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Banko A, Cirkovic A, Jeremic I, Basaric M, Grk M, Miskovic R, Lazarevic I, Miljanovic D. Uncovering the Role of Epstein-Barr Virus Infection Markers for Remission in Rheumatoid Arthritis. Biomedicines 2023; 11:2375. [PMID: 37760816 PMCID: PMC10525384 DOI: 10.3390/biomedicines11092375] [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: 07/31/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Epstein-Barr virus (EBV) infection has been shown as a potential risk factor for the development of rheumatoid arthritis (RA). This prospective research aimed to investigate whether EBV infection markers changed during the six-month follow-up period in 133 RA patients (80 newly diagnosed on methotrexate (MTX)-RA-A, and 53 on biologic therapy-RA-B) and whether it was related to a disease outcome. Reduction of disease activity and inflammation was obtained. A significant decline in seroprevalence and titer for anti-VCA-IgM (p = 0.022 and p = 0.026) and anti-EA(D)-IgM (p = 0.022 and p = 0.006) in RA-A, and in seroprevalence and titer of anti-EA(D)-IgG in the RA-B subgroup (p = 0.021 and p = 0.006) were detected after the follow-up. A lower titer of anti-EBNA1-IgG could be considered a significant marker of RA remission in all RA patients regardless of age and gender (OR = 0.99, 95% CI OR = 0.98-0.99, p = 0.038), and also in RA-B patients separately (OR = 0.988, 95% CI OR = 0.98-0.99, p = 0.041). This study supported the basic hypothesis that the immune response to EBV infection is involved in the RA pathogenesis, at the beginning of the disease or during the RA evolution. Moreover, the potential influence of MTX or TNF-alpha inhibitors on the impairment of the host to control EBV infection was indirectly refuted.
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Affiliation(s)
- Ana Banko
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.L.); (D.M.)
| | - Andja Cirkovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Ivica Jeremic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.J.); (R.M.)
- Institute of Rheumatology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Milica Basaric
- Institute of Rheumatology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Milka Grk
- Institute of Human Genetics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Rada Miskovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.J.); (R.M.)
- Clinic of Allergy and Immunology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ivana Lazarevic
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.L.); (D.M.)
| | - Danijela Miljanovic
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.L.); (D.M.)
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Opoka-Winiarska V, Grywalska E, Sobiesiak A, Roliński J. The Impact of Epstein-Barr Virus Infection on Juvenile Idiopathic Arthritis Activity and Patient's Response to Treatment. J Clin Med 2020; 9:jcm9113453. [PMID: 33121089 PMCID: PMC7692171 DOI: 10.3390/jcm9113453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 12/14/2022] Open
Abstract
This study aimed to investigate the relationship between Epstein-Barr virus (EBV) infection and the onset of juvenile idiopathic arthritis (JIA), disease activity, and response to treatment. The study included 44 children with JIA, 23 children with different types of arthritis, and 44 controls. We measured EBV infection markers, including the EBV DNA load and the concentration of antibodies to viral antigens, at disease onset, before treatment. Six months after JIA diagnosis and the initiation of treatment patients with anti-viral capsid antigen IgG had a higher disease activity and worse response to treatment than patients without previous infection. After six months of treatment, the probability of disease inactivity in children without a history of EBV infection was almost 6.5 times greater than in a child with a history of infection. Furthermore, the probability of a better response after six months of treatment in a child with a history of EBV infection was more than five times smaller than in a child without infection. A past EBV infection can have a negative effect on achieving disease remission and may be associated with a worse response to treatment. Our results do not indicate the need for routine assessment of EBV infection markers in patients with JIA.
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Affiliation(s)
- Violetta Opoka-Winiarska
- Department of Paediatric Pulmonology and Rheumatology, Medical University of Lublin, 20-093 Lublin, Poland;
- Correspondence: ; Tel.: +48-691-721-360
| | - Ewelina Grywalska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (E.G.); (J.R.)
| | - Aleksandra Sobiesiak
- Department of Paediatric Pulmonology and Rheumatology, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Jacek Roliński
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (E.G.); (J.R.)
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Qiu Q, Zheng X. Comparison of effects of methotrexate/calcium folinate and actinomycin D on trophoblastic tumors. ALL LIFE 2020. [DOI: 10.1080/26895293.2020.1830186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Qian Qiu
- Fujian Maternal and Child Health Hospital, Fuzhou, People’s Republic of China
| | - Xiangqing Zheng
- Fujian Maternal and Child Health Hospital, Fuzhou, People’s Republic of China
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Tokuhira M, Tamaru JI, Kizaki M. Clinical management for other iatrogenic immunodeficiency-associated lymphoproliferative disorders. J Clin Exp Hematop 2019; 59:72-92. [PMID: 31257348 PMCID: PMC6661962 DOI: 10.3960/jslrt.19007] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPD), a category of immunodeficiency-associated LPD according to the World Health Organization classification, is associated with immunosuppressive drugs (ISDs). Several factors, including autoimmune disease (AID) activity, Epstein-Barr virus (EBV) infection, ISD usage, and aging, influence the development of OIIA-LPD, resulting in complicated clinical courses and outcomes. Most OIIA-LPD develops in patients with rheumatoid arthritis using methotrexate (MTX-LPD). The management of MTX-LPD is based on the clinical course, i.e., with/without regression, with/without relapse/regrowth event (RRE), LPD subtype, and ISDs for AIDs after LPD development. There are three clinical courses after ISD withdrawal: regressive LPD without relapse/regrowth (R-G), regressive LPD with RRE (R/R-G), and persistent LPD (P-G). The majority of EBV+ diffuse large B-cell lymphomas are classified in R-G, whereas classic Hodgkin lymphoma is generally classified in R/R-G. Polymorphic LPD (P-LPD) in MTX-LPD develops with heterogeneous pathological features similar to monomorphic LPD. Chemotherapy for MTX-LPD is selected according to that for de novo LPD, although the strategy for aggressive P-LPD and non-specific LPD is not well established. The absolute lymphocyte count in the peripheral blood has been suggested as a candidate marker for MTX-LPD development and RRE. Several clinical issues, including correct diagnosis among overlapping clinicopathological features in MTX-LPD and clinical management of LPD by ISDs other than MTX, require further investigation.
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Balandraud N, Roudier J. Epstein-Barr virus and rheumatoid arthritis. Joint Bone Spine 2017; 85:165-170. [PMID: 28499895 DOI: 10.1016/j.jbspin.2017.04.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/20/2017] [Indexed: 12/12/2022]
Abstract
Rheumatoid arthritis (RA) is one of the most common autoimmune diseases, with a 0.5% worldwide prevalence. The cause of RA remains unknown, however both genetic and environmental factors may contribute to its development. Among these is the Epstein-Barr virus (EBV). Here, we discuss several aspects of the close relationship between EBV and RA. Patients with RA have impaired control of EBV infection. Indeed, they have high titres of antibodies against EBV antigens. Their peripheral blood T lymphocytes are less efficient at controlling the outgrowth of EBV-infected B cells. RA patients have more EBV-infected B cells than normal controls, leading to a 10-fold systemic EBV overload. Post-transplant lymphoproliferative disorder (PTLPD) is a polyclonal EBV-positive B lymphocyte proliferation, which can evolve into an EBV-positive B cell lymphoma. RA patients also have an increased risk of developing EBV-associated lymphoproliferative disorder (LPD). Hence the need to monitor EBV load when treating RA patients with immunosuppressors. EBV, a widespread virus, highly recognized by antibodies but never eliminated, is an ideal candidate to trigger chronic immune complex disease. Anti-EBV antibody responses should be considered as one of the chronic autoantibody responses linked to the development of RA, in the same way as anti-citrullinated protein antibodies.
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Affiliation(s)
- Nathalie Balandraud
- Rheumatology 1, IML, AP-HM, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France; Inserm UMRs 1097, Aix-Marseille University, 163, avenue de Luminy, 13288 Marseille, France.
| | - Jean Roudier
- Rheumatology 1, IML, AP-HM, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France; Inserm UMRs 1097, Aix-Marseille University, 163, avenue de Luminy, 13288 Marseille, France
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Balandraud N, Texier G, Massy E, Muis-Pistor O, Martin M, Auger I, Guzian MC, Guis S, Pham T, Roudier J. Long term treatment with abatacept or tocilizumab does not increase Epstein-Barr virus load in patients with rheumatoid arthritis - A three years retrospective study. PLoS One 2017; 12:e0171623. [PMID: 28199343 PMCID: PMC5310777 DOI: 10.1371/journal.pone.0171623] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/23/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Epstein-Barr Virus (EBV) is a widely disseminated lymphotropic herpes virus implicated in benign and malignant disorders. In transplant patients, immunosuppressive drugs (cyclosporine) diminish control of EBV replication, potentially leading to lymphoproliferative disorders (LPD). Rheumatoid arthritis (RA) patients have impaired control of EBV infection and have EBV load ten times higher than controls. As post transplant patients, patients with RA have increased risk of developing lymphomas. Immunosuppressive drugs used to treat RA (conventional disease modifying drugs cDMARDs or biologics bDMARDs) could enhance the risk of developing LPD in RA patients. We have previously shown that long term treatment with Methotrexate and/or TNF alpha antagonists does not increase EBV load in RA. Our objective was to monitor the Epstein-Barr Virus load in RA patients treated with Abatacept (CTLA4 Ig), a T cell coactivation inhibitor, and Tocilizumab, an anti IL6 receptor antibody. METHODS EBV load in the peripheral blood mononuclear cells (PBMCs) of 55 patients under Abatacept (in 34% associated with Methotrexate) and 35 patients under Tocilizumab (in 37% associated with Methotrexate) was monitored for durations ranging from 6 months to 3 years by real time PCR. The influences of treatment duration and disease activity score 28 (DAS28) index on EBV load were analyzed. RESULTS Abatacept did not significantly modify EBV load over time. Tocilizumab significantly diminished EBV load over time. No patient (of 90) developed EBV associated lymphoma. CONCLUSION Long term treatment with Abatacept or Tocilizumab does not increase EBV load in the PBMNCs of patients with RA.
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MESH Headings
- Abatacept/pharmacology
- Abatacept/therapeutic use
- Adult
- Aged
- Antibodies, Monoclonal, Humanized/pharmacology
- Antibodies, Monoclonal, Humanized/therapeutic use
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/pathology
- Arthritis, Rheumatoid/virology
- DNA, Viral/analysis
- Drug Administration Schedule
- Drug Therapy, Combination
- Female
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Herpesvirus 4, Human/physiology
- Humans
- Immunosuppressive Agents/pharmacology
- Immunosuppressive Agents/therapeutic use
- Male
- Methotrexate/therapeutic use
- Middle Aged
- Real-Time Polymerase Chain Reaction
- Retrospective Studies
- Viral Load/drug effects
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Affiliation(s)
- Nathalie Balandraud
- Rheumatology 1 or 2, IML, AP-HM, 270 Boulevard de Sainte Marguerite, Marseilles, France
- INSERM UMRs 1097, Aix-Marseille University, 163 Avenue de Luminy, Marseilles, France
- * E-mail:
| | - Gaetan Texier
- CESPA, Centre d'épidémiologie et de santé publique des armées, Marseilles, France
- Aix-Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseilles, France
| | - Emmanuel Massy
- Rheumatology 1 or 2, IML, AP-HM, 270 Boulevard de Sainte Marguerite, Marseilles, France
| | - Olivier Muis-Pistor
- Rheumatology 1 or 2, IML, AP-HM, 270 Boulevard de Sainte Marguerite, Marseilles, France
| | - Marielle Martin
- INSERM UMRs 1097, Aix-Marseille University, 163 Avenue de Luminy, Marseilles, France
| | - Isabelle Auger
- INSERM UMRs 1097, Aix-Marseille University, 163 Avenue de Luminy, Marseilles, France
| | - Marie-Caroline Guzian
- Rheumatology 1 or 2, IML, AP-HM, 270 Boulevard de Sainte Marguerite, Marseilles, France
| | - Sandrine Guis
- Rheumatology 1 or 2, IML, AP-HM, 270 Boulevard de Sainte Marguerite, Marseilles, France
| | - Thao Pham
- Rheumatology 1 or 2, IML, AP-HM, 270 Boulevard de Sainte Marguerite, Marseilles, France
| | - Jean Roudier
- Rheumatology 1 or 2, IML, AP-HM, 270 Boulevard de Sainte Marguerite, Marseilles, France
- INSERM UMRs 1097, Aix-Marseille University, 163 Avenue de Luminy, Marseilles, France
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