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Resende GG, Saad CGS, Marques CDL, Ribeiro SLE, de Oliveira Gavi MBR, Yazbek MA, de Oliveira Marinho A, de Cássia Menin R, Ochtrop MLG, Soares AM, Cavalcanti NG, Carneiro JN, Werner de Castro GR, Fernandes JMC, da Cruz Ribeiro E Souza E, de Menezes Alvarenga CQ, de Abreu Vieira RMR, Machado NP, Ximenes AC, Gazzeta MO, de Albuquerque CP, Skare TL, Waldemar Keiserman M, Kohem CL, Benacon GS, Rocha VFS, da Cruz Lage R, Malheiro OB, Golebiovski RTM, Oliveira TL, Duque RH, Londe AC, de Medeiros Pinheiro M, Sampaio-Barros PD. To be or not to B27 positive: implications for the phenotypes of axial spondyloarthritis outcomes. Data from a large multiracial cohort from the Brazilian Registry of Spondyloarthritis. Adv Rheumatol 2024; 64:33. [PMID: 38671475 DOI: 10.1186/s42358-024-00372-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND There is a remarkable variability in the frequency of HLA-B27 positivity in patients with spondyloarthritis (SpA), which may be associated with different clinical presentations worldwide. However, there is a lack of data considering ethnicity and sex on the evaluation of the main clinical and prognostic outcomes in mixed-race populations. The aim of this study was to evaluate the frequency of HLA-B27 and its correlation with disease parameters in a large population of patients from the Brazilian Registry of Spondyloarthritis (RBE). METHODS The RBE is a multicenter, observational, prospective cohort that enrolled patients with SpA from 46 centers representing all five geographic regions of Brazil. The inclusion criteria were as follow: (1) diagnosis of axSpA by an expert rheumatologist; (2) age ≥18 years; (3) classification according to ASAS axial. The following data were collected via a standardized protocol: demographic data, disease parameters and treatment historical. RESULTS A total of 1096 patients were included, with 73.4% HLA-B27 positivity and a mean age of 44.4 (±13.2) years. Positive HLA-B27 was significantly associated with male sex, earlier age at disease onset and diagnosis, uveitis, and family history of SpA. Conversely, negative HLA-B27 was associated with psoriasis, higher peripheral involvement and disease activity, worse quality of life and mobility. CONCLUSIONS Our data showed that HLA-B27 positivity was associated with a classic axSpA pattern quite similar to that of Caucasian axSpA patients around the world. Furthermore, its absence was associated with peripheral manifestations and worse outcomes, suggesting a relevant phenotypic difference in a highly miscegenated population.
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Affiliation(s)
- Gustavo Gomes Resende
- Hospital das Clínicas da UFMG, Belo Horizonte, Brazil.
- Serviço de Reumatologia do Hospital das Clínicas da Universidade Federal de Minas Gerais, Alameda Álvaro Celso, 175/2nd floor, Santa Efigênia, Belo Horizonte, MG, Brazil.
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Ziade N. Human leucocyte antigen-B27 testing in clinical practice: a global perspective. Curr Opin Rheumatol 2023; 35:235-242. [PMID: 37115941 DOI: 10.1097/bor.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
PURPOSE OF REVIEW The association between human leucocyte antigen (HLA)-B27 and spondyloarthritis (SpA) was described half a century ago. New insights about pathophysiologic pathways and their role in bone formation were reported in recent years and will be discussed in this review. RECENT FINDINGS There is a considerable variation in the association between HLA-B27 and SpA across the globe, with the strongest association reported in populations of Northern European and Asian descent and the lowest in the Middle East and Africa. Other genes are also involved in disease susceptibility, highlighting the importance of newly proposed weighted genetic scores to support the diagnosis. On the global level, the interaction between genetic background and gut dysbiosis seems critical for disease predisposition. As for the individual patient, the presence of HLA-B27 can have a significant influence on SpA diagnosis and disease phenotype. More importantly, new studies suggested a role for HLA-B27 in radiographic damage in the sacroiliac joints and the progression of bone formation in the spine. SUMMARY Findings in recent years have enhanced our understanding of the role of HLA-B27 in the pathophysiology and in disease-related bone formation in SpA, which may pave the way for new therapeutic targets.
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Affiliation(s)
- Nelly Ziade
- Saint-Joseph University
- Hotel-Dieu de France Hospital, Beirut, Lebanon
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Schor D, Porto LC, Roma EH, Castro-Alves J, Villela AP, Araújo AQC, Glória Bonecini-Almeida M. Putative role of HLA polymorphism among a Brazilian HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) population. Sci Rep 2023; 13:7659. [PMID: 37169817 PMCID: PMC10173239 DOI: 10.1038/s41598-023-34757-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/06/2023] [Indexed: 05/13/2023] Open
Abstract
Around ten million people are infected with HTLV-1 worldwide, and 1-4% develop HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), characterized by an important degeneration of the spinal cord, which can lead to death. Distinct HLA alleles have been associated with either HAM/TSP susceptibility or protection. However, these HLA alleles set may change according to the population studied. Brazil is the second country in the number of HTLV-1-infected people and there are few reports addressing the HLA influence on HTLV-1 infection as well as on disease outcome. The objective of this study was to evaluate the influence of HLA alleles as a risk factor for HAM/TSP and the proviral load (PVL) levels, clinical progression, and death outcomes in an admixed Brazilian population. The HLA-A, -B, -C, and -DRB1 were genotyped in 375 unrelated HTLV-1-infected individuals divided into asymptomatic carriers (AC) (n = 165) and HAM/TSP (n = 210) in a longitudinal cohort from 8 to 22 years of follow-up. Because locus B deviated from Hardy-Weinberg Equilibrium for the study groups, the results represented for HLA-B alleles were inconclusive. The alleles HLA-A*68 and -C*07 were related to HAM/TSP risk in multivariate analysis. The alleles HLA-A*33, and -A*36 were associated with protection against disease progression in HAM/TSP patients, while -C*12, -C*14, and -DRB1*08 were associated with increased risk of death. In the AC group, the presence of, -C*06 and -DRB1*15 alleles influenced an increased PVL, in an adjusted linear regression model, while -A*30, -A*34, -C*06, -C*17 and -DRB1*09 alleles were associated with increased PVL in HAM/TSP group compared to HAM/TSP individuals not carrying these alleles. All these alleles were also related to increased PVL associated with clinical progression outcome. Increased PVL associated with the death outcome was linked to the presence of HLA-A*30. PVL has been associated with HLA, and several alleles were related in AC and HAM/TSP patients with or without interacting with clinical progression outcomes. Understanding the prognostic value of HLA in HAM/TSP pathogenesis can provide important biomarkers tools to improve clinical management and contribute to the discovery of new therapeutic interventions.
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Affiliation(s)
- Doris Schor
- Laboratório de Imunologia e Imunogenética em Doenças Infecciosas, Instituto Nacional de Infectologia Evandro Chagas-INI/FIOCRUZ, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Luís Cristóvão Porto
- Laboratório de Histocompatibilidade e Criopreservação, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, 20950-000, Brazil
| | - Eric Henrique Roma
- Laboratório de Imunologia e Imunogenética em Doenças Infecciosas, Instituto Nacional de Infectologia Evandro Chagas-INI/FIOCRUZ, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 21040-900, Brazil.
| | - Julio Castro-Alves
- Plataforma de Pesquisa Clínica, Instituto Nacional de Infectologia Evandro Chagas-INI/FIOCRUZ, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Anna Paula Villela
- Laboratório de Histocompatibilidade e Criopreservação, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, 20950-000, Brazil
| | - Abelardo Q C Araújo
- Laboratório de Pesquisa Clínica em Neuroinfecções, Instituto Nacional de Infectologia Evandro Chagas-INI/FIOCRUZ, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Maria Glória Bonecini-Almeida
- Laboratório de Imunologia e Imunogenética em Doenças Infecciosas, Instituto Nacional de Infectologia Evandro Chagas-INI/FIOCRUZ, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 21040-900, Brazil
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Hayashi H, Sun J, Yanagida Y, Yoshida S, Baba S, Tenma A, Toyoura M, Kawabata S, Ehara T, Asaki R, Sakaguchi M, Tomioka H, Shimamura M, Morishita R, Rakugi H, Tomita T, Nakagami H. Peptide-based vaccine targeting IL17A attenuates experimental spondyloarthritis in HLA-B27 transgenic rats. RMD Open 2023; 9:rmdopen-2022-002851. [PMID: 36737108 PMCID: PMC9900070 DOI: 10.1136/rmdopen-2022-002851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Spondyloarthritis (SpA) is known as series of immune-mediated inflammatory disease of the axial and peripheral joints. Human leucocyte antigen (HLA)-B27 is a genetic risk factor for SpA. Recent evidence suggests that the interleukin -17 (IL17) axis strongly contributes to SpA. This study aimed to assess the efficacy of an IL17A peptide-based vaccine on SpA manifestations in model rats. METHODS HLA-B27/human β2-microglobulin (hβ2M) transgenic rats were immunised with heat-inactivated Mycobacterium tuberculosis (MT) to develop spondylitis and arthritis as an experimental SpA model after immunisation with a keyhole limpet hemocyanin-conjugated IL17A peptide-based vaccine with an alum adjuvant three times. The IL17A antibody titre was assessed using ELISA, and arthritis score and joint thickness were monitored two times a week. Enzyme-linked immunospot (ELISpot) assays for IL4- and interferon-γ-secreting splenocytes were conducted to evaluate IL17A-specific T cell activation. We also evaluated the effect of IL17A vaccine in SpA therapeutic model. RESULTS The IL17A peptide-based vaccine with alum adjuvant successfully induced antibody production and suppressed the arthritis score and joint thickness. X-ray and histological analyses showed that enthesitis, bone destruction and new bone formation were inhibited by the IL17A vaccine. The ELISpot assay showed that the IL17A peptide-based vaccine did not elicit any IL17A-reactive T cell responses. IL17A vaccine tends to mitigate, but not significant, in SpA treatment model. These data showed that the peptide-based vaccine targeting IL17A alleviated the SpA phenotype in a heat-inactivated MT-induced SpA model in HLA-B27/hβ2M transgenic rats. CONCLUSIONS IL17A peptide-based vaccine may be a therapeutic option for SpA treatment.
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Affiliation(s)
- Hiroki Hayashi
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Jiao Sun
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yuka Yanagida
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shota Yoshida
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan,Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Satoshi Baba
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan,Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | | | | | | | | | | | | | | | - Munehisa Shimamura
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan,Department of Neurology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ryuichi Morishita
- Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tetsuya Tomita
- Graduate School of Health Science, Morinomiya University of Medical Sciences, Osaka, Osaka, Japan
| | - Hironori Nakagami
- Department of Health Development and Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Intestinal Microbial Metabolites in Ankylosing Spondylitis. J Clin Med 2021; 10:jcm10153354. [PMID: 34362137 PMCID: PMC8347740 DOI: 10.3390/jcm10153354] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022] Open
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by inflammation of axial joints and the pelvis. It is known that intestinal dysbiosis may exert direct pathogenic effects on gut homeostasis and may act as a triggering factor for the host innate immune system to activate and cause inflammation in extraintestinal sites in the so-called "gut-joint axis", contributing to AS pathogenesis. However, although the intestinal microbiota's influence on the clinical manifestation of AS is widely accepted, the mechanisms mediating the cross-talk between the intestinal lumen and the immune system are still not completely defined. Recent evidence suggests that the metabolism of microbial species may be a source of metabolites and small molecules participating in the complex network existing between bacteria and host cells. These findings may give inputs for further research of novel pharmacological targets and pave the way to applying dietary interventions to prevent the onset and ameliorate the clinical presentation of the disease. In this review, we discuss the role of some of the biological mediators of microbial origin, with a particular focus on short-chain fatty acids, tryptophan and vitamin B derivatives, and their role in barrier integrity and type 3 immunity in the context of AS.
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Profaizer T, Dibb K, Bethers H, Monds C, Andreasen J, Delgado JC, Lázár-Molnár E. Comparison of Next-Generation Sequencing-Based Human Leukocyte Antigen Typing with Clinical Flow Cytometry and Allele-Specific PCR Melting Assays for HLA-B27 Genotyping. J Appl Lab Med 2021; 6:1221-1227. [PMID: 34151972 DOI: 10.1093/jalm/jfab046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/05/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Due to the strong association between ankylosing spondylitis and Human Leukocyte Antigen (HLA)-B27, accurate identification of HLA-B27 is important in the diagnosis of patients with suspected spondyloarthritides. For this study, we compared a high-resolution HLA-B typing method to the clinical flow cytometry and allele-specific PCR melting assays to determine clinical benefits of high-resolution testing. METHODS Residual clinical samples submitted for HLA-B27 testing by flow cytometry were tested by single-locus HLA-B genotyping using next-generation sequencing (NGS), and PCR with melting curve analysis, currently used as a reflex test for indeterminate flow cytometry results. RESULTS Fifty out of the 51 samples (98%) positive by flow cytometry confirmed as HLA-B27 positive by PCR melting assay and by NGS. The sample that did not confirm was genotyped as HLA-B*07:02. All the samples negative by flow cytometry were confirmed as HLA-B27 negative by both PCR melting assay and NGS. For the group that was indeterminate by flow cytometry, 84.5% (n = 49) typed as positive for HLA-B27, while 15.5% (n = 9) were negative for HLA-B27 but positive for HLA-B*07:02. NGS was the only method able to distinguish between pathogenic and nonpathogenic HLA-B27 variants, in contrast to the flow cytometry or the PCR melting assays. CONCLUSIONS Single-locus NGS is superior to flow cytometry and PCR melting assay for the unambiguous identification of HLA-B27 variants, and uniquely able to distinguish between pathogenic and nonpathogenic B27 alleles. Due to its high accuracy, it may be a feasible superior alternative to flow cytometry and traditional molecular methods for clinical HLA-B27 testing.
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Affiliation(s)
- Tracie Profaizer
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | - Kimberly Dibb
- Histocompatibility & Immunogenetics Laboratory, University of Utah Health, Salt Lake City, UT
| | - Holly Bethers
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | - Cassandra Monds
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | - John Andreasen
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
| | - Julio C Delgado
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT
| | - Eszter Lázár-Molnár
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT
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Zhang S, Wang Y, Peng L, Su J, Zeng X, Li M, Wu Z, Xu J, Yang M, Wu L, Zhao C, Duan X, Li Q, Zhu J, Fan W. Comparison of Clinical Features in HLA-B27 Positive and Negative Patients With Axial Spondyloarthritis: Results From a Cohort of 4,131 Patients. Front Med (Lausanne) 2021; 7:609562. [PMID: 33425955 PMCID: PMC7785867 DOI: 10.3389/fmed.2020.609562] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/24/2020] [Indexed: 01/31/2023] Open
Abstract
Objective: The aim of our study was to assess the influence of the HLA-B27 status on axial spondyloarthritis (axSpA) in the largest cohort in China. Methods: An observational, cross-sectional, and analytic study of axSpA patients from the China axSpA database was performed. Demographic and clinical data were compared in terms of the HLA-B27 status. Univariate and multivariate analyses were performed to identify variables related to HLA-B27 presence. Results: We enrolled 4,131 patients in this study; of those, 36,95 (89.4%) were HLA-B27 positive. In the multivariate analysis, male gender (p < 0.001), younger age (p < 0.001), a disease duration of more than 3 years (p < 0.001), a family history of SpA (p < 0.001), uveitis (p < 0.001), ASDAS-CRP (p < 0.001), and biologic treatment (p < 0.001) were the main variables that were independently related to HLA-B27 presence, whereas a diagnosis delay time >36 months (p < 0.001) and psoriasis (p < 0.001) were independently related to HLA-B27 absence. Conclusion: In Chinese axial SpA patients, presence of HLA-B27 is associated with the male sex, younger age, longer disease duration, greater family aggregation, and higher frequency of uveitis; absence of HLA-B27 is associated with longer diagnosis delay time and higher frequency of psoriasis.
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Affiliation(s)
- Shangzhu Zhang
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Ministry of Science and Technology, Department of Rheumatology, National Clinical Research Center for Dermatologic and Immunologic Diseases, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanhong Wang
- Department of Epidemiology and Bio-Statistics (YW), Peking Union Medical College, Institute of Basic Medical Sciences, China Academy of Medical Sciences, Beijing, China
| | - Linyi Peng
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Ministry of Science and Technology, Department of Rheumatology, National Clinical Research Center for Dermatologic and Immunologic Diseases, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinmei Su
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Ministry of Science and Technology, Department of Rheumatology, National Clinical Research Center for Dermatologic and Immunologic Diseases, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaofeng Zeng
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Ministry of Science and Technology, Department of Rheumatology, National Clinical Research Center for Dermatologic and Immunologic Diseases, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mengtao Li
- Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Ministry of Science and Technology, Department of Rheumatology, National Clinical Research Center for Dermatologic and Immunologic Diseases, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhenbiao Wu
- Department of Rheumatology, Xijing Hospital affiliated to the Fourth Military Medical University, Xi'an, China
| | - Jian Xu
- Department of Rheumatology, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Min Yang
- Department of Rheumatology, Nanfang Hospital Affiliated to Southern Medical University, Guangzhou, China
| | - Lijun Wu
- Department of Rheumatology, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumchi, China
| | - Cheng Zhao
- Department of Rheumatology, Guangxi Medical University First Affiliated Hospital, Nanning, China
| | - Xinwang Duan
- Department of Rheumatology, Nanchang University Second Affiliated Hospital, Nanchang, China
| | - Qin Li
- Department of Rheumatology, First People's Hospital of Yunnan, Kunming, China
| | - Jing Zhu
- Department of Rheumatology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Wenqiang Fan
- Department of Rheumatology, Xinxiang Central Hospital, Xinxiang, China
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