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Rosa I, Romano E, Fioretto BS, Manetti M. Autoantibodies as putative biomarkers and triggers of cell dysfunctions in systemic sclerosis. Curr Opin Rheumatol 2024:00002281-990000000-00128. [PMID: 39046085 DOI: 10.1097/bor.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
PURPOSE OF REVIEW Antinuclear autoantibodies represent a serological hallmark of systemic sclerosis (SSc), with anticentromere, antitopoisomerase-I, and anti-RNA polymerase III antibodies routinely assessed for diagnosis, clinical subset classification, and prognosis. In addition, an increasing number of autoantibodies have been demonstrated to play a pathogenic role by mediating different SSc manifestations. This review aims to give an overview on autoantibodies as putative biomarkers in SSc and discuss their possible pathogenic role as triggers of cell dysfunctions. RECENT FINDINGS Over the years, different autoantibodies have been proposed as biomarkers aiding in diagnosis, disease subtype classification, disease progression prediction, organ involvement, as well as in understanding treatment response. Increasing literature also indicates functional autoantibodies as direct contributors to SSc pathogenesis by exerting agonistic or antagonistic activities on their specific cognate targets. SUMMARY In SSc, search and validation of novel autoantibodies with higher diagnostic specificity and more accurate predictive values are increasingly needed for early diagnosis and specific follow-up, and to define the best therapeutic option according to different disease subsets. Moreover, since autoantibodies are also emerging as functional pathogenic players, a better unraveling of their possible pathomechanisms becomes essential to identify new targets and develop promising therapeutic agents able to neutralize their effects.
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Affiliation(s)
- Irene Rosa
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Rubio-Rivas M, Pestaña-Fernández M. Prevalence of the limited vs. extensive scleroderma-related interstitial lung disease at the time of diagnosis of SSc-ILD based on Goh et al. criteria. Systematic review and meta-analysis. Rev Clin Esp 2024; 224:189-196. [PMID: 38387499 DOI: 10.1016/j.rceng.2024.02.008] [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] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Goh et al. proposed in 2008 a classificatory algorithm of limited or extensive SSc-ILD. The prevalence of both at the time of diagnosis of SSc-ILD is not known with exactitude. METHODS The review was undertaken by means of MEDLINE and SCOPUS from 2008 to 2023 and using the terms: "systemic", "scleroderma" or "interstitial lung disease" [MesH]. The Newcastle-Ottawa Scale was used for the qualifying assessment for observational studies and the Jadad scale for clinical trials. The inverse variance-weighted method was performed. RESULTS Twenty-seven studies were initially included in the systematic review and meta-analysis (SRMA). Of these, 17 studies had no overlapping data. They reported data from 2,149 patients, 1,369 (81.2%) were female. The mean age was 52.4 (SD 6.6) years. 45.2% of the patients had the diffuse subtype and 54.8% had the limited or sine scleroderma subtype. A total of 38.7% of the patients showed positive antitopoisomerase antibodies (ATA) and 14.2% positive anticentromere antibodies (ACA). The mean percentage of forced vital capacity (FVC) at baseline was 80.5% (SD 6.9) and of diffusing capacity of the lungs for carbon monoxide (DLco) was 59.1% (SD 9.6). Twelve studies presented SSc-ILD extension data adjusted for PFTs and were included in the meta-analysis. The 10 observational cohort studies were analyzed separately. The overall percentage of limited extension was estimated at 63.5% (95%CI 55.3-73; p < 0.001) using the random-effects model. Heterogeneity between studies (I2) was 9.8% (95%CI 0-68.2%) with the random-effects model. Extensive pulmonary involvement was estimated at 34.3% (95%CI 26-45.4; p < 0.001). Heterogeneity between studies (I2) was 0% (95%CI 0-61.6%) with the random-effects model. CONCLUSION The overall percentage of limited SSc-ILD at the time of diagnosis of SSc-ILD was estimated at 63.5% and extensive at 34.3%.
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Affiliation(s)
- Manuel Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, Barcelona, Spain.
| | - Melani Pestaña-Fernández
- Department of Internal Medicine, Moisés Broggi Hospital, Esplugues de Llobregat, Barcelona, Spain.
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Le Gall A, Hoang-Thi TN, Porcher R, Dunogué B, Berezné A, Guillevin L, Le Guern V, Cohen P, Chaigne B, London J, Groh M, Paule R, Chassagnon G, Vakalopoulou M, Dinh-Xuan AT, Revel MP, Mouthon L, Régent A. Prognostic value of automated assessment of interstitial lung disease on CT in systemic sclerosis. Rheumatology (Oxford) 2024; 63:103-110. [PMID: 37074923 DOI: 10.1093/rheumatology/kead164] [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: 12/01/2022] [Revised: 03/10/2023] [Accepted: 03/27/2023] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE Stratifying the risk of death in SSc-related interstitial lung disease (SSc-ILD) is a challenging issue. The extent of lung fibrosis on high-resolution CT (HRCT) is often assessed by a visual semiquantitative method that lacks reliability. We aimed to assess the potential prognostic value of a deep-learning-based algorithm enabling automated quantification of ILD on HRCT in patients with SSc. METHODS We correlated the extent of ILD with the occurrence of death during follow-up, and evaluated the additional value of ILD extent in predicting death based on a prognostic model including well-known risk factors in SSc. RESULTS We included 318 patients with SSc, among whom 196 had ILD; the median follow-up was 94 months (interquartile range 73-111). The mortality rate was 1.6% at 2 years and 26.3% at 10 years. For each 1% increase in the baseline ILD extent (up to 30% of the lung), the risk of death at 10 years was increased by 4% (hazard ratio 1.04, 95% CI 1.01, 1.07, P = 0.004). We constructed a risk prediction model that showed good discrimination for 10-year mortality (c index 0.789). Adding the automated quantification of ILD significantly improved the model for 10-year survival prediction (P = 0.007). Its discrimination was only marginally improved, but it improved prediction of 2-year mortality (difference in time-dependent area under the curve 0.043, 95% CI 0.002, 0.084, P = 0.040). CONCLUSION The deep-learning-based, computer-aided quantification of ILD extent on HRCT provides an effective tool for risk stratification in SSc. It might help identify patients at short-term risk of death.
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Affiliation(s)
- Aëlle Le Gall
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | | | - Raphaël Porcher
- Université de Paris, Paris, France
- Service d'Epidémiologie Clinique, Hôpital Hôtel Dieu, AP-HP, Paris, France
| | - Bertrand Dunogué
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Alice Berezné
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Véronique Le Guern
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Pascal Cohen
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Jonathan London
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Matthieu Groh
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Romain Paule
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Guillaume Chassagnon
- Service de Radiologie, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Maria Vakalopoulou
- Centre de Vision Numérique, École Centrale Supelec, Gif-sur-Yvette, France
| | - Anh-Tuan Dinh-Xuan
- Service de Physiologie et Explorations Fonctionnelles, Hôpital Cochin, AP-HP, Paris, France
| | - Marie Pierre Revel
- Service de Radiologie, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Alexis Régent
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
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Petelytska L, Bonomi F, Cannistrà C, Fiorentini E, Peretti S, Torracchi S, Bernardini P, Coccia C, De Luca R, Economou A, Levani J, Matucci-Cerinic M, Distler O, Bruni C. Heterogeneity of determining disease severity, clinical course and outcomes in systemic sclerosis-associated interstitial lung disease: a systematic literature review. RMD Open 2023; 9:e003426. [PMID: 37940340 PMCID: PMC10632935 DOI: 10.1136/rmdopen-2023-003426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/02/2023] [Indexed: 11/10/2023] Open
Abstract
Objective The course of systemic sclerosis-associated interstitial lung disease (SSc-ILD) is highly variable and different from continuously progressive idiopathic pulmonary fibrosis (IPF). Most proposed definitions of progressive pulmonary fibrosis or SSc-ILD severity are based on the research data from patients with IPF and are not validated for patients with SSc-ILD. Our study aimed to gather the current evidence for severity, progression and outcomes of SSc-ILD.Methods A systematic literature review to search for definitions of severity, progression and outcomes recorded for SSc-ILD was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in Medline, Embase, Web of Science and Cochrane Library up to 1 August 2023.Results A total of 9054 papers were reviewed and 342 were finally included. The most frequent tools used for the definition of SSc-ILD progression and severity were combined changes of carbon monoxide diffusing capacity (DLCO) and forced vital capacity (FVC), isolated FVC or DLCO changes, high-resolution CT (HRCT) extension and composite algorithms including pulmonary function test, clinical signs and HRCT data. Mortality was the most frequently reported long-term event, both from all causes or ILD related.Conclusions The studies presenting definitions of SSc-ILD 'progression', 'severity' and 'outcome' show a large heterogeneity. These results emphasise the need for developing a standardised, consensus definition of severe SSc-ILD, to link a disease specific definition of progression as a surrogate outcome for clinical trials and clinical practice.PROSPERO registration number CRD42022379254.Cite Now.
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Affiliation(s)
- Liubov Petelytska
- Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department Internal Medicine #3, Bogomolets National Medical University, Kiiv, Ukraine
| | - Francesco Bonomi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Carlo Cannistrà
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Elisa Fiorentini
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Silvia Peretti
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Sara Torracchi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Pamela Bernardini
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Carmela Coccia
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Riccardo De Luca
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Alessio Economou
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Juela Levani
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Hospital, Milan, Italy
| | - Oliver Distler
- Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Cosimo Bruni
- Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence - Careggi University Hospital, Florence, Italy
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Walsh SLF, Lafyatis RA, Cottin V. Imaging Features of Autoimmune Disease-Related Interstitial Lung Diseases. J Thorac Imaging 2023; 38:S30-S37. [PMID: 37732704 DOI: 10.1097/rti.0000000000000734] [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: 09/22/2023]
Abstract
Interstitial lung diseases (ILDs) associated with autoimmune diseases show characteristic signs of imaging. Radiologic signs are also used in the identification of ILDs with features suggestive of autoimmune disease that do not meet the criteria for a specific autoimmune disease. Radiologists play a key role in identifying these signs and assessing their relevance as part of multidisciplinary team discussions. A radiologist may be the first health care professional to pick up signs of autoimmune disease in a patient referred for assessment of ILD or with suspicion for ILD. Multidisciplinary team discussion of imaging findings observed during follow-up may inform a change in diagnosis or identify progression, with implications for a patient's treatment regimen. This article describes the imaging features of autoimmune disease-related ILDs and the role of radiologists in assessing their relevance.
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Affiliation(s)
- Simon L F Walsh
- National Heart and Lung Institute, Imperial College, London, UK
| | - Robert A Lafyatis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, PA
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Claude Bernard University Lyon 1, Lyon, France
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Volkmann ER, Kreuter M, Hoffmann-Vold AM, Wijsenbeek M, Smith V, Khanna D, Denton CP, Wuyts W, Miede C, Alves M, Sambevski S, Allanore Y. Dyspnoea and cough in patients with systemic sclerosis-associated interstitial lung disease in the SENSCIS trial. Rheumatology (Oxford) 2022; 61:4397-4408. [PMID: 35150246 PMCID: PMC9629379 DOI: 10.1093/rheumatology/keac091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of these analyses was to investigate the rate of decline in forced vital capacity (FVC) in patients with SSc-associated interstitial lung disease (SSc-ILD) with and without cough or dyspnoea in the SENSCIS trial. METHODS Patients in the SENSCIS trial were randomized to receive nintedanib or placebo. Subgroups with and without cough or dyspnoea at baseline were defined by responses to the St George's Respiratory Questionnaire. RESULTS At baseline, 114/575 patients (19.8%) did not have cough and 172/574 patients (30.0%) did not have dyspnoea. In the placebo group, the rate of FVC decline over 52 weeks was similar in patients with and without cough (-95.6 and -83.4 mL/year, respectively) or dyspnoea (-95.8 and -87.7 mL/year, respectively). The effect of nintedanib vs placebo on reducing the rate of FVC decline was numerically more pronounced in patients without than with cough [difference: 74.4 (95% CI -11.1, 159.8) vs 31.5 (-11.1, 74.1)] and without than with dyspnoea [79.8 (9.8, 149.7) vs 25.7 (-19.9, 71.3)], but interaction P-values did not indicate heterogeneity in the treatment effect between these subgroups (P = 0.38 and P = 0.20, respectively). CONCLUSION In the placebo group of the SENSCIS trial, the rate of FVC decline was similar irrespective of the presence of cough or dyspnoea at baseline. The effect of nintedanib on reducing the rate of FVC decline was numerically more pronounced in patients without than with cough or dyspnoea at baseline, but no statistically significant heterogeneity was observed between the subgroups. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT02597933.
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Affiliation(s)
- Elizabeth R Volkmann
- Department of Medicine, Division of Rheumatology, University of California, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Care Medicine, Thoraxklinik, University of Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | | | - Marlies Wijsenbeek
- Department of Respiratory Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Vanessa Smith
- Department of Rheumatology and Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Christopher P Denton
- University College London Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
| | - Wim A Wuyts
- Unit for Interstitial Lung Diseases, Department of Pulmonary Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Margarida Alves
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Steven Sambevski
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
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Dual-energy CT lung perfusion in systemic sclerosis: preliminary experience in 101 patients. Eur Radiol 2022; 33:401-413. [PMID: 35881181 DOI: 10.1007/s00330-022-09016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/13/2022] [Accepted: 07/04/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate lung perfusion in systemic sclerosis (SSc). METHODS The study population included 101 patients who underwent dual-energy CT (DECT) in the follow-up of SSc with pulmonary function tests obtained within 2 months. Fifteen patients had right heart catheterization-proven PH. RESULTS Thirty-seven patients had no SSc-related lung involvement (Group A), 56 patients had SSc-related interstitial lung disease (Group B) of variable extent (Group B mild: ≤ 10% of lung parenchyma involved: n = 17; Group B moderate: between 11 and 50%: n = 31; Group B severe: > 50%: n = 8), and 8 patients had PVOD/PCH (Group C). Lung perfusion was abnormal in 8 patients in Group A (21.6%), 14 patients in Group B (25%), and 7 patients in Group C (87.5%). In Group A and Group B mild (n = 54), (a) patients with abnormal lung perfusion (n = 14; 26%) had a higher proportion of NYHA III/IV scores of dyspnea (7 [50%] vs 7 [17.5%]; p = 0.031) and a shorter mean walking distance at the 6MWT (397.0 [291.0; 466.0] vs 495.0 [381.0; 549.0]; p = 0.042) but no evidence of difference in the DLCO% predicted (61.0 [53.0; 67.0] vs 68.0 [61.0; 78.0]; p = 0.055) when compared to patients with normal lung perfusion (n = 40; 74%); (b) a negative correlation was found between the iodine concentration in both lungs and the DLCO% predicted but it did not reach statistical significance (r = -0.27; p = 0.059) and no correlation was found with the PAPs (r = 0.16; p = 0.29) and walking distance during the 6MWT (r = -0.029; p = 0.84). CONCLUSIONS DECT lung perfusion provides complementary information to standard HRCT scans, depicting perfusion changes in SSc patients with normal or minimally infiltrated lung parenchyma. KEY POINTS • In a retrospective observational study of 101 consecutive patients with SSc, dual-energy CT pulmonary angiography was obtained to evaluate lung perfusion. • Lung perfusion was abnormal in 14 out of 54 patients (26%) with no or mild SSc-related lung infiltration. • Patients with abnormal perfusion and no or mild SSc-related lung infiltration had more severe scores of dyspnea and shorter walking distance than patients with similar lung findings and normal perfusion, suggesting the presence of small vessel vasculopathy.
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Chepy A, Bourel L, Koether V, Launay D, Dubucquoi S, Sobanski V. Can Antinuclear Antibodies Have a Pathogenic Role in Systemic Sclerosis? Front Immunol 2022; 13:930970. [PMID: 35837382 PMCID: PMC9274282 DOI: 10.3389/fimmu.2022.930970] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/26/2022] [Indexed: 12/30/2022] Open
Abstract
Systemic sclerosis (SSc) is a connective tissue disease characterized by extensive fibrosis of the skin and internal organs, associated with vasculopathy and autoimmune features. Antinuclear antibodies (ANA) are found in almost all SSc patients and constitute strong diagnosis and prognosis biomarkers. However, it remains unclear whether ANA are simple bystanders or if they can have a role in the pathophysiology of the disease. One might think that the nuclear nature of their targets prevents any accessibility to autoantibodies. Nevertheless, recent data suggest that ANA could be pathogenic or at least contribute to the perennation of the disease. We review here first the indirect clues of the contribution of ANA to SSc: they are associated to the disease subtypes, they may precede disease onset, their titer correlates with disease activity and severity, there is an association between molecular subsets, and some patients can respond to B-cell targeting therapy. Then, we describe in a second part the mechanisms of ANA production in SSc from individual genetic background to post-transcriptional modifications of neoantigens. Finally, we elaborate on the potential mechanisms of pathogenicity: ANA could be pathogenic through immune-complex-mediated mechanisms; other processes potentially involve molecular mimicry and ANA penetration into the target cell, with a focus on anti-topoisomerase-I antibodies, which are the most probable candidate to play a role in the pathophysiology of SSc. Finally, we outline some technical and conceptual ways to improve our understanding in this field.
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Affiliation(s)
- Aurélien Chepy
- Univ. Lille, Inserm, CHU Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - Louisa Bourel
- Univ. Lille, Inserm, CHU Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
| | - Vincent Koether
- Univ. Lille, Inserm, CHU Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - David Launay
- Univ. Lille, Inserm, CHU Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - Sylvain Dubucquoi
- Univ. Lille, Inserm, CHU Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- CHU Lille, Institut d’Immunologie, Lille, France
| | - Vincent Sobanski
- Univ. Lille, Inserm, CHU Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
- Institut Universitaire de France (IUF), Paris, France
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Landini N, Orlandi M, Bruni C, Carlesi E, Nardi C, Calistri L, Morana G, Tomassetti S, Colagrande S, Matucci-Cerinic M. Computed Tomography Predictors of Mortality or Disease Progression in Systemic Sclerosis-Interstitial Lung Disease: A Systematic Review. Front Med (Lausanne) 2022; 8:807982. [PMID: 35155484 PMCID: PMC8829727 DOI: 10.3389/fmed.2021.807982] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/06/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Although interstitial lung disease (ILD) is a major cause of morbidity and mortality in systemic sclerosis (SSc), its prognostication remains challenging. Given that CT represents the gold standard imaging technique in ILD assessment, a systematic review on chest CT findings as predictors of mortality or ILD progression in SSc-ILD was performed. MATERIALS AND METHODS Three databases (Medline, Embase, and Web of Science) were searched to identify all studies analyzing CT mortality or ILD progression predictors in SSc-ILD, from inception to December 2020. ILD progression was defined by worsening of forced vital capacity and/or CT ILD findings. Manuscripts not written in English, with not available full-text, not focusing on SSc-ILD or with SSc-ILD not extrapolated, otherwise with overlap syndromes, pediatric patients, <10 cases or predictors other than CT features were excluded. RESULTS Out of 3,513 citations, 15 full-texts (2,332 patients with SSc-ILD) met the inclusion criteria. ILD extent and extensive ILD, ILD densitometric analysis parameters, fibrotic extent and reticulation extent resulted as independent mortality predictors. Extensive ILD is also an independent predictor of death, need for supplemental oxygen or lung transplantation. Honeycombing extent is an independent risk factor for respiratory mortality. Independent predictors of ILD progression were not identified. CONCLUSIONS ILD extent and extensive ILD independently predict mortality in SSc-ILD on CT, as well as ILD densitometric analysis, fibrotic extent and reticulation extent. Extensive ILD is also a predictor of death, need for supplemental oxygen, or lung transplantation. Honeycombing extent predicts respiratory mortality. CT predictors of ILD progression need to be further investigated. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, PROSPERO, identifier: CRD420202005001.
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Affiliation(s)
- Nicholas Landini
- Department of Radiology, Ca' Foncello General Hospital, Treviso, Italy
- Department of Experimental and Clinical Biomedical Sciences, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Martina Orlandi
- Department of Experimental and Clinical Medicine, Division of Rheumatology, Azienda Ospedaliero-Universitaria Careggi and Scleroderma Unit, University of Florence, Florence, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, Azienda Ospedaliero-Universitaria Careggi and Scleroderma Unit, University of Florence, Florence, Italy
| | - Edoardo Carlesi
- Department of Experimental and Clinical Biomedical Sciences, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giovanni Morana
- Department of Radiology, Ca' Foncello General Hospital, Treviso, Italy
| | - Sara Tomassetti
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, Azienda Ospedaliero-Universitaria Careggi and Scleroderma Unit, University of Florence, Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Istituti di Ricovero e Cura a Carattere Scientifico, Vita-Salute San Raffaele University, Milan, Italy
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