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Wielosz E, Wiąk-Walerowicz K, Łyś E, Lipska A, Dryglewska M, Majdan M. Late-age onset systemic sclerosis-clinical and serological characteristics. Clin Rheumatol 2024; 43:2565-2572. [PMID: 38904748 PMCID: PMC11269490 DOI: 10.1007/s10067-024-07025-z] [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: 03/11/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
The clinical course and serological profile of the late-age onset systemic sclerosis (LAO SSc) and the early-age onset SSc (EAO SSc) was compared. The study enrolled 157 patients that fulfilled the American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) classification criteria for systemic sclerosis (SSc). Among them, 69 had diffuse cutaneous SSc (dcSSc) and 88 limited cutaneous SSc (lcSSc). Within this population, 39 patients developed the disease over the age of 60 years old (LAO SSc) and 118 prior to that age (EAO SSc). The subtype of SSc, the incidence of internal organ involvement, the prevalence of malignancy, mortality, and serological profile were compared between both groups. The LAO SSc was observed in 39 of total 157 patients with SSc and exhibited a notably higher prevalence of pulmonary arterial hypertension (p = 0.014), heart involvement (p = 0.0014), and renal involvement (p = 0.0002). The occurrence of arthralgias was less common in the LAO SSc group (p = 0.02) than in the EAO SSc group. Furthermore, in the LAO SSc group, the prevalence of anti -RNA polymerase III antibodies (p = 0.008) and antiPM/Scl antibodies (p = 0.048) were significantly lower than in the EAO SSc group. On the other hand, higher anti-Th/To antibody levels (p = 0.014) were recorded in the LAO SSc group. Approximately 25% of SSc patients experienced a delayed onset of the disease after the age of 60 years old. Some clinical and serological features of late-onset SSc were markedly different from that in early-onset disease. Particularly noteworthy is the fact that involvement of internal organs such as heart and kidneys, as well as pulmonary arterial hypertension were much more often observed among patients with LAO SSc which in our suggestion may be referred to age-related co-morbidities. Key Points • Significant differences in clinical and serological profile of the disease were found between late-age onset (LAO) and early-age onset (EAO) SSc. • Incidence of dcSSc as well as prevalence of anti-RNA polymerase III and anti-PM/Scl antibodies were found to be lower in patients over 60 years old compared to those before 60, but regardless of the age of the disease onset. • Internal organ morbidity, notably pulmonary arterial hypertension, renal impairment and heart disease were significantly more common in elder SSc patients as well as in those with late disease onset. • These findings may suggest an impact of age-related co-morbidities on the course of late-age onset SSc.
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Affiliation(s)
- Ewa Wielosz
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Jaczewskiego 8 St., 20-090, Lublin, Poland.
| | - Katarzyna Wiąk-Walerowicz
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Jaczewskiego 8 St., 20-090, Lublin, Poland
| | - Ewa Łyś
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Jaczewskiego 8 St., 20-090, Lublin, Poland
| | - Aleksandra Lipska
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Jaczewskiego 8 St., 20-090, Lublin, Poland
| | - Magdalena Dryglewska
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Jaczewskiego 8 St., 20-090, Lublin, Poland
| | - Maria Majdan
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Jaczewskiego 8 St., 20-090, Lublin, Poland
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Rosa I, Romano E, Fioretto BS, Manetti M. Autoantibodies as putative biomarkers and triggers of cell dysfunctions in systemic sclerosis. Curr Opin Rheumatol 2024:00002281-990000000-00128. [PMID: 39046085 DOI: 10.1097/bor.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
PURPOSE OF REVIEW Antinuclear autoantibodies represent a serological hallmark of systemic sclerosis (SSc), with anticentromere, antitopoisomerase-I, and anti-RNA polymerase III antibodies routinely assessed for diagnosis, clinical subset classification, and prognosis. In addition, an increasing number of autoantibodies have been demonstrated to play a pathogenic role by mediating different SSc manifestations. This review aims to give an overview on autoantibodies as putative biomarkers in SSc and discuss their possible pathogenic role as triggers of cell dysfunctions. RECENT FINDINGS Over the years, different autoantibodies have been proposed as biomarkers aiding in diagnosis, disease subtype classification, disease progression prediction, organ involvement, as well as in understanding treatment response. Increasing literature also indicates functional autoantibodies as direct contributors to SSc pathogenesis by exerting agonistic or antagonistic activities on their specific cognate targets. SUMMARY In SSc, search and validation of novel autoantibodies with higher diagnostic specificity and more accurate predictive values are increasingly needed for early diagnosis and specific follow-up, and to define the best therapeutic option according to different disease subsets. Moreover, since autoantibodies are also emerging as functional pathogenic players, a better unraveling of their possible pathomechanisms becomes essential to identify new targets and develop promising therapeutic agents able to neutralize their effects.
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Affiliation(s)
- Irene Rosa
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Dima A, Vonk MC, Garaiman A, Kersten BE, Becvar R, Tomcik M, Hoffmann-Vold AM, Castellvi I, Jaime JT, Brzosko M, Milchert M, Krasowska D, Michalska-Jakubus M, Airo P, Matucci-Cerinic M, Bruni C, Iudici M, Distler J, Gheorghiu AM, Poormoghim H, Motta F, De Santis M, Parvu M, Distler O, Mihai C. Clinical significance of the anti-Nucleolar Organizer Region 90 antibodies (NOR90) in systemic sclerosis: Analysis of the European Scleroderma Trials and Research (EUSTAR) cohort and a systematic literature review. Eur J Intern Med 2024; 125:104-110. [PMID: 38599922 DOI: 10.1016/j.ejim.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/11/2024] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The anti-Nucleolar Organizer Region 90 antibodies (NOR90) are rare antinuclear antibodies (ANA) reported in systemic sclerosis (SSc). Especially due to low prevalence, the clinical relevance of NOR90 in SSc remains uncertain. OBJECTIVES To analyze the clinical associations of NOR90 in patients with SSc in a multicentric cohort. METHODS Post-hoc, cross-sectional study of prospectively collected data from the European Scleroderma Trials and Research (EUSTAR) database, with additional information on NOR90. Further, we performed a systematic literature search, using the terms "systemic sclerosis" and "NOR90" across three databases: Medline via PubMed, Scopus, and Thomson Reuters' Web of Science Core Collection, from inception to November 1st, 2023. RESULTS Overall, 1318 patients with SSc were included (mean age 58.3 ± 13.7 years, 81.3 % female), of whom 44 (3.3 %) were positive for NOR90. Of these, 32 were also positive for one of the SSc-criteria antibodies: 9/44 (20.5 %) for anti-topoisomerase I, 18/42 (42.9 %) for anti-centromere, and 5/40 (12.5 %) for anti-RNA polymerase III. NOR90-positive patients were more frequently female, had lower modified Rodnan skin score (mRSS), and lower prevalence of upper and lower gastrointestinal (GI) symptoms compared to NOR90-negative patients. In multivariable analysis, NOR90 remained significantly associated with lower mRSS and less frequent GI symptoms. The literature search identified 17 articles, including a total number of 87 NOR90-positive out of 3357 SSc patients, corresponding to an overall prevalence of 2.6 %. CONCLUSION To our best knowledge, this is the largest SSc cohort tested for NOR90 to date, confirming the NOR90 prevalence in SSc patients is around 3 %.
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Affiliation(s)
- A Dima
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland; Department of Rheumatology, Colentina Clinical Hospital, 19-21 Stefan cel Mare, 020125 Bucharest, Romania.
| | - M C Vonk
- Department of the Rheumatology, Radboud University Nijmegen Medical Centre Huispost 667, 6500HB Nijmegen, the Netherlands
| | - A Garaiman
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - B E Kersten
- Department of the Rheumatology, Radboud University Nijmegen Medical Centre Huispost 667, 6500HB Nijmegen, the Netherlands
| | - R Becvar
- Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Charles University - Na Slupi 4, 12800 Praha 2, Czechia
| | - M Tomcik
- Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Charles University - Na Slupi 4, 12800 Praha 2, Czechia
| | - A-M Hoffmann-Vold
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland; Department of Rheumatology, Rikshospitalet University Hospital - Sognsvannveien 20, 0027 Oslo, Norway
| | - I Castellvi
- Department of Rheumatology, Hospital Universitari de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167 Barcelona, Spain
| | - Jl Tandaipan Jaime
- Department of Rheumatology, Hospital Universitari de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167 Barcelona, Spain
| | - M Brzosko
- Department of Internal Medicine Rheumatology Diabetology Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland
| | - M Milchert
- Department of Internal Medicine Rheumatology Diabetology Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland
| | - D Krasowska
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Staszica 11L, 20-081 Lublin, Poland
| | - M Michalska-Jakubus
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Staszica 11L, 20-081 Lublin, Poland
| | - P Airo
- 9 Spedali Civili di Brescia, Scleroderma UNIT, UOC Reumatologia ed Immunologia Clinica, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - M Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence & Division of Rheumatology AOUC, Florence, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - C Bruni
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland; Department of Experimental and Clinical Medicine, University of Florence & Division of Rheumatology AOUC, Florence, Italy
| | - M Iudici
- Rheumatology Unit, Geneva University Hospitals, 1211 Geneva 14, Switzerland
| | - Jhw Distler
- Department of Rheumatology, University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - A M Gheorghiu
- Department of Internal Medicine and Rheumatology Clinic, Ion Cantacuzino Hospital - Ion Movila Street 5-7, 020475 Bucharest, Romania
| | - H Poormoghim
- Department of Rheumatology, Firoozgar Hospital - Beh Afarin street, Tehran, Iran
| | - F Motta
- Department of Biomedical Sciences, Humanitas University, via R Levi Montalcini, 20090, Pieve Emanuele, Italy; Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, via A Manzoni 56, 20089, Rozzano, Milan, Italy
| | - M De Santis
- Department of Biomedical Sciences, Humanitas University, via R Levi Montalcini, 20090, Pieve Emanuele, Italy; Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, via A Manzoni 56, 20089, Rozzano, Milan, Italy
| | - M Parvu
- Department of Rheumatology, Colentina Clinical Hospital, 19-21 Stefan cel Mare, 020125 Bucharest, Romania
| | - O Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - C Mihai
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
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Możdżan M, Węgiel A, Biskup L, Brzezińska O, Makowska J. Anti-Th/To Antibodies in Scleroderma: Good Prognosis or Serious Concern? J Clin Med 2024; 13:3022. [PMID: 38892733 PMCID: PMC11172938 DOI: 10.3390/jcm13113022] [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: 04/15/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Systemic sclerosis (SSc) represents a rare and intricate autoimmune connective tissue disease, the pathophysiology of which has not been fully understood. Its key features include progressive fibrosis of the skin and internal organs, vasculopathy and aberrant immune activation. While various anti-nuclear antibodies can serve as biomarkers for the classification and prognosis of SSc, their direct role in organ dysfunction remains unclear. Anti-Th/To antibodies are present in approximately 5% of SSc patients, and are particularly prevalent among those with the limited subtype of the disease. Although the presence of these autoantibodies is associated with a mild course of the disease, there is a strong connection between them and severe clinical manifestations of SSc, including interstitial lung disease, pulmonary arterial hypertension and gastrointestinal involvement. Also, the additional clinical correlations, particularly with malignancies, need further research. Moreover, the disease's course seems to be influenced by antibodies, specific serum cytokines and TLR signaling pathways. Understanding the relationships between presence of anti-Th/To, its molecular aspects and response to treatment options is crucial for the development of novel, personalized therapeutic techniques and should undergo profound analysis in future studies.
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Affiliation(s)
- Maria Możdżan
- Department of Rheumatology, Medical University of Lodz, 90-549 Lodz, Poland; (A.W.); (L.B.); (O.B.)
| | | | | | | | - Joanna Makowska
- Department of Rheumatology, Medical University of Lodz, 90-549 Lodz, Poland; (A.W.); (L.B.); (O.B.)
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Martel ME, Leurs A, Launay D, Behal H, Chepy A, Collet A, Sanges S, Hachulla E, Dubucquoi S, Dauchet L, Sobanski V. Prevalence of anti-Ro52-kDa/SSA (TRIM21) antibodies and associated clinical phenotype in systemic sclerosis: Data from a French cohort, a systematic review and meta-analysis. Autoimmun Rev 2024; 23:103536. [PMID: 38555075 DOI: 10.1016/j.autrev.2024.103536] [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: 01/04/2024] [Revised: 03/24/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES Estimate the global prevalence of anti-Ro52-kDa/SSA (TRIM21) autoantibodies in systemic sclerosis (SSc), and describe the associated clinical phenotype, through a systematic review and meta-analysis of published reports and new data from our French cohort. METHODS Anti-TRIM21 seropositivity and associated SSc characteristics were assessed in a cross-sectional study including 300 patients of Lille University Hospital. A systematic review of the literature was performed in Pubmed and Embase, followed by a meta-analysis, using data on prevalence, clinical/demographical/biological characteristics of SSc patients and the type of assay used for anti-TRIM21 antibodies detection (PROSPERO n° CRD42021223719). FINDINGS In the cross-sectional study, anti-TRIM21 antibodies prevalence was 26% [95%CI: 21; 31]. Anti-centromere antibodies were the most frequent SSc specific autoantibodies coexisting with anti-TRIM21. Patients with anti-TRIM21 antibodies were more frequently women (91% vs 77%, p = 0.006), more likely to present an associated Sjögren's syndrome (19% vs 7%, p < 0.001), had a higher rate of pulmonary arterial hypertension (PAH) (15% vs 6%, p = 0.017) and a greater frequency of digestive complications such as dysphagia (12% vs 5%, p = 0.038) or nausea/vomiting (10% vs 3%, p = 0.009) than anti-TRIM21 negative patients. Thirty-five articles corresponding to a total of 11,751 SSc patients were included in the meta-analysis. In this population, the overall seroprevalence of anti-TRIM21 antibodies was 23% [95%CI: 21; 27] with a high degree of heterogeneity (I2: 93% Phet: <0.0001), partly explained by the methods of detection. Anti-TRIM21 seropositivity was positively associated with female sex (OR: 1.60 [95%CI: 1.25, 2.06]), limited cutaneous subset (OR: 1.29 [1.04, 1.61]), joint manifestations (OR: 1.33 [1.05, 1.68]), pulmonary hypertension (PH) (OR: 1.82 [1.42, 2.33]), and interstitial lung disease (ILD) (OR: 1.31 [1.07, 1.60]). INTERPRETATION Anti-TRIM21 antibodies frequently co-exist with usual SSc antibodies, but are independently associated to a higher risk of cardio-pulmonary complications. The presence of these autoantibodies should therefore be considered when assessing the risk of developing PH and ILD, and deserves further studies on appropriate screening and follow-up of patients.
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Affiliation(s)
- Marie-Elise Martel
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Amélie Leurs
- CH Dunkerque, Département de Médecine interne et Maladies infectieuses, F-59240 Dunkerque, France
| | - David Launay
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Hélène Behal
- CHU Lille, SEED: Statistique, évaluation, économique, data-management - Maison Régionale de la Recherche Clinique, F-59000 Lille, France
| | - Aurélien Chepy
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Aurore Collet
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Sébastien Sanges
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Eric Hachulla
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Sylvain Dubucquoi
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Luc Dauchet
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F-59000 Lille, France
| | - Vincent Sobanski
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France; Institut Universitaire de France (IUF), Paris, France.
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Kim JS, Woods A, Gutierrez-Alamillo L, Laffoon M, Wigley FM, Hummers LK, Rosen A, Zeger S, Domsic RT, Casciola-Rosen L, Shah AA. Distinct Scleroderma Autoantibody Profiles Stratify Patients for Cancer Risk at Scleroderma Onset and During the Disease Course. Arthritis Rheumatol 2024; 76:68-77. [PMID: 37488962 PMCID: PMC10807373 DOI: 10.1002/art.42663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES We examined whether an array of scleroderma autoantibodies associates with risk of cancer and could be useful tools for risk stratification. METHODS Scleroderma cancer cases and scleroderma controls without cancer from the Johns Hopkins Scleroderma Center and the University of Pittsburgh Scleroderma Center were studied. Sera were assayed by Lineblot and enzyme-linked immunosorbent assay (ELISA) for autoantibodies against centromere, topoisomerase 1, RNA polymerase (POLR) 3, PM/Scl, Th/To, NOR90, U3 RNP, Ku, Ro52, U1RNP, and RNPC3. Logistic regression models were constructed to examine whether distinct autoantibodies associated with overall cancer at any time and cancer-associated scleroderma (cancer occurring three years before and after scleroderma onset). The effects of having more than one autoantibody on cancer were further examined using random forest analysis. RESULTS A total of 676 cases and 687 controls were studied. After adjusting for relevant covariates, anti-POLR3 (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.03-2.11) and monospecific anti-Ro52 (OR 2.19, 95% CI 1.29-3.74) were associated with an increased overall cancer risk, whereas anticentromere (OR 0.69, 95% CI 0.51-0.93) and anti-U1RNP (OR 0.63, 95% CI 0.43-0.93) were associated with lower risk. When examining risk of cancer-associated scleroderma, these immune responses remained associated with increased or decreased risk: anti-POLR3 (OR 2.28, 95% CI 1.33-3.91), monospecific anti-Ro52 (OR 2.58, 95% CI 1.05-6.30), anticentromere (OR 0.39, 95% CI 0.20-0.74), and anti-U1RNP (OR 0.32, 95% CI 0.11-0.93). Anti-Ro52 plus anti-U1RNP or anti-Th/To was associated with decreased cancer risk compared with anti-Ro52 alone. CONCLUSIONS These data suggest that five distinct scleroderma immune responses, alone or in combination, may be useful tools to stratify the risk of cancer for scleroderma patients. Further study examining cancer risk in autoantibody subgroups relative to the general population is warranted.
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Affiliation(s)
- Ji Soo Kim
- Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD USA
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD USA
| | - Adrianne Woods
- Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD USA
| | | | | | - Fredrick M. Wigley
- Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD USA
| | - Laura K. Hummers
- Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD USA
| | - Antony Rosen
- Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD USA
| | - Scott Zeger
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD USA
| | | | - Livia Casciola-Rosen
- Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD USA
| | - Ami A. Shah
- Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD USA
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Assassi S. Autoantibody and Cancer Connection in Systemic Sclerosis: Type and Overlap Matter. Arthritis Rheumatol 2024; 76:11-13. [PMID: 37551618 DOI: 10.1002/art.42669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023]
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Kosałka-Węgiel J, Lichołai S, Pacholczak-Madej R, Dziedzina S, Milewski M, Kuszmiersz P, Korona A, Gąsior J, Matyja-Bednarczyk A, Kwiatkowska H, Zaręba L, Siwiec-Koźlik A, Koźlik-Siwiec P, Wach A, Pociej-Marciak W, Sanak M, Musiał J, Bazan-Socha S, Korkosz M. Serum IL-17 and TNFα as prognostic biomarkers in systemic sclerosis patients: a prospective study. Rheumatol Int 2024; 44:119-128. [PMID: 38051374 PMCID: PMC10766799 DOI: 10.1007/s00296-023-05499-9] [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: 09/03/2023] [Accepted: 10/24/2023] [Indexed: 12/07/2023]
Abstract
Recent reports have demonstrated that endothelial injury is critical in the pathogenesis of systemic sclerosis (SSc) and is associated with increased levels of circulating inflammatory biomarkers. This study aims to analyze the serum concentrations of selected cytokines and evaluate their relationship with SSc clinics and the long-term course of the disease. This study included 43 SSc patients and 24 matched healthy controls. In both groups, we measured serum levels of inflammatory cytokines related to the inflammatory response, such as tumor necrosis factor (TNF)α, interferon (IFN)γ, interleukin (IL)-4, IL-6, IL-10, and IL-17, and fibroblast activation protein (FAP). Additionally, in SSc patients, we evaluated the presence of four single nucleotide polymorphisms (SNPs) located in the promotor region of the TNFA gene, namely rs361525, rs1800629, rs1799964, and rs1799724, which might be related to increased TNFα concentrations. The main aim consisted of associating inflammatory cytokines with (1) clinical disease characteristics and (2) longitudinal observation of survival and cancer prevalence. SSc patients were characterized by a 17% increase in serum TNFα. There was no other difference in serum cytokines between the studied groups and diffuse vs. limited SSc patients. As expected, evaluated serum cytokines correlated with inflammatory biomarkers (e.g., IL-6 and C-reactive protein). Interestingly, patients with higher IL-17 had decreased left ventricle ejection fraction. During the median 5-year follow-up, we recorded four cases of neoplastic diseases (lung cancer in two cases, squamous cell carcinoma of unknown origin, and breast cancer with concomitant multiple myeloma) and nine deaths. The causes of death included lung cancer (n = 2), renal crisis (n = 1), multiple-organ failure (n = 1), and unknown reasons in five cases. Surprisingly, higher TNFα was associated with an increased cancer prevalence, while elevated IL-17 with death risk in the follow-up. Furthermore, the AG rs361525 genotype referred to higher TNFα levels than GG carriers. Both AG rs361525 and CT rs1799964 genotypes were associated with increased cancer risk. Higher serum concentrations of TNFα characterize the SSc patients, with the highest values associated with cancer. On the other hand, increased IL-17 in peripheral blood might predict poor SSc prognosis. Further research is needed to validate these findings.
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Affiliation(s)
- Joanna Kosałka-Węgiel
- Rheumatology and Immunology Clinical Department, University Hospital, Krakow, Poland.
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland.
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland.
| | - Sabina Lichołai
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland
| | - Renata Pacholczak-Madej
- Department of Chemotherapy, The District Hospital, Sucha Beskidzka, Poland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Sylwia Dziedzina
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland
| | - Mamert Milewski
- Rheumatology and Immunology Clinical Department, University Hospital, Krakow, Poland
| | - Piotr Kuszmiersz
- Rheumatology and Immunology Clinical Department, University Hospital, Krakow, Poland
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland
| | - Anna Korona
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland
| | - Jolanta Gąsior
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland
| | - Aleksandra Matyja-Bednarczyk
- Rheumatology and Immunology Clinical Department, University Hospital, Krakow, Poland
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland
| | | | - Lech Zaręba
- Interdisciplinary Centre for Computational Modelling, College of Natural Sciences, University of Rzeszow, Rzeszow, Poland
| | - Andżelika Siwiec-Koźlik
- Rheumatology and Immunology Clinical Department, University Hospital, Krakow, Poland
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland
| | - Paweł Koźlik-Siwiec
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland
- Department of Haematology, University Hospital, Krakow, Poland
| | - Anita Wach
- Rheumatology and Immunology Clinical Department, University Hospital, Krakow, Poland
| | - Weronika Pociej-Marciak
- Division of Ophthalmology and Ocular Oncology, Department of Ophthalmology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
- Department of Ophthalmology and Ocular Oncology, University Hospital, Krakow, Poland
| | - Marek Sanak
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland
| | - Jacek Musiał
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland
| | - Stanisława Bazan-Socha
- Rheumatology and Immunology Clinical Department, University Hospital, Krakow, Poland
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland
| | - Mariusz Korkosz
- Rheumatology and Immunology Clinical Department, University Hospital, Krakow, Poland
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Jakubowskiego 2 Str., 30-688, Kraków, Poland
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9
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Muruganandam M, Ariza-Hutchinson A, Patel RA, Sibbitt WL. Biomarkers in the Pathogenesis, Diagnosis, and Treatment of Systemic Sclerosis. J Inflamm Res 2023; 16:4633-4660. [PMID: 37868834 PMCID: PMC10590076 DOI: 10.2147/jir.s379815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
Systemic sclerosis (SSc) is a complex autoimmune disease characterized by vascular damage, vasoinstability, and decreased perfusion with ischemia, inflammation, and exuberant fibrosis of the skin and internal organs. Biomarkers are analytic indicators of the biological and disease processes within an individual that can be accurately and reproducibly measured. The field of biomarkers in SSc is complex as recent studies have implicated at least 240 pathways and dysregulated proteins in SSc pathogenesis. Anti-nuclear antibodies (ANA) are classical biomarkers with well-described clinical classifications and are present in more than 90% of SSc patients and include anti-centromere, anti-Th/To, anti-RNA polymerase III, and anti-topoisomerase I antibodies. Transforming growth factor-β (TGF-β) is central to the fibrotic process of SSc and is intimately intertwined with other biomarkers. Tyrosine kinases, interferon-1 signaling, IL-6 signaling, endogenous thrombin, peroxisome proliferator-activated receptors (PPARs), lysophosphatidic acid receptors, and amino acid metabolites are new biomarkers with the potential for developing new therapeutic agents. Other biomarkers implicated in SSc-ILD include signal transducer and activator of transcription 4 (STAT4), CD226 (DNAX accessory molecule 1), interferon regulatory factor 5 (IRF5), interleukin-1 receptor-associated kinase-1 (IRAK1), connective tissue growth factor (CTGF), pyrin domain containing 1 (NLRP1), T-cell surface glycoprotein zeta chain (CD3ζ) or CD247, the NLR family, SP-D (surfactant protein), KL-6, leucine-rich α2-glycoprotein-1 (LRG1), CCL19, genetic factors including DRB1 alleles, the interleukins (IL-1, IL-4, IL-6, IL-8, IL-10 IL-13, IL-16, IL-17, IL-18, IL-22, IL-32, and IL-35), the chemokines CCL (2,3,5,13,20,21,23), CXC (8,9,10,11,16), CX3CL1 (fractalkine), and GDF15. Adiponectin (an indicator of PPAR activation) and maresin 1 are reduced in SSc patients. A new trend has been the use of biomarker panels with combined complex multifactor analysis, machine learning, and artificial intelligence to determine disease activity and response to therapy. The present review is an update of the various biomarker molecules, pathways, and receptors involved in the pathology of SSc.
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Affiliation(s)
- Maheswari Muruganandam
- Department of Internal Medicine, Division of Rheumatology and School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Angie Ariza-Hutchinson
- Department of Internal Medicine, Division of Rheumatology and School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Rosemina A Patel
- Department of Internal Medicine, Division of Rheumatology and School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Wilmer L Sibbitt
- Department of Internal Medicine, Division of Rheumatology and School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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10
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Lopez L, Barnetche T, Galli G, Seneschal J, Blanchard E, Shipley E, Pellegrin JL, Lazaro E, Constans J, Duffau P, Schaeverbeke T, Richez C, Kostine M, Truchetet ME. Clinical and immunological features of patients with cancer-associated systemic sclerosis: An observational study. Joint Bone Spine 2023; 90:105555. [PMID: 36842760 DOI: 10.1016/j.jbspin.2023.105555] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/14/2023] [Accepted: 02/15/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Clinical and immunological features of patients with cancer-associated systemic sclerosis: an observational study. OBJECTIVE Several studies have reported an increased incidence of cancer in patients with systemic sclerosis (SSc). The presence of RNA polymerase III antibodies (anti-RNA Pol 3) associates with an increased risk of cancer, but other risk factors need yet to be identified. We aimed to assess clinical and immunological predictive factors of cancer-associated SSc to guide clinicians when setting up selective cancer screening. METHODS We conducted a monocentric, retrospective, observational study of SSc patients with and without associated malignancy. Clinical, laboratory and imaging data were collected, as well as SSc treatment. Subgroup analyses were performed according to the type of cancer and the time of diagnosis. RESULTS Of 464 SSc patients, 74 (16%) had cancer, with breast (n=26) and lung cancer (n=13) being the most frequent. Diagnosis of cancer was made less than 3 years before or after SSc diagnosis for 23 patients (31%). In a multivariate analysis, anti-RNA Pol 3 and anti-SSA antibodies were significantly associated with an increased overall risk of cancer with an odds ratio (OR) of 4.12 (95% CI [1.6-10.7]; P<0.01) and 2.43 (95% CI [1.1-5.4]; P<0.05), respectively. Age at diagnosis of SSc and delay from the SSc diagnosis were also independent risk factors of cancer. Interstitial lung disease and anti-topoisomerase antibodies were associated with an increased risk of lung cancer and cancer occuring more than three years after SSc diagnosis. CONCLUSION In addition to anti-RNA Pol 3 antibodies, anti-SSA antibodies associated with an increased risk of cancer in SSc patients. Interstitial lung disease was a risk factor specifically for lung cancer and cancers diagnosed more than 3 years after SSc diagnosis. For these patients, a systematic and regular cancer screening should be considered.
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Affiliation(s)
- Léa Lopez
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases, Bordeaux University Hospital, Hôpital Pellegrin, place Amélie-Raba-Léon, Bordeaux, France
| | - Thomas Barnetche
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases, Bordeaux University Hospital, Hôpital Pellegrin, place Amélie-Raba-Léon, Bordeaux, France
| | - Gael Galli
- Department of Internal Medicine, National Reference Center for Systemic Autoimmune Rare Diseases, Bordeaux University Hospital, Hôpital Haut Lévêque, Pessac, France
| | - Julien Seneschal
- Department of Dermatology, Bordeaux University Hospital, Hôpital Saint-André, Bordeaux, France
| | - Elodie Blanchard
- Department of Pneumology, Bordeaux University Hospital, Hôpital Haut Leveque, Pessac, France
| | - Emilie Shipley
- Department of Rheumatology, Hôpital de Dax, boulevard Yves-du-Manoir, Dax, France
| | - Jean-Luc Pellegrin
- Department of Internal Medicine, National Reference Center for Systemic Autoimmune Rare Diseases, Bordeaux University Hospital, Hôpital Haut Lévêque, Pessac, France
| | - Estibaliz Lazaro
- Department of Internal Medicine, National Reference Center for Systemic Autoimmune Rare Diseases, Bordeaux University Hospital, Hôpital Haut Lévêque, Pessac, France
| | - Joel Constans
- Department of Vascular Medicine, Bordeaux University Hospital, Hôpital Saint-André, Bordeaux, France
| | - Pierre Duffau
- Department of Internal Medicine, Bordeaux University Hospital, Hôpital Saint-André, Bordeaux, France
| | - Thierry Schaeverbeke
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases, Bordeaux University Hospital, Hôpital Pellegrin, place Amélie-Raba-Léon, Bordeaux, France; CNRS, Immunoconcept, UMR 5164, Bordeaux University, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - Christophe Richez
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases, Bordeaux University Hospital, Hôpital Pellegrin, place Amélie-Raba-Léon, Bordeaux, France; CNRS, Immunoconcept, UMR 5164, Bordeaux University, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - Marie Kostine
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases, Bordeaux University Hospital, Hôpital Pellegrin, place Amélie-Raba-Léon, Bordeaux, France; CNRS, Immunoconcept, UMR 5164, Bordeaux University, 146, rue Léo-Saignat, 33076 Bordeaux, France
| | - Marie-Elise Truchetet
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Rare Diseases, Bordeaux University Hospital, Hôpital Pellegrin, place Amélie-Raba-Léon, Bordeaux, France; CNRS, Immunoconcept, UMR 5164, Bordeaux University, 146, rue Léo-Saignat, 33076 Bordeaux, France.
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11
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Calderon LM, Domsic RT, Shah AA, Pope JE. Preventative Care in Scleroderma: What Is the Best Approach to Bone Health and Cancer Screening? Rheum Dis Clin North Am 2023; 49:411-423. [PMID: 37028844 PMCID: PMC10845237 DOI: 10.1016/j.rdc.2023.01.011] [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] [Indexed: 04/09/2023]
Abstract
Systemic sclerosis (SSc) is a rare multisystem autoimmune disease characterized by fibrosis, vasculopathy, and autoimmunity. Lesser known complications inherent to SSc, such as malignancies and osteoporosis, can lead to decreased quality of life and increased morbidity and mortality. Patients with SSc have a greater risk of developing malignancies than the general population. In addition, they are more likely to be vitamin D deficient and are at great risk of osteoporosis-related fractures. However, these complications can be addressed through preventative measures. The purpose of this review is to provide clinicians with an approach to bone health and cancer screening in SSc.
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Affiliation(s)
- Leonardo Martin Calderon
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Robyn T Domsic
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ami A Shah
- Johns Hopkins Scleroderma Center, Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F. Lord Building Center Tower, Suite 4100, Baltimore, MD 21224, USA.
| | - Janet E Pope
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Division of Rheumatology, University of Western Ontario, St. Joseph's Health Care, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada.
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12
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Molecular Pathways of Breast Cancer in Systemic Sclerosis: Exploratory Immunohistochemical Analysis from the Sclero-Breast Study. J Pers Med 2022; 12:jpm12122007. [PMID: 36556228 PMCID: PMC9780893 DOI: 10.3390/jpm12122007] [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: 10/03/2022] [Revised: 11/13/2022] [Accepted: 11/25/2022] [Indexed: 12/11/2022] Open
Abstract
Several authors reported an increased risk of cancer in SSc patients, including breast cancer (BC). Nevertheless, the mechanisms underlying this association have not yet been clarified. SSc and BC share several molecular pathways, which seem to play a common etiopathogenetic role. The previously published Sclero-Breast study demonstrated the development of BC with a good prognosis among these patients, which could be explained by an autoimmune background as a possible mechanism for limiting tumor extension. Here, we report the results of an IHC analysis of molecular pathways known to be common drivers for both diseases, with the aim to better define the mechanisms underlying a good prognosis of BC in patients affected by SSc. The analysis demonstrated higher TILs rates in all BC subgroups, with a high rate of PD-L1 expression especially in TNBC and HER2-positive BC, suggesting a less aggressive behavior in these patients compared to the general population. These results support a possible de-escalation strategy of cancer therapies in these fragile patients. These data could represent a starting point for future prospective studies based on the clinical application of these biomarkers with a larger sample size to promote a personalized and targeted oncological treatment for this specific subset of patients.
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13
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Tang H, Geng R, Xu X, Wang Y, Zhou J, Zhang S, Zhao L, Guan M, Bai C. Safety and Efficacy of PD-1/PD-L1 Inhibitors in Cancer Patients With Preexisting Autoantibodies. Front Immunol 2022; 13:893179. [PMID: 35651612 PMCID: PMC9148956 DOI: 10.3389/fimmu.2022.893179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/15/2022] [Indexed: 12/12/2022] Open
Abstract
Background Programmed cell death protein-1/programmed cell death ligand-1 (PD-1/PD-L1) inhibitors therapy is now a routine scheme in cancers. However, the effect of preexisting autoantibodies on the safety and efficacy of PD-1/PD-L1 inhibitors in cancer patients is not well understood. Methods The present retrospective cohort study evaluated the safety and efficacy of PD-1/PD-L1 inhibitors in patients with preexisting autoantibodies. Patients who received PD-1/PD-L1 inhibitors in the Department of Medical Oncology, Peking Union Medical College Hospital between November 2017 and August 2021 were reviewed. Results 67 (37.9%) of the 177 patients, 27 (20.3%) of the 133 patients, and 16 (11.0%) of 146 patients who received PD-1/PD-L1 inhibitors were positive for ANA, anti-Ro52, and antithyroid antibodies, respectively. Preexisting ANA and anti-Ro52 antibody were not associated with the increased risk of immune-related adverse events (irAEs), while thyroid dysfunction was more frequent in patients with positive antithyroid antibody (75.0% versus 13.8%, p < 0.001). The median progression-free survival (PFS, 13.1 versus 7.0 months, p = 0.015) was significantly longer in the ANA-positive patients, while the median overall survival (OS, 14.5 versus 21.8 months, p = 0.67) did not differ significantly between the ANA-positive and ANA-negative groups. Moreover, the preexisting anti-Ro52 and antithyroid antibodies were not significantly associated with PFS and OS. Conclusions The presence of ANA and anti-Ro52 antibody were not associated with a higher risk of irAEs, whereas patients positive for antithyroid antibody should monitor closely immune-related thyroid dysfunction. Preexisting ANA might be a predictor of longer PFS, while anti-Ro52 and antithyroid antibodies had no significant effect on survival outcomes in patients receiving PD-1/PD-L1 inhibitors therapy.
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Affiliation(s)
- Hui Tang
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruixuan Geng
- Department of International Medical Services, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiuxiu Xu
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingyi Wang
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaxin Zhou
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Shulan Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science and Technology; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Lin Zhao
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Lin Zhao, ; Mei Guan,
| | - Mei Guan
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Lin Zhao, ; Mei Guan,
| | - Chunmei Bai
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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14
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Guilpain P, Mollevi C. Cancer-associated systemic sclerosis in a Canadian cohort: beyond strengths and weaknesses of epidemiological studies. Rheumatology (Oxford) 2022; 61:2717-2719. [PMID: 34986223 DOI: 10.1093/rheumatology/keab924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Philippe Guilpain
- Department of internal medicine and multi-organic diseases, local referral center for systemic and autoimmune diseases, St Eloi Hospital, 80 avenue Augustin Fliche, Montpellier, 34295, France.,University of Montpellier, Montpellier, France.,Inserm U1183, Institute for Regenerative Medicine and Biotherapy (IRMB), St Eloi Hospital, 80 avenue Augustin Fliche, Montpellier, 34295, France
| | - Caroline Mollevi
- Institute Desbrest of Epidemiology and Public Health,University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
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