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Wang X, Yang G, Li J, Meng C, Xue Z. Dynamic molecular signatures of acute myocardial infarction based on transcriptomics and metabolomics. Sci Rep 2024; 14:10175. [PMID: 38702356 PMCID: PMC11068872 DOI: 10.1038/s41598-024-60945-3] [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: 11/20/2023] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
Acute myocardial infarction (AMI) commonly precedes ventricular remodeling, heart failure. Few dynamic molecular signatures have gained widespread acceptance in mainstream clinical testing despite the discovery of many potential candidates. These unmet needs with respect to biomarker and drug discovery of AMI necessitate a prioritization. We enrolled patients with AMI aged between 30 and 70. RNA-seq analysis was performed on the peripheral blood mononuclear cells collected from the patients at three time points: 1 day, 7 days, and 3 months after AMI. PLC/LC-MS analysis was conducted on the peripheral blood plasma collected from these patients at the same three time points. Differential genes and metabolites between groups were screened by bio-informatics methods to understand the dynamic changes of AMI in different periods. We obtained 15 transcriptional and 95 metabolite expression profiles at three time points after AMI through high-throughput sequencing. AMI-1d: enrichment analysis revealed the biological features of 1 day after AMI primarily included acute inflammatory response, elevated glycerophospholipid metabolism, and decreased protein synthesis capacity. Phosphatidylcholine (PC) and phosphatidylethanolamine (PE) might stand promising biomarkers to differentiate post-AMI stage. Anti-inflammatory therapy during the acute phase is an important direction for preventing related pathology. AMI-7d: the biological features of this stage primarily involved the initiation of cardiac fibrosis response and activation of platelet adhesion pathways. Accompanied by upregulated TGF-beta signaling pathway and ECM receptor interaction, GP5 help assess platelet activation, a potential therapeutic target to improve haemostasis. AMI-3m: the biological features of 3 months after AMI primarily showed a vascular regeneration response with VEGF signaling pathway, NOS3 and SHC2 widely activated, which holds promise for providing new therapeutic approaches for AMI. Our analysis highlights transcriptional and metabolomics signatures at different time points after MI, which deepens our understanding of the dynamic biological responses and associated molecular mechanisms that occur during cardiac repair.
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Affiliation(s)
- Xuejiao Wang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange, Xicheng District, Beijing, 100053, China
| | - Guang Yang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange, Xicheng District, Beijing, 100053, China
| | - Jun Li
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange, Xicheng District, Beijing, 100053, China.
| | - Chao Meng
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5 Beixiange, Xicheng District, Beijing, 100053, China
| | - Zengming Xue
- Department of Cardiology, Langfang People's Hospital, Hebei Medical University, No. 37, Xinhua Road, Langfang, 065000, China.
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Stamatis P, Mohammad MA, Gisslander K, Merkel PA, Englund M, Turesson C, Erlinge D, Mohammad AJ. Myocardial infarction in a population-based cohort of patients with biopsy-confirmed giant cell arteritis in southern Sweden. RMD Open 2024; 10:e003960. [PMID: 38599652 PMCID: PMC11015192 DOI: 10.1136/rmdopen-2023-003960] [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: 11/29/2023] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVES To determine the incidence rate (IR) of myocardial infarction (MI), relative risk of MI, and impact of incident MI on mortality in individuals with biopsy-confirmed giant cell arteritis (GCA). METHODS MIs in individuals diagnosed with GCA 1998-2016 in Skåne, Sweden were identified by searching the SWEDEHEART register, a record of all patients receiving care for MI in a coronary care unit (CCU). The regional diagnosis database, with subsequent case review, identified GCA patients receiving care for MI outside of a CCU. A cohort of 10 reference subjects for each GCA case, matched for age, sex and area of residence, was used to calculate the incidence rate ratio (IRR) of MI in GCA to that in the general population. RESULTS The GCA cohort comprised 1134 individuals. During 7958 person-years of follow-up, 102 were diagnosed with incident MI, yielding an IR of 12.8 per 1000 person-years (95% CI 10.3 to 15.3). The IR was highest in the 30 days following GCA diagnosis and declined thereafter. The IRR of MI in GCA to that of the background population was 1.29 (95% CI 1.05 to 1.59). Mortality was higher in GCA patients who experienced incident MI than in those without MI (HR 2.8; 95% CI 2.2 to 3.6). CONCLUSIONS The highest incidence of MI occurs within the 30 days following diagnosis of GCA. Individuals with GCA have a moderately increased risk of MI compared with a reference population. Incident MI has a major impact on mortality in GCA.
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Affiliation(s)
- Pavlos Stamatis
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
- Department of Rheumatology, Sunderby Hospital, Luleå, Sweden
| | | | - Karl Gisslander
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, and Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Carl Turesson
- Department of Clinical Sciences Malmö, Rheumatology, Lund Universtiy, Malmö, Sweden
| | - David Erlinge
- Department of Clinical Sciences Lund, Cardiology, Lund University, Lund, Sweden
| | - Aladdin J Mohammad
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
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Fernández-Lozano D, Hernández-Rodríguez I, Narvaez J, Domínguez-Álvaro M, De Miguel E, Silva-Díaz M, Belzunegui JM, Moriano Morales C, Sánchez J, Galíndez-Agirregoikoa E, Aldaroso V, Abasolo L, Loricera J, Garrido-Puñal N, Moya Alvarado P, Larena C, Navarro VA, Calvet J, Casafont-Solé I, Ortiz-Sanjuán F, Salman Monte TC, Castañeda S, Blanco R. Incidence and clinical manifestations of giant cell arteritis in Spain: results of the ARTESER register. RMD Open 2024; 10:e003824. [PMID: 38531620 DOI: 10.1136/rmdopen-2023-003824] [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: 11/11/2023] [Accepted: 03/01/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE This study aimed to estimate the incidence of giant cell arteritis (GCA) in Spain and to analyse its clinical manifestations, and distribution by age group, sex, geographical area and season. METHODS We included all patients diagnosed with GCA between 1 June 2013 and 29 March 2019 at 26 hospitals of the National Health System. They had to be aged ≥50 years and have at least one positive results in an objective diagnostic test (biopsy or imaging techniques), meet 3/5 of the 1990 American College of Rheumatology classification criteria or have a clinical diagnosis based on the expert opinion of the physician in charge. We calculated incidence rate using Poisson regression and assessed the influence of age, sex, geographical area and season. RESULTS We identified 1675 cases of GCA with a mean age at diagnosis of 76.9±8.3 years. The annual incidence was estimated at 7.42 (95% CI 6.57 to 8.27) cases of GCA per 100 000 people ≥50 years with a peak for patients aged 80-84 years (23.06 (95% CI 20.89 to 25.4)). The incidence was greater in women (10.06 (95% CI 8.7 to 11.5)) than in men (4.83 (95% CI 3.8 to 5.9)). No significant differences were found between geographical distribution and incidence throughout the year (p=0.125). The phenotypes at diagnosis were cranial in 1091 patients, extracranial in 337 patients and mixed in 170 patients. CONCLUSIONS This is the first study to estimate the incidence of GCA in Spain at a national level. We found a predominance among women and during the ninth decade of life with no clear variability according to geographical area or seasons of the year.
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Affiliation(s)
| | | | - Javier Narvaez
- Rheumatology, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | | | | | - Maite Silva-Díaz
- Rheumatology, Complexo Hospitalario Universitario A Coruna, A Coruna, Spain
| | | | | | - Julio Sánchez
- Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Lydia Abasolo
- Rheumatology, Hospital Clinico Universitario San Carlos, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Loricera
- Rheumatology, Hospital Universitario Marques de Valdecilla, Santander, Spain
- Immunopathology Group-IDIVAL, Santander, Spain
| | | | | | - Carmen Larena
- Rheumatology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Joan Calvet
- Rheumatology, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
- Universitat Autònoma de Barcelona, Sabadell, Spain
| | | | | | | | - Santos Castañeda
- Rheumatology, Hospital Universitario de la Princesa. IIS-Princesa, Madrid, Spain
| | - Ricardo Blanco
- Rheumatology, Hospital Universitario Marques de Valdecilla, Santander, Spain
- Immunopathology Group-IDIVAL, Santander, Spain
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Wladis EJ, Ata A, Li C, Peng X, Waxman MJ, Pauze DR, Lum F. The impact of month and season on the incidence of giant cell arteritis: an Intelligent Research in Sight (IRIS) Registry analysis. Graefes Arch Clin Exp Ophthalmol 2024; 262:609-614. [PMID: 37819458 DOI: 10.1007/s00417-023-06268-x] [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: 06/07/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE Previous investigations into the relationship between season and the incidence of giant cell arteritis (GCA) have produced conflicting results. This study aimed to explore the impact of season and new diagnoses of GCA in a more definitive sense by employing the large dataset of the Intelligent Research in Sight (IRIS) database. METHODS The IRIS Registry was queried to identify new cases of GCA from 2013 to 2021. Statistical analyses were performed to determine the significance of the relationship between the time of year and the incidence of GCA on regional and nationwide bases via Cochran's Q statistical test. RESULTS A total of 27,339 eyes with a new diagnosis of GCA were identified. Neither the month nor the season of the year correlated with the incidence of GCA, regardless of geographic location within the USA (p > 0.05 for each variable). CONCLUSIONS In the USA, the incidence of GCA does not appear to vary by month or season. While this finding contradicts certain previous studies that identified a relationship, the cohort of patients identified from the IRIS Registry is much larger than that of previous investigations. Clinicians should be mindful of the possibility of GCA, regardless of the time of the year.
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Affiliation(s)
- Edward J Wladis
- Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Albany, NY, USA.
- Department of Otolaryngology, Albany Medical College, Albany, NY, USA.
| | - Ashar Ata
- Department of Emergency Medicine, Albany Medical College, Albany, NY, USA
| | - Charles Li
- American Academy of Ophthalmology, San Francisco, CA, USA
| | - Xuan Peng
- American Academy of Ophthalmology, San Francisco, CA, USA
| | - Michael J Waxman
- Department of Emergency Medicine, Albany Medical College, Albany, NY, USA
| | - Denis R Pauze
- Department of Emergency Medicine, Albany Medical College, Albany, NY, USA
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, CA, USA
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Skaug HK, Fevang BT, Assmus J, Diamantopoulos AP, Myklebust G, Brekke LK. Giant cell arteritis: incidence and phenotypic distribution in Western Norway 2013-2020. Front Med (Lausanne) 2023; 10:1296393. [PMID: 38148911 PMCID: PMC10749960 DOI: 10.3389/fmed.2023.1296393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/27/2023] [Indexed: 12/28/2023] Open
Abstract
Objectives There is an increasing awareness of the spectrum of phenotypes in giant cell arteritis (GCA). However, there is sparse evidence concerning the phenotypic distribution which may be influenced by both genetic background and the environment. We established a cohort of all GCA-patients in the Bergen Health Area (Western Norway), to describe the phenotypic distribution and whether phenotypes differ with regards to incidence and clinical features. Methods This is a retrospective cohort study including all GCA-patients in the Bergen Health Area from 2013-2020. Data were collected by reviewing patient records, and patients considered clinically likely GCA were included if they fulfilled at least one set of classification criteria. Temporal artery biopsy (TAB) and imaging results were used to classify the patients according to phenotype. The phenotype "cranial GCA" was used for patients with a positive TAB or halo sign on temporal artery ultrasound. "Non-cranial GCA" was used for patients with positive findings on FDG-PET/CT, MRI-, or CT angiography, or wall thickening indicative of vasculitis on ultrasound of axillary arteries. Patients with features of both these phenotypes were labeled "mixed." Patients that could not be classified due to negative or absent examination results were labeled "unclassifiable". Results 257 patients were included. The overall incidence of GCA was 20.7 per 100,000 persons aged 50 years or older. Overall, the cranial phenotype was dominant, although more than half of the patients under 60 years of age had the non-cranial phenotype. The diagnostic delay was twice as long for patients of non-cranial and mixed phenotype compared to those of cranial phenotype. Headache was the most common clinical feature (78% of patients). Characteristic clinic features occurred less frequently in patients of non-cranial phenotype compared to cranial phenotype. Conclusion The overall incidence for GCA was comparable to earlier reports from this region. The cranial phenotype dominated although the non-cranial phenotype was more common in patients under 60 years of age. The diagnostic delay was longer in patients with the non-cranial versus cranial phenotype, indicating a need for examination of non-cranial arteries when suspecting GCA.
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Affiliation(s)
- H. K. Skaug
- Haugesund Hospital for Rheumatic Diseases, Haugesund, Norway
- Department of Clinical Science (K2), Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Rheumatology, Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Haukeland University Hospital, Bergen, Norway
| | - B. T. Fevang
- Department of Clinical Science (K2), Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Rheumatology, Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Haukeland University Hospital, Bergen, Norway
| | - J. Assmus
- Center for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - A. P. Diamantopoulos
- Division of Internal Medicine, Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
| | - G. Myklebust
- Research Department, Hospital of Southern Norway, Kristiansand, Norway
| | - L. K. Brekke
- Haugesund Hospital for Rheumatic Diseases, Haugesund, Norway
- Department of Rheumatology, Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease (BEaBIRD), Haukeland University Hospital, Bergen, Norway
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Pacoureau L, Barde F, Seror R, Nguyen Y. Association between infection and the onset of giant cell arteritis and polymyalgia rheumatica: a systematic review and meta-analysis. RMD Open 2023; 9:e003493. [PMID: 37949615 PMCID: PMC10649904 DOI: 10.1136/rmdopen-2023-003493] [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: 07/13/2023] [Accepted: 09/18/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE We aimed to analyse the association between infections and the subsequent risk of giant cell arteritis (GCA) and/or polymyalgia rheumatica (PMR) by a systematic review and a meta-analysis of observational studies. METHODS Two databases (Medline and Embase) were systematically reviewed. Epidemiological studies studying the association between any prior infection and the onset of GCA/PMR were eligible. Risk of bias was assessed using the Newcastle-Ottawa quality assessment scale. Outcomes and pooled statistics were reported as OR and their 95% CI. RESULTS Eleven studies (10 case-control studies and one cohort study) were analysed, seven of them were included in the meta-analysis. Eight were at low risk of bias. A positive and significant association was found between prior overall infections and prior Herpes Zoster (HZ) infections with pooled OR (95% CI) of 1.27 (1.18 to 1.37) and 1.20 (1.08 to 1.21), respectively. When analysed separately, hospital-treated and community-treated infections, were still significantly associated with the risk of GCA, but only when infections occurring within the year prior to diagnosis were considered (pooled OR (95% CI) 1.92 (1.67 to 2.21); 1.67 (1.54 to 1.82), respectively). This association was no longer found when infections occurring within the year prior to diagnosis were excluded. CONCLUSION Our study showed a positive association between the risk of GCA and prior overall infections (occurring in the year before), and prior HZ infections. Infections might be the reflect of an altered immunity of GCA patients or trigger the disease. However, reverse causation cannot be excluded.CRD42023404089.
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Affiliation(s)
- Lucas Pacoureau
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
| | - François Barde
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
| | - Raphaele Seror
- Auto-immunity team, IMVA, INSERM U1184, Le Kremlin Bicêtre, France
- Department of Rheumatology, Hôpital Bicêtre, AP-HP.Sud, Université Paris Saclay, Le Kremlin-Bicetre, France
| | - Yann Nguyen
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France
- Department of Rheumatology, Hôpital Bicêtre, AP-HP.Sud, Université Paris Saclay, Le Kremlin-Bicetre, France
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Gisslander K, de Boer R, Ingvar C, Turesson C, Isaksson K, Jayne D, Mohammad AJ. Can active sun exposure decrease the risk of giant cell arteritis and polymyalgia rheumatica in women? Rheumatol Adv Pract 2023; 7:rkad071. [PMID: 37675201 PMCID: PMC10477307 DOI: 10.1093/rap/rkad071] [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: 05/04/2023] [Accepted: 07/28/2023] [Indexed: 09/08/2023] Open
Abstract
Objectives To study if active sun exposure among women affects the risk of developing GCA or PMR in a prospective cohort study with restricted latitudinal variability. Methods We linked the response to questions relating to sun exposure from the Melanoma Inquiry in Southern Sweden (MISS) prospective cohort study in women to the risk of developing GCA or PMR. Healthcare data were gathered from the Skåne Healthcare Register (SHR), covering all public healthcare consultations. The direct effect of active sun exposure on the risk of developing GCA or PMR was assessed using Cox proportional hazards models adjusted for covariates based on a directed acyclic graph. Results A total of 14 574 women were included in the study; 601 women were diagnosed with GCA or PMR (144 and 457, respectively) during the follow-up time. Women with moderate or high sun exposure were not less likely to develop GCA or PMR compared with women that indicated they avoided sun exposure [hazard ratio (HR) 1.2 (CI 0.9, 1.6) and 1.3 (0.9, 1.9), respectively] when adjusted for diabetes, hyperlipidaemia, hypertension, smoking, obesity and stratified by age. Similar patterns were observed when studying only GCA [HR 1.2 (CI 0.7, 2.3) and 1.3 (0.7, 2.6)] and only PMR [HR 1.3 (CI 0.9, 1.8) and 1.4 (0.9, 2.0)]. Conclusion Active sun exposure did not affect the risk of developing GCA or PMR in women in a cohort with restricted latitudinal variability.
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Affiliation(s)
- Karl Gisslander
- Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Raïssa de Boer
- Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Christian Ingvar
- Surgery, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Karolin Isaksson
- Surgery, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Surgery, Kristianstad Hospital, Kristianstad, Sweden
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Aladdin J Mohammad
- Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
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Mulhearn B, Ellis J, Skeoch S, Pauling J, Tansley S. Incidence of giant cell arteritis is associated with COVID-19 prevalence: A population-level retrospective study. Heliyon 2023; 9:e17899. [PMID: 37483752 PMCID: PMC10359857 DOI: 10.1016/j.heliyon.2023.e17899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023] Open
Abstract
Background Following the first wave of the COVID-19 pandemic, it was observed that giant cell arteritis (GCA) diagnoses increased at the Royal National Hospital for Rheumatic Diseases (RNHRD) in Bath, UK. This finding may support the viral aetiology hypothesis of GCA. Better understanding of the causes of GCA may help improve diagnostic and treatment strategies leading to better outcomes for patients. Objectives The study aims to estimate the local incidence of GCA during the early COVID-19 pandemic (2020-2021) and compare it to pre-pandemic (2015-2019) data. This study will also evaluate the temporal relationship between COVID-19 infections and GCA diagnoses. Methods Annual incidence rates of GCA were calculated between 2015 and 2021. Local COVID-19 prevalence was estimated by measuring the number of hospital beds taken up by COVID-19 positive patients. Poisson statistics were used to compare the annual mean incidence of GCA between 2019 and 2020, and Granger causality tested the temporal relationship between COVID-19 prevalence and GCA incidence. Results There were 60 (95% confidence interval [CI] 46-77) GCA diagnoses made in 2020 compared to 28 (CI 19-41) in 2019 (P = 0.016). Peaks in the number of COVID-19 inpatients correlated with peaks in GCA diagnoses. Granger causality testing found a statistically significant association between these peaks with a lag period of 40-45 days. Conclusion The incidence of GCA in Bath was significantly increased in 2020 and 2021 compared to 2015-2019. The lag period between peaks was 40-45 days, suggesting that the COVID-19 virus may be a precipitating factor for GCA. More work is currently underway to interrogate the causal relationship between these two diseases.
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Affiliation(s)
- Ben Mulhearn
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Trust, Combe Park, Bath, BA1 3NG, UK
- Department of Life Sciences, The University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Jessica Ellis
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Trust, Combe Park, Bath, BA1 3NG, UK
- Department of Life Sciences, The University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Sarah Skeoch
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Trust, Combe Park, Bath, BA1 3NG, UK
- Department of Life Sciences, The University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - John Pauling
- Department of Life Sciences, The University of Bath, Claverton Down, Bath, BA2 7AY, UK
- North Bristol Hospital NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Sarah Tansley
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Trust, Combe Park, Bath, BA1 3NG, UK
- Department of Life Sciences, The University of Bath, Claverton Down, Bath, BA2 7AY, UK
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Atlas IS, Colley SM, Chia MA. Utility of biomarkers and temporal artery biopsy length for investigating giant cell arteritis in Western Australia. Int J Rheum Dis 2023; 26:286-291. [PMID: 36401819 PMCID: PMC10098702 DOI: 10.1111/1756-185x.14488] [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: 07/07/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 11/21/2022]
Abstract
AIM To explore demographic characteristics, biopsy length, and blood biomarker performance in an Australian cohort of patients who have undergone temporal artery biopsy (TAB) for giant cell arteritis (GCA). METHODS We extracted data on biopsies performed for GCA between January 2016 and December 2020 at public hospitals in Perth. Sensitivity, specificity, and area under the curve (AUC) were calculated for blood results. We evaluated the proportion of biopsies with post-fixation length less than 15 mm and explored several length associations. RESULTS We retrospectively reviewed biopsies of 360 patients (65.8% female, mean age 72.1 years). Biopsy-positive patients were older (6.0 years, P < 0.01), and had higher C-reactive protein (CRP) (44.5 mg/L, P < 0.01), erythrocyte sedimentation rate (ESR) (18.9 mm/h, P < 0.01), and platelets (86.8 × 103 /μL, P < 0.01) compared with biopsy-negative patients. CRP and platelets had the highest AUCs at 0.76 and 0.71, respectively. Sensitivities for CRP and ESR were 96.2% and 91.5%, respectively. Specificities were comparatively low at 41.3% for CRP and 37.4% for ESR. The proportion of biopsies with sub-optimal length was 55.9% and this varied significantly by site (P < 0.01). Smaller sites performed worse, with a sub-optimal biopsy rate of 87% amongst the three smallest sites. CONCLUSION ESR and CRP are helpful preliminary investigations, especially in identifying low-risk patients, but their specificity is limited. Smaller centers had a higher proportion of biopsies with sub-optimal length. Considering the importance of biopsy length for TAB diagnostic value, reviewing biopsy data may assist services in developing improvement strategies.
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Affiliation(s)
| | | | - Mark A Chia
- Fremantle Hospital, Perth, Australia.,Institute of Ophthalmology, University College London, London, UK
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Yang X, Li J, Hu X, Zhang Y, Kuang Y, Liu Y, Liu C, Gao H, Ma L, Tang J, Ma Q. Identification of PFKFB2 as a key gene for the transition from acute to old myocardial infarction in peripheral blood. Front Cardiovasc Med 2022; 9:993579. [PMID: 36561770 PMCID: PMC9763698 DOI: 10.3389/fcvm.2022.993579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Objective This study aims to analyze the gene expression profile of peripheral blood in different stages of myocardial infarction (MI) by transcriptome sequencing, and to study the gene expression characteristics of peripheral blood after MI. Methods Differentially expressed genes (DEGs) and weighted gene co-expression network analysis (WGCNA) were used to identify genes and modules associated with old myocardial infarction (OMI). Gene Ontology (GO) functional annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway annotation were applied to analyze the potential functions of genes. Hub genes were identified by Random Forest Classifier. CIBERSORT was used to provide an estimate of the abundance of 22 immune cells in peripheral blood. Quantitative polymerase chain reaction (qPCR) was used to detect gene expression levels in clinical samples. The cellular components (CC) of peripheral blood were counted by an automatic hematology analyzer. Results Through differential gene analysis and co-expression network analysis, 11 candidate genes were obtained. A random forest classifier identified 10 hub genes. Immune cell distribution of peripheral blood was found that T cell CD4 memory resting, NK cells resting, Dendritic cells activated, Mast cells resting, Monocytes and Neutrophils were correlated with OMI. Spearman correlation analysis found that PFKFB2 is related to the above immune cells. Low expression of PFKFB2 in peripheral blood of OMI was detected in clinical samples, and the relationship between PFKFB2 and peripheral blood immune cell counts was analyzed, which showed monocytes were associated with PFKFB2 in our study. Conclusion PFKFB2 was low expressed in OMI, and related to the distribution of immune cells. PFKFB2 may play a key role in reflecting the transition from AMI to OMI, and predicting the distribution of immune cells, which provided a new perspective for improving myocardial fibrosis and adverse remodeling.
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Affiliation(s)
- Xiangyu Yang
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Li
- Department of Reproductive Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinyao Hu
- Department of Reproductive Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinzhuang Zhang
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yuanyuan Kuang
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yubo Liu
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Chenxi Liu
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Haodong Gao
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Li Ma
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jia Tang
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Qilin Ma
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Qilin Ma,
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11
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Stamatis P, Turesson C, Michailidou D, Mohammad AJ. Pathogenesis of giant cell arteritis with focus on cellular populations. Front Med (Lausanne) 2022; 9:1058600. [PMID: 36465919 PMCID: PMC9714577 DOI: 10.3389/fmed.2022.1058600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/31/2022] [Indexed: 08/27/2023] Open
Abstract
Giant cell arteritis (GCA), the most common non-infectious vasculitis, mainly affects elderly individuals. The disease usually affects the aorta and its main supra-aortic branches causing both general symptoms of inflammation and specific ischemic symptoms because of the limited blood flow due to arterial structural changes in the inflamed arteries. The pathogenesis of the GCA is complex and includes a dysregulated immune response that affects both the innate and the adaptive immunity. During the last two decades several studies have investigated interactions among antigen-presenting cells and lymphocytes, which contribute to the formation of the inflammatory infiltrate in the affected arteries. Toll-like receptor signaling and interactions through the VEGF-Notch-Jagged1 pathway are emerging as crucial events of the aberrant inflammatory response, facilitating among others the migration of inflammatory cells to the inflamed arteries and their interactions with the local stromal milieu. The increased use of checkpoint inhibitors in cancer immunotherapy and their immune-related adverse events has fed interest in the role of checkpoint dysfunction in GCA, and recent studies suggest a dysregulated check point system which is unable to suppress the inflammation in the previously immune-privileged arteries, leading to vasculitis. The role of B-cells is currently reevaluated because of new reports of considerable numbers of plasma cells in inflamed arteries as well as the formation of artery tertiary lymphoid organs. There is emerging evidence on previously less studied cell populations, such as the neutrophils, CD8+ T-cells, T regulatory cells and tissue residing memory cells as well as for stromal cells which were previously considered as innocent bystanders. The aim of this review is to summarize the evidence in the literature regarding the cell populations involved in the pathogenesis of GCA and especially in the context of an aged, immune system.
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Affiliation(s)
- Pavlos Stamatis
- Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Rheumatology, Sunderby Hospital, Luleå, Sweden
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Despina Michailidou
- Division of Rheumatology, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Aladdin J. Mohammad
- Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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12
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Gonzalez Chiappe S, Lechtman S, Maldini CS, Mekinian A, Papo T, Sené T, Mahr AD. Incidence of giant cell arteritis in six districts of Paris, France (2015-2017). Rheumatol Int 2022; 42:1721-1728. [PMID: 35819504 DOI: 10.1007/s00296-022-05167-4] [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: 02/10/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022]
Abstract
This prospective population-based study estimated the incidence of giant cell arteritis (GCA) in northeastern Paris. GCA cases diagnosed between 2015 and 2017 were obtained from local hospital and community-based physicians and the national health insurance system database. Criteria for inclusion were living in the study area at that time and fulfilling the 1990 American College of Rheumatology classification criteria and/or its expanded version. Cranial and large-vessel GCA cases were defined by the presence or absence of cranial signs and/or symptoms, respectively. Annual incidence was calculated by dividing the number of incident cases by the size of the study population ≥ 50 years old. Completeness of case ascertainment was assessed by a three-source capture-recapture analysis. Among the 62 included cases, 42 (68%) were women, mean (± SD) age 77.3 ± 9.1 years. The annual incidence of GCA in northeastern Paris and completeness of case ascertainment were estimated at 7.6 (95% CI 5.9-9.8) per 100,000 inhabitants ≥ 50 years old and 66% (95% CI 52-92%), respectively. Incidence increased with age, peaked at age 80-89 years, and was almost twice as high in women versus men. Large-vessel GCA cases, mean (± SD) age 68.6 ± 11.5 years, accounted for 8% of all GCA cases. In this study, GCA epidemiology was mainly driven by cases with cranial GCA signs or symptoms and incidence results were consistent with recent European and past French studies.
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Affiliation(s)
- Solange Gonzalez Chiappe
- Internal Medicine, AP-HP, Saint-Louis Hospital, Paris Diderot University, Paris, France. .,Rheumatology Department, Saint Gallen Kantonsspital, Saint Gallen, Switzerland.
| | - Sarah Lechtman
- Internal Medicine, AP-HP, Lariboisière Hospital, Paris Diderot University, Paris, France
| | - Carla Soledad Maldini
- Internal Medicine, AP-HP, Saint-Louis Hospital, Paris Diderot University, Paris, France
| | - Arsène Mekinian
- Internal Medicine and Inflammation-Immunopathology-Biotherapy Department (DMU i3), AP-HP, Saint Antoine Hospital, Sorbonne Université, Paris, France.,French-Armenian Clinical Research Center, National Institute of Health, 0051, Yerevan, Armenia
| | - Thomas Papo
- Internal Medicine, AP-HP, Bichat Hospital, Paris Diderot University, Paris, France
| | - Thomas Sené
- Internal Medicine, Croix Saint-Simon Hospital, University Paris 6, Paris, France
| | - Alfred Daniel Mahr
- Internal Medicine, AP-HP, Saint-Louis Hospital, Paris Diderot University, Paris, France.,ECSTRA Team, Epidemiology and Biostatistics, Sorbonne Paris Cité Research Center, UMR 1153 Inserm, Paris, France.,Rheumatology Department, Saint Gallen Kantonsspital, Saint Gallen, Switzerland
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13
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Skoog J, Svensson C, Eriksson P, Sjöwall C, Zachrisson H. The Diagnostic Performance of an Extended Ultrasound Protocol in Patients With Clinically Suspected Giant Cell Arteritis. Front Med (Lausanne) 2022; 8:807996. [PMID: 35118098 PMCID: PMC8804250 DOI: 10.3389/fmed.2021.807996] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo evaluate the diagnostic performance of an extended ultrasound protocol in patients referred under the suspicion of giant cell arteritis (GCA).MethodsConsecutive patients with suspected GCA were examined with an extended color duplex ultrasound (CDU) protocol during a period of 2 years. The extended CDU protocol included temporal, axillary, subclavian, brachiocephalic, and carotid arteries. The reference was clinically diagnosed GCA, confirmed after ≥6-month follow-up. Hypo- or medium-echogenic, circumferential, homogenous wall thickening, and/or a positive compression sign in temporal arteries, were regarded as typical signs of arteritis.ResultsOf the eligible 201 patients, 83 (41%) received a clinical GCA diagnosis at follow-up ≥6 months post CDU examination. Among these cases, 48 (58%) demonstrated inflammation solely in temporal arteries, 8 (10%) showed abnormalities restricted to extra-cranial vessels, and 23 (28%) patients displayed inflammatory changes in both temporal and extra-cranial arteries. Color duplex ultrasound of temporal arteries yielded a diagnostic sensitivity and specificity [95% confidence intervals (CI)] of 86% (76–92%) and 99% (95–99%), respectively. By adding axillary artery examination, the sensitivity increased to 92% (83–97%) while the specificity remained unchanged. Further, inclusion of subclavian artery marginally increased the sensitivity by 1%. Finally, by also including brachiocephalic and common carotid arteries resulted in a sensitivity of 95% (88–99%) and a specificity of 98% (94–99%).ConclusionsColor duplex ultrasound examination demonstrated a high accuracy in diagnosing patients both with cranial and extra-cranial GCA. Further examination of brachiocephalic and common carotid arteries can increase the sensitivity without affecting the specificity when temporal and axillary findings are indecisive. Finally, the extended CDU protocol allows measurement of the general burden of inflammation, which could be relevant for future monitoring purposes.
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Affiliation(s)
- Johan Skoog
- Department of Clinical Physiology and Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- *Correspondence: Johan Skoog
| | - Christina Svensson
- Department of Clinical Physiology and Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Per Eriksson
- Division of Inflammation and Infection/Rheumatology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Christopher Sjöwall
- Division of Inflammation and Infection/Rheumatology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Helene Zachrisson
- Department of Clinical Physiology and Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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14
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Temporal Artery Vascular Diseases. J Clin Med 2022; 11:jcm11010275. [PMID: 35012016 PMCID: PMC8745856 DOI: 10.3390/jcm11010275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 02/06/2023] Open
Abstract
In the presence of temporal arteritis, clinicians often refer to the diagnosis of giant cell arteritis (GCA). However, differential diagnoses should also be evoked because other types of vascular diseases, vasculitis or not, may affect the temporal artery. Among vasculitis, Anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis is probably the most common, and typically affects the peri-adventitial small vessel of the temporal artery and sometimes mimics giant cell arteritis, however, other symptoms are frequently associated and more specific of ANCA-associated vasculitis prompt a search for ANCA. The Immunoglobulin G4-related disease (IgG4-RD) can cause temporal arteritis as well. Some infections can also affect the temporal artery, primarily an infection caused by the varicella-zoster virus (VZV), which has an arterial tropism that may play a role in triggering giant cell arteritis. Drugs, mainly checkpoint inhibitors that are used to treat cancer, can also trigger giant cell arteritis. Furthermore, the temporal artery can be affected by diseases other than vasculitis such as atherosclerosis, calcyphilaxis, aneurysm, or arteriovenous fistula. In this review, these different diseases affecting the temporal artery are described.
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Abstract
The many forms of vasculitis are characterized by inflammation of blood vessels, leading to potentially long-term sequelae including vision loss, aneurysm formation and kidney failure. Accurate estimation of the incidence and prevalence has been hampered by the absence of reliable diagnostic criteria and the rarity of these conditions; however, much progress has been made over the past two decades, although data are still lacking from many parts of the world including the Indian subcontinent, China, Africa and South America. Giant cell arteritis occurs in those aged 50 years and over and seems to mainly affect persons of northern European ancestry, whereas Takayasu arteritis occurs mainly in those aged under 40 years. By contrast, Kawasaki disease mainly occurs in children aged under 5 years and is most common in children of Asian ancestry, and IgA vasculitis occurs in children and adolescents. Although much less common than giant cell arteritis, the different forms of antineutrophil cytoplasmic antibody-associated vasculitis are being increasingly recognized in most populations and occur more frequently with increasing age. Behçet syndrome occurs most commonly along the ancient silk road between Europe and China. Much work needs to be done to better understand the influence of ethnicity, geographical location, environment and social factors on the development of vasculitis.
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16
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Yang V, McMaster C, Owen CE, Leung JL, Schachna L, Buchanan RRC, Liew DFL. Comment on: Epidemiology of biopsy-confirmed giant cell arteritis in southern Sweden-an update on incidence and first prevalence estimate. Rheumatology (Oxford) 2021; 60:e421-e422. [PMID: 34264311 DOI: 10.1093/rheumatology/keab558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Victor Yang
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia
| | - Christopher McMaster
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Claire E Owen
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Jessica L Leung
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Lionel Schachna
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Russell R C Buchanan
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - David F L Liew
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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