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Al-Obeidi AF, Nowatzky J. Immunopathogenesis of Behçet's disease. Clin Immunol 2023; 253:109661. [PMID: 37295542 PMCID: PMC10484394 DOI: 10.1016/j.clim.2023.109661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
Behçet's disease (BD) is a multi-system inflammatory disorder with vasculitic features. It does not suit any of the current pathogenesis-driven disease classifications well, a unifying concept of its pathogenesis is not unanimously conceivable at present, and its etiology is obscure. Still, evidence from immunogenetic and other studies supports the notion of a complex-polygenic disease with robust innate effector responses, reconstitution of regulatory T cells upon successful treatment, and first clues to the role of an, as of yet, underexplored adaptive immune system and its antigen recognition receptors. Without an attempt to be comprehensive, this review aims to collect and organize impactful parts of this evidence in a way that allows the reader to appreciate the work done and define the efforts needed now. The focus is on literature and notions that drove the field into new directions, whether recent or more remote.
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Affiliation(s)
- Arshed F Al-Obeidi
- New York University Grossman School of Medicine, Department of Medicine, New York, NY, USA
| | - Johannes Nowatzky
- New York University Grossman School of Medicine, Department of Medicine, New York, NY, USA; New York University Grossman School of Medicine, Department of Pathology, USA; New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology, NYU Langone Ocular Rheumatology Program, New York, NY, USA; New York University Grossman School of Medicine, Department of Medicine, Division of Rheumatology, NYU Langone Center for Behçet's Disease, New York, NY, USA.
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2
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Deng Y, Zhang Y, Cai T, Wang Q, Zhang W, Chen Z, Luo X, Su G, Yang P. Transcriptomic profiling of iris tissue highlights LCK signaling and T cell-mediated immunity in Behcet's uveitis. J Autoimmun 2022; 133:102920. [PMID: 36191467 DOI: 10.1016/j.jaut.2022.102920] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 12/13/2022]
Abstract
Uveitis is the most common form of ocular lesions in Behcet's disease, severely affecting visual function. Molecular pathological changes of ocular lesions in patients with Behcet's uveitis (BU) are largely unknown. In this study, we performed the first comprehensive transcriptomic profiling of iris specimens from BU patients and healthy donors to provide an insight into intraocular immunopathogenesis. The mRNA sequencing identified 1633 differentially expressed genes (DEGs) between the BU group and healthy controls. GO functional enrichment analysis on DEGs showed that T cell activation was the most significantly enriched biological process. KEGG analysis of DEGs also revealed several prominently enriched T cell-related pathways, including the T cell receptor signaling pathway, Th17 cell differentiation, and Th1 and Th2 cell differentiation. The lymphocyte-specific protein tyrosine kinase (LCK) was identified as the key hub gene in the protein interaction network of DEGs. Western blot analysis further showed increased expression of active LCK in the BU group, suggesting activation of LCK signaling. Using publicly accessible single-cell RNA-sequencing data of the healthy iris, LCK was found to be expressed in clusters of activated T cells but not in other iris cell clusters, suggesting an overt association between LCK upregulation and T cell-mediated immune dysregulation. Additionally, 16 drugs were predicted to be potential inhibitors of LCK. Overall, these findings not only highlighted the central role of T cell-mediated immunity and previously unreported LCK signaling in intraocular immunopathogenesis but also revealed the potential value of LCK as a new therapeutic target for BU patients.
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Affiliation(s)
- Yang Deng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, PR China
| | - Yinan Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Henan Province Eye Hospital, Henan International Joint Research Laboratory for Ocular Immunology and Retinal Injury Repair, Zhengzhou, PR China; The Academy of Medical Sciences, Zhengzhou University, Zhengzhou, PR China
| | - Tao Cai
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, PR China
| | - Qingfeng Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, PR China
| | - Wanyun Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, PR China
| | - Zhijun Chen
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, PR China
| | - Xiang Luo
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, PR China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, PR China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, PR China.
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3
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Cavers A, Kugler MC, Ozguler Y, Al-Obeidi AF, Hatemi G, Ueberheide BM, Ucar D, Manches O, Nowatzky J. Behçet's disease risk-variant HLA-B51/ERAP1-Hap10 alters human CD8 T cell immunity. Ann Rheum Dis 2022; 81:1603-1611. [PMID: 35922122 DOI: 10.1136/ard-2022-222277] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/27/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The endoplasmic reticulum aminopeptidase (ERAP1) haplotype Hap10 encodes for a variant allotype of the endoplasmic reticulum (ER)-resident peptide-trimming aminopeptidase ERAP1 with low enzymatic activity. This haplotype recessively confers the highest risk for Behçet's diseases (BD) currently known, but only in carriers of HLA-B*51, the classical risk factor for the disease. The mechanistic implications and biological consequences of this epistatic relationship are unknown. Here, we aimed to determine its biological relevance and functional impact. METHODS We genotyped and immune phenotyped a cohort of 26 untreated Turkish BD subjects and 22 healthy donors, generated CRISPR-Cas9 ERAP1 KOs from HLA-B*51 + LCL, analysed the HLA class I-bound peptidome for peptide length differences and assessed immunogenicity of genome-edited cells in CD8 T cell co-culture systems. RESULTS Allele frequencies of ERAP1-Hap10 were similar to previous studies. There were frequency shifts between antigen-experienced and naïve CD8 T cell populations of carriers and non-carriers of ERAP1-Hap10 in an HLA-B*51 background. ERAP1 KO cells showed peptidomes with longer peptides above 9mer and significant differences in their ability to stimulate alloreactive CD8 T cells compared with wild-type control cells. CONCLUSIONS We demonstrate that hypoactive ERAP1 changes immunogenicity to CD8 T cells, mediated by an HLA class I peptidome with undertrimmed peptides. Naïve/effector CD8 T cell shifts in affected carriers provide evidence of the biological relevance of ERAP1-Hap10/HLA-B*51 at the cellular level and point to an HLA-B51-restricted process. Our findings suggest that variant ERAP1-Hap10 partakes in BD pathogenesis by generating HLA-B51-restricted peptides, causing a change in immunodominance of the ensuing CD8 T cell response.
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Affiliation(s)
- Ann Cavers
- Department of Medicine, Division of Rheumatology, NYU Langone Behçet's Disease Program, NYU Langone Ocular Rheumatology Program, New York University Grossman School of Medicine, New York, NY, USA
| | - Matthias Christian Kugler
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Yesim Ozguler
- Department of Medicine, Division of Rheumatology, NYU Langone Behçet's Disease Program, NYU Langone Ocular Rheumatology Program, New York University Grossman School of Medicine, New York, NY, USA.,Department of Internal Medicine, Division of Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Behçet's Disease Research Center, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Arshed Fahad Al-Obeidi
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Gulen Hatemi
- Department of Internal Medicine, Division of Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Behçet's Disease Research Center, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Beatrix M Ueberheide
- Department of Biochemistry and Molecular Pharmacology, Department of Neurology, Perlmutter Cancer Center, Proteomics Laboratory at the Division of Advanced Research Technologies, New York University Grossman School of Medicine, New York, NY, USA
| | - Didar Ucar
- Behçet's Disease Research Center, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Department of Ophthalmology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Olivier Manches
- Immunobiology and Immunotherapy in Chronic Diseases, Institute for Advanced Biosciences, Inserm U 1209, Université Grenoble-Alpes, Grenoble, France.,Recherche et Développement, Etablissement Français du Sang Auvergne-Rhône-Alpes, La Tronche, France
| | - Johannes Nowatzky
- Department of Medicine, Division of Rheumatology, NYU Langone Behçet's Disease Program, NYU Langone Ocular Rheumatology Program, New York University Grossman School of Medicine, New York, NY, USA .,Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA
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Ünsal P, Çerçi P, Açıkgöz ŞA, Keskin G, Ölmez Ü. Serum Levels of Interleukin-36 Alpha and Interleukin-36 Receptor
Antagonist In Behcet’s Syndrome. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1550-2069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background Behcet’s syndrome (BS) is a systemic vasculitic
disorder. This study aimed to investigate the levels of serum IL-36α and
IL-36Ra in patients with BS.
Material and Methods A total of 80 subjects (60 BS patients and 20 healthy
controls [HC]) were included.
Results The median IL-36α level was 0.11 ng/ml in
the BS group and 0.09 ng/ml in the HC group (p=0.058).
The mean IL-36Ra level was 13.62 pg/ml in the BS group and
13.26 pg/ml in the HC group (p=0.348). Serum IL-36Ra
levels of the active group were significantly higher (p=0.037). Patients
with oral ulcers and central nervous system involvement had higher serum IL36Ra
levels. In the BS group, a positive correlation was found between serum IL-36Ra
and CRP. In a multivariate analysis, the IL-36Ra level (OR=1.067;
95% CI=1.001–1.137; p=0.045) was independently
associated with disease activity.
Conclusion According to these findings, it is not clear whether such a
slight difference is clinically significant, but they suggest that the IL-36
cytokine family may play a role in the course of the disease.
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Affiliation(s)
- Pelin Ünsal
- Department of Internal Medicine, Ankara University Faculty of Medicine,
Ankara, Turkey
| | - Pamir Çerçi
- Department of Internal Medicine, Division of Immunology and Allergy,
Ankara University Faculty of Medicine, Ankara, Turkey
| | - Şükrü Alper Açıkgöz
- Department of Internal Medicine, Division of Immunology and Allergy,
Ankara University Faculty of Medicine, Ankara, Turkey
| | - Göksal Keskin
- Department of Internal Medicine, Division of Immunology and Allergy,
Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ümit Ölmez
- Department of Internal Medicine, Division of Immunology and Allergy,
Ankara University Faculty of Medicine, Ankara, Turkey
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Vural S, Kerl K, Doğan PE, Vollmer S, Puchta U, He M, Arakawa Y, Heper AO, Karal A, Hartmann D, Boyvat A, Prinz JC, Arakawa A. Lesional activation of T c 17 cells in Behçet's disease and psoriasis supports HLA-class I-mediated autoimmune responses. Br J Dermatol 2021; 185:1209-1220. [PMID: 34254298 DOI: 10.1111/bjd.20643] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Behçet's disease (BD) presents with lymphocytic and neutrophilic vasculitis of unknown aetiology. HLA-B*51 ERAP1 and IL12R/IL23R are genetic risk factors. IL-23 regulates IL-17A, which controls recruitment and activation of neutrophils. OBJECTIVES To determine pathological changes in BD skin lesions related to the complex genetic predisposition METHODS: We characterised the expression of IL-17A and IL-23A in various cell types by immunohistological double staining of sections from papulopustular skin lesions (PPL) of acute attacks of BD and lesions of psoriasis vulgaris (PV), another HLA-class I-associated T-cell mediated autoimmune disease in which excessive T-cell derived IL-17A production promotes neutrophil activation. RESULTS We found that in BD lesions, as in psoriasis, actively expanding CD8+ T cells were the predominant source of IL-17A. IL-17A+ CD8+ T (Tc17) cells outnumbered infiltrating IL-17A+ CD4+ T cells. Unlike the epidermal localisation of CD8+ T cells in psoriasis, Tc17 cells in BD lesions infiltrated mainly the perivascular tissue and also the blood vessel walls of dermis and subcutaneous tissue. They colocalised with a marked IL-23A expression by CD11c+ dendritic cells (DCs) and CD68+ macrophages. IL-17A expression was associated with extensive recruitment of neutrophils around blood vessels that formed neutrophil extracellular traps (NETs). CONCLUSIONS In BD, the genetic predisposition may mediate antigen-specific activation and differentiation of a Tc 17 response, possibly targeting endothelial antigens. Neutrophils recruited by IL-17A in this process may enhance tissue damage by extensive NET formation (NETosis). Thus, the IL-23/IL-17 axis presumably controls neutrophilic inflammation in BD vasculitis in the context of a predominant antigen-specific CD8+ T-cell response.
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Affiliation(s)
- S Vural
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany.,Department of Dermatology, Koç University School of Medicine, Istanbul, 34010, Turkey
| | - K Kerl
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - P E Doğan
- Department of Dermatology, Ankara University, 06100, Ankara, Turkey
| | - S Vollmer
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - U Puchta
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - M He
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - Y Arakawa
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - A O Heper
- Department of Pathology, Ankara University, 06100, Ankara, Turkey
| | - A Karal
- Department of Dermatology, Ankara University, 06100, Ankara, Turkey
| | - D Hartmann
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - A Boyvat
- Department of Dermatology, Ankara University, 06100, Ankara, Turkey
| | - J C Prinz
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
| | - A Arakawa
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University Munich, Munich, D-80337, Germany
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Djaballah-Ider F, Touil-Boukoffa C. Effect of combined colchicine-corticosteroid treatment on neutrophil/lymphocyte ratio: a predictive marker in Behçet disease activity. Inflammopharmacology 2020; 28:819-829. [PMID: 32227261 DOI: 10.1007/s10787-020-00701-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/13/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Behçet's disease (BD) is an auto-immune vasculitis, characterized by episodic inflammation of multiple organs. The neutrophil to lymphocyte ratio (NLR) is used as a marker of inflammation in several diseases nowadays. While nitric oxide (NO) seem to be involved in BD pathogenicity. Our study aims to investigate the NLR as an inflammatory marker of BD activity as well as to evaluate the relationship between the NO production and NLR in Algerian BD patients with different clinical manifestations before and under colchicine + corticosteroid treatment. METHODS For this purpose, we evaluated the NLR as the ratio of neutrophil count to lymphocyte count in naïve and treated active BD patients with different clinical manifestations and in inactive ones. Furthermore, we assessed NO production by the Griess' method in the same patients. Additionally, we evaluated in vivo interferon-γ (IFN-γ) and interleukin-4 (IL-4) levels using ELISA. RESULTS AND DISCUSSION Our results indicate that the NLR and nitrite levels were higher in naïve active BD patients. Interestingly, this high ratio and NO production differed according to the clinical manifestations and was associated with an increased risk of mucocutaneous and vascular involvement. Importantly, in treated BD patients NLR was higher in active patients especially in those with mucocutaneous involvement while increased nitrites levels were regardless of the clinical manifestations studied. Both NLR and NO production decreased in these treated active patients. In addition, IL-4 production differed according to the clinical manifestations studied contrary to the IFN-γ production. CONCLUSION Collectively our results suggest that the NLR is a potential marker of BD activity in Algerian patients, predicting the disease severity. Moreover, the positive relationship between the NLR and NO production is related to an increased risk of mucocutaneous lesions and vascular involvement. Thus, the application of these two accessible tools could be benefit for the clinical prognosis and treatment of BD.
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Affiliation(s)
- Fatmazohra Djaballah-Ider
- Cytokines and NO-Synthases, Laboratory of Cellular and Molecular Biology (LBCM), Faculty of Biological Science, USTHB, PB 32, 16111, Algiers, Algeria
| | - Chafia Touil-Boukoffa
- Cytokines and NO-Synthases, Laboratory of Cellular and Molecular Biology (LBCM), Faculty of Biological Science, USTHB, PB 32, 16111, Algiers, Algeria.
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Gheita TA, Sakr BR, Rabea RE, Abd ElHamid SM. Value of hematological indices versus VEGF as biomarkers of activity in Behçet’s disease. Clin Rheumatol 2019; 38:2201-2210. [PMID: 30919148 DOI: 10.1007/s10067-019-04513-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/22/2019] [Accepted: 03/12/2019] [Indexed: 02/05/2023]
Affiliation(s)
- T A Gheita
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - B R Sakr
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Giza, Egypt.
| | - R E Rabea
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - S M Abd ElHamid
- Clinical Pathology Department, Faculty of Medicine, Cairo University, Giza, Egypt
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8
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Cosan F, Aktas Cetin E, Akdeniz N, Emrence Z, Cefle A, Deniz G. Natural Killer Cell Subsets and Their Functional Activity in Behçet's Disease. Immunol Invest 2017; 46:419-432. [PMID: 28388249 DOI: 10.1080/08820139.2017.1288240] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Behçet's disease (BD) is a rare, chronic autoinflammatory disorder of unknown origin. Natural killer (NK) cells are one of the major immunoregulatory cell groups of the innate immune system, but their role in BD pathogenesis is not well documented. OBJECTIVES We aimed to investigate the role of NK cell subsets and their cytokine secretion and cytotoxic activity in patients with BD. PATIENTS AND METHODS The study group consisted of BD patients who had only mucocutaneous involvement, and they were compared with healthy subjects. BD patients were divided into two groups according to their frequencies of oral ulcerations. NK cell cytotoxicity was determined using CD107a expression and a CFSE-based cytotoxicity test. Expression of NK cell receptors and surface markers and the intracellular IL-5, IL-10, IL-17, and IFN-γ levels in CD16+ NK cells were assessed by flow cytometry. RESULTS Although the cytokine secretion pattern was different, no difference was obtained in cytotoxic activity, expression of activatory receptors, or degranulation of NK cells. CONCLUSION Increases in NK1/NK2 ratio and CD16+IFN-γ+ NK1 cells might support the idea of a biased IFN-γ dominant immune response in the mucocutaneous involvement of BD pathogenesis. Although the cytokine secretion pattern was different, no difference was obtained in cytotoxic activity, expression of activatory receptors, or degranulation of NK cells.
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Affiliation(s)
- Fulya Cosan
- a Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology , Bahcesehir University , Istanbul , Turkey.,b Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology , Kocaeli University , Kocaeli , Turkey
| | - Esin Aktas Cetin
- c Aziz Sancar Institute of Experimental Medicine (Aziz Sancar DETAE), Department of Immunology , Istanbul University , Istanbul , Turkey
| | - Nilgun Akdeniz
- c Aziz Sancar Institute of Experimental Medicine (Aziz Sancar DETAE), Department of Immunology , Istanbul University , Istanbul , Turkey
| | - Zeliha Emrence
- d Aziz Sancar Institute of Experimental Medicine (Aziz Sancar DETAE), Department of Genetics , Istanbul University , Istanbul , Turkey
| | - Ayse Cefle
- b Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology , Kocaeli University , Kocaeli , Turkey
| | - Gunnur Deniz
- c Aziz Sancar Institute of Experimental Medicine (Aziz Sancar DETAE), Department of Immunology , Istanbul University , Istanbul , Turkey
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Oğuz AK, Yılmaz ST, Oygür ÇŞ, Çandar T, Sayın I, Kılıçoğlu SS, Ergün İ, Ateş A, Özdağ H, Akar N. Behçet's: A Disease or a Syndrome? Answer from an Expression Profiling Study. PLoS One 2016; 11:e0149052. [PMID: 26890122 PMCID: PMC4758705 DOI: 10.1371/journal.pone.0149052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 01/26/2016] [Indexed: 12/03/2022] Open
Abstract
Behçet's disease (BD) is a chronic, relapsing, multisystemic inflammatory disorder with unanswered questions regarding its etiology/pathogenesis and classification. Distinct manifestation based subsets, pronounced geographical variations in expression, and discrepant immunological abnormalities raised the question whether Behçet's is "a disease or a syndrome". To answer the preceding question we aimed to display and compare the molecular mechanisms underlying distinct subsets of BD. For this purpose, the expression data of the gene expression profiling and association study on BD by Xavier et al (2013) was retrieved from GEO database and reanalysed by gene expression data analysis/visualization and bioinformatics enrichment tools. There were 15 BD patients (B) and 14 controls (C). Three subsets of BD patients were generated: MB (isolated mucocutaneous manifestations, n = 7), OB (ocular involvement, n = 4), and VB (large vein thrombosis, n = 4). Class comparison analyses yielded the following numbers of differentially expressed genes (DEGs); B vs C: 4, MB vs C: 5, OB vs C: 151, VB vs C: 274, MB vs OB: 215, MB vs VB: 760, OB vs VB: 984. Venn diagram analysis showed that there were no common DEGs in the intersection "MB vs C" ∩ "OB vs C" ∩ "VB vs C". Cluster analyses successfully clustered distinct expressions of BD. During gene ontology term enrichment analyses, categories with relevance to IL-8 production (MB vs C) and immune response to microorganisms (OB vs C) were differentially enriched. Distinct subsets of BD display distinct expression profiles and different disease associated pathways. Based on these clear discrepancies, the designation as "Behçet's syndrome" (BS) should be encouraged and future research should take into consideration the immunogenetic heterogeneity of BS subsets. Four gene groups, namely, negative regulators of inflammation (CD69, CLEC12A, CLEC12B, TNFAIP3), neutrophil granule proteins (LTF, OLFM4, AZU1, MMP8, DEFA4, CAMP), antigen processing and presentation proteins (CTSS, ERAP1), and regulators of immune response (LGALS2, BCL10, ITCH, CEACAM8, CD36, IL8, CCL4, EREG, NFKBIZ, CCR2, CD180, KLRC4, NFAT5) appear to be instrumental in BS immunopathogenesis.
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Affiliation(s)
- Ali Kemal Oğuz
- Department of Internal Medicine, Ufuk University School of Medicine, Ankara, Turkey
- Biotechnology Institute, Ankara University, Ankara, Turkey
| | | | - Çağdaş Şahap Oygür
- Department of Internal Medicine, Başkent University School of Medicine, Ankara, Turkey
| | - Tuba Çandar
- Department of Biochemistry, Ufuk University School of Medicine, Ankara, Turkey
| | - Irmak Sayın
- Department of Internal Medicine, Ufuk University School of Medicine, Ankara, Turkey
| | - Sibel Serin Kılıçoğlu
- Department of Histology and Embryology, Ufuk University School of Medicine, Ankara, Turkey
| | - İhsan Ergün
- Division of Nephrology, Department of Internal Medicine, Ufuk University School of Medicine, Ankara, Turkey
| | - Aşkın Ateş
- Division of Rheumatology, Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Hilal Özdağ
- Biotechnology Institute, Ankara University, Ankara, Turkey
| | - Nejat Akar
- Department of Pediatrics, TOBB University of Economics and Technology Hospital, Ankara, Turkey
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10
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Oğuz AK, Yılmaz S, Akar N, Özdağ H, Gürler A, Ateş A, Oygür ÇŞ, Kılıçoğlu SS, Demirtaş S. C-type lectin domain family 12, member A: A common denominator in Behçet's syndrome and acute gouty arthritis. Med Hypotheses 2015; 85:186-91. [PMID: 25957656 DOI: 10.1016/j.mehy.2015.04.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 04/25/2015] [Indexed: 01/09/2023]
Abstract
C-type lectin domain family 12, member A (CLEC12A) is a C-type lectin-like pattern recognition receptor capable of recognizing monosodium urate crystals. Monosodium urate crystals, the causative agents of gout are also among the danger-associated molecular patterns reflecting cellular injury/cell death. In response to monosodium urate crystals, CLEC12A effectively inhibits granulocyte and monocyte/macrophage functions and hence acts as a negative regulator of inflammation. Behçet's syndrome and gout are autoinflammatory disorders sharing certain pathological (neutrophilic inflammation), clinical (exaggerated response to monosodium urate crystals) and therapeutic (colchicine) features. We propose the hypothesis that decreased expression of CLEC12A is a common denominator in the hyperinflammatory responses observed in Behçet's syndrome and gout. Major lines of evidence supporting this hypothesis are: (1) Downregulation/deficiency of CLEC12A is associated with hyperinflammatory responses. (2) CLEC12A polymorphisms with functional and clinical implications have been documented in other inflammatory diseases. (3) Colchicine, a fundamental therapeutic agent used both in Behçet's syndrome and gout is shown to oppose the downregulation of CLEC12A. (4) Behçet's syndrome and gout are characterized by a hyperinflammatory response to monosodium urate crystals and other than gout, Behçet's syndrome is the only inflammatory condition exhibiting this exaggerated response. (5) Genomewide linkage and association studies of Behçet's syndrome collectively point to 12p12-13, the chromosomal region harboring CLEC12A. (6) Patients with severe forms of Behçet's syndrome underexpress CLEC12A with respect to patients with mild forms of the disease. If supported by well-designed, rigorous experiments, the forementioned hypothesis pertinent to CLEC12A will carry important implications for therapy, designing experimental models, and uncovering immunopathogenic mechanisms in Behçet's syndrome and gout.
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Affiliation(s)
- Ali Kemal Oğuz
- Department of Internal Medicine, Ufuk University School of Medicine, Ankara, Turkey; Biotechnology Institute, Ankara University, Ankara, Turkey.
| | - Seda Yılmaz
- Department of Internal Medicine, Ufuk University School of Medicine, Ankara, Turkey; Biotechnology Institute, Ankara University, Ankara, Turkey
| | - Nejat Akar
- Department of Internal Medicine, Ufuk University School of Medicine, Ankara, Turkey; Biotechnology Institute, Ankara University, Ankara, Turkey
| | - Hilal Özdağ
- Department of Internal Medicine, Ufuk University School of Medicine, Ankara, Turkey; Biotechnology Institute, Ankara University, Ankara, Turkey
| | - Aysel Gürler
- Department of Internal Medicine, Ufuk University School of Medicine, Ankara, Turkey; Biotechnology Institute, Ankara University, Ankara, Turkey
| | - Aşkın Ateş
- Department of Internal Medicine, Ufuk University School of Medicine, Ankara, Turkey; Biotechnology Institute, Ankara University, Ankara, Turkey
| | - Çağdaş Şahap Oygür
- Department of Internal Medicine, Ufuk University School of Medicine, Ankara, Turkey; Biotechnology Institute, Ankara University, Ankara, Turkey
| | - Sibel Serin Kılıçoğlu
- Department of Internal Medicine, Ufuk University School of Medicine, Ankara, Turkey; Biotechnology Institute, Ankara University, Ankara, Turkey
| | - Selda Demirtaş
- Department of Internal Medicine, Ufuk University School of Medicine, Ankara, Turkey; Biotechnology Institute, Ankara University, Ankara, Turkey
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Genital aphthosis in Behçet's disease: is it associated with less eye involvement? Rheumatol Int 2014; 34:1581-7. [PMID: 24728029 DOI: 10.1007/s00296-014-3011-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/28/2014] [Indexed: 12/25/2022]
Abstract
Behçet's disease (BD) is a multisystem disease classified among the vasculitides with various clinical features. Genital aphthosis (GA) is one of the major manifestations of BD. The aim of this study was to evaluate the characteristics of BD patients with GA. A cross-sectional sample of BD patients registered in 37 years was selected. We determined clinical and laboratory features of BD patients with GA (GA cases) and compared them with the patients who never developed GA (non-GA cases). The comparisons were performed by the chi-square test and logistic regression analysis. Odds ratios (ORs) with 95 % confidence intervals were calculated to estimate the precision of ORs. Among 6,935 BD patients, 4,489 cases (64.7 %) were ascribed to GA cases. Male to female ratio (1.11:1.00 vs. 1.48:1.00 OR 0.753, P value <0.001) and mean age of disease onset (OR = 0.9, P value <0.001) were lower in GA subset. In GA cases, oral aphthosis (OA) was a more common onset manifestation (OR 2.250, P value <0.001), while uveitis (OR 0.140, P value <0.001) and retinal vasculitis (OR 0.077, P value <0.001) were less common at the disease onset. In the whole course of disease, eye involvement was less common in GA cases (OR 0.215, P value <0.001). On the contrary, OA (OR 19.698, P value <0.001), skin (OR 1.762, P value <0.001), joint (OR 1.257, P value = 0.001), gastrointestinal (OR 1.302, P value = 0.009), neurological (OR 1.624, P value <0.001) and vascular involvements (OR 1.362, P value <0.001), epididymitis (OR 1.596, P value <0.001), positive pathergy test (OR 1.209, P value <0.001) and positive familial history of OA (OR 1.325, P value <0.001) were more common in GA subset. This study showed that GA subset of BD is associated with less eye involvement but higher rates of other BD manifestations.
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Shim JA, Cho S, Bang D, Anower AM, Kim DY, Cho S, Sohn S. Differential expression of monocyte/macrophage markers between active and inactive stage of patients with Behçet's disease. ACTA ACUST UNITED AC 2013. [DOI: 10.7243/2052-7896-1-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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