JM, Jin A, Berber E. A Review of Recent Advances Using Tocilizumab in the Treatment of Rheumatic Diseases. Rheumatol Ther 2018; 5:21-42. [PMID: 29502236 PMCID: PMC5935615 DOI: 10.1007/s40744-018-0102-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Indexed: 12/20/2022] Open
Abstract
Tocilizumab (TCZ) is the first humanized anti-interleukin-6 (IL-6) receptor monoclonal antibody approved for the treatment of patients with rheumatoid arthritis (RA), Castleman's disease, polyarticular and systemic juvenile idiopathic arthritis, and, most recently, giant cell arteritis as well as for the treatment of chimeric antigen receptor T cell therapy-induced cytokine release syndrome. The global clinical development program for TCZ provides a wealth of clinical data on intravenous TCZ, and more recent studies in patients with RA have provided evidence characterizing the role of intravenous TCZ as monotherapy in early disease and led to the introduction of a subcutaneous formulation of TCZ. In addition, recently published open-label extension and observational studies continue to support the long-term efficacy and safety of TCZ in both clinical trial and real-world settings. Given the involvement of IL-6-mediated signaling in inflammatory disorders, TCZ is also being investigated in other immunological diseases. In particular, a phase 2 trial on the safety and efficacy of subcutaneous TCZ in adults with systemic sclerosis shows clinically relevant improvements in skin sclerosis and lung function in these patients. Another anti-IL-6 receptor agent, sarilumab, targeting the IL6 receptor alpha subunit, was recently approved for the treatment of patients with RA, although long-term data for this biologic are not yet published. In this article we review the placement of TCZ in current treatment guidelines; recent clinical trial data, including quality of life in patients with RA; recent updates to the TCZ safety profile; recent investigations of TCZ in other immunological diseases; and the clinical development of other novel IL-6-targeted agents.
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Affiliation(s)
- Andrea Rubbert-Roth
- Kantonsspital St Gallen, St Gallen, Switzerland.
- Clinic for Rheumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
| | - Daniel E Furst
- University of California, Los Angeles, Los Angeles, CA, USA
- University of Washington, Seattle, WA, USA
- University of Florence, Florence, Italy
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