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Reiter A, Verweyen EL, Queste E, Fuehner S, Jakob A, Masjosthusmann K, Hinze C, Wittkowski H, Foell D, Meinzer U, Melki I, Kessel C. Proteomic mapping identifies serum marker signatures associated with MIS-C specific hyperinflammation and cardiovascular manifestation. Clin Immunol 2024; 264:110237. [PMID: 38723855 DOI: 10.1016/j.clim.2024.110237] [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: 01/17/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/19/2024]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) shares several clinical and immunological features with Kawasaki Disease (KD) and pediatric hyperinflammation, but the immuno-phenotypic overlap among these clinical mimics is still incompletely understood. Here we analyzed serum samples from treatment-naïve patients with MIS-C (n = 31) and KD (n = 11), pediatric hyperinflammation (n = 13) and healthy controls (HC, n = 10) by proximity extension assay (PEA) to profile 184 blood biomarkers. Collectively, immunophenotypic overlap between MIS-C and hyperinflammation exceeds overlap with KD. Overexpression of IL-17A in MIS-C and KD could best separate these conditions from hyperinflammatory conditions, while those were hallmarked by overabundance of adenosin deaminase and IL-18. Depletion in serum TNF-related subfamily member 9 (TNFRSF9) and apoptosis inducing ligand (TRAIL) linked with cardiovascular manifestations and myocarditis in MIS-C. Altogether, our analysis highlights important differences in molecular marker signatures also across different MIS-C and KD cohorts and suggests several previously unidentified molecular associations in context of cardiovascular inflammation.
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Affiliation(s)
- Andrea Reiter
- Department of Pediatric Rheumatology & Immunology, University Children's Hospital, Muenster, Germany
| | - Emely L Verweyen
- Department of Pediatric Rheumatology & Immunology, University Children's Hospital, Muenster, Germany
| | - Emmanuelle Queste
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France; Université Paris Cité, INSERM, Centre de Recherche sur l'inflammation UMR 1149, Paris, France
| | - Sabrina Fuehner
- Department of Pediatric Rheumatology & Immunology, University Children's Hospital, Muenster, Germany
| | - André Jakob
- Division of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilians University, Munich, Germany
| | - Katja Masjosthusmann
- Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Claas Hinze
- Department of Pediatric Rheumatology & Immunology, University Children's Hospital, Muenster, Germany
| | - Helmut Wittkowski
- Department of Pediatric Rheumatology & Immunology, University Children's Hospital, Muenster, Germany
| | - Dirk Foell
- Department of Pediatric Rheumatology & Immunology, University Children's Hospital, Muenster, Germany
| | - Ulrich Meinzer
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France; Université Paris Cité, INSERM, Centre de Recherche sur l'inflammation UMR 1149, Paris, France
| | - Isabelle Melki
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune diseases (RAISE), Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, F-75019 Paris, France; Paediatrics, Rheumatology and Paediatric Internal Medicine, Children's Hospital, F-33000 Bordeaux, France; Laboratory of Neurogenetics and Neuroinflammation, Imagine Institute, Université Paris Cité, Inserm UMR 1163, F-75015 Paris, France
| | - Christoph Kessel
- Department of Pediatric Rheumatology & Immunology, University Children's Hospital, Muenster, Germany.
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Hinze CH, Foell D, Kessel C. Treatment of systemic juvenile idiopathic arthritis. Nat Rev Rheumatol 2023; 19:778-789. [PMID: 37923864 DOI: 10.1038/s41584-023-01042-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/06/2023]
Abstract
Systemic juvenile idiopathic arthritis (sJIA) is an inflammatory disease with hallmarks of severe systemic inflammation, which can be accompanied by arthritis. Contemporary scientific insights set this paediatric disorder on a continuum with its counterpart, adult-onset Still disease (AOSD). Patients with sJIA are prone to complications, including life-threatening hyperinflammation (macrophage activation syndrome (sJIA-MAS)) and sJIA-associated lung disease (sJIA-LD). Meanwhile, the treatment arsenal in sJIA has expanded markedly. State-of-the-art therapeutic approaches include biologic agents that target the IL-1 and IL-6 pathways. Beyond these, a range of novel agents are on the horizon, some of them already being used on a compassionate use basis, including JAK inhibitors and biologic agents that target IL-18, IFNγ, or IL-1β and IL-18 simultaneously. However, sJIA, sJIA-MAS and sJIA-LD still pose challenging conundrums to rheumatologists treating paediatric and adult patients worldwide. Although national and international consensus treatment plans exist for the treatment of 'classic' sJIA, the treatment approaches for early sJIA without arthritis, and for refractory or complicated sJIA, are not well defined. Therefore, in this Review we outline current approaches for the treatment of sJIA and provide an outlook on knowledge gaps.
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Affiliation(s)
- Claas H Hinze
- Department of Paediatric Rheumatology and Immunology, Münster University Hospital, Münster, Germany
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, Münster University Hospital, Münster, Germany.
| | - Christoph Kessel
- Department of Paediatric Rheumatology and Immunology, Münster University Hospital, Münster, Germany
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3
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Raimbault S, Monneret G, Gossez M, Venet F, Belot A, Zekre F, Remy S, Javouhey E. Elevated monocyte HLA-DR in pediatric secondary hemophagocytic lymphohistiocytosis: a retrospective study. Front Immunol 2023; 14:1286749. [PMID: 38077325 PMCID: PMC10704813 DOI: 10.3389/fimmu.2023.1286749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition, and its diagnosis may be challenging. In particular, some cases show close similarities to sepsis (fever, organ failure, and high ferritin), but their treatment, while urgent, differ: prompt broad-spectrum antibiotherapy for sepsis and immunosuppressive treatment for HLH. We questioned whether monocyte human leucocyte antigen (mHLA)-DR could be a diagnostic marker for secondary HLH (sHLH). Methods We retrospectively reviewed data from patients with a sHLH diagnosis and mHLA-DR quantification. mHLA-DR data from healthy children and children with septic shock, whose HLA-DR expression is reduced, from a previously published study were also included for comparison. Results Six patients with sHLH had mHLA-DR quantification. The median level of monocyte mHLA-DR expression in patients with sHLH [79,409 antibodies bound per cell (AB/C), interquartile range (IQR) (75,734-86,453)] was significantly higher than that in healthy children and those with septic shock (29,668 AB/C, IQR (24,335-39,199), and 7,493 AB/C, IQR (3,758-14,659), respectively). Each patient with sHLH had a mHLA-DR higher than our laboratory normal values. Four patients had a second mHLA-DR sampling 2 to 4 days after the initial analysis and treatment initiation with high-dose corticosteroids; for all patients, mHLA-DR decreased to within or close to the normal range. One patient with systemic juvenile idiopathic arthritis had repeated mHLA-DR measurements over a 200-day period during which she underwent four HLH episodes. mHLA-DR increased during relapses and normalized after treatment incrementation. Conclusion In this small series, mHLA-DR was systematically elevated in patients with sHLH. Elevated mHLA-DR could contribute to sHLH diagnosis and help earlier distinction with septic shock.
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Affiliation(s)
- Sylvain Raimbault
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service de Réanimation Pédiatrique, Bron, France
| | - Guillaume Monneret
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d’Immunologie, Lyon, France
| | - Morgane Gossez
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d’Immunologie, Lyon, France
| | - Fabienne Venet
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Laboratoire d’Immunologie, Lyon, France
| | - Alexandre Belot
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service de Néphrologie et Rhumatologie Pédiatrique, Centre de Référence RAISE (Rhumatismes Inflammatoires et Maladies Auto-Immunes Systémiques Rares de l’Enfant), ERN RITA (European Reference Network for Immunodeficiency, Autoinflammatory, Autoimmune and Paediatric Rheumatic Diseases), Bron, France
| | - Franck Zekre
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service de Néphrologie et Rhumatologie Pédiatrique, Centre de Référence RAISE (Rhumatismes Inflammatoires et Maladies Auto-Immunes Systémiques Rares de l’Enfant), ERN RITA (European Reference Network for Immunodeficiency, Autoinflammatory, Autoimmune and Paediatric Rheumatic Diseases), Bron, France
| | - Solene Remy
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service de Réanimation Pédiatrique, Bron, France
| | - Etienne Javouhey
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service de Réanimation Pédiatrique, Bron, France
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Schulert GS, Kessel C. Molecular Pathways in the Pathogenesis of Systemic Juvenile Idiopathic Arthritis. Rheum Dis Clin North Am 2023; 49:895-911. [PMID: 37821202 DOI: 10.1016/j.rdc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Systemic juvenile idiopathic arthritis (sJIA) is a rare childhood chronic inflammatory disorder with risk for life-threatening complications including macrophage activation syndrome and lung disease. At onset, sJIA pathogenesis resembles that of the autoinflammatory periodic fever syndromes with marked innate immune activation, expansion of neutrophils and monocytes, and high levels of interleukin-18. Here, we review the current conceptual understanding of sJIA pathogenesis with a focus on both innate and adaptive immune pathways. Finally, we consider how recent progress toward understanding the immunologic basis of sJIA may support new therapies for refractory disease courses.
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Affiliation(s)
- Grant S Schulert
- Division of Rheumatology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 4010, Cincinnati, OH 45229, USA.
| | - Christoph Kessel
- Department of Pediatric Rheumatology and Immunology, Translational Inflammation Research, University Children's Hospital, Muenster, Germany
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5
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Foell D, Saers M, Park C, Brix N, Glerup M, Kessel C, Wittkowski H, Hinze C, Berntson L, Fasth A, Myrup C, Nordal E, Rygg M, Hasle H, Albertsen BK, Herlin T, Holzinger D, Niederberger C, Schlüter B. A novel serum calprotectin (MRP8/14) particle-enhanced immuno-turbidimetric assay (sCAL turbo) helps to differentiate systemic juvenile idiopathic arthritis from other diseases in routine clinical laboratory settings. Mol Cell Pediatr 2023; 10:14. [PMID: 37878193 PMCID: PMC10600080 DOI: 10.1186/s40348-023-00168-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Differential diagnosis in children with signs of unprovoked inflammation can be challenging. In particular, differentiating systemic juvenile idiopathic arthritis (SJIA) from other diagnoses is difficult. We have recently validated the complex of myeloid-related proteins 8/14 (MRP8/14, also known as S100A8/A9 complex or serum calprotectin) as a helpful biomarker supporting the diagnosis of SJIA. The results were subsequently confirmed with a commercial ELISA. However, further optimization of the analytical technology is important to ensure its feasibility for large-scale use in routine laboratory settings. METHODS To evaluate the accuracy in identifying children with SJIA, the performance of a particle-enhanced immuno-turbidimetric assay for serum calprotectin (sCAL turbo) on an automated laboratory instrument was analyzed. Samples from 615 children were available with the diagnoses SJIA (n = 99), non-systemic JIA (n = 169), infections (n = 51), other inflammatory diseases (n = 126), and acute lymphoblastic leukemia (ALL, n = 147). In addition, samples from 23 healthy controls were included. RESULTS The sCAL turbo assay correlated well with the MRP8/14 ELISA used in previous validation studies (r = 0.99, p < 0.001). It could reliably differentiate SJIA from all other diagnoses with significant accuracy (cutoff at 10,500 ng/ml, sensitivity 84%, specificity 94%, ROC area under curve 0.960, p < 0.001). CONCLUSIONS Serum calprotectin analyses are a helpful tool supporting the diagnosis of SJIA in children with prolonged fever or inflammatory disease. Here, we show that an immuno-turbidimetric assay for detection of serum calprotectin on an automated laboratory instrument can be implemented in clinical laboratory settings to facilitate its use as a diagnostic routine test in clinical practice.
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Affiliation(s)
- Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, D-48149, Germany.
| | - Melanie Saers
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, D-48149, Germany
| | - Carolin Park
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, D-48149, Germany
| | - Ninna Brix
- Department of Pediatric and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Mia Glerup
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Christoph Kessel
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, D-48149, Germany
| | - Helmut Wittkowski
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, D-48149, Germany
| | - Claas Hinze
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Muenster, D-48149, Germany
| | - Lillemor Berntson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anders Fasth
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Charlotte Myrup
- Department of Pediatrics, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ellen Nordal
- Department of Pediatrics, University Hospital of North Norway, Tromso, Norway
- Department of Clinical Medicine, Arctic University of Norway, Tromso, Norway
| | - Marite Rygg
- Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Birgitte Klug Albertsen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Troels Herlin
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Dirk Holzinger
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany
- Department of Applied Health Sciences, University of Applied Sciences Bochum, Bochum, Germany
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6
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Wobma H, Bachrach R, Farrell J, Chang MH, Day‐Lewis M, Dedeoglu F, Fishman MP, Halyabar O, Harris C, Ibanez D, Kim L, Klouda T, Krone K, Lee PY, Lo MS, McBrearty K, Meidan E, Prockop SE, Samad A, Son MBF, Nigrovic PA, Casey A, Chang JC, Henderson LA. Development of a Screening Algorithm for Lung Disease in Systemic Juvenile Idiopathic Arthritis. ACR Open Rheumatol 2023; 5:556-562. [PMID: 37688362 PMCID: PMC10570670 DOI: 10.1002/acr2.11600] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE Lung disease (LD) is an increasingly recognized complication of systemic juvenile idiopathic arthritis (sJIA). As there are no currently available guidelines for pulmonary screening in sJIA, we sought to develop such an algorithm at our institution. METHODS A multidisciplinary workgroup was convened, including members representing rheumatology, pulmonary, stem cell transplantation, and patient families. The workgroup leaders drafted an initial algorithm based on published literature and experience at our center. A modified Delphi approach was used to achieve agreement through three rounds of anonymous, asynchronous voting and a consensus meeting. Statements approved by the workgroup were rated as appropriate with moderate or high levels of consensus. These statements were organized into the final approved screening algorithm for LD in sJIA. RESULTS The workgroup ultimately rated 20 statements as appropriate with a moderate or high level of consensus. The approved algorithm recommends pulmonary screening for newly diagnosed patients with sJIA with clinical features that the workgroup agreed may confer increased risk for LD. These "red flag features" include baseline characteristics (young age of sJIA onset, human leukocyte antigen type, trisomy 21), high disease activity (macrophage activation syndrome [MAS], sJIA-related ICU admission, elevated MAS biomarkers), respiratory symptoms or abnormal pulmonary examination findings, and features of drug hypersensitivity-like reactions (eosinophilia, atypical rash, anaphylaxis). The workgroup achieved consensus on the recommended pulmonary work-up and monitoring guidelines. CONCLUSION We developed a pulmonary screening algorithm for sJIA-LD through a multidisciplinary consensus-building process, which will be revised as our understanding of sJIA-LD continues to evolve.
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Affiliation(s)
- Holly Wobma
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Ronny Bachrach
- Division of Immunology, Boston Children's HospitalBostonMassachusetts
| | - Joseph Farrell
- Division of Immunology, Boston Children's HospitalBostonMassachusetts
| | - Margaret H. Chang
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Megan Day‐Lewis
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Fatma Dedeoglu
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Martha P. Fishman
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Olha Halyabar
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Claudia Harris
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Daniel Ibanez
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Liyoung Kim
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Timothy Klouda
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Katie Krone
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Pui Y. Lee
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Mindy S. Lo
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Kyle McBrearty
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Esra Meidan
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Susan E. Prockop
- Dana‐Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical SchoolBostonMassachusetts
| | - Aaida Samad
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Mary Beth F. Son
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Peter A. Nigrovic
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Alicia Casey
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
| | - Joyce C. Chang
- Boston Children's Hospital, Harvard Medical SchoolBostonMassachusetts
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Baggio C, Bindoli S, Guidea I, Doria A, Oliviero F, Sfriso P. IL-18 in Autoinflammatory Diseases: Focus on Adult Onset Still Disease and Macrophages Activation Syndrome. Int J Mol Sci 2023; 24:11125. [PMID: 37446301 DOI: 10.3390/ijms241311125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Interleukin-18 (IL-18) is a potent pro-inflammatory cytokine that is involved in various innate and adaptive immune processes related to infection, inflammation, and autoimmunity. Therefore, it is described as a key mediator of autoinflammatory diseases associated with the development of macrophage activation syndrome (MAS), including systemic juvenile idiopathic arthritis and adult-onset Still's disease. This review focuses on the role of IL-18 in inflammatory responses, placing emphasis on autoinflammatory diseases associated with chronic excess of serum IL-18, which correlate with clinical and biological signs of the disease. Therefore, it is useful for the diagnosis and monitoring of disease activity. Researchers are currently investigating IL-18's role as a therapeutic target for the treatment of inflammatory diseases. The inhibition of IL-18 signaling through recombinant human IL-18BP (IL-18 binding protein) seems to be an effective therapeutic strategy, though further studies are necessary to clarify its importance as a therapeutic target.
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Affiliation(s)
- Chiara Baggio
- Rheumatology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Sara Bindoli
- Rheumatology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Irina Guidea
- Rheumatology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Francesca Oliviero
- Rheumatology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Paolo Sfriso
- Rheumatology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
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Kuehn J, Schleifenbaum S, Hendling M, Siebenhandl S, Krainer J, Fuehner S, Hellige A, Park C, Hinze C, Wittkowski H, Holzinger D, Thurner L, Weinhäusel A, Foell D, Kessel C. Aberrant Naive CD4-Positive T Cell Differentiation in Systemic Juvenile Idiopathic Arthritis Committed to B Cell Help. Arthritis Rheumatol 2022; 75:826-841. [PMID: 36409585 DOI: 10.1002/art.42409] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 11/03/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Systemic juvenile idiopathic arthritis (JIA) features characteristics of autoinflammation and autoimmunity, culminating in chronic arthritis. In this study, we hypothesized that aberrant or incomplete polarization of T helper cells contributes to disease pathology. METHODS Cells or serum samples were obtained from healthy controls (n = 72) and systemic JIA patients (n = 171). Isolated naive T helper cells were cultured under Th1, Th17, and T follicular helper (Tfh) or T peripheral helper (Tph)-polarizing conditions and were partly cocultured with allogenic memory B cells. Cell samples were then analyzed for surface marker, transcription factor, and cytokine expression, as well as plasmablast generation. Serum samples were subjected to multiplexed bead and self-antigen arrays and enzyme-linked immunosorbent assays, and all data were compared to retrospective RNA profiling analyses. RESULTS Differentiation of systemic JIA-naive T helper cells toward Th1 cells resulted in low expression levels of interferon-γ (IFNγ) and eomesodermin, which was associated in part with disease duration. In contrast developing Th1 cells in patients with systemic JIA were found to produce elevated levels of interleukin-21 (IL-21), which negatively correlated with cellular expression of IFNγ and eomesodermin. In both in vitro and ex vivo analyses, IL-21 together with programmed cell death 1 (PD-1), inducible T cell costimulator (ICOS), and CXCR5 expression induced naive T helper cells from systemic JIA patients to polarize toward a Tfh/Tph cell phenotype. Retrospective analysis of whole-blood RNA-sequencing data demonstrated that Bcl-6, a master transcription factor in Tfh/Tph cell differentiation, was overexpressed specifically in patients with systemic JIA. Naive T helper cells from systemic JIA patients which were stimulated in vitro promoted B cellular plasmablast generation, and self-antigen array data indicated that IgG reactivity profiles of patients with systemic JIA differed from those of healthy controls. CONCLUSION In the pathogenesis of systemic JIA, skewing of naive T helper cell differentiation toward a Tfh/Tph cell phenotype may represent an echo of autoimmunity, which may indicate the mechanisms driving progression toward chronic destructive arthritis.
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Affiliation(s)
- Julia Kuehn
- Pediatric Rheumatology and Immunology, University Children's Hospital, Muenster, Germany
| | - Susanne Schleifenbaum
- Pediatric Rheumatology and Immunology, University Children's Hospital, Muenster, Germany
| | - Michaela Hendling
- Competence Unit Molecular Diagnostics, Center for Health and Bioresources, Austrian Institute of Technology, Vienna, Austria
| | - Sandra Siebenhandl
- Competence Unit Molecular Diagnostics, Center for Health and Bioresources, Austrian Institute of Technology, Vienna, Austria
| | - Julie Krainer
- Competence Unit Molecular Diagnostics, Center for Health and Bioresources, Austrian Institute of Technology, Vienna, Austria
| | - Sabrina Fuehner
- Pediatric Rheumatology and Immunology, University Children's Hospital, Muenster, Germany
| | - Antje Hellige
- Pediatric Rheumatology and Immunology, University Children's Hospital, Muenster, Germany
| | - Carolin Park
- Pediatric Rheumatology and Immunology, University Children's Hospital, Muenster, Germany
| | - Claas Hinze
- Pediatric Rheumatology and Immunology, University Children's Hospital, Muenster, Germany
| | - Helmut Wittkowski
- Pediatric Rheumatology and Immunology, University Children's Hospital, Muenster, Germany
| | - Dirk Holzinger
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Essen, Germany, and Department of Applied Health Sciences, University of Applied Sciences Bochum, Bochum, Germany
| | - Lorenz Thurner
- José Carreras Center for Immunology and Gene Therapy and Internal Medicine I, Saarland University Medical School, Homburg, Germany
| | - Andreas Weinhäusel
- Competence Unit Molecular Diagnostics, Center for Health and Bioresources, Austrian Institute of Technology, Vienna, Austria
| | - Dirk Foell
- Pediatric Rheumatology and Immunology, University Children's Hospital, Muenster, Germany
| | - Christoph Kessel
- Pediatric Rheumatology and Immunology, University Children's Hospital, Muenster, Germany
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9
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Regel A, Föll D, Kriegel MA. [Still's syndrome-similarities and differences between the juvenile and adult forms]. Z Rheumatol 2022; 81:22-27. [PMID: 34735597 PMCID: PMC8816857 DOI: 10.1007/s00393-021-01117-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 02/03/2023]
Abstract
Still's syndrome includes systemic juvenile idiopathic arthritis (sJIA) and the adult form of Still's disease (adult-onset Still's disease, AOSD). Except for age, there are many similarities between sJIA and AOSD. A biphasic disease model is currently put forth. At disease onset, autoinflammation predominates, which is caused by dysregulation of the innate immune system. Later on, the disease can progress to a chronic-articular form, which is predominantly mediated by the adaptive immune system and is consequently due to autoimmunity. The "window-of-opportunity" hypothesis is based on this biphasic model and supports the assumption that an early, targeted therapy with cytokine blockade can prevent disease progression to chronic destructive arthritis. Macrophage activation syndrome (MAS) is a serious complication of the so-called cytokine storm during the systemic phase of the disease. Clinically, there are many similarities between sJIA and AOSD. Recurrent fever, a fleeting, salmon-colored rash, and arthralgia/arthritis are common signs and symptoms of both sJIA and AOSD. The few differences are mainly related to the therapies and their side effects in children versus adults. In addition, the contribution of genetics to pathogenesis is more pronounced in sJIA compared to AOSD, but there are also smooth transitions in this respect and both diseases are heavily influenced by exogenous factors such as microbial triggers. Future research aspects could include additional investigation of these triggers such as viruses, bacteria, or dysbiosis of the human microbiome.
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Affiliation(s)
- Andrea Regel
- Sektion für Rheumatologie und Klinische Immunologie, Medizinische Klinik D, Universitätsklinikum Münster, 48149 Münster, Deutschland
| | - Dirk Föll
- Klinik für Pädiatrische Rheumatologie und Immunologie, Universitätsklinikum Münster, 48149 Münster, Deutschland
| | - Martin A. Kriegel
- Sektion für Rheumatologie und Klinische Immunologie, Medizinische Klinik D, Universitätsklinikum Münster, 48149 Münster, Deutschland,Abteilung für Translationale Rheumatologie und Immunologie, Institut für Muskuloskelettale Medizin, Universitätsklinikum Münster, 48149 Münster, Deutschland,Abteilung für Immunbiologie, Yale University School of Medicine, New Haven, CT 06511, USA
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Rocco JM, Sereti I. Expanding role of biomarkers in characterising hyperinflammatory syndromes. THE LANCET. RHEUMATOLOGY 2021; 3:e684-e685. [PMID: 38287605 DOI: 10.1016/s2665-9913(21)00273-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/09/2021] [Indexed: 01/31/2024]
Affiliation(s)
- Joseph M Rocco
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Irini Sereti
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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Kessel C, Foell D. Expanding role of biomarkers in characterising hyperinflammatory syndromes - Authors' reply. THE LANCET. RHEUMATOLOGY 2021; 3:e685-e686. [PMID: 38287606 DOI: 10.1016/s2665-9913(21)00275-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/09/2021] [Indexed: 01/31/2024]
Affiliation(s)
- Christoph Kessel
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, 48149 Muenster, Germany.
| | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, 48149 Muenster, Germany
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Henderson LA. Deciphering the cytokine fingerprint of macrophage activation syndrome. THE LANCET. RHEUMATOLOGY 2021; 3:e535-e538. [PMID: 38287614 DOI: 10.1016/s2665-9913(21)00180-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/19/2021] [Indexed: 01/31/2024]
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