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Romão VC, Fonseca JE. Disease mechanisms in preclinical rheumatoid arthritis: A narrative review. Front Med (Lausanne) 2022; 9:689711. [PMID: 36059838 PMCID: PMC9437632 DOI: 10.3389/fmed.2022.689711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/04/2022] [Indexed: 11/20/2022] Open
Abstract
In the last decades, the concept of preclinical rheumatoid arthritis (RA) has become established. In fact, the discovery that disease mechanisms start years before the onset of clinical RA has been one of the major recent insights in the understanding of RA pathogenesis. In accordance with the complex nature of the disease, preclinical events extend over several sequential phases. In a genetically predisposed host, environmental factors will further increase susceptibility for incident RA. In the initial steps of preclinical disease, immune disturbance mechanisms take place outside the joint compartment, namely in mucosal surfaces, such as the lung, gums or gut. Herein, the persistent immunologic response to altered antigens will lead to breach of tolerance and trigger autoimmunity. In a second phase, the immune response matures and is amplified at a systemic level, with epitope spreading and widening of the autoantibody repertoire. Finally, the synovial and bone compartment are targeted by specific autoantibodies against modified antigens, initiating a local inflammatory response that will eventually culminate in clinically evident synovitis. In this review, we discuss the elaborate disease mechanisms in place during preclinical RA, providing a broad perspective in the light of current evidence.
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Affiliation(s)
- Vasco C. Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ERN-ReCONNET), Lisbon, Portugal
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisbon, Portugal
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2
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Hadwen B, Yu R, Cairns E, Barra L. Presence of Autoantibodies in Males and Females With Rheumatoid Arthritis: A Systematic Review and Metaanalysis. J Rheumatol 2022; 49:663-671. [PMID: 35293336 DOI: 10.3899/jrheum.211020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is more common in females, and although the cause of RA is unknown, it is characterized by the production of autoantibodies. The aims of this study were to determine whether RA-associated autoantibodies are more often found in females than males and to identify factors that influence the relationship between sex and seropositivity. METHODS Databases were searched and studies of RA (N ≥ 100) were included if they reported proportion of seropositive patients with RA by sex. Metaanalyses and metaregression were conducted using the random-effects model. Covariates regressed were smoking, age, BMI, Health Assessment Questionnaire-Disability Index (HAQ-DI), and the Disease Activity Score in 28 joints (DAS28). RESULTS Eighty-four studies with a total of 141,381 subjects with rheumatoid factor (RF) seropositivity and 95,749 subjects with anticitrullinated protein antibody (ACPA) seropositivity met inclusion criteria. The mean age of participants ranged from 37 to 68 years and the proportion of female subjects ranged from 9% to 92%. Results indicated that females were less likely than males to be seropositive: odds ratio (OR) 0.84 [95% CI 0.77-0.91] for RF and OR 0.88 [95% CI 0.81-0.95] for ACPA. BMI, smoking, mean age, DAS28, and HAQ-DI did not affect the relationship between sex and seropositivity. CONCLUSION Although studies report that females have higher RA disease activity than males and that seropositivity predicts worse outcomes, females were less likely to be seropositive than males.
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Affiliation(s)
- Brook Hadwen
- B. Hadwen, BMSc, Department of Epidemiology and Biostatistics, Western University
| | - Richard Yu
- R. Yu, MD, Department of Medicine, Division of Rheumatology, Western University
| | - Ewa Cairns
- E. Cairns, PhD, Department of Medicine, Division of Rheumatology, and Department of Microbiology and Immunology, Western University
| | - Lillian Barra
- L. Barra, MD, Department of Epidemiology and Biostatistics, Department of Medicine, Division of Rheumatology, and Department of Microbiology and Immunology, Western University, London, Ontario, Canada.
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3
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Romero-Sánchez C, Giraldo S, Heredia-P AM, De Avila J, Chila-Moreno L, Londoño J, Valle-Oñate R, Bello-Gualtero JM, Bautista-Molano W. Association of Serum and Crevicular Fluid Dickkopf-1 Levels with Disease Activity and Periodontitis in Patients with Early Rheumatoid Arthritis. Curr Rheumatol Rev 2021; 18:124-135. [PMID: 34784873 DOI: 10.2174/1573397117666211116105118] [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: 03/10/2021] [Revised: 06/30/2021] [Accepted: 08/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of this study was to assess DKK-1 levels, in Gingival Crevicular Fluid (GCF) and serum, as a biomarker for bone loss and disease activity in periodontitis and early RA (eRA). METHODS In this cross-sectional study, we obtained serum and GCF from 10 interproximal sites (Distal Buccal I/S, Mesio Buccal I/S, Distal Palatal/Lingual, Mesio Palatal/Lingual) according to the highest degree of inflammation by a patient for 240 sites from eRA patients. Patients received a periodontal assessment, a radiographic evaluation, tomography of interproximal sites, and DKK1 levels were determined by ELISA. Comparisons were performed by the Mann-Whitney U test and analysis by Chi2 test, and a logistic regression model was applied. RESULTS The mean age was 46.33 ± 12.0 years, the Disease Activity Score (DAS-28-ESR) was 4.08 ± 1.4. Periodontitis was present in 65.2% of the patients, and 59.6% of these patients had bone loss in interproximal sites. Higher GCF-DKK1 levels were associated with serum-DKK1 (OR:2.41 IC95% 1.14-5.09, p=0.021) and were related with DAS28-ESR (p=0.001), Routine Assessment of Patient Index Data 3 (RAPID 3) (p=0.001), and tender joints (p=0.040). Foot bone erosion and juxta-articular osteopenia were associated with high levels of serum-DKK1 (p=0.009 and 0.001, respectively). Serum-DKK1 were associated with SDAI (OR: 2.38 IC95% 1.03-5.52, p=0.043), RAPID 3 (p=0.001), and rheumatoid factor (p=0.018). The GCF-DKK1 levels were associated with periodontal bone loss (p=0.011), periodontitis (p=0.070) and its severity (OR: 2.58 IC95% 2.28-7.28, p=0.001). Bone loss was more frequent in buccal sites (73.5%) and was associated with increased levels of DKK1 (p=0.033). CONCLUSION In the early stages of the eRA disease, serum and GCF-DKK1 could be a biomarker for clinical disease activity and periodontal and articular bone erosion.
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Affiliation(s)
- Consuelo Romero-Sánchez
- Cellular and Molecular Immunology Group/ INMUBO, School of Dentistry, Universidad El Bosque, Bogotá. Colombia
| | - Sebastián Giraldo
- Clinical Immunology Group, Rheumatology and Immunology Department Hospital Militar Central/School of Medicine, Universidad Militar Nueva Granada/, Bogotá. Colombia
| | - Ana María Heredia-P
- Cellular and Molecular Immunology Group/ INMUBO, School of Dentistry, Universidad El Bosque, Bogotá. Colombia
| | - Juliette De Avila
- Cellular and Molecular Immunology Group/ INMUBO, School of Dentistry, Universidad El Bosque, Bogotá. Colombia
| | - Lorena Chila-Moreno
- Cellular and Molecular Immunology Group/ INMUBO, School of Dentistry, Universidad El Bosque, Bogotá. Colombia
| | - John Londoño
- Spondyloarthropathy Group, Rheumatology Department, Hospital Militar Central/Universidad de La Sabana, Bogotá. Colombia
| | - Rafael Valle-Oñate
- Clinical Immunology Group, Rheumatology and Immunology Department Hospital Militar Central/School of Medicine, Universidad Militar Nueva Granada/, Bogotá. Colombia
| | - Juan Manuel Bello-Gualtero
- Clinical Immunology Group, Rheumatology and Immunology Department Hospital Militar Central/School of Medicine, Universidad Militar Nueva Granada/, Bogotá. Colombia
| | - Wilson Bautista-Molano
- Cellular and Molecular Immunology Group/ INMUBO, School of Dentistry, Universidad El Bosque, Bogotá. Colombia
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4
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Lu J, Bi Y, Zhu Y, Huipeng S, Duan W, Zhou J. CD3D, GZMK, and KLRB1 Are Potential Markers for Early Diagnosis of Rheumatoid Arthritis, Especially in Anti-Citrullinated Protein Antibody-Negative Patients. Front Pharmacol 2021; 12:726529. [PMID: 34603038 PMCID: PMC8483717 DOI: 10.3389/fphar.2021.726529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/16/2021] [Indexed: 12/29/2022] Open
Abstract
Early diagnosis and monitoring of rheumatoid arthritis (RA) progress are critical for effective treatment. In clinic, the detection of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) are usually combined to diagnose early RA. However, the poor specificity of RF and high heterogeneity of ACPA make the early diagnosis of RA still challenging. Bioinformatics analysis based on high-throughput omics is an emerging method to identify novel and effective biomarkers, which has been widely used in many diseases. Herein, utilizing an integrated strategy based on expression correlation analysis and weighted gene coexpression network analysis (WGCNA), we identified 76 RA-trait different expression genes (DEGs). Combined with protein-protein interaction (PPI) network construction and clustering, new hub genes associated in RA synovia, CD3D, GZMK, and KLRB1, were identified. We verified the specificity of these genes in the synovium of RA patients through three external datasets. We also observed high sensitivity and specificity of them for ACPA-negative patients. CD3D, GZMK, and KLRB1 are potentially key mediators of RA pathogenesis and markers for RA diagnosis.
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Affiliation(s)
- Junqin Lu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yihui Bi
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yapeng Zhu
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Shi Huipeng
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Wenxiu Duan
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jian Zhou
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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5
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Choy E, Groves L, Sugrue D, Hurst M, Houghton J, Venkatachalam S, Patel YI, Maxwell JR, Pollock KG, Henning S. Outcomes in rheumatoid arthritis patients treated with abatacept: a UK multi-centre observational study. BMC Rheumatol 2021; 5:3. [PMID: 33536080 PMCID: PMC7857859 DOI: 10.1186/s41927-020-00173-0] [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: 08/28/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that causes chronic synovitis, resulting in progressive joint destruction and functional disability and affects approximately 400,000 people in the UK. This real-world study aimed to describe the characteristics, treatment patterns and clinical outcomes of patients who received abatacept in UK clinical practice. METHODS This was a multi-centre, retrospective, observational study of patients with RA treated with abatacept at four UK centres between 01 January 2013 and 31 December 2017. Data were collected from medical records of each patient from the index date (date of first bDMARD initiation) until the most recent visit, death or end of study (31 December 2017). RESULTS In total, 213 patients were included in the study. Patients received up to eight lines of therapy (LOTs). Treatment with abatacept, or any other bDMARD, was associated with reductions in DAS28-ESR and DAS28-CRP scores at 6 and 12 months. The distribution of EULAR responses (good/moderate/no response) tended to be more favourable for patients when receiving abatacept than when receiving other bDMARDs (22.8%/41.3%/35.9% versus 16.6%/41.4%/42.1% at 6 months, and 27.9%/36.1%/36.1% versus 21.2%/34.5%/44.2% at 12 months). Patients receiving abatacept at LOT1 (n = 68) spent significantly longer on treatment compared with patients receiving other bDMARDs (53.4 vs. 17.4 months; p< 0.01); a similar trend was observed for LOT2. Among patients who discontinued after 6 months, a greater proportion experienced infection requiring antibiotics when receiving other bDMARDs compared to those receiving abatacept. CONCLUSIONS RA patients who received bDMARDs, including abatacept, experienced reduced disease activity. When receiving abatacept as first or second line of therapy, patients persisted with treatment significantly longer than those receiving other bDMARDs.
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Affiliation(s)
- Ernest Choy
- CREATE Centre, Division of Infection and Immunity, Cardiff University School of Medicine, Wales, UK
- Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - Lara Groves
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Daniel Sugrue
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Michael Hurst
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - John Houghton
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Srinivasan Venkatachalam
- Cannock and Wolverhampton Rheumatology Centre, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Yusuf I Patel
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | - Kevin G Pollock
- Bristol Myers Squibb, Uxbridge Business Park, Sanderson Road, Uxbridge, Middlesex, UK
| | - Sadie Henning
- Bristol Myers Squibb, Uxbridge Business Park, Sanderson Road, Uxbridge, Middlesex, UK.
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Yago T, Asano T, Fujita Y, Migita K. Familial Mediterranean fever phenotype progression into anti-cyclic citrullinated peptide antibody-positive rheumatoid arthritis:a case report. Fukushima J Med Sci 2020; 66:160-166. [PMID: 33162488 PMCID: PMC7790467 DOI: 10.5387/fms.2020-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Familial Mediterranean fever (FMF) is caused by dysfunction of the MEFV gene product, pyrin. Here we report a case of FMF phenotype which developed into rheumatoid arthritis (RA), based on a positive result for anti-cyclic citrullinated peptide (CCP) antibody (Ab). A 42-year-old woman presented to our clinic with more than 6 months of intermittent arthralgia in the wrists, feet, and fingers associated with menstruation. No fever was reported and there was no family history of FMF or other autoimmune diseases. Laboratory tests revealed elevated C-reactive protein (CRP) and rheumatoid factor (RF). Tests for autoantibodies including anti-CCP Ab, antinuclear Ab, and anti-DNA Ab were all negative. Genetic analysis identified an R304R homozygous mutation in MEFV; however, the pathological significance is unclear because this mutation does not cause amino acid substitution. We diagnosed incomplete FMF phenotype despite the lack of fever due to periodic arthritis, lack of autoantibodies, and complete resolution of arthritis following colchicine treatment within a day. Several months later, increased stiffness and arthralgia persistently occurred in finger joints on both sides. Ultrasonography revealed synovitis at the metacarpophalangeal and metatarsophalangeal joints. Laboratory analysis revealed the patient to be positive for anti-CCP Ab. Therefore, we finally diagnosed RA. Her arthritis diminished following administration of methotrexate and salazosulfapyridine. We consider the possibility that pyrin dysfunction may have affected the acquired immunity, contributing to the onset of RA as an autoimmune disease. This is an interesting case of equivalent FMF progressing into RA and will be valuable to raise awareness of a continuum from autoinflammatory to autoimmune disease.
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Affiliation(s)
- Toru Yago
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Tomoyuki Asano
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Yuya Fujita
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine
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7
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Iwasaki T, Nakabo S, Terao C, Murakami K, Nakashima R, Hashimoto M, Imura Y, Yukawa N, Yoshifuji H, Miura Y, Yurugi K, Maekawa T, van Delft MAM, Trouw LA, Fujii T, Mimori T, Ohmura K. Long-term follow-up of patients with anti-cyclic citrullinated peptide antibody-positive connective tissue disease: a retrospective observational study including information on the HLA-DRB1 allele and citrullination dependency. Arthritis Res Ther 2020; 22:248. [PMID: 33076960 PMCID: PMC7574466 DOI: 10.1186/s13075-020-02351-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/08/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The anti-cyclic citrullinated peptide (CCP) antibody is a diagnostic biomarker of rheumatoid arthritis (RA). However, some non-RA connective tissue disease (CTD) patients also test positive for the anti-CCP antibody and, thus, may ultimately develop RA. We retrospectively investigated whether anti-CCP-positive non-RA CTD patients developed RA and attempted to identify factors that may differentiate RA-overlapping CTD from pure CTD. METHODS In total, 842 CTD patients with a primary diagnosis that was not RA were selected from our CTD database as of December 2012. Anti-CCP antibody titers were obtained from a retrospective chart review or measured using stored sera. RA was diagnosed according to the 1987 revised American College of Rheumatology classification criteria. Thirty-three anti-CCP-positive non-RA CTD patients were retrospectively followed up for the development of RA. Bone erosions on the hands and feet were assessed by X-ray. Citrullination dependency was evaluated by an in-house ELISA, the HLA-DRB1 allele was typed, and the results obtained were then compared between RA-overlapping and non-RA anti-CCP-positive CTD patients. RESULTS Two out of 33 anti-CCP-positive CTD patients (6.1%) developed RA during a mean follow-up period of 8.9 years. X-rays were examined in 27 out of the 33 patients, and only one (3.7%) showed bone erosions. The frequency of the HLA-DRB1 shared epitope (SE) and anti-CCP antibody titers were both significantly higher in anti-CCP-positive RA-overlapping CTD patients than in anti-CCP-positive non-RA CTD patients, while no significant differences were observed in citrullination dependency. CONCLUSIONS Anti-CCP-positive non-RA CTD patients rarely developed RA. HLA-DRB1 SE and anti-CCP antibody titers may facilitate the differentiation of RA-overlapping CTD from anti-CCP-positive non-RA CTD.
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Affiliation(s)
- Takeshi Iwasaki
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Shuichiro Nakabo
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan.,Clinical Research Center, Shizuoka General Hospital, Shizuoka, Japan.,The Department of Applied Genetics, The School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Kosaku Murakami
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Ran Nakashima
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Motomu Hashimoto
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshitaka Imura
- Department of Clinical Immunology and Rheumatology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | | | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Japan
| | - Yasuo Miura
- Department of Transfusion Medicine & Cell Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Kimiko Yurugi
- Department of Transfusion Medicine & Cell Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Taira Maekawa
- Department of Transfusion Medicine & Cell Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Myrthe A M van Delft
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Leendert A Trouw
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Takao Fujii
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Japan.,Department of Clinical Immunology and Rheumatology, Wakayama Medical University, Wakayama, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Japan.,Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Koichiro Ohmura
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, Japan.
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8
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Hähnlein JS, Nadafi R, de Jong TA, Semmelink JF, Remmerswaal EBM, Safy M, van Lienden KP, Maas M, Gerlag DM, Tak PP, Mebius RE, Wähämaa H, Catrina AI, G. M. van Baarsen L. Human Lymph Node Stromal Cells Have the Machinery to Regulate Peripheral Tolerance during Health and Rheumatoid Arthritis. Int J Mol Sci 2020; 21:ijms21165713. [PMID: 32784936 PMCID: PMC7460812 DOI: 10.3390/ijms21165713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In rheumatoid arthritis (RA) the cause for loss of tolerance and anti-citrullinated protein antibody (ACPA) production remains unidentified. Mouse studies showed that lymph node stromal cells (LNSCs) maintain peripheral tolerance through presentation of peripheral tissue antigens (PTAs). We hypothesize that dysregulation of peripheral tolerance mechanisms in human LNSCs might underlie pathogenesis of RA. METHOD Lymph node (LN) needle biopsies were obtained from 24 RA patients, 23 individuals positive for RA-associated autoantibodies but without clinical disease (RA-risk individuals), and 14 seronegative healthy individuals. Ex vivo human LNs from non-RA individuals were used to directly analyze stromal cells. Molecules involved in antigen presentation and immune modulation were measured in LNSCs upon interferon γ (IFNγ) stimulation (n = 15). RESULTS Citrullinated targets of ACPAs were detected in human LN tissue and in cultured LNSCs. Human LNSCs express several PTAs, transcription factors autoimmune regulator (AIRE) and deformed epidermal autoregulatory factor 1 (DEAF1), and molecules involved in citrullination, antigen presentation, and immunomodulation. Overall, no clear differences between donor groups were observed with exception of a slightly lower induction of human leukocyte antigen-DR (HLA-DR) and programmed cell death 1 ligand (PD-L1) molecules in LNSCs from RA patients. CONCLUSION Human LNSCs have the machinery to regulate peripheral tolerance making them an attractive target to exploit in tolerance induction and maintenance.
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Affiliation(s)
- Janine S. Hähnlein
- Department of Rheumatology & Clinical Immunology and Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (J.S.H.); (T.A.d.J.); (J.F.S.); (M.S.); (D.M.G.); (P.P.T.)
- Amsterdam Rheumatology & Immunology Center (ARC), Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Reza Nadafi
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC, VU Medical Center, Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands; (R.N.); (R.E.M.)
- Department of Immunology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Tineke A. de Jong
- Department of Rheumatology & Clinical Immunology and Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (J.S.H.); (T.A.d.J.); (J.F.S.); (M.S.); (D.M.G.); (P.P.T.)
- Amsterdam Rheumatology & Immunology Center (ARC), Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Johanna F. Semmelink
- Department of Rheumatology & Clinical Immunology and Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (J.S.H.); (T.A.d.J.); (J.F.S.); (M.S.); (D.M.G.); (P.P.T.)
- Amsterdam Rheumatology & Immunology Center (ARC), Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Ester B. M. Remmerswaal
- Renal Transplant Unit, Division of Internal Medicine and Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - Mary Safy
- Department of Rheumatology & Clinical Immunology and Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (J.S.H.); (T.A.d.J.); (J.F.S.); (M.S.); (D.M.G.); (P.P.T.)
| | - Krijn P. van Lienden
- Department of Radiology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (K.P.v.L.); (M.M.)
| | - Mario Maas
- Department of Radiology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (K.P.v.L.); (M.M.)
| | - Danielle M. Gerlag
- Department of Rheumatology & Clinical Immunology and Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (J.S.H.); (T.A.d.J.); (J.F.S.); (M.S.); (D.M.G.); (P.P.T.)
| | - Paul P. Tak
- Department of Rheumatology & Clinical Immunology and Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (J.S.H.); (T.A.d.J.); (J.F.S.); (M.S.); (D.M.G.); (P.P.T.)
- Kintai Therapeutics, Cambridge, MA 02140, USA
- Internal Medicine, Cambridge University, Cambridge, CB2 1TN, UK
- Rheumatology, Ghent University, 9000 Ghent, Belgium
| | - Reina E. Mebius
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC, VU Medical Center, Vrije Universiteit Amsterdam, 1081 HZ Amsterdam, The Netherlands; (R.N.); (R.E.M.)
| | - Heidi Wähämaa
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, 17176 Stockholm, Sweden; (H.W.); (A.I.C.)
| | - Anca I. Catrina
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institutet, 17176 Stockholm, Sweden; (H.W.); (A.I.C.)
| | - Lisa G. M. van Baarsen
- Department of Rheumatology & Clinical Immunology and Department of Experimental Immunology, Amsterdam Infection & Immunity Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (J.S.H.); (T.A.d.J.); (J.F.S.); (M.S.); (D.M.G.); (P.P.T.)
- Amsterdam Rheumatology & Immunology Center (ARC), Academic Medical Center, 1105 AZ Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-205668043
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Raslan HM, Attia HR, Hamed Ibrahim M, Mahmoud Hassan E, Salama II, Ismail S, Abdelmotaleb E, El Menyawi MM, Amr KS. Association of anti-cyclic citrullinated peptide antibodies and rheumatoid factor isotypes with HLA-DRB1 shared epitope alleles in Egyptian rheumatoid arthritis patients. Int J Rheum Dis 2020; 23:647-653. [PMID: 32167241 DOI: 10.1111/1756-185x.13819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 02/12/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The most common genetic risk factor for rheumatoid arthritis (RA) is human leucocyte antigen DRB1 (HLA-DRB1) shared epitope (SE). AIM To investigate the relationship between anti-cyclic citrullinated peptide (anti-CCP), rheumatoid factor (RF), immunoglobulin (Ig)G, IgM and IgA and HLA-DRB1 SE among Egyptian patients with RA. METHODS Serum levels of anti-CCP antibodies and RFIgG, RFIgM, RFIgA were assayed using enzyme-linked immunosorbent assay for 157 Egyptian RA patients and 150 healthy controls attending the outpatient clinics of National Research Center and Kasr El Aini Hospital. HLA-DRB1 genotyping was performed by the DynalAllSetTM polymerase chain reaction (PCR) single specific primer low-resolution typing kits. Amplified PCR product was checked using 3% agarose gel. RESULTS HLA-DRB1-SE was found among 129 (82.2%) RA patients and 67 (44.7%) controls (odds ratio [OR] 5.7, CI 3.4-9.6, P < .0001). The risk of RA development was higher with the presence of SE two alleles (OR 11.6, P < .0001), while the OR for 1 copy SE allele was 4.4 (P < .0001). HLA-DRB1-SE was significantly associated with positive as well as negative anti-CCP and RF isotypes. The stronger association was with anti-CCP positivity with OR 11 (5.1-23.6), P < .0001. Furthermore, the risk of development of positive anti-CCP and RF isotypes was higher with the presence of 2 copies of SE alleles than with 1 copy. CONCLUSION The prevalence of HLA-DRB1-SE is high in Egyptian RA patients. The role of SE in RA patients is most probably related to the development of anti-CCP positive RA rather than the development of anti-CCP positivity.
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Affiliation(s)
- Hala M Raslan
- Internal Medicine Department, National Research Center, Cairo, Egypt
| | - Hanaa R Attia
- Clinical and Chemical Pathology Department, National Research Center, Cairo, Egypt
| | - Mona Hamed Ibrahim
- Clinical and Chemical Pathology Department, National Research Center, Cairo, Egypt
| | - Eman Mahmoud Hassan
- Clinical and Chemical Pathology Department, National Research Center, Cairo, Egypt
| | - Iman I Salama
- Community Medicine Research Department, National Research Center, Cairo, Egypt
| | - Sherif Ismail
- Internal Medicine Department, National Research Center, Cairo, Egypt
| | - Eman Abdelmotaleb
- Medical Molecular Genetic Department, National Research Center, Cairo, Egypt
| | | | - Khalda S Amr
- Medical Molecular Genetic Department, National Research Center, Cairo, Egypt
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Ishikawa Y, Terao C. The Impact of Cigarette Smoking on Risk of Rheumatoid Arthritis: A Narrative Review. Cells 2020; 9:cells9020475. [PMID: 32092988 PMCID: PMC7072747 DOI: 10.3390/cells9020475] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/13/2022] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation and subsequent proliferation of synovial tissues, which eventually leads to cartilage and bone destruction without effective treatments. Anti-citrullinated cyclic peptide/protein antibody (ACPA) and rheumatoid factor (RF) are two main characteristic autoantibodies found in RA patients and are associated with unfavorable disease outcomes. Although etiologies and causes of the disease have not been fully clarified yet, it is likely that interactive contributions of genetic and environmental factors play a main role in RA pathology. Previous works have demonstrated several genetic and environmental factors as risks of RA development and/or autoantibody productions. Among these, cigarette smoking and HLA-DRB1 are the well-established environmental and genetic risks, respectively. In this narrative review, we provide a recent update on genetic contributions to RA and the environmental risks of RA with a special focus on cigarette smoking and its impacts on RA pathology. We also describe gene–environmental interaction in RA pathogenesis with an emphasis on cigarette smoking and HLA-DRB1.
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Affiliation(s)
- Yuki Ishikawa
- Section for Immunobiology, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA;
- Laboratory for Statistical and Translational Genetics, Center for Integrative Medical Sciences, RIKEN, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa 230-0045, Japan
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, Center for Integrative Medical Sciences, RIKEN, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa 230-0045, Japan
- Clinical Research Center, Shizuoka General Hospital, 4 Chome-27-1 Kitaando, Aoi Ward, Shizuoka 420-8527, Japan
- Department of Applied Genetics, The School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka 422-8526, Japan
- Correspondence: ; Tel.: +81-(0)45-503-9121
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Harrold LR, Shan Y, Connolly SE, Alemao E, Rebello S, Guo L, Kremer JM. Association among anti-citrullinated protein antibody status, erosive disease and healthcare resource utilization in patients with rheumatoid arthritis. Curr Med Res Opin 2020; 36:337-342. [PMID: 31612736 DOI: 10.1080/03007995.2019.1680354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To characterize the rate of healthcare resource utilization (HCRU) between anti-cyclic citrullinated peptide (CCP; a surrogate for anti-citrullinated protein antibodies [ACPAs]) positive (+) patients with rheumatoid arthritis (RA), either with or without erosions, who initiated biologic disease-modifying antirheumatic drug (bDMARD) treatment.Methods: Data from the Corrona RA registry, a prospective registry of adult patients with RA from 177 sites across 42 states in the US, were analyzed. Annual rates of HCRU (measured based on rates of all-cause hospitalization, joint surgery, imaging procedures and use of assistive devices) were estimated in anti-CCP + patients with and without erosions following bDMARD initiation using a Poisson regression model.Results: Among the 3333 patients with known anti-CCP and erosion status and 12-month post-bDMARD follow-up information in the Corrona registry, 2047 were anti-CCP + and included in this analysis; 868 with and 1179 without erosions. Baseline characteristics were generally well balanced between patients with and without erosions; however, those with erosions had a longer mean RA duration and a higher prior DMARD use. Over 12 months, among anti-CCP + patients, those with erosions had significantly higher rates of all HCRU, except joint surgery, than those without erosions. Age-adjusted risk ratios (95% confidence interval) were as follows: all-cause hospitalization, 1.47 (1.14, 1.90); all-cause imaging, 1.25 (1.03, 1.53); and assistive device use 1.12 (1.00, 1.25). The rate of joint surgery visits was also numerically higher in patients with versus without erosion.Conclusions: ACPA seropositivity with erosive disease was associated with higher rates of HCRU compared with seropositivity without erosions. These findings suggest that providers may want to manage anti-CCP + patients aggressively to achieve better disease control to prevent the development of erosions and the associated increase in HCRU.
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Affiliation(s)
| | | | | | - Evo Alemao
- Bristol-Myers Squibb, Princeton, NJ, USA
| | | | - Lin Guo
- Corrona, LLC, Waltham, MA, USA
| | - Joel M Kremer
- Albany Medical College and The Center for Rheumatology, Albany, NY, USA
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12
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Abstract
Rheumatoid arthritis is a heterogeneous disease, which can be, based on data combining genetic risk factors and autoantibodies, sub-classified into ACPA-positive and -negative RA. Presence of ACPA and RF as well as rising CRP-levels in some patients years before onset of clinical symptoms indicate that relevant immune responses for RA development are initiated very early. ACPA are highly specific for RA, whereas RF can also be found among healthy (elderly) individuals and patients with other autoimmune diseases or infection. The most important genetic risk factor for RA development, the shared epitope alleles, resides in the MHC class II region. Shared epitope alleles, however, only predispose to the development of ACPA-positive RA. Smoking is thus far the most important environmental risk factor associated with the development of RA. Studies on synovitis have shown the importance not only of adaptive but also of innate immune responses. In summary of the various results from immunological changes in blood and synovial tissue, the extension of the immune response from a diffuse myeloid to a lympho-myeloid inflammation appears to be associated with a more successful therapeutic response to biologics. With respect to advances in synovitis research, new targets for treatment against pathological subsets of immune cells or fibroblasts are already on the horizon. However, alternative strategies involving the microbiome may play an important role as well and research in this field is growing rapidly.
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Chen WMY, Subesinghe S, Muller S, Hider SL, Mallen CD, Scott IC. The association between gravidity, parity and the risk of developing rheumatoid arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2019; 50:252-260. [PMID: 31530401 DOI: 10.1016/j.semarthrit.2019.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/18/2019] [Accepted: 09/09/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To establish if gravidity and parity associate with the development of rheumatoid arthritis (RA), and to establish if this effect is influenced by the time elapsed since pregnancy/childbirth, the number of pregnancies/childbirths, and serological status, through systematically reviewing the literature and undertaking a meta-analysis. METHODS We searched Medline/EMBASE (from 1946 to 2018) using the terms "rheumatoid arthritis.mp" or "arthritis, rheumatoid/" and "pregnancy.mp" or "pregnancy/" or "parity.mp" or "parity/" or "gravidity.mp" or "gravidity/" (observational study filter applied). Case-control/cohort studies that examined the relationship between parity/gravidity and the risk of RA in women were included. Studies reporting effect size data for RA in ever vs. never parous/gravid women as ORs/RRs with 95% confidence intervals were included in a meta-analysis. Other relationships (i.e. risk by pregnancy/childbirth numbers) were analysed descriptively. RESULTS Twenty studies (from 626 articles) met our inclusion criteria, comprising 14 case-control (4799 cases; 11,941 controls) and 6 cohort studies (8575 cases; 2,368,439 individuals). No significant association was observed in the meta-analysis of studies reporting the risk of RA in ever vs. never parous women (OR 0.91; 95% CI 0.80-1.04) and ever vs. never gravid women (OR 0.86; 95% CI 0.46-1.62). No consistent evidence of a relationship between the number of pregnancies/childbirths and RA risk was seen. No significant association was observed between being pregnant, or in the immediate post-partum period, and the risk of developing RA. CONCLUSION Our systematic review does not support the concept that gravidity and parity are associated with the risk of RA development.
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Affiliation(s)
- Winnie M Y Chen
- Department of Academic Rheumatology, King's College London, London, UK
| | - Sujith Subesinghe
- Department of Academic Rheumatology, King's College London, London, UK; Department of Rheumatology, Guy's and St Thomas' NHS Trust, London, UK
| | - Sara Muller
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care and Health Sciences, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, Keele, UK
| | - Samantha L Hider
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care and Health Sciences, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, Keele, UK; Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, High Lane, Burslem, Staffordshire, UK
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care and Health Sciences, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, Keele, UK
| | - Ian C Scott
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care and Health Sciences, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, Keele, UK; Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, High Lane, Burslem, Staffordshire, UK.
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14
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Terao C, Brynedal B, Chen Z, Jiang X, Westerlind H, Hansson M, Jakobsson PJ, Lundberg K, Skriner K, Serre G, Rönnelid J, Mathsson-Alm L, Brink M, Dahlqvist SR, Padyukov L, Gregersen PK, Barton A, Alfredsson L, Klareskog L, Raychaudhuri S. Distinct HLA Associations with Rheumatoid Arthritis Subsets Defined by Serological Subphenotype. Am J Hum Genet 2019; 105:616-624. [PMID: 31474319 PMCID: PMC6731376 DOI: 10.1016/j.ajhg.2019.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 07/29/2019] [Indexed: 01/12/2023] Open
Abstract
Rheumatoid arthritis (RA) is the most common immune-mediated arthritis. Anti-citrullinated peptide antibodies (ACPA) are highly specific to RA and assayed with the commercial CCP2 assay. Genetic drivers of RA within the MHC are different for CCP2-positive and -negative subsets of RA, particularly at HLA-DRB1. However, aspartic acid at amino acid position 9 in HLA-B (Bpos-9) increases risk to both RA subsets. Here we explore how individual serologies associated with RA drive associations within the MHC. To define MHC differences for specific ACPA serologies, we quantified a total of 19 separate ACPAs in RA-affected case subjects from four cohorts (n = 6,805). We found a cluster of tightly co-occurring antibodies (canonical serologies, containing CCP2), along with several independently expressed antibodies (non-canonical serologies). After imputing HLA variants into 6,805 case subjects and 13,467 control subjects, we tested associations between the HLA region and RA subgroups based on the presence of canonical and/or non-canonical serologies. We examined CCP2(+) and CCP2(−) RA-affected case subjects separately. In CCP2(−) RA, we observed that the association between CCP2(−) RA and Bpos-9 was derived from individuals who were positive for non-canonical serologies (omnibus_p = 9.2 × 10−17). Similarly, we observed in CCP2(+) RA that associations between subsets of CCP2(+) RA and Bpos-9 were negatively correlated with the number of positive canonical serologies (p = 0.0096). These findings suggest unique genetic characteristics underlying fine-specific ACPAs, suggesting that RA may be further subdivided beyond simply seropositive and seronegative.
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15
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Ishikawa Y, Ikari K, Hashimoto M, Ohmura K, Tanaka M, Ito H, Taniguchi A, Yamanaka H, Mimori T, Terao C. Shared epitope defines distinct associations of cigarette smoking with levels of anticitrullinated protein antibody and rheumatoid factor. Ann Rheum Dis 2019; 78:1480-1487. [PMID: 31427439 DOI: 10.1136/annrheumdis-2019-215463] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/20/2019] [Accepted: 07/23/2019] [Indexed: 01/05/2023]
Abstract
OBJECTS Although the association of cigarette smoking (CS) with susceptibility to rheumatoid arthritis (RA) has been established, the impact of CS on anticitrullinated cyclic peptide/protein antibody (ACPA) and rheumatoid factor (RF) levels in RA has yet been clear, especially in relation to shared epitope (SE) alleles. METHODS A total of 6239 subjects, the largest Asian study ever, from two independent Japanese cohorts were enrolled. Precise smoking histories, levels of ACPA and RF, and HLA-DRB1 allele status were withdrawn from databases. Associations between CS and high ACPA or RF levels, defined by the top quartiles, were evaluated. The effect of HLA-DRB1 alleles on the association was further investigated. RESULTS CS at RA onset conferred the risks of high levels of both antibodies, especially RF (OR 2.06, p=7.4×10-14; ACPA, OR 1.29, p=0.012), suggesting that RF level is more sensitive to CS than ACPA level. The patients who had quitted CS before RA onset showed a trend of decreased risks of developing high levels of ACPA or RF, and the risks steadily decreased according to the cessation years. The association of CS with high ACPA level was observed only in subjects carrying SE alleles, while the association of high RF level was observed regardless of SE. CONCLUSIONS CS confers the risks of high autoantibody levels in RA in different manners; CS interacts with SE alleles on ACPA level, while CS impacts on RF level despite SE allele. These data suggest novel distinct production mechanisms of RF and ACPA.
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Affiliation(s)
- Yuki Ishikawa
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA.,Laboratory for Statistical and Translational Genetics, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan
| | - Katsunori Ikari
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Motomu Hashimoto
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Koichiro Ohmura
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Masao Tanaka
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopeadic Surgery, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Atsuo Taniguchi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, Center for Integrative Medical Sciences, RIKEN, Yokohama, Japan .,Clinical Research Center, Shizuoka General Hospital, Shizuoka, Japan
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16
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Zafari P, Rafiei A, Esmaeili S, Moonesi M, Taghadosi M. Survivin a pivotal antiapoptotic protein in rheumatoid arthritis. J Cell Physiol 2019; 234:21575-21587. [DOI: 10.1002/jcp.28784] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Parisa Zafari
- Department of Immunology School of Medicine, Mazandaran University of Medical Sciences Sari Iran
- Student Research Committee Medical school, Mazandaran University of Medical Sciences Sari Iran
| | - Alireza Rafiei
- Department of Immunology School of Medicine, Mazandaran University of Medical Sciences Sari Iran
| | - Seyed‐Alireza Esmaeili
- Immunology Research Center Bu‐Ali Research Institute, Mashhad University of Medical Sciences Mashhad Iran
- Department of Immunology, Student Research Committee Faculty of Medicine, Mashhad University of Medical Science Mashhad Iran
| | - Mohammadreza Moonesi
- Department of Hematology School of Medicine, Tabriz University of Medical Science Tabriz Iran
| | - Mahdi Taghadosi
- Department of Immunology School of Medicine, Kermanshah University of Medical Sciences Kermanshah Iran
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Abstract
Connective tissue diseases (CTDs), also known as systemic autoimmune diseases, involve a variety of autoantibodies against cellular components. An important factor regarding these autoantibodies is that each antibody is exclusively related to a certain clinical feature of the disease type, which may prove useful in clinical practice. Thus far, more than 100 types of autoantibodies have been found in CTDs, and most of their target antigens have been identified. Many of these autoantigens are enzymes or regulators involved in important cellular functions, such as gene replication, transcription, repair/recombination, RNA processing, and protein synthesis, as well as proteins that form complexes with RNA and DNA. This article reviews the autoantibodies for each CTD, along with an assessment of their clinical significance, and provides suggestions regarding their utilization for clinical practice.
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Affiliation(s)
- Kosaku Murakami
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Japan
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Burbano C, Rojas M, Muñoz-Vahos C, Vanegas-García A, Correa LA, Vásquez G, Castaño D. Extracellular vesicles are associated with the systemic inflammation of patients with seropositive rheumatoid arthritis. Sci Rep 2018; 8:17917. [PMID: 30559453 PMCID: PMC6297132 DOI: 10.1038/s41598-018-36335-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/19/2018] [Indexed: 12/29/2022] Open
Abstract
Patients with rheumatoid arthritis (RA) and autoantibodies, such as rheumatoid factor and those against cyclic citrullinated peptides, are designated as seropositive and have a more severe disease with worse prognosis than seronegative RA patients. Understanding the factors that participate in systemic inflammation, in addition to articular commitment, would allow better treatment approaches for prevention of RA comorbidities and disease reactivation. We evaluated whether monocyte subsets and extracellular vesicles (EVs) could contribute to this phenomenon. Seropositive patients had higher levels of proinflammatory cytokines than those of seronegative patients and healthy controls (HCs); however, this systemic inflammatory profile was unrelated to disease activity. High frequencies of circulating EVs positive for IgG, IgM, CD41a, and citrulline, together with altered counts and receptor expression of intermediate monocytes, were associated with systemic inflammation in seropositive patients; these alterations were not observed in seronegative patients, which seem to be more similar to HCs. Additionally, the EVs from seropositive patients were able to activate mononuclear phagocytes in vitro, and induced proinflammatory cytokines that were comparable to the inflammatory response observed at the systemic level in seropositive RA patients; therefore, all of these factors may contribute to the greater disease severity that has been described in these patients.
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Affiliation(s)
- Catalina Burbano
- Grupo de Inmunología Celular e Inmunogenética, Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No 52-21, Medellín, Colombia
- Unidad de Citometría de Flujo, Sede de Investigación Universitaria, Universidad de Antioquia UdeA, Calle 70 No 52-21, Medellín, Colombia
| | - Mauricio Rojas
- Grupo de Inmunología Celular e Inmunogenética, Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No 52-21, Medellín, Colombia
- Unidad de Citometría de Flujo, Sede de Investigación Universitaria, Universidad de Antioquia UdeA, Calle 70 No 52-21, Medellín, Colombia
| | - Carlos Muñoz-Vahos
- Sección de Reumatología, Hospital Universitario de San Vicente Fundación, Medellín, Colombia
| | - Adriana Vanegas-García
- Sección de Reumatología, Hospital Universitario de San Vicente Fundación, Medellín, Colombia
| | - Luis A Correa
- Sección de Dermatología, Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Laboratorio Clínico VID, Obra de la Congregación Mariana, Medellín, Colombia
| | - Gloria Vásquez
- Grupo de Inmunología Celular e Inmunogenética, Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No 52-21, Medellín, Colombia
| | - Diana Castaño
- Grupo de Inmunología Celular e Inmunogenética, Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia UdeA, Calle 70 No 52-21, Medellín, Colombia.
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Holers VM, Banda NK. Complement in the Initiation and Evolution of Rheumatoid Arthritis. Front Immunol 2018; 9:1057. [PMID: 29892280 PMCID: PMC5985368 DOI: 10.3389/fimmu.2018.01057] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/27/2018] [Indexed: 01/03/2023] Open
Abstract
The complement system is a major component of the immune system and plays a central role in many protective immune processes, including circulating immune complex processing and clearance, recognition of foreign antigens, modulation of humoral and cellular immunity, removal of apoptotic and dead cells, and engagement of injury resolving and tissue regeneration processes. In stark contrast to these beneficial roles, however, inadequately controlled complement activation underlies the pathogenesis of human inflammatory and autoimmune diseases, including rheumatoid arthritis (RA) where the cartilage, bone, and synovium are targeted. Recent studies of this disease have demonstrated that the autoimmune response evolves over time in an asymptomatic preclinical phase that is associated with mucosal inflammation. Notably, experimental models of this disease have demonstrated that each of the three major complement activation pathways plays an important role in recognition of injured joint tissue, although the lectin and amplification pathways exhibit particularly impactful roles in the initiation and amplification of damage. Herein, we review the complement system and focus on its multi-factorial role in human patients with RA and experimental murine models. This understanding will be important to the successful integration of the emerging complement therapeutics pipeline into clinical care for patients with RA.
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Affiliation(s)
| | - Nirmal K. Banda
- Division of Rheumatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Effect of treat-to-target strategies on bone erosion progression in early rheumatoid arthritis: An HR-pQCT study. Semin Arthritis Rheum 2018; 48:374-383. [PMID: 29858113 DOI: 10.1016/j.semarthrit.2018.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 03/12/2018] [Accepted: 05/01/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To investigate the efficacy of two tight-control treatment strategies aimed at simplified disease activity score [SDAI] remission (SDAI ≤ 3.3) compared to DAS28 remission (DAS28 < 2.6) on progression of bone erosions in early rheumatoid arthritis (ERA) patients using high-resolution peripheral quantitative computed tomography (HR-pQCT). METHODS This was an open-label study in which 80 early RA patients were randomized to receive 1-year of tight-control treatment. Group 1 (n = 37) aimed at SDAI ≤ 3.3 and group 2 (n = 43) aimed at DAS28-CRP < 2.6. The number and size of bone erosions, as well as the bone mineral density (BMD) surrounding bone erosion at the second metacarpophalangeal joint (MCP2), were measured at baseline and 12 months. RESULTS After 12 months, images were analyzed in 63 patients. Changes in clinical parameters, number and size of bone erosions as well as the BMD surrounding bone erosion between the two treatment groups were similar. Therefore, a post-hoc analysis including all 63 patients was performed to elucidate the independent predictors of erosion progression and repair. Multivariate analysis revealed that not achieving sustained SDAI remission at month 6, 9 and 12 (p = 0.034) and rheumatoid factor >16U (p = 0.021) were independent predictors associated with an increase in erosion volume. Logistic regression analysis showed that achieving sustained SDAI remission (p = 0.043) was associated with partial erosion repair. CONCLUSIONS Although more stringent treatment target did not notably affect clinical treatment outcome and erosion progression at 1 year, achieving sustained SDAI remission was found to be associated with partial erosion repair.
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Abed El-Gaphar OAM, Abo-Youssef AM, Halal GK. Levetiracetam mitigates lipopolysaccharide-induced JAK2/STAT3 and TLR4/MAPK signaling pathways activation in a rat model of adjuvant- induced arthritis. Eur J Pharmacol 2018; 826:85-95. [PMID: 29501867 DOI: 10.1016/j.ejphar.2018.02.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/21/2018] [Accepted: 02/27/2018] [Indexed: 12/12/2022]
Abstract
Levetiracetam (LEV), a novel anti-epileptic drug that has been demonstrated with an anti-inflammatory effect, but the exact mechanisms of its action remain to be fully defined. The present study aimed to evaluate the possible effects of LEV on lipopolysaccharides (LPS)-induced Janus kinase-signal transducers and activators of transcription (JAK/STAT) as well as toll-like receptor 4 (TLR4)/ mitogen activated protein kinase (MAPK) signaling pathways activation in adjuvant induced arthritis (AIA). Rats were allocated into normal control, three arthritic control groups: Complete Freund's Adjuvant (CFA) (0.4 ml/3days/12days), LPS (100 µg/kg/day), CFA+LPS, and three treated groups: CFA+LEV, LPS+LEV and CFA+LPS+LEV. LEV was administered in a dose 50 mg/kg/day for 15 day. After 28 days, tissue samples were collected for assessment of phosphorylated JAK2, STAT3, TLR4, MAPK and cathepsin K quantitative expression in synovium. Additionally, Serum samples were used for biochemical evaluation of interleukin-6 (IL-6), interleukin-1beta (IL-1B), LPS, anti-citrullinated protein antibody (ACPA) and 8-hydroxydeoxyguanosine (8-OHdG). Histopathological and macroscopical examinations of joints were also performed to support our study. Results indicated that LEV exerted its anti-inflammatory effect through inhibiting LPS-dependent phosphorylation of JAK2/STAT3 signaling. It significantly suppressed TLR4 and MAPK expressions, thereby decreasing release of inflammatory cytokines IL-1β, IL-6.LEV exhibited a potent inhibitory effect on cathepsin K and 8-OHdG parallel to confirmatory histopathological and macroscopical findings. In conclusion, LEV has a powerful therapeutic effect on adjuvant induced arthritis in rats and its mechanisms are strongly related to inhibiting excessive activation of JAK2-STAT3 and TLR4 pathways. This may add a new approach for treatment of RA.
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Affiliation(s)
| | - Amira M Abo-Youssef
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt.
| | - Gouda Kamel Halal
- Pharmacology and Toxicology department, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt.
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Zhang TP, Lv TT, Xu SZ, Pan HF, Ye DQ. Association of interleukin-10 gene single nucleotide polymorphisms with rheumatoid arthritis in a Chinese population. Postgrad Med J 2018; 94:284-288. [PMID: 29487192 DOI: 10.1136/postgradmedj-2017-135441] [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] [Received: 11/13/2017] [Revised: 01/31/2018] [Accepted: 02/12/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE OF THE STUDY Increasing numbers of studies show that interleukin (IL)-10 plays a key role in the pathogenesis of autoimmune diseases including rheumatoid arthritis (RA) and acts as an immunomodulatory cytokine. The purpose of the present study was to analyse the relationship between gene single nucleotide polymorphisms (SNPs) in the IL-10 gene and RA susceptibility. STUDY DESIGN We genotyped three SNPs (rs1800890, rs3024495, rs3024505) of the IL-10 gene in a Chinese population of 354 RA patients and 367 controls. Genotyping was conducted using TaqMan SNP genotyping assays. Plasma IL-10 levels were measured by ELISA. RESULTS The A allele of the rs1800890 variant was significantly related to decreased risk for RA compared with the T allele (A vs T: OR 0.580, 95% CI 0.345 to 0.975, P=0.038). No significant association between the genotype distribution of these SNPs and RA susceptibility was detected. The genotype effect of the dominant model was also evaluated, but no statistical difference was found. Further analysis in RA patients demonstrated that none of these SNPs were associated with rheumatoid factor (RF) or anti-citrullinated protein antibody (anti-CCP). In addition, no significant differences in plasma IL-10 levels were observed among RA patients with different genotypes. CONCLUSIONS The IL-10 rs1800890 variant might contribute to RA susceptibility in the Chinese population. Replication studies in different ethnic groups are required to further examine the critical role of IL-10 gene variation in the pathogenesis of RA.
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Affiliation(s)
- Tian-Ping Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, China
| | - Tian-Tian Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, China
| | - Shu-Zhen Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, China
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, China
| | - Dong-Qing Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, China
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23
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Hiwa R, Ikari K, Ohmura K, Nakabo S, Matsuo K, Saji H, Yurugi K, Miura Y, Maekawa T, Taniguchi A, Yamanaka H, Matsuda F, Mimori T, Terao C. HLA-DRB1 Analysis Identified a Genetically Unique Subset within Rheumatoid Arthritis and Distinct Genetic Background of Rheumatoid Factor Levels from Anticyclic Citrullinated Peptide Antibodies. J Rheumatol 2018; 45:470-480. [PMID: 29419463 DOI: 10.3899/jrheum.170363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE HLA-DRB1 is the most important locus associated with rheumatoid arthritis (RA) and anticitrullinated protein antibodies (ACPA). However, fluctuations of rheumatoid factor (RF) over the disease course have made it difficult to define fine subgroups according to consistent RF positivity for the analyses of genetic background and the levels of RF. METHODS A total of 2873 patients with RA and 2008 healthy controls were recruited. We genotyped HLA-DRB1 alleles for the participants and collected consecutive data of RF in the case subjects. In addition to RF+ and RF- subsets, we classified the RF+ subjects into group 1 (constant RF+) and group 2 (seroconversion). We compared HLA-DRB1 alleles between the RA subsets and controls and performed linear regression analysis to identify HLA-DRB1 alleles associated with maximal RF levels. Omnibus tests were conducted to assess important amino acid positions. RESULTS RF positivity was 88%, and 1372 and 970 RF+ subjects were classified into groups 1 and 2, respectively. RF+ and RF- showed similar genetic associations to ACPA+ and ACPA- RA, respectively. We found that shared epitope (SE) was more enriched in group 2 than 1, p = 2.0 × 10-5, and that amino acid position 11 showed a significant association between 1 and 2, p = 2.7 × 10-5. These associations were independent of ACPA positivity. SE showed a tendency to be negatively correlated with RF titer (p = 0.012). HLA-DRB1*09:01, which reduces ACPA titer, was not associated with RF levels (p = 0.70). CONCLUSION The seroconversion group was shown to have distinct genetic characteristics. The genetic architecture of RF levels is different from that of ACPA.
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Affiliation(s)
- Ryosuke Hiwa
- From the Department of Rheumatology and Clinical Immunology, and the Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto; Institute of Rheumatology, Tokyo Women's Medical University, Tokyo; Aichi Cancer Center Hospital and Research Institute, Nagoya; HLA Laboratory, Kyoto; Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan; Division of Rheumatology, Immunology, and Allergy, and the Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,R. Hiwa, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Ikari, MD, PhD, Associate professor, Institute of Rheumatology, Tokyo Women's Medical University; K. Ohmura, MD, PhD, Associate professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; S. Nakabo, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Matsuo, MD, PhD, Chief, Aichi Cancer Center Hospital and Research Institute; H. Saji, PhD, Director, HLA Laboratory; K. Yurugi, Chief, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; Y. Miura, MD, PhD, Assistant professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; T. Maekawa, MD, PhD, Professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; A. Taniguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; F. Matsuda, PhD, Professor, Center for Genomic Medicine, Graduate School of Medicine, Kyoto University; T. Mimori, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; C. Terao, MD, PhD, Assistant professor, Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, and the Division of Rheumatology, Immunology, and Allergy, and Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, and Program in Medical and Population Genetics, Broad Institute
| | - Katsunori Ikari
- From the Department of Rheumatology and Clinical Immunology, and the Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto; Institute of Rheumatology, Tokyo Women's Medical University, Tokyo; Aichi Cancer Center Hospital and Research Institute, Nagoya; HLA Laboratory, Kyoto; Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan; Division of Rheumatology, Immunology, and Allergy, and the Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,R. Hiwa, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Ikari, MD, PhD, Associate professor, Institute of Rheumatology, Tokyo Women's Medical University; K. Ohmura, MD, PhD, Associate professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; S. Nakabo, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Matsuo, MD, PhD, Chief, Aichi Cancer Center Hospital and Research Institute; H. Saji, PhD, Director, HLA Laboratory; K. Yurugi, Chief, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; Y. Miura, MD, PhD, Assistant professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; T. Maekawa, MD, PhD, Professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; A. Taniguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; F. Matsuda, PhD, Professor, Center for Genomic Medicine, Graduate School of Medicine, Kyoto University; T. Mimori, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; C. Terao, MD, PhD, Assistant professor, Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, and the Division of Rheumatology, Immunology, and Allergy, and Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, and Program in Medical and Population Genetics, Broad Institute
| | - Koichiro Ohmura
- From the Department of Rheumatology and Clinical Immunology, and the Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto; Institute of Rheumatology, Tokyo Women's Medical University, Tokyo; Aichi Cancer Center Hospital and Research Institute, Nagoya; HLA Laboratory, Kyoto; Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan; Division of Rheumatology, Immunology, and Allergy, and the Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,R. Hiwa, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Ikari, MD, PhD, Associate professor, Institute of Rheumatology, Tokyo Women's Medical University; K. Ohmura, MD, PhD, Associate professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; S. Nakabo, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Matsuo, MD, PhD, Chief, Aichi Cancer Center Hospital and Research Institute; H. Saji, PhD, Director, HLA Laboratory; K. Yurugi, Chief, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; Y. Miura, MD, PhD, Assistant professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; T. Maekawa, MD, PhD, Professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; A. Taniguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; F. Matsuda, PhD, Professor, Center for Genomic Medicine, Graduate School of Medicine, Kyoto University; T. Mimori, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; C. Terao, MD, PhD, Assistant professor, Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, and the Division of Rheumatology, Immunology, and Allergy, and Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, and Program in Medical and Population Genetics, Broad Institute
| | - Shuichiro Nakabo
- From the Department of Rheumatology and Clinical Immunology, and the Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto; Institute of Rheumatology, Tokyo Women's Medical University, Tokyo; Aichi Cancer Center Hospital and Research Institute, Nagoya; HLA Laboratory, Kyoto; Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan; Division of Rheumatology, Immunology, and Allergy, and the Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,R. Hiwa, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Ikari, MD, PhD, Associate professor, Institute of Rheumatology, Tokyo Women's Medical University; K. Ohmura, MD, PhD, Associate professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; S. Nakabo, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Matsuo, MD, PhD, Chief, Aichi Cancer Center Hospital and Research Institute; H. Saji, PhD, Director, HLA Laboratory; K. Yurugi, Chief, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; Y. Miura, MD, PhD, Assistant professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; T. Maekawa, MD, PhD, Professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; A. Taniguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; F. Matsuda, PhD, Professor, Center for Genomic Medicine, Graduate School of Medicine, Kyoto University; T. Mimori, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; C. Terao, MD, PhD, Assistant professor, Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, and the Division of Rheumatology, Immunology, and Allergy, and Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, and Program in Medical and Population Genetics, Broad Institute
| | - Keitaro Matsuo
- From the Department of Rheumatology and Clinical Immunology, and the Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto; Institute of Rheumatology, Tokyo Women's Medical University, Tokyo; Aichi Cancer Center Hospital and Research Institute, Nagoya; HLA Laboratory, Kyoto; Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan; Division of Rheumatology, Immunology, and Allergy, and the Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,R. Hiwa, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Ikari, MD, PhD, Associate professor, Institute of Rheumatology, Tokyo Women's Medical University; K. Ohmura, MD, PhD, Associate professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; S. Nakabo, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Matsuo, MD, PhD, Chief, Aichi Cancer Center Hospital and Research Institute; H. Saji, PhD, Director, HLA Laboratory; K. Yurugi, Chief, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; Y. Miura, MD, PhD, Assistant professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; T. Maekawa, MD, PhD, Professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; A. Taniguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; F. Matsuda, PhD, Professor, Center for Genomic Medicine, Graduate School of Medicine, Kyoto University; T. Mimori, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; C. Terao, MD, PhD, Assistant professor, Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, and the Division of Rheumatology, Immunology, and Allergy, and Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, and Program in Medical and Population Genetics, Broad Institute
| | - Hiroh Saji
- From the Department of Rheumatology and Clinical Immunology, and the Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto; Institute of Rheumatology, Tokyo Women's Medical University, Tokyo; Aichi Cancer Center Hospital and Research Institute, Nagoya; HLA Laboratory, Kyoto; Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan; Division of Rheumatology, Immunology, and Allergy, and the Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,R. Hiwa, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Ikari, MD, PhD, Associate professor, Institute of Rheumatology, Tokyo Women's Medical University; K. Ohmura, MD, PhD, Associate professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; S. Nakabo, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Matsuo, MD, PhD, Chief, Aichi Cancer Center Hospital and Research Institute; H. Saji, PhD, Director, HLA Laboratory; K. Yurugi, Chief, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; Y. Miura, MD, PhD, Assistant professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; T. Maekawa, MD, PhD, Professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; A. Taniguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; F. Matsuda, PhD, Professor, Center for Genomic Medicine, Graduate School of Medicine, Kyoto University; T. Mimori, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; C. Terao, MD, PhD, Assistant professor, Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, and the Division of Rheumatology, Immunology, and Allergy, and Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, and Program in Medical and Population Genetics, Broad Institute
| | - Kimiko Yurugi
- From the Department of Rheumatology and Clinical Immunology, and the Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto; Institute of Rheumatology, Tokyo Women's Medical University, Tokyo; Aichi Cancer Center Hospital and Research Institute, Nagoya; HLA Laboratory, Kyoto; Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan; Division of Rheumatology, Immunology, and Allergy, and the Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,R. Hiwa, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Ikari, MD, PhD, Associate professor, Institute of Rheumatology, Tokyo Women's Medical University; K. Ohmura, MD, PhD, Associate professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; S. Nakabo, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Matsuo, MD, PhD, Chief, Aichi Cancer Center Hospital and Research Institute; H. Saji, PhD, Director, HLA Laboratory; K. Yurugi, Chief, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; Y. Miura, MD, PhD, Assistant professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; T. Maekawa, MD, PhD, Professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; A. Taniguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; F. Matsuda, PhD, Professor, Center for Genomic Medicine, Graduate School of Medicine, Kyoto University; T. Mimori, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; C. Terao, MD, PhD, Assistant professor, Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, and the Division of Rheumatology, Immunology, and Allergy, and Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, and Program in Medical and Population Genetics, Broad Institute
| | - Yasuo Miura
- From the Department of Rheumatology and Clinical Immunology, and the Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto; Institute of Rheumatology, Tokyo Women's Medical University, Tokyo; Aichi Cancer Center Hospital and Research Institute, Nagoya; HLA Laboratory, Kyoto; Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan; Division of Rheumatology, Immunology, and Allergy, and the Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,R. Hiwa, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Ikari, MD, PhD, Associate professor, Institute of Rheumatology, Tokyo Women's Medical University; K. Ohmura, MD, PhD, Associate professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; S. Nakabo, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Matsuo, MD, PhD, Chief, Aichi Cancer Center Hospital and Research Institute; H. Saji, PhD, Director, HLA Laboratory; K. Yurugi, Chief, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; Y. Miura, MD, PhD, Assistant professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; T. Maekawa, MD, PhD, Professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; A. Taniguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; F. Matsuda, PhD, Professor, Center for Genomic Medicine, Graduate School of Medicine, Kyoto University; T. Mimori, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; C. Terao, MD, PhD, Assistant professor, Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, and the Division of Rheumatology, Immunology, and Allergy, and Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, and Program in Medical and Population Genetics, Broad Institute
| | - Taira Maekawa
- From the Department of Rheumatology and Clinical Immunology, and the Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto; Institute of Rheumatology, Tokyo Women's Medical University, Tokyo; Aichi Cancer Center Hospital and Research Institute, Nagoya; HLA Laboratory, Kyoto; Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan; Division of Rheumatology, Immunology, and Allergy, and the Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,R. Hiwa, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Ikari, MD, PhD, Associate professor, Institute of Rheumatology, Tokyo Women's Medical University; K. Ohmura, MD, PhD, Associate professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; S. Nakabo, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Matsuo, MD, PhD, Chief, Aichi Cancer Center Hospital and Research Institute; H. Saji, PhD, Director, HLA Laboratory; K. Yurugi, Chief, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; Y. Miura, MD, PhD, Assistant professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; T. Maekawa, MD, PhD, Professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; A. Taniguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; F. Matsuda, PhD, Professor, Center for Genomic Medicine, Graduate School of Medicine, Kyoto University; T. Mimori, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; C. Terao, MD, PhD, Assistant professor, Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, and the Division of Rheumatology, Immunology, and Allergy, and Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, and Program in Medical and Population Genetics, Broad Institute
| | - Atsuo Taniguchi
- From the Department of Rheumatology and Clinical Immunology, and the Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto; Institute of Rheumatology, Tokyo Women's Medical University, Tokyo; Aichi Cancer Center Hospital and Research Institute, Nagoya; HLA Laboratory, Kyoto; Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan; Division of Rheumatology, Immunology, and Allergy, and the Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,R. Hiwa, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Ikari, MD, PhD, Associate professor, Institute of Rheumatology, Tokyo Women's Medical University; K. Ohmura, MD, PhD, Associate professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; S. Nakabo, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Matsuo, MD, PhD, Chief, Aichi Cancer Center Hospital and Research Institute; H. Saji, PhD, Director, HLA Laboratory; K. Yurugi, Chief, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; Y. Miura, MD, PhD, Assistant professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; T. Maekawa, MD, PhD, Professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; A. Taniguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; F. Matsuda, PhD, Professor, Center for Genomic Medicine, Graduate School of Medicine, Kyoto University; T. Mimori, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; C. Terao, MD, PhD, Assistant professor, Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, and the Division of Rheumatology, Immunology, and Allergy, and Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, and Program in Medical and Population Genetics, Broad Institute
| | - Hisashi Yamanaka
- From the Department of Rheumatology and Clinical Immunology, and the Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto; Institute of Rheumatology, Tokyo Women's Medical University, Tokyo; Aichi Cancer Center Hospital and Research Institute, Nagoya; HLA Laboratory, Kyoto; Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan; Division of Rheumatology, Immunology, and Allergy, and the Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,R. Hiwa, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Ikari, MD, PhD, Associate professor, Institute of Rheumatology, Tokyo Women's Medical University; K. Ohmura, MD, PhD, Associate professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; S. Nakabo, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Matsuo, MD, PhD, Chief, Aichi Cancer Center Hospital and Research Institute; H. Saji, PhD, Director, HLA Laboratory; K. Yurugi, Chief, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; Y. Miura, MD, PhD, Assistant professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; T. Maekawa, MD, PhD, Professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; A. Taniguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; F. Matsuda, PhD, Professor, Center for Genomic Medicine, Graduate School of Medicine, Kyoto University; T. Mimori, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; C. Terao, MD, PhD, Assistant professor, Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, and the Division of Rheumatology, Immunology, and Allergy, and Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, and Program in Medical and Population Genetics, Broad Institute
| | - Fumihiko Matsuda
- From the Department of Rheumatology and Clinical Immunology, and the Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto; Institute of Rheumatology, Tokyo Women's Medical University, Tokyo; Aichi Cancer Center Hospital and Research Institute, Nagoya; HLA Laboratory, Kyoto; Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan; Division of Rheumatology, Immunology, and Allergy, and the Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,R. Hiwa, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Ikari, MD, PhD, Associate professor, Institute of Rheumatology, Tokyo Women's Medical University; K. Ohmura, MD, PhD, Associate professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; S. Nakabo, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Matsuo, MD, PhD, Chief, Aichi Cancer Center Hospital and Research Institute; H. Saji, PhD, Director, HLA Laboratory; K. Yurugi, Chief, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; Y. Miura, MD, PhD, Assistant professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; T. Maekawa, MD, PhD, Professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; A. Taniguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; F. Matsuda, PhD, Professor, Center for Genomic Medicine, Graduate School of Medicine, Kyoto University; T. Mimori, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; C. Terao, MD, PhD, Assistant professor, Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, and the Division of Rheumatology, Immunology, and Allergy, and Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, and Program in Medical and Population Genetics, Broad Institute
| | - Tsuneyo Mimori
- From the Department of Rheumatology and Clinical Immunology, and the Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto; Institute of Rheumatology, Tokyo Women's Medical University, Tokyo; Aichi Cancer Center Hospital and Research Institute, Nagoya; HLA Laboratory, Kyoto; Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan; Division of Rheumatology, Immunology, and Allergy, and the Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,R. Hiwa, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Ikari, MD, PhD, Associate professor, Institute of Rheumatology, Tokyo Women's Medical University; K. Ohmura, MD, PhD, Associate professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; S. Nakabo, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Matsuo, MD, PhD, Chief, Aichi Cancer Center Hospital and Research Institute; H. Saji, PhD, Director, HLA Laboratory; K. Yurugi, Chief, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; Y. Miura, MD, PhD, Assistant professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; T. Maekawa, MD, PhD, Professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; A. Taniguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; F. Matsuda, PhD, Professor, Center for Genomic Medicine, Graduate School of Medicine, Kyoto University; T. Mimori, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; C. Terao, MD, PhD, Assistant professor, Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, and the Division of Rheumatology, Immunology, and Allergy, and Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, and Program in Medical and Population Genetics, Broad Institute
| | - Chikashi Terao
- From the Department of Rheumatology and Clinical Immunology, and the Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto; Institute of Rheumatology, Tokyo Women's Medical University, Tokyo; Aichi Cancer Center Hospital and Research Institute, Nagoya; HLA Laboratory, Kyoto; Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital, Kyoto, Japan; Division of Rheumatology, Immunology, and Allergy, and the Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA. .,R. Hiwa, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Ikari, MD, PhD, Associate professor, Institute of Rheumatology, Tokyo Women's Medical University; K. Ohmura, MD, PhD, Associate professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; S. Nakabo, MD, Research student, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; K. Matsuo, MD, PhD, Chief, Aichi Cancer Center Hospital and Research Institute; H. Saji, PhD, Director, HLA Laboratory; K. Yurugi, Chief, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; Y. Miura, MD, PhD, Assistant professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; T. Maekawa, MD, PhD, Professor, Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; A. Taniguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; F. Matsuda, PhD, Professor, Center for Genomic Medicine, Graduate School of Medicine, Kyoto University; T. Mimori, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University; C. Terao, MD, PhD, Assistant professor, Center for Genomic Medicine, Graduate School of Medicine, and the Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, and the Division of Rheumatology, Immunology, and Allergy, and Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, and Program in Medical and Population Genetics, Broad Institute.
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Cordero OJ, Varela-Calviño R, López-González T, Grujic M, Juranic Z, Mouriño C, Hernández-Rodríguez Í, Rodríguez-López M, de la Iglesia BA, Pego-Reigosa JM. Anti-CD26 autoantibodies are involved in rheumatoid arthritis and show potential clinical interest. Clin Biochem 2017; 50:903-910. [DOI: 10.1016/j.clinbiochem.2017.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/19/2017] [Accepted: 06/05/2017] [Indexed: 11/25/2022]
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25
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Terao C, Okada Y, Ikari K, Kochi Y, Suzuki A, Ohmura K, Matsuo K, Taniguchi A, Kubo M, Raychaudhuri S, Yamamoto K, Yamanaka H, Kamatani Y, Mimori T, Matsuda F. Genetic landscape of interactive effects of HLA-DRB1 alleles on susceptibility to ACPA(+) rheumatoid arthritis and ACPA levels in Japanese population. J Med Genet 2017; 54:853-858. [PMID: 29025870 DOI: 10.1136/jmedgenet-2017-104779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/28/2017] [Accepted: 09/18/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND HLA-DRB1 is the strongest susceptibility gene to rheumatoid arthritis (RA). HLA-DRB1 alleles showed significant non-additive and interactive effects on susceptibility to RA in the European population, but these effects on RA susceptibility should vary between populations due to the difference in allelic distribution. Furthermore, non-additive or interactive effects on the phenotypes of RA are not fully known. We evaluated the non-additive and interactive effects of HLA-DRB1 alleles on RA susceptibility and anticitrullinated protein/peptide antibody (ACPA) levels in Japanese patients. METHODS A total of 5581 ACPA(+) RA and 19 170 controls were genotyped or imputed for HLA-DRB1 alleles. Logistic regression analysis was performed for both allelic non-additive effects and interactive effects of allelic combinations. The significant levels were set by Bonferroni's correction. A total of 4371 ACPA(+) RA were analysed for ACPA levels. RESULTS We obtained evidence of non-additive and interactive effects of HLA-DRB1 on ACPA(+) RA susceptibility (p=2.5×10-5 and 1.5×10-17, respectively). Multiple HLA-DRB1 alleles including HLA-DRB1*04:05, the most common susceptibility allele in the Japanese, showed significant non-additive effects (p≤0.0043). We identified multiple allelic combinations with significant interactive effects including a common combination with the European population as well as novel combinations. Additional variance of ACPA(+) RA susceptibility could be explained substantially by heterozygote dominance or interactive effects. We did not find evidence of non-additive and interactive effects on levels of ACPA. CONCLUSION HLA allelic non-additive and interactive effects on ACPA(+) RA susceptibility were observed in the Japanese population. The allelic non-additive and interactive effects depend on allelic distribution in populations.
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Affiliation(s)
- Chikashi Terao
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan.,Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Osaka, Japan.,Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan.,Laboratory of Statistical Immunology, Immunology, Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
| | - Katsunori Ikari
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.,Core Research for Evolutional Science and Technology, Japan Science and Technology Agency, Kyoto, Japan
| | - Yuta Kochi
- Laboratory for Autoimmune Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Akari Suzuki
- Laboratory for Autoimmune Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Koichiro Ohmura
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Keitaro Matsuo
- Division of Molecular and Clinical Epidemiology, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Atsuo Taniguchi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Michiaki Kubo
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Soumya Raychaudhuri
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,Arthritis Research UK Epidemiology Unit, Musculoskeletal Research Group, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Kazuhiko Yamamoto
- Laboratory for Autoimmune Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoichiro Kamatani
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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26
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Anti-centromere antibody exhibits specific distribution levels among anti-nuclear antibodies and may characterize a distinct subset in rheumatoid arthritis. Sci Rep 2017; 7:6911. [PMID: 28761166 PMCID: PMC5537247 DOI: 10.1038/s41598-017-07137-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/22/2017] [Indexed: 11/09/2022] Open
Abstract
Anti-centromere antibody (ACA) is one of the classical anti-nuclear antibody (ANA) staining patterns. However, characteristics of ACA in comparison with the other ANA patterns and clinical features of ACA-positive subjects have not been elucidated. Here, we examined all ANA patterns by indirect immunofluorescence for 859 rheumatoid arthritis (RA) patients. Together with the ANA data of 9,575 healthy volunteers, we compared distributions of the ANA levels. ACA was the only ANA that demonstrated a definite bimodal distribution of levels. ACA showed significantly higher levels than the other ANA staining patterns in both RA and healthy population (p < 0.0001). ACA-positivity was associated with old age and was observed more in females. We further recruited another cohort of 3,353 RA patients and confirmed the findings. ACA was also associated with Raynaud's phenomenon (p = 6.8 × 10-11) in RA. As a conclusion, ACA displays a specific ANA staining pattern with a bimodal distribution, and ACA-positive RA may constitute a distinct subset with specific clinical features.
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27
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Viatte S, Massey J, Bowes J, Duffus K, Eyre S, Barton A, Worthington J. Replication of Associations of Genetic Loci Outside the HLA Region With Susceptibility to Anti-Cyclic Citrullinated Peptide-Negative Rheumatoid Arthritis. Arthritis Rheumatol 2017; 68:1603-13. [PMID: 26895230 PMCID: PMC4924598 DOI: 10.1002/art.39619] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 01/28/2016] [Indexed: 12/29/2022]
Abstract
Objective Genetic polymorphisms within the HLA region explain only a modest proportion of anti–cyclic citrullinated peptide (anti‐CCP)–negative rheumatoid arthritis (RA) heritability. However, few non‐HLA markers have been identified so far. This study was undertaken to replicate the associations of anti‐CCP–negative RA with non‐HLA genetic polymorphisms demonstrated in a previous study. Methods The Rheumatoid Arthritis Consortium International densely genotyped 186 autoimmune‐related regions in3,339 anti‐CCP–negative RA patients and 15,870 controls across 6 different populations using the Illumina ImmunoChip array. We performed a case–control replication study of the anti‐CCP–negative markers with the strongest associations in that discovery study, in an independent cohort of anti‐CCP–negative UK RA patients. Individuals from the arcOGENConsortium and Wellcome Trust Case Control Consortium were used as controls. Genotyping in cases was performed using Sequenom MassArray technology. Genome‐wide data from controls were imputed using the 1000 Genomes Phase I integrated variant call set release version 3 as a reference panel. Results After genotyping and imputation quality control procedures, data were available for 15 non‐HLA single‐nucleotide polymorphisms in 1,024 cases and 6,348 controls. We confirmed the known markers ANKRD55 (meta‐analysis odds ratio [OR] 0.80; P = 2.8 × 10−13)and BLK (OR 1.13; P = 7.0 × 10−6) and identified new and specific markers of anti‐CCP–negative RA (prolactin [PRL] [OR 1.13; P = 2.1 × 10−6] and NFIA [OR 0.85; P = 2.5 × 10−6]). Neither of these loci is associated with other common, complex autoimmune diseases. Conclusion Anti‐CCP–negative RA and anti‐CCP–positive RA are genetically different disease subsets that only partially share susceptibility factors. Genetic polymorphisms located near the PRL and NFIA genes represent examples of genetic susceptibility factors specific for anti‐CCP–negative RA.
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Affiliation(s)
- Sebastien Viatte
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, and University of Manchester, Manchester, UK
| | - Jonathan Massey
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, and University of Manchester, Manchester, UK
| | - John Bowes
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, and University of Manchester, Manchester, UK
| | - Kate Duffus
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, and University of Manchester, Manchester, UK
| | | | - Stephen Eyre
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, and University of Manchester, Manchester, UK
| | - Anne Barton
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, and University of Manchester, Manchester, UK
| | - Jane Worthington
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, and University of Manchester, Manchester, UK
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28
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Zhou JZ, Li JJ, Hua DJ, Huang SC, Sun QQ, Huang H, Xin XF, Cen H. A study on associations of single-nucleotide polymorphisms within H19 and HOX transcript antisense RNA (HOTAIR) with genetic susceptibility to rheumatoid arthritis in a Chinese population. Inflamm Res 2017; 66:515-521. [DOI: 10.1007/s00011-017-1035-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 01/22/2023] Open
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Terao C, Yoshifuji H, Yamano Y, Kojima H, Yurugi K, Miura Y, Maekawa T, Handa H, Ohmura K, Saji H, Mimori T, Matsuda F. Genotyping of relapsing polychondritis identified novel susceptibility HLA alleles and distinct genetic characteristics from other rheumatic diseases. Rheumatology (Oxford) 2016; 55:1686-92. [DOI: 10.1093/rheumatology/kew233] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Indexed: 11/14/2022] Open
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30
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Terao C, Raychaudhuri S, Gregersen PK. Recent Advances in Defining the Genetic Basis of Rheumatoid Arthritis. Annu Rev Genomics Hum Genet 2016; 17:273-301. [PMID: 27216775 DOI: 10.1146/annurev-genom-090314-045919] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Rheumatoid arthritis (RA) is the most common inflammatory arthritis and exhibits genetic overlap with other autoimmune and inflammatory disorders. Although predominant associations with the HLA-DRB1 locus have been known for decades, recent data have revealed additional insight into the likely causative variants within HLA-DRB1 as well as within other HLA loci that contribute to disease risk. In addition, more than 100 common variants in non-HLA loci have been implicated in disease susceptibility. Genetic factors are involved not only in the development of RA, but also with various disease subphenotypes, including production and circulating levels of autoantibodies and joint destruction. The major current challenge is to integrate these new data into a precise understanding of disease pathogenesis, including the critical cell types and molecular networks involved as well as interactions with environmental factors. We predict that delineating the functional effects of genetic variants is likely to drive new diagnostic and therapeutic approaches to the disease.
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Affiliation(s)
- Chikashi Terao
- Divisions of Genetics and Rheumatology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115.,Partners Center for Personalized Genetic Medicine, Boston, Massachusetts 02115.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142; .,Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto 606-8501, Japan;
| | - Soumya Raychaudhuri
- Divisions of Genetics and Rheumatology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115.,Partners Center for Personalized Genetic Medicine, Boston, Massachusetts 02115.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142; .,Institute of Inflammation and Repair, University of Manchester, M15 6SZ Manchester, United Kingdom.,Rheumatology Unit, Department of Medicine, Karolinska Institutet and Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden
| | - Peter K Gregersen
- Robert S. Boas Center for Genomics and Human Genetics, The Feinstein Institute for Medical Research, Manhasset, New York 11030;
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31
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Terao C, Yamakawa N, Yano K, Markusse IM, Ikari K, Yoshida S, Furu M, Hashimoto M, Ito H, Fujii T, Ohmura K, Murakami K, Takahashi M, Hamaguchi M, Tabara Y, Taniguchi A, Momohara S, Raychaudhuri S, Allaart CF, Yamanaka H, Mimori T, Matsuda F. Rheumatoid Factor Is Associated With the Distribution of Hand Joint Destruction in Rheumatoid Arthritis. Arthritis Rheumatol 2016; 67:3113-23. [PMID: 26245322 DOI: 10.1002/art.39306] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/23/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is a chronic disease leading to joint destruction. Although many studies have addressed factors potentially correlated with the speed of joint destruction, less attention has been paid to the distribution of joint destruction in patients with RA. In this study, destruction of the hand bones in patients with RA was classified into 2 anatomic subgroups, the fingers and the non-fingers, with the aim of analyzing which factors are associated with destruction of the finger joints. METHODS A total of 1,215 Japanese patients with RA were recruited from 2 different populations. The degree of joint destruction was assessed using the total modified Sharp/van der Heijde score (SHS) of radiographic joint damage. The SHS score of joint damage in the finger joints was used as the dependent variable, and the SHS score in the non-finger joints was used as a covariate. Age, sex, disease duration, smoking, C-reactive protein level, treatment for RA, and positivity for and levels of anti-citrullinated protein antibodies and rheumatoid factor (RF) were evaluated as candidate correlates. Overall effect sizes were assessed in a meta-analysis. In addition, associations observed in the Japanese patients were compared to those in a cohort of 157 Dutch RA patients in the BeSt study (a randomized, controlled trial involving 4 different strictly specified treatment strategies for early RA). RESULTS Not surprisingly, disease duration in Japanese patients with RA was associated with the finger SHS score (P ≤ 0.00037). Both positivity for and levels of RF showed significant associations with the finger SHS score after adjustment for covariates (P = 0.0022 and P = 8.1 × 10(-7) , respectively). These associations were also true in relation to the time-averaged finger SHS score. An association between RF positivity and the finger SHS score was also observed in Dutch patients with RA in the BeSt study (P = 0.049). CONCLUSION Positivity for and levels of RF are associated with finger joint destruction independent of non-finger joint destruction and other covariates. Our findings suggest that there are different mechanisms of joint destruction operating in the finger joints of patients with RA.
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Affiliation(s)
- Chikashi Terao
- Kyoto University Graduate School of Medicine, Kyoto, Japan, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and Broad Institute, Cambridge, Massachusetts
| | | | | | | | - Katsunori Ikari
- Tokyo Women's Medical University and CREST Program, Japan Science and Technology Agency, Tokyo, Japan
| | | | - Moritoshi Furu
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Hiromu Ito
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takao Fujii
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | | | - Masahide Hamaguchi
- Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | | | | | | | - Soumya Raychaudhuri
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, Broad Institute, Cambridge, Massachusetts, and University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | | | | | - Tsuneyo Mimori
- Kyoto University Graduate School of Medicine, Kyoto, Japan
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Terao C, Suzuki A, Ikari K, Kochi Y, Ohmura K, Katayama M, Nakabo S, Yamamoto N, Suzuki T, Iwamoto T, Yurugi K, Miura Y, Maekawa T, Takasugi K, Kubo M, Saji H, Taniguchi A, Momohara S, Yamamoto K, Yamanaka H, Mimori T, Matsuda F. An association between amino acid position 74 of HLA-DRB1 and anti-citrullinated protein antibody levels in Japanese patients with anti-citrullinated protein antibody-positive rheumatoid arthritis. Arthritis Rheumatol 2015; 67:2038-45. [PMID: 25832994 DOI: 10.1002/art.39133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/24/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Anti-citrullinated protein antibodies (ACPAs) are highly specific to rheumatoid arthritis (RA), and strong associations between HLA-DRB1 alleles and ACPA levels have been detected in RA patients. We undertook this study to elucidate the associations between particular amino acid positions in HLA-DRB1 and ACPA levels in patients with RA. METHODS We analyzed ACPA data on a total of 4,371 Japanese ACPA-positive RA patients in whom HLA-DRB1 allele genotyping had been performed. Generalized linear regression analysis and omnibus testing were carried out to determine associations of HLA-DRB1 alleles, amino acid residues, or amino acid positions with levels of ACPA. RESULTS HLA-DRB1*09:01 and HLA-DR15 were confirmed to be associated with ACPA levels. HLA-DRB1*08:03 and DRB1*14:06 were associated with reduced and increased ACPA levels, respectively. We detected a strong association between ACPA levels and amino acid position 74 (P = 1.9 × 10(-51) ). The association was mainly conferred by alanine residue (P = 4.5 × 10(-51) ). After adjustment for position 74, amino acid positions 60 and 57 were found to be associated with ACPA levels. Amino acid positions 74 and 57 had previously been reported to be associated with susceptibility to ACPA-positive RA in Asians. Combinations of the amino acid residues at position 74 and position 60 or 57 could induce improvement in Akaike's information criterion comparable to that induced by the 5 significant HLA-DRB1 alleles (HLA-DRB1*08:03, DRB1*09:01, DRB1*14:06, DRB1*15:01, and DRB1*15:02). CONCLUSION Amino acid position 74 in HLA-DRB1 is strongly associated with ACPA levels in ACPA-positive RA, as well as with RA susceptibility. The mechanisms of ACPA production and susceptibility to ACPA-positive RA seem to partly overlap.
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Affiliation(s)
- Chikashi Terao
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akari Suzuki
- Center for Genomic Medicine, RIKEN, Yokohama, Japan
| | | | - Yuta Kochi
- Center for Genomic Medicine, RIKEN, Yokohama, Japan
| | | | | | | | | | - Taku Suzuki
- Tokyo Women's Medical University, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | - Tsuneyo Mimori
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Fumihiko Matsuda
- Kyoto University Graduate School of Medicine and INSERM U852, Kyoto, Japan, and CREST Program, Japan Science and Technology Agency, Kawaguchi, Japan
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The amount of citrullinated proteins in synovial tissue is related to serum anti-cyclic citrullinated peptide (anti-CCP) antibody levels. Clin Rheumatol 2015; 35:55-61. [PMID: 26255191 DOI: 10.1007/s10067-015-3047-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
The objective of this study was to determine the relationship between citrullinated proteins in synovial tissue with peripheral anti-citrullinated peptides autoantibodies (ACPA) and peptidylarginine deiminase (PADI) PADI2, PADI3, and PADI4 messenger RNA (mRNA) expressions in synovial tissue and fibroblast-like synoviocytes in rheumatoid arthritis (RA) patients. Eleven RA and 12 osteoarthritis (OA) patients who underwent knee replacement surgery were studied. We detected citrullinated proteins in synovial tissue homogenates by western blot and serum ACPA by ELISA to anti-cyclic citrullinated peptide (anti-CCP) antibodies, and PADI2, PADI3, and PADI4 mRNA expressions in synovial tissue and in fibroblast-like synoviocytes. Patients with high amount of citrullinated proteins in synovial tissue (3 out of 7) have high levels of anti-CCP in serum. However, in the remaining 4 patients, the amount of synovial citrullinated proteins was minimal and their sera showed low levels of anti-CCP antibodies. Furthermore, we observed an increase in PADI2 mRNA expression in RA synovial tissue compared with OA patients (p = 0.02). We detected PADI3 mRNA in the synovial tissue of RA patients, but not in the tissue of OA patients. Even though fibroblast-type synoviocytes in RA are not the main source of PADs in the synovial tissue, they express PADI2 mRNA moderately, PADI4 mRNA weakly, while there is no detectable expression of PADI3 mRNA. In conclusion, we found a variety of citrullinated proteins in the synovial tissue of RA patients and the amount of such proteins is related to serum concentration of anti-CCP antibodies. We identified the presence of PADI3 mRNA expression in synovial tissue and PADI2 and PADI4 mRNA expressions in fibroblast-like synoviocytes from patients with RA.
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Dunaeva M, Buddingh’ BC, Toes REM, Luime JJ, Lubberts E, Pruijn GJM. Decreased serum cell-free DNA levels in rheumatoid arthritis. AUTOIMMUNITY HIGHLIGHTS 2015; 6:23-30. [PMID: 26113482 PMCID: PMC4536238 DOI: 10.1007/s13317-015-0066-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/28/2015] [Indexed: 01/05/2023]
Abstract
Purpose Recent studies have demonstrated that serum/plasma DNA and RNA molecules in addition to proteins can serve as biomarkers. Elevated levels of these nucleic acids have been found not only in acute, but also in chronic conditions, including autoimmune diseases. The aim of this study was to assess cell-free DNA (cfDNA) levels in sera of rheumatoid arthritis (RA) patients compared to controls. Methods cfDNA was extracted from sera of patients with early and established RA, relapsing-remitting multiple sclerosis patients (RRMS) and healthy subjects, and its concentration was determined by quantitative PCR using two amplicons, Alu115 and β-actin205, corresponding to Alu repetitive elements and the β-actin single-copy gene, respectively. Serum DNase activity was measured by a single radial enzyme diffusion method. Results Reduced levels of cfDNA were observed in patients with established RA in comparison with healthy controls, early RA patients and RRMS patients. There were no significant differences in cfDNA concentration between healthy controls, early RA and RRMS patients. Total DNase activity appeared to be similar in the sera of all tested groups. Conclusions Our results demonstrate that cfDNA levels are strongly reduced in the sera of established RA patients, which is not caused by changes in DNase activity. Measurement of cfDNA can distinguish established RA patients from early RA patients. Thus, cfDNA may serve as a biomarker in RA. Electronic supplementary material The online version of this article (doi:10.1007/s13317-015-0066-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marina Dunaeva
- />284 Department of Biomolecular Chemistry, Institute for Molecules and Materials and Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Bastiaan C. Buddingh’
- />284 Department of Biomolecular Chemistry, Institute for Molecules and Materials and Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - René E. M. Toes
- />Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jolanda J. Luime
- />Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erik Lubberts
- />Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ger J. M. Pruijn
- />284 Department of Biomolecular Chemistry, Institute for Molecules and Materials and Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Terao C, Yano K, Ikari K, Furu M, Yamakawa N, Yoshida S, Hashimoto M, Ito H, Fujii T, Ohmura K, Yurugi K, Miura Y, Maekawa T, Taniguchi A, Momohara S, Yamanaka H, Mimori T, Matsuda F. Brief Report: Main Contribution of DRB1*04:05 Among the Shared Epitope Alleles and Involvement of DRB1 Amino Acid Position 57 in Association With Joint Destruction in Anti-Citrullinated Protein Antibody-Positive Rheumatoid Arthritis. Arthritis Rheumatol 2015; 67:1744-50. [DOI: 10.1002/art.39105] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 03/03/2015] [Indexed: 02/01/2023]
Affiliation(s)
- Chikashi Terao
- Kyoto University Graduate School of Medicine; Kyoto Japan
| | | | | | - Moritoshi Furu
- Kyoto University Graduate School of Medicine; Kyoto Japan
| | | | | | | | - Hiromu Ito
- Kyoto University Graduate School of Medicine; Kyoto Japan
| | - Takao Fujii
- Kyoto University Graduate School of Medicine; Kyoto Japan
| | | | | | | | | | | | | | | | - Tsuneyo Mimori
- Kyoto University Graduate School of Medicine; Kyoto Japan
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Terao C, Ohmura K, Kochi Y, Ikari K, Okada Y, Shimizu M, Nishina N, Suzuki A, Myouzen K, Kawaguchi T, Takahashi M, Takasugi K, Murasawa A, Mizuki S, Iwahashi M, Funahashi K, Natsumeda M, Furu M, Hashimoto M, Ito H, Fujii T, Ezawa K, Matsubara T, Takeuchi T, Kubo M, Yamada R, Taniguchi A, Yamanaka H, Momohara S, Yamamoto K, Mimori T, Matsuda F. Anti-citrullinated peptide/protein antibody (ACPA)-negative RA shares a large proportion of susceptibility loci with ACPA-positive RA: a meta-analysis of genome-wide association study in a Japanese population. Arthritis Res Ther 2015; 17:104. [PMID: 25927497 PMCID: PMC4431175 DOI: 10.1186/s13075-015-0623-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 04/08/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction Although susceptibility genes for anti-citrullinated peptide/protein antibodies (ACPA)-positive rheumatoid arthritis (RA) have been successfully discovered by genome-wide association studies (GWAS), little is known about the genetic background of ACPA-negative RA. We intended to elucidate genetic background of ACPA-negative RA. Method We performed a meta-analysis of GWAS comprising 670 ACPA-negative RA and 16,891 controls for 1,948,138 markers, followed by a replication study of the top 35 single nucleotide polymorphisms (SNPs) using 916 cases and 3,764 controls. Inverse-variance method was applied to assess overall effects. To assess overlap of susceptibility loci between ACPA-positive and -negative RA, odds ratios (ORs) of the 21 susceptibility markers to RA in Japanese were compared between the two subsets. In addition, SNPs were stratified by the p-values in GWAS meta-analysis for either ACPA-positive RA or ACPA-negative RA to address the question whether weakly-associated genes were also shared. The correlations between ACPA-positive RA and the subpopulations of ACPA-negative RA (rheumatoid factor (RF)-positive and RF-negative subsets) were also addressed. Results Rs6904716 in LEMD2 of the human leukocyte antigen (HLA) locus showed a borderline association with ACPA-negative RA (overall p = 5.7 × 10−8), followed by rs6986423 in CSMD1 (p = 2.4 × 10−6) and rs17727339 in FCRL3 (p = 1.4 × 10−5). ACPA-negative RA showed significant correlations of ORs with ACPA-positive RA for the 21 susceptibility SNPs and non-HLA SNPs with p-values far from significance. These significant correlations with ACPA-positive RA were true for ACPA-negative RF-positive and ACPA-negative RF-negative RA. On the contrary, positive correlations were not observed between the ACPA-negative two subpopulations. Conclusion Many of the susceptibility loci were shared between ACPA-positive and -negative RA. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0623-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chikashi Terao
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Koichiro Ohmura
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan.
| | - Yuta Kochi
- Laboratory for Autoimmune Diseases, Center for Genomic Medicine, RIKEN, Yokohama, Japan.
| | - Katsunori Ikari
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Yukinori Okada
- Department of Human Genetics and Disease Diversity, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Masakazu Shimizu
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Naoshi Nishina
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Akari Suzuki
- Laboratory for Autoimmune Diseases, Center for Genomic Medicine, RIKEN, Yokohama, Japan.
| | - Keiko Myouzen
- Laboratory for Autoimmune Diseases, Center for Genomic Medicine, RIKEN, Yokohama, Japan.
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Meiko Takahashi
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | | | - Akira Murasawa
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan.
| | - Shinichi Mizuki
- The Centre for Rheumatic Diseases, Matsuyama Red Cross Hospital, Matsuyama, Japan.
| | | | - Keiko Funahashi
- Pharm C, Matsubara Mayflower Hospital, 944-25 Fujita, Kato City, Hyogo, Japan.
| | | | - Moritoshi Furu
- Department of the Control for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Motomu Hashimoto
- Department of the Control for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Hiromu Ito
- Department of the Control for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takao Fujii
- Department of the Control for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | | | - Tsukasa Matsubara
- Matsubara Mayflower Hospital, 944-25 Fujita, Kato City, Hyogo, Japan.
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Michiaki Kubo
- Laboratory for Autoimmune Diseases, Center for Genomic Medicine, RIKEN, Yokohama, Japan.
| | - Ryo Yamada
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Atsuo Taniguchi
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Shigeki Momohara
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Kazuhiko Yamamoto
- Laboratory for Autoimmune Diseases, Center for Genomic Medicine, RIKEN, Yokohama, Japan.
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, 606-8507, Japan.
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan. .,Institut National de la Sante et de la Recherche Medicale (INSERM) Unite U852, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Terao C, Ohmura K, Ikari K, Kawaguchi T, Takahashi M, Setoh K, Nakayama T, Kosugi S, Sekine A, Tabara Y, Taniguchi A, Momohara S, Yamanaka H, Yamada R, Matsuda F, Mimori T. Effects of smoking and shared epitope on the production of anti-citrullinated peptide antibody in a Japanese adult population. Arthritis Care Res (Hoboken) 2015; 66:1818-27. [PMID: 24942650 DOI: 10.1002/acr.22385] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 06/10/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Anti-citrullinated peptide antibody (ACPA) and rheumatoid factor (RF) are markers to rheumatoid arthritis (RA). Smoking and shared epitope (SE) in HLA-DRB1 are associated with the production of these autoantibodies in RA. Detailed distribution and characterization of ACPA and RF in the general population have remained unclear. We aimed to evaluate positivity of ACPA and RF in a general Japanese population and to detect correlates, including genetic components. METHODS ACPA and RF were quantified in 9,804 Japanese volunteers ages 30-75 years. Logistic regression analyses were performed to evaluate the effects of candidates of correlates on the autoantibody positivity. A genome-wide association study (GWAS) was performed using 394,239 single nucleotide polymorphisms for 3,170 participants, and HLA-DRB1 alleles were imputed based on the GWAS data. RESULTS A total of 1.7% and 6.4% of subjects were positive for ACPA and RF, respectively, and the 2 markers showed a significant correlation (P = 2.0 × 10(-23) ). Old age was associated with ACPA positivity (P = 0.00062). Sex, smoking, SE, and other candidates of correlates did not have significant effects. Interaction between smoking and SE positivity was not apparent, but smoking showed a significant association with high levels of ACPA (P = 0.0019). CONCLUSION ACPA and RF could be detected in 1.7% and 6.4% of the Japanese adult population without RA, respectively. ACPA and RF were suggested to share mechanisms even in healthy populations. Old age was associated with increasing ACPA positivity. While positivity of ACPA and RF was not associated with SE and smoking, an association between high ACPA and smoking was observed.
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Sellgren C, Frisell T, Lichtenstein P, Landèn M, Askling J. The association between schizophrenia and rheumatoid arthritis: a nationwide population-based Swedish study on intraindividual and familial risks. Schizophr Bull 2014; 40:1552-9. [PMID: 24714379 PMCID: PMC4193721 DOI: 10.1093/schbul/sbu054] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Numerous studies have reported a reduced risk of rheumatoid arthritis (RA) in schizophrenia. The mechanisms are unknown, but recent genome-wide association studies of schizophrenia have shown strong associations with markers spanning the major histocompatibility complex region, indicating a possible role for adaptive immunity also in schizophrenia. In this population-based cohort study, we assess the associations between RA and schizophrenia and the extent to which any observed associations are specific to RA/schizophrenia. We then extend the assessments per RA subtype and to risks in first-degree relatives. The study population included every individual identified in the Swedish Population Register born in Sweden between 1932 and 1989. The risk for RA in schizophrenia was significantly decreased (hazard ratio [HR] = 0.69, 95% CI = 0.59-0.80), but similar reductions were noted for osteoarthritis (a noninflammatory joint disorder) and ankylosing spondylitis (a non-RA inflammatory disorder). Comparable associations were seen in schizoaffective subjects while no significant associations were observed in bipolar disorder. Overall, first-degree relatives of schizophrenia patients were not at reduced risk of RA, but the risk for seronegative RA was significantly decreased in children and siblings of schizophrenia probands (HR = 0.13, 95% CI = 0.02-0.95 and HR = 0.67, 95% CI = 049-0.92, respectively). In conclusion, our intraindividual analyses suggest that differential misclassification bias is an important factor for the observed inverse association and emphasize the need of optimized care-provision for nonpsychiatric symptoms in schizophrenia patients. Our familial analyses indicted the possibility of an inverse coinheritance of schizophrenia and seronegative RA.
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Affiliation(s)
- Carl Sellgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;
| | - Thomas Frisell
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Landèn
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;,Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Johan Askling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden;,Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
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PRATESI FEDERICO, MIGLIORINI PAOLA. Something Old, Something New: Biomarkers in Rheumatoid Arthritis. J Rheumatol 2014; 41:2091-3. [DOI: 10.3899/jrheum.141069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Homogeneous case subgroups increase power in genetic association studies. Eur J Hum Genet 2014; 23:863-9. [PMID: 25271086 DOI: 10.1038/ejhg.2014.194] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/16/2014] [Accepted: 08/20/2014] [Indexed: 12/12/2022] Open
Abstract
Genome-wide association studies of clinically defined cases against controls have transformed our understanding of the genetic causes of many diseases. However, there are limitations to the simple clinical definitions used in these studies, and GWAS analyses are beginning to explore more refined phenotypes in subgroups of the existing data sets. These analyses are often performed ad hoc without considering the power requirements to justify such analyses. Here we derive expressions for the relative power of such subgroup analyses and determine the genotypic relative risks (GRRs) required to achieve equivalent power to a full analysis for relevant scenarios. We show that only modest increases in GRRs may be required to offset the reduction in power from analysing fewer cases, implying that analyses of more genetically homogenous case subgroups may have the potential to identify further associations. We find that, for lower genotypic relative risks in the full sample, subgroup analyses of more homogeneous cases have relatively more power than for higher index genotypic relative risks and that this effect is stronger for rare as opposed to common variants. As GWA studies are likely to have now identified the majority of SNPs with stronger effects, these results strongly advocate a renewed effort to identify phenotypically homogeneous disease groups, in which power to detect genetic variants with small effects will be greater. These results suggest that analysis of case subsets could be a powerful strategy to uncover some of the hidden heritability for common complex disorders, particularly in identifying rarer variants of modest effect.
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Amaya-Amaya J, Calixto OJ, Saade-Lemus S, Calvo-Paramo E, Mantilla RD, Rojas-Villarraga A, Anaya JM. Does non-erosive rheumatoid arthritis exist? A cross-sectional analysis and a systematic literature review. Semin Arthritis Rheum 2014; 44:489-498. [PMID: 25440525 DOI: 10.1016/j.semarthrit.2014.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/27/2014] [Accepted: 09/11/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the prevalence and factors associated with non-erosive rheumatoid arthritis (RA). METHODS First, a cross-sectional analytical study was performed. Non-erosive disease, defined as the absence of any erosion on X-rays after 5 years of RA, was evaluated in 500 patients. Further and additional evaluations including ultrasonography (US) and computed tomography (CT) were performed in those patients meeting the eligibility criteria. The Spearman correlation coefficient, kappa analysis, and Kendall׳s W test were used to analyze the data. Second, a systematic literature review (SLR) was performed following the PRISMA guidelines. RESULTS Of a total of 40 patients meeting the eligibility criteria for non-erosive RA, eight patients were confirmed to have non-erosive RA by the three methods. A positive correlation between non-erosive RA and shorter disease duration, antinuclear antibodies positivity, lower rheumatoid factor (RF) and C-reactive protein titers, lower global visual analog scale values, toxic exposures, and lower disease activity-(RAPID3) was found. In addition, an inverse correlation with anticyclic citrullinated peptide antibodies (ACPA) positivity and medication use was observed. From the SLR, it was corroborated that factors associated with this subphenotype were shorter disease duration, younger disease onset, negative ACPA and RF titers, low cytokine levels, and some genetic markers. CONCLUSION Non-erosive RA is rare, occurring in less than 2% of cases. These findings improve on the understanding of RA patients who present without erosions and are likely to have less severe disease.
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Affiliation(s)
- Jenny Amaya-Amaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia
| | - Omar-Javier Calixto
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia
| | - Sandra Saade-Lemus
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia
| | - Enrique Calvo-Paramo
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia; School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Ruben-Dario Mantilla
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia
| | - Adriana Rojas-Villarraga
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia; Mederi, Hospital Universitario Mayor, Bogotá, Colombia.
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Yarwood A, Huizinga TWJ, Worthington J. The genetics of rheumatoid arthritis: risk and protection in different stages of the evolution of RA. Rheumatology (Oxford) 2014; 55:199-209. [PMID: 25239882 DOI: 10.1093/rheumatology/keu323] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Indexed: 11/13/2022] Open
Abstract
There is now a general consensus that RA has a spectrum of disease stages that can begin many years before the onset of clinical symptoms. It is widely thought that understanding the complex interplay between genetics and environment, and their role in pathogenesis, is essential in gaining further insight into the mechanisms that drive disease development and progression. More than 100 genetic susceptibility loci have now been identified for RA through studies that have focused on patients with established RA compared with healthy controls. Studying the early preclinical phases of disease will provide valuable insights into the biological events that precede disease and could potentially identify biomarkers to predict disease onset and future therapeutic targets. In this review we will cover recent advances in the knowledge of genetic and environmental risk factors and speculate on how these factors may influence the transition from one stage of disease to another.
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Affiliation(s)
- Annie Yarwood
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, Stopford Building, University of Manchester, Manchester, UK
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands and
| | - Jane Worthington
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, Stopford Building, University of Manchester, Manchester, UK, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Ruyssen-Witrand A, Lukas C, Nigon D, Dawidowicz K, Morel J, Sibilia J, Jamard B, Cambon-Thomsen A, Cantagrel A, Dieudé P, Constantin A. Association of IL-2RA and IL-2RB genes with erosive status in early rheumatoid arthritis patients (ESPOIR and RMP cohorts). Joint Bone Spine 2014; 81:228-34. [DOI: 10.1016/j.jbspin.2013.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
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Li C, Mu R, Guo J, Wu X, Tu X, Liu X, Hu F, Guo S, Zhu J, Xu H, Li Z. Genetic variant in IL33 is associated with susceptibility to rheumatoid arthritis. Arthritis Res Ther 2014; 16:R105. [PMID: 24779919 PMCID: PMC4075243 DOI: 10.1186/ar4554] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 04/11/2014] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Interleukin (IL)-33 is a proinflammatory cytokine contributing to the pathogenesis of rheumatoid arthritis (RA). The gene encoding IL-33 may serve as a genetic factor and be associated with the risk of RA. To investigate the potential association between IL33 and RA, we performed a case-control study based on Chinese Han population. METHODS A three-stage case-control study was performed. Two tag single-nucleotide polymorphisms (SNPs) (rs7044343 and rs10975514), mapping to the IL33 gene, were first genotyped in the discovery population. We further genotyped rs7044343 and rs10975514 in the validation and replication population. The associations between the two tag SNPs and phenotypic subgroups of RA and levels of serum IL-33 were assessed with a logistic regression model. RESULTS In the discovery population, the CC genotype of rs7044343 was associated with RA patients (odds ratio (OR) = 0.777, 95% confidence interval (CI), 0.611 to 0.988; P = 0.040). After anti-citrullinated peptide antibody (ACPA) stratification, the CC genotype of rs7044343 was also shown to be a protective genotype in RA without ACPA (OR = 0.610; 95% CI, 0.379 to 0.982; P = 0.042). In the validation population and replication population, the association between rs7044343 and RA, especially ACPA-negative RA, was still significant. A meta-analysis of discovery, validation, and replication panels confirmed the association between CC genotype of rs7044343 and RA (Pcombined = 0.0004; ORcombined = 0.77; 95% CI, 0.67 to 0.89). No evidence was found for heterogeneity between three sample sets (Phet = 0.99; I² = 0%). Similar results were also obtained in ACPA-negative RA (Pcombined = 0.0002; ORcombined = 0.57; 95% CI, 0.43 to 0.77). No association was detected between rs10975514 polymorphism and RA susceptibility in the discovery and validation population. The serum levels of IL-33 were significantly lower in the patients with the rs7044343 CC genotype. CONCLUSION The CC genotype of rs7044343 in IL33 is associated with RA patients and downregulates IL-33 expression in RA.
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Terao C. Genetic contribution to susceptibility and disease phenotype in rheumatoid arthritis. Inflamm Regen 2014. [DOI: 10.2492/inflammregen.34.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abdul Wahab A, Mohammad M, Rahman MM, Mohamed Said MS. Anti-cyclic citrullinated peptide antibody is a good indicator for the diagnosis of rheumatoid arthritis. Pak J Med Sci 2013; 29:773-7. [PMID: 24353626 PMCID: PMC3809312 DOI: 10.12669/pjms.293.2924] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 09/27/2012] [Accepted: 03/28/2013] [Indexed: 12/15/2022] Open
Abstract
Objectives: Anti-cyclic citrullinated peptide (CCP) antibody has recently been used in the classification of rheumatoid arthritis (RA). This antibody is more specific than rheumatoid factor (RF) for the diagnosis of RA. The study objectives were to determine the sensitivity, specificity, positive and negative predictive values of anti-CCP in RA diagnosis. Methodology: Eighty RA patients and 80 non-RA individuals were included in the study. Blood was collected from both arms of study subjects and tested for anti-CCP and RF antibodies. Relevant clinical information and laboratory profiles of the RA patients were evaluated using patients’ medical records and Integrated Laboratory Management System (ILMS), respectively. Results: The sensitivity and specificity of anti-CCP were 35% and 100% respectively. The positive and negative predictive values were 100% and 61%, respectively. Positive anti-CCP was found significantly associated with multiple joint pain (p< 0.001) and hand’s joints pain (p=0.01), symmetrical joints involvement (p=0.015) and high CRP value (p<0.001). Anti-CCP was also found to have positive association with RF (p<0.001). Conclusion: Anti-CCP is highly specific for the diagnosis of RA. High positive predictive value should be taken into consideration for effective treatment.
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Affiliation(s)
- Asrul Abdul Wahab
- Asrul Abdul Wahab, Department of Medical Microbiology & Immunology, Faculty of Medicine, The National University of Malaysia, Cheras 56000 Kuala Lumpur, Malaysia
| | - Marlyn Mohammad
- Marlyn Mohammad, Department of Medical Microbiology & Immunology, Faculty of Medicine, The National University of Malaysia, Cheras 56000 Kuala Lumpur, Malaysia
| | - M M Rahman
- M.M. Rahman, Department of Medical Microbiology & Immunology, Faculty of Medicine, The National University of Malaysia, Cheras 56000 Kuala Lumpur, Malaysia
| | - Mohd Shahrir Mohamed Said
- Mohd. Shahrir Mohamed Said, Department of Internal Medicine, Faculty of Medicine, The National University of Malaysia, Cheras 56000 Kuala Lumpur, Malaysia
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Yamakawa N, Fujimoto M, Kawabata D, Terao C, Nishikori M, Nakashima R, Imura Y, Yukawa N, Yoshifuji H, Ohmura K, Fujii T, Kitano T, Kondo T, Yurugi K, Miura Y, Maekawa T, Saji H, Takaori-Kondo A, Matsuda F, Haga H, Mimori T. A clinical, pathological, and genetic characterization of methotrexate-associated lymphoproliferative disorders. J Rheumatol 2013; 41:293-9. [PMID: 24334644 DOI: 10.3899/jrheum.130270] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Methotrexate-associated lymphoproliferative disorders (MTX-LPD) often regress spontaneously during MTX withdrawal, but the prognostic factors remain unclear. The aim of our study was to clarify the clinical, histological, and genetic factors that predict outcomes in patients with MTX-LPD. METHODS Patients with MTX-LPD diagnosed between 2000 and 2012 were analyzed retrospectively regarding their clinical course, site of biopsy, histological typing, Epstein-Barr virus (EBV) in situ hybridization and immunostaining, and HLA type. RESULTS Twenty-one patients, including 20 with rheumatoid arthritis (RA) and 1 with polymyositis, were analyzed. The mean dose of MTX was 6.1 mg/week and the mean duration of treatment was 71.1 months. Clinically, 5 patients were diagnosed with EBV-positive mucocutaneous ulcer (EBVMCU) and had polymorphic histological findings. The proportion of those patients successfully treated solely by withdrawal of MTX was significantly greater than that of those without EBVMCU (75% vs 7.7%, p = 0.015). The HLA-B15:11 haplotype was more frequent in patients with EBV+ RA with MTX-LPD than in healthy Japanese controls (p = 0.0079, Bonferroni's method). EBV latency classification and HLA typing were not associated with the prognosis of MTX-LPD in our cohort. CONCLUSION Our data demonstrate that patients in the EBVMCU, a specific clinical subgroup of MTX-LPD, had a better clinical outcome when MTX was withdrawn than did other patients with MTX-LPD.
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Affiliation(s)
- Noriyuki Yamakawa
- From the Department of Rheumatology and Clinical Immunology, the Department of Diagnostic Pathology, the Center for Genomic Medicine, and the Department of Hematology and Oncology, Kyoto University Graduate School of Medicine; the Department of Transfusion Medicine and Cell Therapy, Kyoto University Hospital; the HLA Foundation Laboratory, Kyoto, Japan
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Differences in synovial fluid cytokine levels but not in synovial tissue cell infiltrate between anti-citrullinated peptide/protein antibody-positive and -negative rheumatoid arthritis patients. Arthritis Res Ther 2013; 15:R182. [PMID: 24485167 PMCID: PMC3978623 DOI: 10.1186/ar4372] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 10/25/2013] [Indexed: 02/06/2023] Open
Abstract
Introduction Comparative data on synovial cell infiltrate and cytokine levels in anti citrullinated peptide/protein antibody (ACPA)-positive and ACPA negative rheumatoid arthritis (RA) patients are scarce. Our aim was to analyze synovial cell infiltrate and synovial fluid (SF) levels of cytokines in patients with RA according to the presence or absence of ACPA in serum. Methods A cross-sectional study in a single center including consecutive RA patients was performed. Patients were defined as 'ACPA negative' if serum was negative to two different ACPAs [second generation commercial anti-cyclic citrullinated peptide antibodies (CCP2) and chimeric fibrin/filaggrin citrullinated antibodies]. Parallel synovial tissue (ST) biopsies and SF were obtained by knee arthroscopy. Synovial cell infiltrate and endothelial cells were analyzed by immunohistochemistry and SF levels of Th1, Th2, Th17 and pro-inflammatory cytokines by Quantibody(R) Human Array. Results A total of 83 patients underwent arthroscopy, with a mean age of 55.9 ± 12 years, and mean disease duration of 45 months (interquartile range, IQR 10.8 to 122). 62% were female and 77% were ACPA positive. No significant differences were found in clinical variables, acute phase reactants, synovial cell infiltrate or lymphoid neogenesis (LN) between ACPA positive and negative patients. However ACPA positive patients had significantly higher levels of IL-1β, IL-10, IL-17 F and CC chemokine ligand 20 (CCL-20) than ACPA negative patients. Conclusions In our cohort of patients with RA no significant differences were found in synovial cell infiltrate or synovial LN according to ACPA status. However, ACPA positive patients had higher levels of T-cell derived and pro-inflammatory cytokines than ACPA negative patients. As systemic and local inflammation was similar in the two groups, these findings support a distinct synovial physiopathology.
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van Beers JJBC, Willemze A, Jansen JJ, Engbers GHM, Salden M, Raats J, Drijfhout JW, van der Helm-van Mil AHM, Toes REM, Pruijn GJM. ACPA fine-specificity profiles in early rheumatoid arthritis patients do not correlate with clinical features at baseline or with disease progression. Arthritis Res Ther 2013; 15:R140. [PMID: 24286543 PMCID: PMC3978944 DOI: 10.1186/ar4322] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 09/16/2013] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Autoantibodies against citrullinated peptides/proteins (ACPA) are found in approximately 75% of the sera of patients with rheumatoid arthritis (RA). The RA-specific ACPA are frequently present prior to disease onset and their presence associates with a more erosive disease course. ACPA can therefore be used to aid the diagnosis and prognosis of RA. Recently, it became clear that ACPA are very heterogeneous, both in an individual patient and among different patients. The aim of this study was to investigate whether clinically meaningful ACPA profiles exist in early RA patients. METHODS Twenty citrullinated peptides and the corresponding non-citrullinated control peptides were immobilized on microarray sensor chips. Sera from 374 early arthritis patients were analyzed by surface plasmon resonance imaging (iSPR) of biomolecular interactions on the sensor chip. RESULTS Cluster analysis of the reactivities with the citrullinated peptides, after subtraction of the reactivities with the corresponding control peptides confirmed the heterogeneity of the ACPA response in RA and revealed 12 distinct ACPA profiles. The association of the 5 most frequent profiles with clinical features at diagnosis and during the disease course was examined, showing no statistically significant associations. CONCLUSIONS Compared to the detection of ACPA in RA sera by CCP-based assays, ACPA profiling in early arthritis patients did not reveal associations with disease activity and progression scores.
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Biswas S, Sharma S, Saroha A, Bhakuni DS, Malhotra R, Zahur M, Oellerich M, Das HR, Asif AR. Identification of novel autoantigen in the synovial fluid of rheumatoid arthritis patients using an immunoproteomics approach. PLoS One 2013; 8:e56246. [PMID: 23418544 PMCID: PMC3572018 DOI: 10.1371/journal.pone.0056246] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 01/07/2013] [Indexed: 11/19/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic, autoimmune and inflammatory joint disease with a poorly understood etiology. Despite widespread diagnostic use of anti-citrullinated protein antibodies and rheumatoid factor proteins there is a strong demand for novel serological biomarkers to improve the diagnosis this disease. The present study was aimed to identify novel autoantigens involved in rheumatoid arthritis (RA) pathogenesis through immune-proteomic strategy. Synovial fluid samples from clinically diagnosed RA patients were separated on two-dimensional gel electrophoresis (2-DE). Samples from patients with non-RA rheumatisms (osteoarthritis and trauma) were used as controls. Immunoreactive proteins were spotted by Western blotting followed by identification through Q-TOF mass spectrometer analysis. Forty Western blots were generated using plasma from ten individual RA patients and 33 reactive spots were identified, 20 from the high molecular weight (HMW) gel and 13 from the low molecular weight (LMW) gel. Among the 33 common immunogenic spots, 18 distinct autoantigens were identified, out of which 14 are novel proteins in this context. Expression analysis of five important proteins, vimentin, gelsolin, alpha 2 HS glycoprotein (AHSG), glial fibrillary acidic protein (GFAP), and α1B-glycoprotein (A1BG) by Western blot analysis using their specific antibodies revealed their higher expression in RA synovial fluid as compared to non-RA samples. Recombinantly expressed GFAP and A1BG protein were used to develop an in-house ELISA to quantify the amount of autoantibodies in the RA patients. RA patients revealed an increase in the expression of GFAP and A1BG in the plasma as compared to osteoarthritis patients. Therefore, GFAP and A1BG can be proposed as potential new autoantigens of diagnostic importance for RA subjects. Further characterization of these proteins in rheumatoid arthritis will be helpful in understanding the role of these proteins in the disease pathogenesis providing new diagnostic tool with better specificity and accurate detection of the disease.
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Affiliation(s)
- Sagarika Biswas
- Department of Genomics & Molecular Medicine, Institute of Genomics and Integrative Biology, New Delhi, India
- Department of Clinical Chemistry, University Medical Center Goettingen, Goettingen, Germany
| | - Saurabh Sharma
- Department of Genomics & Molecular Medicine, Institute of Genomics and Integrative Biology, New Delhi, India
| | - Ashish Saroha
- Department of Genomics & Molecular Medicine, Institute of Genomics and Integrative Biology, New Delhi, India
| | - D. S. Bhakuni
- Department of Clinical Immunology and Rheumatology, Army Hospital (Research and Referral), New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedic, All India Institute of Medical Sciences, New Delhi, India
| | - Muzna Zahur
- Department of Biochemistry and Molecular Biology, University of Gujrat, Gujrat, Pakistan
| | - Michael Oellerich
- Department of Clinical Chemistry, University Medical Center Goettingen, Goettingen, Germany
| | - Hasi R. Das
- Department of Genomics & Molecular Medicine, Institute of Genomics and Integrative Biology, New Delhi, India
| | - Abdul R. Asif
- Department of Clinical Chemistry, University Medical Center Goettingen, Goettingen, Germany
- * E-mail:
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