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Chen Y, Liu H, Luo Z, Zhang J, Dong M, Yin G, Xie Q. ASM is a therapeutic target in dermatomyositis by regulating the differentiation of naive CD4 + T cells into Th17 and Treg subsets. Skelet Muscle 2024; 14:16. [PMID: 39026344 PMCID: PMC11256435 DOI: 10.1186/s13395-024-00347-1] [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: 03/15/2024] [Accepted: 06/29/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND This study aims to investigate the involvement of acid sphingomyelinase (ASM) in the pathology of dermatomyositis (DM), making it a potential therapeutic target for DM. METHODS Patients with DM and healthy controls (HCs) were included to assess the serum level and activity of ASM, and to explore the associations between ASM and clinical indicators. Subsequently, a myositis mouse model was established using ASM gene knockout and wild-type mice to study the significant role of ASM in the pathology and to assess the treatment effect of amitriptyline, an ASM inhibitor. Additionally, we investigated the potential treatment mechanism by targeting ASM both in vivo and in vitro. RESULTS A total of 58 DM patients along with 30 HCs were included. The ASM levels were found to be significantly higher in DM patients compared to HCs, with median (quartile) values of 2.63 (1.80-4.94) ng/mL and 1.64 (1.47-1.96) ng/mL respectively. The activity of ASM in the serum of DM patients was significantly higher than that in HCs. Furthermore, the serum levels of ASM showed correlations with disease activity and muscle enzyme levels. Knockout of ASM or treatment with amitriptyline improved the severity of the disease, rebalanced the CD4 T cell subsets Th17 and Treg, and reduced the production of their secreted cytokines. Subsequent investigations revealed that targeting ASM could regulate the expression of relevant transcription factors and key regulatory proteins. CONCLUSION ASM is involved in the pathology of DM by regulating the differentiation of naive CD4 + T cells and can be a potential treatment target.
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Affiliation(s)
- Yuehong Chen
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, 37 Guoxue lane, Chengdu, 610041, China
| | - Huan Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, 37 Guoxue lane, Chengdu, 610041, China
| | - Zhongling Luo
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, 37 Guoxue lane, Chengdu, 610041, China
| | - Jiaqian Zhang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, 37 Guoxue lane, Chengdu, 610041, China
| | - Min Dong
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, 37 Guoxue lane, Chengdu, 610041, China
| | - Geng Yin
- Department of General Practice, West China Hospital, General Practice Medical Center, Sichuan University, 37 Guoxue lane, Chengdu, 610041, China.
| | - Qibing Xie
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, 37 Guoxue lane, Chengdu, 610041, China.
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Li D, Jia W, Zhou L, Hao Y, Wang K, Yang B, Yang J, Luo D, Fu Z. Increased expression of the p-STAT3/IL-17 signaling pathway in patients with dermatomyositis. Mod Rheumatol 2023; 34:129-136. [PMID: 36478263 DOI: 10.1093/mr/roac147] [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: 09/29/2022] [Revised: 11/13/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2023]
Abstract
OBJECTIVES The aim is to explore the roles of phosphorylated signal transduction and activator of transcription 3 (p-STAT3) and interleukin (IL)-17 in patients with dermatomyositis (DM). METHODS A total of 20 DM patients and 12 healthy controls were enrolled. Flow cytometry combined with counting was used to detect the number of Th17 cells. Western blotting and immunohistochemistry were used to examine the muscle levels of p-STAT3 and IL-17, and serum levels of IL-17 were measured by enzyme-linked immunosorbent assays. RESULTS Muscle p-STAT3 and IL-17 levels, the number of Th17 cells, and serum IL-17 levels were markedly increased in DM. p-STAT3 and IL-17 were co-expressed in the muscle of DM patients. The p-STAT3 levels were correlated with the number of Th17 cells as well as muscle and serum IL-17 levels. The correlations of the p-STAT3 level with elevated levels of transaminases, myocardial enzymes, and the health assessment questionnaire score were significantly positive, while the correlation with manual muscle testing-8 was significantly negative. A receiver operating characteristic curve indicated the good predictive value of p-STAT3 for the occurrence of DM. CONCLUSIONS The increased p-STAT3/IL-17 signaling pathway activation in DM patients may induce muscle inflammation and necrosis, and it may be a potential target for DM.
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Affiliation(s)
- Dongmei Li
- Department of Rheumatology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Wen Jia
- Department of Rheumatology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Luyao Zhou
- Department of Rheumatology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yiqun Hao
- Department of Rheumatology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Kai Wang
- Department of Rheumatology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Bo Yang
- Department of Rheumatology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jie Yang
- Department of Rheumatology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Dongping Luo
- Department of Rheumatology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Zili Fu
- Department of Rheumatology, The First Hospital of Shanxi Medical University, Taiyuan, China
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Gandolfi S, Pileyre B, Drouot L, Dubus I, Auquit-Auckbur I, Martinet J. Stromal vascular fraction in the treatment of myositis. Cell Death Discov 2023; 9:346. [PMID: 37726262 PMCID: PMC10509179 DOI: 10.1038/s41420-023-01605-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 09/21/2023] Open
Abstract
Muscle regeneration is a physiological process that converts satellite cells into mature myotubes under the influence of an inflammatory environment progressively replaced by an anti-inflammatory environment, with precise crosstalk between immune and muscular cells. If the succession of these phases is disturbed, the immune system can sometimes become auto-reactive, leading to chronic muscular inflammatory diseases, such as myositis. The triggers of these autoimmune myopathies remain mostly unknown, but the main mechanisms of pathogenesis are partially understood. They involve chronic inflammation, which could be associated with an auto-reactive immune response, and gradually with a decrease in the regenerative capacities of the muscle, leading to its degeneration, fibrosis and vascular architecture deterioration. Immunosuppressive treatments can block the first part of the process, but sometimes muscle remains weakened, or even still deteriorates, due to the exhaustion of its capacities. For patients refractory to immunosuppressive therapies, mesenchymal stem cells have shown interesting effects but their use is limited by their availability. Stromal vascular fraction, which can easily be extracted from adipose tissue, has shown good tolerance and possible therapeutic benefits in several degenerative and autoimmune diseases. However, despite the increasing use of stromal vascular fraction, the therapeutically active components within this heterogeneous cellular product are ill-defined and the mechanisms by which this therapy might be active remain insufficiently understood. We review herein the current knowledge on the mechanisms of action of stromal vascular fraction and hypothesise on how it could potentially respond to some of the unmet treatment needs of refractory myositis.
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Affiliation(s)
- S Gandolfi
- Univ Rouen Normandie, INSERM U1234, FOCIS Center of Excellence PAn'THER, F-76000, Rouen, France
- Toulouse University Hospital, Department of Plastic and Reconstructive Surgery, F-31000, Toulouse, France
| | - B Pileyre
- Univ Rouen Normandie, INSERM U1234, FOCIS Center of Excellence PAn'THER, F-76000, Rouen, France.
- Centre Henri Becquerel, Department of Pharmacy, F-76000, Rouen, France.
| | - L Drouot
- Univ Rouen Normandie, INSERM U1234, FOCIS Center of Excellence PAn'THER, F-76000, Rouen, France
| | - I Dubus
- Univ Rouen Normandie, INSERM U1234, FOCIS Center of Excellence PAn'THER, F-76000, Rouen, France
| | - I Auquit-Auckbur
- Univ Rouen Normandie, INSERM U1234, FOCIS Center of Excellence PAn'THER, CHU Rouen, Department of Plastic, Reconstructive and Hand Surgery, F-76000, Rouen, France
| | - J Martinet
- Univ Rouen Normandie, INSERM U1234, FOCIS Center of Excellence PAn'THER, CHU Rouen, Department of Immunology and Biotherapy, F-76000, Rouen, France
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Chen K, Zhu CY, Bai JY, Xiao F, Tan S, Zhou Q, Zeng L. Identification of Feature Genes and Key Biological Pathways in Immune-Mediated Necrotizing Myopathy: High-Throughput Sequencing and Bioinformatics Analysis. Comput Struct Biotechnol J 2023; 21:2228-2240. [PMID: 37035552 PMCID: PMC10074409 DOI: 10.1016/j.csbj.2023.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Background Immune-mediated necrotizing myopathy (IMNM), a subgroup of idiopathic inflammatory myopathies (IIMs), is characterized by severe proximal muscle weakness and prominent necrotic fibers but no infiltration of inflammatory cells. IMNM pathogenesis is unclear. This study investigated key biomarkers and potential pathways for IMNM using high-throughput sequencing and bioinformatics technology. Methods RNA sequencing was conducted in 18 IMNM patients and 10 controls. A combination of weighted gene coexpression network analysis (WGCNA) and differentially expressed gene (DEG) analysis was conducted to identify IMNM-related DEGs. Feature genes were screened out by employing the protein-protein interaction (PPI) network, support vector machine-recursive feature elimination (SVM-RFE), and least absolute shrinkage selection operator (LASSO). Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to verify their differential expression, and the receiver operating characteristic curve (ROC) was used to evaluate their diagnostic efficiency. Functional enrichment analysis was applied to reveal the hidden functions of feature genes. Furthermore, 28 immune cell abundance patterns in IMNM samples were measured. Results We identified 193 IMNM-related DEGs that were aberrantly upregulated in the IMNM population and were closely associated with immune-inflammatory responses, regulation of skeletal and cardiac muscle contraction, and lipoprotein metabolism. With the help of the PPI network and the LASSO and SVM-RFE algorithms, three feature genes, LTK, MYBPH, and MYL4, were identified and further confirmed by qRT-PCR. ROC curves among IMNM, dermatomyositis (DM), inclusion body myositis (IBM), and polymyositis (PM) samples validated the LTK and MYL4 genes as IMNM-specific feature markers. In addition, all three genes had a notable association with the autophagy-lysosome pathway and immune-inflammatory responses. Ultimately, IMNM displayed a marked immune-cell infiltrative microenvironment. The most significant correlation was found between CD4 T cells, CD8 T cells, macrophages, natural killer (NK) cells, and dendritic cells (DCs). Conclusions LTK, MYBPH, and MYL4 were identified as potential key molecules for IMNM and are believed to play a role in the autophagy-lysosome pathway and muscle inflammation.
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Affiliation(s)
- Kai Chen
- Department of Neurology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chun-yan Zhu
- Department of Neurology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jia-ying Bai
- Department of Neurology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Feng Xiao
- Department of Neurology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Song Tan
- Department of Neurology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Chengdu, China
| | - Qiao Zhou
- Department of Rheumatology and Immunology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Corresponding author at: Department of Rheumatology and Immunology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China.
| | - Li Zeng
- Department of Neurology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Corresponding author.
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Lai Y, Zhao S, Chen B, Huang Y, Guo C, Li M, Ye B, Wang S, Zhang H, Yang N. Iron controls T helper cell pathogenicity by promoting glucose metabolism in autoimmune myopathy. Clin Transl Med 2022; 12:e999. [PMID: 35917405 PMCID: PMC9345506 DOI: 10.1002/ctm2.999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND T helper cells in patients with autoimmune disease of idiopathic inflammatory myopathies (IIM) are characterized with the proinflammatory phenotypes. The underlying mechanisms remain unknown. METHODS RNA sequencing was performed for differential expression genes. Gene expression in CD4+ T-cells was confirmed by quantitative real-time PCR. CD4+ T-cells from IIM patients or healthy controls were evaluated for metabolic activities by Seahorse assay. Glucose uptake, T-cell proliferation and differentiation were evaluated and measured by flow cytometry. Human CD4+ T-cells treated with iron chelators or Pfkfb4 siRNA were measured for glucose metabolism, proliferation and differentiation. Signalling pathway activation was evaluated by western blot and flow cytometry. Mouse model of experimental autoimmune myositis (EAM) were induced and treated with iron chelator or rapamycin. CD4+ T-cell differentiation and muscle inflammation in the EAM mice were evaluated. RESULTS RNA-sequencing analysis revealed that iron was involved with glucose metabolism and CD4+ T-cell differentiation. IIM patient-derived CD4+ T-cells showed enhanced glycolysis and mitochondrial respiration, which was inhibited by iron chelation. CD4+ T-cells from patients with IIM was proinflammatory and iron chelation suppressed the differentiation of interferon gamma (IFNγ)- and interleukin (IL)-17A-producing CD4+ T-cells, which resulted in an increased percentage of regulatory T (Treg) cells. Mechanistically, iron promoted glucose metabolism by an upregulation of PFKFB4 through AKT-mTOR signalling pathway. Notably, the knockdown of Pfkfb4 decreased glucose influx and thus suppressed the differentiation of IFNγ- and IL-17A-producing CD4+ T-cells. In vivo, iron chelation inhibited mTOR signalling pathway and reduced PFKFB4 expression in CD4+ T-cells, resulting in reduced proinflammatory IFNγ- and IL-17A-producing CD4+ T-cells and increased Foxp3+ Treg cells, leading to ameliorated muscle inflammation. CONCLUSIONS Iron directs CD4+ T-cells into a proinflammatory phenotype by enhancing glucose metabolism. Therapeutic targeting of iron metabolism should have the potential to normalize glucose metabolism in CD4+ T-cells and reverse their proinflammatory phenotype in IIM.
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Affiliation(s)
- Yimei Lai
- Department of RheumatologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Siyuan Zhao
- Department of RheumatologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Binfeng Chen
- Department of RheumatologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yuefang Huang
- Department of PediatricsThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Chaohuan Guo
- Department of RheumatologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Mengyuan Li
- Department of RheumatologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Baokui Ye
- Department of RheumatologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Shuyi Wang
- Department of RheumatologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Hui Zhang
- Department of RheumatologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
- Institute of Precision MedicineThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Niansheng Yang
- Department of RheumatologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
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Huang T, Huang J, Liao Z, Lan H, Jian X, Gu R, Ouyang J, Hu J, Liao H. Regenerating myofiber directs Tregs and Th17 responses in inflamed muscle through the intrinsic TGF-β signaling-mediated IL-6 production. Am J Physiol Endocrinol Metab 2022; 323:E92-E106. [PMID: 35532076 DOI: 10.1152/ajpendo.00247.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Transforming growth factor-β (TGF-β) is considered to be an important immune regulatory cytokine. However, it remains unknown whether and how the muscle fiber specific-TGF-β signaling is directly involved in intramuscular inflammatory regulation by affecting T cells. Here, we addressed these in a mouse tibialis anterior muscle Cardiotoxin injection-induced injury repair model in muscle creatine kinase (MCK)-Cre control or transgenic mice with TGF-β receptor II (TGF-βr2) being specifically deleted in muscle cells (SM TGF-βr2-/-). In control mice, TGF-β2 and TGF-βr2 were found significantly upregulated in muscle after the acute injury. In mutant mice, deficiency of TGF-β signaling in muscle cells caused more serious muscle inflammation, with the increased infiltration of macrophages and CD4+ T cells at the degeneration stage (D4) and the early stage of regeneration (D7) after myoinjury. Notably, the loss of TGF-β signaling in myofibers dramatically affected CD4+ T cell function and delayed T cells withdrawal at the later stage of muscle regeneration (D10 and D15), marked by the elevated Th17, but the impaired Tregs response. Furthermore, in vivo and in vitro, the intrinsic TGF-β signaling affected immune behaviors of muscle cells and directed CD4+ T cells differentiation by impairing IL-6 production and release. It suggests that local muscle inflammation can be inhibited potentially by directly activating the TGF-β signaling pathway in muscle cells to suppress Th17, but induce Tregs responses. Thus, according to the results of this study, we found a new idea for the control of local acute inflammation in skeletal muscle.NEW & NOTEWORTHY Myofiber mediates muscle inflammatory response through activating the intrinsic TGF-β signaling. The specific TGF-β signaling activation contributes to myofiber IL-6 production and directs muscle-specific Th17 and Treg cell responses.
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Affiliation(s)
- Tao Huang
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering; Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
- Department of Anatomy, School of Basic Medical Science, Guizhou Medical University, Guizhou, China
| | - JingWen Huang
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering; Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - ZhaoHong Liao
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering; Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - HaiQiang Lan
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering; Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - XiaoTing Jian
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering; Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - RuiCai Gu
- Department of Cell Biology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Jun Ouyang
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering; Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Jijie Hu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hua Liao
- Guangdong Provincial Key Laboratory of Construction and Detection in Tissue Engineering; Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
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Zhao L, Wang Q, Zhou B, Zhang L, Zhu H. The Role of Immune Cells in the Pathogenesis of Idiopathic Inflammatory Myopathies. Aging Dis 2021; 12:247-260. [PMID: 33532139 PMCID: PMC7801271 DOI: 10.14336/ad.2020.0410] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/10/2020] [Indexed: 12/15/2022] Open
Abstract
Idiopathic inflammatory myopathies (IIMs) are chronic autoimmune disorders involving multiple organs, such as the muscle, skin, lungs and joints. Although the detailed pathogenesis of IIMs remains unclear, immune mechanisms have long been recognised as of key importance. Immune cells contribute to many inflammatory processes via intercellular interactions and secretion of inflammatory factors, and many studies have demonstrated the participation of a variety of immune cells, such as T cells and B cells, in the development of IIMs. Here, we summarise the current knowledge regarding immune cells in IIM patients and discuss their potential roles in IIM pathogenesis.
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Affiliation(s)
- Lijuan Zhao
- Department of Rheumatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Qi Wang
- Department of Radiology, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China.
| | - Bin Zhou
- Department of Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Lihua Zhang
- Department of Rheumatology, Hunan Provincial People's Hospital and The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China.
| | - Honglin Zhu
- Department of Rheumatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Miossec P. [Proinflammatory cytokines and cardio-vascular risk: From myocardial infarction tocytokine storm of COVID-19]. BULLETIN DE L ACADEMIE NATIONALE DE MEDECINE 2020; 205:43-48. [PMID: 33199926 PMCID: PMC7657003 DOI: 10.1016/j.banm.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022]
Abstract
The mechanisms of inflammatory diseases involve the key inflammatory cytokines IL-1, TNF, IL-6, and IL-17 which are now therapeutic targets with biotherapies. They contribute to the local manifestations of clinically different diseases. In addition to these local aspects, these cytokines have systemic effects from their action on the liver, muscle, adipose tissue and the cardiovascular system. All these diseases have in common an increase in cardiovascular risk. In the general population, the same concepts are applicable, as shown by the link between an even modest rise in CRP and cardiovascular risk. More recently, the cytokine storm of severe forms of COVID-19 has shown that synergistic interactions between cytokines first described in vitro are further amplified in the clinical picture with multiple and severe impairment of key organs. In these chronic and acute contexts, control of inflammation by targeting cytokines is a new vascular treatment option, with already important results for IL-1.
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Affiliation(s)
- P Miossec
- Unité d'immunologie clinique, département d'immunologie et de rhumatologie, et laboratoire immunogénomique et inflammation EA 4130, université de Lyon, Lyon, France
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9
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Sag E, Kale G, Haliloglu G, Bilginer Y, Akcoren Z, Orhan D, Gucer S, Topaloglu H, Ozen S, Talim B. Inflammatory milieu of muscle biopsies in juvenile dermatomyositis. Rheumatol Int 2020; 41:77-85. [PMID: 33106894 DOI: 10.1007/s00296-020-04735-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/13/2020] [Indexed: 01/08/2023]
Abstract
Juvenile dermatomyositis (JDM) is an inflammatory myopathy which causes severe morbidity and high mortality if untreated. In this study, we aimed to define the T-helper cell profile in the muscle biopsies of JDM patients. Muscle biopsies of twenty-six patients (50% female) were included in the study. Immunohistochemical expression of CD3, CD20, CD138, CD68, IL-17, Foxp3, IFN-ɣ, IFN-alpha and IL-4 was studied and muscle biopsies were scored using the JDM muscle biopsy scoring tool. Inflammatory cells were in small clusters in perimysium and perivascular area or scattered throughout the endomysium in most biopsies; however in 2 biopsies, lymphoid follicle-like big clusters were observed, and in one, there was a very dense and diffuse inflammatory infiltration nearly destroying all the muscle architecture. Seventy-three per cent of the biopsies had T cells, 88% had B cells, 57% had plasma cells, and all had macrophages. As for T-helper cell subtypes, 80% of the biopsies were Th1 positive, 92% Th17 positive and 30% Treg positive. No IL-4 positive inflammatory cell was detected, and only 2 biopsies showed IFN-alpha positivity. The mean JDM biopsy score was 17.6, meaning moderate to severe muscular involvement. Visual analogue score of the pathologist was strongly correlated with histopathological features. B cells, macrophages, plasma cells and T cells constitute the inflammatory milieu of the JDM muscle biopsies. As for T cells, JDM is a disease mainly related with Th1 and Th17 T-helper cell subtypes and to some extend Treg. Th2 cells are not involved in the pathogenesis.
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Affiliation(s)
- Erdal Sag
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey.
| | - Gulsev Kale
- Pediatric Pathology Unit, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Goknur Haliloglu
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Zuhal Akcoren
- Pediatric Pathology Unit, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Diclehan Orhan
- Pediatric Pathology Unit, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Safak Gucer
- Pediatric Pathology Unit, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Haluk Topaloglu
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Seza Ozen
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Beril Talim
- Pediatric Pathology Unit, Department of Pediatrics, Hacettepe University, Ankara, Turkey
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Role of Myokines in Myositis Pathogenesis and Their Potential to be New Therapeutic Targets in Idiopathic Inflammatory Myopathies. J Immunol Res 2020; 2020:9079083. [PMID: 32775472 PMCID: PMC7396002 DOI: 10.1155/2020/9079083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/10/2020] [Accepted: 07/04/2020] [Indexed: 12/16/2022] Open
Abstract
Idiopathic inflammatory myopathies (IIM) represent a heterogeneous group of autoimmune diseases whose treatment is often a challenge. Many patients, even after immunosuppressive therapy, do not respond to treatment, so new alternatives have been sought for this. Therefore, other signaling pathways that could contribute to the pathogenesis of myositis have been investigated, such as the expression of myokines in skeletal muscle in response to the inflammatory process. In this review, we will refer to these muscle cytokines that are overexpressed or downregulated in skeletal muscle in patients with various forms of IIM, thus being able to contribute to the maintenance of the autoimmune process. Some muscle cytokines, through their antagonistic action, may be a helpful contributor to the disease modulation, and thus, they could represent personalized treatment targets. Here, we consider the main myokines involved in the pathogenesis of myositis, expressing our view on the possibility of using them as potential therapeutic targets: interleukins IL-6, IL-15, and IL-18; chemokines CXCL10, CCL2, CCL3, CCL4, CCL5, and CCL20; myostatin; follistatin; decorin; osteonectin; and insulin-like 6. An interesting topic regarding the complex connection between myokines and noninflammatory pathways implied in IIM has also been briefly described, because it is an important scientific approach to the pathogenesis of IIM and can be a therapeutic alternative to be considered, especially for the patients who do not respond to immunosuppressive treatment.
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Wilkinson MGL, Radziszewska A, Wincup C, Ioannou Y, Isenberg DA, Manson JJ, Jury EC. Using peripheral blood immune signatures to stratify patients with adult and juvenile inflammatory myopathies. Rheumatology (Oxford) 2020; 59:194-204. [PMID: 31292651 DOI: 10.1093/rheumatology/kez252] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/20/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The inflammatory idiopathic myopathies (IIM) are a group of rare autoimmune diseases defined by muscle weakness and characterized by pro-inflammatory infiltrates in muscle. Little is known about the immunological profile in peripheral blood of these patients and how this relates to IIM subtypes. This study aimed to stratify adult and juvenile-onset IIM patients according to immune cell profile. METHODS Peripheral blood mononuclear cells from 44 patients with adult myositis (AM), 15 adolescent-onset juvenile dermatomyositis (a-JDM), and 40 age-matched healthy controls were analysed by flow cytometry to quantify 33 immune cell subsets. Adult myositis patients were grouped according to myositis subtype; DM and polymyositis; and also autoantibody specificity. Disease activity was determined by the myositis disease activity assessment tool and clinicians' decision on treatment. RESULTS Unique immune signatures were identified for DM, polymyositis and a-JDM compared with healthy controls. DM patients had a T-cell signature comprising increased CD4+ and TH17 cell frequencies and increased immune cell expression of IL-6. Polymyositis patients had a B-cell signature with reduced memory B cells. A-JDM had decreased naïve B cells and increased CD4+T cells. All patient groups had decreased CD8+central memory T-cell frequencies. The distinct immune signatures were also seen when adult myositis patients were stratified according to auto-antibody expression; patients with anti-synthetase-antibodies had reduced memory B cells and patients with autoimmune rheumatic disease overlap had an elevated Th17 profile. CONCLUSION Unique immune signatures were associated with adult vs juvenile disease. The Th17 signature in DM patients supports the potential use of IL-17 inhibitors in treatment of IIMs.
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Affiliation(s)
- Meredyth G Ll Wilkinson
- Division of Medicine, University College London, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London Hospital and Great Ormond Street Hospital, London, UK.,Infection Inflammation and Rheumatology, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Chris Wincup
- Division of Medicine, University College London, London, UK.,Department of Rheumatology, University College London Hospital, London, UK
| | - Yiannis Ioannou
- Division of Medicine, University College London, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London Hospital and Great Ormond Street Hospital, London, UK.,Department of Rheumatology, University College London Hospital, London, UK
| | - David A Isenberg
- Division of Medicine, University College London, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London Hospital and Great Ormond Street Hospital, London, UK.,Department of Rheumatology, University College London Hospital, London, UK
| | - Jessica J Manson
- Department of Rheumatology, University College London Hospital, London, UK
| | - Elizabeth C Jury
- Division of Medicine, University College London, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London Hospital and Great Ormond Street Hospital, London, UK
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12
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Lentscher AJ, McCarthy MK, May NA, Davenport BJ, Montgomery SA, Raghunathan K, McAllister N, Silva LA, Morrison TE, Dermody TS. Chikungunya virus replication in skeletal muscle cells is required for disease development. J Clin Invest 2020; 130:1466-1478. [PMID: 31794434 PMCID: PMC7269570 DOI: 10.1172/jci129893] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023] Open
Abstract
Chikungunya virus (CHIKV) is an arbovirus capable of causing a severe and often debilitating rheumatic syndrome in humans. CHIKV replicates in a wide variety of cell types in mammals, which has made attributing pathologic outcomes to replication at specific sites difficult. To assess the contribution of CHIKV replication in skeletal muscle cells to pathogenesis, we engineered a CHIKV strain exhibiting restricted replication in these cells via incorporation of target sequences for skeletal muscle cell-specific miR-206. This virus, which we term SKE, displayed diminished replication in skeletal muscle cells in a mouse model of CHIKV disease. Mice infected with SKE developed less severe disease signs, including diminished swelling in the inoculated foot and less necrosis and inflammation in the interosseous muscles. SKE infection was associated with diminished infiltration of T cells into the interosseous muscle as well as decreased production of Il1b, Il6, Ip10, and Tnfa transcripts. Importantly, blockade of the IL-6 receptor led to diminished swelling of a control CHIKV strain capable of replication in skeletal muscle, reducing swelling to levels observed in mice infected with SKE. These data implicate replication in skeletal muscle cells and release of IL-6 as important mediators of CHIKV disease.
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Affiliation(s)
- Anthony J. Lentscher
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Microbial Pathogenesis, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary K. McCarthy
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas A. May
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Bennett J. Davenport
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stephanie A. Montgomery
- Department of Pathology and Laboratory Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Krishnan Raghunathan
- Center for Microbial Pathogenesis, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nicole McAllister
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Microbial Pathogenesis, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Laurie A. Silva
- Center for Microbial Pathogenesis, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Thomas E. Morrison
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Terence S. Dermody
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Microbial Pathogenesis, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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13
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Noack M, Beringer A, Miossec P. Additive or Synergistic Interactions Between IL-17A or IL-17F and TNF or IL-1β Depend on the Cell Type. Front Immunol 2019; 10:1726. [PMID: 31396230 PMCID: PMC6664074 DOI: 10.3389/fimmu.2019.01726] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/09/2019] [Indexed: 01/15/2023] Open
Abstract
Background: IL-17A has effects on several cell types and is a therapeutic target in several inflammatory diseases. IL-17F shares 50% homology and biological activities with IL-17A. It is now of interest to target both cytokines. The objective was to compare the IL-17A and IL-17F effect on cytokine production by RA synoviocytes, and to extend to other cells. Methods: Cells (RA synoviocytes, psoriasis skin fibroblasts, endothelial cells, myoblasts, and hepatocytes) were cultured in the presence or not of: IL-17A, IL-17F, TNF, IL-1β alone or their combinations, IL-17A/TNF, IL-17A/IL-1β, IL-17A/TNF/IL-1β, IL-17F/TNF, IL-17F/IL-1β, and IL-17F/TNF/IL-1β. All experiments were performed in parallel to reduce variability. After 48 h, supernatants were recovered and IL-6 and IL-8 levels were measured by ELISA. Results: IL-17A and IL-17F alone increased significantly IL-6 and IL-8 productions by synoviocytes, with a stronger effect for IL-17A. For IL-6 production, TNF or IL-1β alone had the largest effect on myoblasts (5-fold increase), while for IL-8 production, it was on skin fibroblasts (5-fold increase). The IL-17A/TNF synergistic increase was observed on all cells for IL-6; and for IL-8, except for endothelial cells. For IL-17F/TNF, except with endothelial cells, a synergistic effect was also observed, but less powerful than with IL-17A/TNF. IL-17A/IL-1β or IL-17F/IL-1β effect was cell-type dependent, with an additive effect for synoviocytes (1.6 and 2-fold increase, respectively for IL-6, and 1.8 and 2-fold increase, respectively for IL-8) and a synergistic effect for hepatocytes (3.8 and 4.2-fold increase, respectively for IL-6, and 6 and 2-fold increase, respectively for IL-8). The three-cytokine combination induced an additive effect for synoviocytes and a synergistic effect for skin fibroblasts. Conclusion: IL-17A and IL-17F acted similarly by inducing pro-inflammatory cytokine secretion, with a stronger response intensity with IL-17A. Their activities were potentiated by the combination with TNF and IL-1β, with an effect dependent on the cell type.
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Affiliation(s)
- Mélissa Noack
- Immunogenomics and Inflammation Research Unit, EA 4130, Edouard Herriot Hospital, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Lyon, France
| | - Audrey Beringer
- Immunogenomics and Inflammation Research Unit, EA 4130, Edouard Herriot Hospital, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Lyon, France
| | - Pierre Miossec
- Immunogenomics and Inflammation Research Unit, EA 4130, Edouard Herriot Hospital, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Lyon, France
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14
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Beringer A, Miossec P. Systemic effects of IL-17 in inflammatory arthritis. Nat Rev Rheumatol 2019; 15:491-501. [PMID: 31227819 DOI: 10.1038/s41584-019-0243-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2019] [Indexed: 12/20/2022]
Abstract
Inflammatory arthritis occurs in many diseases and is characterized by joint inflammation and damage. However, the inflammatory state in arthritis is commonly associated with systemic manifestations, which are generally linked to a poor prognosis. The pro-inflammatory cytokine IL-17 functions within a complex network of cytokines and contributes to the pathogenesis of various inflammatory diseases. Three IL-17 inhibitors have already been approved for the treatment of psoriasis, psoriatic arthritis, and ankylosing spondylitis. After a brief description of IL-17 and its local effects on joints, this Review focuses on the systemic effects of IL-17 in inflammatory arthritis. Increased circulating concentrations of bioactive IL-17 mediate changes in blood vessels, liver and cardiac and skeletal muscles. The effects of IL-17 on vascular and cardiac cells might contribute to the increased risk of cardiovascular events that occurs in all patients with inflammatory disorders. In the liver, IL-17 contributes to the high circulating concentrations of acute-phase proteins, such as C-reactive protein, and the appearance of liver lesions. In skeletal muscle, IL-17 contributes to muscle contractibility defects and weakness. Thus, targeting IL-17 might have beneficial effects at both local and systemic levels, and could also be proposed for the treatment of a wider range of inflammatory diseases.
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Affiliation(s)
- Audrey Beringer
- Immunogenomics and Inflammation Research Unit, EA 4130, University of Lyon, Hospices Civils de Lyon, Lyon, France
| | - Pierre Miossec
- Immunogenomics and Inflammation Research Unit, EA 4130, University of Lyon, Hospices Civils de Lyon, Lyon, France.
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15
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Beringer A, Gouriou Y, Lavocat F, Ovize M, Miossec P. Blockade of Store-Operated Calcium Entry Reduces IL-17/TNF Cytokine-Induced Inflammatory Response in Human Myoblasts. Front Immunol 2019; 9:3170. [PMID: 30693003 PMCID: PMC6339936 DOI: 10.3389/fimmu.2018.03170] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/24/2018] [Indexed: 12/20/2022] Open
Abstract
Muscle inflammation as in idiopathic inflammatory myopathies (IIM) leads to muscle weakness, mononuclear cell infiltration, and myofiber dysfunction affecting calcium channels. The effects of interleukin-17A (IL-17) and tumor necrosis factor-α (TNFα) on inflammation and calcium changes were investigated in human myoblasts. Human myoblasts were exposed to IL-17 and/or TNFα with/without store-operated Ca2+ entry (SOCE) inhibitors (2-ABP or BTP2). For co-cultures, peripheral blood mononuclear cells (PBMC) from healthy donors activated or not with phytohemagglutinin (PHA) were added to myoblasts at a 5:1 ratio. IL-17 and TNFα induced in synergy CCL20 and IL-6 production by myoblasts (>14-fold). PBMC-myoblast co-cultures enhanced CCL20 and IL-6 production in the presence or not of PHA compared to PBMC or myoblast monocultures. Anti-IL-17 and/or anti-TNFα decreased the production of IL-6 in co-cultures (p < 0.05). Transwell system that prevents direct cell-cell contact reduced CCL20 (p < 0.01) but not IL-6 secretion. IL-17 and/or TNFα increased the level of the ER stress marker Grp78, mitochondrial ROS and promoted SOCE activation by 2-fold (p < 0.01) in isolated myoblasts. SOCE inhibitors reduced the IL-6 production induced by IL-17/TNFα. Therefore, muscle inflammation induced by IL-17 and/or TNFα may increase muscle cell dysfunction, which, in turn, increased inflammation. Such close interplay between immune and non-immune mechanisms may drive and increase muscle inflammation and weakness.
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Affiliation(s)
- Audrey Beringer
- Immunogenomics and Inflammation Research Unit EA4130, Department of Clinical Immunology and Rheumatology, Edouard Herriot Hospital, University of Lyon, Hospices Civils de Lyon, Lyon, France
| | - Yves Gouriou
- CarMeN Laboratory, University of Lyon, INSERM 1060, INRA 1397, Université Claude Bernard Lyon1, INSA Lyon, Groupement Hospitalier Est, Bron, France.,Service d'Explorations Fonctionnelles Cardiovasculaires and CIC de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Fabien Lavocat
- Immunogenomics and Inflammation Research Unit EA4130, Department of Clinical Immunology and Rheumatology, Edouard Herriot Hospital, University of Lyon, Hospices Civils de Lyon, Lyon, France
| | - Michel Ovize
- CarMeN Laboratory, University of Lyon, INSERM 1060, INRA 1397, Université Claude Bernard Lyon1, INSA Lyon, Groupement Hospitalier Est, Bron, France.,Service d'Explorations Fonctionnelles Cardiovasculaires and CIC de Lyon, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Pierre Miossec
- Immunogenomics and Inflammation Research Unit EA4130, Department of Clinical Immunology and Rheumatology, Edouard Herriot Hospital, University of Lyon, Hospices Civils de Lyon, Lyon, France
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16
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Biomarkers in Adult Dermatomyositis: Tools to Help the Diagnosis and Predict the Clinical Outcome. J Immunol Res 2019; 2019:9141420. [PMID: 30766892 PMCID: PMC6350546 DOI: 10.1155/2019/9141420] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/09/2018] [Indexed: 12/22/2022] Open
Abstract
Dermatomyositis pathophysiology is complex. In recent years, medical research has identified molecules associated with disease activity. Besides providing insights into the driving mechanisms of dermatomyositis, these findings could provide potential biomarkers. Activity markers can be used to monitor disease activity in clinical trials and may also be useful in daily practice. This article reviews molecules that could be used as biomarkers for diagnosis and monitoring dermatomyositis disease activity.
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17
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Liu T, Hou Y, Dai TJ, Yan CZ. Upregulation of Interleukin 21 and Interleukin 21 Receptor in Patients with Dermatomyositis and Polymyositis. Chin Med J (Engl) 2018; 130:2101-2106. [PMID: 28836555 PMCID: PMC5586180 DOI: 10.4103/0366-6999.213419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: The immunopathologic mechanism underlying dermatomyositis (DM) and polymyositis (PM) remains poorly understood. Many cytokines play a pathogenic role in DM and PM. Interleukin 21 (IL-21) has a pleiotropic effect on inflammation regulation. This study aimed to detect the serum IL-21 level and investigate the expression of IL-21 and IL-21 receptor (IL-21R) in muscle tissues of patients with DM and PM. Methods: Biopsied muscle samples were obtained from 11 patients with DM, 12 with PM, and six controls; mRNA levels of IL-21 and IL-21R were analyzed by real-time quantitative reverse transcription-polymerase chain reaction; and immunohistochemical staining was used to evaluate the protein expression of IL-21 and IL-21R. Serum samples were obtained from 36 patients with DM, 19 with PM, and 20 healthy controls. The serum IL-21 level was detected by enzyme-linked immunosorbent assay. Results: The expression of IL-21 was upregulated in patients with DM and PM. The IL-21 mRNA level was significantly increased in muscle tissues of patients with DM and PM (DM vs. control, P = 0.001; PM vs. control, P = 0.001), whereas IL-21R mRNA level in patients with DM/PM was not statistically different from that of healthy controls. Immunohistochemical staining showed both IL-21 and IL-21R were significantly expressed in the inflammatory cells in muscle tissues of patients with DM and PM. The serum IL-21 level was also significantly higher in patients with DM/PM than in controls (DM vs. control, 49.12 [45.28, 60.07] pg/ml vs. 42.54 [38.69, 48.85] pg/ml, P = 0.001; PM vs. control, 50.77 [44.19, 60.62] pg/ml vs. 42.54 [38.69, 48.85] pg/ml, P = 0.005). Conclusions: IL-21 expression is upregulated in patients with DM and PM in both muscle tissue and serum. In addition, IL-21R protein is highly expressed in affected muscle tissues of patients with DM and PM. IL-21 may play a pathogenic role through IL-21R in patients with DM and PM.
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Affiliation(s)
- Tao Liu
- Research Institute of Neuromuscular and Neurodegenerative Diseases, Department of Neurology, Qilu Hospital, Shandong University, Jinan, Shandong 250012; Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, China
| | - Ying Hou
- Research Institute of Neuromuscular and Neurodegenerative Diseases, Department of Neurology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, China
| | - Ting-Jun Dai
- Research Institute of Neuromuscular and Neurodegenerative Diseases, Department of Neurology, Qilu Hospital, Shandong University, Jinan, Shandong 250012, China
| | - Chuan-Zhu Yan
- Research Institute of Neuromuscular and Neurodegenerative Diseases, Department of Neurology, Qilu Hospital, Shandong University; Brain Science Research Institute, Shandong University, Jinan, Shandong 250012, China
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18
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Abstract
Histopathological analyses of muscle specimens from myositis patients indicate that skeletal muscle cells play an active role in the interaction with immune cells. Research over the last few decades has shown that skeletal muscle cells exhibit immunobiological properties that perfectly define them as non-professional antigen presenting cells. They are able to present antigens via major histocompatibility complex molecules, exhibit costimulatory molecules and secrete soluble molecules that actively shape the immune response in an either pro- or anti-inflammatory manner. Skeletal muscle cells regulate both innate and adaptive immune responses and are essentially involved in the pathophysiological processes of idiopathic inflammatory myopathies. Understanding the role of skeletal muscle cells might help to identify new therapeutic targets for these devastating diseases. This review summarizes the immunobiological features of skeletal muscle cells, especially in the context of idiopathic inflammatory myopathies, and discusses shortcomings and limitations in skeletal muscle related research providing potential perspectives to overcome them in the future.
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Affiliation(s)
- Ali Maisam Afzali
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Germany; Department of Neurology, University of Münster, Germany
| | | | - Heinz Wiendl
- Department of Neurology, University of Münster, Germany
| | - Sven G Meuth
- Department of Neurology, University of Münster, Germany
| | - Tobias Ruck
- Department of Neurology, University of Münster, Germany.
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19
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20
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Miossec P. Update on interleukin-17: a role in the pathogenesis of inflammatory arthritis and implication for clinical practice. RMD Open 2017; 3:e000284. [PMID: 28243466 PMCID: PMC5318575 DOI: 10.1136/rmdopen-2016-000284] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 01/05/2023] Open
Abstract
Interleukin-17 (IL-17A) is a cytokine critical for the acute defence against extracellular bacterial and fungal infections. Excess production during chronic inflammation has been associated with many inflammatory and autoimmune disorders. The present review describes the key molecules of the IL-17 pathway, which are or could be targeted for treatment. Since targeting of IL-17A may affect defence mechanisms, the pathogenesis of such possible adverse events is analysed. Then the contributions of IL-17 to bone changes in various forms of arthritis are discussed. Finally, the results of current inhibitors of the IL-17 pathway in clinical trials are detailed. IL-17A inhibition has been first registered for the treatment of psoriasis, psoriatic arthritis and ankylosing spondylitis. Other therapeutic options are now tested in a long list of diseases.
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Affiliation(s)
- Pierre Miossec
- Immunogenomics and Inflammation Research Unit EA 4130, Department of Immunology and Rheumatology , University of Lyon , Lyon , France
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21
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Doxycycline Inhibits IL-17-Stimulated MMP-9 Expression by Downregulating ERK1/2 Activation: Implications in Myogenic Differentiation. Mediators Inflamm 2016; 2016:2939658. [PMID: 28042204 PMCID: PMC5155103 DOI: 10.1155/2016/2939658] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 10/12/2016] [Indexed: 12/02/2022] Open
Abstract
Interleukin 17 (IL-17) is a cytokine with pleiotropic effects associated with several inflammatory diseases. Although elevated levels of IL-17 have been described in inflammatory myopathies, its role in muscle remodeling and regeneration is still unknown. Excessive extracellular matrix degradation in skeletal muscle is an important pathological consequence of many diseases involving muscle wasting. In this study, the role of IL-17 on the expression of matrix metalloproteinase- (MMP-) 9 in myoblast cells was investigated. The expression of MMP-9 after IL-17 treatment was analyzed in mouse myoblasts C2C12 cell line. The increase in MMP-9 production by IL-17 was concomitant with its capacity to inhibit myogenic differentiation of C2C12 cells. Doxycycline (Doxy) treatment protected the myogenic capacity of myoblasts from IL-17 inhibition and, moreover, increased myotubes hypertrophy. Doxy blocked the capacity of IL-17 to stimulate MMP-9 production by regulating IL-17-induced ERK1/2 MAPK activation. Our results imply that MMP-9 mediates IL-17's capacity to inhibit myoblast differentiation during inflammatory diseases and indicate that Doxy can modulate myoblast response to inflammatory induction by IL-17.
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22
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López De Padilla CM, Crowson CS, Hein MS, Pendegraft RS, Strausbauch MA, Niewold TB, Ernste FC, Peterson E, Baechler EC, Reed AM. Gene Expression Profiling in Blood and Affected Muscle Tissues Reveals Differential Activation Pathways in Patients with New-onset Juvenile and Adult Dermatomyositis. J Rheumatol 2016; 44:117-124. [PMID: 27803134 DOI: 10.3899/jrheum.160293] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To identify shared and differential molecular pathways in blood and affected muscle between adult dermatomyositis (DM) and juvenile DM, and their association with clinical disease activity measures. METHODS Gene expression of transcription factors and cytokines involved in differentiation and effector function of T cell subsets, regulatory T cells and follicular Th cells, were analyzed in the blood from 21 newly diagnosed adult and 26 juvenile DM subjects and in 15 muscle specimens (7 adult and 8 juvenile DM) using a custom RT2 Profiler PCR Array. Disease activity was determined and measured by established disease activity tools. RESULTS The most prominent finding was the higher blood expression of Th17-related cytokines [retinoic acid-related orphan receptor-γ, interferon regulatory factor 4, interleukin (IL)-23A, IL-6, IL-17F, and IL-21] in juvenile DM at baseline. In contrast, adult patients with DM showed increased blood levels of STAT3 and BCL6 compared with juvenile DM. In muscle, GATA3, IL-13, and STAT5B were found at higher levels in juvenile patients with DM compared with adult DM. Among 25 patients (11 adult and 14 juvenile DM) who had blood samples at baseline and at 6 months, increased expression of IL-1β, STAT3, STAT6, STAT5B, and BCL6 was associated with an improvement in global extramuscular disease activity. CONCLUSION We observed differences in gene expression profiling in blood and muscle between new-onset adult and juvenile DM. Cytokine expression in the blood of juvenile patients with new-onset DM was dominated by Th17-related cytokines compared with adult patients with DM. This may reflect the activation of different Th pathways between muscle and blood.
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Affiliation(s)
- Consuelo M López De Padilla
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Cynthia S Crowson
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Molly S Hein
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Richard S Pendegraft
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Michael A Strausbauch
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Timothy B Niewold
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Floranne C Ernste
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Erik Peterson
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Emily C Baechler
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Ann M Reed
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA. .,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center.
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Coutant F, Miossec P. Altered dendritic cell functions in autoimmune diseases: distinct and overlapping profiles. Nat Rev Rheumatol 2016; 12:703-715. [DOI: 10.1038/nrrheum.2016.147] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Affiliation(s)
- Pierre Miossec
- Department of Clinical Immunology and Rheumatology, and Immunogenomics and Inflammation Research Unit, University of Lyon, Edouard Herriot Hospital, 69437 Lyon, France.
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Haq SA, Tournadre A. Idiopathic inflammatory myopathies: from immunopathogenesis to new therapeutic targets. Int J Rheum Dis 2015; 18:818-25. [PMID: 26385431 DOI: 10.1111/1756-185x.12736] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pathogenesis of idiopathic inflammatory myositis (IIM) involves strong interactions between dendritic cells (DCs), activated Th1 and Th17 cells, B cells, muscle cells, genes and environment. Local maturation of DCs permit the activation and polarization of CD4+ T cells into T(H)1 and T(H)17 that play a key role in maintaining chronic muscle inflammation. T-cell mediated myocytotoxicity promotes the liberation of specific muscle autoantigens from regenerating muscle cells with production of myositis-specific autoantibodies. Type I interferon signature is a key characteristic of IIM. Type I IFN that can be induced by immune complexes containing myositis-specific autoantibodies is produced by scattered plasmacytoid DCs but also by muscle cells particularly regenerating muscle cells. These immature muscle precursors appear to be critical in the pathogenesis of IIM as they up-regulate muscle autoantigens, type I IFN, HLA class I antigens and TLR3-7, all together involved in maintaining chronic muscle inflammation. In addition to the role of immune and muscle cells, genome-wide association studies have confirmed the importance of several MHC and non-MHC genes in IIM. Environmental factors can contribute to the pathogenesis of IIM. In sIBM, distinct features suggest both degenerative and inflammatory processes. In addition to our better understanding of the pathogenesis, identify molecular pathway leads to consider new targeted therapies including cytokine inhibition, B-cell and T-cell costimulation blockade, type I IFN neutralization or inhibition of the ubiquitin proteasome pathway.
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Affiliation(s)
- Syed A Haq
- BSM Medical University, Dhaka, Bangladesh
| | - Anne Tournadre
- Rheumatology department CHU Clermont-Ferrand and UMR 1019 INRA/ University of Auvergne, Clermont-Ferrand, France
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Findlay AR, Goyal NA, Mozaffar T. An overview of polymyositis and dermatomyositis. Muscle Nerve 2015; 51:638-56. [PMID: 25641317 DOI: 10.1002/mus.24566] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 12/23/2022]
Abstract
Polymyositis and dermatomyositis are inflammatory myopathies that differ in their clinical features, histopathology, response to treatment, and prognosis. Although their clinical pictures differ, they both present with symmetrical, proximal muscle weakness. Treatment relies mainly upon empirical use of corticosteroids and immunosuppressive agents. A deeper understanding of the molecular pathways that drive pathogenesis, careful phenotyping, and accurate disease classification will aid clinical research and development of more efficacious treatments. In this review we address the current knowledge of the epidemiology, clinical characteristics, diagnostic evaluation, classification, pathogenesis, treatment, and prognosis of polymyositis and dermatomyositis.
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Affiliation(s)
- Andrew R Findlay
- Department of Neurology, University of California, Irvine UC Irvine, MDA ALS and Neuromuscular Center, 200 South Manchester Avenue, Suite 110, Orange, California, 92868, USA
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Espinosa-Ortega F, Gómez-Martin D, Santana-De Anda K, Romo-Tena J, Villaseñor-Ovies P, Alcocer-Varela J. Quantitative T cell subsets profile in peripheral blood from patients with idiopathic inflammatory myopathies: tilting the balance towards proinflammatory and pro-apoptotic subsets. Clin Exp Immunol 2015; 179:520-8. [PMID: 25348796 DOI: 10.1111/cei.12475] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 12/16/2022] Open
Abstract
The role of T cells in idiopathic inflammatory myopathies (IIM) is not yet clear. Some alterations in certain subsets have been reported in inflamed muscle cells. However, a broad quantitative assessment of peripheral T cell subsets has not been evaluated. The aim of this study was to address the quantitative profile of potential pathogenic T cell subsets, namely follicular helper T cells (Tfh), T helper type 17 (Th17), CD28(null) and regulatory T cells (Tregs ) in peripheral blood from IIM patients. Thirty IIM patients and 30 age- and gender-matched healthy donors were included. Peripheral blood mononuclear cells were isolated. T cell subsets were evaluated by flow cytometry, as follows: Tfh (CD4(+) CXCR5(+) ) and its subsets Tfh1 (CXCR3(+) CCR6(-) ), Tfh2 (CXCR3(-) CCR6(-) ), Tfh17 (CXCR3(-) CCR6(+) ), Th17 (CD4(+) IL17A(+) ), CD28(null) (CD4(+) CD28(-) CD244(+) ) and Tregs (CD4(+) CD25(high) forkhead box protein 3 (FoxP3(+) ); CD8(+) CD25(high) FoxP3(+) ). Percentage, absolute numbers and mean fluorescence intensity were analysed. We found increased numbers of total Tfh cells (28 ± 8.16 versus 6.64 ± 1.29, P=0.031) in IIM patients when compared to healthy controls. Moreover, this increment was dependent upon Tfh2 and Tfh17 (Tfh2:9.49 ± 2.19 versus 1.66 ± 0.46, P=0.005; Tfh17 9.48 ± 2.83 versus 1.18 ± 0.21, P=0.014). Also, IIM patients showed higher numbers of Th17 cells (30.25 ± 6.49 versus 13.46 ± 2.95, P=0.031) as well as decreased number of Tregs (5.98 ± 1.61 versus 30.82 ± 8.38, P=0.009). We also found an expansion of CD28(null) cells (162.88 ± 32.29 versus 64 ± 17.35, P=0.015). Our data suggest that IIM patients are characterized by an expansion of peripheral proinflammatory T cells, such as Tfh and Th17, as well as pro-apoptotic CD28 null cells and a deficiency of suppressor populations of Tregs (CD4(+) and CD8(+) ).
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Affiliation(s)
- F Espinosa-Ortega
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
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Lu X, Peng Q, Wang G. Discovery of new biomarkers of idiopathic inflammatory myopathy. Clin Chim Acta 2015; 444:117-25. [DOI: 10.1016/j.cca.2015.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/02/2015] [Accepted: 02/02/2015] [Indexed: 01/19/2023]
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Arshanapalli A, Shah M, Veerula V, Somani AK. The role of type I interferons and other cytokines in dermatomyositis. Cytokine 2014; 73:319-25. [PMID: 25541432 DOI: 10.1016/j.cyto.2014.11.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 11/20/2014] [Accepted: 11/21/2014] [Indexed: 12/24/2022]
Abstract
Much work has been done to unveil the mechanisms behind the pathogenesis of dermatomyositis (DM) - mainly those involving certain pathogenic cytokines, termed "pathokines" as the principal cytokines involved. Recently, it has become clear that a group of cytokines known as type I interferons (IFN-Is) play a significant role in the development of DM. We review the literature published between 1946 and 2014 using an Ovid Medline database search to provide an update on the role of IFN-Is and other cytokines in the pathogenesis of DM. We provide information about the genes and proteins induced by IFN-Is and potential mechanisms by which these downstream products relate to clinical disease activity. We also explore findings of other autoimmune phenomena that may contribute to disease onset and activity including T-helper 17 (Th17) cells and associated interleukins, as well as autoantibodies. Finally, we provide a brief update on current treatment options for DM as well as some new immunomodulatory treatment modalities in development.
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Affiliation(s)
- Ashish Arshanapalli
- Department of Dermatology, Indiana University School of Medicine, 545 Barnhill Dr., Indianapolis, IN 46202, USA
| | - Mihir Shah
- Northeast Ohio Medical University, 4209 SR 44, Rootstown, OH 44272, USA
| | - Vindhya Veerula
- Department of Dermatology, Indiana University School of Medicine, 545 Barnhill Dr., Indianapolis, IN 46202, USA
| | - Ally-Khan Somani
- Department of Dermatology, Indiana University School of Medicine, 545 Barnhill Dr., Indianapolis, IN 46202, USA.
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Notarnicola A, Lapadula G, Natuzzi D, Lundberg IE, Iannone F. Correlation between serum levels of IL-15 and IL-17 in patients with idiopathic inflammatory myopathies. Scand J Rheumatol 2014; 44:224-8. [DOI: 10.3109/03009742.2014.956141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Ciccia F, Rizzo A, Alessandro R, Guggino G, Maugeri R, Saieva L, Cannizzaro A, Giardina A, De Leo G, Gerardo Iacopino D, Triolo G. Activated IL-22 pathway occurs in the muscle tissues of patients with polymyositis or dermatomyositis and is correlated with disease activity. Rheumatology (Oxford) 2014; 53:1307-12. [PMID: 24599919 DOI: 10.1093/rheumatology/keu005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the expression of IL-22, IL-22 receptor 1 (IL-22R1), IL-22 binding protein (IL-22BP) and p-STAT3 in muscle tissue from patients with PM and DM. METHODS Levels of IL-22, IL-22R1, IL-22BP and STAT3 mRNA were quantified by RT-PCR. The expression of IL-22, IL-22R1, IL-22BP and p-STAT3 was also analysed using immunohistochemistry. RESULTS Significant modulation of the IL-22 pathway was observed in inflammatory myopathic tissues. In particular, a significant overexpression of IL-22 at the protein but not the mRNA level was observed in PM/DM tissues and was correlated with myositis activity. IL-22R1 aberrant expression was also observed among infiltrating mononuclear cells and necrotic muscle cells. IL-22BP, which inhibits IL-22 signalling, was expressed only in some muscle fibres in PM/DM patients. CONCLUSION Our findings indicate that the IL-22 pathway is activated in inflammatory myopathic tissues and may be involved in the induction of muscle inflammatory processes and muscle necrosis.
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Affiliation(s)
- Francesco Ciccia
- Dipartimento Biomedico di Medicina Interna e Specialistiche, Sezione di Reumatologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Sezione di Anatomia Patologica, Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi and Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università di Palermo, Palermo, Italy
| | - Aroldo Rizzo
- Dipartimento Biomedico di Medicina Interna e Specialistiche, Sezione di Reumatologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Sezione di Anatomia Patologica, Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi and Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università di Palermo, Palermo, Italy
| | - Riccardo Alessandro
- Dipartimento Biomedico di Medicina Interna e Specialistiche, Sezione di Reumatologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Sezione di Anatomia Patologica, Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi and Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università di Palermo, Palermo, Italy
| | - Giuliana Guggino
- Dipartimento Biomedico di Medicina Interna e Specialistiche, Sezione di Reumatologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Sezione di Anatomia Patologica, Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi and Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università di Palermo, Palermo, Italy
| | - Rosario Maugeri
- Dipartimento Biomedico di Medicina Interna e Specialistiche, Sezione di Reumatologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Sezione di Anatomia Patologica, Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi and Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università di Palermo, Palermo, Italy
| | - Laura Saieva
- Dipartimento Biomedico di Medicina Interna e Specialistiche, Sezione di Reumatologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Sezione di Anatomia Patologica, Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi and Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università di Palermo, Palermo, Italy
| | - Alessandra Cannizzaro
- Dipartimento Biomedico di Medicina Interna e Specialistiche, Sezione di Reumatologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Sezione di Anatomia Patologica, Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi and Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università di Palermo, Palermo, Italy
| | - AnnaRita Giardina
- Dipartimento Biomedico di Medicina Interna e Specialistiche, Sezione di Reumatologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Sezione di Anatomia Patologica, Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi and Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università di Palermo, Palermo, Italy
| | - Giacomo De Leo
- Dipartimento Biomedico di Medicina Interna e Specialistiche, Sezione di Reumatologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Sezione di Anatomia Patologica, Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi and Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università di Palermo, Palermo, Italy
| | - Domenico Gerardo Iacopino
- Dipartimento Biomedico di Medicina Interna e Specialistiche, Sezione di Reumatologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Sezione di Anatomia Patologica, Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi and Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università di Palermo, Palermo, Italy
| | - Giovanni Triolo
- Dipartimento Biomedico di Medicina Interna e Specialistiche, Sezione di Reumatologia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Sezione di Anatomia Patologica, Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi and Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche, Università di Palermo, Palermo, Italy.
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Moran EM, Mastaglia FL. The role of interleukin-17 in immune-mediated inflammatory myopathies and possible therapeutic implications. Neuromuscul Disord 2014; 24:943-52. [PMID: 25052503 DOI: 10.1016/j.nmd.2014.06.432] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/03/2014] [Accepted: 06/09/2014] [Indexed: 12/26/2022]
Abstract
The idiopathic inflammatory myopathies are a heterogeneous group of autoimmune muscle disorders with distinct clinical and pathological features and underlying immunopathogenic mechanisms. Traditionally, CD4(+) Th1 cells or CD8(+) cytotoxic effector T cells and type I/II interferons have been primarily implicated in the pathogenesis of the inflammatory myopathies. The presence of IL-17A producing cells in the inflamed muscle tissue of myositis patients and the results of in vitro studies suggest that IL-17A and the Th17 pathway may also have a key role in these diseases. The contribution of IL-17A to other chronic inflammatory and autoimmune diseases has been well established and clinical trials of IL-17A inhibitors are now at an advanced stage. However the precise role of IL-17A in the various forms of myositis and the potential for therapeutic targeting is currently unknown and warrants further investigation.
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Affiliation(s)
- Ellen M Moran
- Institute for Immunology & Infectious Diseases (IIID), Murdoch University, Murdoch, WA, Australia.
| | - Frank L Mastaglia
- Institute for Immunology & Infectious Diseases (IIID), Murdoch University, Murdoch, WA, Australia; Western Australian Neuroscience Research Institute, Centre for Neuromuscular & Neurological Disorders, University of Western Australia, Australia
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Bai F, Tian H, Niu Z, Liu M, Ren G, Yu Y, Sun T, Li S, Li D. Chimeric anti-IL-17 full-length monoclonal antibody is a novel potential candidate for the treatment of rheumatoid arthritis. Int J Mol Med 2013; 33:711-21. [PMID: 24378614 DOI: 10.3892/ijmm.2013.1611] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 11/04/2013] [Indexed: 11/06/2022] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease, primarily manifesting as inflammatory arthritis. It is associated with chronic inflammation of the synovial joints, mostly in the hands and feet, as well as with systemic extra-articular inflammation. The chimeric anti-interleukin (IL)-17 full-length monoclonal antibody (CMa17Aab) targets IL-17A, which is an important cytokine in the pathogenesis of RA and other inflammatory disorders. In this study, we investigated whether CMa17Aab exerts therapeutic effects in a mouse model of type II collagen-induced arthritis (CIA). Mice with CIA were subcutaneously injected with the humanized CMa17Aab antibody. The effects of treatment were assessed by estimating the arthritis severity score, the extent of histological damage and bone destruction, the autoreactive humoral and cellular immune responses and the production of cytokines. Treatment with CMa17Aab exerted beneficial effects in the mice with CIA as regards clinical and histological parameters. Compared with the controls, treatment with CMa17Aab resulted in a significant alleviation of the severity of the symptoms of arthritis, by preventing bone damage and cartilage destruction, reducing humoral and cellular immune responses, and downregulating the expression of IL-6, IL-8, matrix metalloproteinase (MMP)-3, IL-17, IL-1β, tumor necrosis factor (TNF)-α, receptor activator for nuclear factor-κB ligand (RANKL) and interferon (IFN)-γ in inflamed tissues. In conclusion, our study demonstrates that treatment with CMa17Aab exerts beneficial effects in mice with CIA, by preventing joint inflammation, cartilage destruction and bone damage. These preliminary results suggest that CMa17Aab is an important regulator in RA, and that it may represent a novel therapeutic agent that may prove useful in the treatment of this disease.
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Affiliation(s)
- Fuliang Bai
- Biopharmaceutical Teaching and Research Section, College of Life Science, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
| | - Hui Tian
- Biopharmaceutical Teaching and Research Section, College of Life Science, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
| | - Zeshan Niu
- Biopharmaceutical Teaching and Research Section, College of Life Science, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
| | - Mingyao Liu
- Biopharmaceutical Teaching and Research Section, College of Life Science, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
| | - Guiping Ren
- Biopharmaceutical Teaching and Research Section, College of Life Science, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
| | - Yinhang Yu
- Biopharmaceutical Teaching and Research Section, College of Life Science, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
| | - Tian Sun
- Biopharmaceutical Teaching and Research Section, College of Life Science, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
| | - Siming Li
- Biopharmaceutical Teaching and Research Section, College of Life Science, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
| | - Deshan Li
- Biopharmaceutical Teaching and Research Section, College of Life Science, Northeast Agricultural University, Harbin, Heilongjiang 150030, P.R. China
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Correlation between the frequency of Th17 cell and the expression of microRNA-206 in patients with dermatomyositis. Clin Dev Immunol 2013; 2013:345347. [PMID: 24288551 PMCID: PMC3830811 DOI: 10.1155/2013/345347] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/11/2013] [Accepted: 09/13/2013] [Indexed: 11/21/2022]
Abstract
It was reported that IL-17 had been detected in the inflammatory infiltrates of patients with DM (dermatomyositis). In this study, we investigated the frequency of Th17 cells and the expression of microRNA-206 (miR-206) in DM patients. Firstly, we observed that the frequency of Th17 cells and the expression of transcription factors were increased significantly in the PBMCs of DM patients. Secondly, we found that there was a positive correlation between the percentages of Th17 cells and serum level of CK in DM patients. And the serum concentrations of IL-6, IL-1β, TGF-β, and IL-23, the important cytokines of Th17 differentiation, were increased in DM patients. It was predicted that Krüppel-like factor 4 (KLF4) is one of the multiple targets of miR-206. We detected the expression of miR-206 in DM patients, and it was decreased in the serum and PBMCs of DM patients. The augmented expression of KLF is accompanied by the attenuated expression of miR-206. Furthermore, a negative correlation between the percentages of Th17 cells and the expression of miR-206 in DM patients has been found. Taken together, these findings suggest the attenuated expression of miR-206, and the augmented frequency of Th17 cells in DM patients.
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Venalis P, Lundberg IE. Immune mechanisms in polymyositis and dermatomyositis and potential targets for therapy. Rheumatology (Oxford) 2013; 53:397-405. [PMID: 23970542 DOI: 10.1093/rheumatology/ket279] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PM and DM are characterized clinically by weakness and low endurance of skeletal muscle. Other organs are frequently involved, suggesting that idiopathic inflammatory myopathies (IIMs) are systemic inflammatory diseases. Involvement of immune mechanisms in IIMs is supported by the presence of T cells, macrophages and dendritic cells in muscle tissue, by the presence of autoantibodies and by HLA-DR being a strong genetic risk factor. T cells may have direct and indirect toxic effects on muscle fibres, causing muscle fibre necrosis and muscle weakness, but the target of the immune reaction is not known. A newly identified T cell subset, CD28(null) T cells, may have cytotoxic effects in the CD4(+) and CD8(+) T cell phenotype. These cells are apoptosis resistant and may contribute to treatment resistance. Several myositis-specific autoantibodies have been identified, but they are all directed against ubiquitously expressed autoantigens and the specificity of the T cell reactivity is not known. These autoantibodies are associated with distinct clinical phenotypes and some with distinct molecular pathways; e.g. sera from patients with anti-Jo-1 autoantibodies may activate the type I IFN system and these sera also contain high levels of B cell activating factor compared with other IIM subsets. The characterization of patients into subgroups based on autoantibody profiles seems to be a promising way to learn more about the specificities of the immune reactions. Careful phenotyping of infiltrating immune cells in muscle tissue before and after specific therapies and relating the molecular findings to clinical outcome measures may be another way to improve knowledge on specific immune mechanism in IIMs. Such information will be important for the development of new therapies.
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Affiliation(s)
- Paulius Venalis
- CMM Foundation, Karolinska University Hospital L8:04, 171 76 Stockholm, Sweden.
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Raschke S, Eckardt K, Bjørklund Holven K, Jensen J, Eckel J. Identification and validation of novel contraction-regulated myokines released from primary human skeletal muscle cells. PLoS One 2013; 8:e62008. [PMID: 23637948 PMCID: PMC3634789 DOI: 10.1371/journal.pone.0062008] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 03/17/2013] [Indexed: 12/15/2022] Open
Abstract
Proteins secreted by skeletal muscle, so called myokines, have been shown to affect muscle physiology and additionally exert systemic effects on other tissues and organs. Although recent profiling studies have identified numerous myokines, the amount of overlap from these studies indicates that the secretome of skeletal muscle is still incompletely characterized. One limitation of the models used is the lack of contraction, a central characteristic of muscle cells. Here we aimed to characterize the secretome of primary human myotubes by cytokine antibody arrays and to identify myokines regulated by contraction, which was induced by electrical pulse stimulation (EPS). In this study, we validated the regulation and release of two selected myokines, namely pigment epithelium derived factor (PEDF) and dipeptidyl peptidase 4 (DPP4), which were recently described as adipokines. This study reveals that both factors, DPP4 and PEDF, are secreted by primary human myotubes. PEDF is a contraction-regulated myokine, although PEDF serum levels from healthy young men decrease after 60 min cycling at VO2max of 70%. Most interestingly, we identified 52 novel myokines which have not been described before to be secreted by skeletal muscle cells. For 48 myokines we show that their release is regulated by contractile activity. This profiling study of the human skeletal muscle secretome expands the number of myokines, identifies novel contraction-regulated myokines and underlines the overlap between proteins which are adipokines as well as myokines.
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Affiliation(s)
- Silja Raschke
- Paul-Langerhans-Group of Integrative Physiology, German Diabetes Center, Düsseldorf, Germany
| | - Kristin Eckardt
- Paul-Langerhans-Group of Integrative Physiology, German Diabetes Center, Düsseldorf, Germany
| | | | - Jørgen Jensen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Jürgen Eckel
- Paul-Langerhans-Group of Integrative Physiology, German Diabetes Center, Düsseldorf, Germany
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Reed AM, Peterson E, Bilgic H, Ytterberg SR, Amin S, Hein MS, Crowson CS, Ernste F, Gillespie EB. Changes in novel biomarkers of disease activity in juvenile and adult dermatomyositis are sensitive biomarkers of disease course. ACTA ACUST UNITED AC 2013; 64:4078-86. [PMID: 22886447 DOI: 10.1002/art.34659] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 07/26/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Muscle enzyme levels are insensitive markers of disease activity in juvenile and adult dermatomyositis (DM), especially during the active treatment phase. To improve our ability to monitor DM disease activity longitudinally, especially in the presence of immunomodulating agents, we prospectively evaluated whether interferon (IFN)-dependent peripheral blood gene and chemokine signatures could serve as sensitive and responsive biomarkers for change in disease activity in adult and juvenile DM. METHODS Peripheral blood and clinical data were collected from 51 patients with juvenile or adult DM prospectively over 2 study visits. We performed disease activity measurements and calculated whole-blood type I IFN gene and chemokine scores. We also measured serum levels of other proinflammatory cytokines, including interleukin-6 (IL-6). RESULTS Changes in juvenile and adult DM global disease activity correlated positively and significantly with changes in the type I IFN gene score before adjustment for medication use (r = 0.33, P = 0.023) and with changes in the IFN chemokine score before and after adjustment for medication use (r = 0.53, P < 0.001 and r = 0.50, P < 0.001, respectively). Changes in muscle and extramuscular visual analog scale (VAS) scores correlated positively with changes in IFN gene and chemokine scores (P = 0.002, P < 0.001, P = 0.095, P < 0.001). Serum levels of IL-6, IL-8, and tumor necrosis factor α (TNFα) correlated positively with changes in global, muscle, and extramuscular VAS scores (P < 0.05). CONCLUSION Our findings suggest that changes in type I IFN gene and chemokine scores as well as in levels of IL-6, IL-8, and TNFα may serve as sensitive and responsive longitudinal biomarkers of change in disease activity in juvenile and adult DM, even in the presence of immunomodulating agents.
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Affiliation(s)
- Ann M Reed
- Division of Rheumatology, Mayo Clinic, Rochester, MN 55905, USA.
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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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Abstract
The key role of interleukin-17 (IL-17) and T helper 17 (T(H)17) cells in tissue inflammation, autoimmunity and host defence led to the experimental targeting of these molecules in mouse models of diseases as well as in clinical settings. Moreover, the demonstration that IL-17 and T(H)17 cells contribute to local and systemic aspects of disease pathogenesis, as well as the finding that the IL-17-T(H)17 cell pathway is regulated by IL-23, prompted the identification of inhibitors. These inhibitors include biotechnology products that target IL-23 as well as the leading member of the IL-17 family, IL-17A, and one of its receptors, IL-17 receptor A. Several clinical trials of these inhibitors are underway, and positive results have been obtained in psoriasis, rheumatoid arthritis and ankylosing spondylitis. This Review focuses on the current knowledge of the IL-17-T(H)17 cell pathway to better understand the positive as well as potential negative consequences of targeting them.
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Kocić J, Santibañez JF, Krstić A, Mojsilović S, Ilić V, Bugarski D. Interleukin-17 modulates myoblast cell migration by inhibiting urokinase type plasminogen activator expression through p38 mitogen-activated protein kinase. Int J Biochem Cell Biol 2012. [PMID: 23183001 DOI: 10.1016/j.biocel.2012.11.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Interleukin-17 belongs to a family of pro-inflammatory cytokines with pleiotropic effects, which can be associated with several inflammatory diseases of the muscle tissue. Although elevated levels of interleukin-17 have been described in inflammatory myopathies, its role in muscle homeostasis remains to be elucidated. The requirement of the urokinase type plasminogen activator in skeletal myogenesis was recently demonstrated in vivo and in vitro, suggesting its involvement in the regulation of extracellular matrix remodeling, cell migration and myoblast fusion. Our previous results have demonstrated that interleukin-17 inhibits myogenic differentiation of C2C12 myoblasts in vitro concomitantly with the inhibition of cell migration. However, the involvement of urokinase type plasminogen activator in interleukin-17-inhibited myogenesis and migration remained to be analyzed. Therefore, the effect of interleukin-17 on the production of urokinase type plasminogen activator by C2C12 myoblasts was determined in the present study. Our results demonstrated that interleukin-17 strongly inhibits urokinase type plasminogen activator expression during myogenic differentiation. This reduction of urokinase type plasminogen activator production corresponded with the inhibition of cell migration by interleukin-17. Activation of p38 signaling pathway elicited by interleukin-17 mediated the inhibition of both urokinase type plasminogen activator expression and cell migration. Additionally, IL-17 inhibited C2C12 cells migration by causing the cells to reorganize their cytoskeleton and lose polarity. Therefore, our results suggest a novel mechanism by which interleukin-17 regulates myogenic differentiation through the inhibition of urokinase type plasminogen activator expression and cell migration. Accordingly, interleukin-17 may represent a potential clinical target worth investigating for the treatment of inflammatory muscle diseases.
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Affiliation(s)
- Jelena Kocić
- Laboratory for Experimental Hematology and Stem Cells, Institute for Medical Research, University of Belgrade, Dr Subotića 4, 11129 Belgrade, Serbia
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Shimojima Y, Ishii W, Matsuda M, Ikeda SI. Phenotypes of Peripheral Blood Lymphocytes and Cytokine Expression in Polymyositis and Dermatomyositis before Treatment and after Clinical Remission. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2012; 5:77-87. [PMID: 23115480 PMCID: PMC3480870 DOI: 10.4137/cmamd.s10272] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To investigate peripheral blood lymphocyte subpopulations, particularly helper T (Th) cells and cytokine expression before and after treatment in polymyositis (PM) and dermatomyositis (DM). Patients and Methods Ten patients with PM and 15 with DM were enrolled in this study. As a control we used 11 age-matched healthy subjects. We analyzed peripheral blood lymphocytes using flow cytometry. Serum cytokines were determined by enzyme-linked immunosorbent assay. Results Th2/Th1 and Th2/Th17 ratios were significantly higher in both PM and DM than in controls and this Th2-predominancy is marked in DM associated with interstitial pneumonia. IL-1β, IL-6 and TGF-β were significantly higher in both PM and DM and IL-4 showed a significant increase in DM when compared to controls. There was no significant correlation between either any lymphocyte subpopulations or serum cytokines and clinical severity markers such as the manual muscle strength test, serum creatine kinase, and the total CT score. Th2/Th17 in both PM and DM, as well as Th2/Th1 in the latter, significantly decreased after clinical remission compared with before treatment. Conclusions Th2-predominancy as shown by the increase in Th2/Th1 and Th2/Th17 ratios may suggest active disease in PM/DM but does not reflect clinical severity.
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Affiliation(s)
- Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
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Romano G, Lorenzon E, Montanaro D. Effects of exercise in renal transplant recipients. World J Transplant 2012; 2:46-50. [PMID: 24175196 PMCID: PMC3782234 DOI: 10.5500/wjt.v2.i4.46] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 04/02/2012] [Accepted: 06/30/2012] [Indexed: 02/05/2023] Open
Abstract
Even after a successful renal transplantation, the renal transplant recipients (RTRs) keeps on suffering the consequences of the uremic sickness. Cardiovascular risk, work capacity, and quality of life do not improve according to expectations since biological and psychological problems are not completely solved by pharmacological treatment. Furthermore, post-transplant treatment, per se, induces additional problems (i.e., side effects of drugs). It becomes, indeed, very important to insert “non-pharmacological” therapies able to reverse this trend. Exercise may represent an important contribution in the solution of this problem. In fact, many studies have demonstrated, in the last two decades, that physical training is able both, to improve graft function, work capacity and quality of life, and to reduce cardiovascular risk. In conclusion, if the analysis of the available data suggests that an appropriate dose of physical training represent a useful, safe and non-pharmacologic contribution to RTR treatment, it becomes a kidney transplantologist responsibility to introduce exercise in the current therapy of RTRs.
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Affiliation(s)
- Giulio Romano
- Giulio Romano, Eric Lorenzon, Domenico Montanaro, Department of Nephrology, S.M. Misericordia University Hospital, DISM, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
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Stübgen JP. Targeted immunotherapy trials for idiopathic inflammatory myopathies. J Neurol 2012; 260:368-85. [DOI: 10.1007/s00415-012-6590-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 06/11/2012] [Accepted: 06/12/2012] [Indexed: 12/13/2022]
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De Pasquale L, D'Amico A, Verardo M, Petrini S, Bertini E, De Benedetti F. Increased muscle expression of interleukin-17 in Duchenne muscular dystrophy. Neurology 2012; 78:1309-14. [PMID: 22496194 DOI: 10.1212/wnl.0b013e3182518302] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Duchenne muscular dystrophy (DMD) is a degenerative muscle wasting disease caused by mutations in the dystrophin gene. Dystrophic muscle is characterized by chronic inflammation, and inflammatory mediators could be promising targets for innovative therapeutic interventions. We analyzed muscle biopsy samples of DMD-affected children to characterize interleukin (IL)-17 and Forkhead box P3 (Foxp3) expression levels and to identify possible correlations with clinical status. METHODS Expression levels of IL-17, Foxp3, tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), IL-6, and transforming growth factor-β (TGF-β) were analyzed by real-time PCR in muscle biopsy samples from patients with DMD (n = 27) and juvenile dermatomyositis (JDM) (n = 8). Motor outcome of patients with DMD was evaluated by North Star Ambulatory Assessment score. RESULTS In DMD, we found higher levels of IL-17 and lower levels of Foxp3 mRNA compared with those for a typical inflammatory myopathy, JDM. Moreover, the IL-17/Foxp3 ratio was higher in DMD than in JDM biopsy samples. IL-17 mRNA levels appeared to be related to the expression levels of other proinflammatory cytokines (TNF-α and MCP-1) and significantly associated with clinical outcome of patients. CONCLUSIONS The association of IL-17 expression with levels of other inflammatory cytokines and with the clinical course of DMD suggests a possible pathogenic role of IL-17.
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Affiliation(s)
- L De Pasquale
- Division of Rheumatology, Bambino Gesù Children’s Hospital, Rome, Italy
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Kocić J, Santibañez JF, Krstić A, Mojsilović S, Đorđević IO, Trivanović D, Ilić V, Bugarski D. Interleukin 17 inhibits myogenic and promotes osteogenic differentiation of C2C12 myoblasts by activating ERK1,2. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2012; 1823:838-49. [DOI: 10.1016/j.bbamcr.2012.01.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 12/12/2011] [Accepted: 01/04/2012] [Indexed: 11/25/2022]
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48
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Tournadre A, Lenief V, Eljaafari A, Miossec P. Immature muscle precursors are a source of interferon-β in myositis: Role of Toll-like receptor 3 activation and contribution to HLA class I up-regulation. ACTA ACUST UNITED AC 2012; 64:533-41. [DOI: 10.1002/art.33350] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Robinson AB, Reed AM. Clinical features, pathogenesis and treatment of juvenile and adult dermatomyositis. Nat Rev Rheumatol 2011; 7:664-75. [PMID: 21947177 DOI: 10.1038/nrrheum.2011.139] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Juvenile and adult dermatomyositis (DM) have multiple commonalities, yet display differing prevalence of features, outcomes and comorbidities. In general, compared with the disease in adults, children with DM have more vasculopathy and a greater likelihood of calcinosis, periungual and gingival telangiectasias, and ulceration, but have a better long-term prognosis with improved survival. Adults with DM are more likely to have myositis-specific antibodies, develop interstitial lung disease, have amyopathic disease, and have a marked association with malignancy and other comorbidities. Both diseases have similar features on muscle biopsy and interferon gene signature, although subtle differences can exist in pathogenesis and pathology, such as more capillary loss and a greater degree of C5b-9 complement deposition in affected muscle of juvenile patients. Initiatives are underway to improve classification, markers of disease activity and ability to predict outcome of juvenile and adult DM. The purpose of this Review is to compare and contrast the unique features between juvenile and adult disease and to outline new initiatives in the field.
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Affiliation(s)
- Angela B Robinson
- Department of Pediatrics, Case Western Reserve University Hospital, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Chiu YE, Co DO. Juvenile dermatomyositis: immunopathogenesis, role of myositis-specific autoantibodies, and review of rituximab use. Pediatr Dermatol 2011; 28:357-67. [PMID: 21793879 DOI: 10.1111/j.1525-1470.2011.01501.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Juvenile dermatomyositis (JDM) is an autoimmune disease of the skin and muscle that affects children. The etiology is poorly understood, but genetic susceptibility, environmental triggers, and abnormal immune responses are each thought to play a part. T cells have traditionally been implicated in the immunopathogenesis of JDM, but dendritic cells, B cells, and microchimerism are increasingly associated. Additionally, myositis-specific autoantibodies (MSA) can be present in the sera of affected patients and may correlate with distinct clinical phenotypes. Given the role of humoral immunity and MSA, there has been recent interest in the use of rituximab to treat JDM. Early results are mixed, but it is hoped that a prospective clinical trial will shed light on the issue in the near future.
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Affiliation(s)
- Yvonne E Chiu
- Division of Pediatric Dermatology, Department of Dermatology, Medical College of Wisconsin Milwaukee, Wisconsin 53226, USA.
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