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Fan W, Li Z, Wang Y, Zhang C, Liu H, Wang D, Bai Y, Luo S, Li Y, Qin Q, Chen W, Yong L, Zhen Q, Yu Y, Ge H, Mao Y, Cao L, Zhang R, Hu X, Yu Y, Li B, Sun L. Imputation of the major histocompatibility complex region identifies major independent variants associated with bullous pemphigoid and dermatomyositis in Han Chinese. J Dermatol 2022; 49:998-1004. [PMID: 35751838 DOI: 10.1111/1346-8138.16499] [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: 01/08/2022] [Revised: 04/29/2022] [Accepted: 06/05/2022] [Indexed: 11/27/2022]
Abstract
As autoimmune skin diseases, both bullous pemphigoid (BP) and dermatomyositis (DM) show significant associations with the major histocompatibility complex (MHC) region. In fact, the coexistence of BP and DM has been previously reported. Therefore, we hypothesized that there may be a potential genetic correlation between BP and DM. Based on data for 312 BP patients, 128 DM patients, and 6793 healthy control subjects, in the MHC region, we imputed single-nucleotide polymorphisms (SNP), insertions and deletions (INDEL), and copy number variations (CNV) using the 1KGP phase 3 dataset and amino acids (AA) and SNP using a Han-MHC reference database. An association study revealed the most significant SNP associated with BP, namely, rs580921 (p = 1.06E-08, odds ratio [OR] = 1.61, 95% confidence interval [CI] = 1.37-1.90), which is located in the C6orf10 gene, and the most significant classic human leukocyte antigen (HLA) allele associated with DM, namely, HLA-DPB1*1701 (p = 6.56E-10, OR = 3.61, 95% CI = 2.40-5.42). Further stepwise regression analyses with rs580921 identified a threonine at position 163 of the HLA-B gene as a new independent disease-associated AA, and HLA-DPB1*1701 indicated that no loci were significant. Three-dimensional ribbon models revealed that the HLA-B AA position 163 (p = 3.93E-07, OR = 1.64, 95% CI = 1.35-1.98) located in the α2 domain of the HLA-B molecule was involved in the process of specific antigen presentation. The calculations showed that there was no significant genetic correlation between BP and DM. Our study identified three significant loci in the MHC region, proving that the HLA region was significantly correlated with BP and DM separately. Our research highlights the key role of the MHC region in disease susceptibility.
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Affiliation(s)
- Wencheng Fan
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Zhuo Li
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Yirui Wang
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Chang Zhang
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Hao Liu
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Daiyue Wang
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Yuanming Bai
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Sihan Luo
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Yuanyuan Li
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Qin Qin
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Weiwei Chen
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Liang Yong
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Qi Zhen
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Yafen Yu
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Huiyao Ge
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Yiwen Mao
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Lu Cao
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Ruixue Zhang
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Xia Hu
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Yanxia Yu
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
| | - Bao Li
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,The Comprehensive Lab, College of Basic Medicine, Anhui Medical University, Hefei, China
| | - Liangdan Sun
- Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China.,Anhui Province Laboratory of Inflammation and Immune Mediated Diseases, Hefei, China.,Anhui Provincial Institute of Translational Medicine, Hefei, China
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2
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Clinical, Serological, and Genetic Characteristics of a Hungarian Myositis-Scleroderma Overlap Cohort. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6251232. [PMID: 35547355 PMCID: PMC9085307 DOI: 10.1155/2022/6251232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022]
Abstract
Overlap myositis is a distinct subgroup of idiopathic inflammatory myositis (IIM) with various clinical phenotypes. The aim of this study was to determine the clinical, serological, and genetic features of systemic sclerosis (SSc)-IIM overlap patients. It was a retrospective study using clinical database of 39 patients, fulfilling both the criteria of SSc and IIM. 56.4% of the patients had limited cutaneous, 43.6% had diffuse cutaneous SSc, whereas 7.7% of the patients had dermatomyositis and 92.3% polymyositis. The two diseases occurred simultaneously in 58.97%, while 10.26% in myositis and 30.77% in scleroderma were initially diagnosed. The frequencies of organ involvement were interstitial lung disease 71.8%, dysphagia 66.7%, cardiac involvement 41%, pulmonary arterial hypertension (PAH) 30.8%, and renal involvement 12.8%, respectively. The presence of human leukocyte antigen (HLA) − DRB1∗03 and DQA1∗051∗01 alleles were significantly higher in the overlap patients than in healthy controls (82.35% vs. 27.54%; p < 0.0001 and 88.24% vs. 30.16; p < 0.0001). Certain clinical parameters, such as fever at diagnosis (41.67% vs. 7.41%, p = 0.0046), cardiac involvement (83.33% vs. 22.22%, p = 0.0008), subcutaneous calcinosis (41.66 vs. 11.11, p = 0.01146), and claw hand deformity (25% vs. 11.11%, p = 0.00016) were significantly associated with the presence of PAH. Upon comparison, the overlap patients and anti-Jo-1 positive antisynthetase patients showed similarities in terms of genetic results and major clinical features; however, SSc-IIM overlap patients could be distinguished with higher erythrocyte sedimentation rate (ESR) level, more frequent presence of Raynaud's phenomenon (p < 0.0001; OR: 20.00), dysphagia (p < 0.0001; OR: 15.63), and infrequent livedo reticularis (p < 0.01; OR: 0.11). SSc-IIM overlap myositis is a unique group within IIM-s possessing characteristic clinical features.
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Botta C, Agostino RM, Dattola V, Cianci V, Calandruccio ND, Bianco G, Mafodda A, Maisano R, Iuliano E, Orizzonte G, Mazzacuva D, Falzea AC, Saladino RE, Giannicola R, Restifo G, Aguglia U, Caraglia M, Correale P. Myositis/Myasthenia after Pembrolizumab in a Bladder Cancer Patient with an Autoimmunity-Associated HLA: Immune-Biological Evaluation and Case Report. Int J Mol Sci 2021; 22:6246. [PMID: 34200673 PMCID: PMC8230397 DOI: 10.3390/ijms22126246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023] Open
Abstract
Pembrolizumab (mAb to PD-1) has been recently approved for the therapy of pretreated urothelial cancer. Despite the efficacy, it is often accompanied by unpredictable and sometime severe immune-related (ir) adverse events (AEs). Here, we report the clinical and immune-biological characterization of a patient with a metastatic bladder cancer who developed myositis signs (M) and a myasthenia-like syndrome (MLS) during treatment with pembrolizumab. The patient presented an autoimmunity-associated HLA haplotype (HLA-A*02/HLA-B*08/HLA-C*07/HLA-DRB1*03) and experienced an increase in activated CD8 T-cells along the treatment. The symptomatology regressed after pembrolizumab discontinuation and a pyridostigmine and steroids-based therapy. This is the first report of concurrent M and MLS appearance in cancer patients receiving pembrolizumab. More efforts are needed to define early the risk and the clinical meaning of irAEs in this setting.
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Affiliation(s)
- Cirino Botta
- Unit of Hematology, Azienda Ospedaliera “Annunziata”, 87100 Cosenza, Italy
- Hematology Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90128 Palermo, Italy
| | - Rita Maria Agostino
- Unit of Oncology, Unit. Grand Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy; (R.M.A.); (N.D.C.); (G.B.); (A.M.); (R.M.); (E.I.); (G.O.); (A.C.F.); (R.G.)
| | - Vincenzo Dattola
- Unit of Neurology, Unit. Grand Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy; (V.D.); (V.C.); (U.A.)
| | - Vittoria Cianci
- Unit of Neurology, Unit. Grand Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy; (V.D.); (V.C.); (U.A.)
| | - Natale Daniele Calandruccio
- Unit of Oncology, Unit. Grand Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy; (R.M.A.); (N.D.C.); (G.B.); (A.M.); (R.M.); (E.I.); (G.O.); (A.C.F.); (R.G.)
| | - Giovanna Bianco
- Unit of Oncology, Unit. Grand Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy; (R.M.A.); (N.D.C.); (G.B.); (A.M.); (R.M.); (E.I.); (G.O.); (A.C.F.); (R.G.)
| | - Antonino Mafodda
- Unit of Oncology, Unit. Grand Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy; (R.M.A.); (N.D.C.); (G.B.); (A.M.); (R.M.); (E.I.); (G.O.); (A.C.F.); (R.G.)
| | - Roberto Maisano
- Unit of Oncology, Unit. Grand Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy; (R.M.A.); (N.D.C.); (G.B.); (A.M.); (R.M.); (E.I.); (G.O.); (A.C.F.); (R.G.)
| | - Eleonora Iuliano
- Unit of Oncology, Unit. Grand Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy; (R.M.A.); (N.D.C.); (G.B.); (A.M.); (R.M.); (E.I.); (G.O.); (A.C.F.); (R.G.)
| | - Giovanna Orizzonte
- Unit of Oncology, Unit. Grand Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy; (R.M.A.); (N.D.C.); (G.B.); (A.M.); (R.M.); (E.I.); (G.O.); (A.C.F.); (R.G.)
| | - Domenico Mazzacuva
- Laboratory of Autoimmunity, Unit. Grand Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy;
| | - Antonia Consuelo Falzea
- Unit of Oncology, Unit. Grand Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy; (R.M.A.); (N.D.C.); (G.B.); (A.M.); (R.M.); (E.I.); (G.O.); (A.C.F.); (R.G.)
| | - Rita Emilena Saladino
- HLA Tissue Typing Laboratory, Unit. Grand Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy;
| | - Rocco Giannicola
- Unit of Oncology, Unit. Grand Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy; (R.M.A.); (N.D.C.); (G.B.); (A.M.); (R.M.); (E.I.); (G.O.); (A.C.F.); (R.G.)
| | - Giorgio Restifo
- Nuclear Medicine Unit, Grand Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy;
| | - Umberto Aguglia
- Unit of Neurology, Unit. Grand Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy; (V.D.); (V.C.); (U.A.)
| | - Michele Caraglia
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy;
- Laboratory of Precision and Molecular Oncology, Biogem Scarl, Institute of Genetic Research, 83031 Ariano Irpino, Italy
| | - Pierpaolo Correale
- Unit of Oncology, Unit. Grand Metropolitan Hospital “Bianchi Melacrino Morelli”, 89124 Reggio Calabria, Italy; (R.M.A.); (N.D.C.); (G.B.); (A.M.); (R.M.); (E.I.); (G.O.); (A.C.F.); (R.G.)
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Castillo RL, Femia AN. Polishing the crystal ball: mining multi-omics data in dermatomyositis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:435. [PMID: 33842656 PMCID: PMC8033302 DOI: 10.21037/atm-20-5319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Precision medicine, which recognizes and upholds the uniqueness of each individual patient and the importance of discerning these inter-individual differences on a molecular scale in order to provide truly personalized medical care, is a revolutionary approach that relies on the discovery of clinically-relevant biomarkers derived from the massive amounts of data generated by epigenomic, genomic, transcriptomic, proteomic, microbiomic, and metabolomic studies, collectively known as multi-omics. If harnessed and mined appropriately with the help of ever-evolving computational and analytic methods, the collective data from omics studies has the potential to accelerate delivery of targeted medical treatment that maximizes benefit, minimizes harm, and eliminates the “fortune-telling” inextricably linked to the prevailing trial-and-error approach. For a disease such as dermatomyositis (DM), which is characterized by remarkable phenotypic heterogeneity and varying degrees of multi-organ involvement, an individualized approach that incorporates big data derived from multi-omics studies with the results of currently available serologic, histopathologic, radiologic, and electrophysiologic tests, and, most importantly, with clinical findings obtained from a thorough history and physical examination, has immense diagnostic, therapeutic, and prognostic value. In this review, we discuss omics-based research studies in DM and describe their practical applications and promising roles in guiding clinical decisions and optimizing patient outcomes.
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Affiliation(s)
- Rochelle L Castillo
- Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, NY, USA
| | - Alisa N Femia
- Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, NY, USA
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Naveen R, Rathore U, Agarwal V, Gupta L. Characteristics and outcomes of overlap myositis: a comparative multigroup cohort study in adults from the MyoCite cohort. Rheumatol Int 2021; 41:551-563. [PMID: 33423071 DOI: 10.1007/s00296-020-04779-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
Overlap myositis (OM), an important subset of idiopathic inflammatory myopathies (IIM), is being increasingly recognized with wider myositis-specific autoantibody (MSA) testing. We studied the differences in clinical characteristics and long-term outcomes of OM with Dermatomyositis (DM), Polymyositis (PM), anti-synthetase syndrome (ASSD), and Cancer-associated IIM (CAM). Data from the MyoCite registry (Dec2017-May2020), a prospective dataset of IIM was extracted for the clinical profile, and MSAs, immunosuppressants received, disease activity (relapses and incomplete response), and treatment-related (drugs ADRs and infections) adverse events (DRAE and TRAE) were collected and analyzed between groups. Of 214 adults (58-OM,89-DM,27-ASSD,33-PM,7-CAM), OM had a greater female preponderance (13.5:1). Raynaud's and sclerodactyly were the prime distinguishing features of OM. OM could be distinguished from PM by frequent arthritis (OR-3.2) and infrequent dysphagia (OR-0.17); DM with greater nephritis (OR-20), infrequent dysphagia (OR-0.24) and rashes (OR-0.02); and ASSD by infrequent ILD (OR-0.07), and mechanic's hand (OR-0.05). 50% fulfilled the classification criteria for ASSD in the absence of MSA testing. ANA was positive more often (PM/DM: OR-6.7) and anti-Ro52 (OR-4.5) frequent in OM. Baseline serum creatinine and acute phase reactants were higher. OM received lower glucocorticoids (0 mg/kg, p < 0.001). Overall, 90% and 84% of OM at 12 and 24 months, respectively, achieved remission, with similar DRAE and TRAE as other IIM subsets. OM can be misdiagnosed as ASSD in the absence of MSA testing. Raynaud's, sclerodactyly, and a positive ANA may identify OM and prevent overtreatment.
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Affiliation(s)
- R Naveen
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Upendra Rathore
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014, India.
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6
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Buendía-Roldán I, Santiago-Ruiz L, Pérez-Rubio G, Mejía M, Rojas-Serrano J, Ambrocio-Ortiz E, Benítez-Valdez G, Selman M, Falfán-Valencia R. A major genetic determinant of autoimmune diseases is associated with the presence of autoantibodies in hypersensitivity pneumonitis. Eur Respir J 2020; 56:13993003.01380-2019. [PMID: 32366487 PMCID: PMC7424117 DOI: 10.1183/13993003.01380-2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 04/13/2020] [Indexed: 11/24/2022]
Abstract
Background Hypersensitivity pneumonitis is an immune-mediated disease triggered by exposure to organic particles in susceptible individuals. It has been reported that a subgroup of patients with hypersensitivity pneumonitis develops autoantibodies with or without clinical manifestations of autoimmune disease. However, the mechanisms involved in this process and the effect of the autoantibodies on clinical course in hypersensitivity pneumonitis is unknown. We evaluated the association between human leukocyte antigen (HLA) class II alleles and hypersensitivity pneumonitis patients with and without autoantibodies. Methods 170 hypersensitivity pneumonitis patients were included. We analysed the presence of antinuclear antibodies, rheumatoid factor, anti-SSA/Ro, anti-SSB/La and anti-CCP at the time of diagnosis. In addition, in a subset of patients we evaluated anti-Scl-70, anti-neutrophil cytoplasmic antibody, and anti-DNA. HLA typing was performed using PCR sequence-specific primers in a high-resolution modality, including HLA-DRB1 and HLA-DQB1 loci. Statistical analysis was performed employing Epi-Info v7 and SPSS v20. Results 60 hypersensitivity pneumonitis patients showed sera autoantibodies (HPAbs+), and 110 hypersensitivity pneumonitis patients did not (HPAbs−). The frequency of the allele HLA-DRB1*03:01 was remarkably increased in the HPAbs+ group (10.8% versus 0.45%; OR 30.14, 95% CI 3.83–237.1; p=1.65×10-4 after Bonferroni's correction). Likewise, we found that the haplotype DRB1*03:01-DQB1*02:01, which is part of the 8.1 ancestral haplotype, a major genetic determinant of autoimmune diseases, confers significant risk to develop autoantibodies (OR 19.23, 95% CI 2.37–155.9; p=0.0088 after Bonferroni's correction). In addition, the HLA-DRB1*03:01 allele was associated with higher mortality in patients with hypersensitivity pneumonitis (adjusted OR 5.9, 95% CI 1.05–33.05; p=0.043). Conclusions A subset of hypersensitivity pneumonitis patients presents circulating autoantibodies and higher mortality that are associated with some alleles of 8.1 ancestral haplotype. Alleles from 8.1 ancestral haplotype (#HLA-DRB1 and DQB1 loci) are associated with #autoantibodies production in #hypersensitivity #pneumonitis in a cohort of Mexican mestizo patientshttps://bit.ly/3bprPeB
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Affiliation(s)
- Ivette Buendía-Roldán
- Translational Research Laboratory on Aging and Pulmonary Fibrosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Luis Santiago-Ruiz
- Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Gloria Pérez-Rubio
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Mayra Mejía
- Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Jorge Rojas-Serrano
- Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Enrique Ambrocio-Ortiz
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Geovanni Benítez-Valdez
- Interstitial Lung Disease and Rheumatology Unit, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Moisés Selman
- Translational Research Laboratory on Aging and Pulmonary Fibrosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.,Joint lead authors
| | - Ramcés Falfán-Valencia
- HLA Laboratory, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico .,Joint lead authors
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7
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Chung MP, Richardson C, Kirakossian D, Orandi AB, Saketkoo LA, Rider LG, Schiffenbauer A, von Mühlen CA, Chung L. Calcinosis Biomarkers in Adult and Juvenile Dermatomyositis. Autoimmun Rev 2020; 19:102533. [PMID: 32234404 PMCID: PMC7225028 DOI: 10.1016/j.autrev.2020.102533] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/13/2019] [Indexed: 02/06/2023]
Abstract
Dermatomyositis (DM) is a rare idiopathic inflammatory myopathy characterized by muscle weakness and cutaneous manifestations in adults and children. Calcinosis, a complication of DM, is the abnormal deposition of insoluble calcium salts in tissues, including skin, subcutaneous tissue, tendons, fascia, and muscle. Calcinosis is more commonly seen in juvenile DM (JDM), but also develops in adult DM. Although the mechanism of calcinosis remains unclear, several pathogenic hypotheses have been proposed, including intracellular accumulation of calcium secondary to an alteration of the cellular membrane by trauma and inflammation, local vascular ischemia, dysregulation of mechanisms controlling the deposition and solubility of calcium and phosphate, and mitochondrial damage of muscle cells. Identifying calcinosis biomarkers is important for early disease detection and risk assessment, and may lead to novel therapeutic targets for the prevention and treatment of DM-associated calcinosis. In this review, we summarize myositis autoantibodies associated with calcinosis in DM, histopathology and chemical composition of calcinosis, genetic and inflammatory markers that have been studied in adult DM and JDM-associated calcinosis, as well as potential novel biomarkers.
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Affiliation(s)
- Melody P Chung
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Carrie Richardson
- Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - David Kirakossian
- Department of Internal Medicine, Kaiser Permanente Santa Clara, Santa Clara, CA, USA
| | - Amir B Orandi
- Division of Pediatric Rheumatology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lesley A Saketkoo
- Louisiana State University School of Medicine, Tulane University School of Medicine, New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Adam Schiffenbauer
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Carlos A von Mühlen
- Consultant in Rheumatology and Clinical Pathology, San Diego, USA; Brazilian Society of Autoimmunity, Porto Alegre, Brazil
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, CA, USA; VA Palo Alto Health Care System, Palo Alto, CA, USA.
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Abstract
The discovery of novel autoantigen systems related to idiopathic inflammatory myopathies (collectively referred to as myositis) in adults and children has had major implications for the diagnosis and management of this group of diseases across a wide range of medical specialties. Traditionally, autoantibodies found in patients with myositis are described as being myositis-specific autoantibodies (MSAs) or myositis-associated autoantibodies (MAAs), depending on their prevalence in other, related conditions. However, certain MSAs are more closely associated with extramuscular manifestations, such as skin and lung disease, than with myositis itself. It is very rare for more than one MSA to coexist in the same individual, underpinning the potential to use MSAs to precisely define genetic and disease endotypes. Each MSA is associated with a distinctive pattern of disease or phenotype, which has implications for diagnosis and a more personalized approach to therapy. Knowledge of the function and localization of the autoantigenic targets for MSAs has provided key insights into the potential immunopathogenic mechanisms of myositis. In particular, evidence suggests that the alteration of expression of a myositis-related autoantigen by certain environmental influences or oncogenesis could be a pivotal event linking autoantibody generation to the development of disease.
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9
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Furukawa H, Oka S, Kawasaki A, Hidaka M, Shimada K, Kondo Y, Ihata A, Matsushita T, Matsumoto T, Hashimoto A, Matsumoto I, Komiya A, Kobayashi K, Osada A, Katayama M, Okamoto A, Setoguchi K, Kono H, Hamaguchi Y, Matsui T, Fukui N, Tamura H, Takehara K, Nagaoka S, Sugii S, Sumida T, Tsuchiya N, Tohma S. Human leukocyte antigen in Japanese patients with idiopathic inflammatory myopathy. Mod Rheumatol 2019; 30:696-702. [PMID: 31242791 DOI: 10.1080/14397595.2019.1637593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: The human leukocyte antigen (HLA) is the strongest genetic risk factor for idiopathic inflammatory myopathy (IIM), and different HLA alleles have been reported to be associated with IIM susceptibility among different ethnic groups. In this study, we have investigated HLA alleles associated with IIM in Japanese patients.Methods: Genotyping of HLA-DRB1 and DPB1 were performed in 252 Japanese IIM patients (166 dermatomyositis [DM] and 86 polymyositis [PM] patients) and the association was analyzed with comparison to controls (n = 1026 for DRB1 and n = 413 for DPB1).Results: DRB1*08:03 was associated with IIM (p = 1.60 × 10-5, pc = .0005, odds ratio [OR] 2.11, 95% confidence interval [CI] 1.52-2.92) and DM (p = .0004, pc = .0128, OR 2.06, 95%CI 1.40-3.02). DPB1*05:01 was also associated with IIM (p = .0001, pc = .0021, OR 1.96, 95%CI 1.38-2.77) and DM (p = .0005, pc = .0075, OR 2.05, 95%CI 1.37-3.08). DRB1*09:01 (p = .0012, pc = .0368, OR 0.35, 95% CI 0.18-0.69) and DPB1*04:01(p = .0004, pc = .0057, OR 0.05, 95% CI 0.00-0.85) were protectively associated with PM. Two locus analyses suggested that DRB1*09:01 and DPB1*04:01 were independently associated with PM.Conclusion: Protective associations of HLA were detected in Japanese PM patients.
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Affiliation(s)
- Hiroshi Furukawa
- Molecular and Genetic Epidemiology Laboratory, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Shomi Oka
- Molecular and Genetic Epidemiology Laboratory, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Aya Kawasaki
- Molecular and Genetic Epidemiology Laboratory, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Misaki Hidaka
- Molecular and Genetic Epidemiology Laboratory, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kota Shimada
- Department of Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.,Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Yuya Kondo
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Atsushi Ihata
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, Yokohama, Japan.,Department of Rheumatology, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - Takashi Matsushita
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Takumi Matsumoto
- Department of Rheumatology, Kin-ikyo Chuo Hospital, Sapporo, Japan
| | - Atsushi Hashimoto
- Department of Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Isao Matsumoto
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akiko Komiya
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.,Department of Clinical Laboratory, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Kouji Kobayashi
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Atsumu Osada
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Masao Katayama
- Department of Internal Medicine, Nagoya Medical Center, National Hospital Organization, Nagoya, Japan
| | - Akira Okamoto
- Department of Rheumatology, Himeji Medical Center, National Hospital Organization, Himeji, Japan
| | - Keigo Setoguchi
- Department of Allergy and Immunological Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hajime Kono
- Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Yasuhito Hamaguchi
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Toshihiro Matsui
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.,Department of Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Naoshi Fukui
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Hiroaki Tamura
- Department of Rheumatology, Kin-ikyo Chuo Hospital, Sapporo, Japan
| | - Kazuhiko Takehara
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Shouhei Nagaoka
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Shoji Sugii
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naoyuki Tsuchiya
- Molecular and Genetic Epidemiology Laboratory, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shigeto Tohma
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.,National Hospital Organization Tokyo National Hospital, Kiyose, Japan
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10
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Gambino CM, Aiello A, Accardi G, Caruso C, Candore G. Autoimmune diseases and 8.1 ancestral haplotype: An update. HLA 2018; 92:137-143. [PMID: 29877054 DOI: 10.1111/tan.13305] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/08/2018] [Accepted: 06/01/2018] [Indexed: 12/11/2022]
Abstract
The aim of the present review is to provide an update of the current research into the pathogenesis of autoimmune diseases associated with 8.1 ancestral haplotype. This is a common Caucasoid haplotype carried by most people who type for HLA-B8, DR3. Numerous genetic studies reported that individuals with certain HLA alleles have a higher risk of specific autoimmune disorders than those without these alleles. However, much remains to be learned about the heritability of autoimmune conditions. Recently, progress and advances in the field of genome-wide-association studies have revolutionized the capacity to perform large, economically feasible, and statistically robust analyses of HLA within 8.1 ancestral haplotype, and understand its contribute to autoimmune events. In this paper, the characteristic features of this haplotype that might give rise to diverse autoimmune phenotypes are reviewed, focusing on the contribution of the HLA-DRB1 gene, the most polymorphic sequence within the HLA II region.
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Affiliation(s)
- C M Gambino
- Department of Pathobiology and Medical Biotechnologies (Di.Bi.Med.), University of Palermo, Palermo, Italy
| | - A Aiello
- Department of Pathobiology and Medical Biotechnologies (Di.Bi.Med.), University of Palermo, Palermo, Italy
| | - G Accardi
- Department of Pathobiology and Medical Biotechnologies (Di.Bi.Med.), University of Palermo, Palermo, Italy
| | - C Caruso
- Department of Pathobiology and Medical Biotechnologies (Di.Bi.Med.), University of Palermo, Palermo, Italy
| | - G Candore
- Department of Pathobiology and Medical Biotechnologies (Di.Bi.Med.), University of Palermo, Palermo, Italy
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11
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Zhang YM, Yang HB, Shi JL, Chen H, Shu XM, Lu X, Wang GC, Peng QL. The prevalence and clinical significance of anti-PUF60 antibodies in patients with idiopathic inflammatory myopathy. Clin Rheumatol 2018. [PMID: 29541951 DOI: 10.1007/s10067-018-4031-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Autoantibodies against poly-U-binding factor 60 kDa protein (PUF60) have been reported in Caucasian dermatomyositis (DM) patients. However, their clinical significance in idiopathic inflammatory myopathy (IIM) remains to be fully clarified. Our objective was to analyze the prevalence and clinical significance of anti-PUF60 antibodies in a large cohort of Chinese IIM patients. In our study, 388 IIM patients, 301 disease controls, and 167 healthy controls (HCs) were involved. An enzyme-linked immunosorbent assay (ELISA) was developed to detect serum anti-PUF60 levels and was validated using immunoblotting methods. Unpaired Mann-Whitney U test and Spearman correlation analysis were used when appropriate. Anti-PUF60 antibodies were observed in IIM patients at a frequency of 10.6% (41/388). Subgrouping analysis revealed that the prevalence of anti-PUF60 antibodies was 10% in DM, 5.5% in polymyositis (PM), 10% in immune-mediated necrotizing myositis (IMNM), and 26.5% in myositis-overlap syndrome. Anti-PUF60 antibodies were also observed in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and Sjögren's syndrome (SS) patients at a positive rate of 17.3, 14.5, and 10.1% respectively. Intriguingly, anti-PUF60 antibodies were frequently observed in clinically amyopathic dermatomyositis (CADM) patients and DM patients without currently known myositis autoantibodies. Furthermore, DM patients with anti-PUF60 antibodies had higher prevalence of skin ulcerations. Moreover, longitudinal investigation in eight DM patients with anti-PUF60 antibodies revealed that the antibodies levels decreased with disease remission. Anti-PUF60 antibodies were nonspecific for myositis, since they could be detected in other rheumatic diseases. Further investigation of anti-PUF60 antibodies may reveal shared pathogenic pathways in systemic autoimmune disorders.
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Affiliation(s)
- Ya-Mei Zhang
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China.,Graduate School of Peking Union Medical College, Beijing, 100730, China
| | - Han-Bo Yang
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China
| | - Jing-Li Shi
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China
| | - He Chen
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China
| | - Xiao-Ming Shu
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China
| | - Xin Lu
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China
| | - Guo-Chun Wang
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China.,Graduate School of Peking Union Medical College, Beijing, 100730, China
| | - Qing-Lin Peng
- Department of Rheumatology, Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Yinghua East Road, Chaoyang District, Beijing, 100029, China.
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12
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Gao S, Luo H, Zhang H, Zuo X, Wang L, Zhu H. Using multi-omics methods to understand dermatomyositis/polymyositis. Autoimmun Rev 2017; 16:1044-1048. [DOI: 10.1016/j.autrev.2017.07.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 07/08/2017] [Indexed: 12/12/2022]
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13
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14
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Comparing and contrasting clinical and serological features of juvenile and adult-onset myositis: implications for pathogenesis and outcomes. Curr Opin Rheumatol 2016; 27:601-7. [PMID: 26352731 DOI: 10.1097/bor.0000000000000224] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW To explore the different characteristics of the serological phenotypes identified in juvenile and adult myositis, consider how differences between the two groups might be explained and discuss how this enhances our understanding of disease pathogenesis. RECENT FINDINGS Current research has focussed on two main areas: first, defining the autoantibody associated disease phenotype in greater detail, particularly with regard to cutaneous disease and within specified populations such as juvenile-onset disease and different ethnic groups, and second, we have gained new insights into disease pathogenesis through studies analysing genetic associations and autoantigen expression. SUMMARY Although there are many clinically important differences between adult and juvenile-onset myositis, recent work has highlighted many of the similarities at least within autoantibody-defined subgroups. Viewing age at disease onset as a continuum with its own influence on disease phenotype strengthens the ability of autoantibodies to define homogenous disease groups, and may be important in understanding the relationship between autoantibodies and disease pathogenesis.
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15
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Zhang CE, Li Y, Wang ZX, Gao JP, Zhang XG, Zuo XB, Sheng YJ, Chen G, Sun LD, Zhang XJ, Xu JH, Yang S. Variation at HLA-DPB1 is associated with dermatomyositis in Chinese population. J Dermatol 2016; 43:1307-1313. [PMID: 27153935 DOI: 10.1111/1346-8138.13397] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/27/2016] [Indexed: 12/15/2022]
Abstract
Dermatomyositis (DM) is a polygenic disorder characterized by inflammation of skeletal muscle and skin. To date, the exact etiopathogenesis of DM remains elusive. To explore the genetic basis of DM, we conducted genome-wide genotyping analysis of 127 patients and 1566 healthy controls by Illumina Human OmniZhongHua-8 BeadChips in the Chinese Han population. We investigated whether the three SNP (rs7750458, rs9501251 and rs9500928) at 6p21.32 in the HLA-DPB1 gene were significantly associated with DM (P < 5 × 10-8 ) and identified two susceptibility loci at 7q34 (PIP, rs9986765, P = 7.45 × 10-7 , odds ratio [OR] = 2.71) and 10q24.2 (CPN1, rs3750716, P = 9.04 × 10-7 , OR = 4.39) with suggestive evidence. We imputed 6674 classical human leukocyte antigen (HLA) alleles, amino acids and SNP from the discovery dataset, and stepwise analysis revealed that HLA-DPB1*17 in class II HLA genes were significantly associated with DM susceptibility. This study represents the first genome-wide association study (GWAS) of DM in the Chinese Han population. For the first time, HLA-DPB1 was found to be associated with DM in this population. Moreover, we identified two novel suggestive susceptibility loci (PIP and CPN1) and confirmed four previously reported genes (DMB, DQA1, DQB1 and DRB1) having potential associations with DM in the Chinese Han population. Our GWAS results in this population should provide important information regarding the genetic etiopathogenesis of DM and facilitate the development of new therapies for the treatment of DM and the prevention of DM progression.
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Affiliation(s)
- Chang-E Zhang
- Institute of Dermatology, Department of Dermatology and Venerology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Department of Dermatology, Zhengzhou Children's Hospital, Henan, China.,Collaborative Innovation Center of Complex and Severe Skin Disease, Anhui Medical University, Hefei, China.,State Key Lab Incubation of Dermatology, Ministry of Science and Technology, Hefei, China
| | - Yang Li
- Institute of Dermatology, Department of Dermatology and Venerology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Collaborative Innovation Center of Complex and Severe Skin Disease, Anhui Medical University, Hefei, China.,State Key Lab Incubation of Dermatology, Ministry of Science and Technology, Hefei, China
| | - Zai-Xing Wang
- Institute of Dermatology, Department of Dermatology and Venerology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Collaborative Innovation Center of Complex and Severe Skin Disease, Anhui Medical University, Hefei, China.,State Key Lab Incubation of Dermatology, Ministry of Science and Technology, Hefei, China
| | - Jin-Ping Gao
- Institute of Dermatology, Department of Dermatology and Venerology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Collaborative Innovation Center of Complex and Severe Skin Disease, Anhui Medical University, Hefei, China.,State Key Lab Incubation of Dermatology, Ministry of Science and Technology, Hefei, China
| | - Xiao-Guang Zhang
- Institute of Dermatology, Department of Dermatology and Venerology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Collaborative Innovation Center of Complex and Severe Skin Disease, Anhui Medical University, Hefei, China.,State Key Lab Incubation of Dermatology, Ministry of Science and Technology, Hefei, China
| | - Xian-Bo Zuo
- Institute of Dermatology, Department of Dermatology and Venerology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Collaborative Innovation Center of Complex and Severe Skin Disease, Anhui Medical University, Hefei, China.,State Key Lab Incubation of Dermatology, Ministry of Science and Technology, Hefei, China
| | - Yu-Jun Sheng
- Institute of Dermatology, Department of Dermatology and Venerology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Collaborative Innovation Center of Complex and Severe Skin Disease, Anhui Medical University, Hefei, China.,State Key Lab Incubation of Dermatology, Ministry of Science and Technology, Hefei, China
| | - Gang Chen
- Institute of Dermatology, Department of Dermatology and Venerology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Collaborative Innovation Center of Complex and Severe Skin Disease, Anhui Medical University, Hefei, China.,State Key Lab Incubation of Dermatology, Ministry of Science and Technology, Hefei, China
| | - Liang-Dan Sun
- Institute of Dermatology, Department of Dermatology and Venerology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Collaborative Innovation Center of Complex and Severe Skin Disease, Anhui Medical University, Hefei, China.,State Key Lab Incubation of Dermatology, Ministry of Science and Technology, Hefei, China
| | - Xue-Jun Zhang
- Institute of Dermatology, Department of Dermatology and Venerology, No. 1 Hospital, Anhui Medical University, Hefei, China.,Collaborative Innovation Center of Complex and Severe Skin Disease, Anhui Medical University, Hefei, China.,State Key Lab Incubation of Dermatology, Ministry of Science and Technology, Hefei, China.,Department of Dermatology, No. 2 Hospital, Anhui Medical University, Hefei, China.,Department of Dermatology, Institutes of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jin-Hua Xu
- State Key Lab Incubation of Dermatology, Ministry of Science and Technology, Hefei, China. .,Department of Dermatology, Institutes of Dermatology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Sen Yang
- Institute of Dermatology, Department of Dermatology and Venerology, No. 1 Hospital, Anhui Medical University, Hefei, China. .,Collaborative Innovation Center of Complex and Severe Skin Disease, Anhui Medical University, Hefei, China. .,State Key Lab Incubation of Dermatology, Ministry of Science and Technology, Hefei, China. .,Department of Dermatology, No. 2 Hospital, Anhui Medical University, Hefei, China.
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16
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Tieu J, Lundberg IE, Limaye V. Idiopathic inflammatory myositis. Best Pract Res Clin Rheumatol 2016; 30:149-68. [DOI: 10.1016/j.berh.2016.04.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 12/11/2022]
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17
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Pagnini I, Vitale A, Selmi C, Cimaz R, Cantarini L. Idiopathic Inflammatory Myopathies: an Update on Classification and Treatment with Special Focus on Juvenile Forms. Clin Rev Allergy Immunol 2015; 52:34-44. [DOI: 10.1007/s12016-015-8512-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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18
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Miller FW, Chen W, O’Hanlon TP, Cooper RG, Vencovsky J, Rider LG, Danko K, Wedderburn LR, Lundberg IE, Pachman LM, Reed AM, Ytterberg SR, Padyukov L, Selva-O’Callaghan A, Radstake TR, Isenberg DA, Chinoy H, Ollier WE, Scheet P, Peng B, Lee A, Byun J, Lamb JA, Gregersen PK, Amos CI. Genome-wide association study identifies HLA 8.1 ancestral haplotype alleles as major genetic risk factors for myositis phenotypes. Genes Immun 2015; 16:470-80. [PMID: 26291516 PMCID: PMC4840953 DOI: 10.1038/gene.2015.28] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 06/15/2015] [Accepted: 06/18/2015] [Indexed: 02/06/2023]
Abstract
Autoimmune muscle diseases (myositis) comprise a group of complex phenotypes influenced by genetic and environmental factors. To identify genetic risk factors in patients of European ancestry, we conducted a genome-wide association study (GWAS) of the major myositis phenotypes in a total of 1710 cases, which included 705 adult dermatomyositis, 473 juvenile dermatomyositis, 532 polymyositis and 202 adult dermatomyositis, juvenile dermatomyositis or polymyositis patients with anti-histidyl-tRNA synthetase (anti-Jo-1) autoantibodies, and compared them with 4724 controls. Single-nucleotide polymorphisms showing strong associations (P<5×10(-8)) in GWAS were identified in the major histocompatibility complex (MHC) region for all myositis phenotypes together, as well as for the four clinical and autoantibody phenotypes studied separately. Imputation and regression analyses found that alleles comprising the human leukocyte antigen (HLA) 8.1 ancestral haplotype (AH8.1) defined essentially all the genetic risk in the phenotypes studied. Although the HLA DRB1*03:01 allele showed slightly stronger associations with adult and juvenile dermatomyositis, and HLA B*08:01 with polymyositis and anti-Jo-1 autoantibody-positive myositis, multiple alleles of AH8.1 were required for the full risk effects. Our findings establish that alleles of the AH8.1 comprise the primary genetic risk factors associated with the major myositis phenotypes in geographically diverse Caucasian populations.
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Affiliation(s)
- Frederick W. Miller
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland 20892
| | - Wei Chen
- M.D. Anderson Cancer Center, Houston, Texas 77030
| | - Terrance P. O’Hanlon
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland 20892
| | - Robert G. Cooper
- MRC/ARUK Institute for Ageing and Chronic Disease, University of Liverpool, United Kingdom, L69 3GA
| | - Jiri Vencovsky
- Institute of Rheumatology, Charles University, Prague, Czech Republic; Na Slupi, 12850 Prague
| | - Lisa G. Rider
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland 20892
| | - Katalin Danko
- 3 Department of Internal Medicine, Division of Immunology University of Debrecen, Debrecen, Hungary H-4032
| | - Lucy R. Wedderburn
- Institute of Child Health, University College London, London, United Kingdom, WC1N 1EH
| | - Ingrid E. Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden SE-171 77
| | - Lauren M. Pachman
- Department of Pediatric Rheumatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611
| | | | | | - Leonid Padyukov
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden SE-171 77
| | | | - Timothy R. Radstake
- Department of Rheumatology and Clinical Immunology, Laboratory for Translational Immunology, Utrecht University Medical Center; and Nijmegen Center for Molecular Life Sciences, Nijmegen, The Netherlands 6500.HB
| | - David A. Isenberg
- Division of Medicine, University College London, London, United Kingdom WC1E63T
| | - Hector Chinoy
- The National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Centre for Musculoskeletal Research, University of Manchester, Manchester, United Kingdom M139PT
| | - William E.R. Ollier
- Centre for Integrated Genomic Medical Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom M13 9PT
| | - Paul Scheet
- M.D. Anderson Cancer Center, Houston, Texas 77030
| | - Bo Peng
- M.D. Anderson Cancer Center, Houston, Texas 77030
| | - Annette Lee
- Robert S. Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York 11030
| | - Jinyoung Byun
- Department of Community and Family Medicine, Dartmouth College, Hanover, New Hampshire 03755
| | - Janine A. Lamb
- Centre for Integrated Genomic Medical Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom M13 9PT
| | - Peter K. Gregersen
- Robert S. Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York 11030
| | - Christopher I. Amos
- Department of Community and Family Medicine, Dartmouth College, Hanover, New Hampshire 03755
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Lu X, Peng Q, Wang G. Discovery of new biomarkers of idiopathic inflammatory myopathy. Clin Chim Acta 2015; 444:117-25. [DOI: 10.1016/j.cca.2015.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/02/2015] [Accepted: 02/02/2015] [Indexed: 01/19/2023]
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Lega JC, Fabien N, Reynaud Q, Durieu I, Durupt S, Dutertre M, Cordier JF, Cottin V. The clinical phenotype associated with myositis-specific and associated autoantibodies: A meta-analysis revisiting the so-called antisynthetase syndrome. Autoimmun Rev 2014; 13:883-91. [DOI: 10.1016/j.autrev.2014.03.004] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 03/30/2014] [Indexed: 10/25/2022]
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Klein M, Mann H, Pleštilová L, Betteridge Z, McHugh N, Remáková M, Novota P, Vencovský J. Arthritis in idiopathic inflammatory myopathy: clinical features and autoantibody associations. J Rheumatol 2014; 41:1133-9. [PMID: 24786927 DOI: 10.3899/jrheum.131223] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the prevalence, distribution, and clinical manifestations of arthritis in a cohort of patients with idiopathic inflammatory myopathies (IIM). Associations with autoantibody status and HLA genetic background were also explored. METHODS Consecutive patients with IIM treated in a single center were included in this cross-sectional study (n = 106). History of arthritis, 68-joint and 66-joint tender and swollen joint index, clinical features of IIM, and autoantibody profiles were obtained by clinical examination, personal interview, and review of patient records. High-resolution genotyping in HLA-DRB1 and HLA-DQB1 loci was performed in 71 and 73 patients, respectively. RESULTS A combination of patients' medical history and cross-sectional physical examination revealed that arthritis at any time during the disease course had occurred in 56 patients (53%). It was present at the beginning of the disease in 39 patients (37%) including 23 cases (22%) with arthritis preceding the onset of muscle weakness. On physical examination, 29% of patients had at least 1 swollen joint. The most frequently affected areas were wrists, and metacarpophalangeal and proximal interphalangeal joints. Twenty-seven out of the 29 anti-Jo1-positive patients had arthritis at any time during the course of their illness; this prevalence was significantly higher compared to patients without the anti-Jo1 autoantibody (p < 0.0001). No association of arthritis with individual HLA alleles was found. CONCLUSION Our data suggest that arthritis is a common feature of myositis. It is frequently present at the onset of disease and it may even precede muscular manifestations of IIM. The most common presentation is a symmetrical, nonerosive polyarthritis affecting particularly the wrists, shoulders, and small joints of the hands. We have confirmed a strong association of arthritis with the presence of the anti-Jo1 antibody.
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Affiliation(s)
- Martin Klein
- From the Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; and the Royal National Hospital for Rheumatic Diseases, Bath, UK.M. Klein, MD; H. Mann, MD; L. Pleštilová, MD, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; Z. Betteridge, PhD; N. McHugh, MD, Professor, Royal National Hospital for Rheumatic Diseases; M. Remáková, MSc, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; P. Novota, Dr, Institute of Rheumatology; J. Vencovský, MD, Professor, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague
| | - Heřman Mann
- From the Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; and the Royal National Hospital for Rheumatic Diseases, Bath, UK.M. Klein, MD; H. Mann, MD; L. Pleštilová, MD, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; Z. Betteridge, PhD; N. McHugh, MD, Professor, Royal National Hospital for Rheumatic Diseases; M. Remáková, MSc, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; P. Novota, Dr, Institute of Rheumatology; J. Vencovský, MD, Professor, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague
| | - Lenka Pleštilová
- From the Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; and the Royal National Hospital for Rheumatic Diseases, Bath, UK.M. Klein, MD; H. Mann, MD; L. Pleštilová, MD, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; Z. Betteridge, PhD; N. McHugh, MD, Professor, Royal National Hospital for Rheumatic Diseases; M. Remáková, MSc, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; P. Novota, Dr, Institute of Rheumatology; J. Vencovský, MD, Professor, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague
| | - Zoe Betteridge
- From the Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; and the Royal National Hospital for Rheumatic Diseases, Bath, UK.M. Klein, MD; H. Mann, MD; L. Pleštilová, MD, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; Z. Betteridge, PhD; N. McHugh, MD, Professor, Royal National Hospital for Rheumatic Diseases; M. Remáková, MSc, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; P. Novota, Dr, Institute of Rheumatology; J. Vencovský, MD, Professor, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague
| | - Neil McHugh
- From the Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; and the Royal National Hospital for Rheumatic Diseases, Bath, UK.M. Klein, MD; H. Mann, MD; L. Pleštilová, MD, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; Z. Betteridge, PhD; N. McHugh, MD, Professor, Royal National Hospital for Rheumatic Diseases; M. Remáková, MSc, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; P. Novota, Dr, Institute of Rheumatology; J. Vencovský, MD, Professor, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague
| | - Martina Remáková
- From the Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; and the Royal National Hospital for Rheumatic Diseases, Bath, UK.M. Klein, MD; H. Mann, MD; L. Pleštilová, MD, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; Z. Betteridge, PhD; N. McHugh, MD, Professor, Royal National Hospital for Rheumatic Diseases; M. Remáková, MSc, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; P. Novota, Dr, Institute of Rheumatology; J. Vencovský, MD, Professor, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague
| | - Peter Novota
- From the Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; and the Royal National Hospital for Rheumatic Diseases, Bath, UK.M. Klein, MD; H. Mann, MD; L. Pleštilová, MD, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; Z. Betteridge, PhD; N. McHugh, MD, Professor, Royal National Hospital for Rheumatic Diseases; M. Remáková, MSc, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; P. Novota, Dr, Institute of Rheumatology; J. Vencovský, MD, Professor, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague
| | - Jiří Vencovský
- From the Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; and the Royal National Hospital for Rheumatic Diseases, Bath, UK.M. Klein, MD; H. Mann, MD; L. Pleštilová, MD, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; Z. Betteridge, PhD; N. McHugh, MD, Professor, Royal National Hospital for Rheumatic Diseases; M. Remáková, MSc, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague; P. Novota, Dr, Institute of Rheumatology; J. Vencovský, MD, Professor, Institute of Rheumatology, and the Department of Rheumatology, First Faculty of Medicine, Charles University in Prague.
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Abstract
Systemic lupus erythematosus, Sjögren's syndrome, and dermatomyositis are systemic autoimmune diseases that develop after environmental triggering of genetically susceptible individuals. The precise cellular and molecular mechanisms leading to autoimmune disease, and what factors determine which organs are involved, remain poorly understood. Recent insights into genetic susceptibility now make obvious that environmental triggers often act via cellular pathways containing disease-associated polymorphisms. In the breaking of tolerance, the initiating tissue--including dendritic cells--provides a decisive microenvironment that affects immune-cell differentiation, leading to activation of adaptive immunity. Type 1 interferon produced by innate immune cells has a central role in systemic autoimmunity and activates B cells and T cells. In turn, B-cell-derived autoantibodies stimulate dendritic cells to produce type 1 interferon; thus, a positive feedforward loop is formed that includes both the innate and adaptive systems. New treatments could simultaneously and specifically target several such vital pathways in autoimmunity.
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Martin N, Li CK, Wedderburn LR. Juvenile dermatomyositis: new insights and new treatment strategies. Ther Adv Musculoskelet Dis 2012; 4:41-50. [PMID: 22870494 DOI: 10.1177/1759720x11424460] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Juvenile dermatomyositis (JDM) is a rare but complex and potentially life-threatening autoimmune disease of childhood, primarily affecting proximal muscles and skin. Although the cause of JDM remains unknown it is clear that genetic and environmental influences play a role in the aetiology. In contrast to adults with dermatomyositis, children with JDM are more likely to have complications that are thought to indicate a vasculopathic process, such as severe skin disease, with ulceration or calcinosis, gut vasculopathy or central nervous system disease. New treatments are much needed and are becoming available and being tested through international multicentre trials. This review will focus on recent insights into pathogenesis, the assessment of the disease in children and the modern approach to its treatment.
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Chinoy H, Lamb JA, Ollier WER, Cooper RG. Recent advances in the immunogenetics of idiopathic inflammatory myopathy. Arthritis Res Ther 2011; 13:216. [PMID: 21658295 PMCID: PMC3218878 DOI: 10.1186/ar3327] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This review summarizes the previous and current literature on the immunogenetics of idiopathic inflammatory myopathy (IIM) and updates the research progress that has been made over the past decade. A substantial part of the genetic risk for developing adult- and juvenile-onset IIM lies within the major histocompatibility complex (MHC), and a tight relationship exists between individual human leukocyte antigen alleles and specific serological subtypes, which in turn dictate clinical disease phenotypes. Multiple genetic regions outside of the MHC are increasingly being identified in conferring IIM disease susceptibility. We are still challenged with the task of studying a serologically and clinically heterogeneous disorder that is rarer by orders of magnitude than the likes of rheumatoid arthritis. An ongoing and internationally coordinated IIM genome-wide association study may provide further insights into IIM immunogenetics.
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Affiliation(s)
- Hector Chinoy
- Rheumatic Diseases Centre, Manchester Academic Health Science Centre, The University of Manchester, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
- Musculoskeletal Research Group, School of Translational Medicine, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, M13 9PT Manchester, UK
| | - Janine A Lamb
- Centre for IIntegrated Genomic Medical Research, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, M13 9PT Manchester, UK
| | - William ER Ollier
- Centre for IIntegrated Genomic Medical Research, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, M13 9PT Manchester, UK
| | - Robert G Cooper
- Rheumatic Diseases Centre, Manchester Academic Health Science Centre, The University of Manchester, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
- Centre for IIntegrated Genomic Medical Research, Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, M13 9PT Manchester, UK
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Current world literature. Curr Opin Rheumatol 2010; 22:704-12. [PMID: 20881793 DOI: 10.1097/bor.0b013e3283404094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martin N, Krol P, Smith S, Murray K, Pilkington CA, Davidson JE, Wedderburn LR. A national registry for juvenile dermatomyositis and other paediatric idiopathic inflammatory myopathies: 10 years' experience; the Juvenile Dermatomyositis National (UK and Ireland) Cohort Biomarker Study and Repository for Idiopathic Inflammatory Myopathies. Rheumatology (Oxford) 2010; 50:137-45. [PMID: 20823094 PMCID: PMC2999955 DOI: 10.1093/rheumatology/keq261] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES The paediatric idiopathic inflammatory myopathies (IIMs) are a group of rare chronic inflammatory disorders of childhood, affecting muscle, skin and other organs. There is a severe lack of evidence base for current treatment protocols in juvenile myositis. The rarity of these conditions means that multicentre collaboration is vital to facilitate studies of pathogenesis, treatment and disease outcomes. We have established a national registry and repository for childhood IIM, which aims to improve knowledge, facilitate research and clinical trials, and ultimately to improve outcomes for these patients. METHODS A UK-wide network of centres and research group was established to contribute to the study. Standardized patient assessment, data collection forms and sample protocols were agreed. The Biobank includes collection of peripheral blood mononuclear cells, serum, genomic DNA and biopsy material. An independent steering committee was established to oversee the use of data/samples. Centre training was provided for patient assessment, data collection and entry. RESULTS Ten years after inception, the study has recruited 285 children, of which 258 have JDM or juvenile PM; 86% of the cases have contributed the biological samples. Serial sampling linked directly to the clinical database makes this a highly valuable resource. The study has been a platform for 20 sub-studies and attracted considerable funding support. Assessment of children with myositis in contributing centres has changed through participation in this study. CONCLUSIONS This establishment of a multicentre registry and Biobank has facilitated research and contributed to progress in the management of a complex group of rare muscloskeletal conditions.
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Affiliation(s)
- Neil Martin
- Rheumatology Unit, UCL Institute of Child Health, Great Ormond Street Hospital, 30 Guilford Street, University College London, London WC1N 1EH, UK
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Saketkoo LA, Ascherman DP, Cottin V, Christopher-Stine L, Danoff SK, Oddis CV. Interstitial Lung Disease in Idiopathic Inflammatory Myopathy. Curr Rheumatol Rev 2010; 6:108-119. [PMID: 21941374 PMCID: PMC3092635 DOI: 10.2174/157339710791330740] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The lung is one of the most common extra-muscular targets in idiopathic inflammatory myopathies (IIM) and interstitial lung disease (ILD) is a prevalent and often devastating manifestation of IIM. IIM-associated ILD (IIM-ILD) contributes to nearly 80% of the mortality in IIM with a reported prevalence of 65% of newly diagnosed IIM cases. Although ILD frequently accompanies clinical and laboratory findings of myositis, overt signs of muscle disease may be absent in the setting of significant lung disease. Understanding the varied scope of presentation of these diseases is essential to providing optimal patient care. This review will provide an in depth examination of ILD in IIM both from a rheumatologic and pulmonary perspective and will discuss the scope of disease, presenting features, genetic associations, pathogenesis, diagnosis, radiographic and histopathologic findings, along with biomarker assessment and a rationale for therapeutic intervention.
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Affiliation(s)
- Lesley Ann Saketkoo
- Louisiana State University Health Sciences Center, Department of Medicine, Division of Rheumatology, New Orleans, LA, USA
- University Cancer Institute, Section of Rheumatology, Boynton Beach, FL, USA
| | - Dana P. Ascherman
- University of Pittsburgh School of Medicine, Division of Rheumatology and Clinical Immunology, Pittsburgh, PA, USA
| | - Vincent Cottin
- Hospices Civils de Lyon, Université de Lyon, Centre de référence des maladies orphelines pulmonaires, Service de pneumologie, UMR 754 INRA-ENVL-UCBL-IFR128, Hôpital Louis Pradel, Lyon, France
| | - Lisa Christopher-Stine
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sonye K. Danoff
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chester V. Oddis
- University of Pittsburgh School of Medicine, Division of Rheumatology and Clinical Immunology, Pittsburgh, PA, USA
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Lega JC, Cottin V, Fabien N, Thivolet-Béjui F, Cordier JF. Interstitial lung disease associated with anti-PM/Scl or anti-aminoacyl-tRNA synthetase autoantibodies: a similar condition? J Rheumatol 2010; 37:1000-9. [PMID: 20231208 DOI: 10.3899/jrheum.090652] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare anti-PM/Scl autoantibody-associated interstitial lung disease (ILD) with anti-aminoacyl-tRNA synthetases (anti-ARS) autoantibody-associated ILD. METHODS We retrospectively studied 21 patients with ILD from a department of respiratory medicine, including 9 with anti-PM/Scl autoantibodies (6 women, median age 55 yrs, followup 5.5 yrs) and 12 with anti-ARS autoantibodies (6 women, median age 59 yrs, followup 2.3 yrs). RESULTS Pulmonary manifestations in patients with anti-PM/Scl autoantibody-associated ILD usually followed the extrapulmonary manifestations of the connective tissue disease (CTD) (7/9 cases). The predominant imaging features on initial high resolution computed tomography were ground-glass attenuation and reticular opacities, and mainly suggested nonspecific interstitial pneumonia in both groups. CTD was classified as dermatomyositis (DM; 2), undifferentiated CTD (2), cutaneous limited systemic sclerosis (2), rheumatoid arthritis (RA; 1), and overlap syndrome (1) in the anti-PM/Scl group; and polymyositis (4), undifferentiated CTD (5), DM (1), amyopathic DM (1), and RA (1) in the anti-ARS group. Frequencies of arthralgia, Raynaud phenomenon, cutaneous rash, and mechanic's hands were comparable in both groups. Myalgia or muscle weakness was present in 0/9 PM/Scl and 5/12 ARS patients (p < 0.05). More than 1 autoantibody was present in 11 patients. ILD worsened despite treatment in 4 patients with anti-PM/Scl autoantibodies and 2 with anti-ARS autoantibodies, and included 1 death. CONCLUSION Anti-PM/Scl and anti-ARS antibodies are associated with similar clinical manifestations, with the exception only of more overt myositis in the latter, therefore challenging the clinical specificity of the antisynthetase syndrome.
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Affiliation(s)
- Jean-Christophe Lega
- Department of Respiratory Medicine, Reference Centre for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon I, University of Lyon, Lyon, France
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Wedderburn LR, Rider LG. Juvenile dermatomyositis: new developments in pathogenesis, assessment and treatment. Best Pract Res Clin Rheumatol 2009; 23:665-78. [PMID: 19853831 PMCID: PMC2774891 DOI: 10.1016/j.berh.2009.07.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Juvenile dermatomyositis (JDM) is a rare, potentially life-threatening systemic autoimmune disease primarily affecting muscle and skin. Recent advances in the recognition, standardised assessment and treatment of JDM have been greatly facilitated by large collaborative research networks. Through these networks, a number of immunogenetic risk factors have now been defined, as well as a number of potential pathways identified in the aetio-pathogenesis of JDM. Myositis-associated and myositis-specific autoantibodies are helping to sub-phenotype JDM, defined by clinical features, outcomes and immunogenetic risk factors. Partially validated tools to assess disease activity and damage have assisted in standardising outcomes. Aggressive treatment approaches, including multiple initial therapies, as well as new drugs and biological therapies for refractory disease, offer promise of improved outcomes and less corticosteroid-related toxicity.
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Affiliation(s)
- Lucy R Wedderburn
- Rheumatology Unit, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.
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